The costs of schizophrenia and predictors of hospitalisation from the statutory health insurance perspective

BACKGROUND: The aim of the study was to determine the costs of treating schizophrenia from the perspective of the statutory health insurance, as well as the identification of predictors of hospitalisation of formerly stable schizophrenia patients. METHODS: Claims data for the years 2004–2006 were analysed. Patients who did not have to be treated in a hospital as a result of an ICD diagnosis F20 both in the year 2005 as well as also in 2006 were defined as stable patients. In contrast, those patients who had to be treated in a hospital in 2006 because of a diagnosis of schizophrenia were defined as unstable. In addition to the overall healthcare costs, the costs specific to schizophrenia were also analysed. Also, based on binary logistic regression analysis, predictors for hospital treatment were determined. RESULTS: 8497 stable and 1449 unstable patients were identified. The schizophrenia specific costs for stable patients were € 1605 and the overall costs were € 4029 in 2006, respectively. Unstable patients had indication-specific costs amounting to € 12864 and overall health care costs of € 16824. For unstable patients, the costs of hospital treatment were identified as being a substantial cost area. Predictors for a higher probability of hospital treatment were: female patients, at least one rehabilitation measure, at least one stay in hospital in 2004, and being co-morbid with substance abuse. In contrast, older patients, who were treated with concomitant medications, and if they received a continuous drug therapy in all quarters of a year had a lower probability of hospitalisation. In addition, an increased number of visits to a doctor reduced the probability of hospitalisation. The variable ‘depot medication’ were close to significance and the variable ‘inability to work lasting more than six weeks’ had, in contrast, no significant influence. CONCLUSIONS: The schizophrenia specific and overall health care costs of unstable patients were clearly higher than was the case with stable patients and mainly determined by inpatient hospital treatment. A range of potential predicting factors which can be extracted from routine claims data have a positive or negative influence on the probability of treatment in hospital

Nutzung von 3D-Printing für die Herstellung von Verpackungen aus aufbereitetem Miscanthusstroh

Der Beitrag berichtet, wie im Rahmen eines Forschungsvorhabens, welches durch das BMWi über einen Zeitraum von zwei Jahren gefördert wurde, ist untersucht worden, inwieweit der nachwachsende Rohstoff Miscanthus zur Herstellung von Verpackungen genutzt werden kann. Hierbei wurden zwei Verfahren, das Fasergussverfahren und das additive Fertigungsverfahren 3D-Printing, betrachtet. Beteiligt waren drei KMU und zwei gemeinnützige Forschungseinrichtungen

Nutzung von 3D-Printing für die Herstellung von Verpackungen aus aufbereitetem Miscanthusstroh

Der Beitrag berichtet, wie im Rahmen eines Forschungsvorhabens, welches durch das BMWi über einen Zeitraum von zwei Jahren gefördert wurde, ist untersucht worden, inwieweit der nachwachsende Rohstoff Miscanthus zur Herstellung von Verpackungen genutzt werden kann. Hierbei wurden zwei Verfahren, das Fasergussverfahren und das additive Fertigungsverfahren 3D-Printing, betrachtet. Beteiligt waren drei KMU und zwei gemeinnützige Forschungseinrichtungen

Frequency of neuroimaging for pediatric minor brain injury is determined by the primary treating medical department

To investigate the use of neuroimaging in children and adolescents with minor brain injury in pediatric and non-pediatric departments.In this observational cohort study data were extracted from a large German statutory health insurance (AOK Plus Dresden ∼3.1 million clients) in a 7-year period (2010-2016). All patients with International Classification of Diseases (ICD) code S06.0 (concussion; minor brain injury; commotio cerebri) aged ≤ 18 years were included. Demographic and clinical data were analyzed by logistic regression analysis for associations with the use of CT and MRI (independent variables: gender, age, length of stay, pediatric vs non-pediatric department, university vs non-university hospital).A total of 14,805 children with minor brain injuries (mean age 6.0 ± 5.6; 45.5% females) were included. Treatment was provided by different medical departments: Pediatrics (N = 8717; 59%), Pediatric Surgery (N = 3582, 24%), General Surgery (N = 2197, 15%), Orthopedic Trauma Surgery (N = 309, 2.1%). Patients admitted to pediatric departments (Pediatrics and Pediatric Surgery) underwent head CT-imaging significantly less frequently (3.8%) compared to patients treated in non-pediatric departments (18.5%; P < .001; General Surgery: 15.6%; Orthopedic Trauma Surgery: 39.2%). Logistic regression confirmed a significantly higher odds ratio (OR) for the use of cranial CT by the non-pediatric departments (OR: 3.2 [95-%-CI: 2.72-3.76]).CT was significantly less frequently used in pediatric departments. Educational efforts and quality improvement initiatives on physicians, especially in non-pediatric departments may be an effective approach to decreasing rates of CT after minor traumatic brain injuries

A survival pack for escaping predation in the open ocean: amphipod – pteropod associations in the Southern Ocean

Hyperiidean amphipods are a major prey for fish and seabirds. In the Southern Ocean, they are particularly abundant, with distributions ranging from the Polar Frontal Zone to Antarctic shelf waters. The species Hyperiella dilatata has previously been reported to show a peculiar anti-predatory behaviour: It captures chemically protected, gymnosome pteropods in the water column and carries them on its dorsum, like a backpack. We report this association at four oceanic sampling sites between latitudes 45° and 71° S. Molecular barcodes of both hosts and pteropods are provided and compared with those of other hyperiidean and pteropod specimens. Morphological identifications as well as molecular analyses show a so far undocumented association of Hyperiella antarctica with the pteropod Spongiobranchaea australis in the Polar Frontal Zone (Lazarev Sea). H. dilatata carried Clione limacina antarctica specimens in the Weddell Sea, as recorded previously for the Ross Sea. Lengths of the abducted pteropods varied between 1 and 5 mm, with the biggest pteropod measuring more than half the host’s size. One of the abducting amphipods was a female carrying eggs. The formation of such tandem is known to be very efficient as protection from visually hunting icefish in the crystal-clear coastal waters around the Antarctic continent; however, in the open ocean, this behaviour was so far undocumented. Here, we develop hypotheses on its origin and function

MicroRNAs are minor constituents of extracellular vesicles that are rarely delivered to target cells

Mammalian cells release different types of vesicles, collectively termed extracellular vesicles (EVs). EVs contain cellular microRNAs (miRNAs) with an apparent potential to deliver their miRNA cargo to recipient cells to affect the stability of individual mRNAs and the cells’ transcriptome. The extent to which miRNAs are exported via the EV route and whether they contribute to cell-cell communication are controversial. To address these issues, we defined multiple properties of EVs and analyzed their capacity to deliver packaged miRNAs into target cells to exert biological functions. We applied well-defined approaches to produce and characterize purified EVs with or without specific viral miRNAs. We found that only a small fraction of EVs carried miRNAs. EVs readily bound to different target cell types, but EVs did not fuse detectably with cellular membranes to deliver their cargo. We engineered EVs to be fusogenic and document their capacity to deliver functional messenger RNAs. Engineered fusogenic EVs, however, did not detectably alter the functionality of cells exposed to miRNA-carrying EVs. These results suggest that EV-borne miRNAs do not act as effectors of cell-to-cell communication. Author summary: The majority of metazoan cells release vesicles of different types and origins, such as exosomes and microvesicles, now collectively termed extracellular vesicles (EVs). EVs have gained much attention because they contain microRNAs (miRNAs) and thus could regulate their specific mRNA targets in recipient or acceptor cells that take up EVs. Using a novel fusion assay with superior sensitivity and specificity, we revisited this claim but found no convincing evidence for an efficient functional uptake of EVs in many different cell lines and primary human blood cells. Even EVs engineered to fuse and deliver their miRNA cargo to recipient cells had no measurable effect on target mRNAs in very carefully controlled, quantitative experiments. Our negative results clearly indicate that EVs do not act as vehicles for miRNA-based cell-to-cell communication

The EBV Immunoevasins vIL-10 and BNLF2a Protect Newly Infected B Cells from Immune Recognition and Elimination

Lifelong persistence of Epstein-Barr virus (EBV) in infected hosts is mainly owed to the virus' pronounced abilities to evade immune responses of its human host. Active immune evasion mechanisms reduce the immunogenicity of infected cells and are known to be of major importance during lytic infection. The EBV genes BCRF1 and BNLF2a encode the viral homologue of IL-10 (vIL-10) and an inhibitor of the transporter associated with antigen processing (TAP), respectively. Both are known immunoevasins in EBV's lytic phase. Here we describe that BCRF1 and BNLF2a are functionally expressed instantly upon infection of primary B cells. Using EBV mutants deficient in BCRF1 and BNLF2a, we show that both factors contribute to evading EBV-specific immune responses during the earliest phase of infection. vIL-10 impairs NK cell mediated killing of infected B cells, interferes with CD4+ T-cell activity, and modulates cytokine responses, while BNLF2a reduces antigen presentation and recognition of newly infected cells by EBV-specific CD8+ T cells. Together, both factors significantly diminish the immunogenicity of EBV-infected cells during the initial, pre-latent phase of infection and may improve the establishment of a latent EBV infection in vivo