Adaptive immune response to lipoproteins of Staphylococcus aureus in healthy subjects

Staphylococcus aureus is a frequent commensal but also a dangerous pathogen, causing many forms of infection ranging from mild to life-threatening conditions. Among its virulence factors are lipoproteins, which are anchored in the bacterial cell membrane. Lipoproteins perform various functions in colonization, immune evasion, and immunomodulation. These proteins are potent activators of innate immune receptors termed Toll-like receptors 2 and 6. This study addressed the specific B-cell and T-cell responses directed to lipoproteins in human S. aureus carriers and non-carriers. 2D immune proteomics and ELISA approaches revealed that titers of antibodies (IgG) binding to S. aureus lipoproteins were very low. Proliferation assays and cytokine profiling data showed only subtle responses of T cells; some lipoproteins did not elicit proliferation. Hence, the robust activation of the innate immune system by S. aureus lipoproteins does not translate into a strong adaptive immune response. Reasons for this may include inaccessibility of lipoproteins for B cells as well as ineffective processing and presentation of the antigens to T cells.</p

Geografische Analyse der Erreichbarkeit von medizinischen Versorgungseinrichtungen in Vorpommern und deren Auswirkung auf die Inanspruchnahme

Die Dichte von medizinischen Versorgungseinrichtungen und Leistungserbringern ist in ländlichen Räumen gering. Zu überwindende Distanzen können aufgrund dessen groß sein. Die Einwohner peripherer Räume sind jedoch oft älter, haben ein höheres Morbiditätsrisiko und einen größeren Bedarf an medizinischer Versorgung. Dazu kommen mit dem Alter zunehmenden Mobilitätseinschränkungen. Obwohl der motorisierte Individualverkehr in ländlichen Räumen dominiert, ist auch die Erreichbarkeit durch den öffentlichen Personennahverkehr (ÖPNV) wichtig, da gerade ältere Menschen seltener ein Auto besitzen. Das Ziel dieser Arbeit war die Untersuchung der Pkw- und ÖPNV-Erreichbarkeit von Hausärzten (Allgemeinmediziner und hausärztliche Internisten), Augenärzten, fachärztlichen Internisten und Urologen im Landkreis Vorpommern-Greifswald sowie die Analyse wie viele Einwohner von guter bzw. schlechter Erreichbarkeit betroffen sind und ob eine längere Fahrzeit mittels Pkw und ÖPNV einen Einfluss auf die Inanspruchnahme von Hausärzten bzw. Frauenärzten in Vorpommern hat. Die Erreichbarkeitsanalysen für diese Vorhaben wurden in einem Geografischen Informationssystem (GIS) mittels Netzwerkanalysen auf der Basis von digitalen routingfähigen Straßendaten mit der Software ESRIArcGIS 10.0 Esri Inc., Redlands/California (USA) durchgeführt. Für die ÖPNV-Erreichbarkeit wurde zusätzlich ein Model verwendet, dass auf der Implementation des Dijkstra Algorithmus‘ die Fahrpläne der regionalen Verkehrsbetriebe einliest und Routen zu den nächstgelegenen medizinischen Leistungserbringern berechnet. Unterschiede zwischen den Arztgruppen wurden mit dem Kruskal-Wallis-Test bestimmt. Die Daten zur Inanspruchnahme stammen aus der Study of Health in Pomerania (SHIP) aus dem 5-Jahres-Follow-Up SHIP-1. Determinanten für die Inanspruchnahme wurden mit multiplen logistischen Regressionen ermittelt. Für die statistischen Berechnungen wurde die Software SAS 9.3 © 2002-2010 (SAS Institute Inc., Cary, NC, USA) verwendet. Die Pkw-Fahrzeit zum Hausarzt beträgt maximal 23 Minuten, während die ausgewählten spezialisierten Fachärzte in maximal 43 Minuten erreicht werden. 80 % der Bevölkerung erreicht den Arzt jedoch innerhalb von 20 Minuten. Die ÖPNV-Fahrzeit (hier Hin- und Rückfahrt) beträgt durchschnittlich 100 Minuten zum Hausarzt und zwischen 130 und 160 Minuten zum ausgewählten spezialisierten Facharzt. 4 – 7 % der Bevölkerung hat keine Verbindung (Hin- und Rückfahrt) mit dem ÖPNV zum Hausarzt bzw. Facharzt. Die Unterschiede zwischen Haus- und Fachärzten sind statistisch signifikant. Bezüglich des Einflusses der Erreichbarkeit auf die Inanspruchnahme hat sich gezeigt, dass die Erreichbarkeit keinen signifikanten Einfluss hat, wenngleich ein Trend zur geringeren Inanspruchnahme bei größeren Entfernungen erkennbar ist. Für die Inanspruchnahme der Frauenärzte sind jedoch das Alter, der Sozialschichtindex und Personen im Haushalt ≥ 18 Jahre (potentielle Mitfahrgelegenheiten) statistisch signifikante Determinanten. Eine gute ÖPNV-Erreichbarkeit ist nicht nur eine Frage der Distanz, sondern vor allem der Anbindung. Mithilfe von Erreichbarkeitsanalysen lassen sich Räume identifizieren, die einen schlechteren räumlichen Zugang zur Versorgung haben, weshalb Erreichbarkeitsanalysen in Planungsprozessen im Gesundheitsbereich grundsätzlich Anwendung finden sollten. Eine geringere Inanspruchnahme ist in Vorpommern nicht signifikant mit schlechterer Erreichbarkeit im Sinne von längeren Fahrzeiten assoziiert. Wichtiger ist, dass es überhaupt eine Verkehrsanbindung gibt, z.B. durch Mitfahrmöglichkeiten.The density of medical care facilities and service providers in rural areas is low. Hence, distances to be overcome can be large. However, the inhabitants of peripheral areas are often older, have a higher morbidity risk and a greater need for medical care. In addition, mobility restrictions increase with age. Although motorised individual transport dominates in rural areas, accessibility by local public transport is also important, because older people in particular are less likely to own a car. The aim of this study was to investigate the accessibility of GPs (general practitioners and GP internists), ophthalmologists, specialist internists and urologists in the district of Vorpommern-Greifswald as well as to analyse how many inhabitants are affected by good and bad accessibility and whether a longer journey time by car and public transport has an influence on the use of GPs and gynecologists in Vorpommern. The accessibility analyses for these projects were performed in a Geographic Information System (GIS) using network analyses on the basis of digital routable road data with the software ESRI ArcGIS 10. 0 Esri Inc., Redlands/California (USA). For public transport accessibility, an aditionally model used. It reads the timetables of the regional transport companies on the basis of the Dijkstra algorithm and calculates routes to the nearest medical service providers. Differences between the doctor groups were determined with the Kruskal-Wallis test. The utilisation data was taken from the 5-year follow-up SHIP-1 of the Study of Health in Pomerania (SHIP). Determinants for utilization were established using multiple logistic regressions. The software SAS 9. 3 © 2002-2010 (SAS Institute Inc. , Cary, NC, USA) was used for the statistical calculations. The travel time by car to the GP takes a maximum of 23 minutes, while the selected specialist physicians can be reached in a maximum of 43 minutes. However, 80 % of the population reaches the doctor within 20 minutes. The travel time by public transport(here round trip) takes on average 100 minutes to the GP and between 130 and 160 minutes to the selected specialists. 4 - 7 % of the population has no connection (round trip) with public transport to the GP or specialist. The differences between GPs and specialists are statistically significant. With regard to the influence of accessibility on utilisation, it has been shown that accessibility has no significant influence, although a trend towards lower utilisation over longer distances is discernible. However, age, social class index and persons in the household ≥ 18 years (potential rideshare opportunities) are statistically significant determinants for the utilization of gynaecologists. Good public transport accessibility is not only a question of distance, but above all of transport connection. Accessibility analyses can be used to identify areas that have poorer spatial access to care, which is why accessibility analyses should generally be used in planning processes in the health sector. In Vorpommern, lower utilisation is not significantly associated with poorer accessibility in the sense of longer travel times. It is more important that there is a transport connection at all, e. g. by rideshares

Attitudes of legal guardians and legally supervised persons with and without previous research experience towards participation in research projects: A quantitative cross-sectional study

Background Vulnerable groups, e.g. persons with mental illness, neurological deficits or dementia, are often excluded as participants from research projects because obtaining informed consent can be difficult and tedious. This may have the consequence that vulnerable groups benefit less from medical progress. Vulnerable persons are often supported by a legal guardian in one or more demands of their daily life. We examined the attitudes of legal guardians and legally supervised persons towards medical research and the conditions and motivations to participate in studies. Methods We conducted a cross-sectional study with standardized surveys of legal guardians and legally supervised persons. Two separate questionnaires were developed for the legal guardians and the supervised persons to asses previous experiences with research projects and the reasons for participation or non-participation. The legal guardians were recruited through various guardianship organizations. The supervised persons were recruited through their legal guardian and from a previous study among psychiatric patients. The data were analysed descriptively. Results Alltogether, 82 legal guardians and 20 legally supervised persons could be recruited. Thereof 13 legal guardians (15.6%) and 13 legally supervised persons (65.0%) had previous experience with research projects. The majority of the guardians with experience in research projects had consented the participation of their supervised persons (n = 12 guardians, 60.0%; in total n = 16 approvals). The possible burden on the participating person was given as the most frequent reason not to participate both by the guardians (n = 44, 54.4%) and by the supervised persons (n = 3, 30.0%). The most frequent motivation to provide consent to participate in a research study was the desire to help other patients by gaining new scientific knowledge (guardians: n = 125, 78.1%; supervised persons: n = 10, 66.6%). Conclusions Overall, an open attitude towards medical research can be observed both among legal guardians and supervised persons. Perceived risks and no sense recognized in the study are reasons for not participating in medical research projects

Economic efficiency versus accessibility: Planning of the hospital landscape in rural regions using a linear model on the example of paediatric and obstetric wards in the northeast of Germany

Abstract Background Costs for the provision of regional hospital care depend, among other things, on the population density and the maximum reasonable distance to the nearest hospital. In regions with a low population density, it is a challenge to plan the number and location of hospitals with respect both to economic efficiency and to the availability of hospital care close to residential areas. We examined whether the hospital landscape in rural regions can be planned on the basis of a regional economic model using the example which number of paediatric and obstetric wards in a region in the Northeast of Germany is economically efficient and what would be the consequences for the accessibility when one or more of the three current locations would be closed. Methods A model of linear programming was developed to estimate the costs and revenues under different scenarios with up to three hospitals with both a paediatric and an obstetric ward in the investigation region. To calculate accessibility of the wards, geographic analyses were conducted. Results With three hospitals in the study region, there is a financial gap of €3.6 million. To get a positive contribution margin for all three hospitals, more cases have to be treated than the region can deliver. Closing hospitals in the parts of the region with the smallest population density would lead to reduced accessibility for about 8% of the population under risk. Conclusions Quantitative modelling of the costs of regional hospital care provides a basis for planning. A qualitative discussion to the locations of the remaining departments and the implementation of alternative healthcare concepts should follow

Is there an association between spatial accessibility of outpatient care and utilization? Analysis of gynecological and general care

Abstract Background In rural regions with a low population density, distances to health care providers as well as insufficient public transport may be barriers for the accessibility of health care. In this analysis it was examined whether the accessibility of gynecologists and GPs, measured as travel time both by car and public transport has an influence on the utilization of health care in the rural region of Western Pomerania in Northern Germany. Methods Utilization data was obtained from the population based Study of Health in Pomerania (SHIP). Utilization was operationalized by the parameter “at least one physician visit during the last 12 months”. To determine travel times by car and by public transport, network analyses were conducted in a Geographic Information System (GIS). Multivariate logistic regression models were calculated to identify determinants for the utilization of gynecologists and GPs. Results There is no significant association between the accessibility by car or public transport and the utilization of gynecologists and GPs. Significant predictors for the utilization of gynecologists in the regression model including public transport are age (OR 0.960, 95% CI 0.950–0.971, p < 0.0001), social class (OR 1.137, 95% CI 1.084–1.193, p < 0.0001) and having persons ≥18 years in the household (OR 2.315, 95% CI 1.116–4.800, p = 0.0241). Conclusions In the examined region less utilization of gynecologists is not explainable with long travel times by car or public transport

Mental health-related telemedicine interventions for pregnant women and new mothers: a systematic literature review

Abstract Background Pregnancy and the postpartum period are times when women are at increased risk for depression and mental problems. This may also negatively affect the foetus. Thus, there is a need for interventions with low-threshold access and care. Telemedicine interventions are a promising approach to address these issues. This systematic literature review examined the efficacy of telemedicine interventions for pregnant women and/or new mothers to address mental health-related outcomes. The primary objective was to analyse whether telemedicine interventions can reduce mental health problems in pregnant women and new mothers. The secondary aim was to clarify the impact of type of interventions, their frequency and their targets. Methods Inclusion criteria: randomized controlled trials, with participants being pregnant women and/or new mothers (with infants up to twelve months), involving telemedicine interventions of any kind (e.g. websites, apps, chats, telephone), and addressing any mental health-related outcomes like depression, postnatal depression, anxiety, stress and others. Search terms were pregnant women, new mothers, telemedicine, RCT (randomised controlled trials), mental stress as well as numerous synonyms including medical subject headings. The literature search was conducted within the databases PubMed, Cochrane Library, Web of Science and PsycINFO. Screening, inclusion of records and data extraction were performed by two researchers according to the PRISMA guidelines, using the online tool CADIMA. Results Forty four articles were included. A majority (62%) reported significantly improved mental health-related outcomes for participants receiving telemedicine interventions compared to control. In particular (internet-delivered) Cognitive Behavioural Therapy was successful for depression and stress, and peer support improved outcomes for postnatal depression and anxiety. Interventions with preventive approaches and interventions aimed at symptom reduction were largely successful. For the most part there was no significant improvement in the symptoms of anxiety. Conclusion Telemedicine interventions evaluated within RCTs were mostly successful. However, they need to be designed to specifically target a certain mental health issue because there is no one-size-fits-all approach. Further research should focus on which specific interventions are appropriate for which mental health outcomes in terms of intervention delivery modes, content, target approaches, etc. Further investigation is needed, in particular with regard to anxiety

Population-Based, Spatial Analysis of Specialised Ambulatory Palliative Care in Mecklenburg-Western Pomerania, Germany, on the Basis of Reimbursement Data

In rural areas, healthcare providers, patients and relatives have to cover long distances. For specialised ambulatory palliative care (SAPV), a supply radius of max. 30 km is recommended. The aim of this study was to analyse whether there are regional disparities in the supply of SAPV and whether it is associated with the distance between the SAPV team&rsquo;s site and the patient&rsquo;s location. Therefore, anonymised data of the Association of Statutory Health Insurance Physicians of the Federal State of Mecklenburg-Western Pomerania (M-V) were retrospectively analysed for the period of 2014&ndash;2017. Identification as a palliative patient was based on palliative-specific items from the ambulatory reimbursement catalogue. In total, 6940 SAPV patients were identified; thereof, 48.9% female. The mean age was 73.3 years. For 28.3% of the identified SAPV patients (n = 1961), the SAPV teams had a travel distance of &gt;30 km. With increasing distance, the average number of treatment days per patient increased. It was found that there are regional disparities in the provision of SAPV services in M-V and that local structures have an important impact on regional supply patterns. The distance between the SAPV team&rsquo;s site and the patient&rsquo;s location is not the only determining factor; other causes must be considered