Untersuchungen zu Risikofaktoren für die Präsenz und Intensität der Tungiasis (Sandflohkrankheit) sowie zur krankheitsbezogenen Beeinträchtigung der Lebensqualität von Kindern in Kilifi County, Kenia

Hintergrund: Die Tungiasis (Sandflohkrankheit) ist eine vernachlässigte Tropenkrankheit (Neglected Tropical Disease, NTD), die in großen Teilen der tropischen Welt verbreitet ist und mit gravierenden Komplikationen einhergehen kann. Sie wird durch die Penetration des weiblichen Sandflohs (Tunga penetrans) in die Haut hervorgerufen, welche eine starke Entzündungsreaktion im umliegenden Gewebe induziert und mit Juckreiz, erheblichen Schmerzen und Funktionseinschränkungen verbunden ist. Extraktionsversuche mit unsterilen Instrumenten führen zu einer bakteriellen Superinfektion oder einer Transmission von Viren wie HBV und HCV. Die epidemiologische Datenlage für den afrikanischen Kontinent ist äußerst spärlich. Methoden: In einer prospektiven Studie wurde der Zusammenhang zwischen dem Schweregrad der akuten bzw. chronischen Tungiasis und der Lebensqualität von Kindern und Jugendlichen untersucht. In zwei Querschnittsstudien auf Haushalts- und Schulebene wurden Prävalenz, Intensität und potenzielle Risikofaktoren für das Auftreten der Erkrankung bzw. schwerer Infektionen analysiert. Ergebnisse: Die Tungiasis beeinträchtigt das physische, psychische und soziale Wohlbefinden von Kindern und Jugendlichen im ländlichen Kenia erheblich. Eine Reduzierung der klinischen Pathologie unter effektiver Behandlung führte zu einer Rekonstitution der Lebensqualität. Die Prävalenz lag bei 25 % in der Allgemeinbevölkerung und bei 48 % in der untersuchten Schülerpopulation. Armutsassoziierte hygienische und architektonische Merkmale der Wohnumgebung wurden als Risikofaktoren identifiziert; eine mindere Qualität von SchulFußböden amplifizierte das Erkrankungsrisiko. Konklusion: Möglichkeiten der Therapie und Prävention der Tungiasis sind vorhanden und müssen der ländlichen Bevölkerung mit hoher Priorität zugänglich gemacht werden. Die Befestigung von Wänden und Fußböden und eine Erweiterung der sogenannten WASH-Initiative (Water, Sanitation and Hygiene) sollten im Fokus der öffentlichen Gesundheitsversorgung stehen.Background: Tungiasis is a neglected tropical disease (NTD) which is widely spread in large parts of the tropical world and may be accompanied by severe complications. It is caused by the penetration of the female sand flea (Tunga penetrans) into the skin, which induces a strong inflammatory response in the surrounding tissue and is associated with itching, considerable pain and functional impairment. Attempts to remove the flea with non-sterile instruments lead to bacterial superinfection or transmission of viruses, e.g. hepatitis B and C. Epidemiological data for the African continent are still extremely scarce. Methods: A prospective study was performed to investigate the relationship between the severity of acute or chronic tungiasis and the quality of life of children and adolescents. In two community- and school-based cross-sectional studies, prevalence, intensity and potential risk factors for the occurrence of tungiasis and severe disease were analyzed. Results: Tungiasis substantially affects the physical, mental and social well-being of children and adolescents in rural Kenya. Under effective treatment, the reduction of clinical pathology correlated with the reconstitution of the quality of life. The prevalence was 25 % in the general population and 48 % in the examined student population. Poverty-related hygienic and architectural characteristics of the living environment were identified as risk factors; low-quality school floors amplified the risk of disease. Conclusions: Therapy and prevention options do exist and must be made accessible to rural communities with high priority. The fastening of walls and floors as well as the extension of the so-called WASH initiative (Water, Sanitation and Hygiene) should be a main focus of public health care

Prevalence and Infection Intensity of Human and Animal Tungiasis in Napak District, Karamoja, Northeastern Uganda

Tungiasis is an important but highly neglected cause of morbidity in resource-poor communities in Latin America and sub-Saharan Africa. Data upon which implementation of control measures can be based are scarce. Before piloting an integrated tungiasis control program in three parishes of Napak district, Uganda, a cross-sectional survey involving the systematic examination of humans and domestic mammals was implemented to establish the occurrence patterns of tungiasis. The study population was 5482 residents, of which 4035 (73.6%) participated in the study. The prevalence of tungiasis in humans was 62.8% (95% CI: 61.3–64.3%), with slightly more males than females affected (p = 0.01). Age-specific prevalence and intensity of human tungiasis followed an S-curve pattern, with children of 5–14 years and the elderly (≥60 years) being the most affected. Half of all lesions (50%) had been manipulated by sharp objects. The prevalence of tungiasis in animals was lower (14.2%, 95% CI: 10.9–18.0) than that of humans (p < 0.001). Animal tungiasis occurred in decreasing order of frequency in pigs (80%), dogs (24%), goats (16.3%), cats (8.1%) and sheep (4.9%). In conclusion, human tungiasis was highly prevalent but animal infections were comparatively few in the study area. Nevertheless, effective control measures should be based on One Health principles

Ambulatory health services utilization in patients with dementia - Is there an urban-rural difference?

<p>Abstract</p> <p>Background</p> <p>Due to demographic changes and an un-equal distribution of physicians, regional analyses of service utilization of elderly patients are crucial, especially for diseases with an impact like dementia. This paper focuses on dementia patients. The aim of the study is to identify differences in service utilization of incident dementia patients in urban and rural areas.</p> <p>Methods</p> <p>Basis for the analysis were all insured persons of a German Health Insurance fund (the GEK) aged 65 years and older living in rural and urban areas. We focussed on physician contacts in the outpatient sector during the first year after an incidence diagnosis of dementia. Special attention was given to contacts with primary care physicians and neurologists/psychiatrists. The dementia cohort was analyzed together with a non-dementia control group drawn according to age, gender and amount of physician contacts. Uni- and bivariate as well as multivariate analysis were performed to estimate the influences on service utilization.</p> <p>Results</p> <p>Results show that the provision of primary care seems to be equally given in urban and rural areas. For specialists contacts however, rural patients are less likely to consult neurologists or psychiatrists. This trend can already be seen before the incident diagnosis of dementia. All consultations rise in the quarter of the incident dementia diagnosis compared to the control group. The results were also tested in a linear and a logistic regression, showing a higher chance for persons living in urban areas to visit a specialist and an overall higher rate in service utilization for dementia patients.</p> <p>Conclusions</p> <p>Because of a probable increase in the number of dementia patients, service provision has to be accessible even in rural areas. Due to this and the fact that demographic change is happening at different paces in different regions, regional variations have to be considered to ensure the future service provision.</p

Specialist involvement and referral patterns in ambulatory medical care for patients with dementia in Germany: results of a claims data based case-control study.

Background: To analyze the referral processes from general practitioners to specialists and among specialists for dementia patients in the time periods before, during and after the diagnosis in Germany. Methods: In this case-control study claims data from 1,848 insurants with incident dementia aged 65 years and more and 7,392 matched controls were compared over a two-year period covering the pre-incidence, incidence and post-incidence time periods. Results: We found an increase in referrals of 30% in the incidence quarter, mainly from general practice to neuropsychiatry and from there to radiology. Referrals to clinical chemistry and other disciplines for dementia-specific reasons were negligible in amount. 34% of incident cases had at least one contact with a neuropsychiatrist during the year of incidence, and the majority of them visited this specialist repeatedly during that year. Only a minority (13.5%) of patients was referred to radiology for imaging. Referrals to other specialists declined whereas self-referrals did not increase. Conclusions: The referral rates to relevant specialists (neuropsychiatry, radiology and clinical chemistry) are far less frequent than proposed in German guidelines. More research is needed to explain the gape between guidelines and daily care and to find ways for a better implementation of guidelines in ambulatory care. Guidelines should not only deal with diagnostic procedures and therapeutic options but also consider questions of applicability in daily clinical practice and propose effective organizational models of care provision

Safety Aspects of Supporting Apron Controllers with Automatic Speech Recognition and Understanding Integrated into an Advanced Surface Movement Guidance and Control System

The information air traffic controllers (ATCos) communicate via radio telephony is valuable for digital assistants to provide additional safety. Yet, ATCos have to enter this information manually. Assistant-based speech recognition (ABSR) has proven to be a lightweight technology that automatically extracts and successfully feeds the content of ATC communication into digital systems without additional human effort. This article explains how ABSR can be integrated into an advanced surface movement guidance and control system (A-SMGCS). The described validations were performed in the complex apron simulation training environment of Frankfurt Airport with 14 apron controllers in a human-in-the-loop simulation in summer 2022. The integration significantly reduces the workload of controllers and increases safety as well as overall performance. Based on a word error rate of 3.1%, the command recognition rate was 91.8% with a callsign recognition rate of 97.4%. This performance was enabled by the integration of A-SMGCS and ABSR: the command recognition rate improves by more than 15% absolute by considering A-SMGCS data in ABSR

Do self-reported hearing and visual impairments predict longitudinal dementia in older adults?

Background Sensory impairments have been associated with dementia in older adults. However, the contribution of different impairments and how they interact in the development of dementia is not clear. We examined the independent and interaction effects of hearing impairment (HI) and visual impairment (VI) on incident dementia. Design Multi-centric population-based prospective cohort study. Setting Data were taken from the AgeDifferent.de platform, pooling participants aged 75 and older from the German LEILA75+ and AgeCoDe/AgeQualiDe cohorts. Participants Older adults (N = 3497) with mean age 79.8 years, 67.2% female. Measurements Standardized interviews and questionnaires were used to assess self-reported HI and VI at baseline and all-cause dementia in 9 follow-ups, spanning over 20 years. Methods Competing risk regression models were conducted to test the main and interaction effects of HI and VI on dementia incidence, adjusting for established risk factors of dementia and accumulated mortality. Results HI and VI at baseline were reported by 30.3% and 16.6% of individuals, respectively. Adjusting for baseline information on sociodemographics, substance use, cognitive functioning and morbidity, and controlling for accumulated mortality risk, HI (sHR 1.16, 95% CI 1.04–1.30, p = 0.011) but not VI (sHR 1.07, 95% CI 0.90–1.28, p = 0.462) was significantly associated with incident dementia. There was no interaction between HI and VI (sHR 1.09, 95% CI 0.81–1.46, p = 0.567). Conclusions Hearing impairment is associated with an increased incidence of all-cause dementia in older adults. There is no excess risk or risk compensation through the additional presence or absence of visual impairment. Early prevention measures for hearing impairment might help to reduce the long-term risk of dementia

Prevalence of pain and its associated factors among the oldest-olds in different care settings – results of the AgeQualiDe study

Background; The prevalence of pain is very common in the oldest age group. Managing pain successfully is a key topic in primary care, especially within the ageing population. Different care settings might have an impact on the prevalence of pain and everyday life. Methods: Participants from the German longitudinal cohort study on Needs, Health Service Use, Costs and Health-related Quality of Life in a large Sample of Oldest-old Primary Care Patients (85+) (AgeQualiDe) were asked to rate their severity of pain as well as the impairment with daily activities. Besides gender, age, education, BMI and use of analgesics we focused on the current housing situation and on cognitive state. Associations of the dependent measures were tested using four ordinal logistic regression models. Model 1 and 4 consisted of the overall sample, model 2 and 3 were divided according to no cognitive impairment (NCI) and mild cognitive impairment (MCI). Results: Results show a decline in pain at very old age but nonetheless a high prevalence among the 85+ year olds. Sixty-three per cent of the participants report mild to severe pain and 69% of the participants mild to extreme impairment due to pain with daily activities. Use of analgesics, depression and living at home with care support are significantly associated with higher and male gender with lower pain ratings. Conclusions: Sufficient pain management among the oldest age group is inevitable. Outpatient care settings are at risk of overlooking pain. Therefore focus should be set on pain management in these settings

Changes in Social Network Size Are Associated With Cognitive Changes in the Oldest-Old

Objectives:Social isolation is increasing in aging societies and several studies have shown a relation with worse cognition in old age. However, less is known about the association in the oldest-old (85+); the group that is at highest risk for both social isolation and dementia. Methods:Analyses were based on follow-up 5 to 9 of the longitudinal German study on aging, cognition, and dementia in primary care patients (AgeCoDe) and the study on needs, health service use, costs, and health-related quality of life in a large sample of oldest-old primary care patients (AgeQualiDe), a multi-center population-based prospective cohort study. Measurements included the Lubben Social Network Scale (LSNS-6), with a score below 12 indicating social isolation, as well as the Mini-Mental Status Examination (MMSE) as an indicator of cognitive function. Results:Dementia-free study participants (n = 942) were M = 86.4 (SD = 3.0) years old at observation onset, 68.2% were women. One third (32.3%) of them were socially isolated. Adjusted linear hybrid mixed effects models revealed significantly lower cognitive function in individuals with smaller social networks (β = 0.5, 95% CI = 0.3-0.7, p < .001). Moreover, changes in an individual's social network size were significantly associated with cognitive changes over time (β = 0.2, 95% CI = 0.1-0.4, p = .003), indicating worse cognitive function with shrinking social networks. Conclusion:Social isolation is highly prevalent among oldest-old individuals, being a risk factor for decreases in cognitive function. Consequently, it is important to maintain a socially active lifestyle into very old age. Likewise, this calls for effective ways to prevent social isolation