Background Over one million asylum seekers were registered in Germany in 2016, most from Syria and Afghanistan. The Refugee Convention guarantees access to healthcare, however delivery mechanisms remain heterogeneous. There is an urgent need for more data describing the health conditions of asylum seekers to guide best practices for healthcare delivery. In this study, we describe the state of health of asylum seekers presenting to a multi-specialty primary care refugee clinic. Methods Demographic and medical diagnosis data were extracted from the electronic medical records of patients seen at the ambulatory refugee clinic in Dresden, Germany between 15 September 2015 and 31 December 2016. Data were de-identified and analyzed using Stata version 14.0. Results Two-thousand-seven-hundred and fifty-three individual patients were seen in the clinic. Of these, 2232 (81.1%) were insured by the state indicating arrival within the last 3 months. The median age was 25, interquartile range 16–34. Only 786 (28.6%) were female, while 1967 (71.5%) were male. The most frequent diagnoses were respiratory (17.4%), followed by miscellaneous symptoms and otherwise not classified ailments (R series, 14.1%), infection (10.8%), musculoskeletal or connective tissue (9.3%), gastrointestinal (6.8%), injury (5.9%), and mental or behavioral (5.1%) categories. Conclusions This study illustrates the diverse medical conditions that affect the asylum seeker population. Asylum seekers in our study group did not have a high burden of communicable diseases, however several warranted additional screening and treatment, including for tuberculosis and scabies. Respiratory illnesses were more common amongst newly arrived refugees. Trauma-related mental health disorders comprised half of mental health diagnoses.

Anther smuts (Microbotryum violaceum s.l.) represent a well-known system for studying pathogens of wild plants and coevolution between pathogens and hosts. Infected plants produce sterile flowers with anthers filled with fungal spores which are transmitted to other host plants by pollinators. Data from existing research come mainly from the genus Silene. However, the applicability of these findings to other host plants of anther smuts is largely unknown. Therefore, this thesis focuses on a different host species - Dianthus carthusianorum. First, the pattern of disease was surveyed in natural populations of D. carthusianorum in a small area in Střední Povltaví. Most populations were infected to various degrees and only a few populations remained completely healthy. The prevalence of disease was positively correlated with size and density of host populations. On the other hand, environmental factors and the degree of connectedness had very little effect on disease prevalence. Second, additional data were collected from a subset of populations to determine plant resistance and densities of pollinators. Differences in resistance among populations (as inferred from flower inoculations) were not significant. Populations differed in densities of pollinators, but there was no correlation between densities...

Gender inequality is the root cause of the differences in mental disorders prevalence between men and women. The aim of this thesis was to examine social inequalities in mental health, focusing on gender as a critical determinant of mental health and mental illness. In the first chapter, the ways mental health is shaped by gender and other social determinants are discussed. Gender-based discrimination, traditional gender roles, unequal distribution of power and lack of control over life events are the most common risk factors for higher prevalence of mental disorders in women. In the empirical part of this thesis the European countries were grouped based on indicators related to women's mental health. The typology was developed using factor and cluster analyses. Subsequently, logistic regression analysis investigated associations between prevalence of depression and various social determinants of mental health in respondents of the Survey of Health, Ageing and Retirement in Europe (SHARE). The results suggest that risk factors for common mental disorders are gender specific.

No description available.

Le Cacao swollen shoot virus (CSSV) est un virus infectant le cacaoyer transmis par des cochenilles farineuses de la famille des Pseudococcidae. La maladie qui en découle existe aujourd'hui dans les principales zones de production de cacao d'Afrique de l'Ouest qui représentent 72% de la production mondiale de cacao. Le CSSV a été découvert en 1922 au Ghana et identifié avec certitude dans le Kloto au Togo en 1955 ; le premier isolat étudié moléculairement est l'isolat très virulent Agou1 du Togo. Cet isolat provoque des gonflements de tiges et de rameaux ainsi que des colorations rouge intense au niveau des nervures des jeunes feuilles engendrant ensuite une défoliation complète de l'arbre et sa mort au bout de 5 ans. La progression actuelle du CSSV dans les nouvelles zones de production, notamment au Togo (Litimé) en 1996 et en Côte d'Ivoire (Issia, Bouaflé, Sinfra) en 2000, indique une nouvelle émergence de la maladie. La découverte de ces nouveaux foyers soulève des questionnements sur l'origine des isolats et sur les mécanismes épidémiologiques impliqués dans la propagation de la maladie à l'échelle parcellaire et à l'échelle des territoires.Ces questionnements scientifiques sont pris en compte dans cette étude à trois niveaux : i) l'analyse statistique de la répartition spatiale et temporelle de la maladie à l'échelle des parcelles (fonctions de Ripley et analyse du nombre de liens entre arbres malades) et la cartographie des dynamiques d'évolution au moyen de systèmes d'information géographique (SIG), ii) la diversité moléculaire des isolats de CSSV en lien avec leur répartition géographique afin d'établir une carte de répartition dans les deux régions de production (Kloto et Litimé) et d'essayer de retracer l'historique de la propagation du virus, iii) la cartographie des zones cacaoyères, des cacaoyères saines en comparaison aux cacaoyères malades, à l'échelle des territoires par la combinaison des données satellites Spot5 à 2.5 m de résolution spatiale et des motifs de paysage relevés sur le terrain.L'analyse spatiale avec les fonctions de Ripley et l'analyse du nombre de liens ont montré que les différents états sanitaires (sain, malade, mort) des cacaoyers sont agrégés indiquant ainsi une propagation à partir de foyers d'infection au niveau parcellaire. L'analyse du nombre de liens indique un processus de contamination de plante à plante dans les parcelles. Les études des dynamiques d'évolution au moyen de SIG ont montré à travers des cartes de densités que les cacaoyers malades et les cacaoyers morts sont regroupés en agrégats dans les parcelles et que la taille de ces agrégats augmente entre les deux années d'observation (2008 et 2009). Les dynamiques de changement ont permis de détecter une progression de la maladie plus rapide dans certaines parcelles, qui peut s'expliquer par leur moins bon entretien. La caractérisation des isolats de virus dans les cacaoyères togolaises a montré l'existence de trois groupes dont les groupes A et B uniquement dans le Litimé, et le groupe C uniquement dans le Kloto, indiquant une forte différenciation géographique. Les coefficients de corrélation de Pearson et de Spearman indiquent qu'il existe un lien entre distance génétique et distance géographique des isolats du groupe A, ce qui implique une contamination de proche en proche pour ce groupe à l'échelle du territoire. Compte tenu de la différenciation marquée entre les groupes du Kloto et du Litimé, nous pouvons conclure que les cacaoyères du Litimé n'ont pas été contaminées par du matériel venant du Kloto mais plus probablement à partir de parcelles cacaoyères situées au Ghana et contaminées précédemment pour se répandre ensuite dans le Litimé. L'étude des images satellites a montré qu'il n'existait pas de relation simple entre l'état sanitaire des motifs de cacaoyers et leur radiométrie en raison de la forte hétérogénéité du système agroforestier du Litimé / Cacao swollen shoot virus 'CSSV ' is a virus transmitted by mealybugs, insects of the Pseudococcidae family. The disease occurs in all the main cocoa-growing areas of Western Africa. It induces swellings on shoots and roots and mosaic and chlorosis on the leaves and has caused very serious crop losses in Ghana, Nigeria and more recently, Togo and Côte d'Ivoire. The cocoa production in Western Africa, representing about 72 % of the worldwide production is particularly important for the economic equilibrium of these countries. The actual progress of the CSSV epidemic in the large production areas in Togo like ‘Litimé' and ‘Kloto' and in Côte d'Ivoire (Issia, Bouaflé, Sinfra) requires to understand and forecast its spread in time. The discovery of these new focuses of the disease raises questions about the origin of the isolates and the mechanisms involved in the epidemiological spread of the disease at field scale and across territories.These scientific questions are addressed in this study at three levels: i) the spatial and temporal distribution of disease across the plots with statistical methods (Ripley and analysis of the number of links) and geographical information systems (GIS) to map the dynamics of evolution, ii) the molecular diversity of CSSV isolates related to their geographical distribution in order to establish a distribution map in the two regions of production (Kloto and Litimé) and try to understand the history of the virus spread, iii) the mapping of cocoa area in Litimé, the mapping of disead cocoa in comparison with healthy cocoa at the territories scale by combining satellite data with SPOT5 2.5 m spatial resolution and landscape motifs field surveys.The spatial analysis with Ripley's method and analysis of the number of links have shown that the different states of health (healthy, disead, dead) of cocoa trees are aggregated indicating a spread by patch at plot level. The analysis of the number of links indicates a process of contamination from plant to plant in the plots. Studies of the dynamics of evolution from Sig showed through density maps that disead cocoa trees and dead cocoa tree are grouped into clusters in the plots and the size of these aggregates increases significantly between the two years observation (2008 and 2009). The dynamics of change have detected a similar progression of the disease in plots 2 and 3 speedy than Parcel 1. This difference of the disease progress on the three plots can be explained by better maintenance of Parcel 1. The characterization of virus isolates on cocoa plots in Togo has shown the existence of three groups with groups A and B only in the Litimé, and group C only in the Kloto, indicating strong geographical differentiation. The correlation coefficients of Pearson and Spearman indicate a link between genetic distance and geographical distance of the isolates of group A, which implies a contamination step by step for this group at territories scale. Given the marked differentiation between the groups of Kloto and Litimé, we can conclude that the cocoa tree of Litimé were not contaminated with material from the Kloto but more likely from plots located in Ghana and previously infected then spread in the Litimé. The study with the satellite images showed that there was no simple relationship between the health patterns of cocoa trees and their radiometry because of the high heterogeneity of the agroforestry system of Litimé. The combination of landscape motifs and radiometry, however, possible to distinguish areas with dominant "cocoa", areas dominated by "crops", areas dominated by "forest". Among the areas to be dominant "cocoa", we have distinguished the cocoa denuded areas that correspond to potential disease areas and cocoa shade. These various studies indicate that disease progression is slow and works gradually. Emergences observed in new areas probably come from human movements

Rationnel: Bien qu'elles constituent la majorité des thromboses veineuses des membres inférieurs, les thromboses veineuses profondes (TVP) distale et les thromboses veineuses superficielles (TVS) ont été peu étudiées et leur significativité clinique et leur prise en charge sont débattues.Méthodes: Cette thèse collige les résultats des travaux effectués par J.P. Galanaud sur les TVP distales et les TVS à partir des études épidémiologiques OPTIMEV, POST et RIETE.Résultats commentés: TVP distale: La TVP distale n'a pas le même profil de facteur de risque que la TVP proximale. Sa mortalité associée à court terme est plus faible que celle des TVP proximales mais supérieure à celle de témoins confirmant qu'il s'agit d'une entité cliniquement significative. Les différences de profil de population et de complications entre ces deux types de TVP suggèrent que le rapport bénéfice/risque du traitement anticoagulant est différent. Il n'est donc pas légitime d'extrapoler les résultats des essais des TVP proximales aux TVP distales. Des essais spécifiques sont donc nécessaires.TVS: En cas de TVS le risque de TVP concomitante est élevé. Un examen écho-doppler doit être réalisé et devra au moins explorer l'ensemble du réseau profond du membre inférieur affecté. Sexe masculin et antécédents de TVP/Embolie pulmonaire constituent des facteurs prédictifs indépendants de récidive. Si certaines TVS peuvent être traitées avec succès sans traitement anticoagulant, celles associées à un cancer ou à une atteinte saphéno-fémorale sont à haut risque de récidive y compris après un traitement anticoagulant curatif. / Background: Though they represent the majority of all lower limbs thromboses, isolated distal deep-vein thrombosis (DVT) (without symptomatic pulmonary embolism (PE)) and isolated superficial vein thrombosis (SVT) (without DVT or PE) have been poorly studied. Their clinical significance and management are under debate.Methods: Data from epidemiological multicenter prospective studies OPTIMEV, POST, RIETEResults and comments: Isolated distal DVT: Distal and proximal DVTs exhibit a different risk factor profile, the latter being more associated with chronic risk factors. Three-month mortality of distal DVT patient is lower than that of proximal DVT ones but is higher than that of controls. This evidences that distal DVT is a clinically significant finding. Differences in population profile and outcomes suggests that the benefit/risk ratio of anticoagulant treatment is not similar. Data from proximal DVT clinical trials should no longer be extrapolated to distal DVT.Isolated SVT: In case of SVT the risk of concomitant DVT is high. A compression ultrasonographic exam should be performed and at least explore the whole deep venous system of the affected limb. Male gender and history of DVT/Pulmonary embolism are independent predicators of recurrence. Some SVT can be safely treated without anticoagulants. On contrary, in patients with cancer or a sapheno-femoral junction involvement, the risk of deep venous recurrence is high even upon full therapeutic dose of anticoagulants.

Les maladies à transmission vectorielle sont dues à des agents pathogènes transmis par des arthropodes hématophages. Ces vecteurs assurent une transmission active (mécanique ou biologique) d’un agent infectieux d’un vertébré vers un autre vertébré. A l’échelle mondiale, les tiques sont responsables de la transmission de la plus grande variété d’agents pathogènes, elles transmettent des microorganismes responsables de maladies bactériennes (borréliose de Lyme, rickettsioses) ou parasitaires (babésioses, theilérioses), ou même virales (encéphalite à tiques).Les Antilles se situent au cœur de la zone Néotropicale des Caraïbes, et constituent une zone à risque pour l’émergence de maladies vectorielles en raison des conditions climatiques favorables aux vecteurs et des échanges intercontinentaux importants (flux illégal d’animaux, oiseaux migrateurs,…). La situation épidémiologique de la zone Caraïbe vis-à-vis des maladies transmises par les tiques est très peu documentée. Les études menées sur le terrain portent essentiellement sur des agents pathogènes affectant les animaux comme Ehrlichia ruminantium, Babesia (bovis et bigemina) et Anaplasma marginale et sont donc loin de pouvoir répondre aux questions concernant le risque d’émergence ou de réémergence de maladies à tique. Ainsi, il est nécessaire et urgent de développer des outils efficaces de surveillance épidémiologique qui permettraient la détection des agents pathogènes, nouveaux, connus ou non suspectés présents dans les tiques. C’est dans ce contexte d’amélioration des performances de veille sanitaire des maladies à tiques dans les Caraïbes que prend place le projet de thèse. La visée de la thèse était de faire un état des lieux des agents pathogènes d’intérêt médical et vétérinaire présents dans les tiques caribéennes à l’aide de techniques de détection à haut débit. Pour cela nous avons d’abord réalisé un séquençage à haut débit d’ARN extraits de tiques collectées en Guadeloupe et en Martinique afin de réaliser un inventaire sans a priori des agents pathogènes (bactéries, parasites, et virus) présents. Cette analyse a permis de mettre en évidence une grande diversité en microorganismes pathogènes au sein de nos échantillons, révélant également la présence de quatre virus appartenant à de nouveaux genres viraux récemment décrits et associés aux arthropodes. Les informations obtenues via le séquençage, additionnées aux données disponibles dans la littérature ont permis de constituer ainsi une liste des agents pathogènes transmis par les tiques nécessitant une surveillance sanitaire dans les caraïbes. A partir de ce répertoire nous avons développé un système de dépistage à haut-débit d’agents infectieux applicable à toute la zone des caraïbes. L’outil de détection est un support microfluidique de type puce à ADN, basé sur la technologie BioMarkTM dynamic arrays (Fluidigm Corporation) qui permet de réaliser de la PCR en temps réel à haut débit afin de détecter simultanément 48 à 96 cibles au sein de 48 à 96 échantillons. Deux puces ont été développées, une première pour le suivi des bactéries et parasites, et une deuxième pour le suivi des virus. Leur performance a été testée sur des échantillons de tiques collectées en Guadeloupe et en Martinique. Ce dépistage à grande échelle a donné un aperçu complet de la situation épidémiologique de 45 bactéries, 17 parasites and 31 virus potentiellement transmis par les tiques dans les Antilles Françaises. La méthode de surveillance développée durant cette thèse représente une amélioration majeure des techniques de veille épidémiologique, permettant la détection rapide et concomitante d’un large panel d’agent pathogène. Elle sera prochainement appliquée au criblage à haut débit des agents infectieux présent dans des tiques collectées à travers la Caraïbe, provenant notamment de Trinité-et-Tobago, Saint-Kitts, la Barbade, et Sainte-Lucie, grâce à la collaboration du réseau CaribVet, et de vétérinaires locaux / Vector-borne diseases are illnesses caused by pathogens transmitted by haematophagous arthropods which provide active transmission (mechanical or biological) of infectious agents from one vertebrate to another. Among these vectors, ticks are known to carry and transmit the greatest variety of pathogens of public health and veterinary importance. They transmit microorganisms responsible for bacterial (Lyme borreliosis, rickettsioses), parasitic (babesiosis, theileriosis), or viral diseases (tick-borne encephalitis).The Antilles are located in the heart of the Caribbean Neotropical Zone. This area can be considered at risk for the emergence of vector-borne diseases mainly due to favorable environmental conditions and intercontinental exchanges (e.g. legal and illegal animal trade, migratory birds). However, the epidemiological situation of the Caribbean area, with regard to tick-borne diseases, is still poorly documented. Indeed, most of field studies only focused on animal pathogens such as Ehrlichia ruminantium, Babesia (bovis and bigemina) and Anaplasma marginale and questions about the risk of emergence or re-emergence of tick-borne diseases remain unanswered. Thus, it is crucial to develop efficient epidemiological surveillance tools that would enable the detection of new, known or unexpected pathogens present in ticks. In this context, the main objective of my thesis was to obtain an overview of pathogens of medical and veterinary interest present in Caribbean ticks using new high-throughput technologies. We first used a high-throughput sequencing approach to determine pathogens present in ticks (bacteria, parasites, and viruses) collected in Guadeloupe and Martinique. This analysis revealed a great diversity of pathogenic agents in our samples and highlighted the presence of four viruses belonging to new viral families recently described and associated with arthropods. Results of sequencing combined with data available in the literature allowed us to make the most exhaustive list of pathogens potentially transmitted by ticks and requiring health surveillance in the Caribbean area. From this pathogen inventory, we developed a system of high-throughput screening of infectious agents applicable to the whole Caribbean area. This molecular tool is a microfluidic system based on the BiomarkTM dynamic arrays technology (Fluidigm Corporation), which enables high-throughput real-time PCR to simultaneously detect 48-96 targets within 48 to 96 samples. Two different chips have been developed, one for bacteria and parasites monitoring, and one for viruses. Their efficiency was tested on tick samples collected in both Guadeloupe and Martinique. This large-scale screening provided a comprehensive overview of the epidemiological situation of 45 bacteria, 17 parasites and 31 viruses potentially transmitted by ticks in the French West Indies. The high-throughput detection tool developed during my thesis represents a major improvement in epidemiological surveillance technology, enabling the rapid and concomitant monitoring of a wide range of pathogens. It will soon be applied to high-throughput screening of infectious agents found in ticks collected throughout the Caribbean, including Trinidad and Tobago, St. Kitts, Barbados, and St. Lucia, thanks to the collaboration with the CaribVet network, and local veterinarians

Aims: Trends in morbidity and mortality, fully or partially attributable to alcohol, for adults aged 18–64 were assessed for Germany. Methods: The underestimation of population exposure was corrected by triangulating survey data with per capita consumption. Alcohol-attributable fractions by sex and two age groups were estimated for major disease categories causally linked to alcohol. Absolute numbers, population rates and proportions relative to all hospitalizations and deaths were calculated. Results: Trends of 100% alcohol-attributable morbidity and mortality over thirteen and eighteen years, respectively, show an increase in rates of hospitalizations and a decrease in mortality rates. Comparisons of alcohol-attributable morbidity including diseases partially caused by alcohol revealed an increase in hospitalization rates between 2006 and 2012. The proportion of alcohol-attributable hospitalizations remained constant. Rates of alcohol-attributable mortality and the proportion among all deaths decreased. Conclusions: The increasing trend in mortality due to alcohol until the mid-1990s has reversed. The constant proportion of all hospitalizations that were attributable to alcohol indicates that factors such as improved treatment and easier health care access may have influenced the general increase in all-cause morbidity. To further reduce alcohol-related mortality, efforts in reducing consumption and increasing treatment utilization are needed.

Aims. Provision and need for mental health services among military personnel are a major concern across nations. Two recent comparisons suggest higher rates of mental disorders in US and UK military personnel compared with civilians. However, these findings may not apply to other nations. Previous studies have focused on the overall effects of military service rather than the separate effects of military service and deployment. This study compared German military personnel with and without a history of deployment to sociodemographically matched civilians regarding prevalence and severity of 12-month DSM-IV mental disorders. Method. 1439 deployed soldiers (DS), 779 never deployed soldiers (NS) and 1023 civilians were assessed with an adapted version of the Munich Composite International Diagnostic interview across the same timeframe. Data were weighted using propensity score methodology to assure comparability of the three samples. Results. Compared with adjusted civilians, the prevalence of any 12-month disorder was lower in NS (OR: 0.7, 95% CI: 0.5–0.99) and did not differ in DS. Significant differences between military personnel and civilians regarding prevalence and severity of individual diagnoses were only apparent for alcohol (DS: OR: 0.3, 95% CI: 0.1–0.6; NS: OR: 0.2, 95% CI: 0.1–0.6) and nicotine dependence (DS: OR: 0.5, 95% CI: 0.3–0.6; NS: OR: 0.5, 95% CI: 0.3–0.7) with lower values in both military samples. Elevated rates of panic/agoraphobia (OR: 2.7, 95% CI: 1.4–5.3) and posttraumatic stress disorder (OR: 3.2, 95% CI: 1.3–8.0) were observed in DS with high combat exposure compared with civilians. Conclusions. Rates and severity of mental disorders in the German military are comparable with civilians for internalising and lower for substance use disorders. A higher risk of some disorders is reduced to DS with high combat exposure. This finding has implications for mental health service provision and the need for targeted interventions. Differences to previous US and UK studies that suggest an overall higher prevalence in military personnel might result from divergent study methods, deployment characteristics, military structures and occupational factors. Some of these factors might yield valuable targets to improve military mental health.

Background: In many countries, the opioid agonists, buprenorphine and methadone, are licensed for maintenance treatment of opioid dependence. Many short-term studies have been performed, but little is known about long-term effects. Therefore, this study described over 6 years (1) mortality, retention and abstinence rates and (2) changes in concomitant drug use and somatic and mental health. Methods: A prevalence sample of n = 2,694 maintenance patients, recruited from a nationally representative sample of n = 223 substitution doctors, was evaluated in a 6-year prospectivelongitudinal naturalistic study. At 72 months, n = 1,624 patients were assessed for outcome; 1,147 had full outcome data, 346 primary outcome data and 131 had died; 660 individuals were lost to follow-up. Results: The 6-year retention rate was 76.6%; the average mortality rate was 1.1%. During follow-up, 9.4% of patients became “abstinent” and 1.9% were referred for drug-free addiction treatment. Concomitant drug use decreased and somatic health status and social parameters improved. Conclusions: The study provides further evidence for the efficacy and safety of maintenance treatment with opioid agonists. In the long term, the number of opioid-free patients is low and most patients are more or less continuously under opioid maintenance therapy. Further implications are discussed.