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Recruiting people with selected citizenships for the health interview survey GEDA Fokus throughout Germany: evaluation of recruitment efforts and recommendations for future research
No full textBackground:
Germany is the second most common country of immigration after the US. However, people with own or familial history of migration are not represented proportionately to the population within public health monitoring and reporting. To bridge this data gap and enable differentiated analyses on migration and health, we conducted the health interview survey GEDA Fokus among adults with Croatian, Italian, Polish, Syrian, or Turkish citizenship living throughout Germany. The aim of this paper is to evaluate the effects of recruitment efforts regarding participation and sample composition.
Methods:
Data collection for this cross-sectional and multilingual survey took place between 11/2021 and 5/2022 utilizing a sequential mixed-mode design, including self-administered web- and paper-based questionnaires as well as face-to-face and telephone interviews. The gross sample (n = 33436; age range 18–79 years) was randomly drawn from the residents’ registers in 120 primary sampling units based on citizenship. Outcome rates according to the American Association for Public Opinion Research, the sample composition throughout the multistage recruitment process, utilization of survey modes, and questionnaire languages are presented.
Results:
Overall, 6038 persons participated, which corresponded to a response rate of 18.4% (range: 13.8% for Turkish citizenship to 23.9% for Syrian citizenship). Home visits accounted for the largest single increase in response. During recruitment, more female, older, as well as participants with lower levels of education and income took part in the survey. People with physical health problems and less favourable health behaviour more often took part in the survey at a later stage, while participants with symptoms of depression or anxiety more often participated early. Utilization of survey modes and questionnaire languages differed by sociodemographic and migration-related characteristics, e.g. participants aged 50 years and above more often used paper- than web-based questionnaires and those with a shorter duration of residence more often used a translated questionnaire.
Conclusion:
Multiple contact attempts, including home visits and different survey languages, as well as offering different modes of survey administration, increased response rates and most likely reduced non-response bias. In order to adequately represent and include the diversifying population in public health monitoring, national public health institutes should tailor survey designs to meet the needs of different population groups considered hard to survey to enable their survey participation.Peer Reviewe
Acceptance and feasibility of a low-threshold and substitution services-based periodical monitoring system for blood-borne and sexually transmitted infections among people who inject drugs in Germany: a mixed-methods analysis
No full textBackground:
To reach the global elimination goals of viral hepatitis B and C (HBC, HCV), human immunodeficiency virus (HIV) and other sexually transmitted infections as a public health threat by 2030, monitoring is needed. Staff members of drug services and opioid substitution treatment (OST) practices in Berlin and Bavaria recruited clients for a pilot study addressing the respective infections among people who injected drugs (PWID) in Germany, 2021/2022. Participants filled a questionnaire and were tested for HBV, HCV, HIV and syphilis using dried blood spots (DBS). We evaluated the study design to implement a feasible and accepted nationwide periodical monitoring among PWID and serve as an example for the implementation of similar monitoring systems in other countries.
Methods:
A mixed-methods design was used, including focus group discussions with study participants and staff members and a semi-quantitative questionnaire filled by the latter. Aspects covered were the setting for recruitment, study preparation for staff members, willingness of clients to participate, the study questionnaire, blood collection and return of results.
Results:
The majority (96%) of 668 study participants were recruited in low-threshold services, drug consumption rooms and OST-practices. Flexibility of recruiting study participants during routine work or testing weeks/days was important to the facilities. Collaborations with local AIDS services helped cope with the work load of data collection. The need to train staff for DBS collection was highlighted. Study participants welcomed the testing opportunity in familiar places. Study participants frequently needed assistance to complete the study questionnaire. Return of results was considered as ethically mandatory by staff members but referral to treatment remained challenging.
Conclusions:
For a successful monitoring time flexibility and adequate training are essential. Individual benefits for study participants by receiving their test results should be ensured and referral networks with infectiology practices may increase number of infected PWID receiving treatment. Overall, the evaluation confirmed that a monitoring through drug services and OST-practices is feasible and well accepted in Germany. Beyond that it shows important lessons learnt for the implementation in other countries.Peer Reviewe
Molecular Detection and Characterization of Rickettsia Species in Ixodid Ticks from Selected Regions of Namibia
No full textRickettsial pathogens are among the emerging and re-emerging vector-borne zoonoses of public health importance. Reports indicate human exposure to Rickettsial pathogens in Namibia through serological surveys, but there is a lack of data on infection rates in tick vectors, hindering the assessment of the relative risk to humans. Our study sought to screen Ixodid ticks collected from livestock for the presence of Rickettsia species in order to determine infection rates in ticks and to determine the Rickettsia species circulating in the country. We collected and pooled Hyalomma and Rhipicephalus ticks from two adjacent regions of Namibia (Khomas and Otjozondjupa) and observed an overall minimum Rickettsia infection rate of 8.6% (26/304), with an estimated overall pooled prevalence of 9.94% (95% CI: 6.5–14.3). There were no statistically significant differences in the estimated pooled prevalence between the two regions or tick genera. Based on the nucleotide sequence similarity and phylogenetic analysis of the outer membrane protein A (n = 9) and citrate synthase (n = 12) genes, BLAST analysis revealed similarity between Rickettsia africae (n = 2) and Rickettsia aeschlimannii (n = 11), with sequence identities ranging from 98.46 to 100%. Our initial study in Namibia indicates that both zoonotic R. africae and R. aeschlimannii are in circulation in the country, with R. aeschlimannii being the predominant species
Clinically inapparent mpox virus (MPXV) infections among clients of three anonymous Community Based Voluntary Counselling and Testing centres in Berlin, Germany, 2022–2023
No full textIntroduction:
Since the mpox outbreak in 2022, it was unclear if and how often infections with mpox virus (MPXV) were clinically inapparent, i.e. not presenting to clinical care with mpox symptoms. Moreover, it was hypothesized that MPXV circulated in the affected communities before the outbreak was officially detected.
Methods:
We retrospectively tested rectal and urethral swabs, and pooled samples for presence of MPXV. Samples were obtained from routine STI testing of three anonymous Community Based Voluntary Counselling and Testing (CBVCT) centres in Berlin, in 2022 and 2023. Testing results were linked to anonymously provided behavioural data.
Results:
Overall, 9,053 samples from 6,600 client visits were included. Clinically inapparent MPXV infections were detectable in 1.1% of the samples. We did not find MPXV infections in the month before the first cases appeared in Berlin or between October 2022 and January 2023 when case numbers were low in Germany. However, during the outbreak period in 2022, we found clinically inapparent MPXV infections among 2.2% of the clients and during summer/autumn 2023 among 0.3%. The number of condomless anal/vaginal intercourse partners within the previous 6 months and PrEP use were identified as predictors of clinically inapparent MPXV infection.
Conclusion:
Clinically inapparent MPXV infections occurred during the mpox outbreak in Berlin in 2022 and post-outbreak in summer/autumn 2023. Unrecognized MPXV circulation in Berlin before the recognition of the outbreak in May 2022 appears unlikely. However, low-level sustained circulation of clinically inapparent MPXV infections need to be acknowledged in mpox prevention strategies.Peer Reviewe
A Framework for Measuring Neighborhood Walkability for Older Adults—A Delphi Consensus Study
No full textWhile mobility in older age is of crucial importance for health and well-being, it is worth noting that currently, there is no German language framework for measuring walkability for older adults that also considers the functional status of a person. Therefore, we combined the results of an expert workshop, a literature review, and a Delphi consensus survey. Through this, we identified and rated indicators relevant for walkability for older adults, additionally focusing on their functional status. The expert workshop and the review led to an extensive list of potential indicators, which we hope will be useful in future research. Those indicators were then adapted and rated in a three-stage Delphi expert survey. A fourth additional Delphi round was conducted to assess the relevance of each indicator for the different frailty levels, namely “robust,” “pre-frail,” and “frail.” Between 20 and 28 experts participated in each round of the Delphi survey. The Delphi process resulted in a list of 72 indicators deemed relevant for walkability in older age groups, grouped into three main categories: “Built environment and transport infrastructure,” “Accessibility and meeting places,” and “Attractiveness and sense of security.” For 35 of those indicators, it was suggested that functional status should be additionally considered. This framework represents a significant step forward in comprehensively covering indicators for subjective and objective walkability in older age, while also incorporating aspects of functioning relevant to older adults. It would be beneficial to test and apply the indicator set in a community setting.Peer Reviewe
Gut microbiota in vaccine naïve Gabonese children with rotavirus A gastroenteritis
No full textBackground:
While the gut microbiome modulates the pathogenesis of enteric viruses, how infections caused by rotavirus A (RVA), with or without diarrhoea, alter the gut microbiota has been sparsely studied.
Methods:
From a cohort of 224 vaccine naïve Gabonese children with and without diarrhoea (n = 177 and n = 67, respectively), 48 stool samples were analysed: (i) RVA with diarrhoea (n = 12); (ii) RVA without diarrhoea (n = 12); (iii) diarrhoea without RVA (n = 12); (iv) healthy controls without diarrhoea and RVA (n = 12). The 16S rRNA metabarcoding using Oxford Nanopore sequencing data was analysed for taxonomic composition, abundance, alpha and beta diversity, and metabolic pathways.
Findings:
Alpha diversity showed that children with acute diarrhoea (with and without RVA infection), and children with acute diarrhoea without RVA had low microbial diversity compared to healthy children (p = 0.001 and p = 0.006, respectively). No significant differences observed when comparing children with RVA with or without diarrhoea. Beta diversity revealed high microbial heterogeneity in children without diarrhoea. Proteobacteria (68%) and Firmicutes (69%) were most common in the diarrhoea and non-diarrhoea groups, respectively. Proteobacteria (53%) were most common in children without RVA, while Firmicutes (55%) were most common with RVA. At the genus level, Escherichia (21%), Klebsiella (10%) and Salmonella (4%) were abundant in children with diarrhoea, while Blautia (11%), Clostridium (8%), Lachnoclostridium (6%) and Ruminococcus (5%) were abundant in children without diarrhoea. Metabolites involved in amino acid, carbohydrate, lipid, nucleotide, and vitamin metabolism were quantitatively altered.
Interpretation:
Although host physiology dictates the intestinal milieu, diarrhoea per se can alter a balanced gut microbiota, whereas infectious diarrhoea disrupts the gut microbiome and reduces its diversity.Peer Reviewe
Intragenomic conflicts with plasmids and chromosomal mobile genetic elements drive the evolution of natural transformation within species
No full textNatural transformation is the only mechanism of genetic exchange controlled by the recipient bacteria. We quantified its rates in 786 clinical strains of the human pathogens Legionella pneumophila (Lp) and 496 clinical and environmental strains of Acinetobacter baumannii (Ab). The analysis of transformation rates in the light of phylogeny revealed they evolve by a mixture of frequent small changes and a few large quick jumps across 6 orders of magnitude. In standard conditions close to half of the strains of Lp and a more than a third in Ab are below the detection limit and thus presumably non-transformable. Ab environmental strains tend to have higher transformation rates than the clinical ones. Transitions to non-transformability were frequent and usually recent, suggesting that they are deleterious and subsequently purged by natural selection. Accordingly, we find that transformation decreases genetic linkage in both species, which might accelerate adaptation. Intragenomic conflicts with chromosomal mobile genetic elements (MGEs) and plasmids could explain these transitions and a GWAS confirmed systematic negative associations between transformation and MGEs: plasmids and other conjugative elements in Lp, prophages in Ab, and transposable elements in both. In accordance with the hypothesis of modulation of transformation rates by genetic conflicts, transformable strains have fewer MGEs in both species and some MGEs inactivate genes implicated in the transformation with heterologous DNA (in Ab). Innate defense systems against MGEs are associated with lower transformation rates, especially restriction-modification systems. In contrast, CRISPR-Cas systems are associated with higher transformation rates suggesting that adaptive defense systems may facilitate cell protection from MGEs while preserving genetic exchanges by natural transformation. Ab and Lp have different lifestyles, gene repertoires, and population structure. Nevertheless, they exhibit similar trends in terms of variation of transformation rates and its determinants, suggesting that genetic conflicts could drive the evolution of natural transformation in many bacteria.Peer Reviewe
RKI-Ratgeber RSV-Infektionen
Get PDFDas Respiratorische Synzytial-Virus (RSV) ist ein weltweit verbreiteter Erreger von akuten Erkrankungen der oberen und unteren Atemwege in jedem Lebensalter und einer der bedeutendsten Erreger von Atemwegsinfektionen bei Säuglingen, insbesondere Frühgeborenen, Kleinkindern sowie älteren Erwachsenen. In Saisonalität und Symptomatik ähneln RSV-Infektionen der Influenza. Ihre Verbreitung in der Allgemeinbevölkerung wurde lange Zeit unterbewertet. Die Übertragung erfolgt in erster Linie durch Tröpfcheninfektion von einer infektiösen Person auf eine Kontaktperson. Die Schleimhaut der oberen Atemwege und die Konjunktiven bilden die Eintrittspforten. Es wird angenommen, dass eine Übertragung auch indirekt über kontaminierte Hände, Gegenstände und Oberflächen auf die Schleimhäute der Atemwege möglich ist. Im RKI-Ratgeber RSV-Infektionen werden wichtige Punkte wie Infektionsweg, klinische Symptomatik, Diagnostik, Infektionsschutz- und Hygienemaßnahmen zusammengefasst
GrippeWeb-Wochenbericht KW 36
No full textDie Aktivität akuter Atemwegserkrankungen (ARE-Inzidenz) in der Bevölkerung ist in der 36. KW 2024 im
Vergleich zur Vorwoche insgesamt stabil geblieben und lag bei rund 5.200 ARE pro 100.000 Einw. (Vorwoche:
5.200). Die Inzidenz der grippeähnlichen Erkrankungen (ILI) ist im Vergleich zur Vorwoche leicht gesunken und
lag bei rund 1.300 ILI pro 100.000 Einw. (Vorwoche: 1.400). Während sich die Gesamt-ARE-Inzidenz leicht
unterhalb des hohen Niveaus vom letzten Jahr befindet, ist die Gesamt-ILI-Inzidenz weiterhin etwas höher. Die
geschätzte COVID-19-Inzidenz in der Bevölkerung basierend auf Angaben der GrippeWeb-Teilnehmenden ist
im Vergleich zur Vorwoche leicht gestiegen und lag in der 36. KW bei rund 1.000 COVID-19-Erkrankungen pro
100.000 Einw. In der virologischen Überwachung in der Bevölkerung (GrippeWeb-Plus) wurde seit der 34. KW
2024 hauptsächlich SARS-CoV-2 nachgewiesen, gefolgt von Rhino-/Enteroviren sowie vereinzelt auch andere
Erreger.
Die für die Bevölkerung in Deutschland geschätzten Inzidenzen beruhen auf den Selbstauskünften von
Personen, die sich bei GrippeWeb registriert haben. Für die 36. KW 2024 haben bisher 7.642 GrippeWeb-
Teilnehmende eine Meldung abgegeben, von diesen hatten 381 eine ARE und 94 eine ILI (Datenstand:
10.9.2024, 0:00 Uhr). Durch Nachmeldungen, die bis zu vier Wochen lang möglich sind, können sich noch
Änderungen ergeben.
Neue Teilnehmende sind herzlich willkommen. Mehr Informationen zu GrippeWeb finden Sie hier. Eine
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Gütekriterien des Interview-Leitfadens für Externale Störungen (ILF-EXTERNAL) im Online-Setting - Ergebnisse aus dem Konsortialprojekt INTEGRATE-ADHD
Get PDFHintergrund: Die Studie untersucht die Gütekriterien der ADHS-Sektion des semistrukturierten diagnostischen Interviews ILF-EXTERNAL, welches online über
Videochat durchgeführt wurde.
Methode: Im Rahmen des Forschungsprojektes INTEGRATE-ADHD wurden 202 Kinder und Jugendliche (Alter M =12,87 Jahre, SD = 3,04, 28,2 % weiblich) mit einer bei ihrer Krankenkasse registrierten administrativen ADHS-Diagnose leitliniengerecht zum Vorliegen einer ADHS klinisch untersucht. Mit dem ILF-EXTERNAL wurden ein Elternteil und ab acht Jahren auch die Kinder selbst interviewt. Eine Fremdbeurteilung durch einen Elternteil fand anhand der Ratingskala FBB-ADHS statt. In einer Substichprobe (n = 65) erfolgte zur Bestimmung der Interrater-Reliabilität des ILF-EXTERNAL ein unabhängiges, verblindetes Zweitrating auf Basis von Videoaufnahmen des ILF-EXTERNAL-Elterninterviews.
Ergebnisse: Alle ADHS-Symptomskalen wiesen gute bis exzellente interne Konsistenzen auf (α = 0,89 bis 0,93). Die Interrater-Reliabilitäten waren sowohl bei kategorialer als auch bei dimensionaler Auswertung hoch (κ = 0,78 und κ = 0,81; ICC(1,1) = 0,97 und 0,98). Hohe Korrelationen des ILF-EXTERNAL-Elterninterviews mit dem FBB-ADHS (r = 0,79 bis r = 0,85) sowie mit dem ILF-EXTERNAL-Kindinterview (r = 0,60 bis r = 0,71) belegten zudem die konvergente Validität.
Schlussfolgerungen: Gute psychometrische Eigenschaften des ILF-EXTERNAL konnten auch für die Durchführung im Online-Setting bestätigt werden. Die hohen Interrater-Reliabilitäten sichern die Qualität der im Projekt INTEGRATE-ADHD durchgeführten ADHS-Diagnostik.Peer Reviewe