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Sorg AL, Von Kries R, Klemme M, Gerstl L, Beyerlein A, Lack N, Felderhoff-Müser U, Dzietko M. Incidence and risk factors of cerebral sinovenous thrombosis in infants. Dev Med Child Neurol 2021; 63:697-704. [PMID: 33506500 DOI: 10.1111/dmcn.14816] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [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] [Accepted: 12/15/2020] [Indexed: 12/16/2022]
Abstract
AIM To describe the incidence of term and preterm neonatal cerebral sinovenous thrombosis (CSVT) and identify perinatal risk factors. METHOD This was a national capture-recapture calculation-corrected surveillance and nested case-control study. Infants born preterm and at term with magnetic resonance imaging-confirmed neonatal CSVT were identified by surveillance in all paediatric hospitals in Germany (2015-2017). Incidence was corrected for underreporting using a capture-recapture method in one federal state and then extrapolated nationwide. We reviewed PubMed for comparisons with previously reported incidence estimators. We used a population-based perinatal database for quality assurance to select four controls per case and applied univariate and multivariable regression for risk factor analysis. RESULTS Fifty-one newborn infants (34 males, 17 females; 14 born preterm) with neonatal CSVT were reported in the 3-year period. The incidence of term and preterm neonatal CSVT was 6.6 (95% confidence interval [CI] 4.4-8.7) per 100 000 live births. Median age at time of confirmation of the diagnosis was 9.95 days (range 0-39d). In the univariate analysis, male sex, preterm birth, hypoxia and related indicators (umbilical artery pH <7.1; 5-minute Apgar score <7; intubation/mask ventilation; perinatal asphyxia), operative vaginal delivery, emergency Caesarean section, and pathological fetal Doppler sonography were associated (p<0.05) with neonatal CSVT. Multivariable regression yielded hypoxia (odds ratio=20.3; 95% CI 8.1-50.8) as the independent risk factor. INTERPRETATION Incidence of neonatal CSVT was within the range of other population-based studies. The results suggest that hypoxia is an important perinatal risk factor for the aetiology of neonatal CSVT.
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Affiliation(s)
- Anna-Lisa Sorg
- Institute of Social Paediatrics and Adolescent Medicine, Division of Paediatric Epidemiology, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Rüdiger Von Kries
- Institute of Social Paediatrics and Adolescent Medicine, Division of Paediatric Epidemiology, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Mathias Klemme
- Department of Neonatology, University Children's Hospital and Perinatal Centre, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Lucia Gerstl
- Department of Paediatric Neurology, University Children's Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Andreas Beyerlein
- Institute of Computational Biology, Helmholtz Zentrum München, Neuherberg, Germany
| | - Nicholas Lack
- Bavarian Quality Assurance for In-Patient Medical Care, Munich, Germany
| | | | - Mark Dzietko
- Department of Paediatrics I, Neonatology, University Duisburg-Essen, Essen, Germany
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Sinzinger AX, Von Kries R, Siedler A, Wichmann O, Harder T. Non-specific effects of MMR vaccines on infectious disease related hospitalizations during the second year of life in high-income countries: a systematic review and meta-analysis. Hum Vaccin Immunother 2019; 16:490-498. [PMID: 31625797 PMCID: PMC7227673 DOI: 10.1080/21645515.2019.1663119] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [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] [Indexed: 11/18/2022] Open
Abstract
Children who had received MMR as the most recent vaccine had a pooled 35% (95%CI: 12–53%) lower risk for hospitalization due to any infectious disease, compared to children who had received DTaP as the most recent vaccine (three studies, 1,919,192 children). The effect was stronger for respiratory tract infections than for gastrointestinal infections. Two studies investigated MMR alone, compared to concurrent administration of MMR and DTaP vaccines. Here, the pooled estimate for reduction in risk of hospitalization for any infectious disease was smaller and not significant (15%; 95%CI: −9% to 34%). Risk of bias was serious to critical in all studies. Moreover, two of the five studies demonstrated a significantly reduced risk for a control outcome (hospitalization for injuries), strongly indicating healthy vaccinee bias or residual confounding. The available evidence is insufficient to support a change in current vaccination schedules.
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Affiliation(s)
- Andrea Xaver Sinzinger
- Institute of Social Paediatrics and Adolescents Medicine, Division of Epidemiology, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Rüdiger Von Kries
- Institute of Social Paediatrics and Adolescents Medicine, Division of Epidemiology, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Anette Siedler
- Immunization Unit, Robert Koch Institute, Berlin, Germany
| | - Ole Wichmann
- Immunization Unit, Robert Koch Institute, Berlin, Germany
| | - Thomas Harder
- Immunization Unit, Robert Koch Institute, Berlin, Germany
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Nehring I, Feurig S, Roebl-Matthieu M, Schiessl B, Kries RV. [Advising Women to Avoid Excessive Gestational Weight Gain: What do Pregnant Women Think?]. Gesundheitswesen 2015; 79:461-467. [PMID: 26551851 DOI: 10.1055/s-0035-1564211] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Gestational weight gain above the IOM recommendations is a risk factor for both pregnancy complications and maternal and childhood overweight. Therefore, pregnant women should be advised about their weight gain. Do these women have special specific needs? A total of 34 pregnant women were interviewed. Using Mayring's frequency analysis, we found that these pregnant women were not aware of health consequences of excessive weight gain. Furthermore, we identified 4 main types of nutritional behavior: (i) women who are informed but do not put into practice their knowledge, (ii) women who adhere strictly to recommendations, (iii) women who are led by their physical feelings and (iv) women mostly indifferent. Women who were physically inactive before pregnancy did not start exercising in pregnancy. There are still information gaps on weight gain and healthy eating that have to be considered for future interventions. According to women's behavioral patterns, interventions might yield varying results. According to women's type of behavior, interventions might yield different success rates. Motivation and providing information on suitable exercise forms during pregnancy are challenging.
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Affiliation(s)
- I Nehring
- LMU München, Institut für Sozaile Pädiatrie und Jugendmedizin, München
| | - S Feurig
- LMU München, Institut für Sozaile Pädiatrie und Jugendmedizin, München
| | | | | | - R V Kries
- LMU München, Institut für Sozaile Pädiatrie und Jugendmedizin, München
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Schroeder AS, Von Kries R, Riedel C, Homburg M, Auffermann H, Blaschek A, Jahn K, Heinen F, Borggraefe I, Berweck S. Patient-specific determinants of responsiveness to robot-enhanced treadmill therapy in children and adolescents with cerebral palsy. Dev Med Child Neurol 2014; 56:1172-1179. [PMID: 25154424 DOI: 10.1111/dmcn.12564] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [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] [Accepted: 06/04/2014] [Indexed: 11/29/2022]
Abstract
AIM The aim of the study was to evaluate patient-specific determinants of responsiveness to robot-enhanced repetitive treadmill therapy (ROBERT) in patients with early-developed movement disorders. METHOD Patients were treated over 12 sessions during a 3-week period. Gross Motor Function Measure-66 (GMFM-66) scores 1 day before ROBERT were compared with scores recorded 1 day after ROBERT. The association of GMFM-66 baseline score, age, sex, aetiology, and add-on botulinum toxin therapy to response to treatment was assessed. RESULTS Eighty-three patients aged between 4 and 18 years (48 males, 35 females; mean age 10y 8mo, SD 6y 1mo; Gross Motor Function Classification System level I [n=12], II [n=21], III [n=35], IV [n=10], and V [n=1]) were each treated for a total of 7.2 (SD 1.9) treadmill walking hours. Aetiology was bilateral spastic cerebral palsy (BS-CP; n=69), unilateral CP (n=3), ataxic CP (n=3), hereditary spastic paraparesis (n=6), and genetic syndrome including spasticity (n=2). Meaningful improvements were observed in GMFM-66 (+2.5; 95% CI 2.0-3.0), GMFM-D (+5.2; 95% CI 3.6-6.8), and GMFM-E (+4.0; 95% CI 2.8-5.3). There was a high inter-individual variability in treatment response. After multivariable adjustment, the improvements in GMFM-66 and GMFM-E scores were positively associated with the GMFM-66 baseline score. The effect on GMFM-D improvement was inversely associated with age. INTERPRETATION Gross motor abilities at baseline and age were identified as relevant determinants for the high degree of interpersonal variability in response to ROBERT.
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Affiliation(s)
- Andreas Sebastian Schroeder
- Department of Pediatric Neurology and Developmental Medicine, Hauner Children's Hospital, University of Munich, Munich, Germany.,German Center of Vertigo and Balance Disorders, IFBLMU, University of Munich, Munich, Germany
| | - Rüdiger Von Kries
- Institute of Social Pediatrics and Adolescent Medicine, University of Munich, Munich, Germany
| | - Christina Riedel
- Institute of Social Pediatrics and Adolescent Medicine, University of Munich, Munich, Germany
| | - Maria Homburg
- Department of Pediatric Neurology and Developmental Medicine, Hauner Children's Hospital, University of Munich, Munich, Germany
| | - Helene Auffermann
- Department of Pediatric Neurology and Developmental Medicine, Hauner Children's Hospital, University of Munich, Munich, Germany
| | - Astrid Blaschek
- Department of Pediatric Neurology and Developmental Medicine, Hauner Children's Hospital, University of Munich, Munich, Germany
| | - Klaus Jahn
- German Center of Vertigo and Balance Disorders, IFBLMU, University of Munich, Munich, Germany
| | - Florian Heinen
- Department of Pediatric Neurology and Developmental Medicine, Hauner Children's Hospital, University of Munich, Munich, Germany
| | - Ingo Borggraefe
- Department of Pediatric Neurology and Developmental Medicine, Hauner Children's Hospital, University of Munich, Munich, Germany
| | - Steffen Berweck
- Department of Pediatric Neurology and Developmental Medicine, Hauner Children's Hospital, University of Munich, Munich, Germany.,Specialist Center for Pediatric Neurology, Epilepsy Center for Children and Adolescents, Vogtareuth, Germany
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Boneberger A, Haider D, Baer J, Kausel L, Von Kries R, Kabesch M, Radon K, Calvo M. Environmental risk factors in the first year of life and childhood asthma in the Central South of Chile. J Asthma 2011; 48:464-9. [PMID: 21548831 DOI: 10.3109/02770903.2011.576740] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Childhood asthma has a high prevalence in South America--a region of the world currently undergoing a thorough modernization and transition process. Asthma in South America is mainly associated with poor urban environment, which actually may challenge the role of the hygiene hypothesis. We systematically assessed the impact of environmental factors in the first year of life on asthma. METHODS A case-control study including 188 asthmatics and 294 hospital-based controls aged 6-15 years was carried out in the Central South of Chile. Parents of study participants completed a computer-assisted interview on environmental factors (such as birth order, day-care attendance, pneumonia infection, regular animal and furry pet contact, and environmental tobacco smoke exposure) in the first year of life and potential confounders. Atopy was assessed using skin prick tests. Multivariate logistic regression models were calculated to assess the association between exposures and asthma, adjusting for potential confounders. RESULTS Day-care attendance (OR = 0.31; 95% CI: 0.10, 0.94) and regular farm animal contact (OR = 0.38; 95% CI: 0.17, 0.85) were inversely related to childhood asthma in the logistic regression models. Pneumonia infection (OR = 2.24; 95% CI: 1.21, 4.16) and mold or dampness in the home (OR = 1.87; 95% CI: 1.18, 2.97) in the first year of life were positively associated with asthma. CONCLUSION Our results suggest that the hygiene hypothesis is also applicable in the Chilean setting, a South American country in epidemiological transition.
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Affiliation(s)
- Anja Boneberger
- Unit for Occupational and Environmental Epidemiology, Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, University Hospital of Munich, Munich, Germany
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Toschke AM, Rückinger S, Böhler E, Von Kries R. Adjusted population attributable fractions and preventable potential of risk factors for childhood obesity. Public Health Nutr 2007; 10:902-6. [PMID: 17381911 DOI: 10.1017/s136898000725846x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE A number of individual risk factors for childhood obesity have been identified, but only some of these are amenable to prevention. To assess the amount of cases in a general population attributable to these risk factors, adjusted population-attributable fractions were estimated. DESIGN Cross-sectional study. SETTING Obligatory school entry examination in 2001/2002 in six Bavarian communities (Germany). SUBJECTS 5472 children at age 5-6 years. MEASURES Anthropometric measures were ascertained by public health nurses, and measures concerning sociodemographics, lifestyle and child behaviour such as child's daily meal frequency were obtained with self-administered parental questionnaires. Obesity was defined according to sex- and age-specific body mass index cut-off points proposed by the International Obesity Task Force. Adjusted population-attributable fractions were calculated based on logistic regression. RESULTS A combination of the risk factors low meal frequency, decreased physical activity, watching television >1 h day- 1, formula feeding and smoking in pregnancy accounted for 48.2% of obese children. This combination yielded a maximal achievable prevalence reduction of 1.5% for obesity (3.2% observed prevalence). CONCLUSIONS A modification of five known risk factors for childhood overweight and obesity could reasonably lower obesity prevalences at school entry. These risk factors should be particularly considered in decision making on preventive measures.
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Affiliation(s)
- André Michael Toschke
- King's College London, Division of Health and Social Care Research, Floor 7, Capital House, 42 Weston Street, London SE1 3QD, UK.
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Klusmann A, Heinrich B, Stöpler H, Gärtner J, Mayatepek E, Von Kries R. A decreasing rate of neural tube defects following the recommendations for periconceptional folic acid supplementation. Acta Paediatr 2005; 94:1538-42. [PMID: 16303691 DOI: 10.1080/08035250500340396] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [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: 10/25/2022]
Abstract
BACKGROUND/AIM Neural tube defects (NTDs) are the most common birth defects, resulting in severe mortality and morbidity. In 1995, the supplementation of folic acid periconceptionally was officially recommended in Germany. The impact of the recommendations on the rate of NTDs was assessed. METHODS An active surveillance system was established in the northern Rhine area. From 1996, all departments of obstetrics were asked to report cases of NTDs in all abortions, live births and stillbirths. Compliance with the recommendations was evaluated in a sample of mothers who delivered at the Department of Obstetrics of Düsseldorf University in 2001. RESULTS From 1996-2003, 520 NTDs were reported. Compared to the rate of NTDs in 1996 (10.5/10,000), the average incidence in the years 1997 to 2003 dropped (6.8/10,000). The intake of folic acid, as recommended, was low among the general population (21.1%). CONCLUSION Active surveillance data on the rate of NTDs are compatible with the maximum decrease of about 20% to be expected from data on the implementation of the recommendations. A much greater decrease in NTDs should be the challenge for the future.
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Affiliation(s)
- Anne Klusmann
- Department of General Paediatrics, Children's Hospital, Heinrich Heine University, Düsseldorf, Germany.
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Nennstiel-Ratzel U, Arenz S, Wildner M, Kries RV, Liebl B. [New challenges to the Screening Center in the Bavarian State office for Health Care and Safe Quality of Foods]. ACTA ACUST UNITED AC 2004; 66 Suppl 1:S8-12. [PMID: 14770331 DOI: 10.1055/s-2004-812758] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
UNLABELLED AIM of the newborn screening model programme implemented in Bavaria, Germany, in 1999 was earliest possible and complete detection of all children with treatable severe inborn errors of metabolism. This was to be achieved by the introduction of new laboratory methods (expanded disease coverage, earlier blood take) and of a tracking system to ensure complete access for all newborns and complete requested repeat testing. Long-term prognosis of the newly screened disorders is to be investigated. The model programme "newborn hearing screening in Bavaria" started in 2003 in the administrative district Oberpfalz aims at testing, whether tracking is also suitable to achieve early detection of all children with inborn severe hearing defects. METHODS To attain these goals a central state screening centre was established. Demographic tracking coordinated by this centre is achieved by matching screening notifications with all birth notifications on name on a regional basis and individual contacts with parents of children with missing screening notification. In addition, all pending recalls are consequently tracked by case-specific contacts. This system was initially introduced for metabolism screening and is currently being implemented also for hearing screening of newborns. Both screening programmes are being scientifically evaluated. Children with disorders detected by screening are followed up in a long-term study by the screening centre. Written consent by the parents is requested yearly at the childs birthday regarding medical care, knowledge of the disease und health development of the child. RESULTS 470,247 newborns were tested for treatable inborn errors of metabolism from 1999 to 2002. With the introduction of tracking, the documented participation rate increased from previously < 80 to 98.5 %. Due to tracking 99.2 % of requested recalls could be achieved. In 14 cases diagnosis was made, respectively therapy was initiated first after intervention by the screening centre. Altogether 368 children affected by the target disorders of the programme were detected. 332 children could be included in the long-term follow up study. Besides encouraging results, this study reveals deficits in parental information, provision with emergency cards, expert medical consultation, and sometimes treatment not according to the guidelines. Corresponding data from the hearing screening programme are not yet available. CONCLUSION The establishment of an independent state screening centre has proved very valuable. It enables comprehensive state-wide demographic tracking despite several laboratories engaged in screening for inborn errors of metabolism. A long-term follow-up study has proved to be effective in this setting.
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Toschke AM, Vignerova J, Lhotska L, Osancova K, Koletzko B, Von Kries R. Overweight and obesity in 6- to 14-year-old Czech children in 1991: protective effect of breast-feeding. J Pediatr 2002; 141:764-9. [PMID: 12461491 DOI: 10.1067/mpd.2002.128890] [Citation(s) in RCA: 135] [Impact Index Per Article: 6.1] [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: 11/22/2022]
Abstract
OBJECTIVE To assess the impact of breast-feeding on childhood overweight/obesity in an Eastern European socialist society with relatively homogeneous lifestyles. STUDY DESIGN Cross-sectional survey data collected in 1991 on 33,768 school-children aged 6 to 14 years in the Czech Republic were analyzed by using multiple logistic regression analyses (main outcome body mass index [BMI] >90th percentile [overweight] and BMI >97th percentile [obesity]). RESULTS Overall prevalence of overweight (obesity) was lower in breast-fed children: ever breast-fed (9.3%; 95% CI, 8.9-9.6 [3.2%; 95% CI, 3.0-3.4]) compared with never breast-fed (12.4%; 95% CI, 11.3-13.6 [4.4%; 95% CI, 3.7-5.2]). The effect of breast-feeding on overweight/obesity did not diminish with age in children 6 to 14 years old and could not be explained by parental education, parental obesity, maternal smoking, high birth weight, watching television, number of siblings, and physical activity. Adjusted odds ratios for breast-feeding were for overweight 0.80 (95% CI, 0.71-0.90) and for obesity 0.80 (95% CI, 0.66-0.96). CONCLUSIONS A reduced prevalence of overweight/obesity was associated with breast-feeding in a setting where socioeconomic status was homogeneous. This suggests that the effect of breast-feeding on the prevalence of obesity is not confounded by socioeconomic status.
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Affiliation(s)
- André Michael Toschke
- Ludwig-Maximilians-University, Institute of Social Pediatrics and Adolescent Medicine, Munich, Germany
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Affiliation(s)
- M J Shearer
- Department of Haematology, Clinical Science Laboratories, Guy's Hospital, London, UK
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Affiliation(s)
- A H Sutor
- Department of Pediatrics, University of Freiburg, Federal Republic of Germany
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