The Berlin index of health and social deprivation: a data based tool to tackle health inequality

Background

Reducing socially induced health inequalities is a key task of urban and regional public health authorities. The Berlin index of health and social deprivation (BIHSD) 2022 aims to show regional differences in health and social situation in sub-areas of the city, to observe developments over time and to identify socially deprived sub-areas of the city.

Methods

The BIHSD 2022 is based on 20 indicators, most of which come from official statistics. Principal component analyses were applied to calculate subindices for the dimensions employment (e.g. unemployment rate), social conditions (e.g. risk-of-poverty rate) and health (e.g. premature mortality). Based on these subindices the final health and social index was derived. The (sub)indices are available on different spatial levels. Relative changes compared to the BIHSD 2013 were calculated to identify regional trends in the transitions in the social structure and health of the city over time.

Results

Besides improvements for most indicators over time in most regions of Berlin, there is still significant evidence for health and social inequality across the city. For example, long-term unemployment rate varies between 0.5% and 40.4% on the lowest spatial level. Following a secular trend, there are substantial improvements in former deprived areas in the inner city while in many peripheral residential areas with an average social structure in the past a downwards trend was observed.

Conclusions

Deprivation indices are helpful tools for research and health reporting in providing evidence for regional inequality. Additionally, they can be used to tailor health promotion strategies and to promote a targeted allocation of financial resources. For example, results of the BIHSD 2022 are being used in epidemiological analyses (e.g. regional inequalities in the risk of SARS-CoV-2 infection) and for (health) policy planning (e.g. needs- and demand-based planning of healthcare).

Key messages

• The Berlin index of health and social deprivation 2022 show regional differences in health and social situation in sub-areas of the city and documents developments over time.

• The index is being used in epidemiological analyses, to tailor health promotion strategies, and to promote a targeted allocation of financial resources.

A bridged loop gap resonator (BLGR) for small animal imaging by 1.5 T MRI systems

A bridged loop gap resonator (BLGR) was developed as a transmit and receive coil for a mobile insert to be used for small animal proton imaging by 1.5 T MRI devices. The insert system has its own gradient system, radio frequency (RF) transmit and receive coil, and control and signal processing unit. The reflection S₁₁ and transmission S₂₁ parameters, quality factor (Q), sensitivity, signal to noise ratio (SNR), and maps of the static (B₀) and RF (B₁) magnetic flux densities were measured. The RF coil was developed starting from a loop gap resonator (LGR) for a balanced LGR and a shielded balanced LGR for a shielded bridged balanced LGR. The purpose of developing this device is to minimize the influence of the sample and surroundings on the RF coil parameters. The final design of the BLGR does not require retuning after a sample change. A 3D image of a mouse in formalin was acquired with a fast low angle shot (FLASH) MRI sequence. The SNR was calculated from one FLASH image. The signal for SNR calculation was acquired from a gadolinium-doped water sample and the noise from the air outside of the sample. This article verifies that the BLGR is viable for small animal nuclear magnetic resonance imaging at 1.5 T and is independent of sample size and material.

Vaccine-Associated Maintenance of Epithelial Integrity Correlated With Protection Against Virus Entry

To identify the mechanisms by which human immunodeficiency virus type 1 (HIV-1) might penetrate the epithelial barrier during sexual transmission to women and the mechanisms of vaccine-associated protection against entry, we characterized early epithelial responses to vaginal inoculation of simian immunodeficiency virus strain mac251 (SIVmac251) in naive or SIVmac239Δnef-vaccinated rhesus macaques. Vaginal inoculation induced an early stress response in the cervicovaginal epithelium, which was associated with impaired epithelial integrity, damaged barrier function, and virus and bacterial translocation. In vaccinated animals, early stress responses were suppressed, and the maintenance of epithelial barrier integrity correlated with prevention of virus entry. These vaccine-protective effects were associated with a previously described mucosal system for locally producing and concentrating trimeric gp41 antibodies at the mucosal interface and with formation of SIV-specific immune complexes that block the stress responses via binding to the epithelial receptor FCGR2B and subsequent inhibitory signaling. Thus, blocking virus entry may be one protective mechanism by which locally concentrated non-neutralizing Ab might prevent HIV sexual transmission to women.

Vaccine-modified NF-kB and GR signaling in cervicovaginal epithelium correlates with protection

Cervicovaginal epithelium plays a critical role in determining the outcome of virus transmission in the female reproductive tract (FRT) by initiating or suppressing transmission-facilitating mucosal immune responses in naïve and SIVmac239Δnef-vaccinated animals, respectively. In this study, we examined the very early responses of cervical epithelium within 24 h after vaginal exposure to SIV in naive and SIVmac239Δnef-vaccinated rhesus macaques. Using both ex vivo and in vivo experimental systems, we found that vaginal exposure to SIV rapidly induces a broad spectrum of pro-inflammatory responses in the epithelium associated with a reciprocal regulation of NF-kB and glucocorticoid receptor (GR) signaling pathways. Conversely, maintenance of high-level GR expression and suppression of NF-kB expression in the epithelium were associated with an immunologically quiescent state in the FRT mucosa and protection against vaginal challenge in SIVmac239Δnef-vaccinated animals. We show that the immunologically quiescent state is induced by FCGR2B-immune complexes interactions that modify the reciprocal regulation of NF-kB and GR signaling pathways. Our results suggest that targeting the balance of NF-kB and GR signaling in early cervicovaginal epithelium responses could moderate mucosal inflammation and target cell availability after vaginal infection, thereby providing a complementary approach to current prevention strategies.

Reduced radioiodine uptake at increased iodine intake and 131I-induced release of “cold” iodine stored in the thyroid

Aim: The extent of urinary iodine excretion (UIE) provides information about iodine supply and release. In the present study we investigated correlations between UIE and radioiodine uptake (RIU) as well as effects of radioiodine therapy on UIE in patients with autonomous goitre. Patients, methods: In 197 consecutive patients with thyroid autonomy, UIE was measured twice during radioiodine test (RITe) and correlated with RIU. In 98 of these patients, thyroglobulin and thyroid volume (V) were determined prior to therapy. Individual changes in urinary iodine excretion (ΔUIE) and TG (ΔTG) could be investigated four weeks (4W) and six months (6M) after radioiodine therapy. Additionally, ΔV was determined 6M after therapy. ΔUIE, ΔTG and ΔV were correlated with target dose and target volume. Results: Patients with higher iodine excretion exhibited significantly lower thyroidal radioiodine uptake values. Twofold increased UIE prior to therapy decreased radioiodine uptake by 25%. Compared with pretherapeutic values, UIE and TG were significantly increased four weeks after radioiodine therapy (p <0.001). Median values of both parameters were found to be doubled. The product of target dose and target volume was not only correlated with a decrease of thyroid volume 6M after therapy, but also with an increase of UIE and TG in the early phase after therapy. Conclusions: It was confirmed that UIE during RITe is a measure for iodine intake and can be used to investigate the competition between stable iodine and radioiodine. The increase of UIE and TG four weeks after therapeutic administration of radioiodine can be explained by disintegrated thyroid follicles. The therapy-induced iodine release may be one important cause for the development of hyperthyroidism in some patients during the first weeks after radioiodine therapy. It may contribute to the known decrease of radioiodine uptake after preapplications of 131I in various thyroid diseases.

Analysis of 2D NMR relaxation data using Chisholm approximations

To analyze 2D NMR relaxation data based on a discrete delta-like relaxation map we extended the Padé-Laplace method to two dimensions. We approximate the forward Laplace image of the time domain signal by a Chisholm approximation, i.e. a rational polynomial in two dimensions. The poles and residues of this approximation correspond to the relaxation rates and weighting factors of the underlying relaxation map. In this work we explain the principle ideas of our algorithm and demonstrate its applicability. Therefore we compare the inversion results of the Chisholm approximation and Tikhonov regularization method as a function of SNR when the investigated signal is based on a given discrete relaxation map. Our algorithm proved to be reliable for SNRs larger than 50 and is able to compete with the Tikhonov regularization method. Furthermore we show that our method is also able to detect the simulated relaxation compartments of narrow Gaussian distributions with widths less or equal than 0.05s^-1. Finally we investigate the resolution limit with experimental data. For a SNR of 750 the Chisholm approximation method was able to resolve two relaxation compartments in 8 of 10 cases when both compartments differ by a factor of 1.7.

Epithelium-innate immune cell axis in mucosal responses to SIV

In the SIV (simian immunodeficiency virus)-rhesus macaque model of HIV-1 (human immunodeficiency virus type I) transmission to women, one hallmark of the mucosal response to exposure to high doses of SIV is CD4 T-cell recruitment that fuels local virus expansion in early infection. In this study, we systematically analyzed the cellular events and chemoattractant profiles in cervical tissues that precede CD4 T-cell recruitment. We show that vaginal exposure to the SIV inoculum rapidly induces chemokine expression in cervical epithelium including CCL3, CCL20, and CXCL8. The chemokine expression is associated with early recruitment of macrophages and plasmacytoid dendritic cells that are co-clustered underneath the cervical epithelium. Production of chemokines CCL3 and CXCL8 by these cells in turn generates a chemokine gradient that is spatially correlated with the recruitment of CD4 T cells. We further show that the protection of SIVmac239Δnef vaccination against vaginal challenge is correlated with the absence of this epithelium-innate immune cell-CD4 T-cell axis response in the cervical mucosa. Our results reveal a critical role for cervical epithelium in initiating early mucosal responses to vaginal infection, highlight an important role for macrophages in target cell recruitment, and provide further evidence of a paradoxical dampening effect of a protective vaccine on these early mucosal responses.

A simple metal staining procedure for identification and visualization of single cells by LA-ICP-MS

High lateral resolution of metal detection in single cells by use of laser ablation inductively coupled plasma mass spectrometry (LA-ICP-MS) demands powerful staining methods.

Apparent rate constant mapping using hyperpolarized [1-(13)C]pyruvate

Hyperpolarization of [1-13C]pyruvate in solution allows real-time measurement of uptake and metabolism using MR spectroscopic methods. After injection and perfusion, pyruvate is taken up by the cells and enzymatically metabolized into downstream metabolites such as lactate, alanine, and bicarbonate. In this work, we present comprehensive methods for the quantification and interpretation of hyperpolarized 13C metabolite signals. First, a time-domain spectral fitting method is described for the decomposition of FID signals into their metabolic constituents. For this purpose, the required chemical shift frequencies are automatically estimated using a matching pursuit algorithm. Second, a time-discretized formulation of the two-site exchange kinetic model is used to quantify metabolite signal dynamics by two characteristic rate constants in the form of (i) an apparent build-up rate (quantifying the build-up of downstream metabolites from the pyruvate substrate) and (ii) an effective decay rate (summarizing signal depletion due to repetitive excitation, T1-relaxation and backward conversion). The presented spectral and kinetic quantification were experimentally verified in vitro and in vivo using hyperpolarized [1-13C]pyruvate. Using temporally resolved IDEAL spiral CSI, spatially resolved apparent rate constant maps are also extracted. In comparison to single metabolite images, apparent build-up rate constant maps provide improved contrast by emphasizing metabolically active tissues (e.g. tumors) and suppression of high perfusion regions with low conversion (e.g. blood vessels). Apparent build-up rate constant mapping provides a novel quantitative image contrast for the characterization of metabolic activity. Its possible implementation as a quantitative standard will be subject to further studies.

Effects of pyruvate dose on in vivo metabolism and quantification of hyperpolarized ¹³C spectra

Real-time in vivo measurements of metabolites are performed by signal enhancement of [1-(13)C]pyruvate using dynamic nuclear polarization, rapid dissolution and intravenous injection, acquisition of free induction decay signals and subsequent quantification of spectra. The commonly injected dose of hyperpolarized pyruvate is larger than typical tracer doses, with measurement before complete dilution of the injected bolus. Pyruvate is in exchange with its downstream metabolites lactate, alanine and bicarbonate. A transient exposure to high pyruvate blood concentrations may cause the saturation of cellular uptake and metabolic conversion. The goal of this study was to examine the effects of a [1-(13)C]pyruvate bolus on metabolic conversion in vivo. Spectra were quantified by three different methods: frequency-domain fitting with LCModel, time-domain fitting with AMARES and simple linear least-squares fitting in the time domain. Since the simple linear least-squares approach showed bleeding artifacts and LCModel produced noisier time signals. AMARES performed best in the quantification of in vivo hyperpolarized pyruvate spectra. We examined pyruvate doses of 0.1-0.4 mmol/kg (body mass) in male Wistar rats by acquiring slice-selective free induction decay signals in slices dominated by heart, liver and kidney tissue. Dose effects were noted in all cases, except for alanine in the cardiac slice below the dose of 0.2 mmol/kg. Our results indicate unlimited cellular uptake of pyruvate up to this dose and limited enzymatic activity of lactate dehydrogenase. In the cardiac slice above 0.2 mmol/kg and in liver and kidney slices, reflect limited cellular uptake or enzymatic activity, or a combination of both effects. The results indicate that the dose of pyruvate must be recognized as an important determinant for metabolic tissue kinetics, and saturation effects must be taken into account for the quantitative interpretation of the observed results.

Exploitation of intestinal colonization-inhibition between salmonella organisms for live vaccines in poultry: potential and limitations

Immunization represents one of the most important methods to increase the resistance of chickens against Salmonella infection. In addition to the development of an adaptive immune response, oral administration of live Salmonella strains to day-old chicks provides protection against infection within hours by intestinal colonization-inhibition. For the exploitation of this phenomenon, practical information on colonization-inhibition between Salmonella organisms is needed. Colonization-inhibition capacity between Salmonella strains from serogroups B, C1, C2, D and G was assessed in chickens. The most profound level of intestinal colonization-inhibition occurred between isogenic strains. Inhibition between strains of the same serovar was greater than that between strains of different serovars. The degree of inhibition between different serovars was not sufficiently high to identify a single strain which might inhibit a wide range of other Salmonella organisms. However, as Salmonella Enteritidis is the dominant serovar in poultry in many countries and because of the profound colonization-inhibition within this serovar there is a considerable potential to exploit this phenomenon in the development of novel live S. Enteritidis vaccines. Treatment of young chicks with mixtures of different Salmonella serovars resulted not only in a very strong growth inhibition of the isogenic strains but also in a substantial inhibition of heterologous serovars. The potential of mixtures of heterologous Salmonella strains as a 'Salmonella Inhibition Culture' and as a 'live Salmonella vaccine' should be further explored.

Protective attenuated lentivirus immunization induces SIV-specific T cells in the genital tract of rhesus monkeys

Live attenuated lentivirus immunization is the only vaccine strategy that elicits consistent protection against intravaginal challenge with pathogenic simian immunodeficiency virus (SIV). To determine the mechanism of protection in rhesus monkeys infected with attenuated simian-human immunodeficiency virus (SHIV)89.6, a detailed analysis of SIV Gag-specific T-cell responses in several tissues including the genital tract was performed. Six months after SHIV infection, antiviral T-cell responses were rare in the cervix; however, polyfunctional, cytokine-secreting, and degranulating SIV Gag-specific CD4(+) T cells were consistently found in the vagina of the immunized macaques. SIV-specific CD8(+) T cells were also detected in the vagina, blood, and genital lymph nodes of most of the animals. Thus, an attenuated SHIV vaccine induces persistent antiviral T cells in tissues, including the vagina, where these effector T-cell responses may mediate the consistent protection from vaginal SIV challenge observed in this model.

Diffusion generated T1 and T2 contrast

In MR images of porous organic samples (such as roots or wood) in water media, the sample is often surrounded by a bright ring, with a corresponding decreased T1 value in T1 maps. When the medium is removed, or contrast agents are added, the ring disappears, indicating that the signal does not originate in the outer layers of the sample, but from the medium itself. It can be shown that this "bright ring effect" is only observed when the medium experiences a reduction in T1 when permeating the sample. In order to investigate this effect, a computer model was used to simulate the diffusion of magnetisation between regions that exhibit different relaxation constants. Using this model, the origin of the signal increase was found to be an inflow effect, as diffusion transports relaxed magnetisation from the boundary regions of the sample into the surrounding medium. In the case of the "bright ring" around the plants described above, a mixing of short T1 values from within the sample and long T1 values within the medium occurs, yielding a "transition region" between the two values. There, a signal increase can be observed at T1 weighted images, compared to the signal from the medium beyond this transition region. The width of the transition region is on the order of magnitude of the diffusion displacement that is calculated from the T1 value as diffusion time. In addition to causing the bright ring around the plant samples, this diffusion effect also limits the resolution of the relaxation time maps. This effect is not limited to T1 relaxation but also applies to T2 relaxation. However, at high B0 field strengths such as those used in this study (11.7 T), a T2 effect is not usually observed due to the considerably shorter T2 times in plants (about 50 ms, compared to T1 times of higher than 1 s). Because the diffusion length during this T2 relaxation is short with respect to the resolution of the imaging experiments, no T2 ring effect is seen.

Functional Assessment of Isolated Right Heart Failure by High Resolution In-Vivo Cardiovascular Magnetic Resonance in Mice

Precise and noninvasive characterization of the development of the cardiac phenotype in murine models of heart failure has been widely demanded in modern cardiovascular research. High-resolution cardiovascular magnetic resonance (CMR) has been proven to be a powerful tool for the accurate and reproducible assessment of LV and RV parameters in healthy mice. Whereas changes in LV parameters in models of heart failure have been thoroughly evaluated, RV dysfunction has not. Purpose of this study was to characterize a model of isolated RV failure induced by pulmonal banding by in vivo CMR at 7T. RV parameters differed significantly from those of normal mice in terms of RV end-diastolic volume (EDV: 85 +/- 14 microL vs. control 36 +/- 3 microL, p < 0.0001), RV end-systolic volume (ESV: 121 +/- 10 microL vs. control 84 +/- 4 microL, p < 0.005) and RV ejection fraction (EF: 31 +/- 6 % vs. control 57 +/- 2 %, p < 0.001). With regard to EDV, ESV, SV and EF LV parameters, there were no significant differences between pulmonary banded and control mice indicating overt isolated RV failure.

Obesity, fitness and health in Taiwanese children and adolescents

OBJECTIVE

To examine the prevalence of childhood and adolescent obesity in Taiwan and investigate the association between excess weight and physical fitness and blood pressure.

DESIGN

Cross-sectional study.

SUBJECTS

A total of 13 935 children and adolescents aged 6-18 years (boys: 7031, girls: 6904) were involved in the 1999 survey and 24 586 (boys: 12 367, girls: 12 219) were available in the 2001 survey.

MEASUREMENTS

Weight, height, systolic and diastolic blood pressures, and health-related fitness tests (bent-leg curl-ups, sit-and-reach test and step test) were measured.

RESULTS

The overall prevalence of obesity (including overweight) in boys was 19.8% in 1999 and 26.8% in 2001. It was lower in girls with 15.2% in 1999 and 16.5% in 2001. The normal weight group performed better (P<0.05) than the overweight/obese group in all fitness tests except in the 2001 sit-and-reach test where there were no differences between the two groups. The risk of hypertension increased nearly two times for the overweight/obese-fit group and nearly three times for the overweight/obese-unfit group compared to the normal weight-fit group (adjusted odds ratio (AOR)=1.93, 95%CI=1.514-2.451 and AOR=2.93, 95%CI=2.493-3.454, respectively).

CONCLUSION

Overall, the findings demonstrated that there is an increasing trend in overweight/obesity prevalence for Taiwanese youth even in a 2-year period. The overweight/obese youngsters tend to have poorer muscular strength and cardiovascular endurance than the normal weight group. The overweight/obese and unfit group had a greater risk of hypertension than other groups. However, this risk was significantly lower if obese/overweight children had a higher than average level of cardiovascular fitness.

A simple geometrical description of the TrueFISP ideal transient and steady-state signal

An intuitive approach is presented for assessment of the TrueFISP signal behavior in the transient phase and the steady state, based on geometrical considerations in combination with the Bloch equations. Short formulations are derived for the zenith and phase angle determining the direction of the magnetization vector for which a smooth monoexponential decay is obtained even at considerable off-resonance frequencies, thus compactly defining the target of various preparation schemes proposed in literature. A pictorial explanation is provided to illustrate how the interplay between RF excitation and relaxation governs the TrueFISP transient phase and steady state. Closed form expressions are developed that describe the signal evolution, accounting for the influence of T(1), T(2), flip angle, and resonance frequency offset in agreement with recently published studies. These results are obtained directly from basic assumptions, without the need for abstract mathematical treatment or further approximations. The validity of the conceptual framework and the analytical description is verified by simulations based on the Bloch equations as well as with MR phantom experiments. The theory may be used for contrast calculations and has the potential to facilitate improved parameter quantification with magnetization prepared TrueFISP experiments accounting for off-resonance effects.

In vivo high-resolution MR imaging of neuropathologic changes in the injured rat spinal cord

BACKGROUND AND PURPOSE

MR imaging is the most comprehensive noninvasive means to assess structural changes in injured central nervous system (CNS) tissue in humans over time. The few published in vivo MR imaging studies of spinal cord injury in rodent models by using field strengths < or = 7T suffer from low spatial resolution, flow, and motion artifacts. The aim of this study was to assess the capacity of a 17.6T imaging system to detect pathologic changes occurring in a rat spinal cord contusion injury model ex vivo and in vivo.

METHODS

Seven adult female Fischer 344 rats received contusion injuries at thoracic level T10, which caused severe and reproducible lesions of the injured spinal cord parenchyma. Two to 58 days postinjury, high-resolution MR imaging was performed ex vivo (2) or in vivo in anesthetized rats (5 spinal cord injured + one intact control animal) by using 2D multisection spin- and gradient-echo imaging sequences, respectively, combined with electrocardiogram triggering and respiratory gating.

RESULTS

The acquired images provided excellent resolution and gray/white matter differentiation without significant artifacts. Signal intensity changes, which were detected with ex vivo and in vivo MR imaging following spinal cord injury, could be correlated with histologically defined structural changes such as edema, fibroglial scar, and hemorrhage.

CONCLUSIONS

These results demonstrate that MR imaging at 17.6T allows high-resolution structural analysis of spinal cord pathology after injury.

[Reduced radioiodine uptake at increased iodine intake and 131I-induced release of "cold" iodine stored in the thyroid]

AIM

The extent of urinary iodine excretion (UIE) provides information about iodine supply and release. In the present study we investigated correlations between UIE and radioiodine uptake (RIU) as well as effects of radioiodine therapy on UIE in patients with autonomous goitre.

PATIENTS, METHODS

In 197 consecutive patients with thyroid autonomy, UIE was measured twice during radioiodine test (RITe) and correlated with RIU. In 98 of these patients, thyroglobulin and thyroid volume (V) were determined prior to therapy. Individual changes in urinary iodine excretion (DeltaUIE) and TG (DeltaTG) could be investigated four weeks (4W) and six months (6M) after radioiodine therapy. Additionally, DeltaV was determined 6M after therapy. DeltaUIE, DeltaTG and DeltaV were correlated with target dose and target volume.

RESULTS

Patients with higher iodine excretion exhibited significantly lower thyroidal radioiodine uptake values. Twofold increased UIE prior to therapy decreased radioiodine uptake by 25%. Compared with pretherapeutic values, UIE and TG were significantly increased four weeks after radioiodine therapy (p < 0.001). Median values of both parameters were found to be doubled. The product of target dose and target volume was not only correlated with a decrease of thyroid volume 6M after therapy, but also with an increase of UIE and TG in the early phase after therapy.

CONCLUSIONS

It was confirmed that UIE during RITe is a measure for iodine intake and can be used to investigate the competition between stable iodine and radioiodine. The increase of UIE and TG four weeks after therapeutic administration of radioiodine can be explained by disintegrated thyroid follicles. The therapy-induced iodine release may be one important cause for the development of hyperthyroidism in some patients during the first weeks after radioiodine therapy. It may contribute to the known decrease of radioiodine uptake after preapplications of 131I in various thyroid diseases.