Dortmund, Germany


Dortmund, Germany
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Objectives To evaluate the benefits of implementing measures to promote skills in the areas of language, mathematics and singing in kindergardeners by statistical analysis of data collected during the school entrance examination (ESU) of 4–5-year-old children from the county of Biberach. Methods Study 1 employs multivariate regression analysis to analyse – in chronological order – the ESU data on 4 cohorts (2011–2014; n=7 148) of children of the Biberach county. Study 2 qualitatively compares identical data representative of the entire state of Baden-Württemberg (N=3×80 000) with the Biberach results. Study 3 focuses on the cohort 2014 in Biberach county (n=1 783) and employs logistical regression techniques to correlate curriculum content and child development. Results There are significant performance improvements in the Biberach population (2011–2014) in the development of language and early mathematics, as well as in visual comprehension and visuomotor skills, but not in the area of gross motor skills. Similar improvements are much more difficult to demonstrate for the entire state of Baden-Württemberg. The detailed analysis of the 2014 Biberach County data reveal that kindergardeners with increased exposure to mathematics will have a decreased risk of failure in early mathematics (OR 0.72) and grammar skills (OR 0.53–0.75). Children with speech impairment or children not fluent in German that had extra language tutorials, typically in small groups and 4 times a week for 30 min, still have a higher risk of failure in all developmental aspects, save gross motor skills (e. g. OR 3.32 in grammar skills, OR 3.08 for hyperactivity). Programs with emphasis on singing have little effect on the above data. The risk of failure in German language is high (OR 2.78) for those of non-German backgrounds, but less in visuomotor skills (OR 0.52) and hyperactivity (OR 0.51). Conclusions Statistical analyses show positive correlation of curriculum content and early child development for the kindergardens in Biberach county. The gains in performance are consistent with those reported from kindergardens known for pedagogical excellence. Copyright ©, Georg Thieme Verlag KG. All rights reserved.

Diel R.,Universitares Lungenzentrum Nord | Priwitzer M.,Gesundheitsamt | Niemann S.,Nationales Referenzzentrum Fur Mykobakterien
Atemwegs- und Lungenkrankheiten | Year: 2016

Detection of latent tuberculosis infection (LTBI) requires optimal test accuracy and a high prevalence of Mycobacterium tuberculosis (MTB) in the group of persons to be tested for gaining a high positive predictive value (PPV). Thus, effectiveness of contact investigations may be improved markedly by a better preselection of contact persons who have probably been exposed. In contrast, mass routine screening may produce a higher number of false positive test results. Contact investigations detect a considerable amount of active TB cases especially in children and adolescents < 15 years in Germany. Only a small portion of health care workers will be tested periodically for LTBI due to the generally low PPV. Performing a preventive therapy given LTBI needs a stable organizational structure to ensure clinical monitoring and to recheck the individual adherence. Next generation sequencing ("NGS") of MTB strains, a recently developed method of molecular epidemiology, may contribute to a better detection of direct transmissions of strains which were classified to be identical in conventional fingerprinting. © 2016 Dustri-Verlag Dr. Karl Feistle.

Background: The body mass index (BMI) of children and adolescents has significantly increased in the last 20 years. Aim: The purpose of this article is to examine the trend in BMI and analyze the influencing factors. Materials and methods: Data of the school entrance examination of the city Dortmund (Germany) for the years 2008–2012 (data from 24,167 children) were included. Results: The BMI did not systematically change over the years 2008–2012: 80.6 % of the children were of normal weight, 8 % of the children were overweight, and 6 % were obese. Factors identified as having an influence were social area cluster, education levels of mother and father, and migration. The education level of the mother and migration are identified as structural characteristics. Factor analysis shows that the educational factors load on one factor, while social area cluster and native language load to a second factor. The education level of the mother represents an important predictor for a child being overweight. © 2015, Springer-Verlag Berlin Heidelberg.

PubMed | Bakteriologie, Net Health, Krankenhaushygiene, Abteilung 2 and Gesundheitsamt
Type: Journal Article | Journal: Gesundheitswesen (Bundesverband der Arzte des Offentlichen Gesundheitsdienstes (Germany)) | Year: 2016

In 2009 the project EurSafety Health-Net, funded by Interreg IVa, was initiated in order to create a cross-border quality alliance to enhance patient safety in the field of infectious diseases. Within this framework, several studies and projects addressing key topics of infection control were carried out. We describe the two-year project MRSA decolonisation in care settings (MSP), which aimed at evaluating a simple and economic way of decolonisation of non-hospitalised MRSA carriers in 2 districts in Lower Saxony. In the course of the project 181 decolonisations of MRSA carriers were performed by nursing homes and nursing services for outpatients in cooperation with the local public health authorities of the districts Ammerland and Grafschaft Bentheim. Of 181 cases 134 were eligible for statistical analysis. The project provided protocols for 2 different starting situations: 1) Continuing and completing a decolonisation treatment subsequent to a hospital stay by nursing services for outpatients or in a nursing home. 2) Starting a decolonisation treatment in a nursing home or by nursing services for outpatients. The carriers were provided with the required materials either by the hospitals (situation 1) or by the local public health authorities (situation 2) free of charge. The decolonisation treatment and the testing were offered only to carriers free of properties deemed as decolonisation obstacles and was applied without involvement of the general practitioner. Short- and long-term success of the 5 day decolonisation treatment was tested afterwards by two swabs (14 days and 6 months after the end of the treatment). The results of the 6-month control swabs showed that 45% of the carriers were successfully decolonised in the long term. All parties involved regarded the procedure of the MSP project as effective with respect to the target. Thus, even after the project was finished, both districts continued applying the MSP protocol.

Background: Most federal states in Germany have adopted the infection control staffing requirements recommended by the German Commission on Hospital Hygiene and Infection Prevention (KRINKO) in their medical infection control stipulations. They are also applied to rehabilitation facilities, although most rehabilitation patients are not comparable with hospital patients as far as their infection risks are concerned. Based on the risk profile published by Eichhorn et al. and the current data of rehabilitation patients, the MDRO network Rhine-Main has calculated alternative target numbers for adequate infection control staffing. Material and Methods: Staffing calculations according to the KRINKO guideline and the provisions stipulated in the 16 German federal state regulations are presented and compared to the risk profile for rehabilitation patients and the corresponding calculations according to Eichhorn et al. Based on the current data for patient characteristics in 4 rehabilitation facilities (number of patients = 412) in the Rhine-Main region, the risk profile was established and staffing requirements calculated. Results: Applying the modified risk score by Eichhorn to the rehabilitation patients Rhine-Main resulted in numbers which largely concurred with the ones proposed by Eichhorn and which are considerably lower than the calculations according to KRINKO. Conclusion: Staffing requirements for infection control personnel calculated according to the risk profile by Eichhorn resulted in much lower numbers than the ratio of 1:500 beds demanded by KRINKO. Both calculation models have not yet been validated based on actual MDRO infection risk data. Therefore it is recommended that health authorities carefully monitor staffing of infection control personnel in rehabilitation facilities in order to be able to make necessary adjustments in a timely manner.

Background: Patients colonized with methicillin resistant Staphylococcus aureus (MRSA) and other multidrug-resistant organisms (MDRO) are entitled to medical rehabilitation similarly to other patients. Some MDRO networks have published recommendations for hygiene management in rehabilitation units. According to the current guideline of the German commission on hospital hygiene and infection prevention (KRINKO), a medical risk analysis is required to establish individual infection control management. Rehabilitation facilities are commissioned to achieve an opti-mal compromise between prevention of transmission of MDROs and enabling the medical rehabilitation of patients colonized with MDRO. Material and method: Medical risk analysis according to KRINKO guidelines is presented, based on two recent studies on MDRO in nursing homes and rehabilitation facilities in the Rhine-Main region. Results: Residents of nursing homes were more often colonized with MRSA (9.2 vs 1.8%) than patients in rehabilitation facilities (excluding neurological rehabilitation). More than one third of the residents exhibited risk factors for MRSA compared to 5% of the patients. Furthermore, 66% of the residents were disoriented or incontinent, leading to the assumption of insufficient personal hygiene - compared to < 1% patients. Conclusion: Implementation of the medical risk analysis shows that the rehabilitation patients (orthopedics, cardiology, surgery) have a low risk for colonization or infection with MDRO. Our analysis did not comprise patients from neurological or geriatric rehabilitation facilities, so that no statement concerning these patients is available.

Following a patient complaint, the Health Department carried out a hygiene inspection of a urological practice in Braunschweig in February 2013. The topic of the complaint was that a patient assumed having acquired a resistant pathogen in the practice. In the subsequent visit, significant hygiene defects were found, particularly with regard to the processing of medical devices. This led to a decision to commit all urological practices in Braunschweig to hygiene inspections as part of a priority project. In retrospect, the hygiene surveys were justified. Deficiencies included inadequate preparation of medical products, procedures in practice inconsistent with hygiene plans, poor knowledge of hygiene procedures among assistant staff and doctors, lack of expertise of assistant staff and lack of hygiene risk awareness by doctors. Positive experiences were: open communication in a good atmosphere with the Practice managers, willingness to change, good cooperation between the Health Authority and the Labor Inspectorate and Physicians' Association. The claimed deficits were corrected by spring 2014 by the practice operators. The consulting expertise of the health authorities was made use of continuously. © Georg Thieme Verlag KG Stuttgart. New York.

Antimicrobial-resistant organisms are regarded as a particular threat to the public health of the European population. In Germany the requirement for a national rollout reporting of positive laboratory test results for methicillin-resistant Staphylococcus aureus (MRSA) in blood cultures was implemented in 2009. This was followed in 2011 by the introduction of a laboratory-based, rollout reporting system for the detection of gram-negative bacteria with acquired carbapenem-resistance (carbapenem-resistant organisms, CRO) in the federal state of Hessen. This article will present the experience gained in Frankfurt am Main with the existing reporting system. Blood or cerebrospinal fluid cultures positive for MRSA were reported from all Frankfurt clinics between 2010 and 2013. The objective of preventing nosocomial infections by introducing a mandatory reporting for MRSA in blood cultures was only partially achieved by the reporting procedure on a population scale. Instead, reporting on a clinic-based scale, i.e., incidence per 1,000 patient days should be used. Moreover, mandatory reporting of clusters of nosocomial colonizations with MRSA could be an appropriate measure for the timely prevention of nosocomial infections with these organisms. CROs were reported from nearly all clinics as well as the ambulatory setting. Different reporting criteria have resulted not only in a greatly varying workload for the institutions and the health authorities but also in vastly different numbers of reported events. Regarding the importance of CRO, mandatory reporting seems reasonable. Criteria of reporting should be simple and easily comprehensible, i.e., all 4MRGN (gram-negative bacteria with resistance against four antibiotic groups such as acylureidopenicillins, third- and fourth-generation cephalosporins, fluorchinolones, and carbapenems) according to the German Commission on Hospital Hygiene and Infection Prevention (KRINKO) should be considered. Reporting and evaluation of multidrug-resistant organisms (MDRO) in a population-based system does not seem to be sufficient regarding these organisms with high importance for hospital hygiene; mandatory reporting on an anonymous clinic-based scale should be used. © 2014, Springer-Verlag Berlin Heidelberg.

Nagel A.,Gesundheitsamt | Schade M.,Gesundheitsamt | Mischler D.,Gesundheitsamt | Heudorf U.,Gesundheitsamt
Umweltmedizin in Forschung und Praxis | Year: 2014

Introduction: Owing to the increasing threat posed by multidrug-resistant organisms, several regional (MDRO-) MRE-networks have been established in recent years, also in the Rhine-Main region. More than 3 years after the official foundation of the MRE-Net Rhine-Main and an interim evaluation in 2011, a further evaluation by all members was conducted in 2013. The members were asked to name the objectives for joining the network, the benefit associated with participation in the network and an evaluation of the offered services (trainings, homepage, flyer, information hotline). Method: The facilities received standardized questionnaires by mail. The questionnaire was largely identical with that of the interim evaluation 2011, allowing for good comparability of the 2013 and 2011 results. Results: In 2013 the participant's objectives were even more ambitious than in 2011 and the benefit of participation in the network was scored higher than in 2011. Particularly homes of the elderly and ambulant care facilities associated the most ambitious aims with the participation and benefited most from their membership. The network services were rated even better in 2013 compared to 2011. Conclusion and discussion: The work of the net continues to be highly appreciated, in some cases even more so than two years earlier. This is an incentive for the organizers to pursue the route already embarked upon. © ecomed Medizin, Verlagsgruppe Hüthig Jehle Rehm GmbH, Landsberg

The long-term aim for the German public health service during National Socialism was a hereditary and racial welfare. Several following legal regulations contributed to the implementation of a specific national socialist population policy on the basis of racial hygiene and gave immense power to health officers. Especially with the Law for the Prevention of Hereditarily Sick Offspring, compulsory sterilisation was legalised and caused about 400 000 victims up to 1945. The central force in this new system was the public health office. The work of two health officers in neighbouring offices in upper Bavaria is compared. Results show that health officers had a large flexibility in their individual estimation. The restrictive interpretation of their duties did not necessarily cause any sanctions by the superior authority © Georg Thieme Verlag KG Stuttgart New York.

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