Johann Popp

Changing epidemiology of Hepatitis B and migration—a comparison of six Northern and North-Western European countries

BACKGROUND Increased migration volume and different Hepatitis B prevalence between immigration and emigration countries have changed the Hepatitis B virus (HBV) epidemiology considerably in Northern and North-Western European migrants-receiving countries. Due to the difference in migration status monitoring, the HBV infection data on migrants are not easily comparable among those countries. The study aims were: to compare the migration status indicators used by the national surveillance system in six Northern and North-Western European countries (the Netherlands, Germany, Finland, Denmark, Sweden and the UK); to determine the impact of the migration status on HBV infection by comparing the available data on prevalence and transmission routes of Hepatitis B in the migration and the general population in the six countries; to recommend sensible indicators and pertinent measures for HBV infection surveillance and control in the region. METHODS Literature review, statistical data analysis on migration and HBV infection in the six countries; expert interviews to identify migration status indicators used in national surveillance systems. RESULTS Evident differences were found between the migration and the general population in Hepatitis B prevalence and transmission routes in the six countries. Migration status is monitored differently in six surveillance systems; immigrants from high/intermediate Hepatitis B endemic countries constitute a substantial proportion of HBsAg(+) and chronic cases in all six countries. CONCLUSIONS International migration has an obvious impact on Hepatitis B prevalence in the six countries. It is important to include common migration status indicators and to collect comparable data for HBV infection surveillance in different notification systems.

Comparison of the prevalence of malnutrition diagnosis in head and neck, gastrointestinal, and lung cancer patients by 3 classification methods.

Background: Malnutrition is prevalent among patients within certain cancer types. There is lack of universal standard of care for nutrition screening and a lack of agreement on an operational definition and on validity of malnutrition indicators. Objective: In a secondary data analysis, we investigated prevalence of malnutrition diagnosis with 3 classification methods using data from medical records of a National Cancer Institute-designated comprehensive cancer center. Methods: Records of 227 patients hospitalized during 1998 with head and neck, gastrointestinal, or lung cancer were reviewed for malnutrition based on 3 methods: (1) physician-diagnosed malnutrition-related International Classification of Diseases, Ninth Revision codes; (2) in-hospital nutritional assessment summaries conducted by registered dietitians; and (3) body mass indexes (BMIs). For patients with multiple admissions, only data from the first hospitalization were included. Results: Prevalence of malnutrition diagnosis ranged from 8.8% based on BMI to approximately 26% of all cases based on dietitian assessment. &kgr; coefficients between any methods indicated a weak (&kgr; = 0.23, BMI and dietitians; and &kgr; = 0.28, dietitians and physicians)-to-fair strength of agreement (&kgr; = 0.38, BMI and physicians). Conclusions: Available methods to identify patients with malnutrition in a National Cancer Institute-designated comprehensive cancer center resulted in varied prevalence of malnutrition diagnosis. A universal standard of care for nutrition screening that uses validated tools is needed. Implications for Practice: The Joint Commission on the Accreditation of Healthcare Organizations requires nutritional screening of patients within 24 hours of admission. For this purpose, implementation of a validated tool that can be used by various healthcare practitioners, including nurses, needs to be considered.

Docetaxel and carboplatin as second-line chemotherapy for metastatic non-small cell lung cancer

The aim of this pilot study was to evaluate the activity and toxicity of docetaxel plus carboplatin as second-line treatment in patients with metastatic non-small cell lung cancer (NSCLC). Patients received docetaxel 75 mg/m(2) followed by carboplatin AUC 5 on day 1 every 3 weeks in an out-patient setting. Twenty-six patients were enrolled; 23 patients were diagnosed stage IV disease and three patients had a IIIB disease with malignant pleural effusion. The median interval from first to second-line treatment was 3.5 months (range 1-13). Patients received a total of 101 cycles with a median number of four cycles per patient (range 1-6). Five patients achieved a partial remission (19.23%; 95% confidence interval (CI) 6.55-39.35%), 11 had stable disease (42.31%) and ten progressed (38.46%) after initiation of second-line therapy. Median survival was 243 days (95% CI 182-336 days), the median progression-free survival was 118 days (95% CI 89-170 days), and the 1-year survival rate was 25.98% (95% CI 6.33-45.63%). Moderate haematological and mild nonhaematological toxicities were observed. No treatment-related death occurred. In conclusion, docetaxel plus carboplatin as second-line regimen has a reasonable activity with good tolerance and encouraging survival data.

Docetaxel and cisplatin as first-line treatment for patients with metastatic esophageal cancer: a pilot study.

Background: We investigated the combination of docetaxel and cisplatin as first-line chemotherapy in patients with metastatic esophageal cancer. Patients and Methods: 16 chemotherapy-naïve patients with distant metastases were included in the study (15 male, 1 female; median age: 58.5 years (range 37-69); median ECOG performance status: 1). 11 patients (69%) had esophageal cancer, and 5 patients (31%) had cancer of the gastroesophageal junction. Patients received docetaxel 75 mg/m2 and cisplatin 80 mg/m2 on day 1 every 3 weeks. A total of 55 chemotherapy cycles was administered. The median number of cycles was 3 (range 1-6). Results: The overall response rate was 31.3%. 4 out of 10 patients (40%) with squamous cell carcinoma and 1 out of 5 patients (20%) with adenocarcinoma responded to chemotherapy. The median overall survival was 29.6 weeks, and the median progression-free survival was 18.6 weeks. Hematological and non-hematological toxicities were moderate (neutropenia WHO grade III/IV: 42.9%, alopecia grade II/III: 64.3%, nausea/vomiting grade II/III: 57.2%, neurotoxicity grade II: 14.3%). Conclusion: The combination of docetaxel and cisplatin is an active regimen with moderate toxicity in the treatment of patients with metastatic esophageal cancer. This pilot study demonstrates the feasibility of a combination treatment containing a taxane and cisplatin in metastatic esophageal cancer.

Methoden für den ÖGD: Strategie zur Auswertung epidemiologischer Fall-Kontroll-Studien

Epidemiologie gilt als die Kernwissenschaft der Gesundheitswissenschaften. Sie konzentriert sich auf die Untersuchung von Erkrankungs− merkmalen und Risikofaktoren für Erkrankungen in Bevölkerungsgruppen. Diese Ergebnisse sollen in der Bekämpfung und Prävention der entspre− chenden Gesundheitsprobleme eine direkte An− wendung finden [1]. In epidemiologischen Studi− en werden Stichproben aus Bevölkerungsgrup− pen untersucht. Aus den Betrachtungen dieser speziellen Stichproben werden dann auf allge− meine Prinzipien geschlossen, die für die gesam− te Bevölkerungsgruppe gelten. Bei einer naiven Betrachtungsweise würde man davon ausgehen, dass eine beobachtete Assoziation zwischen ei− nem möglichen Risikofaktor und der untersuch− ten Krankheit einen kausalen Zusammenhang darstellt. Tatsächlich trifft das nicht in jedem Fall zu. Bei der beobachteten Assoziation kann es sich auch um einen Effekt des Zufalls, einen systema− tischen Fehler im Studiendesign (Bias) oder um Verzerrungen durch eine dritte Variable (z. B. Confounding) handeln [2]. Um zu entscheiden, ob eine Assoziation durch Zufall bedingt ist, wird eine systematische Analyse anhand von statistischen Kriterien durchgeführt. Hierzu wer− den in der Regel Wahrscheinlichkeitsmaße wie p−Wert und 95%−Konfidenzintervall (95 %−KI) be− rechnet [3]. Bias Bei der Planung und Durchführung epidemiolo− gischer Studien können systematische Fehler (Bias) zur Verfälschung der Ergebnisse führen. Dabei werden Kausalzusammenhänge vorge− täuscht, die in Wirklichkeit nicht vorhanden sind, oder es werden tatsächlich vorhandene Ursa− chenzusammenhänge verdeckt (z. B. Selektions− oder Reporting−Bias). Bias kann nicht anhand von statistischen Tests identifiziert, kontrolliert oder behoben werden. Um den Einfluss entspre− chender Fehler zu minimieren, sollten alle mögli− chen Formen des Bias bereits in der Planung der Studie berücksichtigt und im Studienprotokoll explizit formuliert werden, z. B. durch die Ver− blindung des Untersuchers (Blinding) als Gegen− maßnahme eines Informationsbias.

Der Einfluss des Fachkräfteanteils auf die Dekubitusinzidenz in Pflegeheimen

In Deutschland ist ein Mindestanteil von 50% Fachpersonal bei der Betreuung von Heimbewohnern gesetzlich vorgeschrieben. Der Einfluss dieses Fachkrafteanteils auf die pflegerische Ergebnisqualitat ...