1
|
Seraphin TP, Joko-Fru WY, Hämmerl L, Griesel M, Mezger NCS, Feuchtner JC, Adoubi I, Egué MDD, Okerosi N, Wabinga H, Hansen R, Vuma S, Lorenzoni C, Coulibaly B, Odzebe SW, Buziba NG, Aynalem A, Liu B, Medenwald D, Mikolajczyk RT, Efstathiou JA, Parkin DM, Jemal A, Kantelhardt EJ. Presentation, patterns of care, and outcomes of patients with prostate cancer in sub-Saharan Africa: A population-based registry study. Cancer 2021; 127:4221-4232. [PMID: 34328216 DOI: 10.1002/cncr.33818] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Revised: 04/17/2021] [Accepted: 05/18/2021] [Indexed: 12/30/2022]
Abstract
BACKGROUND Although prostate cancer (PCa) is the most commonly diagnosed cancer in men of sub-Saharan Africa (SSA), little is known about its management and survival. The objective of the current study was to describe the presentation, patterns of diagnosis, treatment, and survival of patients with PCa in 10 countries of SSA. METHODS In this observational registry study with data collection from 2010 to 2018, the authors drew a random sample of 738 patients with PCa who were registered in 11 population-based cancer registries. They described proportions of patients receiving recommended care and presented survival estimates. Multivariable Cox regression was used to calculate hazard ratios comparing the survival of patients with and without cancer-directed therapies (CDTs). RESULTS The study included 693 patients, and tumor characteristics and treatment information were available for 365 patients, 37.3% of whom had metastatic disease. Only 11.2% had a complete diagnostic workup for risk stratification. Among the nonmetastatic patients, 17.5% received curative-intent therapy, and 27.5% received no CDT. Among the metastatic patients, 59.6% received androgen deprivation therapy. The 3- and 5-year age-standardized relative survival for 491 patients with survival time information was 58.8% (95% confidence interval [CI], 48.5%-67.7%) and 56.9% (95% CI, 39.8%-70.9%), respectively. In a multivariable analysis, survival was considerably poorer among patients without CDT versus those with therapy. CONCLUSIONS This study shows that a large proportion of patients with PCa in SSA are not staged or are insufficiently staged and undertreated, and this results in unfavorable survival. These findings reemphasize the need for improving diagnostic workup and access to care in SSA in order to mitigate the heavy burden of the disease in the region.
Collapse
Affiliation(s)
- Tobias Paul Seraphin
- Institute of Medical Epidemiology, Biometrics and Informatics, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Walburga Yvonne Joko-Fru
- African Cancer Registry Network, International Network for Cancer Treatment and Research African Registry Programme, Oxford, United Kingdom
- Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Lucia Hämmerl
- Institute of Medical Epidemiology, Biometrics and Informatics, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Mirko Griesel
- Institute of Medical Epidemiology, Biometrics and Informatics, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Nikolaus Christian Simon Mezger
- Institute of Medical Epidemiology, Biometrics and Informatics, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Jana Cathrin Feuchtner
- Institute of Medical Epidemiology, Biometrics and Informatics, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Innocent Adoubi
- Department of Immunology, Haematology and Oncology, University of Felix Houphouet-Boigny, Abidjan, Côte d'Ivoire
- Abidjan Cancer Registry, Programme National de Lutte contre le Cancer, Ministry of Health, Abidjan, Côte d'Ivoire
| | | | - Nathan Okerosi
- National Cancer Registry, Kenya Medical Research Institute, Nairobi, Kenya
| | - Henry Wabinga
- Kampala Cancer Registry, Department of Pathology, School of Biomedical Sciences, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Rolf Hansen
- Namibia National Cancer Registry, Cancer Association of Namibia, Windhoek, Namibia
| | - Samukeliso Vuma
- Bulawayo Cancer Registry, Department of Radiotherapy, Mpilo Hospital, Bulawayo, Zimbabwe
| | - Cesaltina Lorenzoni
- National Cancer Control Programme, Ministry of Health, Maputo, Mozambique
- Maputo Cancer Registry, Department of Pathology, Hospital Central de Maputo, Maputo, Mozambique
| | - Bourama Coulibaly
- Cancer Registry of Bamako, Hôpital National du Point G, Bamako, Mali
| | - Sévérin W Odzebe
- Cancer Registry of Brazzaville, University Hospital Brazzaville, Brazzaville, Republic of Congo
| | - Nathan Gyabi Buziba
- Eldoret Cancer Registry, Moi Teaching Hospital, Eldoret, Kenya
- Department of Haematology and Blood Transfusion, Moi University School of Medicine, Eldoret, Kenya
| | - Abreha Aynalem
- Addis Ababa City Cancer Registry, Radiotherapy Center, Addis-Ababa-University, Addis Ababa, Ethiopia
| | - Biying Liu
- African Cancer Registry Network, International Network for Cancer Treatment and Research African Registry Programme, Oxford, United Kingdom
| | - Daniel Medenwald
- Institute of Medical Epidemiology, Biometrics and Informatics, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Rafael T Mikolajczyk
- Institute of Medical Epidemiology, Biometrics and Informatics, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Jason Alexander Efstathiou
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts
- Claire and John Bertucci Center for Genitourinary Cancers Multidisciplinary Clinic, Massachusetts General Hospital, Boston, Massachusetts
| | - Donald Maxwell Parkin
- Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
- Cancer Surveillance Unit, International Agency for Research on Cancer, Lyon, France
| | - Ahmedin Jemal
- Surveillance & Health Equity Science Department, American Cancer Society, Atlanta, Georgia
| | - Eva Johanna Kantelhardt
- Institute of Medical Epidemiology, Biometrics and Informatics, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
- Department of Gynecology, University Hospital Halle, Martin Luther University Halle-Wittenberg, Halle, Germany
| |
Collapse
|
2
|
Abera SF, Mikolajczyk RT, Kantelhardt EJ, Efremov L, Bedir A, Ostheimer C, Glowka A, Vordermark D, Medenwald D. Lung Cancer Attributed Mortality Among 316,336 Early Stage Breast Cancer Cases Treated by Radiotherapy and/or Chemotherapy, 2000-2015: Evidence From the SEER Database. Front Oncol 2021; 10:602397. [PMID: 33718108 PMCID: PMC7947230 DOI: 10.3389/fonc.2020.602397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 11/02/2020] [Indexed: 11/13/2022] Open
Abstract
Objective To estimate the risk of death from lung cancer in patients treated for breast cancer (BC) in relation to the general population. Methods BC data, covering 2000 to 2015, were extracted from the Surveillance, Epidemiology and End Results-18 (SEER-18) cancer registry database. A comparison of lung cancer attributed mortality between BC patients and the general population was performed using standardized mortality ratios (SMRs) and SMRs conditional on survival length (cSMRs). Prognostic factors of lung cancer mortality were identified using flexible parametric modelling. Our model adjusts the effect of downstream (histopathological BC tumor grade and hormone receptor status) and upstream (age at diagnosis, ethnicity, and marital status) factors. Results The median follow-up was 6.4 years (interquartile range, 3.0–10.3 years). BC cases who received only radiotherapy (cSMR = 0.93; 95%CI: 0.77–1.13), only chemotherapy (cSMR = 0.91; 0.62–1.33), and radio-and chemotherapy (cSMR = 1.04; 0.77–1.39) had no evidence of increased lung cancer mortality relative to the general population. The adjusted model identified that lung cancer mortality was higher for women who were older at diagnosis compared to those <50 years (ranging from HR50-59 = 3.41 [95%CI: 2.72–4.28] to HR70-79 = 10.53 [95%CI: 8.44–13.13]) and for cases with negative estrogen and progesterone receptors (HR =1.38; 95% CI: 1.21–1.57). Compared to married cases, widowed, divorced, single or others had a 76%, 45%, and 25% higher hazard of lung cancer mortality, respectively. Lung cancer mortality was lower for American Indian/Alaska Native and Asian/Pacific Islander ethnicities (HR = 0.51; 95% CI: 0.40–0.64) compared to BC cases with white ethnic background. Conclusions There is no evidence for a higher lung cancer mortality in BC patients when compared to the general population.
Collapse
Affiliation(s)
- Semaw Ferede Abera
- Department of Radiation Oncology, Faculty of Medicine, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Rafael T Mikolajczyk
- Institute for Medical Epidemiology, Biometrics and Informatics (IMEBI), Interdisciplinary Center for Health Sciences, Medical School of the Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Eva Johanna Kantelhardt
- Institute for Medical Epidemiology, Biometrics and Informatics (IMEBI), Interdisciplinary Center for Health Sciences, Medical School of the Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany.,Department of Gynaecology, Faculty of Medicine, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Ljupcho Efremov
- Department of Radiation Oncology, Faculty of Medicine, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany.,Institute for Medical Epidemiology, Biometrics and Informatics (IMEBI), Interdisciplinary Center for Health Sciences, Medical School of the Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Ahmed Bedir
- Department of Radiation Oncology, Faculty of Medicine, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Christian Ostheimer
- Department of Radiation Oncology, Faculty of Medicine, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - André Glowka
- Department of Radiation Oncology, Faculty of Medicine, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Dirk Vordermark
- Department of Radiation Oncology, Faculty of Medicine, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Daniel Medenwald
- Department of Radiation Oncology, Faculty of Medicine, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany.,Institute for Medical Epidemiology, Biometrics and Informatics (IMEBI), Interdisciplinary Center for Health Sciences, Medical School of the Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| |
Collapse
|
3
|
Negash S, Kartschmit N, Mikolajczyk RT, Watzke S, Matos Fialho PM, Pischke CR, Busse H, Helmer SM, Stock C, Zeeb H, Wendt C, Niephaus Y, Schmidt-Pokrzywniak A. Worsened Financial Situation During the COVID-19 Pandemic Was Associated With Depressive Symptomatology Among University Students in Germany: Results of the COVID-19 International Student Well-Being Study. Front Psychiatry 2021; 12:743158. [PMID: 34975561 PMCID: PMC8716444 DOI: 10.3389/fpsyt.2021.743158] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 11/19/2021] [Indexed: 12/16/2022] Open
Abstract
Background: Previous findings suggest that university students are at an elevated risk to experience financial hardship and to suffer from depressive symptoms. This vulnerability may have substantially increased during the coronavirus disease 19 (COVID-19) pandemic which might have affected students' socio-economic situation but possibly also their mental well-being. We examined whether the financial situation changed during the COVID-19 pandemic among German university students, and whether changes were associated with mental well-being. Methods: We conducted a cross-sectional online survey in May and July 2020 at five German universities. Participants were asked, if they had sufficient financial resources to cover monthly expenses before and during the pandemic. The answer options were dichotomized into worsened and no change/better financial situation compared to before the COVID-19 pandemic. Depressive symptoms were assessed using the CES-D 8 scale. For examining associations between sociodemographic, study-related, and financial factors and "worsened financial situation," we ran a generalized linear mixed model. To assess associations between depressive symptoms and worsened financial situation, we performed a linear mixed model. Results: We included 7,199 participants in the analyses (69% female, 30% male, 1% diverse, mean age: 24 years, standard deviation: 4.7). Overall, 25% of the participants reported to have a worsened financial situation at the time of the survey than in the time before COVID-19. Factors associated with a worsened financial situation were migration background, parents not being academics, not being able to borrow money, and payment of tuition fee by student and loan [odds ratios (OR) ranging from 1.20 to 2.35]. Factors associated with lower odds were: being single, living with others, studying a health-related field, being enrolled in a doctoral/Ph.D. or state exam program, and publicly funded tuition/tuition paid with a scholarship (OR ranging from 0.42 to 0.80). A worsened financial situation was associated with 1.02 points more on the CES-D 8 scale (95% CI: 0.80-1.24). Conclusion: Our results suggest that the pandemic put a number of students under financial strain with detrimental consequences for their mental well-being. Renewed attention must be paid to this vulnerable group to prevent the potentially damaging effects on their mental health.
Collapse
Affiliation(s)
- Sarah Negash
- Institute for Medical Epidemiology, Biometrics and Informatics, Interdisciplinary Center for Health Sciences, Medical School of the Martin-Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Nadja Kartschmit
- Institute for Medical Epidemiology, Biometrics and Informatics, Interdisciplinary Center for Health Sciences, Medical School of the Martin-Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Rafael T Mikolajczyk
- Institute for Medical Epidemiology, Biometrics and Informatics, Interdisciplinary Center for Health Sciences, Medical School of the Martin-Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Stefan Watzke
- Clinic for Psychiatry, Psychotherapy and Psychosomatics, University Hospital Halle-Saale, Halle (Saale), Germany
| | - Paula Mayara Matos Fialho
- Medical Faculty, Institute of Medical Sociology, Centre for Health and Society, Heinrich Heine University Duesseldorf, Duesseldorf, Germany
| | - Claudia R Pischke
- Medical Faculty, Institute of Medical Sociology, Centre for Health and Society, Heinrich Heine University Duesseldorf, Duesseldorf, Germany
| | - Heide Busse
- Department Prevention and Evaluation, Leibniz-Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
| | - Stefanie M Helmer
- Institute of Health and Nursing Science, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Christiane Stock
- Institute of Health and Nursing Science, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Hajo Zeeb
- Department Prevention and Evaluation, Leibniz-Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany.,Health Sciences Bremen, University of Bremen, Bremen, Germany
| | - Claus Wendt
- Department of Social Sciences, University Siegen, Siegen, Germany
| | - Yasemin Niephaus
- Department of Social Sciences, University Siegen, Siegen, Germany
| | - Andrea Schmidt-Pokrzywniak
- Institute for Medical Epidemiology, Biometrics and Informatics, Interdisciplinary Center for Health Sciences, Medical School of the Martin-Luther University Halle-Wittenberg, Halle (Saale), Germany
| |
Collapse
|
4
|
Pondorfer SG, Jaeger VK, Scholz-Kreisel P, Horn J, Krumkamp R, Kreuels B, Mikolajczyk RT, Karch A. Risk estimation for air travel-induced malaria transmission in central Europe – A mathematical modelling study. Travel Med Infect Dis 2020; 36:101564. [DOI: 10.1016/j.tmaid.2020.101564] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2019] [Revised: 01/20/2020] [Accepted: 01/23/2020] [Indexed: 11/25/2022]
|
5
|
Caputo M, Stumpe V, Rübsamen N, Mikolajczyk RT, Karch A. Implementation of preventive measures against tick-borne infections in a non-endemic area for tick-borne encephalitis-Results from a population-based survey in Lower Saxony, Germany. Ticks Tick Borne Dis 2019; 10:614-620. [PMID: 30797728 DOI: 10.1016/j.ttbdis.2019.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Revised: 01/08/2019] [Accepted: 02/10/2019] [Indexed: 11/29/2022]
Abstract
Lyme borreliosis (LB) and tick-borne encephalitis (TBE) are the most common tick-borne diseases in Germany. While for LB only non-specific prevention strategies exist, TBE can be additionally prevented by vaccination. It is unclear to which extent non-specific prevention strategies are applied by individuals living in non-endemic areas for TBE in Germany, and whether TBE vaccination status affects their implementation. Participants of the HaBIDS panel (Hygiene and Behavior Infectious Diseases Study) from four counties of Lower Saxony were invited to fill out a questionnaire on their TBE vaccination status, their LB diagnoses as well as their knowledge, attitudes, and practice related to prevention measures for tick-borne diseases. Based on self-reported data we estimated cumulative lifetime incidence (CUM) and incidence of LB as well as TBE vaccination coverage. One year later, participants received a supplementary questionnaire focusing on reasons for vaccination against TBE and compliance with the vaccination schedule. 1,573 (74.2% of those invited) panel members aged 18-69 years participated in this study. Of these, 22.8% reported to have ever been vaccinated against TBE. The estimated CUM of LB was 5.1% (95%-CI: 4.1%-6.4%), and the incidence was 1.09 per 1,000 person years (95%-CI: 0.87-1.36). 98% of participants knew that LB is transmitted by the bite of an infected tick, but about 50% didn't know that TBE vaccination does not protect against LB. Even though about 80% of study participants were convinced that recommended non-specific prevention strategies were indeed protective, a much lower proportion implemented them. TBE-vaccinated participants were better informed about tick-borne diseases compared to non-vaccinated participants, whereby being vaccinated did not negatively affect implementation of non-specific prevention strategies. Based on data from the supplementary questionnaire, traveling to endemic areas (75.3%) was the main reason for TBE vaccination; 33.0% of those vaccinated had a complete vaccination schedule with three doses. Our study in a TBE non-endemic area revealed deficits in knowledge about which pathogens are covered by TBE vaccination, and a lack in the implementation of non-specific prevention measures. TBE vaccination was not associated with a reduced uptake of non-specific prevention measures.
Collapse
Affiliation(s)
- Mahrrouz Caputo
- Helmholtz Centre for Infection Research, Inhoffenstraße 7, 38124, Braunschweig, Germany; PhD Programme "Epidemiology", Braunschweig-Hannover, Germany.
| | - Vivien Stumpe
- Helmholtz Centre for Infection Research, Inhoffenstraße 7, 38124, Braunschweig, Germany.
| | - Nicole Rübsamen
- Helmholtz Centre for Infection Research, Inhoffenstraße 7, 38124, Braunschweig, Germany; PhD Programme "Epidemiology", Braunschweig-Hannover, Germany.
| | - Rafael T Mikolajczyk
- German Center for Infection Research (DZIF), Hannover-Braunschweig, Germany; Medical Faculty of the Martin Luther University Halle-Wittenberg, Magdeburger Str. 8, 06110, Halle (Saale), Germany.
| | - André Karch
- Helmholtz Centre for Infection Research, Inhoffenstraße 7, 38124, Braunschweig, Germany; German Center for Infection Research (DZIF), Hannover-Braunschweig, Germany; Institute of Epidemiology and Social Medicine, University of Münster, Domagkstraße 3, 48149, Münster, Germany.
| |
Collapse
|
6
|
Möhring T, Karch A, Falk CS, Laue T, D'Antiga L, Debray D, Hierro L, Kelly D, McLin V, McKiernan P, Pawlowska J, Czubkowski P, Mikolajczyk RT, Baumann U, Goldschmidt I. Immune Status in Children Before Liver Transplantation-A Cross-Sectional Analysis Within the ChilsSFree Multicentre Cohort Study. Front Immunol 2019; 10:52. [PMID: 30740106 PMCID: PMC6357985 DOI: 10.3389/fimmu.2019.00052] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Accepted: 01/09/2019] [Indexed: 12/21/2022] Open
Abstract
Background: Both, markers of cellular immunity and serum cytokines have been proposed as potential biomarkers for graft rejection after liver transplantation. However, no good prognostic model is available for the prediction of acute cellular rejection. The impact of underlying disease and demographic factors on immune status before pediatric liver transplantation (pLTx) is still poorly understood. We investigated expression of immune markers before pLTx, in order to better understand the pre-transplant immune status. Improved knowledge of the impact of pre-transplant variables may enhance our understanding of immunological changes post pLTx in the future. Methods: This is a cross-sectional analysis of data from the ChilSFree study, a European multicentre cohort study investigating the longitudinal patterns of immune response before and after pLTx. Immune cell counts and soluble immune markers were measured in 155 children 1–30 days before pLTx by TruCount analysis and BioPlex assays. Results were logarithmised due to skewed distributions and then compared according to age, sex, and diagnosis using t-tests, ANOVAs, and Tukey post-hoc tests. The association between immune markers at time of pLTx and patients' age was assessed using a fractional polynomial approach. Multivariable regression models were used to assess the relative contribution of each factor. Results: Sex had no effect on immune status. We found strong evidence for age-specific differences in the immune status. The majority of immune markers decreased in a log-linear way with increasing age. T and B cells showed a sharp increase within the first months of life followed by a log-linear decline in older age groups. Several immune markers were strongly associated with underlying diagnoses. The effects of age and underlying disease remained virtually unchanged when adjusting for each other in multivariable models. Discussion: We show for the first time that age and diagnosis are major independent determinants of cellular and soluble immune marker levels in children with end-stage liver disease. These results need to be considered for future research on predictive immune monitoring after pLTx.
Collapse
Affiliation(s)
- Tamara Möhring
- Research Group Epidemiological and Statistical Methods (ESME), Helmholtz Centre for Infection Research, Braunschweig, Germany.,Division of Pediatric Gastroenterology and Hepatology, Department of Paediatric Liver, Kidney and Metabolic Diseases, Hannover Medical School, Hannover, Germany.,European Paediatric Liver Transplantation Network EPLTN, Hannover, Germany
| | - André Karch
- Research Group Epidemiological and Statistical Methods (ESME), Helmholtz Centre for Infection Research, Braunschweig, Germany.,German Center for Infection Research, TTU-IICH Hannover, Braunschweig, Germany.,Institute for Epidemiology and Social Medicine, University of Münster, Münster, Germany
| | - Christine S Falk
- German Center for Infection Research, TTU-IICH Hannover, Braunschweig, Germany.,Institute of Transplant Immunology, Hannover Medical School, Hannover, Germany
| | - Tobias Laue
- Division of Pediatric Gastroenterology and Hepatology, Department of Paediatric Liver, Kidney and Metabolic Diseases, Hannover Medical School, Hannover, Germany.,European Paediatric Liver Transplantation Network EPLTN, Hannover, Germany
| | - Lorenzo D'Antiga
- European Paediatric Liver Transplantation Network EPLTN, Hannover, Germany.,Ospedali Riuniti di Bergamo, Bergamo, Italy
| | - Dominique Debray
- European Paediatric Liver Transplantation Network EPLTN, Hannover, Germany.,Hôpital Necker-Enfants Malades, Paris, France
| | - Loreto Hierro
- European Paediatric Liver Transplantation Network EPLTN, Hannover, Germany.,Hospital Infantil Universitario La Paz, Madrid, Spain
| | - Deirdre Kelly
- European Paediatric Liver Transplantation Network EPLTN, Hannover, Germany.,Birmingham Children's Hospital, Birmingham, United Kingdom
| | - Valerie McLin
- European Paediatric Liver Transplantation Network EPLTN, Hannover, Germany.,Service Spécialités Pédiatriques, Genève, Switzerland
| | - Patrick McKiernan
- European Paediatric Liver Transplantation Network EPLTN, Hannover, Germany.,Service Spécialités Pédiatriques, Genève, Switzerland.,Centre for Rare Diseases Therapy, Children's Hospital of Pittsburgh, Pittsburgh, PN, United States
| | - Joanna Pawlowska
- European Paediatric Liver Transplantation Network EPLTN, Hannover, Germany.,Department of Gastroenterology, Hepatology, Nutritional Disorders and Pediatrics, The Children's Memorial Health Institute, Warsaw, Poland
| | - Piotr Czubkowski
- European Paediatric Liver Transplantation Network EPLTN, Hannover, Germany.,Department of Gastroenterology, Hepatology, Nutritional Disorders and Pediatrics, The Children's Memorial Health Institute, Warsaw, Poland
| | - Rafael T Mikolajczyk
- Research Group Epidemiological and Statistical Methods (ESME), Helmholtz Centre for Infection Research, Braunschweig, Germany.,German Center for Infection Research, TTU-IICH Hannover, Braunschweig, Germany.,Institute of Medical Epidemiology, Biostatistics and Medical Informatics, University of Halle, Halle, Germany
| | - Ulrich Baumann
- Division of Pediatric Gastroenterology and Hepatology, Department of Paediatric Liver, Kidney and Metabolic Diseases, Hannover Medical School, Hannover, Germany.,European Paediatric Liver Transplantation Network EPLTN, Hannover, Germany.,Birmingham Children's Hospital, Birmingham, United Kingdom
| | - Imeke Goldschmidt
- Division of Pediatric Gastroenterology and Hepatology, Department of Paediatric Liver, Kidney and Metabolic Diseases, Hannover Medical School, Hannover, Germany.,European Paediatric Liver Transplantation Network EPLTN, Hannover, Germany
| |
Collapse
|
7
|
Caputo M, Zoch-Lesniak B, Karch A, Vital M, Meyer F, Klawonn F, Baillot A, Pieper DH, Mikolajczyk RT. Bacterial community structure and effects of picornavirus infection on the anterior nares microbiome in early childhood. BMC Microbiol 2019; 19:1. [PMID: 30616583 PMCID: PMC6322332 DOI: 10.1186/s12866-018-1372-8] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Accepted: 12/11/2018] [Indexed: 11/13/2022] Open
Abstract
Background Little is known regarding the nasal microbiome in early childhood and the impact of respiratory infection on the infants’ nasal microbial composition. Here we investigated the temporal dynamics and diversity of the bacterial composition in the anterior nares in children attending daycare centers. Results For our investigation, we considered 76 parental-taken nasal swabs of 26 children (aged 13 to 36 months) collected over a study period of 3 months. Overall, there was no significant age-specific effect or seasonal shift in the nasal bacterial community structure. In a sub-sample of 14 healthy children the relative abundance of individual taxa as well as the overall diversity did not reveal relevant changes, indicating a stable community structure over the entire study period. Moreover, the nasal bacterial profiles clustered subject-specific with Bray-Curtis similarities being elevated in intra-subject calculations compared to between-subject calculations. The remaining subset of 12 children provided samples taken during picornavirus infection (PVI) and either before or after a PVI. We detected an association between the relative abundance of members of the genus Streptococcus and PV when comparing both (i) samples taken during PVI with samples out of 14 healthy children and (ii) samples taken during PVI with samples taken after PVI within the same individual. In addition, the diversity was higher during PVI than after infection. Conclusions Our findings suggest that a personalized structure of the nasal bacterial community is established already in early childhood and could be detected over a timeframe of 3 months. Studies following infants over a longer time with frequent swab sampling would allow investigating whether certain parameter of the bacterial community, such as the temporal variability, could be related to viral infection. Electronic supplementary material The online version of this article (10.1186/s12866-018-1372-8) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Mahrrouz Caputo
- Department of Epidemiology, Helmholtz Centre for Infection Research, Inhoffenstraße 7, 38124, Braunschweig, Germany.,PhD Programme "Epidemiology", Braunschweig, Germany.,PhD Programme "Epidemiology", Hannover, Germany
| | - Beate Zoch-Lesniak
- Department of Epidemiology, Helmholtz Centre for Infection Research, Inhoffenstraße 7, 38124, Braunschweig, Germany.,PhD Programme "Epidemiology", Braunschweig, Germany.,PhD Programme "Epidemiology", Hannover, Germany
| | - André Karch
- Department of Epidemiology, Helmholtz Centre for Infection Research, Inhoffenstraße 7, 38124, Braunschweig, Germany.,German Centre for Infection Research (DZIF), Hannover-Braunschweig site, Inhoffenstraße 7, 38124, Braunschweig, Germany.,Institute for Epidemiology and Social Medicine, University of Münster, Domagkstraße 3, 48149, Münster, Germany
| | - Marius Vital
- Microbial Interactions and Processes Research Group, Helmholtz Centre for Infection Research, Inhoffenstraße 7, 38124, Braunschweig, Germany
| | - Frederic Meyer
- Microbial Communication Research Group, Helmholtz Centre for Infection Research, Inhoffenstraße 7, 38124, Braunschweig, Germany
| | - Frank Klawonn
- Biostatistics Research Group, Helmholtz Centre for Infection Research, Inhoffenstraße 7, 38124, Braunschweig, Germany.,Institute of Information Engineering, Ostfalia University, Salzdahlumer Str. 46/48, 38302, Wolfenbüttel, Germany
| | - Armin Baillot
- Governmental Institute of Public Health of Lower Saxony, Roesebeckstraße 4-6, 30449, Hannover, Germany
| | - Dietmar H Pieper
- Microbial Interactions and Processes Research Group, Helmholtz Centre for Infection Research, Inhoffenstraße 7, 38124, Braunschweig, Germany
| | - Rafael T Mikolajczyk
- German Centre for Infection Research (DZIF), Hannover-Braunschweig site, Inhoffenstraße 7, 38124, Braunschweig, Germany. .,Institute for Medical Epidemiology, Biometrics, and Informatics (IMEBI), Medical Faculty of the Martin Luther University Halle-Wittenberg, Magdeburger Str. 8, 06110, Halle (Saale), Germany.
| |
Collapse
|
8
|
Caputo M, Raupach-Rosin H, Karch A, Borte M, Lehmann I, Liebert UG, Standl M, Heinrich J, Mikolajczyk RT. Vaccinations and Infections Are Associated With Unrelated Antibody Titers: An Analysis From the German Birth Cohort Study LISA. Front Pediatr 2019; 7:254. [PMID: 31294004 PMCID: PMC6603196 DOI: 10.3389/fped.2019.00254] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2019] [Accepted: 06/04/2019] [Indexed: 11/13/2022] Open
Abstract
The evidence for non-specific effects (NSE) of vaccinations on all-cause morbidity and mortality among children is growing. However, our understanding of the underlying mechanisms is still limited. One hypothesis is that NSE are mediated by antibody titers. We used data of 2,123 children from the population-based birth cohort study LISA conducted in Germany to explore whether routine childhood vaccinations and the individual infection history in the first 2 years of life are associated with unrelated antibody titers. We selected 19 exposures (infections and vaccinations) and investigated their association with levels of 12 IgG antibody titers at the age of 2 years. Based on univariable analyses (ANOVA), we identified 21 crude associations between exposures and titers (p < 0.05), while 11 (95%-CI: 6, 17) spurious associations were expected due to multiple testing. In exploratory multivariable analyses, we observed associations between seven investigated IgG titers and 10 exposures; either administered vaccines [e.g., higher anti-hRSV IgG titer in BCG-vaccinated children (regression-coefficient in standard-deviation-units: 0.38; 95%-CI: 0.12, 0.65)] or infections [e.g., higher anti-measles IgG titer in children with reported chickenpox (0.44; 95%-CI: 0.08, 0.80)]. Our results indicate the existence of associations between immunogenic exposures and unrelated antibody titers. Further studies investigating the underlying immunological mechanisms are required.
Collapse
Affiliation(s)
- Mahrrouz Caputo
- Department of Epidemiology, Helmholtz Centre for Infection Research, Brunswick, Germany.,PhD Programme "Epidemiology," Brunswick, Germany
| | - Heike Raupach-Rosin
- Department of Epidemiology, Helmholtz Centre for Infection Research, Brunswick, Germany
| | - André Karch
- Department of Epidemiology, Helmholtz Centre for Infection Research, Brunswick, Germany.,German Centre for Infection Research (DZIF), Site Brunschwick-Hannover, Brunswick, Germany.,Institute for Epidemiology and Social Medicine, University of Münster, Münster, Germany
| | - Michael Borte
- Children's Hospital, Municipal Hospital St. Georg Leipzig, Academic Teaching Hospital of the University of Leipzig, Leipzig, Germany
| | - Irina Lehmann
- Department of Environmental Immunology, Core Facility Studies, Helmholtz Centre for Environmental Research- UFZ, Leipzig, Germany.,Charitè - Universitätsmedizin Berlin and Berlin Institute of Health (BIH), Berlin, Germany
| | | | - Marie Standl
- Helmholtz Zentrum München- German Research Center for Environmental Health, Institute of Epidemiology, Munich, Germany
| | - Joachim Heinrich
- Helmholtz Zentrum München- German Research Center for Environmental Health, Institute of Epidemiology, Munich, Germany.,Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, University Hospital of Munich, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Rafael T Mikolajczyk
- German Centre for Infection Research (DZIF), Site Brunschwick-Hannover, Brunswick, Germany.,Institute for Medical Epidemiology, Biometry, and Informatics (IMEBI), Medical Faculty of the Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| |
Collapse
|
9
|
Horn J, Hoodgarzadeh M, Klett-Tammen CJ, Mikolajczyk RT, Krause G, Ott JJ. Epidemiologic estimates of hepatitis E virus infection in European countries. J Infect 2018; 77:544-552. [DOI: 10.1016/j.jinf.2018.09.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Accepted: 09/20/2018] [Indexed: 12/16/2022]
|
10
|
Pfister ED, Karch A, Adam R, Polak WG, Karam V, Mirza D, O'Grady J, Klempnauer J, Reding R, Kalicinski P, Coker A, Trunecka P, Astarcioglu I, Jacquemin E, Pratschke J, Paul A, Popescu I, Schneeberger S, Boillot O, Fischer L, Mikolajczyk RT, Baumann U, Duvoux C. Predictive Factors for Survival in Children Receiving Liver Transplants for Wilson's Disease: A Cohort Study Using European Liver Transplant Registry Data. Liver Transpl 2018; 24:1186-1198. [PMID: 30021057 DOI: 10.1002/lt.25308] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Accepted: 04/25/2018] [Indexed: 02/07/2023]
Abstract
Liver transplantation (LT) is a rescue therapy for life-threatening complications of Wilson's disease (WD). However, data on the outcome of WD patients after LT are scarce. The aim of our study was to analyze a large pediatric WD cohort with the aim of investigating the longterm outcome of pediatric WD patients after LT and to identify predictive factors for patient and transplant survival. This is a retrospective cohort study using data of all children (<18 years) transplanted for WD enrolled in the European Liver Transplant Registry from January 1968 until December 2013. In total, 338 patients (57.6% female) transplanted at 80 different European centers (1-26 patients per center) were included in this study. The median age at transplantation was 14.0 years (interquartile range [IQR], 11.2-16.1 years); patients were followed up for a median of 5.4 years (IQR, 1.0-10.9 years) after LT. Overall patient survival rates were high with 87% (1-year survival), 84% (5-year survival), and 81% (10-year survival); survival rates increased considerably with the calendar year (P < 0.001). Early age at LT, living donation, and histidine tryptophan ketoglutarate preservation liquid were identified as risk factors for poor patient survival in the multivariate analysis. LT is an excellent treatment option for pediatric patients with WD and associated end-stage liver disease. Longterm outcome in these patients is similar to other pediatric causes for LT. Overall patient and graft survival rates improved considerably over the last decades. To improve future research in the field, the vast variability of allocation strategies should be harmonized and a generally accepted definition or discrimination of acute versus chronic WD needs to be found.
Collapse
Affiliation(s)
- Eva-Doreen Pfister
- Division of Pediatric Gastroenterology and Hepatology, Departments of Pediatric Kidney, Liver, and Metabolic Diseases, Hannover, Germany
| | - André Karch
- Research Group Epidemiological and Statistical Methods, Helmholtz Center for Infection Research, Braunschweig, Germany.,German Center for Infection Research, Hannover-Braunschweig, Germany
| | - René Adam
- European Liver Transplant Registry.,AP-HP Hôpital Paul Brousse, Université Paris-Sud, Center Hépato-Biliaire, INSERM U 935, Villejuif, France
| | | | - Vincent Karam
- European Liver Transplant Registry.,AP-HP Hôpital Paul Brousse, Université Paris-Sud, Center Hépato-Biliaire, INSERM U 935, Villejuif, France
| | - Darius Mirza
- Liver Unit, Elizabeth Hospital Birmingham, University Hospitals Birmingham National Health Service Foundation Trust, Birmingham, United Kingdom
| | - John O'Grady
- Institute of Liver Studies, King's College Hospital, London, United Kingdom
| | - Jürgen Klempnauer
- General, Visceral and Transplantation Surgery, Hannover Medical School, Hannover, Germany
| | | | - Piotr Kalicinski
- Department of Pediatric and Transplant Surgery, Children's Memorial Health Institute, Warsaw, Poland
| | - Ahmet Coker
- Department of Gastroenterology, Bozyaka Training and Research Hospital, Izmir, Turkey
| | - Pavel Trunecka
- Transplant Center, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Ibrahim Astarcioglu
- HPB Surgery and Liver Transplantation Unit, Department of General Surgery, School of Medicine, Dokuz Eylul University, Inciralti, İzmir, Turkey
| | - Emmanual Jacquemin
- AP-HP Hôpital Paul Brousse, Université Paris-Sud, Center Hépato-Biliaire, INSERM U 935, Villejuif, France
| | | | - Andreas Paul
- Department of General and Transplant Surgery, University Hospital Essen, Essen, Germany
| | - Irinel Popescu
- Department of General Surgery and Liver Transplantation, Fundeni Clinical Institute, Bucharest, Romania
| | - Stefan Schneeberger
- Department of Visceral, Transplant and Thoracic Surgery, Center of Operative Medicine, Innsbruck Medical University, Innsbruck, Austria
| | - Oliver Boillot
- Liver Transplant Unit, Edouard Herriot Hospital, Lyon, France
| | - Lutz Fischer
- Department of Hepatobiliary Surgery and Visceral Transplantation, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Rafael T Mikolajczyk
- Research Group Epidemiological and Statistical Methods, Helmholtz Center for Infection Research, Braunschweig, Germany.,German Center for Infection Research, Hannover-Braunschweig, Germany
| | - Ulrich Baumann
- Division of Pediatric Gastroenterology and Hepatology, Departments of Pediatric Kidney, Liver, and Metabolic Diseases, Hannover, Germany
| | - Christophe Duvoux
- Department of Hepatology and Liver Transplant Unit, AP-HP Henri Mondor Hospital, Paris Est University, Créteil, France
| | | |
Collapse
|
11
|
Petry KU, Horn J, Luyten A, Mikolajczyk RT. Punch biopsies shorten time to clearance of high-risk human papillomavirus infections of the uterine cervix. BMC Cancer 2018; 18:318. [PMID: 29566658 PMCID: PMC5865384 DOI: 10.1186/s12885-018-4225-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Accepted: 03/14/2018] [Indexed: 11/10/2022] Open
Abstract
Background The primary objective was to determine human papilloma virus (HPV) clearance rate after cervical biopsy among women with persistent high-risk HPV infection compared with spontaneous HPV clearance rate in the absence of biopsy. Methods We collected data from a dedicated screening program of women aged 30–70 years old. Inclusion criteria for the baseline non-interventional cohort were a positive HPV test (hybrid capture 2, HC2) and normal cytology. In the baseline cohort women were followed with approximately yearly HPV-tests and cytology until HPV regressed (one negative HPV test) or interventions in the form of diagnostic biopsies or therapy. Women who had a diagnostic biopsy were included in the biopsy cohort and followed until HPV regression or therapy. Observed HPV regression rates and time to HPV regression were compared between baseline and biopsy cohorts. For the comparison, we used Fisher’s exact test for the HPV regression rates and interval-censored, accelerated failure time model for time to HPV regression. Results Among the 1079 women included in the baseline cohort, 499 (46.3%) had HPV clearance and 475 were referred for colposcopy with biopsy. The biopsy cohort comprised all women who were not treated and had at least one HC2 test after biopsy (201/475; 42.3%). Of those, 138 (68.7%) experienced HPV regression. In the biopsy cohort, time to clearance of HPV infection was approximately halved (0.46, 95% CI 0.38–0.56) compared with the baseline cohort. This result was robust in a wide range of sensitivity analyses. Conclusions A higher proportion of women cleared their HPV infection, and time to HPV clearance was shorter in the biopsy cohort than in the baseline cohort. It is reassuring for clinicians to know that conservative management of patients with HPV persistency is successful when colposcopy with biopsies excludes high-grade disease.
Collapse
Affiliation(s)
- K U Petry
- Department of Obstetrics and Gynecology, Klinikum Wolfsburg, Wolfsburg, Germany.
| | - J Horn
- Institute for Medical Epidemiology, Biometrics, and Informatics, Martin-Luther-University Halle-Wittenberg, Halle, Germany
| | - A Luyten
- Department of Obstetrics and Gynecology, Klinikum Wolfsburg, Wolfsburg, Germany
| | - R T Mikolajczyk
- Institute for Medical Epidemiology, Biometrics, and Informatics, Martin-Luther-University Halle-Wittenberg, Halle, Germany.,Hannover Medical School, Hannover, Germany.,German Centre for Infection Research/ Site Braunschweig-Hannover, Braunschweig, Germany
| |
Collapse
|
12
|
Lamping F, Jack T, Rübsamen N, Sasse M, Beerbaum P, Mikolajczyk RT, Boehne M, Karch A. Development and validation of a diagnostic model for early differentiation of sepsis and non-infectious SIRS in critically ill children - a data-driven approach using machine-learning algorithms. BMC Pediatr 2018; 18:112. [PMID: 29544449 PMCID: PMC5853156 DOI: 10.1186/s12887-018-1082-2] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Accepted: 02/26/2018] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Since early antimicrobial therapy is mandatory in septic patients, immediate diagnosis and distinction from non-infectious SIRS is essential but hampered by the similarity of symptoms between both entities. We aimed to develop a diagnostic model for differentiation of sepsis and non-infectious SIRS in critically ill children based on routinely available parameters (baseline characteristics, clinical/laboratory parameters, technical/medical support). METHODS This is a secondary analysis of a randomized controlled trial conducted at a German tertiary-care pediatric intensive care unit (PICU). Two hundred thirty-eight cases of non-infectious SIRS and 58 cases of sepsis (as defined by IPSCC criteria) were included. We applied a Random Forest approach to identify the best set of predictors out of 44 variables measured at the day of onset of the disease. The developed diagnostic model was validated in a temporal split-sample approach. RESULTS A model including four clinical (length of PICU stay until onset of non-infectious SIRS/sepsis, central line, core temperature, number of non-infectious SIRS/sepsis episodes prior to diagnosis) and four laboratory parameters (interleukin-6, platelet count, procalcitonin, CRP) was identified in the training dataset. Validation in the test dataset revealed an AUC of 0.78 (95% CI: 0.70-0.87). Our model was superior to previously proposed biomarkers such as CRP, interleukin-6, procalcitonin or a combination of CRP and procalcitonin (maximum AUC = 0.63; 95% CI: 0.52-0.74). When aiming at a complete identification of sepsis cases (100%; 95% CI: 87-100%), 28% (95% CI: 20-38%) of non-infectious SIRS cases were assorted correctly. CONCLUSIONS Our approach allows early recognition of sepsis with an accuracy superior to previously described biomarkers, and could potentially reduce antibiotic use by 30% in non-infectious SIRS cases. External validation studies are necessary to confirm the generalizability of our approach across populations and treatment practices. TRIAL REGISTRATION ClinicalTrials.gov number: NCT00209768; registration date: September 21, 2005.
Collapse
Affiliation(s)
- Florian Lamping
- Department of Epidemiology, Research Group Epidemiological and Statistical Methods (ESME), Helmholtz Centre for Infection Research, Inhoffenstr. 7, 38124 Braunschweig, Germany
- Department for Pediatric Cardiology and Intensive Care Medicine, Hannover Medical School, 30625 Hannover, Germany
- German Center for Infection Research (DZIF), Hannover-Braunschweig site, 30625 Hannover, Germany
| | - Thomas Jack
- Department for Pediatric Cardiology and Intensive Care Medicine, Hannover Medical School, 30625 Hannover, Germany
| | - Nicole Rübsamen
- Department of Epidemiology, Research Group Epidemiological and Statistical Methods (ESME), Helmholtz Centre for Infection Research, Inhoffenstr. 7, 38124 Braunschweig, Germany
| | - Michael Sasse
- Department for Pediatric Cardiology and Intensive Care Medicine, Hannover Medical School, 30625 Hannover, Germany
| | - Philipp Beerbaum
- Department for Pediatric Cardiology and Intensive Care Medicine, Hannover Medical School, 30625 Hannover, Germany
| | - Rafael T. Mikolajczyk
- Department of Epidemiology, Research Group Epidemiological and Statistical Methods (ESME), Helmholtz Centre for Infection Research, Inhoffenstr. 7, 38124 Braunschweig, Germany
- German Center for Infection Research (DZIF), Hannover-Braunschweig site, 30625 Hannover, Germany
| | - Martin Boehne
- Department for Pediatric Cardiology and Intensive Care Medicine, Hannover Medical School, 30625 Hannover, Germany
| | - André Karch
- Department of Epidemiology, Research Group Epidemiological and Statistical Methods (ESME), Helmholtz Centre for Infection Research, Inhoffenstr. 7, 38124 Braunschweig, Germany
- German Center for Infection Research (DZIF), Hannover-Braunschweig site, 30625 Hannover, Germany
| |
Collapse
|
13
|
Horn J, Damm O, Greiner W, Hengel H, Kretzschmar ME, Siedler A, Ultsch B, Weidemann F, Wichmann O, Karch A, Mikolajczyk RT. Influence of demographic changes on the impact of vaccination against varicella and herpes zoster in Germany - a mathematical modelling study. BMC Med 2018; 16:3. [PMID: 29316913 PMCID: PMC5761134 DOI: 10.1186/s12916-017-0983-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Accepted: 11/30/2017] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Epidemiological studies suggest that reduced exposure to varicella might lead to an increased risk for herpes zoster (HZ). Reduction of exposure to varicella is a consequence of varicella vaccination but also of demographic changes. We analyzed how the combination of vaccination programs and demographic dynamics will affect the epidemiology of varicella and HZ in Germany over the next 50 years. METHODS We used a deterministic dynamic compartmental model to assess the impact of different varicella and HZ vaccination strategies on varicella and HZ epidemiology in three demographic scenarios, namely the projected population for Germany, the projected population additionally accounting for increased immigration as observed in 2015/2016, and a stationary population. RESULTS Projected demographic changes alone result in an increase of annual HZ cases by 18.3% and a decrease of varicella cases by 45.7% between 1990 and 2060. Independently of the demographic scenario, varicella vaccination reduces the cumulative number of varicella cases until 2060 by approximately 70%, but also increases HZ cases by 10%. Unlike the currently licensed live attenuated HZ vaccine, the new subunit vaccine candidate might completely counteract this effect. Relative vaccine effects were consistent across all demographic scenarios. CONCLUSION Demographic dynamics will be a major determinant of HZ epidemiology in the next 50 years. While stationary population models are appropriate for assessing vaccination impact, models incorporating realistic population structures allow a direct comparison to surveillance data and can thus provide additional input for immunization decision-making and resource planning.
Collapse
Affiliation(s)
- Johannes Horn
- ESME - Epidemiological and Statistical Methods Research Group, Helmholtz Centre for Infection Research, Braunschweig, Germany.,Institue of Medical Epidemiology, Biostatistics and Informatics, Martin-Luther-University Halle-Wittenberg, Halle, Germany.,PhD Programme "Epidemiology" Braunschweig-Hannover, Braunschweig, Germany
| | - Oliver Damm
- Department of Health Economics and Health Care Management, School of Public Health, Bielefeld University, Bielefeld, Germany
| | - Wolfgang Greiner
- Department of Health Economics and Health Care Management, School of Public Health, Bielefeld University, Bielefeld, Germany
| | - Hartmut Hengel
- Institute of Virology, Faculty of Medicine, Albert-Ludwigs-University, University Medical Center, Freiburg, Germany
| | - Mirjam E Kretzschmar
- Julius Centre for Health Sciences & Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands.,Centre for Infectious Disease Control, RIVM, Bilthoven, The Netherlands
| | - Anette Siedler
- Immunization Unit, Robert Koch Institute, Berlin, Germany
| | | | | | - Ole Wichmann
- Immunization Unit, Robert Koch Institute, Berlin, Germany
| | - André Karch
- ESME - Epidemiological and Statistical Methods Research Group, Helmholtz Centre for Infection Research, Braunschweig, Germany.,German Center for Infection Research (DZIF), Hannover-Braunschweig site, Braunschweig, Germany
| | - Rafael T Mikolajczyk
- ESME - Epidemiological and Statistical Methods Research Group, Helmholtz Centre for Infection Research, Braunschweig, Germany. .,Institue of Medical Epidemiology, Biostatistics and Informatics, Martin-Luther-University Halle-Wittenberg, Halle, Germany. .,German Center for Infection Research (DZIF), Hannover-Braunschweig site, Braunschweig, Germany. .,Hannover Medical School, Hannover, Germany.
| |
Collapse
|
14
|
Damm O, Horn J, Mikolajczyk RT, Kretzschmar MEE, Kaufmann AM, Deleré Y, Ultsch B, Wichmann O, Krämer A, Greiner W. Cost-effectiveness of human papillomavirus vaccination in Germany. Cost Eff Resour Alloc 2017; 15:18. [PMID: 28878573 PMCID: PMC5583986 DOI: 10.1186/s12962-017-0080-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Accepted: 08/23/2017] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND The aim of this study was to assess the cost-effectiveness of human papillomavirus (HPV) vaccination in addition to the current cervical cancer screening programme in Germany using a dynamic transmission model. METHODS Based on a mathematical model simulating the transmission dynamics and the natural history of HPV infection and associated diseases (cervical intraepithelial neoplasia, cervical cancer, and genital warts), we estimated the epidemiological and economic consequences of HPV vaccination with both the quadrivalent and bivalent vaccines. In our base case analysis, we assessed the cost-effectiveness of vaccinating 12-year-old girls with a 3-dose schedule. In sensitivity analysis, we also evaluated the use of a 2-dose schedule and assessed the impact of vaccinating boys. RESULTS From a health care payer perspective, incremental cost-effectiveness ratios (ICERs) of a 3-dose schedule were €34,249 per quality-adjusted life year (QALY) for the bivalent and €14,711 per QALY for the quadrivalent vaccine. Inclusion of indirect costs decreased ICERs by up to 40%. When adopting a health care payer perspective, ICERs of a 2-dose approach decreased to €19,450 per QALY for the bivalent and to €3645 per QALY for the quadrivalent vaccine. From a societal perspective, a 2-dose approach using the quadrivalent vaccine was a cost-saving strategy while using the bivalent vaccine resulted in an ICER of €13,248 per QALY. Irrespective of the perspective adopted, additional vaccination of boys resulted in ICERs exceeding €50,000 per QALY, except for scenarios with low coverage (20%) in girls. CONCLUSIONS Our model results suggest that routine HPV vaccination of 12-year-old girls with three doses is likely to be cost-effective in Germany. Due to the additional impact on genital warts, the quadrivalent vaccine appeared to be more cost-effective than the bivalent vaccine. A 2-dose schedule of the quadrivalent vaccine might even lead to cost savings when adopting a societal perspective. The cost-effectiveness of additional vaccination of boys was highly dependent on the coverage in girls.
Collapse
Affiliation(s)
- Oliver Damm
- Department of Health Economics and Health Care Management, School of Public Health, Bielefeld University, Universitätsstraße 25, 33615 Bielefeld, Germany
| | - Johannes Horn
- Epidemiological and Statistical Methods Research Group, Helmholtz Centre for Infection Research, Braunschweig, Germany
| | - Rafael T. Mikolajczyk
- Epidemiological and Statistical Methods Research Group, Helmholtz Centre for Infection Research, Braunschweig, Germany
- Hannover Medical School, Hannover, Germany
- German Centre for Infection Research, Site Hannover-Braunschweig, Hannover/Braunschweig, Germany
| | - Mirjam E. E. Kretzschmar
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
- Centre for Infectious Disease Control, RIVM, Bilthoven, The Netherlands
| | - Andreas M. Kaufmann
- Gynecologic Tumor Immunology, Clinic for Gynecology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | | | | | - Ole Wichmann
- Immunisation Unit, Robert Koch Institute, Berlin, Germany
| | - Alexander Krämer
- Department of Public Health Medicine, School of Public Health, Bielefeld University, Bielefeld, Germany
| | - Wolfgang Greiner
- Department of Health Economics and Health Care Management, School of Public Health, Bielefeld University, Universitätsstraße 25, 33615 Bielefeld, Germany
| |
Collapse
|
15
|
Rübsamen N, Akmatov MK, Castell S, Karch A, Mikolajczyk RT. Factors associated with attrition in a longitudinal online study: results from the HaBIDS panel. BMC Med Res Methodol 2017; 17:132. [PMID: 28859617 PMCID: PMC5580321 DOI: 10.1186/s12874-017-0408-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Accepted: 08/21/2017] [Indexed: 11/10/2022] Open
Abstract
Background Knowing about predictors of attrition in a panel is important to initiate early measures against loss of participants. We investigated attrition in both early and late phase of an online panel with special focus on preferences regarding mode of participation. Methods We used data from the HaBIDS panel that was designed to investigate knowledge, attitudes, and practice regarding infections in the German general population. HaBIDS was divided into two phases: an initial phase when some participants could choose their preferred mode of participation (paper-and-pencil or online) and an extended phase when participants were asked to become members of an online panel that was not limited regarding its duration (i.e. participants initially preferring paper questionnaires switched to online participation). Using competing risks regression, we investigated two types of attrition (formal withdrawal and discontinuation without withdrawal) among online participants, separately for both phases. As potential predictors of attrition, we considered sociodemographic characteristics, physical and mental health as well as auxiliary information describing the survey process, and, in the extended phase, initial mode preference. Results In the initial phase, higher age and less frequent Internet usage predicted withdrawal, while younger age, higher stress levels, delay in returning the consent form, and need for receiving reminder emails predicted discontinuation. In the extended phase, only need for receiving reminder emails predicted discontinuation. Numbers of withdrawal in the extended phase were too small for analysis. Initial mode preference did not predict attrition in the extended phase. Besides age, there was no evidence of differential attrition by sociodemographic factors in any phase. Conclusions Predictors of attrition were similar in both phases of the panel, but they differed by type of attrition (withdrawal vs. discontinuation). Sociodemographic characteristics only played a minor role for both types of attrition. Need for receiving a reminder was the strongest predictor of discontinuation in any phase, but no predictor of withdrawal. We found predictors of attrition, which can be identified already in the early phase of a panel so that countermeasures (e.g. special incentives) can be taken. Electronic supplementary material The online version of this article (10.1186/s12874-017-0408-3) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Nicole Rübsamen
- Department of Epidemiology, Helmholtz Centre for Infection Research (HZI), Inhoffenstraße 7, 38124, Braunschweig, Germany.,PhD Programme "Epidemiology", Braunschweig-Hannover, Germany
| | - Manas K Akmatov
- Department of Epidemiology, Helmholtz Centre for Infection Research (HZI), Inhoffenstraße 7, 38124, Braunschweig, Germany.,AG "Biomarkers for Infectious Diseases", TWINCORE, Centre for Experimental and Clinical Infection Research, Feodor-Lynen-Str. 7, 30625, Hannover, Germany.,Centre for Individualized Infection Medicine, Hannover, Germany
| | - Stefanie Castell
- Department of Epidemiology, Helmholtz Centre for Infection Research (HZI), Inhoffenstraße 7, 38124, Braunschweig, Germany.,AG "Biomarkers for Infectious Diseases", TWINCORE, Centre for Experimental and Clinical Infection Research, Feodor-Lynen-Str. 7, 30625, Hannover, Germany
| | - André Karch
- Department of Epidemiology, Helmholtz Centre for Infection Research (HZI), Inhoffenstraße 7, 38124, Braunschweig, Germany.,PhD Programme "Epidemiology", Braunschweig-Hannover, Germany
| | - Rafael T Mikolajczyk
- Department of Epidemiology, Helmholtz Centre for Infection Research (HZI), Inhoffenstraße 7, 38124, Braunschweig, Germany. .,Hannover Medical School, Hannover, Germany. .,Institute for Medical Epidemiology, Biometry, and Informatics (IMEBI), Medical Faculty of the Martin Luther University Halle-Wittenberg, Magdeburger Straße 8, 06110, Halle (Saale), Germany.
| |
Collapse
|
16
|
Obenauer J, Rübsamen N, Castell S, Hoodgarzadeh M, Klett-Tammen CJ, Mikolajczyk RT, Karch A. Perceptions of Zika virus risk in Germany in 2016. Eur J Public Health 2017; 28:139-144. [DOI: 10.1093/eurpub/ckx092] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
|
17
|
Rübsamen N, Akmatov MK, Castell S, Karch A, Mikolajczyk RT. Comparison of response patterns in different survey designs: a longitudinal panel with mixed-mode and online-only design. Emerg Themes Epidemiol 2017; 14:4. [PMID: 28344629 PMCID: PMC5361716 DOI: 10.1186/s12982-017-0058-2] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Accepted: 03/09/2017] [Indexed: 11/10/2022] Open
Abstract
Background Increasing availability of the Internet allows using only online data collection for more epidemiological studies. We compare response patterns in a population-based health survey using two survey designs: mixed-mode (choice between paper-and-pencil and online questionnaires) and online-only design (without choice). Methods We used data from a longitudinal panel, the Hygiene and Behaviour Infectious Diseases Study (HaBIDS), conducted in 2014/2015 in four regions in Lower Saxony, Germany. Individuals were recruited using address-based probability sampling. In two regions, individuals could choose between paper-and-pencil and online questionnaires. In the other two regions, individuals were offered online-only participation. We compared sociodemographic characteristics of respondents who filled in all panel questionnaires between the mixed-mode group (n = 1110) and the online-only group (n = 482). Using 134 items, we performed multinomial logistic regression to compare responses between survey designs in terms of type (missing, “do not know” or valid response) and ordinal regression to compare responses in terms of content. We applied the false discovery rates (FDR) to control for multiple testing and investigated effects of adjusting for sociodemographic characteristic. For validation of the differential response patterns between mixed-mode and online-only, we compared the response patterns between paper and online mode among the respondents in the mixed-mode group in one region (n = 786). Results Respondents in the online-only group were older than those in the mixed-mode group, but both groups did not differ regarding sex or education. Type of response did not differ between the online-only and the mixed-mode group. Survey design was associated with different content of response in 18 of the 134 investigated items; which decreased to 11 after adjusting for sociodemographic variables. In the validation within the mixed-mode, only two of those were among the 11 significantly different items. The probability of observing by chance the same two or more significant differences in this setting was 22%. Conclusions We found similar response patterns in both survey designs with only few items being answered differently, likely attributable to chance. Our study supports the equivalence of the compared survey designs and suggests that, in the studied setting, using online-only design does not cause strong distortion of the results. Electronic supplementary material The online version of this article (doi:10.1186/s12982-017-0058-2) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Nicole Rübsamen
- Department of Epidemiology, Helmholtz Centre for Infection Research, Inhoffenstr. 7, 38124 Brunswick, Germany.,PhD Programme "Epidemiology", Brunswick-Hanover, Germany
| | - Manas K Akmatov
- Department of Epidemiology, Helmholtz Centre for Infection Research, Inhoffenstr. 7, 38124 Brunswick, Germany.,TWINCORE, Centre for Experimental and Clinical Infection Research, Feodor-Lynen-Str. 7, 30625 Hanover, Germany
| | - Stefanie Castell
- Department of Epidemiology, Helmholtz Centre for Infection Research, Inhoffenstr. 7, 38124 Brunswick, Germany.,TWINCORE, Centre for Experimental and Clinical Infection Research, Feodor-Lynen-Str. 7, 30625 Hanover, Germany
| | - André Karch
- Department of Epidemiology, Helmholtz Centre for Infection Research, Inhoffenstr. 7, 38124 Brunswick, Germany.,PhD Programme "Epidemiology", Brunswick-Hanover, Germany
| | - Rafael T Mikolajczyk
- Department of Epidemiology, Helmholtz Centre for Infection Research, Inhoffenstr. 7, 38124 Brunswick, Germany.,Hannover Medical School, Hanover, Germany
| |
Collapse
|
18
|
Ott JJ, Horn J, Krause G, Mikolajczyk RT. Time trends of chronic HBV infection over prior decades - A global analysis. J Hepatol 2017; 66:48-54. [PMID: 27592304 DOI: 10.1016/j.jhep.2016.08.013] [Citation(s) in RCA: 102] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Revised: 08/23/2016] [Accepted: 08/24/2016] [Indexed: 12/13/2022]
Abstract
BACKGROUND & AIMS Information on trends in chronic hepatitis B virus (HBV) prevalence across countries is lacking. We studied changes in chronic HBV infection over previous decades by country, and assessed patterns of change between and within WHO-defined regions. METHODS Based on data from a published systematic review on chronic HBV, we applied a linear model on the logit scale to assess time trends in country-specific prevalence. Estimated HBsAg prevalence in 2000 and relative changes in prevalence over time were evaluated by country and region. RESULTS Sufficient data were available for 50 countries, mostly showing reductions in prevalence over time. Various degrees of heterogeneity were observed within regions, with a relatively homogenous pattern in the Eastern Mediterranean region with strong decreases in HBsAg prevalence. Europe showed a mixed pattern: higher and stable chronic HBsAg prevalence in Eastern, and constantly low prevalence in Western Europe. In Africa, some countries demonstrated no change in prevalence; increases were seen in Uganda (odds ratio 1.05 per year; 95% confidence interval 1.04-1.06), Nigeria (1.02; 1.02-1.02), Senegal (1.01; 1.01-1.02), and South Africa (1.02; 1.01-1.02). With some exceptions, country-patterns overlapped among countries of South East Asian and Western Pacific regions, characterized by low-medium HBsAg decreases, most prominent in China and Malaysia. CONCLUSIONS Most countries experienced decreases in HBsAg prevalence. Dynamics varied, even within regions; decreases occurred mostly before the direct effects of childhood vaccination may have manifested. These findings together with stable and increasing HBsAg prevalence in some countries of Africa and Eastern Europe indicate the need for further tailored country-specific prevention. LAY SUMMARY This study investigated time trends in prevalence of chronic HBV infection in 50 countries worldwide over the last decade, by estimating relative changes in prevalence. Results show decreases in chronic HBV infection in most countries; no changes or increases in prevalence are noted in some African countries. Reasons for time changes need to be investigated further; based on the results, various prevention measures have contributed to reductions, and further tailored HBV prevention is required to combat the disease on a global level.
Collapse
Affiliation(s)
- Jördis J Ott
- Department of Epidemiology, Helmholtz Centre for Infection Research, Braunschweig, Germany; Hannover Medical School, Hannover, Germany.
| | - Johannes Horn
- Department of Epidemiology, Helmholtz Centre for Infection Research, Braunschweig, Germany; PhD Programme Epidemiology, Helmholtz Centre for Infection Research, Braunschweig, Germany
| | - Gérard Krause
- Department of Epidemiology, Helmholtz Centre for Infection Research, Braunschweig, Germany; Hannover Medical School, Hannover, Germany; German Centre for Infection Research, Germany
| | - Rafael T Mikolajczyk
- Department of Epidemiology, Helmholtz Centre for Infection Research, Braunschweig, Germany; Hannover Medical School, Hannover, Germany; German Centre for Infection Research, Germany
| |
Collapse
|
19
|
Lindemann C, Langner I, Banaschewski T, Garbe E, Mikolajczyk RT. The Risk of Hospitalizations with Injury Diagnoses in a Matched Cohort of Children and Adolescents with and without Attention Deficit/Hyperactivity Disorder in Germany: A Database Study. Front Pediatr 2017; 5:220. [PMID: 29114538 PMCID: PMC5660679 DOI: 10.3389/fped.2017.00220] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Accepted: 09/28/2017] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Attention deficit/hyperactivity disorder (ADHD) is a common neuropsychiatric disorder in children and adolescents worldwide, and children with ADHD have elevated risk of injuries. Our aim was to assess the risk of hospitalizations with injury diagnoses and their various subtypes in children and adolescents with newly diagnosed ADHD compared to those without ADHD, as well as to study sex effects on this risk in the setting of the German health care system. METHODS The German Pharmacoepidemiological Research Database, in which 20 million insured from four statutory health insurances in Germany are included, was used to set up a matched cohort study of 3- to 17-year-old children and adolescents with and without ADHD. We calculated age-specific incidence rates and used Cox regression to obtain hazard ratios (HRs) for hospitalizations with injury diagnoses. We used the injury mortality diagnosis matrix for classification of injuries. RESULTS The matched cohort comprised a total of 75,300 children. The age-specific incidence rates for hospitalization with injury diagnosis for males with ADHD displayed a u-shaped form with highest incidences in the in the age groups 3-6 years [26.2 per 1,000 person-years; 95% confidence interval (CI) 20.5-33.0] and 18-21 years (28.6; 22.4-36.0). Girls with ADHD were less affected in younger age-groups, but the incidence rate for 18-21 year olds was similar to boys with ADHD (26.4; 17.4-38.4). The adjusted HR for children with ADHD was 1.40 (95% CI 1.30-1.49) compared to non-affected children. With respect to nature of injury, ADHD was associated with hospitalization with injury diagnoses of the internal organs, open wounds, and contusions but not with other injuries. With respect to body regions, children with ADHD were more prone to hospitalizations with injuries of the abdomen, traumatic brain injuries, other head injuries, and system-wide injuries such as poisoning and intoxication. No significant associations were seen for the other body regions. Differences between sexes were only seen for system-wide injuries. CONCLUSION Children and adolescents with ADHD are at an increased risk for hospitalizations with diagnoses of injuries compared to non-affected children. Despite differences in health-care systems, the risk increase is at a similar level in Germany as in other countries.
Collapse
Affiliation(s)
- Christina Lindemann
- Department of Clinical Epidemiology, Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany.,Medical School Hannover, Hannover, Germany
| | - Ingo Langner
- Department of Clinical Epidemiology, Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
| | - Tobias Banaschewski
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Mannheim, Germany
| | - Edeltraut Garbe
- Department of Clinical Epidemiology, Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany.,Core Scientific Area 'Health Sciences' at the University of Bremen, Bremen, Germany
| | - Rafael T Mikolajczyk
- Medical School Hannover, Hannover, Germany.,ESME - Epidemiological and Statistical Methods Research Group, Helmholtz Centre for Infection Research, Braunschweig, Germany.,Institute for Medical Epidemiology, Biometrics and Computer Science, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| |
Collapse
|
20
|
Luyten A, Mikolajczyk RT, Horn J, Petry KU. Accelerated regression rates of cervical high-risk human papillomavirus infections by punch biopsies of the uterine cervix. Geburtshilfe Frauenheilkd 2016. [DOI: 10.1055/s-0036-1592723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
|
21
|
Mikolajczyk RT, Sebena R, Warich J, Naydenova V, Dudziak U, Orosova O. Alcohol Drinking in University Students Matters for Their Self-Rated Health Status: A Cross-sectional Study in Three European Countries. Front Public Health 2016; 4:210. [PMID: 27730122 PMCID: PMC5037320 DOI: 10.3389/fpubh.2016.00210] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Accepted: 09/13/2016] [Indexed: 11/17/2022] Open
Abstract
Background Alcohol drinking was linked to self-rated health in different populations, but the observed association was inconsistent. We studied the association among university students across three European countries with different patterns of drinking. Methods We analyzed data from three universities, one from each country: Germany (beer dominant), Bulgaria (wine dominant), and Poland (unclassified among youths, spirits dominant in adults) (N = 2103). Frequency of drinking and problem drinking (≥2 positive responses on CAGE-scale), on the one side, and self-rated health, caring for one’s own health, and worsening of health since the last year, on the other side, were assessed by means of self-administered questionnaire. The association between alcohol- (independent) and health-related (dependent) variables was evaluated by means of logistic regression, adjusting for country and sex. Results Poor self-rated health and worsened health since previous year were associated with problem drinking {odds ratio 1.82 [95% confidence interval (CI) 1.21–2.73] and 1.61 (95% CI 1.17–2.21), respectively}, but not with a higher frequency of drinking. In contrast, not caring for one’s own health was associated with frequent drinking [1.40 (95% CI 1.10–1.78)], but not with problem drinking [1.25 (95% CI 0.95–1.63)]. The results were consistent across the studied countries and for both sexes. Conclusion The health status of university students was associated with problem drinking. A high frequency of drinking was associated with the lack of care of own health, but it was not associated with current health status. These associations were independent of the predominant pattern of drinking across the studied countries.
Collapse
Affiliation(s)
- Rafael T Mikolajczyk
- Department of Epidemiology of Infectious Diseases, Hannover Medical School, Hannover, Germany; Department of Epidemiology, Helmholtz-Centre for Infection Research, Braunschweig, Germany
| | - Rene Sebena
- Department of Psychology, Faculty of Arts, PJ Šafárik University , Košice , Slovakia
| | - Julia Warich
- Department of Public Health Medicine, School of Public Health, Bielefeld University , Bielefeld , Germany
| | | | - Urszula Dudziak
- Institute of Family Sciences, Catholic University of Lublin , Lublin , Poland
| | - Olga Orosova
- Department of Psychology, Faculty of Arts, PJ Šafárik University , Košice , Slovakia
| |
Collapse
|
22
|
Dempsey RC, McAlaney J, Helmer SM, Pischke CR, Akvardar Y, Bewick BM, Fawkner HJ, Guillen-Grima F, Stock C, Vriesacker B, Van Hal G, Salonna F, Kalina O, Orosova O, Mikolajczyk RT. Normative Perceptions of Cannabis Use Among European University Students: Associations of Perceived Peer Use and Peer Attitudes With Personal Use and Attitudes. J Stud Alcohol Drugs 2016; 77:740-8. [DOI: 10.15288/jsad.2016.77.740] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
|
23
|
Helmer SM, Sebena R, McAlaney J, Petkeviciene J, Salonna F, Lukács A, Mikolajczyk RT. Perception of High Alcohol Use of Peers Is Associated With High Personal Alcohol Use in First-Year University Students in Three Central and Eastern European Countries. Subst Use Misuse 2016; 51:1224-31. [PMID: 27219473 DOI: 10.3109/10826084.2016.1162810] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES The objectives of this study were to assess discrepancies between estimated peer and personal drinking behavior and to determine associations between perceptions of peer and personal drinking behavior among university students from Hungary (HU), Lithuania (LT), and the Slovak Republic (SK). METHODS 2,554 freshman university students completed an online questionnaire on the frequency of their personal alcohol use, the number of heavy drinking occasions and on their perception concerning the corresponding drinking behavior of a typical student. Associations between perceived peer and personal use were analyzed by means of logistic regression, adjusting for sex. RESULTS The majority of students across all countries thought their peers drink more frequently and are more often involved in heavy drinking occasions than themselves. Students who perceived the frequency of peer alcohol use to be higher were more likely to drink alcohol twice a week or more often (SR: OR = 3.81, 95% CI = 2.51-5.79; LT: OR = 3.16, 95% CI = 2.11-4.75; HU: OR = 2.10, 95% CI = 1.53-2.87) compared with students who drink alcohol monthly or less. Those who perceived the number of peer heavy drinking occasions as high were more likely to report heavy drinking weekly or more often (SR: OR = 3.16, 95% CI = 1.92-5.20; LT:OR = 3.56, 95% CI = 2.14-5.94; HU:OR = 1.41, 95% CI = 0.79-2.51) compared with students who report heavy drinking less than monthly. CONCLUSIONS/IMPORTANCE University students perceived peer alcohol use to be higher than their personal use. Given the association between perceptions and personal alcohol use, future research should investigate if targeting perceptions in the surveyed countries may have an impact on alcohol use.
Collapse
Affiliation(s)
- Stefanie M Helmer
- a Department of Prevention and Evaluation , Leibniz Institute for Prevention Research and Epidemiology (BIPS) , Bremen , Germany
| | - Rene Sebena
- b Department of Psychology , PJ Safarik University , Košice , Slovak Republic
| | - John McAlaney
- c Department of Psychology , Bournemouth University , Bournemouth , United Kingdom
| | - Janina Petkeviciene
- d Faculty of Public Health, Lithuanian University of Health Sciences , Kaunas , Lithuania
| | - Ferdinand Salonna
- e Institute of Active Lifestyle, Palacký University of Olomuoc , Olomuoc , Czech Republic
| | - Andrea Lukács
- f Institute of Basic Health Sciences, University of Miskolc , Miskolc , Hungary
| | - Rafael T Mikolajczyk
- g Helmholtz Centre for Infection Research , Braunschweig , Germany.,h Hannover Medical School , Hannover , Germany
| |
Collapse
|
24
|
Mikolajczyk RT, Zhang J, Grewal J, Chan LC, Petersen A, Gross MM. Early versus Late Admission to Labor Affects Labor Progression and Risk of Cesarean Section in Nulliparous Women. Front Med (Lausanne) 2016; 3:26. [PMID: 27446924 PMCID: PMC4921453 DOI: 10.3389/fmed.2016.00026] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2016] [Accepted: 05/21/2016] [Indexed: 11/29/2022] Open
Abstract
Background Rates of cesarean section increase worldwide, and the components of this increase are partially unknown. A strong role is prescribed to dystocia, and at the same time, the diagnosis of dystocia is highly subjective. Previous studies indicated that risk of cesarean is higher when women are admitted to the hospital early in the labor. Methods We examined data on 1,202 nulliparous women with singleton, vertex pregnancies and spontaneous labor onset. We selected three groups based on cervical dilatation at admission: early (0.5–1.5 cm, N = 178), intermediate (2.5–3.5 cm, N = 320), and late (4.5–5.5 cm, N = 175). The Kaplan–Meier estimator was used to analyze the risk of delivery by cesarean section at a given dilatation, and thin-plate spline regression with a binary outcome (R library gam) to assess the form of the associations between the cesarean section in either the first or second stage versus vaginal delivery and dilatation at admission. Results Women who were admitted to labor early had a higher risk of delivery by cesarean section (18 versus 4% in the late admission group), while the risk of instrumental delivery did not differ (24 versus 24%). Before 4 cm dilatation, the earlier a woman was admitted to labor, the higher was her risk of delivery by cesarean section. After 4 cm dilatation, however, the relationship disappeared. These patterns were true for both first and second stage cesarean deliveries. Oxytocin use was associated with a higher risk of cesarean section only in the middle group (2.5–3.5 cm dilatation at admission). Conclusion Early admission to labor was associated with a significantly higher risk of delivery by cesarean section during the first and second stages. Differential effects of oxytocin augmentation depending on dilation at admission may suggest that admission at the early stage of labor is an indicator rather than a risk factor itself, but admission at the intermediate stage (2.5–3.5 cm) becomes a risk factor itself. Further research is needed to study this hypothesis.
Collapse
Affiliation(s)
- Rafael T Mikolajczyk
- Department for Epidemiology of Infectious Diseases, Hannover Medical School, Hannover, Germany; Department of Epidemiology, Helmholtz-Centre for Infection Research, Braunschweig, Germany
| | - Jun Zhang
- Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiaotong University School of Medicine , Shanghai , China
| | - Jagteshwar Grewal
- Epidemiology Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health , Bethesda, MD , USA
| | - Linda C Chan
- Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Naval Hospital Camp Lejeune , Camp Lejeune, NC , USA
| | - Antje Petersen
- Midwifery Research and Education Unit, Department of Gynecology and Obstetrics, Hannover Medical School , Hannover , Germany
| | - Mechthild M Gross
- Midwifery Research and Education Unit, Department of Gynecology and Obstetrics, Hannover Medical School , Hannover , Germany
| |
Collapse
|
25
|
Horn J, Karch A, Damm O, Kretzschmar ME, Siedler A, Ultsch B, Weidemann F, Wichmann O, Hengel H, Greiner W, Mikolajczyk RT. Current and future effects of varicella and herpes zoster vaccination in Germany - Insights from a mathematical model in a country with universal varicella vaccination. Hum Vaccin Immunother 2016; 12:1766-76. [PMID: 26835890 DOI: 10.1080/21645515.2015.1135279] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Varicella zoster virus (VZV) is primarily known for causing varicella in childhood, but can reactivate again as herpes zoster (HZ) after a period of latency, mainly in persons older than 50 years. Universal varicella vaccination was introduced in Germany in 2004, while HZ vaccination has not been recommended yet. We aimed to quantify the potential long-term effects of universal childhood varicella vaccination and HZ vaccination of the elderly on varicella and HZ incidence in Germany over a time horizon of 100 years, using a transmission model calibrated to pre-vaccination data and validated against early post-vaccination data. Using current vaccination coverage rates of 87% (64%) with one (two) varicella vaccine dose(s), the model predicts a decrease in varicella cases by 89% for the year 2015. In the long run, the incidence reduction will stabilize at about 70%. Under the assumption of the boosting hypothesis of improved HZ protection caused by exposure to VZV, the model predicts a temporary increase in HZ incidence of up to 20% for around 50 years. HZ vaccination of the elderly with an assumed coverage of 20% has only limited effects in counteracting this temporary increase in HZ incidence. However, HZ incidence is shown to decrease in the long-term by 58% as vaccinated individuals get older and finally reach age-classes with originally high HZ incidence. Despite substantial uncertainties around several key variables, the model's results provide valuable insights that support decision-making regarding national VZV vaccination strategies.
Collapse
Affiliation(s)
- Johannes Horn
- a ESME - Epidemiological and Statistical Methods Research Group, Helmholtz Centre for Infection Research , Braunschweig , Germany.,b PhD Programme "Epidemiology" Helmholtz Centre for Infection Research/Hannover Medical School , Braunschweig/Hannover , Germany
| | - André Karch
- a ESME - Epidemiological and Statistical Methods Research Group, Helmholtz Centre for Infection Research , Braunschweig , Germany.,c German Center for Infection Research (DZIF) , Hannover-Braunschweig site , Germany
| | - Oliver Damm
- d Department of Health Economics and Health Care Management , School of Public Health, Bielefeld University , Bielefeld , Germany
| | - Mirjam E Kretzschmar
- e Julius Centre for Health Sciences & Primary Care, University Medical Centre Utrecht , Utrecht , The Netherlands.,f Centre for Infectious Disease Control, RIVM , Bilthoven , The Netherlands
| | - Anette Siedler
- g Immunization Unit, Robert Koch Institute , Berlin , Germany
| | - Bernhard Ultsch
- g Immunization Unit, Robert Koch Institute , Berlin , Germany
| | - Felix Weidemann
- g Immunization Unit, Robert Koch Institute , Berlin , Germany
| | - Ole Wichmann
- g Immunization Unit, Robert Koch Institute , Berlin , Germany
| | - Hartmut Hengel
- h Institute of Virology, Department of Medical Microbiology and Hygiene, University Medical Center , Freiburg , Germany
| | - Wolfgang Greiner
- d Department of Health Economics and Health Care Management , School of Public Health, Bielefeld University , Bielefeld , Germany
| | - Rafael T Mikolajczyk
- a ESME - Epidemiological and Statistical Methods Research Group, Helmholtz Centre for Infection Research , Braunschweig , Germany.,c German Center for Infection Research (DZIF) , Hannover-Braunschweig site , Germany.,i Hannover Medical School , Hannover , Germany
| |
Collapse
|
26
|
Abstract
Knowledge about actual risks was poor, creating the potential for inappropriate behavior changes. Ebola virus disease (EVD) outbreaks have occurred during the past 5 decades, but none has affected European countries like the 2014 epidemic in West Africa. We used an online questionnaire to investigate risk perceptions in Germany during this epidemic peak. Our questionnaire covered risk perceptions, knowledge about transmission routes, media use, reactions to the outbreak, attitudes toward measures to prevent the spread of EVD and vaccination against EVD, and willingness to volunteer for aid missions. Of 974 participants, 29% indicated that they worried about EVD, 4% correctly stated virus transmission routes, and 75% incorrectly rated airborne transmission and transmission by asymptomatic patients as possible. Many indicated that if a patient were flown to Germany for treatment in a nearby hospital, they would adapt preventive behavior. Although most participants were not worried about EVD at the current stage of the epidemic, misperceptions regarding transmission were common and could trigger inappropriate behavior changes.
Collapse
|
27
|
Karch A, Schmitz RP, Rißner F, Castell S, Töpel S, Jakob M, Brunkhorst FM, Mikolajczyk RT. Bloodstream infections, antibiotic resistance and the practice of blood culture sampling in Germany: study design of a Thuringia-wide prospective population-based study (AlertsNet). BMJ Open 2015; 5:e009095. [PMID: 26671957 PMCID: PMC4679894 DOI: 10.1136/bmjopen-2015-009095] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
INTRODUCTION Bloodstream infections are a major cause of death worldwide; blood culture (BC) sampling remains the most important tool for their diagnosis. Current data suggest that BC rates in German hospitals are considerably lower than recommended; this points to shortfalls in the application of microbiological analyses. Since early and appropriate BC diagnostics are associated with reduced case fatality rates and a shorter duration of antimicrobial therapy, a multicomponent study for the improvement of BC diagnostics was developed. METHODS AND ANALYSIS An electronic BC registry established for the German Federal state of Thuringia is the structural basis of this study. The registry includes individual patient data (microbiological results and clinical data) and institutional information for all clinically relevant positive BCs at the participating centres. First, classic result quality indicators for bloodstream infections (eg, sepsis rates) will be studied using Poisson regression models (adjusted for institutional characteristics) in order to derive relative ranks for feedback to clinical institutions. Second, a target value will be established for the process indicator BC rate. On the basis of this target value, recommendations will be made for a given combination of institutional characteristics as a reference for future use in quality control. An interventional study aiming at the improvement of BC rates will be conducted thereafter. On the basis of the results of a survey in the participating institutions, a targeted educational intervention will be developed. The success of the educational intervention will be measured by changes in the process indicator and the result indicators over time using a pre-post design. ETHICS AND DISSEMINATION Ethics approval was obtained from the Ethics committee of the University Hospital Jena and from the Ethics committee of the State Chamber of Physicians of Thuringia. Findings of AlertsNet will be disseminated through public media releases and publications in peer-reviewed journals. TRIAL REGISTRATION NUMBER DRKS00004825.
Collapse
Affiliation(s)
- André Karch
- Department of Epidemiology, Helmholtz Centre for Infection Research, Braunschweig, Germany
| | - Roland P Schmitz
- Paul-Martini Research Group, Department of Anesthesiology and Intensive Care Medicine, Jena University Hospital, Jena, Germany
| | - Florian Rißner
- Center for Clinical Studies Jena (ZKS), Center for Sepsis Control and Care (CSCC), Jena University Hospital, Jena, Germany
| | - Stefanie Castell
- Department of Epidemiology, Helmholtz Centre for Infection Research, Braunschweig, Germany
| | - Sandra Töpel
- Paul-Martini Research Group, Department of Anesthesiology and Intensive Care Medicine, Jena University Hospital, Jena, Germany
| | - Matthias Jakob
- Paul-Martini Research Group, Department of Anesthesiology and Intensive Care Medicine, Jena University Hospital, Jena, Germany
| | - Frank M Brunkhorst
- Paul-Martini Research Group, Department of Anesthesiology and Intensive Care Medicine, Jena University Hospital, Jena, Germany
- Center for Clinical Studies Jena (ZKS), Center for Sepsis Control and Care (CSCC), Jena University Hospital, Jena, Germany
| | - Rafael T Mikolajczyk
- Department of Epidemiology, Helmholtz Centre for Infection Research, Braunschweig, Germany
| |
Collapse
|
28
|
Pischke CR, Helmer SM, McAlaney J, Bewick BM, Vriesacker B, Van Hal G, Mikolajczyk RT, Akvardar Y, Guillen-Grima F, Salonna F, Orosova O, Dohrmann S, Dempsey RC, Zeeb H. Normative misperceptions of tobacco use among university students in seven European countries: baseline findings of the 'Social Norms Intervention for the prevention of Polydrug usE' study. Addict Behav 2015; 51:158-64. [PMID: 26275842 DOI: 10.1016/j.addbeh.2015.07.012] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2015] [Revised: 07/14/2015] [Accepted: 07/22/2015] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Research conducted in North America suggests that students tend to overestimate tobacco use among their peers. This perceived norm may impact personal tobacco use. It remains unclear how these perceptions influence tobacco use among European students. The two aims were to investigate possible self-other discrepancies regarding personal use and attitudes towards use and to evaluate if perceptions of peer use and peer approval of use are associated with personal use and approval of tobacco use. METHODS The EU-funded 'Social Norms Intervention for the prevention of Polydrug usE' study was conducted in Belgium, Denmark, Germany, Slovak Republic, Spain, Turkey and United Kingdom. In total, 4482 students (71% female) answered an online survey including questions on personal and perceived tobacco use and personal and perceived attitudes towards tobacco use. RESULTS Across all countries, the majority of students perceived tobacco use of their peers to be higher than their own use. The perception that the majority (>50%) of peers used tobacco regularly in the past two months was significantly associated with higher odds for personal regular use (OR: 2.66, 95% CI: 1.90-3.73). The perception that the majority of peers approve of tobacco use was significantly associated with higher odds for personal approval of tobacco use (OR: 6.49, 95% CI: 4.54-9.28). CONCLUSIONS Perceived norms are an important predictor of personal tobacco use and attitudes towards use. Interventions addressing perceived norms may be a viable method to change attitudes and tobacco use among European students, and may be a component of future tobacco control policy.
Collapse
Affiliation(s)
- Claudia R Pischke
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Achterstr. 30, 28359 Bremen, Germany.
| | - Stefanie M Helmer
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Achterstr. 30, 28359 Bremen, Germany.
| | - John McAlaney
- Division of Psychology, University of Bradford, Bradford, BD7 1DP, United Kingdom.
| | - Bridgette M Bewick
- Leeds Institute of Health Sciences, School of Medicine, University of Leeds, 101 Clarendon Road, West Yorkshire, LS2 9LJ, Leeds, United Kingdom.
| | - Bart Vriesacker
- Research & Development, Occupational Health Services Mensura, Italiëlei 2, 2000 Antwerp, Belgium; Epidemiology and Social Medicine, University of Antwerp, Campus Drie Eiken, Universiteitsplein 1, 2610 Wilrijk, Antwerp, Belgium.
| | - Guido Van Hal
- Epidemiology and Social Medicine, University of Antwerp, Campus Drie Eiken, Universiteitsplein 1, 2610 Wilrijk, Antwerp, Belgium.
| | - Rafael T Mikolajczyk
- Department of Epidemiology, Helmholtz Centre for Infection Research, Inhoffenstr. 7, 33824 Braunschweig, Germany.
| | - Yildiz Akvardar
- Department of Psychiatry, Marmara University School of Medicine, 34899 Istanbul, Turkey.
| | - Francisco Guillen-Grima
- Department of Health Sciences, Faculty of Health Sciences, Public University of Navarra, Avda de Baranain s/n, 31008 Pamplona, Navarra, Spain.
| | - Ferdinand Salonna
- Institute of Active Lifestyle, Palacky University of Olomouc, 771 47 Olomouc, Czech Republic.
| | - Olga Orosova
- Department of Educational Psychology and Health Psychology, PJ Safarik University, Kosice, Slovakia.
| | - Solveig Dohrmann
- Unit for Health Promotion Research, University of Southern Denmark, Niels Bohrs Vej 9, 6700 Esbjerg, Denmark.
| | - Robert C Dempsey
- Division of Psychology, University of Bradford, Bradford, BD7 1DP, United Kingdom; School of Psychology, Sport and Exercise, Staffordshire University, Science Center, Leek Road, Stoke-On-Trent ST4 2DF, United Kingdom.
| | - Hajo Zeeb
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Achterstr. 30, 28359 Bremen, Germany.
| |
Collapse
|
29
|
Zoch B, Karch A, Dreesman J, Monazahian M, Baillot A, Mikolajczyk RT. Feasibility of a birth cohort study dedicated to assessing acute infections using symptom diaries and parental collection of biomaterials. BMC Infect Dis 2015; 15:436. [PMID: 26493700 PMCID: PMC4618955 DOI: 10.1186/s12879-015-1189-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Accepted: 10/07/2015] [Indexed: 11/23/2022] Open
Abstract
Background A birth cohort dedicated to studying infections in early childhood may be assisted by parental recording of symptoms on a daily basis and a collection of biomaterials. We aimed at testing the feasibility of this approach for use in a long-term study focusing on infections in children in Germany. Methods Parents of 1- to 3-year-old children (n = 75) were recruited in nursery schools. They were asked to complete a symptom diary on a daily basis and to take monthly and symptom-triggered nasal swabs and stool samples from their child over the study period of three months. Feasibility was measured by means of the return proportions of symptom diaries and bio samples; acceptance was assessed by a questionnaire delivered to participants at the end of the study. Results The majority of the participants filled in the symptom diary during the three months study for 75 or more days (77.3 %), and provided the monthly nasal swabs (62.7 %) and stool samples (65.3 %). The time needed for the tasks was acceptable for most participants (symptom diary: 92.3 %, nasal swabs: 98.5 %, stool samples: 100.0 %). In 64.3 % of the symptom-triggered nasal swabs, respiratory viruses were found compared to 55.5 % in throat swabs taken by health-care professionals within the “ARE surveillance Lower Saxony”, a special project by the Governmental Institute of Public Health of Lower Saxony to investigate causal pathogens for acute respiratory infections in children. Conclusions The parental assessment of symptoms and collection of biomaterials in a birth cohort dedicated to studying infections appears feasible in a middle class German population. The success of the study will depend on the ability to maintain these activities over a long time period. Electronic supplementary material The online version of this article (doi:10.1186/s12879-015-1189-0) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Beate Zoch
- ESME - Research Group Epidemiological and Statistical Methods, Helmholtz Centre for Infection Research, Inhoffenstr. 7, 38124, Braunschweig, Germany. .,PhD Programme "Epidemiology", Braunschweig-Hannover, Braunschweig, Germany.
| | - André Karch
- ESME - Research Group Epidemiological and Statistical Methods, Helmholtz Centre for Infection Research, Inhoffenstr. 7, 38124, Braunschweig, Germany. .,PhD Programme "Epidemiology", Braunschweig-Hannover, Braunschweig, Germany. .,German Centre for Infection Research (DZIF), Hannover-Braunschweig site, Braunschweig, Germany.
| | - Johannes Dreesman
- Governmental Institute of Public Health of Lower Saxony, Hannover, Germany.
| | - Masyar Monazahian
- Governmental Institute of Public Health of Lower Saxony, Hannover, Germany.
| | - Armin Baillot
- Governmental Institute of Public Health of Lower Saxony, Hannover, Germany.
| | - Rafael T Mikolajczyk
- ESME - Research Group Epidemiological and Statistical Methods, Helmholtz Centre for Infection Research, Inhoffenstr. 7, 38124, Braunschweig, Germany. .,German Centre for Infection Research (DZIF), Hannover-Braunschweig site, Braunschweig, Germany. .,Hannover Medical School (MHH), Hannover, Germany.
| |
Collapse
|
30
|
Schweitzer A, Horn J, Mikolajczyk RT, Krause G, Ott JJ. Estimations of worldwide prevalence of chronic hepatitis B virus infection: a systematic review of data published between 1965 and 2013. Lancet 2015; 386:1546-55. [PMID: 26231459 DOI: 10.1016/s0140-6736(15)61412-x] [Citation(s) in RCA: 1853] [Impact Index Per Article: 205.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND The quantification of the burden of disease attributable to hepatitis B virus (HBV) infection and the adaptation of prevention and control measures requires knowledge on its prevalence in the general population. For most countries such data are not routinely available. We estimated the national, regional, and global prevalence of chronic HBV infection. METHODS For this systematic review and pooled analysis, we searched for data on prevalence of chronic HBV infection published between Jan 1, 1965, and Oct 23, 2013, in the databases Medline, Embase, CAB Abstracts (Global health), Popline, and Web of Science. We included studies reporting the hepatitis B surface antigen (HBsAg) serological marker of chronic HBV infection in non-high-risk groups and extracted data into a customised database. For each country, we calculated HBsAg prevalence estimates and 95% CIs weighted by study size. We extrapolated prevalence estimates to population sizes in 2010 to obtain the number of individuals with chronic HBV infection. FINDINGS Of the 17,029 records screened, 1800 report on the prevalence of HBsAg covering 161 countries were included. HBsAg seroprevalence was 3·61% (95% CI 3·61-3·61) worldwide with highest endemicity in countries of the African region (total 8·83%, 8·82-8·83) and Western Pacific region (total 5·26%, 5·26-5·26). Within WHO regions, prevalence ranged from 0·20% (0·19-0·21; Mexico) to 13·55% (9·00-19·89; Haiti) in the Americas, to 0·48% (0·12-1·90; the Seychelles) to 22·38% (20·10-24·83; South Sudan) in the African region. We estimated that in 2010, globally, about 248 million individuals were HBsAg positive. INTERPRETATION This first global assessment of country-level population prevalence of chronic HBV infection found a wide variation between countries and highlights the need for continued prevention and control strategies and the collection of reliable epidemiologic data using standardised methodology. FUNDING World Health Organization.
Collapse
Affiliation(s)
- Aparna Schweitzer
- Department of Epidemiology, Helmholtz Centre for Infection Research, Braunschweig, Germany; PhD Programme 'Epidemiology' Braunschweig-Hannover, Braunschweig, Germany
| | - Johannes Horn
- Department of Epidemiology, Helmholtz Centre for Infection Research, Braunschweig, Germany; PhD Programme 'Epidemiology' Braunschweig-Hannover, Braunschweig, Germany; Research Group Epidemiological and Statistical Methods, Helmholtz Center for Infection Research, Braunschweig, Germany
| | - Rafael T Mikolajczyk
- Department of Epidemiology, Helmholtz Centre for Infection Research, Braunschweig, Germany; Research Group Epidemiological and Statistical Methods, Helmholtz Center for Infection Research, Braunschweig, Germany; Hannover Medical School, Hannover, Germany
| | - Gérard Krause
- Department of Epidemiology, Helmholtz Centre for Infection Research, Braunschweig, Germany; Hannover Medical School, Hannover, Germany
| | - Jördis J Ott
- Department of Epidemiology, Helmholtz Centre for Infection Research, Braunschweig, Germany; Hannover Medical School, Hannover, Germany.
| |
Collapse
|
31
|
Akmatov MK, Rübsamen N, Schultze A, Kemmling Y, Obi N, Günther K, Ahrens W, Pessler F, Krause G, Mikolajczyk RT. Diverse recruitment strategies result in different participation percentages in a web-based study, but in similar compliance. Int J Public Health 2015; 60:937-43. [PMID: 26370905 DOI: 10.1007/s00038-015-0737-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Revised: 09/01/2015] [Accepted: 09/02/2015] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVES We compared participation and compliance with a web-based data collection on infections among population-based samples recruited in different ways. METHODS Individuals were recruited from participants in the German National Cohort study (Group A, n = 279) or persons who were invited to this study but did not participate (Group B, n = 53). A third group was invited to the web-based study only (Group C, n = 145). RESULTS Response varied among groups between 3 % (B), 11 % (C) and 61 % (A), but compliance was similar (81-85 %). Response did not differ by age and sex. Compliance was lower among the youngest and oldest participants. In addition, participants currently not employed were more likely to have better compliance. Semi-parametric group-based modelling identified three distinct compliance trajectories; "poor compliance" (8 %), "improving compliance" (14 %) and "very good compliance" (78 %). CONCLUSIONS Participation differed among modes of recruitment, but compliance was similar among groups and notably high. Different recruitment approaches can be used and collected data can be combined to achieve greater sample sizes for longitudinal web-based studies.
Collapse
Affiliation(s)
- Manas K Akmatov
- Department of Epidemiology, Helmholtz Centre for Infection Research, Brunswick, Germany. .,TWINCORE Centre for Experimental and Clinical Infection Research, Hannover, Germany.
| | - Nicole Rübsamen
- Department of Epidemiology, Helmholtz Centre for Infection Research, Brunswick, Germany
| | - Anja Schultze
- Department of Epidemiology, Helmholtz Centre for Infection Research, Brunswick, Germany
| | - Yvonne Kemmling
- Department of Epidemiology, Helmholtz Centre for Infection Research, Brunswick, Germany
| | - Nadia Obi
- University Cancer Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Kathrin Günther
- Department of Epidemiological Methods and Etiologic Research, Leibniz Institute for Prevention Research and Epidemiology-BIPS, Bremen, Germany
| | - Wolfgang Ahrens
- Department of Epidemiological Methods and Etiologic Research, Leibniz Institute for Prevention Research and Epidemiology-BIPS, Bremen, Germany
| | - Frank Pessler
- TWINCORE Centre for Experimental and Clinical Infection Research, Hannover, Germany
| | - Gérard Krause
- Department of Epidemiology, Helmholtz Centre for Infection Research, Brunswick, Germany
| | - Rafael T Mikolajczyk
- Department of Epidemiology, Helmholtz Centre for Infection Research, Brunswick, Germany
| |
Collapse
|
32
|
Damm O, Ultsch B, Horn J, Mikolajczyk RT, Greiner W, Wichmann O. Systematic review of models assessing the economic value of routine varicella and herpes zoster vaccination in high-income countries. BMC Public Health 2015; 15:533. [PMID: 26041469 PMCID: PMC4455277 DOI: 10.1186/s12889-015-1861-8] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2014] [Accepted: 05/21/2015] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND A systematic review was conducted to assess the cost-effectiveness of routine varicella and herpes zoster (HZ) vaccination in high-income countries estimated by modelling studies. METHODS A PubMed search was performed to identify relevant studies published before October 2013. Studies were included in the review if they (i) evaluated the cost-effectiveness of routine childhood or adolescent varicella vaccination and/or HZ vaccination targeting the elderly, and if they (ii) reported results for high-income countries. RESULTS A total of 38 model-based studies were identified that fulfilled the inclusion criteria. Routine childhood or adolescent varicella vaccination was cost-effective or cost-saving from a payer perspective and always cost-saving from a societal perspective when ignoring its potential impact on HZ incidence due to reduced or absent exogenous boosting. The inclusion of the potential impact of childhood varicella vaccination on HZ led to net quality-adjusted life-year (QALY) losses or incremental cost-effectiveness ratios exceeding commonly accepted thresholds. Additional HZ vaccination could partially mitigate this effect. Studies focusing only on the evaluation of HZ vaccination reported a wide range of results depending on the selected target age-group and the vaccine price, but most found HZ vaccination to be a cost-effective or marginally cost-effective intervention. Cost-effectiveness of HZ vaccination was strongly dependent on the age at vaccination, the price of the vaccine, the assumed duration of protection and the applied cost per QALY threshold. CONCLUSIONS While HZ vaccination is mostly considered cost-effective, cost-effectiveness of varicella vaccination primarily depends on the in- or exclusion of exogenous boosting in the model. As a consequence, clarification on the role of exogenous boosting is crucial for decision-making regarding varicella vaccination.
Collapse
Affiliation(s)
- Oliver Damm
- Department of Health Economics and Health Care Management, Bielefeld School of Public Health, Bielefeld University, Bielefeld, Germany.
| | | | - Johannes Horn
- Helmholtz Centre for Infection Research, Brunswick, Germany.
| | - Rafael T Mikolajczyk
- Helmholtz Centre for Infection Research, Brunswick, Germany.
- Hannover Medical School, Hannover, Germany.
| | - Wolfgang Greiner
- Department of Health Economics and Health Care Management, Bielefeld School of Public Health, Bielefeld University, Bielefeld, Germany.
| | - Ole Wichmann
- Immunisation Unit, Robert Koch Institute, Berlin, Germany.
| |
Collapse
|
33
|
Akmatov MK, Kimani-Murage E, Pessler F, Guzman CA, Krause G, Kreienbrock L, Mikolajczyk RT. Evaluation of invalid vaccine doses in 31 countries of the WHO African Region. Vaccine 2014; 33:892-901. [PMID: 25523526 DOI: 10.1016/j.vaccine.2014.10.089] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2014] [Revised: 10/06/2014] [Accepted: 10/08/2014] [Indexed: 11/30/2022]
Abstract
We examined (a) the fraction of and extent to which vaccinations were administered earlier than recommended (age-invalid) or with too short intervals between vaccine doses (interval-invalid) in countries of the World Health Organisation (WHO) African Region and (b) individual- and community-level factors associated with invalid vaccinations using multilevel techniques. Data from the Demographic and Health Surveys conducted in the last 10 years in 31 countries were used. Information about childhood vaccinations was based on vaccination records (n=134,442). Invalid vaccinations (diphtheria, tetanus, pertussis [DTP1, DTP3] and measles-containing vaccine (MCV)) were defined using the WHO criteria. The median percentages of invalid DTP1, DTP3 and MCV vaccinations across all countries were 12.1% (interquartile range, 9.4-15.2%), 5.7% (5.0-7.6%), and 15.5% (10.0-18.1%), respectively. Of the invalid DTP1 vaccinations, 7.4% and 5.5% were administered at child's age of less than one and two weeks, respectively. In 12 countries, the proportion of invalid DTP3 vaccinations administered with an interval of less than two weeks before the preceding dose varied between 30% and 50%. In 13 countries, the proportion of MCV doses administered at child's age of less than six months varied between 20% and 45%. Community-level variables explained part of the variation in invalid vaccinations. Invalid vaccinations are common in African countries. Timing of childhood vaccinations should be improved to ensure an optimal protection against vaccine-preventable infections and to avoid unnecessary wastage in these economically deprived countries.
Collapse
Affiliation(s)
- Manas K Akmatov
- Department of Epidemiology, Helmholtz Centre for Infection Research, Braunschweig, Germany; TWINCORE Centre for Experimental and Clinical Infection Research, Hannover, Germany.
| | | | - Frank Pessler
- TWINCORE Centre for Experimental and Clinical Infection Research, Hannover, Germany
| | - Carlos A Guzman
- Department of Vaccinology and Applied Microbiology, Helmholtz Centre for Infection Research, Braunschweig, Germany
| | - Gérard Krause
- Department of Epidemiology, Helmholtz Centre for Infection Research, Braunschweig, Germany; Hannover Medical School, Hannover, Germany
| | - Lothar Kreienbrock
- Department of Biometry, Epidemiology and Information Processing, University for Veterinary Medicine, Hanover, Germany
| | - Rafael T Mikolajczyk
- Department of Epidemiology, Helmholtz Centre for Infection Research, Braunschweig, Germany; Hannover Medical School, Hannover, Germany
| |
Collapse
|
34
|
Mikolajczyk RT, Horn J, Prins M, Wiessing L, Kretzschmar M. Trajectories of injecting behavior in the Amsterdam Cohort Study among drug users. Drug Alcohol Depend 2014; 144:141-7. [PMID: 25248472 DOI: 10.1016/j.drugalcdep.2014.08.020] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2014] [Revised: 08/25/2014] [Accepted: 08/29/2014] [Indexed: 11/27/2022]
Abstract
BACKGROUND Injecting frequency among people who inject drugs (IDU) can change along distinct trajectories, which can reflect on incidence of HIV and HCV infections. We aimed at assessing these patterns of longitudinal changes, their predictors and their association with the incidence of HIV and HCV. METHODS We analyzed data from the Amsterdam Cohort Study among Drug Users, selecting participants recruited from 1985 to 2005, injecting drugs before cohort entry and with records in at least three different six months intervals (N=740). We used latent class mixed models to identify distinct trajectories of injecting, multinomial regression to identify socio-demographic variables associated with those patterns and Kaplan-Meier analysis for the estimation of the corresponding cumulative HIV and HCV incidence. RESULTS Five distinct patterns for injecting frequency and for injecting since last visit were identified. The majority of participants (three groups, 69% of participants) had stable risk injecting behavior; the remaining displayed a decrease in injecting over time. Those with longer duration of injecting at cohort entry and those who entered the cohort in earlier years tended to have continuing high risk behavior. The HIV risk was highest among those with continuing high risk behavior and its changes over time mirrored the patterns of change in injecting in a group with decrease in injecting. CONCLUSIONS Individual longitudinal patterns of changes in injecting behavior are related to socio-demographic and drug use variables and are reflected in the incidence of HIV infections. Understanding these associations might provide valuable information for targeted interventions.
Collapse
Affiliation(s)
- Rafael T Mikolajczyk
- Department of Epidemiology, Helmholtz Centre for Infection Research, Braunschweig, Germany; Hannover Medical School, Hannover, Germany.
| | | | - Maria Prins
- Department of Internal Medicine, Academic Medical Centre, CINIMA, Amsterdam, The Netherlands; Public Health Service Amsterdam, Cluster Infectious Diseases, Department of Research, Amsterdam, The Netherlands
| | - Lucas Wiessing
- European Monitoring Centre for Drugs and Drug Addiction (EMCDDA), Lisbon, Portugal
| | - Mirjam Kretzschmar
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands; Centre for Infectious Disease Control, RIVM, Bilthoven, The Netherlands
| |
Collapse
|
35
|
Helmer SM, Mikolajczyk RT, McAlaney J, Vriesacker B, Van Hal G, Akvardar Y, Guillen-Grima F, Salonna F, Stock C, Dempsey RC, Bewick BM, Zeeb H. Illicit substance use among university students from seven European countries: a comparison of personal and perceived peer use and attitudes towards illicit substance use. Prev Med 2014; 67:204-9. [PMID: 25091880 DOI: 10.1016/j.ypmed.2014.07.039] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2014] [Revised: 05/26/2014] [Accepted: 07/23/2014] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To compare European students' personal use and approval of illicit substance use with their perceptions of peer behaviours and attitudes, and investigate whether perceptions of peer norms are associated with personal use of illicit substances and attitudes. METHOD This study used baseline data from the Social Norms Intervention for the prevention of Polydrug usE (SNIPE) project involving 4482 students from seven European countries in 2012. Students completed an online survey which included questions on personal and perceived peer illicit substance use and personal and perceived peer attitude towards illicit substances. RESULTS 8.3% of students reported having used illicit substances at least once in their life. 49.7% of students perceived that the majority of their peers have used illicit substances more frequently than themselves. The perception was significantly associated with higher odds for personal illicit substance use (OR: 1.97, 95% CI: 1.53-2.54). The perception that the majority of peers approve illicit substance use was significantly associated with higher odds for personal approval of illicit substance use (OR: 3.47, 95% CI: 2.73-4.41). CONCLUSION Students commonly perceived that their peers used illicit subtances more often than themselves. We found an association between the perceived peer norms/attitudes and reported individual behaviour/attitudes.
Collapse
Affiliation(s)
- S M Helmer
- Leibniz Institute for Prevention Research and Epidemiology (BIPS), 28359 Bremen, Germany.
| | - R T Mikolajczyk
- Department of Epidemiology, Helmholtz Centre for Infection Research, 38124 Braunschweig, Germany; Hannover Medical School, 30625 Hannover, Germany
| | - J McAlaney
- Division of Psychology, University of Bradford, Bradford BD7 1DP, United Kingdom
| | - B Vriesacker
- Medical Sociology and Health Policy, University of Antwerp, 2610 Antwerp, Belgium; Research & Development, Occupational Health Services Mensura, 2000 Antwerp, Belgium
| | - G Van Hal
- Medical Sociology and Health Policy, University of Antwerp, 2610 Antwerp, Belgium
| | - Y Akvardar
- Department of Psychiatry, Marmara University Medical School, 34722 Istanbul, Turkey
| | - F Guillen-Grima
- Department of Health Sciences, Public University of Navarra, 31008 Pamplona, Navarra, Spain
| | - F Salonna
- Institute of Active Lifestyle, Palacky University of Olomouc, 771 47 Olomouc, Czech Republic
| | - C Stock
- Unit for Health Promotion Research, University of Southern Denmark, 6700 Esbjerg, Denmark
| | - R C Dempsey
- Division of Psychology, University of Bradford, Bradford BD7 1DP, United Kingdom; School of Psychology, Sport and Exercise, Staffordshire University, Stoke-On-Trent ST4 2DF, United Kingdom
| | - B M Bewick
- School of Medicine, Leeds Institute of Health Sciences, Academic Unit of Psychiatry and Behavioural Sciences, University of Leeds, Leeds LS2 9LJ, United Kingdom
| | - H Zeeb
- Leibniz Institute for Prevention Research and Epidemiology (BIPS), 28359 Bremen, Germany; Health Sciences Bremen, University of Bremen, 28359 Bremen, Germany
| |
Collapse
|
36
|
Stich HL, Krämer A, Mikolajczyk RT. Clustering of developmental delays in Bavarian preschool children - a repeated cross-sectional survey over a period of 12 years. BMC Pediatr 2014; 14:18. [PMID: 24450504 PMCID: PMC3936812 DOI: 10.1186/1471-2431-14-18] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2013] [Accepted: 01/15/2014] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND While most children display a normal development, some children experience developmental delays compared to age specific development milestones assessed during school entry examination. Data exist on prevalence of delays in single areas, but there is lack of knowledge regarding the clustering patterns of developmental delays and their determinants. METHODS During the observation period 1997-2008, 12 399 preschool children (5-7 years of age) in one district of Bavaria, Germany, were assessed in twelve schooling-relevant development areas. The co-occurrence of developmental delays was studied by means of Pearson's correlation. Subsequently, a two-step cluster algorithm was applied to identify patterns of developmental delays, and multinomial logistic regression was conducted to identify variables associated with the specific patterns. RESULTS Fourteen percent of preschool children displayed developmental delays in one and 19% in two or more of the studied areas. Among those with at least two developmental delays, most common was the combination of delays in "fine motor skills" + "grapho-motor coordination" (in 9.1% of all children), followed by "memory/concentration" + "endurance" (5.8%) and "abstraction" + "visual perception" (2.1%). In the cluster analysis, five distinct patterns of delays were identified, which displayed different associations with male gender and younger age. CONCLUSIONS While developmental delays can affect single areas, clustering of multiple developmental delays is common. Such clustering should be taken into account when developing diagnostic tests, in pediatric practice and considering interventions to reduce delays.
Collapse
Affiliation(s)
- Heribert L Stich
- Department of Public Health Medicine, District of Erding, Erding 85435, Germany
- Department of Public Health Medicine, School of Public Health, University of Bielefeld, Bielefeld 33501, Germany
| | - Alexander Krämer
- Department of Public Health Medicine, School of Public Health, University of Bielefeld, Bielefeld 33501, Germany
| | - Rafael T Mikolajczyk
- Department of Epidemiology, Helmholtz Centre for Infection Research, Braunschweig, Germany
- Hannover Medical School, Hannover, Germany
| |
Collapse
|
37
|
Lopez-del Burgo C, Mikolajczyk RT, Osorio A, Errasti T, de Irala J. Women's attitudes towards mechanisms of action of birth control methods: a cross-sectional study in five European countries. J Clin Nurs 2013; 22:3006-15. [PMID: 23957574 DOI: 10.1111/jocn.12180] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/31/2012] [Indexed: 01/30/2023]
Abstract
AIMS AND OBJECTIVES To assess women's attitudes towards the mechanisms of action of birth control methods. BACKGROUND When addressing women's knowledge of and attitudes towards birth control methods, researchers frequently focus on side effects, effectiveness or correct use. Women's opinions about mechanisms of action have been much less investigated, and research is usually concentrated on the EC pill. DESIGN Cross-sectional study. METHODS Women, aged 18-49, from Germany, France, the UK, Sweden and Romania were randomly selected (n = 1137). They were asked whether they would use a method that may work after fertilisation or after implantation and whether they would continue using it after learning it may have such effects. Logistic regression was performed to evaluate the influence of certain characteristics on women's attitudes. RESULTS Almost half of women in Romania and Germany would not use methods with postfertilisation effects, while the lowest percentages were found in Sweden and in France. Regarding methods with postimplantation effects, higher percentages were found in all the countries. Highly educated women and those using a highly effective method were more likely to use methods with postfertilisation effects. On the contrary, married women, those who stated that human life begins at fertilisation and women with middle/high religiosity were less likely to consider using methods that may act after fertilisation. CONCLUSIONS One-third of European women reported that they would not consider using a method that may have postfertilisation effects. RELEVANCE TO CLINICAL PRACTICE Given that postfertilisation effects may not be acceptable to some women, informing them of which methods may have these effects is essential to obtaining complete informed consent and to promoting women's autonomy.
Collapse
Affiliation(s)
- Cristina Lopez-del Burgo
- Department of Preventive Medicine and Public Health, School of Medicine, University of Navarra, Pamplona, Spain; Institute for Culture and Society, University of Navarra, Pamplona, Spain
| | | | | | | | | |
Collapse
|
38
|
Mikolajczyk RT, Kraut AA, Garbe E. Evaluation of pregnancy outcome records in the German Pharmacoepidemiological Research Database (GePaRD). Pharmacoepidemiol Drug Saf 2013; 22:873-80. [PMID: 23733705 DOI: 10.1002/pds.3467] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2012] [Revised: 03/19/2013] [Accepted: 04/29/2013] [Indexed: 11/11/2022]
Abstract
PURPOSE Routine health care data are a valuable source for the assessment of risks of drugs during pregnancy. Therefore, the aim of the current analysis was the evaluation of pregnancy outcome records in German health insurance data. METHODS We used the German Pharmacoepidemiologic Research Database including data of more than 15 million insurants (about 18% of the German population). Among 10-49 year-old women, we identified six categories of pregnancy outcomes: term births, preterm births, stillbirths, induced abortions, spontaneous abortions and ectopic pregnancies. In order to assess the validity of these records, we have set our results in relation to representative data for the corresponding outcomes in Germany. We also investigated whether pregnancy markers (diagnoses, procedures or medical services which indicate an existing pregnancy) can be used to identify pregnancies. RESULTS In total, we identified 94 261 pregnancy outcomes in 2005. The percentage of births outside hospital (1.2%) and of preterm births (11.6%), the rate of stillbirths (3 per 1000 live births) and the rate of ectopic pregnancies (20 per 1000 live births) agreed well with representative data for Germany. Compared to epidemiological data, the occurrence of spontaneous abortions was underestimated (5.4% of all pregnancies). There were 4.1 induced abortions per 100 live births, compared to 18.1 in national data. Positive predictive values and sensitivities of markers varied across marker categories and for different pregnancy outcomes. CONCLUSIONS Completeness of pregnancy outcomes recorded in the database varied by pregnancy outcome. This should be taken into account in studies of drug safety in pregnancy.
Collapse
Affiliation(s)
- R T Mikolajczyk
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany.
| | | | | |
Collapse
|
39
|
Mikolajczyk RT, Schmedt N, Zhang J, Lindemann C, Langner I, Garbe E. Regional variation in caesarean deliveries in Germany and its causes. BMC Pregnancy Childbirth 2013; 13:99. [PMID: 23634820 PMCID: PMC3652783 DOI: 10.1186/1471-2393-13-99] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2012] [Accepted: 04/24/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Determinants of regional variation in caesarean sections can contribute explanations for the observed overall increasing trend of caesarean sections. We assessed which mechanism explains the higher rate of caesarean sections in the former West than East Germany: a more liberal use of caesarean sections in the case of relative indications or more common caesarean sections without indications. METHODS We used a health insurance database from all regions of Germany with approximately 14 million insured individuals (about 17% of the total population in Germany). We selected women who gave birth in the years 2004 to 2006 and identified indications for caesarean section on the basis of hospital diagnoses in 30 days around birth. We classified pregnancies into three groups: those with strong indications for caesarean section (based on classification of absolute indications recommended by the Unmet Obstetrics Need network), those with moderate indications (other indications increasing the probability of caesarean section) and those with no indications. We investigated the percentage of caesarean sections among all births, presence of strong or moderate indications in all pregnancies, the probability of caesarean sections in the presence of indications and the fraction of caesarean sections attributable to strong, moderate and no indications. RESULTS In total, 294,841 births from 2004-2006 were included in the analysis. In the former West Germany, 30% births occurred by caesarean section, while in the former East Germany the caesarean section rate was 22%. Proportions of pregnancies with strong and moderate indications for caesarean section were similar in both regions. For strong indications the probability of caesarean section was similar in East and West Germany, but the probability of caesarean section among women with moderate indications was substantially higher in the former West Germany. Caesarean sections were also more common among women with no indications in the former West (8%) than in the former East (4-5%). The higher probability of caesarean section in the case of strong or moderate indications in the former West than in the East explained 87% of the difference between section rates in these two regions, while caesarean sections without indications contributed to only 13% of the difference observed. CONCLUSIONS The observed difference between caesarean section rates in the former East and West Germany was most likely due to different medical practice in handling relative indications.
Collapse
Affiliation(s)
- Rafael T Mikolajczyk
- Department of Clinical Epidemiology, Leibniz Institute for Prevention Research and Epidemiology-BIPS, Bremen, Germany.
| | | | | | | | | | | |
Collapse
|
40
|
Horn J, Damm O, Kretzschmar MEE, Deleré Y, Wichmann O, Kaufmann AM, Garbe E, Krämer A, Greiner W, Mikolajczyk RT. Estimating the long-term effects of HPV vaccination in Germany. Vaccine 2013; 31:2372-80. [PMID: 23518405 DOI: 10.1016/j.vaccine.2013.03.006] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2012] [Revised: 02/22/2013] [Accepted: 03/04/2013] [Indexed: 12/15/2022]
Abstract
In Germany, vaccination against the most oncogenic HPV types 16/18 is recommended by the Standing Committee on Vaccination (STIKO) for 12-17 year old girls since March 2007. We developed a dynamic mathematical model for the natural history and transmission of HPV infections to estimate the impact of vaccination on incidence and mortality of cervical cancer and its pre-stages, and on anogenital warts. We focused on an extensive model calibration to epidemiologic data for all stages of the natural history model as well as on a detailed implementation of cervical cancer screening modalities in Germany. Our model predicts first a substantial reduction of cervical cancer incidence and mortality over the next 30 years, which is mainly attributable to an increase in screening participation in the 1990s and not to HPV vaccination, followed by a further reduction attributable to vaccination. Over the next 100 years, HPV vaccination will prevent approximately 37% of cervical cancer cases even if vaccination coverage is only 50% (as currently observed in Germany). Consideration of cross-protection results in a further reduction of approximately 7% of all cervical cancer cases for the bivalent and about 5% for the quadrivalent vaccine in our model. Vaccination of boys was only reasonable if moderate to high vaccination coverage in girls was not achieved. Strategies should be implemented in Germany to increase HPV vaccination coverage among girls thereby making better use of the demonstrated benefits of the vaccine.
Collapse
Affiliation(s)
- J Horn
- Department of Epidemiology, Helmholtz Centre for Infection Research, Braunschweig, Germany
| | | | | | | | | | | | | | | | | | | |
Collapse
|
41
|
Kraut AA, Langner I, Lindemann C, Banaschewski T, Petermann U, Petermann F, Mikolajczyk RT, Garbe E. Comorbidities in ADHD children treated with methylphenidate: a database study. BMC Psychiatry 2013; 13:11. [PMID: 23294623 PMCID: PMC3544568 DOI: 10.1186/1471-244x-13-11] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2012] [Accepted: 01/04/2013] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Methylphenidate (MPH) is the most common drug treatment of attention deficit / hyperactivity disorder (ADHD) in children. Treatment with MPH is contraindicated in the presence of certain psychiatric, cerebro- and cardiovascular conditions. We assessed MPH treatment prevalence and incidence and the frequency of comorbid conditions related to these contraindications in new MPH users compared to a control group without ADHD and ADHD medication. METHODS We used health care data for the years 2004 to 2006 from the German Pharmacoepidemiological Research Database (GePaRD) which includes about 18% of the German population. MPH treatment prevalence and incidence was assessed based on at least one MPH prescription in the given year. In MPH users, the prevalence of psychiatric and other comorbidities was assessed in the quarter of the first MPH prescription and the three preceding quarters, whereas in controls it was assessed in the earliest four quarters of continuous insurance time starting at 01.01.2004 or the start of insurance if this was later. Differences in the presence of comorbid diagnoses between MPH users and controls were tested by logistic regression. RESULTS In 2005, 1.5% of all children and adolescents aged 3 to 17 years (2.3% of males and 0.6% of females) received MPH in Germany. The proportion of children with a record of a psychiatric comorbidity in any of the nine ICD categories of diagnoses was substantially higher in new MPH users (83%) compared to controls (20%). Cerebro- and cardiovascular comorbidities were rare in general. Still, among new MPH users, 2% of males and females had a diagnosis of a pre-existing cardiovascular disorder but only 1.2% of controls. CONCLUSIONS Besides MPH treatment prevalence we first publish age-specific incidence rates for Germany. A high proportion of children who were started on MPH had a record of a psychiatric comorbidity preceding the first prescription. Cerebro- and cardiovascular conditions were rare in the studied age range, but still higher among children who received MPH than in the control group. Results show that in a substantial subgroup of patients, comorbidities require a thorough weighting of possible risks of MPH medication against the risks of untreated ADHD.
Collapse
Affiliation(s)
- Angela A Kraut
- Department of Clinical Epidemiology, Leibniz Institute for Prevention Research and Epidemiology – BIPS, Achterstrasse 30, Bremen 28359, Germany
| | - Ingo Langner
- Department of Clinical Epidemiology, Leibniz Institute for Prevention Research and Epidemiology – BIPS, Achterstrasse 30, Bremen 28359, Germany
| | - Christina Lindemann
- Department of Clinical Epidemiology, Leibniz Institute for Prevention Research and Epidemiology – BIPS, Achterstrasse 30, Bremen 28359, Germany
| | - Tobias Banaschewski
- Department of Child and Adolescent Psychiatry, Central Institute of Mental Health, University of Heidelberg, Mannheim, J 5, Mannheim, 68159, Germany
| | - Ulrike Petermann
- Centre for Psychology and Rehabilitation, University of Bremen, Grazer Strasse 2 & 6, Bremen, 28359, Germany
| | - Franz Petermann
- Centre for Psychology and Rehabilitation, University of Bremen, Grazer Strasse 2 & 6, Bremen, 28359, Germany
| | - Rafael T Mikolajczyk
- Department of Clinical Epidemiology, Leibniz Institute for Prevention Research and Epidemiology – BIPS, Achterstrasse 30, Bremen 28359, Germany,Department of Epidemiology, Helmholtz Centre for Infection Research, Inhoffenstraße 7, 38124 Braunschweig, Germany
| | - Edeltraut Garbe
- Department of Clinical Epidemiology, Leibniz Institute for Prevention Research and Epidemiology – BIPS, Achterstrasse 30, Bremen 28359, Germany,Faculty of Human and Health Sciences, University of Bremen, Bremen, Germany
| |
Collapse
|
42
|
Helmer SM, Krämer A, Mikolajczyk RT. Health-related locus of control and health behaviour among university students in North Rhine Westphalia, Germany. BMC Res Notes 2012; 5:703. [PMID: 23273039 PMCID: PMC3544606 DOI: 10.1186/1756-0500-5-703] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2012] [Accepted: 12/12/2012] [Indexed: 11/27/2022] Open
Abstract
Background Health control beliefs were postulated to be associated with health behaviour. However, the results of studies assessing these associations suggest that they might not be universal. Among young adults associations have been reported, but the evidence is limited. The objective of this analysis was to re-examine these associations in a sample of university students in Germany. Findings Data from a multicentre cross-sectional study among university students in North Rhine-Westphalia, Germany was used (N=3,306). The Multidimensional Health Locus of Control Scale with three dimensions (one internal and two external) and six aspects of health behaviour (smoking habits, alcohol use, drug consumption, being over-/ or underweight, physical activity, and importance of healthy nutrition) were evaluated. Students with stronger internal locus of control paid more attention to healthy nutrition and displayed a higher level of physical activity. Individuals with a stronger belief in health professionals were less likely to use drugs and paid more attention to healthy nutrition. Furthermore, higher scores in the second external locus of control dimension (beliefs in luck or chance) were associated with a higher likelihood of current smoking, lower physical activity and less attention to healthy nutrition. Conclusions Students engaged more strongly in unhealthy behaviour if they believed that luck determines health. In contrast, believing in having control over one’s own health was associated with more healthy behaviour. These findings support the need to consider health control beliefs while designing preventive strategies in this specific population.
Collapse
Affiliation(s)
- Stefanie M Helmer
- Bremen Institute for Epidemiology and Prevention Research, University of Bremen, Bremen, Germany
| | | | | |
Collapse
|
43
|
Stich HL, Baune BT, Caniato RN, Mikolajczyk RT, Krämer A. Individual development of preschool children-prevalences and determinants of delays in Germany: a cross-sectional study in Southern Bavaria. BMC Pediatr 2012; 12:188. [PMID: 23216820 PMCID: PMC3549452 DOI: 10.1186/1471-2431-12-188] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2011] [Accepted: 12/03/2012] [Indexed: 11/10/2022] Open
Abstract
Background Even minor abnormalities of early child development may have dramatic long term consequences. Accurate prevalence rates for a range of developmental impairments have been difficult to establish. Since related studies have used different methodological approaches, direct comparisons of the prevalence of developmental delays are difficult. The understanding of the key factors affecting child development, especially in preschool aged children remains limited. We used data from school entry examinations in Bavaria to measure the prevalence of developmental impairments in pre-school children beginning primary school in 1997–2009. Methods The developmental impairments of all school beginners in the district of Dingolfing- Landau, Bavaria were assessed using modified “Bavarian School Entry Model” examination from 1997 to 2009 (N=13,182). The children were assessed for motor, cognitive, language and psychosocial impairments using a standardised medical protocol. Prevalence rates of impairments in twelve domains of development were estimated. Using uni- and multivariable logistic regression models, association between selected factors and development delays were assessed. Results The highest prevalence existed for impairments of pronunciation (13.8%) followed by fine motor impairments (12.2%), and impairments of memory and concentration (11.3%) and the lowest for impairments of rhythm of speech (3.1%). Younger children displayed more developmental delays. Male gender was strongly associated with all developmental impairments (highest risk for fine motor impairments = OR 3.22, 95% confidence interval 2.86-3.63). Preschool children with siblings (vs. children without any siblings) were at higher risk of having impairments in pronunciation (OR 1.31, 1.14-1.50). The influence of the non-German nationality was strong, with a maximum risk increase for the subareas of grammar and psychosocial development. Although children with non-German nationality had a reduced risk of disorders for the rhythm of speech and pronunciation, in all other 10 subareas their risk was increased. Conclusions In preschool children, most common were delays of pronunciation, memory and concentration. Age effects suggest that delays can spontaneously resolve, but providing support at school entry might be helpful. Boys and migrant children appear at high risk of developmental problems, which may warrant tailored intervention strategies.
Collapse
Affiliation(s)
- Heribert L Stich
- Department of Public Health, District of Erding, Erding, Germany
| | | | | | | | | |
Collapse
|
44
|
Garbe E, Mikolajczyk RT, Banaschewski T, Petermann U, Petermann F, Kraut AA, Langner I. Drug treatment patterns of attention-deficit/hyperactivity disorder in children and adolescents in Germany: results from a large population-based cohort study. J Child Adolesc Psychopharmacol 2012; 22:452-8. [PMID: 23234588 PMCID: PMC3523251 DOI: 10.1089/cap.2012.0022] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Despite a substantial increase in total methylphenidate (MPH) prescriptions in Germany over the last 20 years, and the introduction of modified release MPH (MR MPH) and atomoxetine (ATX), remarkably little is known about treatment patterns of attention- deficit/hyperactivity disorder (ADHD) in individual patients. METHODS Usage patterns of ADHD drugs in children and adolescents in Germany were analyzed using data from one large German health insurance including >7,200,000 members. Of those, 6210 ADHD patients newly diagnosed in 2005 were followed for a maximum of 4 years. Kaplan-Meier estimates were calculated for onset and discontinuation of ADHD drug treatment. Predictors of time until drug treatment initiation were assessed by Cox regression. RESULTS During follow-up, 52.0% of ADHD subjects (53.4% of boys, 47.5% of girls) received ADHD drug treatment. The majority of them (91.6%) were started on MPH, with immediate release MPH (IR MPH) being the initial treatment choice in 75.3%. In these subjects, change to drug treatment with MR MPH in the first year occurred in 48% by switch or addition. Significant predictors of drug treatment were behavioral and emotional disorders (HR=1.13; 95% CI 1.03-1.24) and a diagnosis of ADHD with conduct disorder (HR=1.21, 95% CI 1.12-1.32), whereas young age showed a protective effect. After 6, 12, and 24 months of treatment initiation, 22.4%, 43.4%, and 66.3% of treated girls, and 17.8%, 36.1%, and 54.1% of treated boys had discontinued ADHD treatment. CONCLUSION Drug treatment of ADHD was relatively common in Germany and more frequent in boys than in girls. IR MPH was the predominant treatment choice at treatment initiation. Approximately 20% of treated subjects discontinued drug treatment within the first 6 months, with girls stopping drug treatment earlier than boys. The reasons for early drug discontinuation need to be further explored.
Collapse
Affiliation(s)
- Edeltraut Garbe
- BIPS-Institute for Epidemiology and Prevention Research, Bremen, Germany.
| | | | - Tobias Banaschewski
- Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Department of Child and Adolescent Psychiatry and Psychotherapy, Mannheim, Germany
| | - Ulrike Petermann
- Center of Clinical Psychology and Rehabilitation, University of Bremen, Bremen, Germany
| | - Franz Petermann
- Center of Clinical Psychology and Rehabilitation, University of Bremen, Bremen, Germany
| | - Angela A. Kraut
- BIPS-Institute for Epidemiology and Prevention Research, Bremen, Germany
| | - Ingo Langner
- BIPS-Institute for Epidemiology and Prevention Research, Bremen, Germany
| |
Collapse
|
45
|
Pischke CR, Zeeb H, van Hal G, Vriesacker B, McAlaney J, Bewick BM, Akvardar Y, Guillén-Grima F, Orosova O, Salonna F, Kalina O, Stock C, Helmer SM, Mikolajczyk RT. A feasibility trial to examine the social norms approach for the prevention and reduction of licit and illicit drug use in European University and college students. BMC Public Health 2012; 12:882. [PMID: 23075043 PMCID: PMC3534014 DOI: 10.1186/1471-2458-12-882] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2012] [Accepted: 10/14/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Incorrect perceptions of high rates of peer alcohol and tobacco use are predictive of increased personal use in student populations. Correcting misperceptions by providing feedback has been shown to be an effective intervention for reducing licit drug use. It is currently unknown if social norms interventions are effective in preventing and reducing illicit drug use in European students. The purpose of this paper is to describe the design of a multi-site cluster controlled trial of a web-based social norms intervention aimed at reducing licit and preventing illicit drug use in European university students. METHODS/DESIGN An online questionnaire to assess rates of drug use will be developed and translated based on existing social norms surveys. Students from sixteen universities in seven participating European countries will be invited to complete the questionnaire. Both intervention and control sites will be chosen by convenience. In each country, the intervention site will be the university that the local principal investigator is affiliated with. We aim to recruit 1000 students per site (baseline assessment). All participants will complete the online questionnaire at baseline. Baseline data will be used to develop social norms messages that will be included in a web-based intervention. The intervention group will receive individualized social norms feedback. The website will remain online during the following 5 months. After five months, a second survey will be conducted and effects of the intervention on social norms and drug use will be measured in comparison to the control site. DISCUSSION This project is the first cross-national European collaboration to investigate the feasibility of a social norms intervention to reduce licit and prevent illicit drug use among European university students. FINAL TRIAL REGISTRATION NUMBER: DRKS00004375 on the 'German Clinical Trials Register'.
Collapse
Affiliation(s)
- Claudia R Pischke
- BIPS - Institute for Epidemiology and Prevention Research, Achterstraße 30, 28359, Bremen, Germany.
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
46
|
Lindemann C, Langner I, Kraut AA, Banaschewski T, Schad-Hansjosten T, Petermann U, Petermann F, Schreyer-Mehlhop I, Garbe E, Mikolajczyk RT. Age-specific prevalence, incidence of new diagnoses, and drug treatment of attention-deficit/hyperactivity disorder in Germany. J Child Adolesc Psychopharmacol 2012; 22:307-14. [PMID: 22856384 DOI: 10.1089/cap.2011.0064] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
OBJECTIVE The purpose of this study was to estimate the prevalence and incidence of new diagnoses of attention-deficit/hyperactivity disorder (ADHD) and assess drug treatment of ADHD in the 3-17 year age group in Germany. METHOD We analysed data from the German Pharmacoepidemiological Research Database (GePaRD) for the years 2004-2006. The GePaRD includes claim records of 14,000,000 members of four statutory health insurances, representing 17% of the German population. The assessment of ADHD diagnoses was based on International Classification of Diseases version 10 (ICD-10) codes in outpatient and hospital data. RESULTS In 2005, the age-standardized prevalence and incidence of new diagnoses were 2.5% and 9/1000 person-years, respectively. Both measures were 3-4 times higher for males than for females. Incidence of new ADHD diagnoses increased linearly up to the age of 8 years for boys and 9 years for girls and decreased abruptly thereafter. In the calendar quarter of the initial ADHD diagnosis, 9.4% (95% confidence interval [CI] 8.9-9.8%) received methylphenidate or atomoxetine and 36.8% (95% CI 36.1-37.6%) received at least one prescription of either drug within the first year. Initiation of drug treatment and choice of drug were similar for both sexes. CONCLUSIONS ADHD is a common condition among children and youth in Germany. There are substantial differences by sex in the prevalence and incidence of new ADHD diagnoses, but only a small difference in drug treatment among those diagnosed with ADHD. A relatively low percentage of children receives drug treatment in the first year after the initial diagnosis of ADHD.
Collapse
Affiliation(s)
- Christina Lindemann
- Bremen Institute for Prevention Research and Social Medicine, Bremen, Germany
| | | | | | | | | | | | | | | | | | | |
Collapse
|
47
|
Mikolajczyk RT, Iannotti RJ, Farhat T, Thomas V. Ethnic differences in perceptions of body satisfaction and body appearance among U.S. schoolchildren: a cross-sectional study. BMC Public Health 2012; 12:425. [PMID: 22691404 PMCID: PMC3490835 DOI: 10.1186/1471-2458-12-425] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2011] [Accepted: 06/12/2012] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Perceived body appearance and body satisfaction are potentially related to weight problems and poor health. The purpose of this study was to examine how gender, and ethnic differences in body satisfaction, perceived body appearance and weight status change by age in a representative sample of U.S. adolescents 11-17 years old. METHODS We used the US Health Behavior in School-Aged Children (HBSC) 2001 survey which assessed perceived body appearance, body satisfaction, self-reported body mass index (BMI) and socio-demographic indicators. The associations between age and perceived appearance, age and body satisfaction, and between z-transformed BMI and body satisfaction were analyzed using separate non-parametric regression models for both genders and the three ethnic groups. RESULTS Body satisfaction did not vary significantly by age except for an increase with age in the proportion of Non-Hispanic White girls who perceived themselves as too fat. Although boys did not report being too fat unless their BMI was above the age- and gender-specific median, one third of Non-Hispanic White girls felt too fat at or below the age- and gender-specific median. Compared to other ethnicities, African-American students' perceived appearance was significantly more positive and they were less likely to perceive themselves overweight at higher BMI scores. However, during adolescence, the positive self-reported perceived appearance of African-American boys dropped substantially while it remained relatively stable in African-American girls. CONCLUSIONS There were substantial differences in body satisfaction and perceived appearance across the three largest ethnic groups of school-age children in the U.S. Stability across age indicates that these perceptions are most likely established before the age of 10 and underline the importance of primary schools and parents in prevention. Special attention should be directed to the dramatic loss of positive perceived appearance among African-American boys.
Collapse
Affiliation(s)
- Rafael T Mikolajczyk
- Department of Clinical Epidemiology, Bremen Institute for Prevention Research and Social Medicine, Bremen, Germany
| | - Ronald J Iannotti
- Division of Epidemiology, Statistics and Prevention Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, USA
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, 6100 Executive Blvd Room 7B13Q, MSC 7510, Bethesda, MD, 20892-7510, USA
| | - Tilda Farhat
- Division of Epidemiology, Statistics and Prevention Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, USA
| | - Vijaya Thomas
- Division of Epidemiology, Statistics and Prevention Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, USA
| |
Collapse
|
48
|
Sebena R, El Ansari W, Stock C, Orosova O, Mikolajczyk RT. Are perceived stress, depressive symptoms and religiosity associated with alcohol consumption? A survey of freshmen university students across five European countries. Subst Abuse Treat Prev Policy 2012; 7:21. [PMID: 22640549 PMCID: PMC3395565 DOI: 10.1186/1747-597x-7-21] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/13/2011] [Accepted: 05/28/2012] [Indexed: 01/17/2023]
Abstract
BACKGROUND The aim of this study was to investigate the association of perceived stress, depressive symptoms and religiosity with frequent alcohol consumption and problem drinking among freshmen university students from five European countries. METHODS 2529 university freshmen (mean age 20.37, 64.9% females) from Germany (n = 654), Poland (n = 561), Bulgaria (n = 688), the UK (n = 311) and Slovakia (n = 315) completed a questionnaire containing the modified Beck Depression Inventory for measuring depressive symptoms, the Cohen's perceived stress scale for measuring perceived stress, the CAGE-questionnaire for measuring problem drinking and questions concerning frequency of alcohol use and the personal importance of religious faith. RESULTS Neither perceived stress nor depressive symptoms were associated with a high frequency of drinking (several times per week), but were associated with problem drinking. Religiosity (personal importance of faith) was associated with a lower risk for both alcohol-related variables among females. There were also country differences in the relationship between perceived stress and problem drinking. CONCLUSION The association between perceived stress and depressive symptoms on the one side and problem drinking on the other demonstrates the importance of intervention programs to improve the coping with stress.
Collapse
Affiliation(s)
- Rene Sebena
- Department of Psychology, Faculty of Arts, PJ Safarik University, Kosice, Slovak Republic
| | | | | | | | | |
Collapse
|
49
|
Sagel U, Krämer A, Mikolajczyk RT. "Blind periods" in screening for toxoplasmosis in pregnancy in Austria - a debate. BMC Infect Dis 2012; 12:118. [PMID: 22591211 PMCID: PMC3476441 DOI: 10.1186/1471-2334-12-118] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2011] [Accepted: 05/01/2012] [Indexed: 11/30/2022] Open
Abstract
Recent studies from Austria, France and Italy have shown that there is a poor adherence to the screening scheme for maternal Toxoplasma infections in pregnancy demonstrated by the fact that many recommended examinations are missed. This leads to undetected infections and limits our knowledge of incidence of the disease. We discuss the negative consequences of this situation on research on treatment effectiveness and the outcomes of congenital toxoplasmosis. The responsible public health institutions should assume responsibility for appropriate surveillance of the screening programme and take measures to improve screening adherence during pregnancy. Screening should start as early as possible in pregnancy and the latest test should be done at delivery. Screening schedule should allow distinguishing infections from the first, second and third trimester of pregnancy, as the risk of materno-foetal transmission and outcomes in case of foetal infections varies by time.
Collapse
Affiliation(s)
- Ulrich Sagel
- Department of Public Health Medicine, School of Public Health, University of Bielefeld, Bielefeld D-33501, Germany
| | | | | |
Collapse
|
50
|
El Ansari W, Stock C, Mikolajczyk RT. Relationships between food consumption and living arrangements among university students in four European countries - a cross-sectional study. Nutr J 2012; 11:28. [PMID: 22531503 PMCID: PMC3420253 DOI: 10.1186/1475-2891-11-28] [Citation(s) in RCA: 140] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2011] [Accepted: 04/24/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The transition of young people from school to university has many health implications. Food choice at the university can differ because of childhood food consumption patterns, sex and the living arrangements. Food consumption may change especially if students are living away from home. We aimed to assess food consumption patterns among university students from four European countries and how they differ by their living arrangements. METHODS We analysed data from a cross-country survey assessing health and health behaviours of students. The sample comprised a total of 2402 first year undergraduate students from one university in each of the countries of Germany, Denmark, Poland and Bulgaria. Food consumption was assessed by means of a food frequency questionnaire with 9 food groups (indicators). RESULTS Students' food consumption patterns differed across the countries. Frequent consumption of unhealthy items was common. Bulgarian students reported most often frequent consumption of sweets and cakes and snacks (e.g. chips and fast food). Polish students reported the least frequent consumption of vegetables and a low consumption of fruits. Across all countries except Bulgaria, men reported substantially more often frequent consumption of snacks than women. Students living at parental home consumed more fruit, vegetables, and meat than those who resided outside of their family home in all studied countries. There was more variation with regard to cakes and salads with more frequent consumption of cakes among Bulgarian female students and Danish male students and more frequent consumption of salads among Danish female students not living at parental home, compared to students from other countries. CONCLUSIONS Nutrition habits of university students differed across countries and by sex. Students living at parental home displayed more healthy nutrition habits, with some exceptions.
Collapse
Affiliation(s)
- Walid El Ansari
- Faculty of Sport, Health & Social Care, University of Gloucestershire, Gloucester, United Kingdom
| | | | | |
Collapse
|