Suchergebnisse

OBJECTIVE: To quantify the association between long working hours and alcohol use. DESIGN: Systematic review and meta-analysis of published studies and unpublished individual participant data. DATA SOURCES: A systematic search of PubMed and Embase databases in April 2014 for published studies, supplemented with manual searches. Unpublished individual participant data were obtained from 27 additional studies. REVIEW METHODS: The search strategy was designed to retrieve cross sectional and prospective studies of the association between long working hours and alcohol use. Summary estimates were obtained with random effects meta-analysis. Sources of heterogeneity were examined with meta-regression. RESULTS: Cross sectional analysis was based on 61 studies representing 333 693 participants from 14 countries. Prospective analysis was based on 20 studies representing 100 602 participants from nine countries. The pooled maximum adjusted odds ratio for the association between long working hours and alcohol use was 1.11 (95% confidence interval 1.05 to 1.18) in the cross sectional analysis of published and unpublished data. Odds ratio of new onset risky alcohol use was 1.12 (1.04 to 1.20) in the analysis of prospective published and unpublished data. In the 18 studies with individual participant data it was possible to assess the European Union Working Time Directive, which recommends an upper limit of 48 hours a week. Odds ratios of new onset risky alcohol use for those working 49-54 hours and ≥55 hours a week were 1.13 (1.02 to 1.26; adjusted difference in incidence 0.8 percentage points) and 1.12 (1.01 to 1.25; adjusted difference in incidence 0.7 percentage points), respectively, compared with working standard 35-40 hours (incidence of new onset risky alcohol use 6.2%). There was no difference in these associations between men and women or by age or socioeconomic groups, geographical regions, sample type (population based v occupational cohort), prevalence of risky alcohol use in the cohort, or sample attrition rate. CONCLUSIONS: Individuals whose working hours exceed standard recommendations are more likely to increase their alcohol use to levels that pose a health risk.

Botulinum neurotoxins (BoNTs), produced by the spore-forming bacterium Clostridium botulinum, cause botulism, a rare but fatal illness affecting humans and animals. Despite causing a life-threatening disease, BoNT is a multipurpose therapeutic. Nevertheless, as the most potent natural toxin, BoNT is classified as a Select Agent in the US, placing C. botulinum research under stringent governmental regulations. The extreme toxicity of BoNT, its impact on public safety, and its diverse therapeutic applications urge to devise safe solutions to expand C. botulinum research. Accordingly, we exploited CRISPR/Cas9-mediated genome editing to introduce inactivating point mutations into chromosomal bont/e gene of C. botulinum Beluga E. The resulting Beluga Ei strain displays unchanged physiology and produces inactive BoNT (BoNT/Ei) recognized in serological assays, but lacking biological activity detectable ex- and in vivo. Neither native single-chain, nor trypsinized di-chain form of BoNT/Ei show in vivo toxicity, even if isolated from Beluga Ei sub-cultured for 25 generations. Beluga Ei strain constitutes a safe alternative for the BoNT research necessary for public health risk management, the development of food preservation strategies, understanding toxinogenesis, and for structural BoNT studies. The example of Beluga Ei generation serves as template for future development of C. botulinum producing different inactive BoNT serotypes. ; Peer Reviewed

The Delta variant (Phylogenetic Assignment of Named Global Outbreak (Pango) lineage designation B.1.617.2) of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was first reported in October 2020 and has spread to more than 180 countries globally [1]. Concerns were raised about how well the currently available vaccines protect against this variant. Since January 2021, the Robert Koch Institute (RKI), in collaboration with the National Immunisation Technical Advisory Groups (NITAGs) network coordinated by the European Centre for Disease Prevention and Control (ECDC) is performing a living systematic review on the efficacy, effectiveness and safety of coronavirus disease (COVID-19) vaccines authorised in the European Union (EU) (PROSPERO registration: CRD42020208935) [2]. Here we present results on the effectiveness and the duration of protection provided by the EU-licensed COVID-19 vaccines in respect to the Delta variant. ; Peer Reviewed

Antimicrobial resistance (AMR) poses an important One Health challenge for all countries of the world. As human, animal and environmental health are closely linked, it is essential that interventions targeted at reducing the spread of AMR and those promoting antimicrobial stewardship are conducted with all sectors in mind. Tackling this global slow-moving pandemic (AMR) also requires action and strong commitment from all countries of the world. Nigeria, like many other countries, have made considerable progress in implementing the National Action Plan on Antimicrobial Resistance. The accomplishments and ongoing work led by the National Technical Working Group on AMR is commendable. However, gaps still exist in terms of operationalising One Health interventions for AMR, especially regarding rational antimicrobial use and antimicrobial stewardship. The 2020 World Antimicrobial Awareness Week presented an opportunity to convene a multi-sectoral expert panel from national government agencies, research, academia and the World Health Organisation across the Nigerian One Health space. The panel discussion analysed the progress made so far and identified the barriers and the opportunities for operationalising One Health interventions on AMR. The discussion highlighted poor awareness and the fear phenomenon, driven by technical and socio-economic factors, as a common cross-sectoral denominator at the heart of inappropriate antibiotic use within the country. At the system level, suboptimal use of antimicrobials fuelled by the ease of purchase, poor regulations and insufficient enforcement of prescription-only access to antimicrobials, and limited infection prevention and biosecurity measures resonated as drivers of AMR across One Health sectors in Nigeria. Looking forward, the panel discussion identified substantial investment in the governance of the existing One Health component structures, inclusive bottom-up institutional antimicrobial stewardship that fosters community participation and multi-level cross-sectoral ...

Aktinische Keratosen (AK) sind häufige Hautveränderungen bei hellhäutigen Menschen mit dem Potenzial, in ein kutanes Plattenepithelkarzinom (PEK) überzugehen. Beide Erkrankungen können mit erheblicher Morbidität verbunden sein und stellen eine große Krankheitslast insbesondere in der älteren Bevölkerung dar. Um eine evidenzbasierte, klinische Entscheidungsfindung zu unterstützen, wurde die Leitlinie "Aktinische Keratose und Plattenepithelkarzinom der Haut" auf der Methodikebene S3 nach dem Regelwerk der AWMF entwickelt. Die Leitlinie richtet sich dabei an Dermatologen, Allgemeinmediziner, HNO‐Ärzte, Chirurgen, Onkologen, Radiologen und Strahlentherapeuten in Klinik und Praxis sowie an andere medizinische Fachgebiete, die sich mit der Diagnose und Behandlung von Patienten mit AK und PEK befassen. Die Leitlinie richtet sich auch an betroffene Patienten, deren Angehörige, politische Entscheidungsträger und Versicherungsgesellschaften. In diesem Teil behandeln wir die Themen Diagnostik, Interventionen bei AK, Versorgungsstrukturen und Qualitätsindikatoren. ; Peer Reviewed

Analysis of sequencing data for 143 blaNDM-1- and blaOXA-48-positive Klebsiella pneumoniae isolates from 13 European national collections and the public domain resulted in the identification of 15 previously undetected multi-country transmission clusters. For 10 clusters, cases had prior travel/hospitalisation history in countries outside of the European Union including Egypt, Iran, Morocco, Russia, Serbia, Tunisia and Turkey. These findings highlight the benefit of European whole genome sequencing-based surveillance and data sharing for control of antimicrobial resistance. ; Peer Reviewed

Mehr als 35 Millionen erwachsene Frauen leben in Deutschland. Ihre Lebenslagen sind sehr unterschiedlich. Alter, Bildung, Berufstätigkeit, Einkommen, Familienform, kultureller Hintergrund und viele weitere Aspekte tragen dazu bei. All diese Faktoren beeinflussen die Gesundheit. Der Bericht "Gesundheitliche Lage der Frauen in Deutschland" enthält umfassende und aktuelle Informationen zum Gesundheitszustand, Gesundheitsverhalten und zur Gesundheitsversorgung von Frauen in Deutschland. Berichtet wird über Frauen aller Altersgruppen, ein Kapitel widmet sich der Gesundheit von Mädchen. Fokuskapitel nehmen die Gesundheit von speziellen Gruppen von Frauen in den Blick, z. B. Frauen mit Migrationshintergrund oder Frauen mit Behinderungen. Der Bericht nutzt eine breite Datengrundlage, um Unterschiede und Gemeinsamkeiten in der Gesundheit von Frauen und Männern ("differences between") als auch innerhalb der Gruppe der Frauen ("differences within") aufzuzeigen. Neben unterschiedlichen Erkrankungshäufigkeiten gibt es Unterschiede bei der Wahrnehmung und Kommunikation von Symptomen, im gesundheitsrelevanten Verhalten und bei der Inanspruchnahme von Versorgungsangeboten. Die Ursachen sind vor allem sozialer und gesellschaftlicher Natur. Sie sind eng mit den biologischen Geschlechterunterschieden verknüpft. Der Bericht bietet Erklärungsansätze an und greift auch das Thema geschlechtliche und sexuelle Vielfalt auf, das durch die gegenwärtigen gesellschaftspolitischen Debatten an Bedeutung gewonnen hat. Er wurde von der Gesundheitsberichterstattung des Bundes (GBE) am Robert Koch-Institut (RKI) unter Mitarbeit zahlreicher externer Expertinnen und Experten erstellt. Eine enge Kooperation bestand mit dem Statistischen Bundesamt. Der Frauengesundheitsbericht der GBE liefert die empirischen Grundlagen zu vielen Themen der Frauengesundheit und will dazu beitragen, die Sensibilisierung in Politik, Wissenschaft und Praxis weiter voranzutreiben und damit die Gesundheit von Frauen zu erhalten und zu fördern.

Die heutige hochmobile und vernetzte Welt bietet unzählige Möglichkeiten für die rasche Ausbreitung von Infektionskrankheiten, wie die aktuelle COVID-19-Pandemie zeigt. Ein Ausbruch oder eine Epidemie in einem Teil der Welt kann nur wenige Stunden davon entfernt sein, an einem anderen Ort zu einer unmittelbaren Bedrohung zu werden. Seit den 1970er-Jahren werden neu auftretende Infektionskrankheiten mit einer beispiellosen Rate von einer oder mehreren pro Jahr identifiziert. Heute gibt es fast 40 Krankheiten, die vor einer Generation noch unbekannt waren. Darüber hinaus hat die Weltgesundheitsorganisation (WHO) in den letzten 5 Jahren weltweit mehr als 1100 epidemische Ereignisse verifiziert. Die Infektionserreger können jede Grenze überwinden. Epidemien bedrohen die Gesundheit der Bevölkerung, erzeugen großes menschliches Leid und bergen ein enormes wirtschaftliches Schadenspotenzial. Ihre Folgen tragen besonders in ressourcenarmen Ländern zur sozialen und politischen Instabilität bei und können Fluchtbewegungen verstärken. Ebenso führen soziale und politische Instabilität zu Umständen, die das Auftreten neuer Erreger sowie die Verbreitung von Infektionskrankheiten fördern. Seit der Ebolakrise 2014/2015 in Westafrika, und spätestens durch die aktuelle COVID-19-Pandemie, ist deutlich geworden, wie eng der nationale mit dem internationalen Gesundheitsschutz zusammenhängt. Eine internationale Perspektive ist daher ein wesentlicher Bestandteil einer nationalen Gesundheitspolitik. Dies spiegelt sich auch in den Erklärungen der Bundesregierung anlässlich des G‑7-Gipfels 2015 in Elmau sowie des G‑20-Gipfels in Hamburg 2017 wider. Deutschland übernimmt darin künftig eine strategische und gestaltende Rolle innerhalb der Staatengemeinschaft zur langfristigen Stärkung von Gesundheit im internationalen Kontext. Für die Umsetzung dieses Ziels hat das Bundesministerium für Gesundheit die Einrichtung eines "Zentrums für Internationalen Gesundheitsschutz – ZIG" am Robert Koch-Institut (RKI) veranlasst. "Ein leistungsfähiges ...

The COVID-19 pandemic is not only a challenge to public health structures and economies but also a touchstone for international solidarity. Due to the implicit cross-border nature of the outbreak, the international health imperative of "Leaving No One Behind" has become more categorical than ever before. Central Asia, however, still seems to be a white spot on the map of Coronavirus response activities, with sparse international media coverage and few, if any, scientific publications. Geographically and culturally remote, the five countries Kazakhstan, Kirgizstan, Tajikistan, Turkmenistan, and Uzbekistan of ex-Soviet Asia have often been overlooked and are indifferently considered to be among the most repressive and self-isolating countries in the world. While the pandemic ruthlessly unveiled many weaknesses of public health systems globally, it also disclosed hitherto unrecognised positive changes in foreign policy, including new affirmative approaches to international cooperation in COVID-19 outbreak response. With more than 33.5 million people, Uzbekistan is the region's most populous state and one example of a country in transition. Since the election of Shavkat Mirziyoyev as president in December 2016, it signalled not only its intention to improve relations with its neighbouring countries, but also a commitment to open Uzbekistan to the international community. ; Peer Reviewed

Background: Travel to countries with high or intermediate hepatitis A virus (HAV) endemicity is a risk factor for infection in residents of countries with low HAV endemicity. Aim: The objective of this study was to estimate the risk for hepatitis A among European travellers using surveillance and travel denominator data. Methods: We retrieved hepatitis A surveillance data from 13 European Union (EU)/ European Economic Area (EEA) countries with comprehensive surveillance systems and travel denominator data from the Statistical Office of the European Union. A travel-associated case of hepatitis A was defined as any case reported as imported. Results: From 2009to2015, the 13 countries reported 18,839 confirmed cases of hepatitis A, of which 5,233 (27.8%) were travel-associated. Of these, 39.8% were among children younger than 15 years. The overall risk associated with travel abroad decreased over the period at an annual rate of 3.7% (95% confidence interval (CI): 0.7–2.7) from 0.70 cases per million nights in 2009 to 0.51 in 2015. The highest risk was observed in travellers to Africa (2.11 cases per million nights). Cases more likely to be reported as travel-associated were male and of younger age (<25 years). Conclusion: Travel is still a major risk factor for HAV infection in the EU/EEA, although the risk of infection may have slightly decreased in recent years. Children younger than 15 years accounted for a large proportion of cases and should be prioritised for vaccination. ; Peer Reviewed

In 2015, several provinces in Lao People's Democratic Republic (Lao PDR) experienced a vaccine-derived poliovirus outbreak. This survey was conducted (i) to evaluate the vaccination coverage in different settings and cohorts using the seroprevalence of anti-poliovirus (PV) antibodies as a surrogate measure, and (ii) to explore the usefulness of an ELISA in a country with limited resources and a specific epidemiological setting. IgG antibodies were assessed by ELISA in Lao children (n = 1216) and adults (n = 1228), including blood donors and health care workers. Protective antibody titers against the 3 vaccine serotypes were determined by microneutralization (VNT) in a subset of participants. More than 92% of the children had anti-poliovirus antibodies, regardless of nutritional status or access to health care, highlighting the success of the vaccination outreach activities in the country. In contrast, anti-poliovirus seroprevalence reached only 81.7% in blood donors and 71.9% in health care workers. Participants born before the introduction of poliovirus vaccination in Lao PDR were considerably less likely to be seropositive. These findings align with the epidemiology of the outbreak. Neutralizing antibodies against at least one of the 3 poliovirus serotypes were detected in all children (99/99) and 93/99 had antibodies against all serotypes. Similarly, all health care workers had neutralizing antibodies against at least one and 92/99 against all serotypes. The comparison of both assays shows an acceptable underestimation of vaccine coverage in children by ELISA, but a low sensitivity of the ELISA in the adults. We show that the ELISA is a reasonable alternative to the VNT in particular in vaccinated children, that an improved version should be serotype specific, and that negativity thresholds should be revisited for optimal sensitivity and specificity. Thus, polio-free countries with an uncertain vaccination coverage and limited laboratory capacity, that are at risk of vaccine-derived poliovirus outbreaks or of ...

Yellow fever (YF) remains a public health issue in endemic areas despite the availability of a safe and effective vaccine. In 2015–2016, urban outbreaks of YF were declared in Angola and the Democratic Republic of Congo, and a sylvatic outbreak has been ongoing in Brazil since December 2016. Of great concern is the risk of urban transmission cycles taking hold in Brazil and the possible spread to countries with susceptible populations and competent vectors. Vaccination remains the cornerstone of an outbreak response, but a low vaccine stockpile has forced a sparing-dose strategy, which has thus far been implemented in affected African countries and now in Brazil. Accurate laboratory confirmation of cases is critical for efficient outbreak control. A dearth of validated commercial assays for YF, however, and the shortcomings of serological methods make it challenging to implement YF diagnostics outside of reference laboratories. We examine the advantages and drawbacks of existing assays to identify the barriers to timely and efficient laboratory diagnosis. We stress the need to develop new diagnostic tools to meet current challenges in the fight against YF. ; Peer Reviewed

Das Buch "Gesundheit und Medizin im interdisziplinären Diskurs" eröffnet die gleichnamige Schriftenreihe und bildet deren programmatische Einleitung. In acht Beiträgen nähern sich hochrangige Wissenschaftler unterschiedlicher fachlicher Herkunft dem Thema "Gesundheit und Medizin": philosophisch, theologisch, ethisch, ökonomisch, juristisch und medizinisch. Sie loten die gesellschaftliche Bedeutung von Gesundheit und Medizin aus und beleuchten die politischen, ökonomischen und juristischen Herausforderungen. Anhand brisanter Beispiele wie der Gesundheitsreform oder der Sterbehilfe zeigen die Au

Auf der internationalen Agenda steht Tuberkulose weit oben und war im Herbst 2018 erstmals Thema in der Generalversammlung der Vereinten Nationen. Dort wurde eine historische politische Deklaration verabschiedet mit dem Ziel, den weltweiten Kampf für die Elimination einer der ältesten Krankheiten der Menschheit zu beschleunigen. Eine niedrige TB-Inzidenz sowie ein gut funktionierendes Sozial- und Gesundheitssystem versetzen Deutschland in diesem globalen Unterfangen zwar in eine gute Ausgangslage. Die Zahl der Tuberkulose-Erkrankungen in Deutschland war 2018 jedoch ähnlich hoch wie 2017, berichtet das RKI im Epidemiologischen Bulletin 11/12 2019. Ein jährlicher Rückgang um 10 Prozent wäre aber erforderlich, um das Ziel der WHO zu erreichen, Tuberkulose bis 2050 zu eliminieren. Daher sind in der Tuberkulosekontrolle auch in Deutschland zusätzliche Anstrengungen notwendig. Von zentraler Bedeutung sind leistungsfähige Gesundheitsämter, um im Umfeld eines Tuberkulosepatienten infizierte oder bereits erkrankte Personen zu identifizieren und eine Verbreitung der Tuberkulose zu verhindern. Bei Symptomen wie länger bestehendem Husten, Nachtschweiß, Fieber und Gewichtsabnahme sollte immer auch an Tuberkulose gedacht werden. Bedeutsam sind auch eine frühzeitige Resistenztestung und eine resistenzgerechte Behandlung. Auch die molekulare Surveillance ist ein wichtiger Beitrag zur Elimination der Tuberkulose und sollte landesweit etabliert werden. ; Peer Reviewed