90 research outputs found
SAFE MULTIBYGG, Slutrapport Riskidentifiering, analys och ÄtgÀrdsmetodik för olycksförebyggande arbete för multifunktionella byggnader med avseende pÄ specifika antagonistiska hot
Multifunktionella byggnader karaktÀriseras av att flera olika funktioner (verksamheter) finns inom en och samma byggnad. Ofta Àr nÄgra av funktionerna att betrakta som samhÀllsviktiga. Brandskyddet i sÄdana byggnader Àr av största vikt med hÀnsyn till att ett stort antal personer kan befinna sig i byggnaden samtidigt som en brand skulle kunna orsaka förlust av samhÀllsviktiga funktioner. Vidare har det i samhÀllet skett en ökning av antagonistiska attacker. I forskningsprojektet SAFE MULTIBYGG har ett helhetsgrepp tagits över den problematik som finns avseende brandskydd och antagonistiska hot i multifunktionella byggnader. Denna rapport utgör en sammanfattande slutrapport för forskningsprojektet och summerar resultaten av ingÄende arbetspaket. Projektet har finansierats av MSB, Myndigheten för samhÀllsskydd och beredskap. Projektet inleddes 2011 och avslutades i december 201
Associations between enteral nutrition and outcomes in the SUP â ICU trial: Results of exploratory post hoc analyses
Background: Enteral nutrition may affect risks of gastrointestinal bleeding, pneumonia and mortality in critically ill patients and may also modify the effects of pharmacological stress ulcer prophylaxis. We undertook post hoc analyses of the stress ulcer prophylaxis in the intensive care unit trial to assess for any associations and interactions between enteral nutrition and pantoprazole. Methods: Extended Cox models with timeâvarying coâvariates and competing events were used to assess potential associations, adjusted for baseline severity of illness. Potential interactions between daily enteral nutrition and allocation to pantoprazole on outcomes were similarly assessed. Results: Enteral nutrition was associated with lower risk of clinically important gastrointestinal bleeding (causeâspecific hazard ratio [HR]: 0.29, 95% confidence interval: [CI] 0.19â0.44, p < .001), higher risk of pneumonia (HR: 1.44, 95% CI: 1.14â1.82, p = .003), and lower risk of allâcause mortality (HR: 0.22, 95% CI: 0.18â0.27, p < .001). Enteral nutrition with allocation to pantoprazole was associated with a lower risk of mortality (HR: 0.27, 95% CI: 0.21â0.35, p < .001), similar to enteral nutrition with allocation to placebo (HR: 0.17, 95% CI: 0.13â0.23, p < .001). Allocation to pantoprazole with no enteral nutrition had little effect on mortality (HR: 0.83, 95% CI: 0.63â1.09, p = .179), whilst allocation to pantoprazole and receipt of enteral nutrition was mostly compatible with increased allâcause mortality (HR: 1.27, 95% CI: 0.99â1.64, p = .061). The test of interaction between enteral nutrition and pantoprazole treatment allocation for allâcause mortality was statistically significant (p = .024). Conclusions: Enteral nutrition was associated with an increased risk of pneumonia and a reduced risk of gastrointestinal bleeding. The interaction between pantoprazole and enteral nutrition suggesting an increased risk of mortality requires further study
Mycobacterium tuberculosis transmission from patients with drug-resistant compared to drug-susceptible TB: a systematic review and meta-analysis.
The extent to which drug-resistant (DR) Mycobacterium tuberculosis strains cause infection and progression to tuberculosis (TB) disease in comparison to drug-susceptible (DS) strains is unknown. Studies in guinea pigs and in vitro experiments have suggested a reduced fitness of organisms that harbour mutations that confer drug resistance [1, 2]; it was therefore believed that transmitted drug resistance was a rare event. However, more recent work using molecular typing has shown transmission events occurring in the context of DR-TB [3]. Understanding the risk of transmission, infection and progression to disease in the context of DR-TB is important to guide control measures and help predict the evolution and magnitude of the multidrug-resistant (MDR)-TB epidemic. Hence, we performed a systematic review and meta-analysis to assess whether M. tuberculosis transmission and progression to TB disease (risk/rate of M. tuberculosis infection in all contacts, risk/rate of TB disease in all contacts and risk/rate of TB disease in infected contacts) differ between DR- and DS-TB
Einfluss von Impfungen und Kontaktreduktionen auf die dritte Welle der SARS-CoV-2-Pandemie und perspektivische RĂŒckkehr zu prĂ€-pandemischem Kontaktverhalten
Das im Epidemiologischen Bulletin 13/2021 vorgestellte mathematische Modell schĂ€tzt die voraussichtlichen Effekte der COVID-19-Impfung in der Bevölkerung in Deutschland und vergleicht mögliche Strategien zur Priorisierung einzelner Bevölkerungsgruppen bei Knappheit der verfĂŒgbaren Impfstoffdosen. Das Modell ermöglicht nicht nur die Abbildung des aktuellen Infektionsgeschehens, sondern kann ĂŒber Fragestellungen zur Impfstrategie hinaus auch Strategien zur Lockerung der bestehenden bzw. die Wiederaufnahme von KontaktbeschrĂ€nkungen analysieren. Dabei können saisonale Effekte auf die Ăbertragung von SARS-CoV-2 sowie der Einfluss neuer Virusvarianten berĂŒcksichtigt werden
Die Impfung gegen COVID-19 in Deutschland zeigt eine hohe Wirksamkeit gegen SARS-CoV-2-Infektionen, Krankheitslast und SterbefÀlle
Um die Bevölkerung vor den akuten und langfristigen Auswirkungen einer COVID-19-Infektion zu schĂŒtzen und die Pandemie langfristig einzudĂ€mmen, sind zum einen nicht-pharmakologische PrĂ€ventionsmaĂnahmen und zum anderen eine Schutzimpfung notwendig. Basierend auf den Ergebnissen einer mathematischen Modellierung wurden Effekte der Impfung gegen COVID-19 auf den Pandemieverlauf in Deutschland im Zeitraum Januar bis Juli 2021 quantifiziert. Die Analysen zeigen, dass die Impfungen gegen COVID-19 bisher geschĂ€tzt 706.000 MeldefĂ€lle, 76.600 stationĂ€re und etwa 19.600 intensiv-medizinische FĂ€lle sowie mehr als 38.300 SterbefĂ€lle verhindert hat. Insbesondere in der Altersgruppe â„ 60 Jahre wurde die Anzahl der zu erwartenden FĂ€lle fĂŒr jeden der genannten Endpunkte um mehr als 40% reduziert.Peer Reviewe
Effect of risk status for severe COVID-19 on individual contact behaviour during the SARS-CoV-2 pandemic in 2020/2021-an analysis based on the German COVIMOD study.
BACKGROUND: One of the primary aims of contact restriction measures during the SARS-CoV-2 pandemic has been to protect people at increased risk of severe disease from the virus. Knowledge about the uptake of contact restriction measures in this group is critical for public health decision-making. We analysed data from the German contact survey COVIMOD to assess differences in contact patterns based on risk status, and compared this to pre-pandemic data to establish whether there was a differential response to contact reduction measures. METHODS: We quantified differences in contact patterns according to risk status by fitting a generalised linear model accounting for within-participant clustering to contact data from 31 COVIMOD survey waves (April 2020-December 2021), and estimated the population-averaged ratio of mean contacts of persons with high risk for a severe COVID-19 outcome due to age or underlying health conditions, to those without. We then compared the results to pre-pandemic data from the contact surveys HaBIDS and POLYMOD. RESULTS: Averaged across all analysed waves, COVIMOD participants reported a mean of 3.21 (95% confidence interval (95%CI) 3.14,3.28) daily contacts (truncated at 100), compared to 18.10 (95%CI 17.12,19.06) in POLYMOD and 28.27 (95%CI 26.49,30.15) in HaBIDS. After adjusting for confounders, COVIMOD participants aged 65 or above had 0.83 times (95%CI 0.79,0.87) the number of contacts as younger age groups. In POLYMOD, this ratio was 0.36 (95%CI 0.30,0.43). There was no clear difference in contact patterns due to increased risk from underlying health conditions in either HaBIDS or COVIMOD. We also found that persons in COVIMOD at high risk due to old age increased their non-household contacts less than those not at such risk after strict restriction measures were lifted. CONCLUSIONS: Over the course of the SARS-CoV-2 pandemic, there was a general reduction in contact numbers in the German population and also a differential response to contact restriction measures based on risk status for severe COVID-19. This differential response needs to be taken into account for parametrisations of mathematical models in a pandemic setting
Effects of stress ulcer prophylaxis in adult ICU patients receiving renal replacement therapy (Sup-Icu RENal, SIREN): Study protocol for a pre-planned observational study.
BACKGROUND
Proton pump inhibitors are often used in critically ill patients to prevent gastrointestinal bleeding despite limited evidence for benefit. Patients with acute kidney injury requiring renal replacement therapy (RRT) are at high risk of gastrointestinal bleeding as (pre-)uremia induces coagulopathy through effects on platelets and coagulation cascades. No high-quality randomized clinical trials have previously assessed the benefits and harms of prophylactic proton pump inhibitor use in this high-risk population of adult critically ill patients.
METHODS/DESIGN
Among the 3350 patients included in the Stress Ulcer Prophylaxis in the Intensive Care Unit (SUP-ICU) trial-an investigator-initiated international randomized clinical trial on prophylactic proton pump inhibitor versus placebo in acutely admitted adult ICU patients at risk of gastrointestinal bleeding-we will compare the benefits and harms of prophylactic use of proton pump inhibitor in patients in need of RRT versus those not requiring this treatment. We will determine the proportion of patients with clinically important bleeding, the proportion of patients with adverse events including pneumonia, Clostridium difficile enteritis, or acute myocardial ischemia in the ICU, as well as transfusion requirements. Moreover, 90Â day and 365Â day mortality post-randomization will be investigated. As a secondary analysis, we will examine the association between acute kidney injury and RRT during ICU stay and gastrointestinal bleeding.
DISCUSSION
With the outlined predefined analysis, we will characterize the balance between the benefits and harms of stress ulcer prophylaxis in acutely admitted adult ICU patients in need of RRT, including the potential interaction of allocation to proton pump inhibitor versus placebo.
TRIAL REGISTRATION
ClinicalTrials.gov, NCT02718261 . Registered on 14 March 2016
An appeal for strengthening genomic pathogen surveillance to improve pandemic preparedness and infection prevention: the German perspective
The SARS-CoV-2 pandemic has highlighted the importance of viable infection surveillance and the relevant infrastructure. From a German perspective, an integral part of this infrastructure, genomic pathogen sequencing, was at best fragmentary and stretched to its limits due to the lack or inefficient use of equipment, human resources, data management and coordination. The experience in other countries has shown that the rate of sequenced positive samples and linkage of genomic and epidemiological data (person, place, time) represent important factors for a successful application of genomic pathogen surveillance. Planning, establishing and consistently supporting adequate structures for genomic pathogen surveillance will be crucial to identify and combat future pandemics as well as other challenges in infectious diseases such as multi-drug resistant bacteria and healthcare-associated infections. Therefore, the authors propose a multifaceted and coordinated process for the definition of procedural, legal and technical standards for comprehensive genomic pathogen surveillance in Germany, covering the areas of genomic sequencing, data collection and data linkage, as well as target pathogens. A comparative analysis of the structures established in Germany and in other countries is applied. This proposal aims to better tackle epi- and pandemics to come and take action from the âlessons learnedâ from the SARS-CoV-2 pandemic
Twenty-three unsolved problems in hydrology (UPH) â a community perspective
This paper is the outcome of a community initiative to identify major unsolved scientific problems in hydrology motivated by a need for stronger harmonisation of research efforts. The procedure involved a public consultation through on-line media, followed by two workshops through which a large number of potential science questions were collated, prioritised, and synthesised. In spite of the diversity of the participants (230 scientists in total), the process revealed much about community priorities and the state of our science: a preference for continuity in research questions rather than radical departures or redirections from past and current work. Questions remain focussed on process-based understanding of hydrological variability and causality at all space and time scales.
Increased attention to environmental change drives a new emphasis on understanding how change propagates across interfaces within the hydrological system and across disciplinary boundaries. In particular, the expansion of the human footprint raises a new set of questions related to human interactions with nature and water cycle feedbacks in the context of complex water management problems. We hope that this reflection and synthesis of the 23 unsolved problems in hydrology will help guide research efforts for some years to come
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