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D Altmann

Publications and source records attributed to D Altmann.

18 recordsLinked to original sources
PubMed2003

[First evaluation of the surveillance systems of notifiable diseases under the infectious disease control law in Germany].

INTRODUCTION: The implementation of the infectious disease control law (IfSG) in 1.1.2001 standardised the German surveillance system for notifiable diseases. For management and transmission of reports health departments use either the software programme Surv Net@RKI, which was developed by the Robert Koch-Institut (RKI), or one of five commercially offered disease-reporting software. After more than one year of its existence, we investigated the success of the implementation of the new surveillance system with the aim to identify possibilities for further improvement. METHODS: Based on 2001 data available to the RKI, we evaluated the criteria simplicity (standardisation of legal regulation and of software systems), acceptability (number of reporting regional counties), time (period from data entry at the health department to entry at the RKI) and data quality (information on immunisation status among reports of hepatitis A cases). RESULTS: For electronic processing 5 versions of Surv Net@RKI and 47 versions of the 5 commercial products are used. Additional rules of individual states expand the legal obligation for notification of the IfSG, by adding new diseases, different definitions or different reporting channels. Within the first quarter after implementation of the IfSG, 393 (90 %) of the 425 counties transmitted data weekly. The median transmission time from data entry at the health department and entry at the RKI was 5 to 7 days after the fourth reporting week. The proportion of hepatitis A case reports with information on immunisation status was 58 % (1323 of 2277); among the 1052 reports by health departments using Surv Net@RKI the proportion was 82 % (n = 858); among the 1225 reports from health departments using other programmes the proportion was 38 %. CONCLUSION: Implementation of the new surveillance system is successful. Electronic data systems should be standardised to improve data quality and simplicity. The deadlines for transmission should be shortened to allow earlier detection and control of multi-state outbreaks. State-specific rules on notifiable diseases should be standardised to avoid conflicting or redundant reporting channels.

Communicable Disease Control↗
PubMed2001

Frequency of genotypic and phenotypic drug-resistant HIV-1 among therapy-naive patients of the German Seroconverter Study.

Genotypic and phenotypic resistance of viral reverse transcriptase (RT) and protease (PR) was determined for 64 therapy-naive, HIV-1-infected seroconverters of the German Seroconverter Study coordinated by the Robert Koch-Institut, Berlin. The date of seroconversion of patients and the laboratory, clinical, and therapeutic follow-up data were documented. Samples were collected between 1996 and 1999. Phenotypic resistant HIV-1 were found in 8 (13%) seroconverters; in most cases resistance was weak and mainly directed against RT inhibitors (4 nucleoside reverse transcriptase inhibitors [NRTIs], 2 nonnucleoside reverse transcriptase inhibitors [NNRTIs], 1 combination NRTI/NNRTI). Only one infection with a weak PR inhibitor resistance was identified. Transmission of multidrug-resistant HIV-1 has not yet been observed. Frequently at least one or more amino acid mutations associated with antiretroviral drug resistance were detected by genotypic analysis. The mean number of resistance-associated mutations in the RT of the transmitted virus has increased significantly since 1996. Studies have shown the improved benefit of initial antiretroviral therapy if based on genotypic resistance data. In view of the considerably high level of transmission of resistant HIV-1 in Germany, which is also seen in other studies in Europe and the United States, we suggest determining the genotypic resistance pattern before starting therapy of newly HIV-1-infected patients.

Anti-HIV Agents↗
PubMed2001

Tomato ribonuclease LX with the functional endoplasmic reticulum retention motif HDEF is expressed during programmed cell death processes, including xylem differentiation, germination, and senescence.

We have studied the subcellular localization of the acid S-like ribonuclease (RNase) LX in tomato (Lycopersicon esculentum Mill.) cells using a combination of biochemical and immunological methods. It was found that the enzyme, unexpectedly excluded from highly purified vacuoles, accumulates in the endoplasmic reticulum. The evidence that RNase LX is a resident of the endoplasmic reticulum (ER) is supported by an independent approach showing that the C-terminal peptide HDEF of RNase LX acts as an alternative ER retention signal in plants. For functional testing, the cellular distribution of chimeric protein constructs based on a marker protein, Brazil nut (Bertholletia excelsa) 2S albumin, was analyzed immunochemically in transgenic tobacco (Nicotiana tabacum) plants. Here, we report that the peptide motif is necessary and sufficient to accumulate 2S albumin constructs of both vacuolar and extracellular final destinations in the ER. We have shown immunochemically that RNase LX is specifically expressed during endosperm mobilization and leaf and flower senescence. Using immunofluorescence, RNase LX protein was detected in immature tracheary elements, suggesting a function in xylem differentiation. These results support a physiological function of RNase LX in selective cell death processes that are also thought to involve programmed cell death. It is assumed that RNase LX accumulates in an ER-derived compartment and is released by membrane disruption into the cytoplasma of those cells that are intended to undergo autolysis. These processes are accompanied by degradation of cellular components supporting a metabolic recycling function of the intracellular RNase LX.

Amino Acid Motifs↗
PubMed2000

Is the presence of dyspnea a risk factor for morbidity in cancer patients?

Data collected from six home palliative care teams in Ireland were analyzed to determine the prevalence of dyspnea in the population studied and to identify factors associated with the presence of dyspnea that might impact on future care. The prevalence of mild, moderate, or severe dyspnea, as measured by the Support Team Assessment Schedule (STAS), fell from 39% at referral in 327 evaluable patients to 23%. The presence of dyspnea at referral was positively correlated with severity of patient spiritual distress (Spearman rho = 0.110, P = 0.042) and weakness (Spearman rho = 0.105, P = 0.008) at referral. In analysis of contingency tables, dyspnea was also significantly associated with low patient (chi 2 9.5, P = 0.002) and family (chi 2 50.78, P < 0.001) well-being, high staff anxiety (chi 2 4.14, P = 0.04), male sex (chi 2 8.9, P = 0.003), a diagnosis of lung cancer (chi 2 59.88, P < 0.001), and dying in hospital rather than hospice or nursing home (chi 2 18.03, P = 0.001). In adjusting for covariates using a logistic regression analysis, however, only the presence of low family well-being, a diagnosis of lung cancer, and increased likelihood of a hospital death remained significantly associated with the presence of dyspnea at referral. These data suggest that the presence of dyspnea may be associated with increased family distress, which may influence place of death.

Adolescent↗
PubMed2000

Estimating vaccine coverage by using computer algebra.

The approach of N Gay for estimating the coverage of a multivalent vaccine from antibody prevalence data in certain age cohorts is complemented by using computer aided elimination theory of variables. Hereby, Gay's usage of numerical approximation can be replaced by exact formulae which are surprisingly nice, too.

Child↗
PubMed2000

Which terminally ill cancer patients in the United Kingdom receive care from community specialist palliative care nurses?

This study investigates how cancer patients who receive care from community specialist palliative care (CSPC) nurses differ from those who do not. This was achieved by secondary data analyses from the Regional Study of Care for the Dying, a retrospective interview survey of deaths in 1990 in 20 nationally representative health districts. Interviews were obtained for 2,074/2,915 (71%) of randomly selected cancer deaths; 574 (27.8%) were reported to have received care from a Macmillan nurse, hospice home-care nurse, or other community specialist palliative care nurse. Using logistic regression analysis 10 factors were found to predict independently CSPC use. Being dependent with dressing/undressing, needing help at night, having constipation, experiencing vomiting/nausea, being mentally confused, having breast cancer and being under the age of 75 years increased the likelihood of receiving CSPC. Having a lymphoma, leukaemia or myeloma, a brain tumour and being dependent on others for help with self-care for more than 1 year decreased the likelihood. The use of CSPC nurses to provide expertise in symptom control and to support families of dependent patients is consistent with the aims of palliative care, and therefore appears appropriate. Further research is, however, needed to investigate the apparent age bias in access to these services, and to ensure that CSPC services are provided on the basis of need, irrespective of patient age.

Activities of Daily Living↗
PubMed1999

[Vaccination status and illnesses in foreign travelers].

Millions of German citizens travel outside Europe every year. How they prepare themselves for these travels from a medical viewpoint, or whether they fall ill during these travels is inadequately researched. The German National Health Interview and Examination Survey showed that 11% of the people questioned travelled to Africa, Asia, South or Central America within the last three years. The highest proportion of these travellers was in the 20-59 year age group. Men travelled more frequently than women. The travellers also had better vaccination coverage against tetanus and polio compared to those who had not travelled. 30% of the travellers to endemic areas for malaria had received malaria prophylaxis and 30% who travelled to endemic areas for yellow fever were protected by vaccination. 28% of those questioned said they experienced general health problems related to their travel, mostly due to mild diarrhea.

Adolescent↗
PubMed1998

Which terminally ill cancer patients receive hospice in-patient care?

The objective of this study was to investigate which terminally ill cancer patients receive in-patient care in hospices and other specialist palliative care in-patient units. An interview survey was made of family or others who knew about the last year of life of a random sample of people who died in 1990. Twenty district health authorities from a range of inner city, outer urban and rural settings took part. Although self-selected, districts were nationally representative in terms of social characteristics and on many indicators of health service provision and usage. Interviews were obtained for 2074 cancer deaths out of a random sample of 2915, a 71% response rate. 342 had been admitted to a total of 31 different hospices. Using logistic regression analysis five factors were found to independently predict hospice in-patient care: having pain in the last year of life, having constipation, being dependent on others for help with activities of daily living for between one and six months before death, having breast cancer, and being under the age of 85 years. A third of patients with all five factors were admitted, compared with no patients with none of these factors. It was found that symptom severity, age, dependency level and site of cancer played a role in determining hospice admission but have limited predictive value. Admission seems to be governed more by chance than by need. Further research is needed to identify which patients benefit most from in-patient care in hospices and other specialist palliative care units as the present arrangements appear to be both inequitable and insupportable.

Adult↗
PubMed1997

The experience of dying with dementia: a retrospective study.

OBJECTIVE: To describe the last year of life of people with dementia, their symptoms, care needs, use of and satisfaction with health services and the bereavement state of the respondent. METHODS: The study is drawn from the Regional Study of Care for the Dying, a retrospective sample survey of the carers, family members or others who knew about the last year of life of a random sample of people age 15 and over dying in the last quarter of 1990. The samples were drawn in 20 English health districts which, although self-selected, were nationally representative. There was a total of 3696 patients (response rate of 69%) dying from all causes. Within this sample, 170 dementia patients were identified and compared with 1513 cancer patients. RESULTS: The symptoms most commonly reported in the last year were mental confusion (83%), urinary incontinence (72%), pain (64%), low mood (61%), constipation (59%) and loss of appetite (57%). Dementia patients saw their GP less often than cancer patients and their respondents rated GP assistance less highly. Dementia patients needed more help at home compared with cancer patients, and received more social services; 78% of respondents for dementia patients and 64% for cancer said they had come to terms with the patient's death. CONCLUSION: Patients dying from dementia have symptoms and health care needs comparable with cancer patients. Greater attention should be given to these needs.

Aged↗
PubMed1995

Symptom control, communication with health professionals, and hospital care of stroke patients in the last year of life as reported by surviving family, friends, and officials.

BACKGROUND AND PURPOSE: The needs of and appropriate service provision for patients dying from stroke have received little attention. The quality of care in the last year of life received by a population-based sample of stroke patients is described here, focusing on symptom control, communication with health professionals, and hospital care. METHODS: Secondary analysis was made of data from the Regional Study of Care for the Dying, a retrospective interview survey in 20 nationally representative English health districts. Subjects were 237 persons who died from stroke in 1990. Of informants, 20% were spouses, 48% relatives, 11% friends or neighbors, and 20% officials. RESULTS: More than half the patients were reported to have experienced pain (65%), mental confusion (51%), low mood (57%), and urinary incontinence (56%) in the last year of life. Pain control was inadequate: 51% of those treated for pain by hospital doctors and 45% of those treated by general practitioners were reported to have received treatment that relieved pain partially if at all. One third of respondents thought that hospital doctors had been too rushed (37%), and 25% thought that the patient had had insufficient choice about treatment. Two fifths had been unable to get all the information they had wanted about the patient's condition. CONCLUSIONS: Improvements in symptom control and psychosocial support for patients who die from stroke are needed, as is better communication between health professionals and patients and their families. Education of doctors and nurses working with stroke patients in the principles of palliative care may help ensure that all dying stroke patients receive high-quality care.

Aged↗
PubMed1994

Neurodevelopment of adopted children exposed in utero to cocaine.

OBJECTIVE: To assess the neurodevelopment of adopted children who had been exposed in utero to cocaine. DESIGN: A case-control observational study. PARTICIPANTS: Twenty-three children aged 14 months to 6.5 years exposed in utero to cocaine and their adoptive mothers, and 23 age-matched control children not exposed to cocaine and their mothers, matched with the adoptive mothers for IQ and socioeconomic status. SETTING: The Motherisk Programme at The Hospital for Sick Children, Toronto, a consultation service for chemical exposure during pregnancy. MAIN OUTCOME MEASURES: Height, weight and head circumference at birth and at follow-up, and achievement on standard tests of cognitive and language development. RESULTS: Compared with the control group, children exposed in utero to cocaine had an 8-fold increased risk for microcephaly (95% confidence interval 1.5 to 42.3); they also had a lower mean birth weight (p = 0.005) and a lower gestational age (p = 0.002). In follow-up the cocaine-exposed children caught up with the control subjects in weight and stature but not in head circumference (mean 31st percentile v. 63rd percentile) (p = 0.001). Although there were no significant differences between the two groups in global IQ, the cocaine-exposed children had significantly lower scores than the control subjects on the Reynell language test for both verbal comprehension (p = 0.003) and expressive language (p = 0.001). CONCLUSIONS: This is the first study to document that intrauterine exposure to cocaine is associated with measurable and clinically significant toxic neurologic effects, independent of postnatal home and environmental confounders. Because women who use cocaine during pregnancy almost invariably smoke cigarettes and often use alcohol, it is impossible to attribute the measured toxic effects to cocaine alone.

Adoption↗
PubMed1993

[HIV prevalence and HIV incidence in blood donors in Baden-Württemberg].

Since several years the frequency of HIV infections among screened blood donors in Baden-Württemberg (a state in southwest Germany) shows no remarkable differences between the German Red Cross donors and the donors of other blood banks. The authors advocate the hypothesis that different HIV rates among donors depend on their social environment. The number of HIV infections expected increases with the size of the donors' places of residence. The donor populations of different blood banks of Baden-Württemberg seem to be equal. Within the framework of epidemiological surveillance, the results of HIV screening of blood donors should be thoroughly analysed.

Adolescent↗
PubMed1991

Critical role for the Val/Gly86 HLA-DR beta dimorphism in autoantigen presentation to human T cells.

Helper T lymphocytes recognize fragments of foreign (or self) antigens in the peptide-binding clefts of major histocompatibility complex class II molecules; their activation is a crucial step in the induction of many immune and autoimmune responses. While studying the latter, we raised a T-cell line from the thymus of a myasthenia gravis patient against recombinant alpha subunit of the human acetylcholine receptor, the target of this autoimmune disease. The line responds to the 144-156 region of the human sequence and not to the same region of the electric fish homolog, which differs by only three residues. These CD4+ T cells recognize this epitope only in the context of HLA-DR4 class II molecules, of which the variants with Gly86 are absolutely required. Thus the naturally occurring alternatives Dw14.2 (Gly86) and Dw14.1 (Val86)--which differ only at this one position in the entire antigen-binding region--show an all-or-nothing difference in presenting activity. This dimorphism at position 86 is widespread, occurring in subtypes of DR1, DR2, DR3, DR5, and DR6 alleles as well as DR4. Since other DR4 subtypes with substitutions at positions 70-74 also fail to present this peptide, and glycine residues can be uniquely flexible, we suggest that this replacement at position 86 acts locally or at a distance by altering the conformation of the peptide-binding cleft. Such profound functional consequences for T-cell recognition as we report here may explain this example of conserved major histocompatibility complex diversity.

Adolescent↗
PubMed1991

An analysis of synthetic peptide restriction by HLA-DR alleles in T cells from human subjects, naturally sensitized by Streptococcus mutans.

T cells from most human subjects show significant in vitro proliferative responses to a 185-kDa surface Ag from Streptococcus mutans as well as to synthetic peptides derived from the sequence of a Mr 3800 streptococcal Ag. T cells from subjects expressing each of the alleles from DR1 to DR7 responded to synthetic peptides of 17 or 21 amino acid residues. Furthermore, inhibition studies with mAb to HLA class I and class II Ag showed that the DR Ag was a restriction molecule for the proliferative responses. Mouse L cells transfected with DR1, DR2, DR4, DR5, and DR7 were used to confirm the permissive nature of the responses. An analysis of the fine specificity of the responses showed that the minimum peptides capable of stimulating T cells from subjects with different DR types varied by one or two residues. For DR2 and DR3 the shortest peptide was residues 6-15, an additional serine (residue 5) was required for DR1 and DR7 and an aspartic acid (residue 4) for DR4, DR5, and DR6. Successful oral-mucosal bacterial colonisation in humans, by a largely commensal Streptococcus, might be associated with the permissive nature of the HLA-DR restriction of the response to a major streptococcal cell surface peptide. The peptide recognised in association with the HLA-DR molecule may induce an immune response that prevents central entry of the organism from the peripheral mucosal site.

Alleles↗
PubMed1991

Role of the adhesion molecule ICAM-1 (CD54) in staphylococcal enterotoxin-mediated cytotoxicity.

Staphylococcal enterotoxin A (SEA) binds to major histocompatibility complex (MHC) class II molecules on target cells and directs human cytotoxic T lymphocytes (CTL) of irrelevant nominal specificity to mediate strong cytotoxicity against target cells. In this report we describe the importance of ICAM-1 (CD54) expression on the target cell in SEA-dependent cell-mediated cytotoxicity (SDCC), utilizing murine L cells co-transfected with HLA-DR and ICAM-1. Human CTL mediated a low but significant cytotoxicity against HLA-DR2- and HLA-DR7-transfected cells after preincubation with SEA, but no reactivity towards uncoated HLA-DR2 and HLA-DR7 cells or SEA-coated ICAM-1-transfected and untransfected L cells. In contrast, a strong cytotoxic response was mediated by CTL against L cells co-transfected with HLA-DR2/ICAM-1 and HLA-DR7/ICAM-1. Similar cytotoxic activity of the CTL was seen at a 30-fold lower effector-to-target cell ratio when comparing the HLA-DR2/ICAM-1-expressing cells with the HLA-DR2-expressing cells. SEA dose-response analysis demonstrated that the HLA-DR2/ICAM-1-expressing target cells enabled the CTL to respond to a 1000-fold lower concentration of SEA in comparison to the HLA-DR2-expressing cells. CD3+CD4+ and CD3+CD8+ cytotoxic T cell lines were equally dependent on the expression of ICAM-1 on the target cell. The strong CTL activity against HLA-DR2/ICAM-1-transfected cells could be blocked by anti-CD11a or anti-CD18 monoclonal antibodies (mAb), but not by anti-CD11b, anti-CD11c, anti-CD2 or unrelated control mAb. The great sensitivity of HLA-DR2/ICAM-1 expressing target cells to SDCC was strongly reduced by preincubation with various anti-ICAM-1 mAb but not by mAb against monomorphic HLA-DR or murine MHC class I determinants. The result in this study clearly demonstrates that efficient re-targeting of human CTL by SE is dependent on a proper interaction with the heterodimer CD11a/CD18 (Leu-CAMa, LFA-1) on the CTL and its target cell ligand ICAM-1.

Antibodies, Monoclonal↗