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BACKGROUND: Inborn errors of immunity (IEI) are rare diseases, which makes diagnosis a challenge. A better description of the initial presenting manifestations should improve awareness and avoid diagnostic delay. Although increased infection susceptibility is a well-known initial IEI manifestation, less is known about the frequency of other presenting manifestations.OBJECTIVE: We sought to analyze age-related initial presenting manifestations of IEI including different IEI disease cohorts.METHODS: We analyzed data on 16,486 patients of the European Society for Immunodeficiencies Registry. Patients with autoinflammatory diseases were excluded because of the limited number registered.RESULTS: Overall, 68% of patients initially presented with infections only, 9% with immune dysregulation only, and 9% with a combination of both. Syndromic features were the presenting feature in 12%, 4% had laboratory abnormalities only, 1.5% were diagnosed because of family history only, and 0.8% presented with malignancy. Two-third of patients with IEI presented before the age of 6 years, but a quarter of patients developed initial symptoms only as adults. Immune dysregulation was most frequently recognized as an initial IEI manifestation between age 6 and 25 years, with male predominance until age 10 years, shifting to female predominance after age 40 years. Infections were most prevalent as a first manifestation in patients presenting after age 30 years.CONCLUSIONS: An exclusive focus on infection-centered warning signs would have missed around 25% of patients with IEI who initially present with other manifestations.

Background and objective The work situation is an important dimension of professional life and wellbeing, and a policy lever to strengthen recruitment and retention. This study aims to explore the work situation of physicians and residents in internal medical rheumatology, considering the impact of the coronavirus pandemic COVID-19. Methods A questionnaire-based online survey was conducted in early 2021 at the Hannover Medical School, supported by the German Society of Rheumatology. Target groups were all rheumatology physicians and residents in Germany. The main areas of investigation included work hours, task delegation, and collaboration; workload and mental health issues; discrimination and sexual harassment experiences; and the impact of COVID-19. Descriptive statistical analysis was performed for the standardized items and qualitative content analysis for the free-text information. Results The respondents (n = 101) expressed positive attitudes towards cooperation and task delegation to medical assistants, especially those specialized in rheumatology, while attitudes towards cooperation with GPs pointed to blockades. There was a strong mismatch between actual and desired work hours both in the group of women and in the group of men. 81% rated their workload as high or very high; every sixth rheumatologist has suffered from stress or burnout syndromes at least once in the past. Experiences of gender discrimination and sexual harassment/violence were frequently reported, mostly by women. COVID-19 was an amplifier of stress, with major stressors being digitalization and increased demand for communication and patient education. Conclusion There is an urgent need to improve the work situation of rheumatologists and reduce stress and mental health risks.

Zusammenfassung Hintergrund und Fragestellung Fachkräftemangel in der Rheumatologie in Deutschland ist als Versorgungsproblem erkannt. Die Gesundheitspolitik hat mit neuen Planungszielen reagiert, aber es fehlen effektive Interventionsstrategien. Ziel dieser Studie ist ein systematischer berufsstruktureller Überblick, um die Grundlage für Interventionen zu verbessern und Möglichkeiten für ein effektives Fachkräftemanagement aufzuzeigen. Methode Die WHO National Health Workforce Accounts (NHWA) dienen als konzeptioneller Rahmen. Ausgewählt werden 4 Indikatoren: Personalbestand, Arbeitsmarktbewegungen, Komposition und Weiterbildung. Die Exploration von Entwicklungstrends stützt sich auf vergleichende Analysen von Altersgruppen und Zeitreihen. Die Erhebung nutzt öffentliche Statistiken und andere Sekundärliteratur; die Auswertung erfolgt deskriptiv. Ergebnisse In Deutschland sind 1076 Ärzt*innen mit einer Facharztqualifikation oder Schwerpunktbezeichnung in der internistischen Rheumatologie ärztlich tätig. Die absolute Zahl verdoppelte sich seit 2000 deutlich (91 %), aber mit einem demografischen Bias. Im Zeitraum 2000 bis 2019 stieg die Zahl der über 50-Jährigen deutlich, aber die der unter 50-Jährigen nur um 9 %; seit 2010 sind die Zahlen in der Gruppe 40 bis 50 Jahre rückläufig. Im Jahr 2019 waren mehr Rheumatolog*innen im Rentenalter als unter 40-Jährige ärztlich tätig. Seit 2015 schwächt sich der steigende Trend insgesamt ab, aber am stärksten im Krankenhaussektor; die Weiterbildungen lassen keine konstante Steigerung erkennen. Schlussfolgerungen Berufsstrukturelle Trends zeigen, dass die gesundheitspolitischen Planziele mit den verfügbaren Humanressourcen nicht zu erreichen sind. Gefordert ist ein besseres Fachkräftemanagement, insbesondere durch Innovation der Weiterbildung, Aufgabenverschiebung und verbesserte Geschlechtergerechtigkeit.

Zusammenfassung Hintergrund In der ambulanten Versorgung wurde Telemedizin im Lockdown von März bis Mai 2020 eingesetzt. Ziel der Studie war es, Patienten aus einer Praxis und der Hochschulambulanz bezüglich Patientenzufriedenheit mit Telemedizin, COVID-19-Sorgen und Impfverhalten auszuwerten sowie die Gesprächsführung durch eine rheumatologische Fachassistenz (RFA) mit einem Arzt zu vergleichen. Methoden Patienten mit rheumatoider Arthritis, Psoriasisarthritis oder Spondyloarthritis ohne Therapieänderung seit der letzten Vorstellung wurde ein telemedizinischer Ersatztermin im Rahmen dieser Studie bei Terminabsage durch die versorgenden Zentren angeboten. Randomisiert wurden sie von einem Arzt oder einer RFA (RFA nur Universität) telemedizinisch versorgt. Die Anamnese erfolgte telefonisch standardisiert mittels Fragebogen. Die Krankheitsaktivität wurde mittels modifizierten Clinical Disease Activity Score (CDAI) und BASDAI festgestellt. Im Anschluss erhielten die Patienten einen pseudonymisierten Evaluationsbogen. Ergebnisse Von 112/116 (96 %) eingeschlossenen Patienten schickten 88/112 (79 %) den Fragebogen zurück. RFAs führten 19/112 (17 %) Telefonate. Die Therapie wurde in 19/112 (17 %) geändert. Die meisten Sorgen bezüglich COVID-19 hatten Patienten mit der höchsten Krankheitsaktivität (p = 0,031), den meisten schmerzhaften Gelenken (p = 0,001) sowie den meisten Schmerzen (VAS Score ≥7) (p = 0,009). Diese Patienten hätten auch selbst ihren Termin abgesagt (p = 0,015). Die Patientenzufriedenheit mit der Gesprächsführung war gut (Mittelwert 4,3/5,0 modifizierter FAPI), unabhängig von der Institution, der Gesprächsdauer oder dem Gesprächspartner. Patienten mit hoher Schmerzintensität waren am unzufriedensten (p = 0,036); 42/100 (38,2 %) Patienten waren gegen Pneumokokken und 59/100 (53,6 %) gegen Influenza geimpft. Zusammenfassung Für ausgewählte Patienten ist die telemedizinische Versorgung im Rahmen eines Telefongespräches gut geeignet. Hinsichtlich der Patientenzufriedenheit ist die Delegation einer telefonischen Visite an eine RFA möglich. Bezüglich des Impfverhaltens besteht Verbesserungsbedarf.

Zusammenfassung Hintergrund Zur Bekämpfung der SARS-CoV-2-Pandemie wurden in Deutschland Mitte März 2020 weitgehende Kontaktbeschränkungen erlassen (sog. Lockdown). Die vorliegende Arbeit soll klären, welche Auswirkungen diese Maßnahmen auf Rettungsdiensteinsätze hatten. Material und Methoden Retrospektive Auswertung von 6668 Einsatzprotokollen von vier Rettungswachen in Ostniedersachsen der beiden ersten Quartale 2020. Deskription und teststatistischer Vergleich der Einsätze sechs Wochen vor den Kontaktbeschränkungen mit einem gleich großen Zeitraum nach deren Erlass. Ergebnisse In den sechs Wochen im Lockdown gab es 17,7 % weniger Einsätze als in den Wochen vor dem Lockdown. Insbesondere zeigte sich eine Abnahme von Einsätzen wegen Atemwegserkrankungen um 40,6 % (91 Fälle), die insbesondere auf den Rückgang von Pneumonien und exazerbierten chronisch-obstruktiven Lungenerkrankungen (COPD) zurückgeht. Gleichzeitig zeigte sich ein Anstieg des durchschnittlichen Alters der Patienten mit einer Verringerung des Anteils der unter 65-Jährigen. Veränderungen bei psychiatrischen Erkrankungen, verstorbenen oder verletzten Patienten oder der Verweigerung von Behandlung und Transport wurden nicht beobachtet. Insgesamt wurden im Zeitraum 67 Patienten (1,0 %) mit Verdacht auf oder bestätigter COVID-19-Erkrankung behandelt. Diskussion Im Rettungsdienst zeigt sich eine Reduktion der Einsätze in Folge der Kontaktbeschränkungen, wobei diese nicht so stark ausfällt, wie für Notaufnahmen beschrieben wurde. Dieser Rückgang könnte auf eine Reduktion insbesondere weniger schwerer Erkrankungsfälle und jüngerer Patienten zurückzuführen sein. Auffällig ist die Reduktion von Pneumonien und exazerbierter COPD. Dies könnte einerseits bedeuten, dass Kontaktbeschränkungen das Infektionsgeschehen bei anderen Atemwegserkrankungen reduziert haben, aber ebenfalls, dass Patienten Krankenhausbehandlungen vermeiden wollten.

Background Serology testing is explored for epidemiological research and to inform individuals after suspected infection. During the coronavirus disease 2019 (COVID-19) pandemic, frontline healthcare professionals (HCP) may be at particular risk for infection. No longitudinal data on functional seroconversion in HCP in regions with low COVID-19 prevalence and low pre-test probability exist. Methods In a large German university hospital, we performed weekly questionnaire assessments and anti-severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) immunoglobulin G (IgG) measurements with various commercial tests, a novel surrogate virus neutralisation test, and a neutralisation assay using live SARS-CoV-2. Results From baseline to week 6, 1080 screening measurements for anti-SARS CoV-2 (S1) IgG from 217 frontline HCP (65% female) were performed. Overall, 75.6% of HCP reported at least one symptom of respiratory infection. Self-perceived infection probability declined over time (from mean 20.1% at baseline to 12.4% in week 6, p

Background: Infections, as well as adverse birth outcomes, may be more frequent in migrant women. Schistosomiasis, echinococcosis, and hepatitis E virus (HEV) seropositivity are associated with the adverse pregnancy outcomes of fetal growth restriction and premature delivery. Methods: A cohort study of 82 pregnant women with a history of migration and corresponding delivery of newborns in Germany was conducted. Results: Overall, 9% of sera tested positive for anti-HEV IgG. None of the patients tested positive for anti-HEV IgM, schistosomiasis, or echinococcus serology. Birth weights were below the 10th percentile for gestational age in 8.5% of the neonates. No association between HEV serology and fetal growth restriction (FGR) frequency was found. Conclusions: In comparison to German baseline data, no increased risk for HEV exposure or serological signs of exposure against schistosomiasis or echinococcosis could be observed in pregnant migrants. An influence of the anti-HEV serology status on fetal growth restriction could not be found.

Background:Restrictions to contain the COVID-19 pandemic affect the social participation of people worldwide. Especially those at high risk for a severe disease tend to abstain from social gatherings. While there are a few questionnaires to measure social participation in elderly or chronic patients, a valid survey instrument that includes pandemic-related social participation is needed.MethodsWe developed a social participation questionnaire that aims to assess pandemic-related restrictions in social participation. Items were developed using a theory and literature-based approach and then compiled in a discursive process involving experts and lay people. This was followed by the validation of the questionnaire through a cross-sectional survey on 431 individuals. Items with low item-total correlations and low factor loadings using exploratory factor analysis [EFA] were excluded. Using EFA on the remaining items, the factor structure was retrieved and tested with a confirmatory factor analysis [CFA]. Internal consistency was assessed with Chronbachs α.ResultsInitially, 27 items were developed which were used for validation. 13 items were excluded due to low item-total correlations and factors loadings. EFA of the remaining 14 items revealed three factors which were identified as domains “active social participation,” “wellbeing,” and “restrictions”. CFA showed an acceptable model fit using the three-dimensional structure. Chronbachs α of 0.81 and McDonalds Ω of 0.87 indicate good internal consistency. Correlation analysis showed an association between the developed questionnaire and previously-established participation and mental health scales.ConclusionThis study suggests that our 14 item questionnaire is of high reliability and validity and can be used to measure social participation during a pandemic.

Background The COVID-19 pandemics has reinforced Germany's role as global health player, but the education system is lagging behind and does not adequately prepare health professionals for the new challenges. This study aims to strengthen global health in undergraduate medical education in Germany. Major objectives include: to review the current situation, explore changing demand for global health and introduce innovative teaching models and the role of student as drivers for change. Methods Mixed methods and an explorative approach were applied, comprising a scoping review, online surveys carried out at Hannover Medical School, March/April 2020, and finally a new multi-professional teaching courses initiated by students and developed collaboratively. Target groups of the survey were undergraduate medical students (n = 384) and additionally lecturers (n = 172). Results The results reveal that new health policies and Germany's new global political responsibility do not adequately translate into innovation in the education system. At the same time, demand for global health education has increased markedly and students have taken action bottom-up and introduced new courses. However, the transformative power on the level of institutions is limited. There is a need for appropriate funding and comprehensive governance innovation to align health and education institutions, research and education, policy and practice, and students and lecturers. Conclusions Implementation of global health programmes illustrates how students can become change agents and enhance institutional innovation bottom-up. However, in order to achieve wider transformative potential, these efforts must be flanked by macro-level policy changes and integrated in future pandemic preparedness strategies. Key messages Strengthening global health education is driven by students’ demand and novel teaching models. Innovation driven by students needs institutional support to achieve transformative powers.

The work situation is an important dimension of professional life and wellbeing, and a policy lever to strengthen recruitment and retention. This study aims to explore the work situation of physicians and residents in internal medical rheumatology, considering the impact of the coronavirus pandemic COVID-19.A questionnaire-based online survey was conducted in early 2021 at the Hannover Medical School, supported by the German Society of Rheumatology. Target groups were all rheumatology physicians and residents in Germany. The main areas of investigation included work hours, task delegation, and collaboration; workload and mental health issues; discrimination and sexual harassment experiences; and the impact of COVID-19. Descriptive statistical analysis was performed for the standardized items and qualitative content analysis for the free-text information.The respondents (n = 101) expressed positive attitudes towards cooperation and task delegation to medical assistants, especially those specialized in rheumatology, while attitudes towards cooperation with GPs pointed to blockades. There was a strong mismatch between actual and desired work hours both in the group of women and in the group of men. 81% rated their workload as high or very high; every sixth rheumatologist has suffered from stress or burnout syndromes at least once in the past. Experiences of gender discrimination and sexual harassment/violence were frequently reported, mostly by women. COVID-19 was an amplifier of stress, with major stressors being digitalization and increased demand for communication and patient education.There is an urgent need to improve the work situation of rheumatologists and reduce stress and mental health risks.HINTERGRUND UND FRAGESTELLUNG: Die Arbeitssituation ist ein wichtiger Aspekt im Berufsleben und für das Wohlergehen und ein politischer Hebel, um den Verbleib im Beruf sowie die Fachkräfterekrutierung zu verbessern. Ziel dieser Studie war es, die Arbeitsbedingungen internistischer Rheumatolog*innen und Weiterbildungsassistent*innen unter Berücksichtigung der Auswirkungen der Coronavirus-Pandemie COVID-19 zu untersuchen.Eine fragebogenbasierte Online-Erhebung wurde Anfang 2021 an der Medizinischen Hochschule Hannover durchgeführt, unterstützt von der Deutschen Gesellschaft für Rheumatologie. Zielgruppe waren alle Rheumatolog*innen und Weiterbildungsassistent*innen in Deutschland. Thema waren Arbeitszeiten, Kooperation und Delegation, Arbeitsbelastungen und Burnout-Syndrome, Diskriminierung und sexuelle Belästigung sowie Auswirkungen von COVID-19. Standardisierte Items wurden deskriptiv und Freitextinformationen mittels qualitativer Inhaltsanalyse ausgewertet.In der Untersuchungsgruppe (n = 101) zeigten sich positive Einstellungen zu Kooperation und Aufgabendelegation an medizinische Fachangestellte, v. a. Rheumatologische Fachassistenz, während die Einstellungen zur Kooperation mit Hausärzt*innen Blockaden sichtbar machten. Die tatsächliche Arbeitszeit unterschied sich sowohl in der Gruppe der Frauen als auch der Männer sehr deutlich von der Wunscharbeitszeit. Ihre Arbeitsbelastung bewerteten 81 % als hoch oder sehr hoch; jede*r 6. Befragte war mindestens einmal in der Vergangenheit von Stress und Burnout betroffen. Diskriminierungserfahrungen und sexuelle Belästigungen waren weitverbreitet und betrafen Frauen stärker als Männer. COVID-19 erwies sich als Stressverstärker; Digitalisierung, erhöhter Bedarf an Kommunikation und Patientenaufklärung waren wesentliche Stressfaktoren.Die Arbeitssituation von Rheumatolog*innen sollte dringend verbessert werden, um Stress und Gesundheitsrisiken zu verringern.

According to the Robert Koch Institute, the estimated HIV prevalence in Germany is 86 100. On-third of the affected persons is over 50 years old. Overall, the prognosis of patients with HIV infection depends crucially on the time of diagnosis. The unfounded stigmatization of affected patients stands in the way of today's treatment options as it did 30 years ago. Every practice of primary care must also take into consideration the medical care of HIV-infected people. The purpose of this article is to make the general practitioner aware of this topic and to prepare for the necessary procedure in everyday practice in this rare but not unlikely situation.

Impfen ist insbesondere bei immundefizienten Patienten eine wichtige Schutzmasnahme. Welche Impfungen sind unproblematisch, welche mussen gut abgewogen werden? Welches Vorgehen ist vor geplanter Immunsuppression empfehlenswert?

Vaccine-induced neutralizing antibodies are key in combating the COVID-19 pandemic. However, delays of boost immunization due to limited availability of vaccines may leave individuals vulnerable to infection and disease for prolonged periods. The emergence of SARS-CoV-2 variants of concern (VOC), B.1.1.7 (United Kingdom), B.1.351 (South Africa) and P.1 (Brazil), may reinforce this issue with the latter two being able to evade control by antibodies. We assessed humoral and T cell responses against SARS-CoV-2 WT and VOC and endemic human coronaviruses (hCoV) that were induced after single and double vaccination with BNT162b2. Despite readily detectable IgG against the receptor-binding domain (RBD) of the SARS-CoV-2 S protein at day 14 after a single vaccination, inhibition of SARS-CoV-2 S-driven host cell entry was weak and particularly low for the B.1.351 variant. Frequencies of SARS-CoV-2 specific T cells were low in many vaccinees after application of a single dose and influenced by immunity against endemic hCoV. The second vaccination significantly boosted T cell frequencies reactive for WT, B.1.1.7 and B.1.351 variants. These results call into question whether neutralizing antibodies significantly contribute to protection against COVID-19 upon single vaccination and suggest that cellular immunity is central for the early defenses against COVID-19.

Health workforce shortage in German rheumatology has been identified as a healthcare service and delivery problem. Health policy has increased staffing targets, yet effective intervention strategies are lacking. This research aimed to systematically map the rheumatology workforce to improve the evidence for interventions and explore possibilities for more effective health workforce management.The WHO National Health Workforce Accounts provided a conceptual framework for the mapping exercise. Four major sets of indicators were selected, comprising staffing levels, health labor market flows, composition and education/training. A comparison of age groups and time series was applied to explore trends. Public statistics and other secondary sources served our analysis using descriptive methodology.In Germany there are 1076 physicians specialized in internal medical rheumatology. Absolute numbers have nearly doubled (91%) since 2000 but with a strong demographic bias. Between 2000 and 2019 numbers markedly increased in the group aged 50 years and older but only by 9% in the younger group under 50 years; since 2010 the group aged 40-50 years even faces a decrease. In 2019, the absolute numbers of rheumatologists in retirement age exceeded those aged 40 years and under. Since 2015 an expanding workforce trend has overall flattened but this was strongest in the hospital sector; the numbers in resident training did not show any relevant growth.Health workforce trends reveal that an available number of rheumatologists cannot meet new health policy planning targets. There is a need for effective health workforce management, focusing on innovation in resident training, improved task delegation and gender equality.HINTERGRUND UND FRAGESTELLUNG: Fachkräftemangel in der Rheumatologie in Deutschland ist als Versorgungsproblem erkannt. Die Gesundheitspolitik hat mit neuen Planungszielen reagiert, aber es fehlen effektive Interventionsstrategien. Ziel dieser Studie ist ein systematischer berufsstruktureller Überblick, um die Grundlage für Interventionen zu verbessern und Möglichkeiten für ein effektives Fachkräftemanagement aufzuzeigen.Die WHO National Health Workforce Accounts (NHWA) dienen als konzeptioneller Rahmen. Ausgewählt werden 4 Indikatoren: Personalbestand, Arbeitsmarktbewegungen, Komposition und Weiterbildung. Die Exploration von Entwicklungstrends stützt sich auf vergleichende Analysen von Altersgruppen und Zeitreihen. Die Erhebung nutzt öffentliche Statistiken und andere Sekundärliteratur; die Auswertung erfolgt deskriptiv.In Deutschland sind 1076 Ärzt*innen mit einer Facharztqualifikation oder Schwerpunktbezeichnung in der internistischen Rheumatologie ärztlich tätig. Die absolute Zahl verdoppelte sich seit 2000 deutlich (91 %), aber mit einem demografischen Bias. Im Zeitraum 2000 bis 2019 stieg die Zahl der über 50-Jährigen deutlich, aber die der unter 50-Jährigen nur um 9 %; seit 2010 sind die Zahlen in der Gruppe 40 bis 50 Jahre rückläufig. Im Jahr 2019 waren mehr Rheumatolog*innen im Rentenalter als unter 40-Jährige ärztlich tätig. Seit 2015 schwächt sich der steigende Trend insgesamt ab, aber am stärksten im Krankenhaussektor; die Weiterbildungen lassen keine konstante Steigerung erkennen.Berufsstrukturelle Trends zeigen, dass die gesundheitspolitischen Planziele mit den verfügbaren Humanressourcen nicht zu erreichen sind. Gefordert ist ein besseres Fachkräftemanagement, insbesondere durch Innovation der Weiterbildung, Aufgabenverschiebung und verbesserte Geschlechtergerechtigkeit.

Hintergrund Zur Bekämpfung der SARS-CoV-2-Pandemie wurden in Deutschland Mitte März 2020 weitgehende Kontaktbeschränkungen erlassen (sog. Lockdown). Die vorliegende Arbeit soll klären, welche Auswirkungen diese Maßnahmen auf Rettungsdiensteinsätze hatten. Material und Methoden Retrospektive Auswertung von 6668 Einsatzprotokollen von vier Rettungswachen in Ostniedersachsen der beiden ersten Quartale 2020. Deskription und teststatistischer Vergleich der Einsätze sechs Wochen vor den Kontaktbeschränkungen mit einem gleich großen Zeitraum nach deren Erlass. Ergebnisse In den sechs Wochen im Lockdown gab es 17,7 % weniger Einsätze als in den Wochen vor dem Lockdown. Insbesondere zeigte sich eine Abnahme von Einsätzen wegen Atemwegserkrankungen um 40,6 % (91 Fälle), die insbesondere auf den Rückgang von Pneumonien und exazerbierten chronisch-obstruktiven Lungenerkrankungen (COPD) zurückgeht. Gleichzeitig zeigte sich ein Anstieg des durchschnittlichen Alters der Patienten mit einer Verringerung des Anteils der unter 65-Jährigen. Veränderungen bei psychiatrischen Erkrankungen, verstorbenen oder verletzten Patienten oder der Verweigerung von Behandlung und Transport wurden nicht beobachtet. Insgesamt wurden im Zeitraum 67 Patienten (1,0 %) mit Verdacht auf oder bestätigter COVID-19-Erkrankung behandelt. Diskussion Im Rettungsdienst zeigt sich eine Reduktion der Einsätze in Folge der Kontaktbeschränkungen, wobei diese nicht so stark ausfällt, wie für Notaufnahmen beschrieben wurde. Dieser Rückgang könnte auf eine Reduktion insbesondere weniger schwerer Erkrankungsfälle und jüngerer Patienten zurückzuführen sein. Auffällig ist die Reduktion von Pneumonien und exazerbierter COPD. Dies könnte einerseits bedeuten, dass Kontaktbeschränkungen das Infektionsgeschehen bei anderen Atemwegserkrankungen reduziert haben, aber ebenfalls, dass Patienten Krankenhausbehandlungen vermeiden wollten.

Purpose Unnecessary and inappropriate use of antibiotics is a widespread problem in primary care. However, current data on the care of refugees and migrants in initial reception centers is pending. This article provides data on prescription frequencies of various antibiotics and associated diagnoses. Methods In this retrospective observational study, patient data of 3255 patients with 6376 medical contacts in two initial reception centers in Germany were analyzed. Patient data, collected by chart review, included sociodemographic characteristics, diagnoses, and prescriptions. Antibiotic prescription behavior and corresponding physician‐coded diagnoses were analyzed. Results Nineteen percent of all patients in our study received systemic antibiotics during the observation period, with children below the age of 10 years receiving antibiotics most frequently (24%). The most commonly prescribed antibiotics were penicillins (65%), macrolides (12%), and cephalosporins (7%). The most frequent diagnoses associated with antibiotic prescription were acute tonsillitis (26%), bronchitis (21%), infections of the upper respiratory tract (14%), and urinary tract infections (10%). In case of acute bronchitis 74% of the antibiotic prescriptions were probably not indicated. In addition, we found a significant number of inappropriate prescriptions such as amoxicillin for tonsillitis (67%), and ciprofloxacin and cotrimoxazol for urinary tract infections (49%). Conclusion Regarding inappropriate prescription of antibiotics in refugee healthcare, this study shows a rate ranging from 8% for upper respiratory tract infections to 75% for acute bronchitis. Unnecessary use of antibiotics is a global problem contributing to gratuitous costs, side effects, and antimicrobial resistance. This research contributes to the development of stringent antibiotic stewardship regiments in the particularly vulnerable population of migrants and refugees.

The COVID‐19 pandemic has reinforced Germany's role as global health player, but the education system is lagging behind and does not adequately prepare health professionals for the new challenges. This study aims to strengthen global health in undergraduate medical education in Germany. Major objectives include: to review the current situation, explore changing demand for global health and introduce innovative teaching models and the drivers for change. Mixed methods and an explorative approach were applied, comprising a scoping review, online surveys carried out at Hanover Medical School, March/April 2020. Target groups were undergraduate medical students (n = 384) and additionally lecturers (n = 172), and finally new multiprofessional teaching courses initiated by students and developed collaboratively. The results reveal only slow pace of change on the level of the education system, while demand for global health education has increased markedly in all actor groups, but strongest in the group of students in the preclinical phase. Implementation of global health programmes illustrates how students can become change agents and enhance institutional innovation bottom‐up. However, in order to achieve wider transformative potential, these efforts must be flanked by macro‐level policy changes and integrated in future pandemic preparedness strategies.

Background Currently, health care systems worldwide are challenged with providing care to an increasing number of migrants, refugees, and displaced persons. In this article, we report on disease burden and drug prescription patterns in a large refugee cohort in Germany. Methods We conducted a cross-sectional study of anonymized medical records including demographic data, diagnoses, and drug prescriptions in two refugee reception centres between 2015 and 2019. Refugees and migrants received medical assistance exclusively through the on-site clinics. Thus, this study represents all medical visits of the housed residents. Results In total, n = 15531 diagnoses from n = 4858 patients in a cohort of n = 10431 accommodated refugees were recorded. N = 11898 medications were prescribed. Overall, 29.8% of all refugees sought medical attention. Half of the patients were female (49.6%), the average age was 23.8 years (SD [standard deviation] 17.0, min 0, max 81), and 41.5% were minors (

Background The importance of a sustainable health workforce is increasingly recognised. However, the specialised heath workforce remains marginal in health workforce planning, policy and research. This paper aims to improve the integration of small specialised professional groups in health workforce governance and to critically assess existing tools, using Germany and rheumatology physicians as a case study. Methods A qualitative explorative approach was applied, which draws on a scoping review of the literature, public statistics and expert information. The National Health Workforce Accounts (NHWA) and the WHO 'AAAQ' framework served as guidance to assess workforce development in rheumatology in Germany. Results On average physician density is high in Germany, yet access to specialised care may be seriously delayed and services may not be accessible to all patients; e.g. currently only half of the patients with spondyloarthritis are treated by a rheumatologist which impacts quality of care. An estimated 850 to 1000 additional rheumatologists are needed to ensure early diagnoses and treatment and prevent long-term health damage. However, shortage will even reinforce in future: annual inflow of newly registered rheumatologists over recent years did not exceed 30 to 50 physicians and young rheumatologists more often prefer part-time work. Conclusions Specialised health professions with small numbers and long duration of training face specific challenges to create a sustainable workforce. This calls for (1) greater investment in education and training, (2) greater attention to qualitative indicators, such as assess and prevention measurements like early diagnosis, and (3) a dynamic health workforce approach to respond to both new technologies/ treatments and changing preferences of the health professionals, like part-time work. Key messages Integrating the specialised health workforce in health workforce governance is important to improve prevention, quality and access to care. NHWA may be aligned to qualitative indicators and prevention policies to respond more effectively to future population needs.

Background: Migrant women may have an increased risk of adverse birth outcomes. This study analyses the occurrence of low birth weight, preterm birth and intrauterine growth restriction (IUGR) in pregnant migrants. Method: Cross-sectional study of 82 mother-child pairs of pregnant migrants attending medical care in Germany.Results: Median age was 27 years, 49% were of oriental-asian ethnicity and median year of migration was 2015. At least one previous pregnancy was reported in 76%. Delivery mode was caesarian section in 40%. Median gestational age was 39.7 weeks. Preterm birth occurred in 6.1%. Median gestational age for preterm birth was 32.3 weeks. Low birth weight (Conclusions: Compared to German data no increased occurrence of low birth weight, preterm birth or IUGR was found. Of note, rate of caesarian section was higher than in the general population for reasons yet to be identified. The authors propose stratification according to migration status for the national documentation of birth outcomes in Germany.Trial registration: ClinicalTrails.gov, NCT03158298. Registered 18 May 2017 - Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT03158298

BackgroundSerology testing is explored for epidemiological research and to inform individuals after suspected infection. During the COVID-19 pandemic, frontline healthcare professionals (HCP) may be at particular risk for infection. No longitudinal data on functional seroconversion in HCP in regions with low COVID-19 prevalence and low pre-test probability exist.MethodsIn a large German university hospital, we performed weekly questionnaire assessments and anti-SARS-CoV-2 IgG measurements with various commercial tests, a novel surrogate virus neutralization test, and a neutralization assay using live SARS-CoV-2.ResultsFrom baseline to week six, n=1,080 screening measurements for anti-SARS CoV-2 (S1) IgG from n=217 frontline HCP (65% female) were performed. Overall, 75.6% of HCP reported at least one symptom of respiratory infection. Self-perceived infection probability declined over time (from mean 20.1% at baseline to 12·4 % in week six, pConclusionWhen assessing anti-SARS-CoV-2 immune status in individuals with low pre-test probability, we suggest confirming positive results from single measurements by alternative serology tests or functional assays. Our data highlight the need for a methodical serology screening approach in regions with low SARS-CoV-2 infection rates.

Background:The COVID-19 pandemic has disrupted healthcare systems worldwide. Besides the direct impact of the virus on morbidity and mortality of patients, the effect of lockdown strategies on health and healthcare utilization become more and more apparent. Little is known on the effect of the pandemic on pediatric healthcare utilization. We examined the impact of the pandemic on pediatric emergency healthcare.Methods: We conducted a monocentric, retrospective analysis of n=5.424 pediatric emergency visits between January 1st and April 19th of 2019 and 2020, and compared healthcare utilization in the month post lockdown 2020 to the same period in 2019.Results: In the four weeks after lockdown in Germany began, we observed a massive drop of 63.8% in pediatric emergency healthcare utilization (mean daily visits 26.8 ±SEM 1.5 in 2019 vs. 9.7 ±SEM 1 in 2020, pConclusion: Our data illustrate a significant decrease in pediatric emergency room visits during the COVID-19 pandemic. Public outreach is needed to encourage parents to seek medical attention for pediatric emergencies in spite of the pandemic.

Uncertain rates of asymptomatic infections have raised concerns about potentially high rates of thus far undiagnosed SARS-CoV-2 infections. Serological testing for SARS-CoV-2 specific IgG can be helpful in identification of asymptomatic infections. We report baseline results of the CVOID-19 Contact (CoCo) Study, which follows 217 frontline healthcare workers at a university hospital and performs weekly SARS-CoV-2 specific serology (IgA/IgG). The majority of participants had direct contact to patients with infectious respiratory diseases. Study participants estimated their personal likelihood of having had a SARS-CoV-2 infection with a mean of 20.9% (range 0 to 90%). In contrast, anti-SARS-CoV-2-IgG prevalence was in the range of 1-2% among health care workers. The CoCo Study is not fully representative for other hospitals and the sensitivity of anti-SARS-CoV-2 serology in low prevalence conditions may require further improvement. Taken together, low rates of SARS-CoV-2 specific IgG in healthcare workers in Northern Germany are in sharp contrast to the high personal risk perception. Regular anti-SARS-CoV-2 IgG testing of health-care workers may aid in monitoring the pandemic, assessing the quality of immune responses, directing resources for protective measures, and assuring CVID-19 care in the long run.

Background The COVID-19 pandemic has disrupted healthcare systems worldwide. In addition to the direct impact of the virus on patient morbidity and mortality, the effect of lockdown strategies on health and healthcare utilization have become apparent. Little is known on the effect of the pandemic on pediatric and adolescent medicine. We examined the impact of the pandemic on pediatric emergency healthcare utilization. Methods We conducted a monocentric, retrospective analysis of n = 5,424 pediatric emergency department visits between January 1st and April 19th of 2019 and 2020, and compared healthcare utilization during the pandemic in 2020 to the same period in 2019. Results In the four weeks after lockdown in Germany began, we observed a massive drop of 63.8% in pediatric emergency healthcare utilization (mean daily visits 26.8 ± SEM 1.5 in 2019 vs. 9.7 ± SEM 1 in 2020, p p p Conclusions Our data illustrate a significant decrease in pediatric emergency department visits during the COVID-19 pandemic. Public outreach is needed to encourage parents and guardians to seek medical attention for pediatric emergencies in spite of the pandemic.

There have been concerns about high rates of thus far undiagnosed SARS-CoV-2 infections in the health-care system. The COVID-19 Contact (CoCo) Study follows 217 frontline health-care professionals at a university hospital with weekly SARS-CoV-2-specific serology (IgA/IgG). Study participants estimated their personal likelihood of having had a SARS-CoV-2 infection with a mean of 21% [median 15%, interquartile range (IQR) 5–30%]. In contrast, anti-SARS-CoV-2 IgG prevalence was about 1–2% at baseline. Regular anti-SARS-CoV-2 IgG testing of health-care professionals may aid in directing resources for protective measures and care of COVID-19 patients in the long run.

The phenotype of primary immunodeficiency disorders (PID), and especially common variable immunodeficiency (CVID), may be dominated by symptoms of autoimmune disorders. Furthermore, autoimmunity may be the first manifestation of PID, frequently preceding infections and the diagnosis of hypogammaglobulinemia, which occurs later on. In this case, distinguishing PID from hypogammaglobulinemia secondary to anti-inflammatory treatment of autoimmunity may become challenging. The aim of this study was to evaluate the diagnostic accuracy of peripheral blood lymphocyte phenotyping in resolving the diagnostic dilemma between primary and secondary hypogammaglobulinemia. Comparison of B and T cell subsets from patients with PID and patients with rheumatic disease, who developed hypogammaglobulinemia as a consequence of anti-inflammatory regimes, revealed significant differences in proportion of na&iuml, ve B cells, class-switched memory B cells and CD21low B cells among B cells as well as in CD4+ memory T cells and CD4+ T follicular cells among CD4+ T cells. Identified differences in B cell and T cell subsets, and especially in the proportion of class-switched memory B cells and CD4+ T follicular cells, display a considerable diagnostic efficacy in distinguishing PID from secondary hypogammaglobulinemia due to anti-inflammatory regimens for rheumatic disease.

Introduction The way syphilis affects the immunologic and virologic parameters of a human immunodeficiency virus (HIV) infection remains controversial. The aim of this study was to investigate the impact of syphilis infection on lymphocyte and lymphocyte subset counts as well as viral load in HIV-infected patients. Methods All HIV-infected patients attending the outpatient clinic for infectious diseases of Hannover Medical University Hospital diagnosed with syphilis between 2009 and 2016 were retrospectively evaluated for changes in total lymphocyte, B cell, CD3+ T cell, CD4+ and CD8+ T cell counts as well as in HIV viral load. These parameters were assessed at three different time points, i.e., 3–6 months before, at diagnosis and 3–6 months after treatment of syphilis. Results Eighty-four HIV-infected patients, all with early syphilis, were identified. The vast majority were men who have sex with men (MSM), and 80% were receiving antiretroviral therapy (ART). Syphilis was associated with a significant reduction in the total lymphocyte count and counts of all studied lymphocyte subsets, including CD4+ T cells, whose percentage among lymphocytes did not change. No significant changes in HIV viral load were observed at any of the studied time points. Further, antibiotic treatment of syphilis restored lymphocyte counts back to pretreatment levels. Conclusion Syphilis induces a relative non-CD4+ T cell-specific lymphopenia in HIV-infected patients. Our data suggest that serologic testing for syphilis should be considered in HIV-infected MSM in case of an otherwise unexplained drop in total lymphocyte count. Electronic supplementary material The online version of this article (10.1007/s40121-018-0219-9) contains supplementary material, which is available to authorized users.