Der Wirkungsgrad von Training

Upper respiratory tract infections (URTIs) represent ahazard with highrelevance for elite athletes of all disciplines. They can lead to a reduction in performance and/or the necessity of a training/competition break. On average, each athlete experiences 3 URTIs per year with symptoms lasting for a mean of five days. Therefore, the intention of this review is to summarize the risk factors for URTIs, deduce preventive measures and give recommendations for return to sports to reduce re-infections and to avoid serious complications.The influence of training and competitive load on the risk of illness has been discussed controversially. There are indications that the frequency of infections seems to be increased shortly after a competition (open window-theory). URTIs occur more frequently in the winter months like in the general population. International air travelling was identified as the single biggest circumstantial risk factor for infections.An instrumental task of sports medicine is education of athletes about measures for infection prophylaxis and supervision of their implementation. A significant infection reduction is reached through compliance to general hygiene recommendations and a minimization of the contact with people outside the team in the hours after competition. Moreover, URTIs are prevented by an optimized planning of exercise load and travel as well as through vaccinations.Return to sports should not be allowed before a medical examination indicates the absence of generalized symptoms. This should typically include a determination of laboratory parameters and other organ-specific parameters (e.g. resting ECG). KEY WORDS: URTI, Physical Activity, Influential Factors, Illness Precautions, Infection Managemen

Einstellung von Ärztinnen und Ärzten in der Primärversorgung gegenüber Antibiotic Stewardship und der Einfluss eines mehrteiligen Fortbildungskurses - eine Pilotstudie

Background: A plethora of antimicrobial stewardship (AMS) programs has been initiated during the past years, focusing on hospital settings. Primary-care physicians have seldom been addressed, although the majority of antibiotic prescriptions are issued for outpatients. We sought to investigate attitudes of primary-care physicians and the impact of a customized training course.Methods: Primary-care physicians in southwest Germany were invited to a multi-part training course on AMS in the primary-care setting. Participants were asked to answer a questionnaire about their attitude and factors that hinder them from implementing AMS or enable them to perform AMS. In addition, a knowledge assessment exam at the beginning and end of the training was conducted on selected infectious diseases/syndromes.Results: In total, 36 primary-care physicians participated in the training course. The predominant age group was 51-60 years old (36%; 13/36). The majority, 23/35 (66%), indicated never having had AMS training, while 22/35 (63%) acknowledged partly implementing AMS activities in their daily routine. The primary barrier was lack of expertise, while the main motives were reducing antimicrobial resistance and optimizing patient care. The provision of guidelines was regarded as more important than feedback on their prescription behavior. Exam performance improved from the initial to the final exam on all topics.Conclusion: Customized AMS training courses are a feasible and potentially complimentary tool to address antibiotic misuse in the primary-care setting.Hintergrund: In den letzten Jahren wurde eine Vielzahl von "Antibiotic Stewardship" (ABS) Kampagnen in Krankenhäusern ins Leben gerufen. Ärzte in der Primärversorgung wurden nur selten adressiert, obwohl die Mehrzahl der Antibiotikaverordnungen bei ambulanten Patienten veranlasst wird. Wir hatten das Ziel, die Einstellung von Ärzten in der Primärversorgung zu ABS und die Auswirkungen eines maßgeschneiderten Fortbildungskurses zu untersuchen.Methoden: Ärzte in der Primärversorgung im Südwesten Deutschlands wurden zu einem mehrteiligen Fortbildungskurs über ABS in der Primärversorgung eingeladen. Die Teilnehmer wurden gebeten, einen Fragebogen zu ihrer Einstellung und zu Faktoren zu beantworten, die sie an der Durchführung von ABS hindern oder sie dazu befähigen. Darüber hinaus wurde bei der Teilnahme und beim Verlassen des Kurses ein Wissenstest zu ausgewählten Infektionssyndromen durchgeführt.Ergebnisse: Insgesamt nahmen 36 Ärzte an dem Kurs teil. Die vorherrschende Altersgruppe war die der 51- bis 60-Jährigen mit 36% (13/36). Die Mehrheit, 23/35 (66%), gab an, noch nie an einer ABS-Fortbildung teilgenommen zu haben, während 22/35 (63%) angaben, ABS-Aktivitäten teilweise in ihre tägliche Routine integriert zu haben. Das Haupthindernis war der Mangel an Fachwissen, während die Hauptmotive die Reduzierung der Antibiotikaresistenz und die Optimierung der Patientenversorgung waren. Die Bereitstellung von Leitlinien wurde als wichtiger erachtet als eine Rückmeldung über das eigene Verordnungsverhalten. Die Prüfungsleistungen im Wissenstest stiegen während des Kurses in allen Themenbereichen.Schlussfolgerung: Maßgeschneiderte ABS-Fortbildungen sind ein praktikables und potenziell ergänzendes Instrument zur Bekämpfung des übermäßigen Einsatzes von Antibiotika in der Primärversorgung

Prophylaxis and treatment of influenza: options, antiviral susceptibility, and existing recommendations

Influenza viruses of types A and B attack 5-10% of adults and 20-30% of children, thereby causing millions of acute respiratory infections in Germany annually. A significant number of these infections are associated with complications such as pneumonia and bacterial superinfections that need hospitalization and might lead to death. In addition to vaccines, drugs were developed that might support influenza prevention and that can be used to treat influenza patients. The timely application of anti-influenza drugs can inhibit virus replication, help reduce and shorten the symptoms, and prevent death as well as virus transmission.This review concisely describes the mechanism of action, the potential for prophylactic and therapeutic use, and the knowledge on resistance of anti-influenza drugs approved today. However, the main aim is to give an overview on the recommendations available in Germany for the proper use of these drugs. In doing so, the recommendations published in statements and guidelines of medical societies as well as the German influenza pandemic preparedness plan are summarized with the consideration of specific circumstances and groups of patients

Zellkulturbasierte Influenzaimpfstoffe: Eine effektive Impfstoffoption für unter 60-Jährige

Aim: Seasonal influenza poses a significant burden of disease, affecting not only older adults but also individuals under the age of 60. It carries a high economic burden, mainly driven by influenza-associated productivity losses in the working population. Conventional egg-based influenza vaccines may have reduced effectiveness due to antigen adaptation in eggs. In contrast, cell-based influenza vaccines are less likely to be affected by such antigen adaptation. This review aims to present real-world data (RWD) comparing the effectiveness of quadrivalent cell-based (QIVc) and egg-based (QIVe) influenza vaccines over three consecutive seasons.Methods: A comprehensive review was conducted, analyzing RWD from retrospective cohort and case-control studies on the relative vaccine effectiveness (rVE) of QIVc versus QIVe during the 2017/18-2019/20 seasons.Results: This study included six retrospective cohort studies and one case-control study, with a combined total of approximately 29 million participants. A cohort study involving people aged >=4 years during the 2017/18 season showed a statistically significant rVE of QIVc compared to QIVe in preventing influenza-like illness, with a value of 36.2%. QIVc demonstrated statistically significant superiority over QIVe in preventing outpatient and inpatient medical encounters as observed in two cohort studies conducted during the 2018/19 and 2019/20 seasons. The rVE of QIVc compared to QIVe was found to be 7.6% in individuals aged >=4 years and 9.5% in individuals aged >=18 years. Three additional cohort studies conducted between 2017/18-2019/20 reported a statistically significant improvement in rVE (5.3-14.4%) of QIVc compared to QIVe in preventing influenza-related hospitalizations and emergency department visits due to influenza in individuals aged 4-64 years. In a case-control study across all three seasons, QIVc showed statistically significantly higher effectiveness compared to QIVe in preventing test-confirmed influenza, with rVEs of 10.0-14.8%.Conclusions: RWD from the 2017/18-2019/20 seasons demonstrated that QIVc is more effective than QIVe in preventing influenza-related outcomes in individuals aged 4-64 years. Preferential use of cell-based influenza vaccines, as opposed to conventional egg-based vaccines, could reduce the burden of influenza-related symptoms on individuals and alleviate the economic impact on the German population under 60 years of age.Zielsetzung: Die saisonale Influenza verursacht nicht nur bei älteren Erwachsenen, sondern auch in der Bevölkerung =4 Jahre ergab eine statistisch signifikante rVE von QIVc vs. QIVe von 36,2% bei der Prävention Influenza-ähnlicher Erkrankung. QIVc war statistisch signifikant effektiver vs. QIVe bei der Prävention ambulanter und stationärer medizinischer Behandlungen in zwei Kohortenstudien der Saisons 2018/19 bzw. 2019/20 mit rVEs von 7,6% bei >=4-Jährigen bzw. 9,5% bei >=18-Jährigen. Drei weitere Kohortenstudien der Saisons 2017/18-2019/20 ergaben eine statistisch signifikant höhere rVE von QIVc vs. QIVe bei der Prävention Influenza-bedingter Hospitalisierungen/Besuchen der Notaufnahme bei 4-64-Jährigen (5,3-14,4%). Auch bei der Prävention testbestätigter Influenza war QIVc in einer Fall-Kontroll-Studie über alle drei Saisons statistisch signifikant effektiver mit rVEs von 10,0-14,8%.Schlussfolgerungen: RWD der Saisons 2017/18-2019/20 zeigten eine bessere Impfeffektivität von QIVc vs. QIVe bei der Prävention Influenza-bedingter Endpunkte bei Personen im Alter von 4-64 Jahren. Der präferenzielle Einsatz von zellkulturbasierten vs. konventionellen Influenzaimpfstoffen könnte zu einer Verringerung der Influenza-bedingten Krankheitslast und wirtschaftlichen Belastung in der deutschen Bevölkerung <60 Jahre führen