Understanding the decline of incident, active tuberculosis in people with HIV in Switzerland

BACKGROUND: People with human immunodeficiency virus type 1 (HIV) (PWH) are frequently coinfected with Mycobacterium tuberculosis (MTB) and at risk for progressing from asymptomatic latent TB infection (LTBI) to active tuberculosis (TB). LTBI testing and preventive treatment (TB specific prevention) are recommended, but its efficacy in low transmission settings is unclear. METHODS: We included PWH enrolled from 1988 to 2022 in the Swiss HIV Cohort study (SHCS). The outcome, incident TB, was defined as TB ≥6 months after SHCS inclusion. We assessed its risk factors using a time-updated hazard regression, modeled the potential impact of modifiable factors on TB incidence, performed mediation analysis to assess underlying causes of time trends, and evaluated preventive measures. RESULTS: In 21,528 PWH, LTBI prevalence declined from 15.1% in 2001 to 4.6% in 2021. Incident TB declined from 90.8 cases/1000 person-years in 1989 to 0.1 in 2021. A positive LTBI test showed a higher risk for incident TB (HR 9.8, 5.8-16.5) but only 10.5% of PWH with incident TB were tested positive. Preventive treatment reduced the risk in LTBI test positive PWH for active TB (relative risk reduction, 28.1%, absolute risk reduction 0.9%). On population level, the increase of CD4 T-cells and reduction of HIV viral load were the main driver of TB decrease. CONCLUSIONS: TB specific prevention is effective in selected patient groups. On a population level, control of HIV-1 remains the most important factor for incident TB reduction. Accurate identification of PWH at highest risk for TB is an unmet clinical need

Development of undergraduate gerodontology courses in Austria, Switzerland, and Germany from 2004 to 2009

The growing number of individuals over the age of sixty-five with specific dental needs requires increased teaching efforts to adequately prepare predoctoral dental students. The study assessed whether such increases in undergraduate gerodontology teaching in German-speaking countries between 2004 and 2009 occurred. Questionnaires were mailed in 2004 and 2009 to all deans (n=37) and all department heads (n=140) of Austrian, Swiss, and German dental schools. Results show that gerodontology is still mostly included in traditional core subjects but that specific lecture series and practical teaching have increased. These cover a broad variety of subjects including geriatric medicine, gerontopsychiatry, nursing care, pharmacology, and public health. The number of departments with dedicated staff for gerodontology, research activities, and mean number of publications has increased. Barriers to the further integration of the subject include its continued exclusion from final examinations in Austria and Germany. Guidelines of the European College of Gerodontology (2009), which aim to prepare students to provide dental treatment to seniors by teaching theoretical knowledge, practical skills, patient management techniques, and the ethical foundation of gerodontology, need to be implemented. Continued professional education of faculty in all departments, intensified cooperation between universities, and the presence of faculty specializing in gerodontology are suggested

„Fördern und Fordern“ im Diskurs

Wie werden die „Hartz-Reformen“ und die „Aktivierung“ von Arbeitslosen durch „Fördern und Fordern“ in der Bevölkerung aufgenommen? Die Beiträge in diesem Sonderheft behandeln diese Frage mittels einer innovativen Forschungsmethode: Bei dieser als „Deliberative Foren“ bzw. „Mini-Publics“ bezeichneten Methode werden Bürger*innen eingeladen, über ein Thema zu diskutieren und ggf. unter Bereitstellung von Informationsmaterial politische Empfehlungen zu erarbeiten oder Szenarien zu entwickeln. Auf diese Weise können Formierungen und Begründungen von Einstellungen sowie ein möglicher Wandel im Verlauf der Diskussion beobachtet werden. Das Heft schlägt Brücken zwischen Sozialpolitik-, Einstellungs- und Deliberationsforschung. Seit der Sozialstaat durch verstärkten globalen Wettbewerb, demographischen Wandel und steigende Staatsschulden unter Druck geraten ist, erhöht sich auch der Druck auf die Bürger*innen: So wird im Zuge des Umbaus zum „schlanken“ bzw. „aktivierenden“ Staat auch in der Sozialpolitik vermehrt deren individuelle Verantwortung und Eigeninitiative betont. In diesem Zusammenhang stellt sich die Frage, in welchem Maß sich die fundamentale Verschiebung sozialer Rechte auch auf die Sicht der Bürger*innen auf den Sozialstaat auswirkt und wie heute Prinzipien wie Statuserhalt, Grundsicherung und Eigenverantwortung beurteilt werden. In der Forschung gibt es hierzu bisher lediglich vereinzelte Studien, die mittels quantitativer Umfragen generelle Zustimmung oder Ablehnung der Reformen erfassen. Studierende der Humboldt-Universität Berlin haben nun die Einstellungen in der Bevölkerung zur aktivierenden Arbeitsmarktpolitik mittels einer innovativen sozialwissenschaftlichen Methode erforscht. Bei dieser als „Deliberative Foren“ bzw. „Mini-Publics“ bezeichneten Methode werden Bürger*innen eingeladen, über ein Thema zu diskutieren und ggf. unter Bereitstellung von Informationsmaterial politische Empfehlungen zu erarbeiten oder Szenarien zu entwickeln. Auf diese Weise können Formierungen und Begründungen von Einstellungen sowie ein möglicher Wandel im Verlauf der Diskussion beobachtet werden. Alle Aufsätze in diesem Sonderband bearbeiten eine eigene und unabhängige Forschungsfrage mit teilweise neuen theoretischen Perspektiven und neuen methodischen Herangehensweisen. Gleichzeitig greifen alle Arbeiten auch auf eine gemeinsame Datenquelle zurück: ein Deliberatives Forum, das im Winter 2017 in Berlin durchgeführt wurde. Die gesammelten Fachaufsätze in diesem Sonderheft bieten Beiträge zur Sozialpolitik-, Einstellungs- und Deliberationsforschung, die auch für fachwissenschaftliche Debatten in der Soziologie und Politikwissenschaft von großem Interesse sind

Intratympanic corticosteroids for sudden sensorineural hearing loss

BACKGROUND: Idiopathic sudden sensorineural hearing loss (ISSNHL) is common, and defined as a sudden decrease in sensorineural hearing sensitivity of unknown aetiology. Systemic corticosteroids are widely used, however their value remains unclear. Intratympanic injections of corticosteroids have become increasingly common in the treatment of ISSNHL. OBJECTIVES: To assess the effects of intratympanic corticosteroids in people with ISSNHL. SEARCH METHODS: The Cochrane ENT Information Specialist searched the Cochrane ENT Trials Register; CENTRAL (2021, Issue 9); PubMed; Ovid Embase; CINAHL; Web of Science; ClinicalTrials.gov; ICTRP and additional sources for published and unpublished trials (search date 23 September 2021). SELECTION CRITERIA: We included randomised controlled trials (RCTs) involving people with ISSNHL and follow-up of over a week. Intratympanic corticosteroids were given as primary or secondary treatment (after failure of systemic therapy). DATA COLLECTION AND ANALYSIS: We used standard Cochrane methods, including GRADE to assess the certainty of the evidence. Our primary outcome was change in hearing threshold with pure tone audiometry. Secondary outcomes included the proportion of people whose hearing improved, final hearing threshold, speech audiometry, frequency-specific hearing changes and adverse effects. MAIN RESULTS: We included 30 studies, comprising 2133 analysed participants. Some studies had more than two treatment arms and were therefore relevant to several comparisons. Studies investigated intratympanic corticosteroids as either primary (initial) therapy or secondary (rescue) therapy after failure of initial treatment. 1. Intratympanic corticosteroids versus systemic corticosteroids as primary therapy We identified 16 studies (1108 participants). Intratympanic therapy may result in little to no improvement in the change in hearing threshold (mean difference (MD) -5.93 dB better, 95% confidence interval (CI) -7.61 to -4.26; 10 studies; 701 participants; low-certainty). We found little to no difference in the proportion of participants whose hearing was improved (risk ratio (RR) 1.04, 95% CI 0.97 to 1.12; 14 studies; 972 participants; moderate-certainty). Intratympanic therapy may result in little to no difference in the final hearing threshold (MD -3.31 dB, 95% CI -6.16 to -0.47; 7 studies; 516 participants; low-certainty). Intratympanic therapy may increase the number of people who experience vertigo or dizziness (RR 2.53, 95% CI 1.41 to 4.54; 1 study; 250 participants; low-certainty) and probably increases the number of people with ear pain (RR 15.68, 95% CI 6.22 to 39.49; 2 studies; 289 participants; moderate-certainty). It also resulted in persistent tympanic membrane perforation (range 0% to 3.9%; 3 studies; 359 participants; very low-certainty), vertigo/dizziness at the time of injection (1% to 21%, 3 studies; 197 participants; very low-certainty) and ear pain at the time of injection (10.5% to 27.1%; 2 studies; 289 participants; low-certainty). 2. Intratympanic plus systemic corticosteroids (combined therapy) versus systemic corticosteroids alone as primary therapy We identified 10 studies (788 participants). Combined therapy may have a small effect on the change in hearing threshold (MD -8.55 dB better, 95% CI -12.48 to -4.61; 6 studies; 435 participants; low-certainty). The evidence is very uncertain as to whether combined therapy changes the proportion of participants whose hearing is improved (RR 1.27, 95% CI 1.15 to 1.41; 10 studies; 788 participants; very low-certainty). Combined therapy may result in slightly lower (more favourable) final hearing thresholds but the evidence is very uncertain, and it is not clear whether the change would be important to patients (MD -9.11 dB, 95% CI -16.56 to -1.67; 3 studies; 194 participants; very low-certainty). Some adverse effects only occurred in those who received combined therapy. These included persistent tympanic membrane perforation (range 0% to 5.5%; 5 studies; 474 participants; very low-certainty), vertigo or dizziness at the time of injection (range 0% to 8.1%; 4 studies; 341 participants; very low-certainty) and ear pain at the time of injection (13.5%; 1 study; 73 participants; very low-certainty).  3. Intratympanic corticosteroids versus no treatment or placebo as secondary therapy We identified seven studies (279 participants). Intratympanic therapy may have a small effect on the change in hearing threshold (MD -9.07 dB better, 95% CI -11.47 to -6.66; 7 studies; 280 participants; low-certainty). Intratympanic therapy may result in a much higher proportion of participants whose hearing is improved (RR 5.55, 95% CI 2.89 to 10.68; 6 studies; 232 participants; low-certainty). Intratympanic therapy may result in lower (more favourable) final hearing thresholds (MD -11.09 dB, 95% CI -17.46 to -4.72; 5 studies; 203 participants; low-certainty). Some adverse effects only occurred in those who received intratympanic injection. These included persistent tympanic membrane perforation (range 0% to 4.2%; 5 studies; 185 participants; very low-certainty), vertigo or dizziness at the time of injection (range 6.7% to 33%; 3 studies; 128 participants; very low-certainty) and ear pain at the time of injection (0%; 1 study; 44 participants; very low-certainty).  4. Intratympanic plus systemic corticosteroids (combined therapy) versus systemic corticosteroids alone as secondary therapy We identified one study with 76 participants. Change in hearing threshold was not reported. Combined therapy may result in a higher proportion with hearing improvement, but the evidence is very uncertain (RR 2.24, 95% CI 1.10 to 4.55; very low-certainty). Adverse effects were poorly reported with only data for persistent tympanic membrane perforation (rate 8.1%, very low-certainty). AUTHORS' CONCLUSIONS: Most of the evidence in this review is low- or very low-certainty, therefore it is likely that further studies may change our conclusions.   For primary therapy, intratympanic corticosteroids may have little or no effect compared with systemic corticosteroids. There may be a slight benefit from combined treatment when compared with systemic treatment alone, but the evidence is uncertain. For secondary therapy, there is low-certainty evidence that intratympanic corticosteroids, when compared to no treatment or placebo, may result in a much higher proportion of participants whose hearing is improved, but may only have a small effect on the change in hearing threshold. It is very uncertain whether there is additional benefit from combined treatment over systemic steroids alone. Although adverse effects were poorly reported, the different risk profiles of intratympanic treatment (including tympanic membrane perforation, pain and dizziness/vertigo) and systemic treatment (for example, blood glucose problems) should be considered when selecting appropriate treatment

EarLy elimination of fatty acids iN hypertriglyceridemia-induced acuTe pancreatitis (ELEFANT trial): protocol of an open-label, multicenter, adaptive randomized clinical trial

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Understanding the decline of incident, active tuberculosis in people with HIV in Switzerland.

BACKGROUND People with human immunodeficiency virus type 1 (HIV) (PWH) are frequently coinfected with Mycobacterium tuberculosis (MTB) and at risk for progressing from asymptomatic latent TB infection (LTBI) to active tuberculosis (TB). LTBI testing and preventive treatment (TB specific prevention) are recommended, but its efficacy in low transmission settings is unclear. METHODS We included PWH enrolled from 1988 to 2022 in the Swiss HIV Cohort study (SHCS). The outcome, incident TB, was defined as TB ≥6 months after SHCS inclusion. We assessed its risk factors using a time-updated hazard regression, modeled the potential impact of modifiable factors on TB incidence, performed mediation analysis to assess underlying causes of time trends, and evaluated preventive measures. RESULTS In 21,528 PWH, LTBI prevalence declined from 15.1% in 2001 to 4.6% in 2021. Incident TB declined from 90.8 cases/1000 person-years in 1989 to 0.1 in 2021. A positive LTBI test showed a higher risk for incident TB (HR 9.8, 5.8-16.5) but only 10.5% of PWH with incident TB were tested positive. Preventive treatment reduced the risk in LTBI test positive PWH for active TB (relative risk reduction, 28.1%, absolute risk reduction 0.9%). On population level, the increase of CD4 T-cells and reduction of HIV viral load were the main driver of TB decrease. CONCLUSIONS TB specific prevention is effective in selected patient groups. On a population level, control of HIV-1 remains the most important factor for incident TB reduction. Accurate identification of PWH at highest risk for TB is an unmet clinical need