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Background Comprehensive evidence synthesis on the associations between comorbidities and behavioural factors with hospitalisation, intensive care unit (ICU) admission, and death due to COVID-19 is required for deriving national and international recommendations on primary targets for non-pharmacological interventions (NPI) and vaccination strategies. Methods We performed a rapid systematic review and meta-analysis on studies and publicly accessible data to quantify associations between predisposing health conditions, demographics, behavioural factors on the one hand and hospitalisation, ICU admission, and death from COVID-19 on the other hand. We provide ranges of reported and calculated effect estimates and pooled relative risks derived from a meta-analysis and meta-regression. Results Seventy-five studies were included in qualitative and 74 in quantitative synthesis, with study populations ranging from 19 to 44,672 COVID-19 cases. The risk of dying from COVID-19 was significantly associated with cerebrovascular [pooled relative risk (RR) 2.7 (95% CI 1.7–4.1)] and cardiovascular [RR 3.2 (CI 2.3–4.5)] diseases, hypertension [RR 2.6 (CI 2.0–3.4)], and renal disease [RR 2.5 (CI 1.8–3.4)], with high heterogeneity in pooled estimates, partly but not solely explained by age of study participants. For some comorbidities, our meta-regression showed a decrease in effect on the severity of disease with a higher median age of the study population. Compared to death, associations between several comorbidities and hospitalisation and ICU admission were less pronounced. Conclusions We obtained robust estimates on the magnitude of risk for COVID-19 hospitalisation, ICU admission, and death associated with comorbidities, demographic, and behavioural risk factors and show that these estimates are modified by age of study participants. This interaction is an important finding to be kept in mind for current vaccination strategies and for the protection of individuals with high risk for a severe COVID-19 course.

Background In response to a high number of incoming asylum seekers and refugees (AS&R) in Germany, initial reception centres were established to provide immediate shelter, food and health support. This study evaluates the satisfaction with and use of the health care available at the Freiburg initial reception centre (FIRC) where an integrated health care facility (ICF) was set up in 2015. Methods We assessed use and satisfaction with health services available to resident AS&R within and outside the FIRC in a cross-sectional design. Data were collected in 2017 using a questionnaire with both open and closed ended items. Results The majority of 102 included participants were young (mean age 24.2; 95%CI 22.9–25.5, range 18–43) males (93%), from Sub-Saharan Africa (92%). High use frequencies were reported from returning patients of the ICF; with 56% fortnightly use and 19% daily use reported. The summary of satisfaction scores indicated that 84% (CI95 76–89%) of respondents were satisfied with the ICF. Multivariate analysis showed female gender and non-English speaking as risk factors for low satisfaction. Outside the FIRC, the satisfaction scores indicated that 60% of participants (95%CI 50–69%) were satisfied with the health care received. Conclusion Our study shows that AS&R residing in the FIRC are generally satisfied with the services at the ICF, though strategies to enhance care for females and non-English speakers should be implemented. Satisfaction with health care outside of the FIRC was not as high, indicating the need to improve quality of care and linkage to regular health care services.

BackgroundComprehensive evidence synthesis on the associations between comorbidities and behavioural factors with hospitalisation, Intensive Care Unit (ICU) admission, and death due to COVID-19 is lacking leading to inconsistent national and international recommendations on who should be targeted for non-pharmaceutical interventions and vaccination strategies.MethodsWe performed a systematic review and meta-analysis on studies and publicly available data to quantify the association between predisposing health conditions, demographics, and behavioural factors with hospitalisation, ICU admission, and death from COVID-19. We provided ranges of reported and calculated effect estimates and pooled relative risks derived from a meta-analysis and meta-regression.Results75 studies were included into qualitative and 74 into quantitative synthesis, with study populations ranging from 19 - 44,672 COVID-19 cases. The risk of dying from COVID-19 was significantly associated with cerebrovascular [pooled RR 2.7 (95% CI 1.7-4.1)] and cardiovascular [RR 3.2 (CI 2.3-4.5)] diseases, hypertension [RR 2.6 (CI 2.0-3.4)], and renal disease [RR 2.5 (CI 1.8-3.4)]. Health care workers had lower risk for death and severe outcomes of disease (RR 0.1 (CI 0.1-0.3). Our meta-regression showed a decrease of the effect of some comorbidities on severity of disease with higher median age of study populations. Associations between comorbidities and hospitalisation and ICU admission were less strong than for death.ConclusionsWe obtained robust estimates on the magnitude of risk for COVID-19 hospitalisation, ICU admission, and death associated with comorbidities, demographic, and behavioural risk factors. We identified and confirmed population groups that are vulnerable and that require targeted prevention approaches.SummaryComorbidities such as cardiovascular disease or hypertension are less strongly associated with hospitalization and ICU admission than with death in COVID-19 patients. Increasing age is associated with a lower effect on comorbidities on disease severity.

The aim of this study was to investigate whether a method of designing digital models of facial prostheses was suitable for patients with orbital defects. 32 patients were included in a retrospective study. 23 of them already had a facial prosthesis. 3D-data of the faces were acquired optically using fringe projection technique without and with (if available) the facial prosthesis in place. The healthy side of the surface models was mirrored to reconstruct the defect area. By generating a NURBS-model, the edges of the virtual prostheses were adapted to the defect region. The CAD models were stored in STL format as templates for facial prostheses. Using an automatically calculated asymmetry index (AI), four situations of the digitized facial surface were analysed for symmetry: 1. with defect area excluded, 2. with mirrored healthy surface, 3. with digital CAD template, and 4. with manually produced facial prosthesis inserted (if available). Mean AI values were 6.05 ± 3.26 (situation 1), 4.79 ± 2.51 (situation 2), 5.12 ± 2.61 (situation), and 6.74 ± 2.77 (situation 4). Additionally, the CAD templates were rated by three anaplastologists. Ratings did not differ significantly. They partially agreed with the three statements “The CAD prosthesis fits harmoniously within the face”, “The CAD prosthesis could be used for a wax pattern during conventional fabrication” and “The CAD prosthesis and the wax pattern reduce workload”. The results indicate that the presented technique has the potential to increase facial symmetry and facilitate the technical procedure. However, symmetry alone is not a sufficient criterion for design of a facial prosthesis.

Tuberkulose ist weiterhin die Infektionskrankheit, an welcher weltweit die meisten Menschen versterben. Die aktuelle Literatur zur Assoziation von Diabetes und Tuberkulose wird beschrieben, und Fragen des klinischen Managements bei Patienten mit beiden Diagnosen werden diskutiert. Das Risiko, an einer Tuberkulose zu erkranken, ist bei Patienten mit Diabetes im Vergleich zur nicht an dieser Stoffwechselerkrankung leidenden Bevolkerung verdreifacht. Die Behandlungsergebnisse bezuglich der Tuberkulose sind bei Patienten mit vs. ohne Diabetes schlechter, und sowohl die Therapie der Tuberkulose als auch die des Diabetes werden durch Medikamenteninteraktionen erschwert.

Germany’s experiences during the arrival of a large number of refugees in 2015 and 2016 have revealed a substantial need for coordinated and integrated healthcare. This includes evidence-based management and prevention of infectious diseases on arrival, easily accessible healthcare during the time after arrival and good integration into regular healthcare afterwards. While there is no evidence of the major transmission of infectious diseases from arriving refugees to the general population, the risk of transmission within groups of refugees, in particular in combination with crowded living conditions and the compounding effect of previous flight experience, is relevant. Screening for infectious diseases can identify only a proportion of infectious diseases and needs to take into account the dynamics of the risks associated with the different periods of flight/migration. In Germany, initial chest X-ray screening for pulmonary tuberculosis among adults by local health authorities is the only infectious disease screening that is uniformly applied across all states and counties. Apart from this screening, practices vary across different regions and states due to the non-existence of overall recommendations. We give an overview of existing evidence and guidelines on infectious disease screening of refugees for tuberculosis, HIV and hepatitis B & C and describe the practical experience of an integrated healthcare model for arriving refugees in Freiburg, including the management (although not initial screening) of infectious diseases. We also present an argument for screening to be integrated into the regular provision of healthcare during the first few months after arrival beyond just a one-off chest X-ray.