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DMP-Qualitätszielerreichung Typ-2-Diabetes - Erwachsene
No full textDer hier dargestellte Indikator (Kennzahl) ist Teil des Indikatorensets der Diabetes-Surveillance (Forschungsprojekt am Robert Koch-Institut 2015-2024) mit insgesamt 40 definierten Indikatoren beziehungsweise Indikatorgruppen. Zusätzlich zu den Indikator-Ergebnissen werden das methodische Vorgehen und die Datengrundlage beschrieben sowie die Daten in aggregierter Form bereitgestellt. Alle Indikatoren sind in vier Handlungsfelder eingeordnet: (1) Diabetesrisiko reduzieren, (2) Diabetesfrüherkennung und behandlung verbessern, (3) Diabeteskomplikationen reduzieren bzw. (4) Krankheitslast und Krankheitskosten senken. Zudem wird zwischen Kindern und Jugendlichen sowie Erwachsenen unterschieden. Der Ergebnisstand der Diabetes-Surveillance zum Projektende 2024 ist auf dem Publikationsserver des Robert Koch-Institutes (https://edoc.rki.de/handle/176904/12467) veröffentlicht. Zukünftig werden einige Diabetes-Indikatoren als Teil einer erweiterten Surveillance nichtübertragbarer Erkrankungen unter http://www.gbe.rki.de regelmäßig mit neuen Daten aktualisiert werden
Evidence of a Viable but Nonculturable (VBNC) Phase in B. abortus S19 under Oxidative Stress (H2O2, -Fe2+, Bleach) and under Non-Oxidative Inhibitory Conditions (Isopropanol, Erythritol, Selenite)
Get PDFThe effect of oxidative stress on the survival of various Brucella species has not been fully investigated yet. We here conducted a study in which we investigated the effect of different types of oxidative stress (Fe2+, H2O2, bleach) versus non-oxidative inhibitory effects (selenite, erythritol, and isopropanol) on the survival of B. abortus S19, B. abortus S19 ∆mglA 3.14, and B. neotomae 5K33. The work focuses on the appearance of ATP–CFU quotient imbalances indicating the existence of a viable but nonculturable (VBNC) form of B. abortus S19, as has previously been shown.Peer Reviewe
Genomic insights into virulence, antimicrobial resistance, and adaptation acumen of Escherichia coli isolated from an urban environment
Get PDFPopulations of common commensal bacteria such as Escherichia coli undergo genetic changes by the acquisition of certain virulence and antimicrobial resistance (AMR) encoding genetic elements leading to the emergence of pathogenic strains capable of surviving in the previously uninhabited or protected niches. These bacteria are also reported to be prevalent in the environment where they survive by adopting various recombination strategies to counter microflora of the soil and water, under constant selection pressure(s). In this study, we performed molecular characterization, phenotypic AMR analysis, and whole genome sequencing (WGS) of E. coli (n = 37) isolated from soil and surface water representing the urban and peri-urban areas. The primary aim of this study was to understand the genetic architecture and pathogenic acumen exhibited by environmental E. coli. WGS-based analysis entailing resistome and virulome profiling indicated the presence of various virulence (adherence, iron uptake, and toxins) and AMR encoding genes, including blaNDM-5 in the environmental isolates. A majority of our isolates belonged to phylogroup B1 (73%). A few isolates in our collection were of sequence type(s) (ST) 58 and 224 that could have emerged recently as clonal lineages and might pose risk of infection/transmission. Mobile genetic elements (MGEs) such as plasmids (predominantly) of the IncF family, prophages, pipolins, and insertion elements such as IS1 and IS5 were also observed to exist, which may presumably aid in the propagation of genes encoding resistance against antimicrobial drugs. The observed high prevalence of MGEs associated with multidrug resistance in pathogenic E. coli isolates belonging to the phylogroup B1 underscores the need for extended surveillance to keep track of and prevent the transmission of the bacterium to certain vulnerable human and animal populations.Peer Reviewe
How has life expectancy without functional limitations developed in Germany? An analysis with data from the German Ageing Survey (DEAS)
No full textEinleitung:
Der langfristige Anstieg der Lebenserwartung wirft die Frage auf, ob die gewonnene Lebenszeit mit einer Verlängerung der Jahre ohne gesundheitliche Einschränkungen einhergeht. Die Studie untersucht, wie sich die Lebenserwartung ohne funktionelle und Mobilitätseinschränkungen ab dem Alter 46 und 65 Jahre sowie ihre Anteile an der Restlebenserwartung seit 2008 verändert haben.
Methoden:
Wir analysieren Daten des Deutschen Alterssurveys der Wellen 2008, 2014 und 2020/2021. Die Lebenserwartung ohne funktionelle Einschränkungen (Disability Free Life Expectancy – DFLE) wurde mit der Sullivan-Methode berechnet. Untersucht wurden starke funktionelle Einschränkungen mit dem „Global Activity Limitation Indicator“ (GALI) und Einschränkungen der Mobilität (Treppensteigen, mehr als 1 km Gehen).
Ergebnisse:
Kompression der Morbidität beim GALI ist bei 46- und 65-jährigen Männern seit 2014 zu beobachten, bei gleichaltrigen Frauen dagegen nicht. Bei der Mobilität zeigen 46- und 65-jährige Männer Tendenzen zur Kompression beim Treppensteigen und 46-jährige Männer beim Gehen von mehr als 1 km seit 2014. Die Werte für Frauen stagnieren für die beiden erstgenannten Indikatoren, aber nicht für 46-jährige Frauen beim Gehen von mehr als 1 km seit 2014.
Diskussion:
Unsere Analysen zeigen je nach Indikator, Alter und Geschlecht unterschiedliche Trends der DFLE und lassen keine eindeutige Antwort auf die Frage nach Morbiditätskompression oder -expansion zu. Kompression der Morbidität sehen wir eher bei Männern, Tendenzen der Stagnation oder Expansion dagegen eher bei Frauen. Diese Resultate signalisieren Herausforderungen in der Erhaltung der funktionellen Gesundheit vor allem bei Frauen und weisen auf die Notwendigkeit gezielter Interventionen hin, um die Lebensqualität und die gesunde Lebenserwartung zu verbessern.Introduction:
The long-term increase in life expectancy raises the question of whether the increased life expectancy is accompanied by an extension of years without health limitations. The study analyzes how life expectancy without functional and mobility limitations from the ages of 46 and 65 and their proportions of remaining life expectancy have changed since 2008.
Methods:
We analyze data from the German Ageing Survey of the 2008, 2014, and 2020/21 waves. Life expectancy without functional limitations (disability-free life expectancy—DFLE) was calculated using the Sullivan method. Severe functional limitations (using the Global Activity Limitation Indicator—GALI) and mobility limitations (climbing stairs, walking more than 1 km) were examined.
Results:
Compression of morbidity in the GALI has been observed in 46- and 65-year-old men since 2014, but not in women of the same age. In terms of mobility, 46- and 65-year-old men show trends towards compression when climbing stairs and 46-year-old men when walking more than 1 km since 2014. The values for women have stagnated for the first two indicators mentioned, but not for 46-year-old women since 2014 when walking more than 1 km.
Discussion:
Our analyses show different trends in DFLE depending on the indicator, age, and gender and do not allow a clear answer to the question of morbidity compression or expansion. We tend to see morbidity compression in men, whereas trends of stagnation or expansion tend to be seen in women. These results signal challenges in maintaining functional health, especially in women, and point to the need for targeted interventions to improve quality of life and healthy life expectancy.Peer Reviewe
Epidemiological data of an influenza A/H5N1 outbreak in elephant seals in Argentina indicates mammal-to-mammal transmission
Get PDFH5N1 high pathogenicity avian influenza virus has killed thousands of marine mammals in South America since 2022. Here we report epidemiological data and full genome characterization of clade 2.3.4.4b H5N1 HPAI viruses associated with a massive outbreak in southern elephant seals (Mirounga leonina) at Península Valdés, Argentina, in October 2023. We also report on H5N1 viruses in concurrently dead terns. Our genomic analysis shows that viruses from pinnipeds and terns in Argentina form a distinct clade with marine mammal viruses from Peru, Chile, Brazil and Uruguay. Additionally, these marine mammal clade viruses share an identical set of mammalian adaptation mutations which were also present in tern viruses. Our combined ecological and phylogenetic data support mammal-to-mammal transmission and occasional mammal-to-bird spillover and suggest multinational transmission of H5N1 viruses in mammals. We reflect that H5N1 viruses becoming more evolutionary flexible and adapting to mammals in new ways could have global consequences for wildlife, humans, and/or livestock.Peer Reviewe
LRBA, a BEACH protein mutated in human immune deficiency, is widely expressed in epithelia, exocrine and endocrine glands, and neurons
Get PDFMutations in LRBA, a BEACH domain protein, cause severe immune deficiency in humans. LRBA is expressed in many tissues and organs according to biochemical analysis, but little is known about its cellular and subcellular localization, and its deficiency phenotype outside the immune system. By LacZ histochemistry of Lrba gene-trap mice, we performed a comprehensive survey of LRBA expression in numerous tissues, detecting it in many if not all epithelia, in exocrine and endocrine cells, and in subpopulations of neurons. Immunofluorescence microscopy of the exocrine and endocrine pancreas, salivary glands, and intestinal segments, confirmed these patterns of cellular expression and provided information on the subcellular localizations of the LRBA protein. Immuno-electron microscopy demonstrated that in neurons and endocrine cells, which co-express LRBA and its closest relative, neurobeachin, both proteins display partial association with endomembranes in complementary, rather than overlapping, subcellular distributions. Prominent manifestations of human LRBA deficiency, such as inflammatory bowel disease or endocrinopathies, are believed to be primarily due to immune dysregulation. However, as essentially all affected tissues also express LRBA, it is possible that LRBA deficiency enhances their vulnerability and contributes to the pathogenesis.Peer Reviewe
Clinical analysis of Bornavirus Encephalitis cases demonstrates a small time window for Etiological Diagnostics and treatment attempts, a large case series from Germany 1996–2022
Get PDFPurpose:
The emerging zoonotic Borna disease virus 1 (BoDV-1) and the variegated squirrel bornavirus 1 (VSBV-1) cause severe and fatal human encephalitis in Germany. We conducted the first systematic clinical analysis of acute, molecularly confirmed fatal bornavirus encephalitis cases comprising 21 BoDV-1 and four VSBV-1 patients to identify options for better diagnosis and timely treatment.
Methods:
Analyses were based on medical records and, for BoDV-1, on additional medical interviews with patients’ relatives.
Results:
Disease onset was unspecific, often with fever and headache, inconsistently mixed with early fluctuating neurological symptoms, all rapidly leading to severe encephalopathy and progressive vigilance decline. Very shortly after seeking the first medical advice (median time interval 2 and 0 days for BoDV-1 and VSBV-1, respectively), all except one patient were hospitalised upon manifest neurological symptoms (median 10 and 16 days respectively after general symptom onset). Neurological symptoms varied, always progressing to coma and death. BoDV-1 and VSBV-1 patients required ventilation a median of three and five days, and died a median of 32 and 72 days, after hospitalisation. Death occurred mostly after supportive treatment cessation at different points in time based on poor prognosis. Disease duration therefore showed a wide, incomparable range.
Conclusion:
The extremely rapid progression is the most obvious clinical characteristic of bornavirus encephalitis and the timeframe for diagnosis and targeted therapy is very short. Therefore, our results demand an early clinical suspicion based on symptomatology, epidemiology, imaging, and laboratory findings, followed by prompt virological testing as a prerequisite for any potentially effective treatment.Peer Reviewe
Increased Susceptibility of Rousettus aegyptiacus Bats to Respiratory SARS-CoV-2 Challenge Despite Its Distinct Tropism for Gut Epithelia in Bats
Get PDFIncreasing evidence suggests bats are the ancestral hosts of the majority of coronaviruses. In general, coronaviruses primarily target the gastrointestinal system, while some strains, especially Betacoronaviruses with the most relevant representatives SARS-CoV, MERS-CoV, and SARS-CoV-2, also cause severe respiratory disease in humans and other mammals. We previously reported the susceptibility of Rousettus aegyptiacus (Egyptian fruit bats) to intranasal SARS-CoV-2 infection. Here, we compared their permissiveness to an oral infection versus respiratory challenge (intranasal or orotracheal) by assessing virus shedding, host immune responses, tissue-specific pathology, and physiological parameters. While respiratory challenge with a moderate infection dose of 1 × 104 TCID50 caused a systemic infection with oral and nasal shedding of replication-competent virus, the oral challenge only induced nasal shedding of low levels of viral RNA. Even after a challenge with a higher infection dose of 1 × 106 TCID50, no replication-competent virus was detectable in any of the samples of the orally challenged bats. We postulate that SARS-CoV-2 is inactivated by HCl and digested by pepsin in the stomach of R. aegyptiacus, thereby decreasing the efficiency of an oral infection. Therefore, fecal shedding of RNA seems to depend on systemic dissemination upon respiratory infection. These findings may influence our general understanding of the pathophysiology of coronavirus infections in bats.Peer Reviewe
Human macrophages infected with Egyptian Rousette bat-isolated Marburg virus display inter-individual susceptibility and antiviral responsiveness
Get PDFMarburg virus (MARV) is a highly pathogenic filovirus and a causative agent of sporadic zoonotic viral hemorrhagic fever outbreaks with high case fatality rates. In humans, filoviruses like MARV and Zaire Ebola virus (EBOV) target, among others, innate immune cells like dendritic cells and macrophages (MΦs). Filovirus-infected dendritic cells display impaired maturation and antigen presentation, while MΦs become hyper-activated and secrete proinflammatory cytokines and chemokines. Our current understanding of human macrophage responses to MARV remains limited. Here, we used human monocyte-derived macrophages (moMΦs) to address how their phenotype, transcriptional profile, and protein expression change upon an in vitro infection with a bat isolate of MARV. Confirming its tropism for macrophages, we show that MARV induces notable shifts in their transcription distinct from responses induced by lipopolysaccharide (LPS), marked by upregulated gene expression of several chemokines, type I interferons, and IFN-stimulated genes. MARV infection also elicited pronounced inter-individually different transcriptional programs in moMΦs, the induction of Wnt signaling-associated genes, and the downregulation of multiple biological processes and molecular pathways.Peer Reviewe
Implementation of the WHO core components of an infection prevention and control programme in two sub-saharan African acute health-care facilities: a mixed methods study
Get PDFBackground:
The coronavirus pandemic again highlighted the need for robust health care facility infection prevention and control (IPC) programmes. WHO guidelines on the core components (CCs) of IPC programmes provides guidance for facilities, but their implementation can be difficult to achieve in resource-limited settings. We aimed to gather evidence on an initial WHO IPC implementation experience using a mixed methods approach.
Methods:
A five-day training on the WHO IPC CCs was conducted at two reference acute health care facilities in the Democratic Republic of Congo and Burkina Faso. This was accompanied by a three-part mixed-methods evaluation consisting of a: (1) baseline and follow-up survey of participants’ knowledge, attitudes and practices (KAP), (2) qualitative assessment of plenary discussion transcripts and (3) deployment of the WHO IPC assessment framework (IPCAF) tool. Results were analysed descriptively and with a qualitative inductive thematic approach.
Results:
Twenty-two and twenty-four participants were trained at each facility, respectively. Baseline and follow-up KAP results suggested increases in knowledge related to the necessity of a dedicated IPC focal person and annual evaluations of IPC training although lack of recognition on the importance of including hospital leadership in IPC training and hand hygiene monitoring recommendations remained. Most participants reported rarely attending IPC meetings or participating in IPC action planning although attitudes shifted towards stronger agreement with the feeling of IPC responsibility and importance of an IPC team. A reocurring theme in plenary discussions was related to limited resources as a barrier to IPC implementation, namely lack of reliable water access. However, participants recognised the importance of IPC improvement efforts such as practical IPC training methods or the use of data to improve quality of care. The facilities’ IPCAF scores reflected a ‘basic/intermediate’ IPC implementation level.
Conclusions:
The training and mixed methods evaluation revealed initial IPC implementation experiences that could be used to inform stepwise approaches to facility IPC improvement in resource-limited settings. Implementation strategies should consider both global standards such as the WHO IPC CCs and specific local contexts. The early involvement of all relevant stakeholders and parallel efforts to advocate for sufficient resources and health system infrastructure are critical.Peer Reviewe