Background: It is unclear whether generalized anxiety disorder (GAD) has a specific relationship to pain syndromes, going beyond the established association of pain with anxiety syndromes in general. Methods: Mental disorders were assessed in a community sample (N = 4181; 18–65 years) using the DSM-IV/M-CIDI. Several threshold definitions were used to define GAD and medically unexplained pain. Results: The association between pain and GAD (odds ratio, OR = 5.8 pain symptoms; OR = 16.0 pain disorder) is stronger than the association between pain and other anxiety disorders (OR = 2.4 pain symptoms; OR = 4.0 pain disorder). This association extends to subthreshold level definitions of GAD with some indication for a non-linear dose–response relationship. The GAD-pain link cannot sufficiently be explained by demographic factors, comorbid mental or physical disorders. Conclusions: The association of pain and generalized anxiety is not artifactual. Compared to other anxiety syndromes, it appears to be stronger and more specific suggesting the need to explore clinical and public health implications.

Background: Cannabis use (CU) and disorders (CUD) are highly prevalent among adolescents and young adults. We aim to identify clinically meaningful latent classes of users of cannabis and other illegal substances with distinct problem profiles. Methods: N= 3021 community subjects aged 14–24 at baseline were followed-up over a period ranging up to 10 years. Substance use (SU) and disorders (SUD) were assessed with the DSM-IV/M-CIDI. Latent class analysis (LCA) was conducted with a subset of N= 1089 subjects with repeated illegal SU. The variables entered in the LCA were CU-related problems, CUD, other SUD, and other mental disorders. Results: Four latent classes were identified: “Unproblematic CU” (class 1: 59.2%), “Primary alcohol use disorders” (class 2: 14.4%), “Delinquent cannabis/alcohol DSM-IV-abuse” (class 3: 17.9%), “CUD with multiple problems” (class 4: 8.5%). Range and level of CU-related problems were highest in classes 3 and 4. Comorbidity with other mental disorders was highest in classes 2 and 4. The probability of alcohol disorders and unmet treatment needs was considerable in classes 2–4. Conclusion: While the majority of subjects with repeated illegal SU did not experience notable problems over the 10-year period, a large minority (40.8%) experienced problematic outcomes, distinguished by clinically meaningful profiles. The data underline the need for specifically tailored interventions for adolescents with problematic CU and highlight the potentially important role of alcohol and other mental disorders.

The role of comorbidity as a risk for suicide attempts is investigated in a random sample of 3021 young adults aged 14–24 years. The M-CIDI, a fully standardized and modified version of the Composite International Diagnostic Interview, was used for the assessment of various DSM-IV lifetime and 12-month diagnoses as well as suicidal ideation and suicide attempts. Of all suicide attempters, 91% had at least one mental disorder, 79% were comorbid or multimorbid respectively and 45% had four or more diagnoses (only 5% in the total sample reached such high levels of comorbidity). Suicide attempters with more than three diagnoses were 18 times more likely (OR = 18.4) to attempt suicide than subjects with no diagnosis. Regarding specific diagnoses, multivariate comorbidity analyses indicated the highest risk for suicide attempt in those suffering from anxiety disorder (OR = 4.3), particularly posttraumatic stress disorder followed by substance disorder (OR = 2.2) and depressive disorder (OR = 2.1). Comorbidity, especially when anxiety disorders are involved, increases the risk for suicide attempts considerably more than any other individual DSM-IV diagnoses.

Discussion surrounds the question as to whether criteria for generalized anxiety disorder (GAD) should change, particularly in youth. This study examines the effects of possible criteria changes on GAD prevalence and clinical correlates. DSM-IV GAD was assessed using the M-CIDI in a community sample of adolescents and young adults. Diagnostic thresholds were modified in two age spans (9–20 and 21–34 years) using a person-by-year data file (N = 38,534 cases). Relaxing the duration or excessiveness criteria led to the most pronounced changes in GAD prevalence, while relaxing frequency, uncontrollability, or associated-symptom criteria had smaller effects. A lower duration requirement increased rates more in older than younger age spans. Opposite effects occurred for changes in associated-symptoms or clinical-significance criteria. Broader GAD definitions identified cases in both age spans that appeared mostly milder than DSM-IV cases but that still differed from non-GAD cases in various clinical factors and validators. Developmental aspects require stronger consideration in future diagnostic systems.

Background Among adolescents and young adults with DSM-IV alcohol use disorders (AUDs), there are inter-individual differences in the speed of transition from initial alcohol use (AU) to AUD. AUDs are highly co-morbid with other mental disorders. The factors associated with rapid transition from first AU to AUD remain unknown and the role of mental disorders in rapid transitions is unclear. Given this background we examined (1) whether prior anxiety, mood, externalizing and non-alcohol substance use disorders are related to the risk and speed of transition from first AU to DSM-IV alcohol abuse (AA) and alcohol dependence (AD) and (2) whether early age of onset of prior mental disorders (PMDs) is a promoter of rapid transition. Method A total of 3021 community subjects (97.7% lifetime AU) aged 14–24 years at baseline were followed up prospectively for up to 10 years. AU and mental disorders were assessed with the DSM-IV/M-CIDI. Results Among subjects with lifetime AU, several PMDs, such as specific phobia, bipolar disorder and nicotine dependence, were associated with an increased risk of AUD independent of externalizing disorders. Associations of PMDs with the speed of transition to AUDs were mostly weak and inconsistent. Only social phobia and externalizing disorders were associated with faster transitions to AD even after adjustment for other PMDs. Earlier age of onset of PMD was not associated with rapid transition. Conclusions Mental disorders are associated with the risk of AUD. With the possible exception of social phobia and externalizing disorders, they do not promote rapid transition, even if they occur particularly early. Future research needs to identify factors relevant to rapid transition to AUD.

No description available.

In den letzten Jahren erreichten viele neue (emerging) Viren Europa, die zum Teil (z.T.) zoonotisch auf den Menschen übertragbar sind. So musste man sich mit Geflügel- und Schweinegrippe, Blauzungenkrankheit, Infektiöser Anämie der Einhufer oder auch SARS (severe acute respiratory syndrome) auseinandersetzen. Bedingt durch verschiedene Faktoren, wie Klimawandel oder zunehmende Globalisierung und damit einhergehendem Verkehr zwischen den Kontinenten verbesserten sich auch die Bedingungen für die Virusverbreitung, so dass viele für Deutschland untypische Krankheitserreger auch hier auftraten. Das West-Nil-Virus (WNV) ist in Europa bereits endemisch verbreitet und könnte somit eine besondere Gefahr für Deutschland darstellen. Es ist ein bekannter Zoonose-Erreger, und sein Eintrag und die rasche Verbreitung des Virus in Amerika 1999 zeigten wie gefährlich neue Viren in naiven Populationen sein können. Über die Verbreitung des Virus in Deutschland gibt es nur wenige Studien z.B. des Robert-Koch-Instituts (LINKE et al. 2007a) und des Friedrich-Loeffler-Instituts (SEIDOWSKI et al. 2010), wobei in keiner Studie tote Vögel als Untersuchungsmaterial genutzt wurden. Da das WNV in Amerika mit einem auffälligen Vogelsterben einherging, ist es naheliegend, den Virusnachweis zuerst bei toten Vögeln zu erbringen.

Einleitung: Im Rahmen eines Projekts wird untersucht, ob sich medizinische Laien mit einem neugestalteten internetbasierten Informationssystem besser informieren können, als dieses mit Suchmaschinen und Gesundheitsportalen möglich ist. Die Evaluation eines Systems zur Informationsversorgung von Kopfschmerzpatienten ist nur dann sinnvoll, wenn tatsächlich viele Menschen im deutschsprachigen Raum unter Kopfschmerzen leiden und mit Ihren Beschwerden eher das Internet als einen Arzt konsultieren. Daher wurde in drei Studien die Prävalenz von Kopfschmerzen und die damit verbundene Arztkonsultationsquote untersucht. Methode: Dazu wurden 2000 Versicherte der BARMER Ersatzkasse, ca. 9000 Studenten der Hochschule Bremen und ca. 1000 Studenten der Universität für Gesundheitswissenschaften, Medizinische Informatik und Technik in Tirol, Österreich (UMIT) angeschrieben und gefragt, ob sie unter Kopfschmerzen leiden und wenn ja, ob sie für ihre Kopfschmerzen bereits eine ärztliche Diagnose haben. Insgesamt nahmen 521 Personen an der Untersuchung teil. Ergebnisse: Davon litten 292 Teilnehmer (56 %) unter Kopfschmerzen. Eine ärztliche Diagnose für diese hatten 52 (18 %). Alles in allem zeigt sich damit eine etwas geringere Kopfschmerzprävalenz als in den vorangegangen Studien. Die in der Literatur genannte Arztkonsultationsquote wird bestätigt. Diskussion: Die Auswertung der drei Studien zeigte, dass die Prävalenz von Kopfschmerzen weiterhin hoch und die damit verbundene Arztkonsultationsquote immer noch gering ist. / Introduction: In a project, it is investigated whether a newly designed web-information system can better inform medical laymen than traditional search engines and health portals. The evaluation of a system for providing information to headache patients is only useful when in fact many people suffer from headaches in the German speaking area and if these people with their complaints rather consult the Internet than a practitioner. Therefore, in three studies the prevalence of headache and the associated physician consultation rate was examined. Method: About 9000 students of the University of Applied Sciences Bremen, 2000 insurants of the BARMER, and about 1000 students of the University of Health Sciences, Medical Informatics and technology Tyrol, Austria (UMIT) were asked if they suffer from headaches and if so whether they already have a medical diagnosis. A total of 521 persons participated in the investigation. Results: From headaches suffered 292 (56%) participants. A medical diagnosis for these had 52 (18%). All in all, it shows slightly lower headache prevalence than found in previous studies. The medical consultation rate cited in the literature is confirmed. Discussion: The evaluation of the three studies showed that the prevalence of headache remains high and the associated physician consultation rate is still low.

This study focuses on the question of the epidemiology of resistance to antibiotics in Acinetobacter baumannii, which is nowadays one of the most problematic bacterial patho- gens associated with failing antimicrobial therapy. Its aim was to define population-genetic properties, epidemiology and the nature of multidrug resistance for a sample of the current population of A. baumannii from Czechia. A total of 55 isolates were collected in eight medi- cal facilities in central Bohemia from October 2016 to May 2018. The isolates were assessed for their identity at the species, clonal and strain levels as well as resistance phenotype and genotype; they were classified into five clonal groups, each of which encompassed isolates that were likely to be epidemiologically related. The 55 isolates studied belonged, nearly exclusively, to global clone ECII, with 53 % of them forming a genetically relatively homoge- neous group characterized by extensive resistance to antibiotics (susceptible only to col- istin), the presence of genes encoding ArmA a OXA-23 (resistance to all aminoglycosides and carbapenems) and spread in all locations. The in-depth epidemiological analysis of isolates from the city of Příbram and its vicinity indicated the regional spread of two strains, one of which belonged to the...

Notre travail est une contribution à l'étude des leishmanioses en Iran. Il s'est focalisé sur trois volets. Le principal concerne les Phlébotomes. Les deux autres sont constitués par les Rongeurs réservoirs de L. major et l'Homme.L'étude des phlébotomes s'est réalisée selon deux axes : systématique et épidémiologique. Les approches de systématique nous a conduit à réaliser des inventaires faunistiques dans plusieurs régions d'Iran (nord-ouest, Nord-est, est et centre du pays). Ces inventaires nous ont permis de réactualiser la distribution de certains groupes, notamment les phlébotomes du sous-genre Adlerius et de mentionner deux espèces nouvelles pour la faune du l'Iran : Phlebotomus turanicus et P. salangensis. A côté de ces travaix de faunistique, nous avons réalisé deux travaux de systématique évolutive qui couplent des approches morphologique et morphométrique à des approches moléculaires associant un marqueur ribosomique à un marqueur mitochondrial. Nous avons ainsi étudié P. perfiliewi s.l. et le sous-genre Adlerius sur un échantillonnage débordant largement le cadre de l'Iran. Les travaux d'épidémiologie nous ont permis de vérifier que les foyers que nous avons étudiés fonctionnent sur un mode classique dans lequel P. papatasi, et à un degré probablement moindre les femelles du groupe Caucasicus transmettent Leishmania major alors que P. sergenti assure la transmission de L. tropica. L'identification des parasites est réalisée par voie moléculaire : PCR et RFLP et/ou séquençage de marqueurs ribosomiques. L'étude des Rongeurs réservoirs de L. major nous a permis de constater le rôle essentiel de réservoir de Rhombomys opimus et de Meriones libycus dans le pays avec l'observation de prévalences très élevées, supérieures à 30 % chez ces espèces.Enfin, une étude a été conduite dans la region de Fars où sévissent classiquement des leishmanioses à L. major, L. tropica et à L. infantum. Chez 44 patients présentant des lésions cutanées, nous avons isolé et identifié essentiellement L. major et quelques souches de L. tropica. / This work focused on the leishmaniases in Iran. It includes three topics: i) the Phlebotomine sand flies, ii) the rodent reservoirs of Leishmania major and iii) the Humans.The entomological studies concern both systematics and epidemiology.The systematic part of the study of Phlebotomine sand flies includes several inventories carrired out in several provinces of Iran (North-West, North-East, East and Center of the country). Our results update the distribution of the subgenus Adlerius. We also recorded two new species for the fauna of Iran: Phlebotomus turanicus and P. salangensis. We also carried out evolutive and comparative systematics including specimens from Iran, neighbouring and Mediterranean countries. We coupled morphology to morphometrics and molecular systematics. In the latter approach, we coupled a ribosomal DNA marker to a mitochondrial one. We studied P. perfiliewi s.l. and the subgenus Adlerius. Our epidemiological works focusing on the epidemiology in several parts of the country showed that the studied foci are classical: P. papatasi, and also the females of the Caucasicus group transmit Leishmania major whereas P. sergenti is the vector of L. tropica.The identification of the Leishmania has been done using PCR then RFLP and/or sequencing of rDNA Internal Transcribed Spacer 1.We studied the rodent reservoirs of L. major. Rhombomys opimus and Meriones libycus play an important role and the percentage of L. major infection is high (> 30%).Lastly, we carried out a study on patients from the province of Fars. In this area, leishmaniases are due to L. major, L. tropica and L. infantum. We have typed strains isolated from 42 ot 44 patients. The majority of the strains have been identified as L. major and a few L. tropica.