Migraine patients in Germany - need for medical recognition and new preventive treatments: results from the PANORAMA survey

Background Migraine is a primary headache disorder characterized by recurrent attacks that may have a significant impact on patients’ daily life. Treatment options must often be re-evaluated in light of efficacy, tolerability and compliance issues. Few data on commonly applied treatment algorithms and treatment failures have existed in Germany in 2017/2018. The PANORAMA survey was designed to explore and characterize the migraine healthcare landscape and to demonstrate the medical treatment need at that time in Germany. Methods Three different questionnaires were used to assess the profile of the 119 participating centers, characterize migraine patients at centers and evaluate qualitative aspects of the current migraine healthcare situation from a physician´s professional perspective. Data were analyzed as observed and summarized by descriptive statistics. Results The results demonstrate that once referred to a migraine specialist, the majority of patients continue to be treated at a specialist. At specialized centers, 41.6 % of migraine patients receive prophylactic treatment. 45.4 % of prophylactic treatments are initiated with a beta-blocker and 28.1 % with an anti-epileptic. Pivotal factors to initiate prophylactic treatment are migraine attack frequency and intensity (58.0 %). Treatment decisions are largely based on prior / concomitant diseases and physical constitution of the patient (52.1 %). Following an inadequate treatment, most patients either switch substance class or discontinue prophylactic treatment. Conclusions PANORAMA gives a comprehensive overview of the migraine healthcare landscape in Germany in 2017/2018, elucidates a lack of common treatment algorithms and reveals a high demand for defined therapy strategies and new prophylactic treatment going forwards.

Migraine patients in Germany - Need for Medical Recognition and New Preventive Treatments: Results from the PANORAMA Survey

Background: Migraine is a primary headache disorder characterized by recurrent attacks that may have a significant impact on patients’ daily life. Treatment options must often be re-evaluated in light of efficacy, tolerability and compliance issues. Few data on commonly applied treatment algorithms and treatment failures have existed in Germany in 2017/2018. The PANORAMA survey was designed to explore and characterize the migraine healthcare landscape and to demonstrate the medical treatment need at that time in Germany.Methods: Three different questionnaires were used to assess the profile of the 119 participating centers, characterize migraine patients at centers and evaluate qualitative aspects of the current migraine healthcare situation from a physician´s professional perspective. Data were analyzed as observed and summarized by descriptive statistics.Results: The results demonstrate that once referred to a migraine specialist, the majority of patients continue to be treated at a specialist. At specialized centers, 41.6% of migraine patients receive prophylactic treatment. 45.4% of prophylactic treatments are initiated with a beta-blocker and 28.1% with an anti-epileptic. Pivotal factors to initiate prophylactic treatment are migraine attack frequency and intensity (58.0%). Treatment decisions are largely based on prior / concomitant diseases and physical constitution of the patient (52.1%). Following an inadequate treatment, most patients either switch substance class or discontinue prophylactic treatment. Conclusions: PANORAMA gives a comprehensive overview of the migraine healthcare landscape in Germany in 2017/2018, elucidates a lack of common treatment algorithms and reveals a high demand for defined therapy strategies and new prophylactic treatment going forwards.

Problems of implementing the rights to housing and health protection of internally displaced persons in Ukraine: theoretical and practical aspects

The article studies the problems of state provision of such socio-economic rights and freedoms of internally displaced persons as the right to housing and the right to health protections and proposes updating of current legislation in this area. It is found that Ukraine lacks the Unified registry of state, communal and private property to register internally displaced persons. Special emphasis is laid on the necessity for such registry’s provision and maintenance. The low level of medical services provision of internally displaced persons is revealed. The cause of displacement is identified and recommendations concerning improvement of the current healthcare situation are given.

Bioethical Issues in Antarctica

This paper describes the Antarctic environment, the mission and work setting at the U.S. research stations, the general population and living conditions, and the healthcare situation. It also dispels some common misconceptions that persist about this environment and about the scope and quality of medicine practiced there. The paper then describes specific ethical issues that arise in this environment, incorporating examples drawn from both the author’s experiences and those of his colleagues. The ethics of providing healthcare in resource-poor environments implies two related questions. The first is: What can we do with the available resources? This suggests that clinicians must not only know how to use all available equipment and supplies in the standard manner, but also that they must be willing and able to go beyond standard procedures and improvise, when necessary. The second question is: Of all the things we can do, which ones should we do? This paper addresses both questions in relation to Antarctic medical care. It describes the wide range of activities required of healthcare providers and some specific ethical issues that arise. Finally, it suggests some remedies to ameliorate some of those issues.

DenseNet Convolutional Neural Networks Application for Predicting COVID-19 Using CT Image

Public health and human lives recently have been impacted by the devastating effect of Coronavirus 2019. This catastrophic effect has destroyed the human experience by creating a chaotic healthcare situation infinitely more destructive than the Second World War. Strong communicable characteristics of COVID-19 among human communities make the world’s situation a severe pandemic. Due to the unavailable vaccine of COVID-19 to control rather than cure, early and accurate detection of the virus can be a promising technique for tracking and preventing the infection spreading (e.g., by isolating the patients). This situation indicates to improve auxiliary COVID-19 detection technique. Computed tomography (CT) imaging is a mostly used technique for pneumonia because of its common availability. The application of artificial intelligence systems integrated with images can be a promising alternative for the identification of COVID-19. This paper presents a promising technique of predicting COVID-19 patients from the CT image using convolutional neural networks (CNN). The novel approach is based on DenseNet is the updated CNN architecture in the present state to detect COVID-19. The results outperformed 92% accuracy, with 95% recall showing good performance for the identification of COVID-19.

Towards developing a Healthcare Situation Monitoring Method for Smart City Initiatives

Research in Smart City development has been proliferated over the past few years, which focused heavily on various supporting service sectors, such as healthcare. However, little effort has been made to design health surveillance support systems, which is also important for the advancement of public healthcare monitoring as an essential smart city initiatives. From an information system (IS) design perspective, this paper introduces a social media-based health surveillance supporting method, which can automatically extricates relevant online posts for health symptom management and prediction. We describe and demonstrate an IS design approach in this paper for hay-fever prediction solution concept based on Twitter posts. This concept can be applicable to fully functional solution design by relevant practitioners in this field.

Health situation and health care of women aged 50 years and older in rural regions in Germany

Background In many countries demographic changes and regional differences lead to inequalities in healthcare provision. In Germany, this applies especially to rural regions and could affect the healthcare situation of middle-aged and older women in particular. Our study, which is part of the project “Frauen 5.0”, explores the health and healthcare situation of women 50 years and older in Northeastern Germany, with focus on outpatient gynaecological and general medical care and reasons for healthcare utilisation. Methods Our analyses comprise the health situation of women aged 50 years and older, their utilisation of outpatient gynaecologists and general practitioners (GPs), reasons for utilisation, access barriers to outpatient care, the demographic situation and the spatial distribution of gynaecological and GP practices in Northeastern Germany. We use a variety of data sources; main data source is the German Health Interview and Examination Survey for Adults (DEGS1, 2008-2011), which was carried out by the Robert Koch Institute and is representative of the German adult population. Results There is an unequal distribution of gynaecologic and GP practices in Northeastern Germany, with the highest density in and around Berlin. About 30% of gynaecologists and GPs in the study region are aged 60 years and older. Whereas in all age groups at least 80% of women used GP services in the last 12 months, the use of gynaecologic services declines from 80% in 18- to 29 year-old to 45% in 70- to 79 year-old women. Most important reasons for seeking gynaecological treatment are menopause and early detection of cancer. Conclusions The analyses show that there is need to ensure adequate health care for women aged 50 and over in rural regions in Germany. Based on the results, within the project “Frauen 5.0” innovative solutions for this task, e.g. interprofessional cooperation, will be identified. Key messages Analyses of outpatient healthcare services show an unequal distribution of gynaecologic and GP practices in Northeastern Germany; about 30% of the gynaecologists and GPs are aged 60 years and older. Whereas in all age groups at least 80% of women used GP services in the last 12 months, the use of gynaecologic services declines from 80% in 18- to 29 year-old to 45% in 70- to 79 year-old women.

Prevalence, symptomatology, risk factors and healthcare services utilization regarding paternal depression in Germany: study protocol of a controlled cross-sectional epidemiological study

Background While postpartum depression is a well-researched disorder in mothers, there is growing evidence indicating that some fathers also develop depressive symptoms (paternal postpartum depression, PPD). A recent meta-analysis revealed a total prevalence of paternal depression during pregnancy and up to one year postpartum of 8.4%, with significant heterogeneity observed among prevalence rates. International studies suggest that PPD is characterized by additional symptoms compared to maternal postpartum depression. Furthermore, various risk factors of PPD have been identified. However, the prevalence, symptomatology, risk factors and healthcare situation of fathers affected by PPD in Germany are unknown. Methods/design This study comprises a controlled, cross-sectional epidemiological survey administered via postal questionnaires. The primary objective is to compare the prevalence of depressive symptoms in fathers with a 0–12-month-old infant to the prevalence of depressive symptoms in men without recent paternity. Two structurally differing regions (concerning birthrate, employment status, socioeconomic structure, and nationality of inhabitants) will be included. A random sample of 4600 fathers (2300 in each region) in the postpartum period and 4600 men without recent paternity matched by age, nationality and marital status will be assessed regarding depressive symptoms using the PHQ-9. Contact data will be extracted from residents’ registration offices. As secondary objectives, the study aims to provide insights into symptoms and risk factors of PPD in fathers and to assess the current healthcare situation of fathers with PPD in Germany. In an add-on study, genetic and epigenetic mechanisms of PPD will be explored. Discussion This study will conduct the first direct comparison between fathers in the postpartum period of one year after childbirth and a matched sample of men without a newborn child. Besides closing this research gap, the findings will provide prevalence estimates as well as insights into specific symptomatology, risk factors, and the current healthcare situation regarding fathers with PPD in Germany. The results will identify low-threshold approaches as a relevant issue for healthcare. Moreover, the findings should inform the development of PPD-specific screening instruments and healthcare offers addressing fathers with PPD. Trial registration German Clinical Trials Register (DRKS): DRKS00013339; Trial registration date: August 20, 2018; Universal Trial Number (UTN): U1111–1218-8185.