Clinical Outcomes of Advanced-Stage Cutaneous Lymphoma under Low-Dose Gemcitabine Treatment: Real-Life Data from the German Cutaneous Lymphoma Network

BACKGROUND

Gemcitabine is an effective single-agent chemotherapy used in advanced stages of cutaneous T-cell lymphoma (CTCL). However, gemcitabine used in the current standard regimen is frequently associated with adverse events (AE), such as an increased risk for myelosuppression and severe infections.

OBJECTIVES

We investigated in this retrospective study the effect of low-dose gemcitabine in pretreated advanced-stage CTCL and in blastic plasmacytoid dendritic cell neoplasia (BPDCN) regarding overall response (OR), progression-free survival (PFS), and AE.

MATERIAL AND METHODS

A retrospective, multicenter study was conducted on 64 CTCL and BPDCN patients treated with gemcitabine in average absolute dosage of 1,800 mg/m2 per cycle, which is 50% lower compared to standard dosage of 3,600 mg/m2 per cycle (1,200 mg/m2 day 1, 8, 15). Evaluation of response to therapy and AE was done 4-6 weeks after the sixth cycle.

RESULTS

OR was 62% with 11% demonstrating a complete response. The median time of PFS was 12 months and median time to next treatment was 7 months. Only 3/63 patients showed serious side effects, e.g., port infection or acute renal failure. Almost 73% of the patients experienced minor to moderate side effects (CTCAE grade 0-2). Fatigue (27.2%), fever (22.7%), and mild blood count alteration (18.2%) were the most common AE.

CONCLUSIONS

This retrospective analysis supports the use of low-dose gemcitabine therapy in CTCL, demonstrating with 62% OR and PFS of 12 months an almost identical response rate and survival as compared to the standard dose therapy reported in previous studies but with a significantly improved safety profile and tolerability.

Predictors of hospitalizations for diabetes in Germany: an ecological study on a small-area scale

OBJECTIVES

Our objective was to evaluate the role of potential predictors in explaining spatial variation among diabetes hospitalization rates in Germany.

STUDY DESIGN

This was an ecological analysis using hospital routine data.

METHODS

County-level hospitalization rates (n = 402) in 2015 were calculated based on the German Diagnosis Related Groups database. We used a funnel plot to identify counties with high hospitalization rates. To examine the impact of predictors such as socio-economic status or structure of primary care, we performed linear and logistic regression analyses.

RESULTS

The crude hospitalization rate was 262 admissions per 100,000 population. In multivariable logistic models, we found the percentage of employees with academic degree (odds ratio [OR]: 0.72, 95% confidence interval [CI]: 0.56-0.91), high hospital bed rate (4th quartile vs 1st quartile; OR: 2.73, CI: 1.03-7.24), and diabetes prevalence (OR: 1.49, CI: 1.17-1.90) to be significant predictors for high hospitalization rates. In multivariable linear models, the percentage of unemployed (regression coefficient b: 4.79, CI: 0.81-8.78) and rurality (b: 0.52, CI: 0.19-0.85) explained the variation in addition to predictors from logistic regression. Primary care structure was not a significant predictor in multivariable models.

CONCLUSIONS

The non-significant impact of primary care in adjusted models casts the use of diabetes hospitalizations as indicators for access and quality of primary care into doubt. Diabetes hospitalizations may rather reflect demand for care.

[Hospitalizations and amputations for diabetes mellitus-trends and small-area variation in Germany]

BACKGROUND

Hospitalizations and lower limb amputations related to diabetes mellitus (DM) are considered to be potentially avoidable. Appropriate outpatient care of diabetes prevents complications. Rates on potentially avoidable hospitalizations for diabetes are core indicators of the German diabetes surveillance program. International comparisons showed high hospitalization rates in Germany for both indicators.

OBJECTIVES

The objective of this analysis is to describe time trends on hospitalizations and inpatient lower limb amputations (major amputations) for DM. Furthermore, we analyze small area variations.

MATERIALS AND METHODS

Based on the German diagnosis related groups (DRGs) dataset we calculated age-standardized rates covering 2005-2015. Calculations rely on the Organisation for Economic Co-operation and Development (OECD) indicator definitions. Time trends are obtained by linear regression modelling. We also stratified into age groups and analyzed 2015 small-area variations using age-adjusted rates.

RESULTS

Crude hospitalization rates were 310 admissions per 100,000 inhabitants in men (amputation rate: 15.6) and 216 admissions per 100,000 inhabitants in women (amputation rate: 7.1) in 2015. Age-adjusted hospitalizations and amputations rates in women decreased over time (10.3 and 1.2 cases per 100,000 inhabitants and year, respectively). In men, the amputation rate decreased significantly (1.5 cases per 100,000 inhabitants and year). We found higher rates for men than for women in almost all age categories. In eastern Germany and parts of Bavaria and North Rhine-Westphalia rates are particularly high.

CONCLUSIONS

A decrease in hospitalization rates may indicate improvements in ambulatory diabetes care over time. Future studies should consider age-specific differences and small-area variations.

Secondary data in diabetes surveillance - co-operation projects and definition of references on the documented prevalence of diabetes

In addition to the Robert Koch Institute's health surveys, analyses of secondary data are essential to successfully developing a regular and comprehensive description of the progression of diabetes as part of the Robert Koch Institute's diabetes surveillance. Mainly, this is due to the large sample size and the fact that secondary data are routinely collected, which allows for highly stratified analyses in short time intervals. The fragmented availability of data means that various sources of secondary data are required in order to provide data for the indicators in the four fields of action for diabetes surveillance. Thus, a milestone in the project was to check the suitability of different data sources for their usability and to carry out analyses. Against this backdrop, co-operation projects were specifically funded in the context of diabetes surveillance. This article presents the results that were achieved in co-operation projects between 2016 and 2018 that focused on a range of topics: from evaluating the usability of secondary data to statistically modelling the development of epidemiological indices. Moreover, based on the data of the around 70 million people covered by statutory health insurance, an initial estimate was calculated for the documented prevalence of type 2 diabetes for the years 2010 and 2011. To comparably integrate these prevalences over the years in diabetes surveillance, a reference definition was established with external expertise.

Impact of Disease Prevalence Adjustment on Hospitalization Rates for Chronic Ambulatory Care-Sensitive Conditions in Germany

OBJECTIVES

To explore effects of disease prevalence adjustment on ambulatory care-sensitive hospitalization (ACSH) rates used for quality comparisons.

DATA SOURCES/STUDY SETTING

County-level hospital administrative data on adults discharged from German hospitals in 2011 and prevalence estimates based on administrative ambulatory diagnosis data were used.

STUDY DESIGN

A retrospective cross-sectional study using in- and outpatient secondary data was performed.

DATA COLLECTION

Hospitalization data for hypertension, diabetes, heart failure, chronic obstructive pulmonary disease, and asthma were obtained from the German Diagnosis Related Groups (DRG) database. Prevalence estimates were obtained from the German Central Research Institute of Ambulatory Health Care.

PRINCIPAL FINDINGS

Crude hospitalization rates varied substantially across counties (coefficients of variation [CV] 28-37 percent across conditions); this variation was reduced by prevalence adjustment (CV 21-28 percent). Prevalence explained 40-50 percent of the observed variation (r = 0.65-0.70) in ACSH rates for all conditions except asthma (r = 0.07). Between 30 percent and 38 percent of areas moved into or outside condition-specific control limits with prevalence adjustment.

CONCLUSIONS

Unadjusted ACSH rates should be used with caution for high-stakes public reporting as differences in prevalence may have a marked impact. Prevalence adjustment should be considered in models analyzing ACSH.

Gestational Weight Gain and Fetal-Maternal Adiponectin, Leptin, and CRP: results of two birth cohorts studies

Gestational weight gain (GWG) is an important modifiable factor known to influence fetal outcomes including birth weight and adiposity. Unlike behaviors such as smoking and alcohol consumption, the effect of GWG throughout pregnancy on fetal development and other outcomes has not been extensively studied. The aim of this study was to investigate the relationship of GWG with endocrine factors such as adiponectin, leptin, and C-reactive protein which may be associated with inflammatory response, fetal growth, and adiposity later in life. Data were obtained from the Ulm Birth Cohort Study (UBCS) and the Ulm SPATZ Health Study, two methodologically similar birth cohort studies including newborns and their mothers recruited from 11/2000–11/2001 and 04/2012–05/2013. In the two included birth cohorts we consistently observed statistically significant positive associations between GWG beginning as early as the second trimester with fetal cord blood leptin and stronger association beginning as early as the first trimester with post-delivery maternal serum leptin. Total weight gain exceeding commonly accepted recommended guidelines was consistently associated with higher leptin levels in both cord blood and post-delivery maternal serum. These results suggest a potential pathomechanistic link between fetal environment and surrogate markers of long-term health.

Plasma insulin levels in childhood are related to maternal factors--results of the Ulm Birth Cohort Study

AIMS

The cardiovascular risk factor profile of a child as well as the development of body weight are influenced by genetic and childhood factors. Circulating insulin concentrations reflect the metabolic cardiovascular risk and may trigger weight gain. We aimed at identifying parental and childhood factors which may influence fasting plasma insulin concentrations in children.

METHODS

The Ulm Birth Cohort study (UBCS) is a prospective birth cohort study. At baseline, birth characteristics, maternal pre-pregnancy body mass index (BMI) values as well as parental socioeconomic parameters were obtained. At the 8-yr follow-up examination, weights, heights, and fasting plasma insulin concentrations in n = 422 children and their parents were measured. Offspring of women with gestational diabetes mellitus were excluded from statistical analysis.

RESULTS

Fasting plasma insulin concentrations of children were significantly correlated with maternal pre-pregnancy BMI values (r = 0.16) as well as with maternal (r = 0.26) but not with paternal fasting plasma insulin concentrations (r = 0.11) at the 8-yr follow-up examination. The risk for high fasting plasma insulin concentrations (≥75th internal percentile) was 2.30 (1.34-3.92) in children who also had high plasma insulin concentrations in umbilical cord blood compared to children having lower plasma insulin concentrations (<75th internal percentile) in umbilical cord blood. In addition, we observed that children with high fasting plasma insulin concentrations at the age of 8 had an altered BMI trajectory in childhood, characterized by higher BMI values from the age of 1 onwards, compared to children with lower insulin concentrations.

CONCLUSION

Our observations support the hypothesis of perinatal programming of offspring insulin concentrations and BMI values by maternal pre-pregnancy BMI values.

Short-term goal attainment of in-patient rehabilitation in Germany and long-term risk of early retirement in patients with musculoskeletal diseases: results from a prospective 5-year follow-up study

PURPOSE

Occupational consequences of musculoskeletal disorders (MSDs) are consistently found in epidemiological studies. The aim of this study was to evaluate the prognostic value of various short-term rehabilitation outcome parameters on early retirement in Germany.

METHOD

In a prospective multi-centre cohort study of self-rated patient status, physician chosen therapy goals and attainment were measured by means of standardized questionnaires at the beginning and end of medical rehabilitation. Information with regard to disability was collected by self-report over a 5-year follow-up period.

RESULTS

We included 1268 MSD patients aged 45-57 who underwent a 3-week, multidisciplinary, in-patient rehabilitation programme in 10 rehabilitation centres in Southern Germany between January and December 2001. During follow-up (mean duration: 3.9 years) 117 (9%) patients received a disability pension. After adjustment for sex, age and patient outcomes, risk for early retirement was significantly increased for patients with only partial success with respect for the therapy goals pain reduction (HR 1.95), improvement in spine motility (HR 1.6) and improvement of muscle strength (HR 2.3). Patients who did not have the therapy goal were at the same risk as patients with full goal achievement.

CONCLUSIONS

Clinicians' rating of short-term therapy outcome might be of prognostic relevance of MSD patients' long-term employment status.

Genetic variants in the FADS gene cluster are associated with arachidonic acid concentrations of human breast milk at 1.5 and 6 mo postpartum and influence the course of milk dodecanoic, tetracosenoic, and trans-9-octadecenoic acid concentrations over the duration of lactation

BACKGROUND

Breastfeeding is considered an optimal nutritional source of n-6 (omega-6) and n-3 (omega-3) fatty acids (FAs) for the proper visual and cognitive development of newborn children. In addition to maternal nutrition as an important regulator of FA concentrations, first results exist on an association of breast-milk FAs with single nucleotide polymorphisms (SNPs) in the FADS gene cluster, which encodes the rate-limiting enzymes in the elongation-desaturation pathway of long-chain polyunsaturated fatty acids (LC-PUFAs).

OBJECTIVE

We analyzed the influence of FADS SNPs on breast-milk FA concentrations and their time course during lactation in the Ulm Birth Cohort study, which comprised 772 nursing mothers at 1.5 mo after giving birth, and in a subset of 463 mothers who were still breastfeeding at 6 mo postpartum.

DESIGN

We conducted linear regression analysis of 8 FADS SNPs with FA concentrations at both time points separately and assessed the genotype effect over time in a longitudinal analysis by using a generalized estimating equation regression model.

RESULTS

We observed significant associations of FADS genotypes with arachidonic acid (AA) concentrations and the 20:4n-6/20:3n-6 ratio at both time points but no association of FADS SNPs with the time course of AA concentrations. A longitudinal analysis of FAs other than LC-PUFAs by genotype over time showed associations for dodecanoic acid, cis-15-tetracosenoic acid, and trans-9-octadecenoic acid.

CONCLUSIONS

Maternal FADS genotypes are associated with breast-milk AA concentrations and might therefore influence the supply of this FA for children. Furthermore, our data indicate an interrelation between the LC-PUFA pathway and saturated and monounsaturated FAs.

Acquisition of Helicobacter pylori infection in early childhood: independent contributions of infected mothers, fathers, and siblings

OBJECTIVES

Infected siblings, mothers, and fathers have all been suggested to be major sources for Helicobacter pylori acquisition among children, but few studies have addressed the potential role of various family members simultaneously.

METHODS

A systematic review was performed on studies investigating intrafamilial transmission of childhood H. pylori infection. Within the Ulm Birth Cohort Study, which consists of 1,066 healthy newborns, born between November 2000 and November 2001 and followed up to age 4, and their siblings and parents, the independent role of the infection status of parents and siblings in transmission of H. pylori among children at age 4 was assessed.

RESULTS

Among four studies reporting infected mothers and siblings as independent risk factors for childhood H. pylori infection, odds ratios (ORs) for childhood infection given an infected sibling decreased meaningfully after adjustment for maternal infection status. Within the Ulm Birth Cohort Study, the prevalence of infection was 3.0% among index children at age 4. In bivariate analyses, maternal, paternal, and sibling infection were all strongly and significantly related to infection of the child. However, after multivariate adjustment, only maternal infection persisted as the single strong and significant risk factor (OR 13.0, 95% confidence interval 3.0-55.2).

CONCLUSIONS

These patterns suggest that mutual control for H. pylori status of other family members is crucial for estimating the role of mothers, fathers, and siblings in the transmission of childhood H. pylori infection. In populations with low H. pylori prevalence the infected mother is likely to be the main source for childhood H. pylori infection.

Adipokines in cord blood and risk of wheezing disorders within the first two years of life

BACKGROUND

Adipokines are involved in the regulation of many inflammatory processes and are present at very high concentrations in cord blood of term infants.

OBJECTIVE

We analysed data of a large prospective birth cohort study to examine whether adiponectin and leptin concentration in cord blood are determinants of wheezing disorders in children within the first 2 years of life.

METHODS

Seven hundred and forty mothers and their newborns were included in this analysis. Adiponectin and leptin concentrations were measured in cord blood. The cumulative incidence of physician-reported asthma or obstructive bronchitis was recorded during a 2-year follow-up.

RESULTS

During the first 2 years of life, asthma or obstructive bronchitis was reported by the caring paediatricians for 157 (19.6%) of the children. We found a strong interaction of cord blood adiponectin and history of atopic disease in the mother with respect to the risk of physician-reported asthma or obstructive bronchitis (P=0.006). Compared with children with cord blood levels in the middle quintile (reference category), the odds ratios for physician-reported asthma or obstructive bronchitis in the bottom quintile and top quintile were 0.14 [95% confidence interval (CI) 0.02-0.90] and 2.12 (95% CI 0.67-6.66), respectively (P for trend=0.0003), among children of mothers with a history of atopy. This association was independent of other established risk factors. Leptin levels in cord blood were not associated with risk of asthma or obstructive bronchitis.

CONCLUSIONS

In children of mothers with a history of atopy, concentrations of adiponectin in cord blood could play an important role in determining risk of wheezing disorders in early childhood.

trans Octadecenoic acid and trans octadecadienoic acid are inversely related to long-chain polyunsaturates in human milk: results of a large birth cohort study

BACKGROUND

Several observational studies indicate that trans isomeric fatty acids may interfere with the metabolism of essential fatty acids in the human organism.

OBJECTIVE

The objective was to investigate the relation between trans fatty acids and long-chain polyunsaturates in mature human milk.

DESIGN

Human milk samples (n=769) were obtained at the 6th week of lactation from mothers participating in a birth cohort study in Germany. The fatty acid composition of the milk samples was measured by high-resolution capillary gas-liquid chromatography.

RESULTS

trans Octadecenoic and trans octadecadienoic acids were inversely correlated with linoleic acid (r=-0.32 and -0.33, P<0.0001 for both), alpha-linolenic acid (r=-0.35 and -0.27, P<0.0001), arachidonic acid (r=-0.60 and -0.47, P<0.0001), and docosahexaenoic acid (r=-0.51 and -0.33, P<0.0001). In contrast, no inverse correlations were observed between trans hexadecenoic acid and polyunsaturated fatty acids.

CONCLUSIONS

The data obtained in the present study suggest that the availability of 18-carbon trans isomeric fatty acids may be inversely related to the availability of long-chain polyunsaturated fatty acids in mature human milk.

Adiponectin and Leptin in Maternal Serum, Cord Blood, and Breast Milk

Background: The presence of the adipokines adiponectin and leptin in cord blood and placental and fetal tissues suggests a possible role in fetal development.

Methods: We measured concentrations of adiponectin and leptin in maternal serum, cord blood, and breast milk and examined their correlations within a large, population-based study. Between November 2000 and November 2001, we recruited all mothers and their newborns after delivery at the University of Ulm (Ulm, Germany). The current analysis included 766 mothers with available breast milk samples collected 6 weeks postpartum. Adipokine concentrations were measured with commercially available ELISAs (R&D Systems).

Results: Median adiponectin concentrations in maternal serum (n = 713), cord blood (n = 709), and breast milk (n = 766) were 8.6 mg/L, 30.6 mg/L, and 10.9 μg/L, respectively. Median leptin concentrations were 12.8 μg/L in maternal serum, 7.8 μg/L in cord blood, and 174.5 ng/L in breast milk. Whereas increases in leptin concentrations with increasing birth weight, birth weight according to gestational age, and ponderal index were statistically significant in cord blood (all P values &lt;0.0001), cord blood adiponectin was clearly related only to birth weight (P = 0.0004). Concentrations of both adipokines were moderately correlated in breast milk and maternal serum (both Spearman ρ values were 0.43; P &lt;0.0001).

Conclusions: Concentrations of adiponectin and leptin vary strongly in maternal serum, cord blood, and breast milk, with only moderate correlations between both adipokines in maternal serum and breast milk. The health implications of these patterns warrant further investigation.

The mother as source of Helicobacter pylori infection

BACKGROUND

To further elucidate the intrafamilial transmission of Helicobacter pylori infection, we investigated the occurrence of infection by parental infection status in a large community-based birth cohort of children from Germany.

METHODS

Parental infection (at birth) and children's infection (at age 3 years) were determined by C-urea breath test and by monoclonal antigen stool test.

RESULTS

Twenty of 834 children (2.4%) were found to be infected. The odds ratio for H. pylori infection of the child was 12.9 (95% confidence interval = 3.2-52.5) if the mother was infected and 1.4 (0.4-4.6) if the father was infected, after adjustment for infection status of the other parent and for nationality. The number of older siblings was not a risk factor for H. pylori infection of the child.

CONCLUSIONS

This longitudinal study suggests that infected mothers are the main source of H. pylori infection of their children.

Duration of breastfeeding and risk of overweight in childhood: a prospective birth cohort study from Germany

BACKGROUND

Whereas a recently published meta-analysis showed that ever breastfeeding reduces the risk of obesity in childhood significantly, the recent literature describing the relationship between duration of breastfeeding and risk of overweight or obesity in childhood remains inconclusive.

METHODS

Between November 2000 and November 2001, all mothers and their newborns were recruited after delivery at the Department of Gynecology and Obstetrics at the University of Ulm, Germany. Active follow-up was performed at the age of 12 months and 24 months.

RESULTS

Of the 1066 children included in the baseline examination, information on body mass index was available for 855 (80%) at the 2-year follow-up. At this age 72 children (8.4%) were overweight and 24 (2.8%) were severely overweight. Whereas 76 children (8.9%) were never breastfed, 533 children (62.3%) were breastfed for at least 6 months, and 322 children (37.7%) were exclusively breastfed for at least 6 months. Compared to children who were breastfed for less than 3 months, the adjusted odds ratio (OR) for overweight was 0.4 (95% confidence interval (CI) 0.2-0.8) in children who were breastfed for at least 6 months. When considering the time of exclusive breastfeeding, the adjusted OR for overweight was 0.8 (95% CI 0.4; 1.5) in children who were exclusively breastfed for at least 3 but less than 6 months and 0.4 (95% CI 0.2; 0.9) in children who were exclusively breastfed for at least 6 months compared to children who were exclusively breastfed less than 3 months.

CONCLUSION

These results highlight the importance of prolonged breastfeeding for the prevention of overweight in children.

Breastfeeding, soluble CD14 concentration in breast milk and risk of atopic dermatitis and asthma in early childhood: birth cohort study

BACKGROUND

Breast milk contains a variety of bioactive substances, among them, soluble CD14 (sCD14), which plays an important role in innate immunity.

OBJECTIVE

We analysed data of a large prospective birth cohort study to examine the determinants of sCD14 in breast milk, and investigated whether breastfeeding practice and sCD14 concentrations in breast milk are determinants of the risk of atopic dermatitis (AD) and asthma in children.

METHODS

Eight hundred and three mothers and their newborns were included in this analysis. We measured sCD14 concentrations in breast milk samples collected 6 weeks post-partum. During a 2-year follow-up the cumulative incidences of AD and asthma were recorded.

RESULTS

Overall, AD was reported for 20.6% of the 2-year-olds and asthma was reported for 19.6%. We found the lowest incidence of physician-reported AD in children of mothers without a history of atopic diseases if breastfed for 6 to less than 9 months. Furthermore, we found an inverse association between duration of breastfeeding and risk of asthma, which was especially evident in children with mothers without a history of atopic disease (P=0.01). These patterns persisted after control for other factors by multivariate analysis methods. The protective effect of breastfeeding seemed to be synergistic with sCD14 concentrations in breast milk (P for trend 0.0005).

CONCLUSIONS

The results of this prospective birth cohort study suggest that a longer duration of breastfeeding does decrease the risk for asthma in early childhood, especially in children of mothers without a history of atopic disease. The beneficial effects of breastfeeding might be further supported by high levels of sCD14 in breast milk.

Clustering of Helicobacter pylori infection in couples: differences between high- and low-prevalence population groups

PURPOSE

Several mostly small-scale studies reported clustering of Helicobacter pylori infections as a possible indicator of conjugal transmission, but results have been inconsistent. We assessed clustering of H pylori infections in a large community-based study from Germany that included both high-prevalence and low-prevalence population subgroups.

METHODS

Current H pylori infection was determined among 670 couples by means of carbon-13-urea breath test ((13)C-UBT) breath test and a monoclonal antigen immunoassay for H pylori in stool.

RESULTS

Prevalences of infection among women were 34.9% (51 of 146 women) if the partner was infected and 14.5% (76 of 524 women) if the partner was not infected. Stratification by nationality showed a strong association of infection for partners with other than German nationality (adjusted odds ratio [OR], 6.05; 95% confidence interval [CI], 1.31-17.96), for whom prevalence of infection was greater than 50%, whereas no association was seen for German partners born in Germany (OR, 1.10; 95% CI, 0.47-2.61), for whom infection prevalence was approximately 10% (p for interaction = 0.048).

CONCLUSIONS

Conjugal transmission of infection caused by H pylori is unlikely to be of relevance in low-prevalence population groups. Our results are consistent with the hypothesis of a potential role of conjugal transmission of H pylori infection in high-prevalence population groups.

Helicobacter pylori-specific immune response in maternal serum, cord blood, and human milk among mothers with and without current Helicobacter pylori infection

We assessed the patterns of Helicobacter pylori (H. pylori) specific maternal antibodies in maternal serum, cord blood, and milk, which might play a role in prevention of H. pylori infection because transferred to the infant. Between November 2000 and November 2001, mothers were recruited after delivery of their offspring. H. pylori infection status was determined by 13C-urea breath test (UBT). Specific H. pylori antibody profiles were analysed using commercial H. pylori-specific enzyme-linked immunosorbent assay and Western blots. Among 898 mothers, 23% had a current H. pylori infection. Median H. pylori IgG antibody titers in serum and cord blood of UBT-positive mothers were 23.8 U/mL and 24.0 U/mL, respectively. Whereas prevalences of H. pylori-specific antibodies in serum of UBT-negative mothers were clearly lower than those among UBT-positive mothers, patterns of H. pylori-specific IgA antibodies in milk were similar among UBT-positive and UBT-negative mothers. Neonates born from H. pylori-infected women are provided with large amounts of transplacentally transferred specific IgG H. pylori antibodies. Breast-fed neonates are additionally provided with specific IgA antibodies in human milk. Notably, the latter may also be activated if exposure of the mother to H. pylori might have been long time ago and been cleared in the meantime.

Role of Helicobacter pylori infection in iron deficiency during pregnancy

OBJECTIVE

We investigated the possible role of Helicobacter pylori infection in iron deficiency during pregnancy in a large group of mothers in Germany after the birth of their baby under special consideration of iron supplementation.

STUDY DESIGN

All women who were delivered of their baby between November 2000 and November 2001 at the Department of Gynecology and Obstetrics at the University of Ulm, Germany, were recruited for the study. Hemoglobin levels at various points of time during pregnancy were obtained from the mothers' health charts. Current H pylori infection was determined by 13 C-urea breath test. We used multiple linear regression analyses to assess the impact of infection status on hemoglobin level at the beginning of pregnancy and on hemoglobin change during pregnancy.

RESULTS

Twenty-three percent of the 898 mothers had a H pylori infection, and 20% of the mothers had a hemoglobin level below 12 g/dL at the beginning of pregnancy. Compared with uninfected mothers, mothers with H pylori infection had a lower mean hemoglobin level at the beginning of pregnancy (-0.25 g/dL; 95% CI, -0.49, -0.003) and a more unfavorable change in hemoglobin level during pregnancy (-0.14 g/dL; 95% CI, -0.38, 0.10).

CONCLUSION

This study supports a possible moderate, but still relevant, independent role of H pylori infection in iron deficiency during pregnancy.

Role of Lewis A and Lewis B blood group antigens in Helicobacter pylori infection

BACKGROUND AND AIMS

We investigated the prevalence of Helicobacter pylori infection in a large group of women to determine whether there was an association of current infection status with Lewis blood group antigen A and B phenotype.

METHODS

Between November 2000 and November 2001, mothers were recruited after delivery of their offspring at the Department of Gynecology and Obstetrics at the University of Ulm, Ulm, Germany. The H. pylori infection status of the women was determined by 13C urea breath test. Their Lewis A and Lewis B phenotype was determined using standard laboratory techniques.

RESULTS

In total, 22.2% of the 712 women included in the study (mean age 30.7 years) had a current H. pylori infection. The prevalence of infection varied from 15.5% in women of German nationality to 75.0% in women of Turkish nationality (p < .001). Most women (68.1%) had a Le(a-b+) phenotype. The prevalence of H. pylori infection in women with Le(a-b+) phenotypes was lower than in other women (p = .02). In multivariate analysis, the odds ratio (OR) for a current H. pylori infection given Le(a-b+) was 0.56 [95% confidence interval (CI) 0.33-0.95] compared to women with Le(a-b-).

CONCLUSION

Le(a-b+) blood group phenotype in combination with secretor status may hinder colonization of H. pylori in the population studied.

Helicobacter pylori infection and the occurrence and severity of gastrointestinal symptoms during pregnancy

OBJECTIVE

We investigated the possible role of Helicobacter pylori infection in the occurrence and severity of gastrointestinal symptoms during pregnancy in a large group of mothers after delivery.

STUDY DESIGN

Between November 2000 and November 2001, mothers were recruited after delivery at the Department of Gynecology and Obstetrics at the University of Ulm. Present H pylori infection was determined by (13)C-urea breath test. Associations between gastrointestinal symptoms during pregnancy (sickness, vomiting, increased saliva production, heartburn) and H pylori infection were quantified by crude and adjusted odds ratios with 95% CI.

RESULTS

Twenty-three percent of the 898 mothers had a current H pylori infection. Eighty-four percent of the mothers reported at least one of the evaluated gastrointestinal symptoms, and 30% of the mothers reported at least one physician visit because of the severity of these symptoms. None of the analyzed gastrointestinal symptoms showed an association to a current H pylori infection after an adjustment for the covariates, even after a virulence marker of H pylori infection was taken into account.

CONCLUSION

This study does not support an involvement of H pylori infection in the generation of gastrointestinal symptoms during pregnancy.

p53 autoantibodies in patients with primary ovarian cancer are associated with higher age, advanced stage and a higher proportion of p53-positive tumor cells

Autoantibodies (AAb) directed against the nuclear phosphoprotein p53 can be detected in patients with various forms of cancer. The objective was to determine the prevalence of p53 AAb at the time of diagnosis in ovarian cancer patients and to correlate the presence of p53 AAb with clinicopathological parameters. Sera of 83 patients were analyzed by an ELISA using p53 expressed from a human wild-type cDNA. p53 AAb were detectable at all stages. The overall prevalence was 46%. p53 AAb were more frequent in patients with higher age (p = 0.014), postmenopausal status (p = 0.050), or advanced tumor stage (p = 0.046). p53 AAb positivity was related to the proportion of cells positive in immunohistochemistry but not with the staining intensity. In bivariate analysis, patients with p53 AAb had a 1.96-fold risk for relapse (95% confidence interval 1.02-3.78).

Factors affecting bone demineralization and blood lead levels of postmenopausal women--a population-based study from Germany

We investigated the influence of various lifestyle factors on blood lead levels in postmenopausal women from the general population of Germany. Particular consideration was given to those factors which are suspected to be related to bone demineralization. The study population consisted of 424 women, aged 45 to 80 years, who were examined in a substudy of the National Health and Nutrition Survey called VERA (Verbundstudie Ernährungserhebung, und Risikofaktorenanalyse) from 1987 to 1988. Mean blood lead level was 61.4 micrograms/liter (SD, 27.3). In multiple linear regression analysis alcohol consumption, former use of oral contraception, hematocrit, and age were positively associated with blood lead levels, whereas calcium intake and high physical activity showed a negative association with blood lead levels. Some of the identified risk factors which are suspected to exert their influence on blood lead levels by affecting bone demineralization can be influenced by change of individual behavior. Thus, we conclude that reduction of alcohol consumption, adequate calcium intake, and physical activity may reduce blood lead levels as well as negative health effects of osteoporosis in postmenopausal women.

Alcohol consumption and smoking habits as determinants of blood lead levels in a national population sample from Germany

We investigated the influence of various lifestyle factors on blood lead levels in a representative sample from the general adult population (i.e., > or = 18 y of age) of West Germany in 1987-1988. The overall mean blood lead level was 73 microg/l (standard deviation = 41.4 microg/l) in 834 men and 54 microg/l (standard deviation = 26.8 microg/l) in 1,065 women. In a multiple linear regression analysis, alcohol consumption accounted for the largest proportion of variability in blood lead levels, followed by both age and smoking. Other significant contributing factors were gender, hematocrit, calcium intake, and consumption of milk and milk products. Wine had a greater effect on blood lead levels than beer (i.e., per g of alcohol consumed). With respect to cigarette smoking (i.e., no. of cigarettes smoked/d), filterless cigarettes were associated with higher blood lead levels than filter-tipped cigarettes. In addition, smoking cigars, cigarillos, or a pipe resulted in higher blood lead levels than smoking only cigarettes. Alcohol consumption and smoking were independent contributors to blood lead levels in both men and women, but effects of alcohol consumption were stronger in women than in men. We concluded that consumption of alcohol and tobacco represent major avoidable sources of lead exposure.