[Medical Care for Refugees by the Public Health Services: Always Ready--But for How Much Longer?]. / Medizinische Versorgung von Flüchtlingen durch den Öffentlichen Gesundheitsdienst: Allzeit bereit--nur wie lange noch?

Refugees continue seeking sanctuary in Germany and it can reasonably be expected that their health will be affected by the conditions they lived in before and during flight. Ensuring nationwide care for refugees should be demand oriented, effective and efficient, which requires tackling mostly similar challenges a community level in a consistent manner. The aim must be providing adequate medical care based on the principle of respect for human dignity and ensuring public health standards. Within the currently situation, this basic expectations are often not sufficiently met. Generally accepted national standards, longer-term strategies and sustainable care are not yet achieved noticeably by public health services in Germany.To warrant permanent and sustainable high-quality medical care for refugees, local networks of involved institutions should be established with a longer-term perspective. Moreover, the financially eroded and personnel thinned public health service will only be able to fulfil statutory requirements and expectations of the local, state and federal policy makers for a limited amount of time only. Safeguarding that services are coping with the size of challenges over longer periods of time and anchoring the acquired expertise of medical care for refugees within the public health services, requires immediately better financial and personnel resources. Then the public health services will be a reliable partner supporting all people in Germany, particularly those that require subsidiary and socially-compensatory supply.

[Cologne Statement for Medical Care of Refugees]. / Kölner Statement zur medizinischen Versorgung von Flüchtlingen.

The Cologne statement resulted from both regional and nationwide controversial discussions about meaning and purpose of an initial examination for infectious diseases of refugees with respect to limited time, personnel and financial resources. Refugees per se are no increased infection risk factors for the general population as well as aiders, when the aiders comply with general hygiene rules and are vaccinated according to the recommendations of the German Standing Committee on Vaccination (STIKO). This is supported by our own data. Based on individual medical history, refugees need medical care, which is offered purposeful, economic, humanitarian and ethical. In addition to medical confidentiality, the reporting obligation according § 34 Infection Protection Act (IPA) and the examination concerning infectious pulmonary tuberculosis according to § 36 (4) IPA must be considered.

[Sexual health in Germany: indicators as instruments for describing, planning and evaluating : indicators of the German STI society]. / Sexuelle Gesundheit in Deutschland - Indikatoren als Instrumente zum Beschreiben, Planen und Evaluieren : Der Indikatorenkatalog der Deutschen STI-Gesellschaft.

In June 2012 the "Sexual Health" section of the German STI Society (DSTIG) adopted a set of indicators for sexual health in order to depict the sexual health status of people in Germany, as well as to plan and evaluate activities for the improvement of sexual health as a whole. The compiled indicators are measures for determining sexual health in Germany. A logical, convincingly conclusive and yet manageable list of indicators is presented on the basis of the draft submittals of the World Health Organization (WHO). The selected indicators reflect the German situation and are at the same time highly comparable internationally. Potential users of the document are health experts, policy developers, researchers, and other health care professionals.

Molecular epidemiology and characterisation of MRSA isolates from Trinidad and Tobago.

Eighty methicillin-resistant Staphylococcus aureus (MRSA) isolates from three hospitals in Trinidad and Tobago were collected and genotyped using microarray hybridisation. They were found to belong to three distinct MRSA strains. Of the 80 isolates, 76 were assigned to ST239-MRSA-III. They were largely homogeneous, although some variations affected the presence of the enterotoxin A gene, as well as of resistance markers (mercury resistance operon, aadD, tet(K), qacA). The mupA gene conferring mupirocin resistance was found in 7.3% of isolates. One isolate was identified as CC5-MRSA-II and three isolates belonged to the Panton-Valentine leukocidin (PVL)-positive ST8-MRSA-IV strain USA300. While community-acquired MRSA strains are rare in Trinidad and Tobago, the vast majority of MRSA cases can be attributed to healthcare-associated strains. Thus, infection control procedures within medical facilities need to be revised and enforced. This could substantially reduce the burden of MRSA to healthcare in Trinidad and Tobago.

[Observing migration and deficiencies in health care - STD center at the Cologne Municipal Health Department]. / Seismograf für Migration und Versorgungsdefizite - STD-Sprechstunde im Gesundheitsamt Köln.

BACKGROUND: In spite of the compulsory health insurance in Germany, many people only have limited access to medical services. This has serious consequences, especially in the field of sexual health. The affected people are not only undocumented migrants, but also many people from the new European Union countries who are temporarily living in Germany. Many of these people, especially in larger cities, frequent STD counselling centers. METHOD: Since 2002, in addition to basic socio-demographic data, other anonymous data have been recorded for all consultations in the STD offices of the Cologne Health Department. These data include the patients' country of origin, rea-son for consultation, whether the patients are medically insured, as well as the medical services provided and the diagnoses. The data is evaluated with the help of EpiInfo. RESULTS: During the study period, between 608 and 883 people visited the STD Counselling Centre per year. During this period, 4 235 people received in total medical help. The proportion of patients with a migration history rose from 65% in 2002 to 83% in 2010. The proportion of patients without health insurance rose from 45% (2002) to 67% (2010).About half of the counselled migrants were, at least for a short time, involved in professional sexwork. The number of counselled patients from the sub-Saharan region decreased from 123 (2002) to 72 (2010). The number of patients from Central Europe increased from 112 to 364 in this period.Migrants were over-represented in the group of patients who were diagnosed with gonorrhea and trichomoniasis, as well as among women with a conspicuous cytological swab. Chlamydia infections were, in contrast, more frequent among German clients.Gender, sexual orientation, age and the proportion of people involved in sexwork are, however, more important predictive factors than having an immigration status. CONCLUSION: The client spectrum has changed considerably during the study period.These changes are related to economic and political developments, as well as to the consequences of immigration laws. For the majority of patients with a migration history, the STD centre is the primary means of access to medical care in Germany. The rapid change in the client spectrum, the patients' limited access to information and to medical care and the resulting changes in epidemiology represent a major challenge for the public health services.

[Anonymous STD counselling versus mandatory checks for prostitutes--what is effective in STD prevention?]. / Anonyme STD-Sprechstunde versus Pflichtuntersuchung für Prostituierte--was ist effektiv in der STD-Prävention?

BACKGROUND: When in 2001 in Germany the new act for control of infectious diseases came into force, mandatory checks for prostitutes were abolished. The consequences of this paradigm shift in STD prevention are being judged controversially even today. The public health department of the city of Cologne, like others, adapted its programme, staff, equipment, and diagnostic procedures to the new requirements. The department for venereal disease control was converted into a walk-in-clinic for STD and now forms part of a comprehensive STD and Aids prevention unit. The present article illustrates the changes by comparing the clients and the STD numbers of the years 1994 and 2004. METHOD: The following data were compared: number of consultations, number of clients regarding sex, occupation in sex business, health insurance, national or ethnic background, frequency of consultation, number of STD. RESULTS: In 1994, almost all clients of the department for venereal disease control were female prostitutes. 74% of them worked in established sex business venues with a high grade of professionalism, few STD cases were diagnosed. In 2004, the STD clinic was open for anybody considered to be at risk and not having access to the regular health care system. Only 49% of the patients were prostitutes, either female or male. 25% of the clients were male. 68% of the patients were migrants, many of them without any legal status and without any access to regular health care. A high number of acute STD and subsequent disorders that required treatment was registered. Besides the STD-related services, a great need for gynaecological and urological differential diagnostics as well as a high demand for counselling and provision of other problems of sexual health were observed. DISCUSSION: The data show that an STD department providing comprehensive services anonymously and free of charge will reach a broader range of highly vulnerable persons in comparison with an obligatory VD check of prostitutes. The high numbers of STD and STD-related disorders demonstrate the improved effectiveness of the new service.

[Are we testing the right people? Results of a patient questionnaire in the STD and HIV counselling office of the local health authority in the city of Cologne]. / Testen wir die Richtigen? Ergebnisse einer Klientenbefragung in der Beratungsstelle zu STD einschliesslich Aids des Gesundheitsamtes der Stadt Köln.

BACKGROUND: HIV testing and counselling is offered free of charge in most local health offices in Germany. During 2003, a survey was performed among German-speaking clients of the Cologne local health office to look at socio-demographic background, reasons for testing and sexual risk behaviour. METHODS: All German-speaking clients attending the HIV counselling office from March to July 2003 were asked to fill in an anonymous standardised questionnaire. Questions included demographic characteristics, social status, STI history, reasons for HIV testing, sexual orientation and number of sexual partners. Data were compared to the general Cologne population regarding demographic characteristics. Female respondents were compared to heterosexual men and men who have sex with men (MSM); German respondents were compared to migrants using SPSS 14.0. RESULTS: A total of 457 female and 488 male clients participated (response rate 93.9 %). Average age was 28.4 years. Of all participants, 17.7 % were of non-German origin. The respondents had a high school degree in 80.8 % of the cases compared to 33.5 % in the general Köln population (p < 0.001). Among men, 30.2 % were MSM. Having a "new partner" or "unprotected sex with a person with unknown HIV status" were reported by 483 (39.8 %) and 373 (30.8 %) as reasons for testing. 38.7 % of the respondents reported choosing the local health office for HIV testing because it was free of charge and 24.5 % because it was anonymous. Women and heterosexual men had a median of 1, MSM a median of 3 sexual partners within the past 6 months (p < 0.001). Vaccination against hepatitis B was reported by 34.4 % of the clients, the proportion was higher among MSM (46.9 % p < 0.001) and lower among migrants. 112 (11.9 %) persons reported having had a previous STI. CONCLUSIONS: With the exception of MSM, the offer of free and anonymous HIV testing and counselling does not reach persons who carry a higher risk for HIV. As the risk for STI is higher than for HIV in Germany and there is a low public awareness, HIV counselling should be used for comprehensive sexual health counselling and include the offer for STI testing, Further outreaching efforts and other settings are necessary to reach persons with a low education level and highly vulnerable persons.

[Effect of plasmapheresis treatment on immunoglobulin and immune complex levels in patients following kidney transplantation]. / Zum Einfluss der Plasmapheresebehandlung auf Immunglobulin- und Immunkomplexkonzentration bei Patienten nach Nierentransplantation.

Five patients who received cadaver kidneys between May 1982 and January 1983 in the Kidney Transplant Centre in Berlin were subjected to two plasmapheresis (= pph.) treatments in addition to basic immunosuppression with Prednisolone and Azathioprine. The decision to use pph. was due to the presence of donor-specific, complement-dependent lymphocytotoxic antibodies (51Cr release test) in the recipient's serum taken immediately before transplantation. The 1st pph. was carried out on the 1st or 2nd day after operation and the 2nd pph. between the 2nd and 4th day. The quantity of plasma exchanged was between 1.6 and 3.1 1 per pph. Four of the five transplants commenced functioning after 12 to 47 days, and one transplant had to be removed. Frequent measurement of the immunoglobulin and immune-complex levels in the serum revealed drastic reduction due to pph. The concentration of immunoglobulin (G, A, M) was reduced by 42-55% after the 1st pph. and by 20-35% after the 2nd. Whereas the IgM level was normalized after a few days, the levels of IgG and IgA only rose again 2-4 weeks later. The immunodeficiency induced by means of pph. and immunosuppression is accompanied by an increased risk of infection. It is therefore considered important that an adequate anti-infectious treatment including i. v. human gammaglobulin be administered parallel to pph. The final evaluation of the efficacy of pph. in protecting transplants will depend on further studies.

[1st results with the Treponema pallidum hemagglutination (TPHA) test in blood stains]. / Erste Erfahrungen mit dem Treponema-pallidum-Hämagglutinations-(TPHA)-Test an Blutspuren.

Bloodstains were produced from probationers who had had syphilis at some time in their lives and from others whose anamnesis had no indication of syphilis. After storage the stain eluates underwent the treponema-pallidum-haemagglutination (TPHA) test, with the eluates' IgG content being adapted to a concentration adequate to the test conditions. The results received from the stain eluates of the previous syphilis patients corresponded in 85% of the cases with the serum findings of these probationers. It appears that the TPHA test can already provide clues as to the identity of an unknown stain producer at the beginning of the police investigation. Methodical parallels to dried-blood tests of syphilis as a clinical problem will be discussed.