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Biomedical subjects

M Wildner

Publications and source records attributed to M Wildner.

At least 19 recordsLinked to original sources
PubMed2007

[The model project "newborn auditory screening" in the Upper Palatinate: high process and result quality of an interdisciplinary concept].

BACKGROUND: In May 2003, a newborn auditory screening program was initiated in the Upper Palatinate. METHODS: Sequential OAE- and BERA-screening was conducted in all hospitals with obstetric facilities. The Screening Center at the Public Health Authority was responsible for the coordination of the screening process, completeness of participation, the follow-up of all subjects with a positive screening test and the quality of instrumental screening. RESULTS: A total of 96% of 17,469 newborns were screened. The referral rate at discharge was 1.6% (0.4% for bilateral positive findings). For 97% of the positive screening results, a definite diagnosis to confirm or exclude hearing loss was achieved; for 43% only after intervention by the Screening Center. Fifteen children with profound bilateral hearing impairment were identified of whom eight were only detected by the intervention of the Screening Center. CONCLUSION: The effective structures established in the Upper Palatinate provide a standard for the quality of neonatal auditory screening achievable in Germany.

Female↗
PubMed2006

[Surveillance of infectious foodborne diseases after enactment of the German Protection against Infection Act in 2001. Potentials and requirements].

The epidemiology of infectious foodborne diseases has changed. Outbreaks more frequently occur geographically dispersed or protractedly over longer periods of time, and they often appear as a scatter of seemingly sporadic cases. This hampers and delays the identification of their epidemiological link. The surveillance of infectious foodborne diseases has to be refined accordingly to be able to detect these diffuse outbreaks. The German Protection against Infection Act, enacted in 2001, offers the potential of increased sensitivity due to timely electronic reporting of individual cases and detailed data accompanying each report. In addition to a timely and comprehensive reporting system, subtyping of pathogens has become an invaluable tool in identifying epidemiologically linked cases, i.e. outbreaks. Still, the sensitivity of foodborne disease surveillance still hinges on the willingness of physicians to order stool testing for enteric pathogens (and to report suspected outbreaks to local health departments). Without the active participation of physicians, the chance of detecting outbreaks and successfully investigating them is markedly reduced. Consequently, the general preventive strategy would be jeopardised, namely to understand the (often new) mechanisms by which contamination and disease transmission occur well enough to interrupt them.

Communicable Disease Control↗
PubMed2006

[Differences in small area prevalence of respiratory diseases in children: challenges of an investigation initiated by parents].

OBJECTIVE: The aim of our study was to assess the prevalence of respiratory diseases in children living in a rural area in Bavaria in a systematic and standardised way to clarify whether a disease cluster exists. Reports from a parents' initiative claiming an increase of diseased children and assuming an association with air pollution due to nearby industrial sources and heavy traffic were the reason for the study. METHODS: Parents of all children living in small towns specified by the parents' initiative as affected region (central area) and parents of those children aged 6-7 or 13-14 years living in adjacent areas (control area) were asked to complete a written questionnaire. In bivariate analysis, differences in prevalences between the central area and the control area were assessed by the chi (2) test. In multivariate analysis, confounder-adjusted odds ratios with 95 % confidence intervals were calculated by logistic regression. In addition, generalized linear mixed models were used to control for potential clusters in families. RESULTS: The response rate was rather low (total 46 %, central area 53 %, control area 34 %). The study population comprised 121 girls and 141 boys. There was a pattern of increased prevalences of cough, wheeze and respiratory diseases caused by infections in children living in the central area compared to the control area. However, statistical significance was rarely observed. No systematic differences were observed for the prevalence of allergic rhinitis and atopic dermatitis. Selection bias due to varying response rates in the central versus the control area and information bias introduced by the preceding intensive public discussion could not be excluded. The comparison of prevalences detected in the small area with published data from other epidemiological studies in Germany did not indicate a systematically increased prevalence of respiratory symptoms or physician-diagnosed respiratory diseases in children from the whole area as well as in children from the central area only. CONCLUSION: This study exemplifies the challenges of small area investigations initiated by the residential community to clarify an assumed disease cluster caused by environmental pollution. The prior comparison of small area prevalence data with results of other epidemiological studies aids the decision making as to whether a detailed study with comprehensive assessment of individual exposure is justifiable.

Adolescent↗
PubMed2005

[Fractures in the elderly--a challenge for prevention and health promotion--results from the KORA fracture study Augsburg].

Fractures of the appendicular bones are frequent and can cause a loss of the ability for independent living, depending on age and fracture localisation. They affect both sexes at different times and in different ways. The basic epidemiology for Germany of this injury resp. disease and knowledge regarding medium-term health-related consequences has been provided by work done in the context of the KORA Augsburg Fracture Study 1998, a follow-up of older participants of the third MONICA Augsburg survey S3 (1994/95) and through further research in the past years. Results of a validation study support the value of questionnaire-based patients recall of fractures and their location. It could be shown that age, gender, time since fracture and impaired walking have the greatest predictive value among a number of factors. Limitations of physical function are apparent especially during the first two years after a fragility fracture. After five years functional capacity of survivors equals the functional capacity of control persons of the same age. These population-representative and validated data support model-based cost-effective strategies of population-orientated disease prevention and health promotion. An age and gender-specific approach (gender mainstreaming) is mandatory.

Age Distribution↗
PubMed2005

[Accumulated occurrence of illnesses with Salmonella enteritidis in hospitals and nursing homes in the district Oberallgaeu, Bavaria, in July 2004].

We report on the investigation of a Salmonella enteritidis outbreak in hospitals and nursing homes in the district Oberallgaeu, Bavaria, in July 2004. Affected by this outbreak were hospital patients, inhabitants of nursing homes, kitchen coworkers and maintenance personnel. Within this outbreak six deaths were observed. A forensic medical investigation of four deaths revealed two cases of Salmonella enteritis as the primary cause of death, another cause of death was due to other causes and one cause of death remained unclear. The microbiological investigation of stool samples linked all positive samples to an outbreak during this period. The epidemiological outbreak curve pointed towards a foodborne transmission of the pathogen. The infection period could be limited to the weekend of the 3./4.7.2004. All affected institutions were supplied by a catering service with several sites. All tested food samples were negative for Salmonella enteritis. Epidemiological investigations revealed that a contaminated pudding was probably responsible for the outbreak.

Adult↗
PubMed2005

[Cluster of meningococcal diseases in Allgaeu -- strategies for intervention].

In spring 2004 an accumulation of cases of invasive meningococcal disease was observed in the Allgaeu/Bavaria. Investigations of the isolates showed, that four cases in neighbouring municipalities of the district Oberallgaeu were caused by an identical strain of serogroup C. The particular strain was a rare variant of the so called ET-15 clone, which had caused several outbreaks of severe meningococcal disease among young people in the past, for example in Rottal/Inn (1998), Karlsruhe (1999 - 2000) and Schwerte (2003). The involved health authorities had to decide, which intervention strategies were reasonable and appropriate to the given situation. An epidemiological assessment of the situation was made by the Bavarian Health and Food Safety Authority (LGL) using the recommendations of the permanent immunization committee at the Robert Koch-Institute and of the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention (CDC) . The LGL together with the Robert Koch-Institute and the national meningococcal reference centre concluded that the situation fulfilled the criteria for a vaccination indication in accordance with section sign 20 Abs. 5 of the infectious disease control act (Infektionsschutzgesetz, IfSG). On the basis of this assessment the responsible regional health authority issued a public recommendation for vaccination and the district health authority of the Oberallgaeu was assigned to implement a vaccination campaign. The Oberallgaeu health authority offered vaccination sessions to the public in the concerned communities. The target group comprised babies, children, young people and adults up to twenty years, who lived in the concerned communities in the northern part of Oberallgaeu, as well as close contacts of cases and members of the above age group, who had visited communal facilities in the communities concerned. Our report describes the implementation of the vaccination campaign.

Bacterial Vaccines↗
PubMed2005

[Risk factors for abundance of shiga toxin producing Escherichia coli in sewage water].

Shiga toxin producing Escherichia coli (STEC) in sewage influent into surface water are a potential source of human infections with STEC. Eight sewage treatment plants in Bavaria, Germany, were sampled at regular intervals from 2003 to 2004 in order to estimate STEC load and quantify risk factors. 95 of 378 samples (25 %) were tested positive for stx1and/or stx2 with PCR after enrichment culture. STEC elimination after treatment was 44 %. The following risk factors were analysed with logistic regression: location of sewage plant (rural vs. urban), treatment plant technology (two stage vs. three stage treatment) and sampling location (sewage input vs. sewage output). Rural plants had odds-ratios of 1,7 (95 % CI 1.03 - 2.69; p = 0.038) for a positive stx1 and/ or stx2 PCR result, sampling at sewage input of 2.1 (95 %CI 1.28 - 3.36; p = 0.003) and three stage plants of 1.51 (95 % CI 0.94 - 2.44; p = 0.087, not significant). Sampling after rain and after dry spells had no impact on STEC abundance (univariate Chi-square test = 0.01; df1; p = 0.920). Rural sewage plants had higher odds of STEC content. The influence of the sewage plant technology on the STEC load requires further clarification.

Environmental Microbiology↗
PubMed2004

[Incidence of severe injuries. Results of a population-based analysis].

It is still unknown exactly how many persons sustain a severe injury (ISS > or =16) in Germany each year. Considering the growing restrictions and the introduction of DRGs, it was necessary to acquire data about this rather resource-intensive aspect of trauma care. The aim of this study was therefore to assess the incidence of severe trauma within a defined population. In a retrospective study all surgical emergencies within a 5-year period (1996-2000) were reviewed. Data on type, pattern, severity of injury, and mortality were extracted from the patients' records. During the study period 454 persons sustained a severe injury (ISS > or =16), 112 individuals died at the scene of the accident, and 64 during the hospital stay. The average ISS of the surviving patients was 27 (ISS 16-75). The calculated incidence of severe trauma was 25/100,000 inhabitants per year. Extrapolated, up to 40,000 persons sustain a severe injury each year in Germany. For the first time, this study has provided data on the incidence of major trauma in Germany. Based on the acquired data and a previous cost analysis, hospital treatment costs for severely injured patients amount to up to 2 billion Euros per year in Germany.

Adolescent↗
PubMed2004

[Basics of Bavarian health assessment reporting].

Management information systems which support a demand-oriented, integrative and comprehensive decision-making in health care policy are of pre-eminent importance for the health care system. Present health care legislation in Bavaria underlines the importance of health reporting as a tool for periodical assessment of the situation and starting-point for decision-making in health care. Demands made on the Bavarian health report stem from both European and national levels and also from the regional structure within the state. It is intended that the health reporting should reach the local level. Single reports cannot cover all relevant aspects. Therefore, health reporting in Bavaria has a modular structure. There is a need for integrated, flexibly useful information. Following an evidence-based approach, health information may be subject to critical assessment. This approach enables decision makers to assess the grade of certainty of recommendations. Health reporting in Bavaria aims at following the people through time. The intelligent use of new media will have to play a key role.

Delivery of Health Care↗
PubMed2004

[New challenges to the Screening Center in the Bavarian State office for Health Care and Safe Quality of Foods].

UNLABELLED: AIM of the newborn screening model programme implemented in Bavaria, Germany, in 1999 was earliest possible and complete detection of all children with treatable severe inborn errors of metabolism. This was to be achieved by the introduction of new laboratory methods (expanded disease coverage, earlier blood take) and of a tracking system to ensure complete access for all newborns and complete requested repeat testing. Long-term prognosis of the newly screened disorders is to be investigated. The model programme "newborn hearing screening in Bavaria" started in 2003 in the administrative district Oberpfalz aims at testing, whether tracking is also suitable to achieve early detection of all children with inborn severe hearing defects. METHODS: To attain these goals a central state screening centre was established. Demographic tracking coordinated by this centre is achieved by matching screening notifications with all birth notifications on name on a regional basis and individual contacts with parents of children with missing screening notification. In addition, all pending recalls are consequently tracked by case-specific contacts. This system was initially introduced for metabolism screening and is currently being implemented also for hearing screening of newborns. Both screening programmes are being scientifically evaluated. Children with disorders detected by screening are followed up in a long-term study by the screening centre. Written consent by the parents is requested yearly at the childs birthday regarding medical care, knowledge of the disease und health development of the child. RESULTS: 470,247 newborns were tested for treatable inborn errors of metabolism from 1999 to 2002. With the introduction of tracking, the documented participation rate increased from previously < 80 to 98.5 %. Due to tracking 99.2 % of requested recalls could be achieved. In 14 cases diagnosis was made, respectively therapy was initiated first after intervention by the screening centre. Altogether 368 children affected by the target disorders of the programme were detected. 332 children could be included in the long-term follow up study. Besides encouraging results, this study reveals deficits in parental information, provision with emergency cards, expert medical consultation, and sometimes treatment not according to the guidelines. Corresponding data from the hearing screening programme are not yet available. CONCLUSION: The establishment of an independent state screening centre has proved very valuable. It enables comprehensive state-wide demographic tracking despite several laboratories engaged in screening for inborn errors of metabolism. A long-term follow-up study has proved to be effective in this setting.

Child↗
PubMed2004

[Surveillance of notifiable infectious diseases in Bavaria - results in 2002].

In 2002 nearly 36 000 cases of notifiable infectious diseases were reported in Bavaria representing a 10 % increase compared to 2001 (33 000 cases). As in 2001, around 75 % of reported cases were gastrointestinal infections. Every third infection was due to salmonella. As compared to last year, the incidence of Norwalk-like virus infections increased fivefold. These infections occurred mostly as outbreaks in nursing homes, hospitals or other institutions, affecting as many as 200 persons. Other frequently reported infections in Bavaria are tuberculosis and hepatitis. The relatively high incidence of measles is mainly due to an outbreak in Coburg. The decline in the incidence of tuberculosis observed over the last years has ceased. Around 70 % of reported hepatitis cases were due to hepatitis C. It should be noted that these cases were a mixture of new infections and ongoing infections diagnosed for the first time. Of great epidemiological importance are diseases caused by meningitis pathogens. The incidence of meningococcal infections was practically unchanged as compared to last year. Around half of them were caused by serotype B, which is currently not preventable by vaccination. Meningitis caused by Haemophilus influenzae B is continually declining due to the high vaccination rate and is very rarely reported. Several cases of FSME were described. According to investigations carried out by health departments these infections were acquired in countries not yet classified as FSME risk areas. Hence, the endemics maps of FSME have to be revised. Two years of reporting according to IfSG (infectious disease control law) yielded very encouraging results, i. e. rapid accessibility of data, flexibility, complete and standardised reporting with high quality of data. We thank all the reporting physicians and laboratories and the staff of the Bavarian health departments for their continuous support.

Adolescent↗
PubMed2002

Independent living after fractures in the elderly.

Although fractures are an important source of disability among the growing elderly populations of industrialized societies, patient-centered multidimensional outcome information is scarce. The purpose of this study was to quantify the natural history of recovery from fractures of the upper and lower extremities. From the 1994/95 WHO MONICA survey in Augsburg, Germany, we selected all persons aged 58-78 years who had experienced a fracture during the preceeding 10 years, along with a control population twice as large. The Health Assessment Questionnaire (HAQ) and the Medical Outcomes Study Short Form 36 (SF-36) were administered to these subjects in 1998. Patients' recollection of fracture type and location were validated against medical records. The most recent fracture was in the upper extremity in 45 cases, lower extremity in 55 cases and elsewhere in 46 cases. Extremity fractures resulted in persistent and measurable impairment of the activities of daily living or general quality of life in patients 65 years or older, especially if the femur was involved. More than 40% of the interindividual variation of functional disability in the study group could be explained by age, sex, history of a fracture within 12 years and perceived difficulties walking. Existing generic and specific musculoskeletal outcome measurement instruments thus allow the assessment of functional recovery and health status after fractures in an elderly population. Geriatric assessment following fractures at higher age may improve ability to live independently. Difficulty walking deserves special attention, as it is associated with more general functional disability among the elderly.

Activities of Daily Living↗
PubMed2002

[Epidemiology of limb fractures].

To analyze age- and sex-specific frequencies of peripheral fractures, we used data from the third MONICA-Augsburg Survey (1994/95). The study comprises 2404 male and 2450 female participants (age 25 to 74 years) who were questioned regarding fracture history. We investigated fracture prevalence, age-specific incidence rates, and the circumstances under which the fractures occurred. The age-standardized, cumulative fracture prevalence among men (m) 25 to 74 years of age was 45% and among women (w) of the same age 31%. Fracture prevalence among women was more than 10% lower than among men in the younger age groups (age 25 to 64 years), but after an significant increase in the 65 to 74-year-olds the fracture prevalence corresponded to that of men (m: 42%, w: 40%). A peak of incidence rates was found among men at age 15-24 (overall incidence rate: 2017 fractures/100,000 person-years) and at age 45-54 (overall incidence rate: 1640 fractures/100,000 PY), respectively, and among women at age 65-74 (overall incidence rate: 3214 fractures/100,000 PY). The prevalence of self-reported osteoporosis (age 25 to 74 years) was higher in women (7%) than in men (1%). Falls caused 43% (w: 59%, m: 33%) of all fractures, external violence 40% (m: 47%, w: 29%), and sports activities 15% (m: 18%, w: 10%). Further investigation of risk factors related to fractures can contribute to the development of specific preventive measures in that field. In the future, the prevention and efficient treatment of an existing or an often undiagnosed osteoporosis and also the prevention of falls in elderly persons should be an important public health concern.

Adolescent↗
PubMed2002

[DRGs of musculoskeletal diseases: consequences for orthopaedics and accident surgery].

The introduction of the new prospective payment system for inpatient care entails considerable changes for hospitals in Germany. The Australian Refined Diagnosis Related Groups (AR-DRGs), which form the basis for the German system, give the chance to estimate the consequences and implications for the specialty of orthopaedic surgery in Germany. Our study aims at highlighting the most important musculoskeletal diagnoses and to provide an initial economic forecast for them. The comparison with Australian data gives hints for operative and conservative-rehabilitative orthopaedic departments in respect to potentials and focal points for the development of novel patient management tools. The success of orthopaedic departments will depend in the future much more than now on organisational and management issues.

Australia↗
PubMed2001

[Regional and sex-specific differences in fulfillment of patient rights: results of a representative population survey in Munich, Dresden, Vienna and Bern].

OBJECTIVES: The European Office of the World Health Organization formulated the Amsterdam Declaration in 1994, demanding thereby the realisation of the principles of a humane health care. These principles relate to the protection of dignity of personhood, to self-determination, the right of information, and the right of quality, continuity and equality in health care. The present study aims at a gender-specific analysis of the fulfillment of these rights. METHODS: Computer-assisted telephone interviews were conducted during the months February and March 2000 in four German speaking European cities (Munich, Dresden, Vienna and Berne). A paragraph of the Declaration on the Promotion of Patients' Rights was regarded as fulfilled if there was at least 80% agreement. RESULTS: Deficiencies were most pronounced for the provision of community and domiciliary services after hospital treatment and for the right concerning humane terminal care and death in dignity. Moreover, regional differences were found between Munich, Dresden and Vienna on one side and Berne on the other side, with degrees of fulfillment being higher in Berne. CONCLUSIONS: In summary, these regional differences are more pronounced than single gender-specific differences, which may be due to chance. Areas with potential for improvement could be identified and can be actively restructured, e.g., in the context of the setting of health targets. An evaluation of the influence of the managed care system which has been established only sporadically in Berne requires more data.

Adult↗