Forecast of omicron wave time evolution

Adopting an early doubling time of three days for the rate of new infections with the omicron mutant the temporal evolution of the omicron wave in different countries is predicted. The predictions are based on the susceptible-infectious-recovered/removed (SIR) epidemic compartment model with a constant stationary ratio k=mu(t)/a(t) between the infection (a(t)) and recovery (mu(t)) rate. The fixed early doubling time then uniquely relates the initial infection rate a0 to the ratio k, which therefore determines the full temporal evolution of the omicron waves. For each country three scenarios (optimistic, pessimistic, intermediate) are considered and the resulting pandemic parameters are calculated. These include the total number of infected persons, the maximum rate of new infections, the peak time and the maximum 7-day incidence per 100000 persons. Among the considered European countries Denmark has the smallest omicron peak time and the recently observed saturation of the 7-day incidence value at 2478 is in excellent agreement with the prediction in the optimistic scenario. For Germany we predict peak times of the omicron wave ranging from 32 to 38 and 45 days after the start of the omicron wave in the optimistic, intermediate and pessimistic scenario, respectively, with corresponding maximum SDI values of 7090, 13263 and 28911, respectively. Adopting Jan 1st, 2022 as the starting date our predictions implies that the maximum of the omicron wave is reached between Feb 1 and Feb 15, 2022. Rather similar values are predicted for Switzerland. Due to an order of magnitude smaller omicron hospitalization rate, due to the high percentage of vaccinated and boostered population, the German health system can cope with maximum omicron SDI value of 2800 which is about a factor 2.5 smaller than the maximum omicron SDI value 7090 in the optimistic case. By either reducing the duration of intensive care during this period of maximum, and/or by making use of the nonuniform spread of the omicron wave across Germany, it seems that the German health system can barely cope with the omicron wave avoiding triage decisions. The reduced omicron hospitalization rate also causes significantly smaller mortality rates compared to the earlier mutants in Germany. In the optimistic scenario one obtains for the total number of fatalities 7445 and for the maximum death rate 418 per day which are about one order of magnitude smaller than the beta fatality rate and total number.

Total health insurance costs in children with a migraine diagnosis compared to a control group

Background Health care costs of migraine constitute a major issue in health economics. Several publications analyzed health care costs for adult migraine patients, based on questionnaires or secondary (health insurance) data. Although migraine often starts already in primary school age, data on migraine related costs in children is scarce. In this paper we aimed to assess the migraine-related health care costs in 6 to 11 year old children in Germany. Methods Using claims data of a large German health insurer (BARMER), overall annual health care costs of 6 to 11 year old children with a diagnosis of migraine in 2017 (n = 2597) were compared to a control group of 6 to 11 year old children without a headache diagnosis between 2013 and 2017 (n = 306,926). The association of migraine and costs was modeled by generalized linear regression (Gamma regression) with adjustment for sex, age and comorbidities. Results Children with migraine caused considerably higher annual per capita health care costs than children without a headache diagnosis (migraine group: € 1018, control group: € 618). Excess costs directly related to migraine amounted to € 115. The remaining excess costs were related to comorbidities, which were more frequent in the migraine group. Mental and behavioural disorders constituted the most expensive comorbidity, accounting for € 105 of the € 400 annual excess costs in the migraine group. Conclusion 6 to 11 year old children with a migraine diagnosis cause significant direct and comorbidity related excess costs in the German health care system.

Physical Therapy Use and Associated Factors in Adults with and without Osteoarthritis—An Analysis of the Population-Based German Health Update Study

Background: Physical therapy (PT) is recommended as first-line management for osteoarthritis (OA). The purpose of this study was to assess the PT use among adults with OA and those without (Non-OA) and subsequently identify associated factors among these populations. Methods: This cross-sectional study obtained national data from the population-based German Health Update (GEDA2014/2015-EHIS) study containing 24,016 participants aged 18 years and older. Analyses were stratified by sex, age, socioeconomic status (SES), residence, smoking behavior, body mass index, pain and general health. Multivariate regression analysis was conducted to evaluate factors associated with PT use within the past 12 months. Results: PT was used more frequently in the OA population compared with the Non-OA population (35.8% vs. 18.7%). In both populations, women, participants with high SES, residence in Eastern Germany, severe pain, poor general health and non-smokers received PT more frequently. Multivariate analysis confirmed these findings, in addition to people aged 80 years and older. The influence of SES was higher among OA participants. Conclusion: The underutilization of PT in OA patients (35.8%) was particularly evident among males, people with a low SES and those being older than 60 years, which aids to develop strategies increasing PT use towards guideline-oriented OA management.

Sick and Tired—Sociodemographic and Psychosocial Characteristics of Asylum Seekers Awaiting an Appointment for Psychotherapy

Background: An EU directive holds the EU member states responsible for implementing the provision of health care for asylum seekers. However, current literature indicates insufficient care for asylum seekers in the German health system. This article aims to characterize the situation of the client population on the waiting list of a psychosocial center (PSZ). Methods: We conducted a retrospective observational study based on client files in Halle (Saale), Germany. We included 437 adults who were on the PSZ waiting list between 2016 and 2019. Questionnaires that collected information on the clientele at two different times were analyzed. Results: The average waiting time for psychotherapy was 50 weeks. In total, 85.6% of the 188 respondents reported sleep disorders (n = 161), 65.4% of clients reported pain (n = 123) and 54.8% suicide attempts/suicidal thoughts (n = 54). In the 16-week waiting period in which the clients waited for an initial appointment with a psychologist, the residence status deteriorated in 21.3% (n = 40). Conclusion: Improving asylum seekers’ access to the German health system is urgently needed in order to prevent unnecessary suffering in the future and to comply with EU law.

How do health professionals translate evidence on early childhood allergy prevention into health literacy-responsive practice? A protocol for a mixed-method study on the views of German health professionals

IntroductionPaediatricians, general practitioners (GPs) and midwives in primary care are important sources of information for parents on early childhood allergy prevention (ECAP). Research has shown that preventive counselling by health professionals can be effective in improving patients’ health literacy (HL) and health behaviour. Providing effective advice relies on two factors. First, health professionals need be up-to-date with research evidence on ECAP, to consider popular misconceptions and fears and to translate this knowledge into clear recommendations for parents (knowledge translation). Second, they need to know and apply counselling techniques and create a practice setting which accommodates parental HL needs (health literacy-responsive care). The objective of this study is to explore and assess how German health professionals take up and translate ECAP evidence into appropriate recommendations for parents, how they consider HL in counselling and practice organisation and what barriers and enablers they find in their performance of HL-responsive ECAP.Methods and analysisThe study has a sequential mixed-method design, in two phases. In the first phase, qualitative semi-structured expert interviews will be conducted with health professionals (paediatricians, GPs and midwives) at primary care level and professional policy level. Data collection is ongoing until January 2022. In the second phase, based on the qualitative results, a standardised questionnaire will be developed, and pilot-tested in a wider population of German health professionals. The findings of both phases will be integrated.Ethics and disseminationThe study has received ethical approval from the Ethics Committee of the University of Regensburg (18-1205-101). The results will be published in international peer-reviewed open access journals and via presentations at scientific conferences. The results will also be shared with German health professionals, decision-makers and potential funders of interventions.

The Security State of the German Health Web: An Exploratory Study

The internet has become an important resource for health information and for interactions with healthcare providers. However, information of all types can go through many servers and networks before reaching its intended destination and any of these has the potential to intercept or even manipulate the exchanged information if data’s transfer is not adequately protected. As trust is a fundamental concept in healthcare relationships, it is crucial to offer a secure medical website to maintain the same level of trust as provided in a face-to-face meeting. This study provides a first analysis of the SSL/TLS security of and the security headers used within the health-related web limited to web pages in German, the German health web (GHW). Methods: testssl.sh and TLS-Scanner were used to analyze the URLs of the 1,000 top-ranked health-related web sites (according to PageRank) for each of the country- code top level domains: “.de”, “.at” and “.ch”. Results: Our study revealed that most websites in the GHW are potentially vulnerable to common SSL/TLS security vulnerabilities, offer deprecated SSL/TLS protocol versions and mostly do not implement HTTP security headers at all. Conclusions: These findings question the concept of trust within the GHW. Website owners should reconsider the use of outdated SSL/TLS protocol versions for compatibility reasons. Additionally, HTTP security headers should be implemented more consequently to provide additional security aspects. In future work, the authors intend to repeat this study and to incorporate a website’s category, i.e. governmental or public health, to get a more detailed view of the GHW’s security.