TY  - JOUR
AB  - Background: Multiple sclerosis (MS) is a neuroinflammatory disease of presumed autoimmune origin. A combination of genetic susceptibility and exposure to certain environmental and lifestyle factors might trigger the onset of MS. The currently known risk factors include a genetic predisposition, infection with the Epstein-Barr virus (EBV), smoking, and an increased body mass index. Methods: In 2021-22, we carried out a case-control study nested within the German National Cohort (NAKO) to investigate associations of potential risk factors with MS. Results: The subjects included 576 persons with MS (cases) and 895 without MS (controls). Beyond the known risk factors, we observed associations between MS and the cumulative number of common childhood infections (odds ratio (OR) 1.14 per additional infection, 95% confidence interval (CI): [1.03; 1.25]), major stressful life events (SLE) (OR 1.25 per additional event, [1.06; 1.48]), being the firstborn child of a mother aged 30 or older (OR 2.11, [1.08; 4.13]); higher amounts of physical activity in the teenage years were associated with a lower risk of MS (OR 0.82 per unit increase in activity level, [0.71; 0.95]). Conclusion: We confirmed known risk factors for MS and found associations with a number of new ones, e.g., the cumulative number of common child-hood infections. These findings may shed light on the etiology of MS and merit further study.
AU  - Holz, A.*
AU  - Obi, N.*
AU  - Pischon, T.*
AU  - Schulze, M.B.*
AU  - Ahrens, W.*
AU  - Berger, K.*
AU  - Bohn, B.*
AU  - Brenner, H.*
AU  - Emmel, C.*
AU  - Fischer, B.*
AU  - Greiser, K.H.*
AU  - Harth, V.*
AU  - Holleczek, B.*
AU  - Kaaks, R.*
AU  - Karch, A.*
AU  - Katzke, V.*
AU  - Keil, T.*
AU  - Krist, L.*
AU  - Leitzmann, M.*
AU  - Meinke-Franze, C.*
AU  - Michels, K.B.*
AU  - Nimptsch, K.*
AU  - Peters, A.
AU  - Riedel, O.*
AU  - Schikowski, T.*
AU  - Schipf, S.*
AU  - Schmidt, B.*
AU  - Thierry, S.
AU  - Hellwig, K.*
AU  - Riemann-Lorenz, K.*
AU  - Heesen, C.*
AU  - Becher, H.*
C1  - 75460
C2  - 57919
CY  - Dieselstrabe 2, Postfach 400265, D-50859 Cologne, Germany
TI  - The relation of multiple sclerosis to family history, lifestyle, and health factors in childhood and adolescence findings of a case-control study nested within the German National Cohort (NAKO) study.
JO  - Dtsch. Arztebl. Int.
VL  - 122
IS  - 13
PB  - Deutscher Aerzte-verlag Gmbh
PY  - 2025
SN  - 1866-0452
ER  - 

TY  - JOUR
AB  - BACKGROUND: Magnetic resonance imaging (MRI) yields important information on the development and current status of many different diseases. Whole-body MRI was accordingly made a part of the multicenter, population-based NAKO Health Study. The present analysis concerns the feasibility of the baseline MRI examination and various aspects of quality assurance over the period 2014-2019. METHODS: 32 252 participants in the NAKO Health Study, aged 20 to 74, who had no contraindication to MRI were invited to undergo scanning in one of five MRI study centers across Germany. The whole-body MRI scan took about one hour and consisted of sequences for the visualization of structural and functional features of the brain, musculoskeletal system, cardiovascular system, and thoracoabdominal system. A comprehensive quality-assurance assessment was carried out, with evaluation of adverse events, the completeness of the MRI protocols, the participants' subjective perceptions, and image quality. RESULTS: 31 578 participants (97.9%) were successfully included in the MRI study. They reported a high level of comfort and suffered no severe adverse events (mild adverse events occurred in only four participants). Depending on the imaging sequence, the image quality was rated as excellent in 80.2% to 96.8% of cases. Quality assessment with respect to structural features of the brain revealed high consistency across study centers, as well as with regard to age- and sex-based differences in brain volume (men, 1203.81 ± 102.06 cm³; women, 1068.10 ± 86.69 cm³). CONCLUSION: Whole-body MRI was successfully implemented in the NAKO baseline examination and was associated with high patient comfort and very good image quality. The imaging biomarkers of the brain confirmed previously observed differences based on age and sex, underscoring the feasibility of data pooling.
AU  - Bamberg, F.*
AU  - Schlett, C.L.*
AU  - Caspers, S.*
AU  - Ringhof, S.*
AU  - Günther, M.*
AU  - Hirsch, J.G.*
AU  - Rüdebusch, J.*
AU  - Miklánková, P.*
AU  - Bittner, N.*
AU  - Jockwitz, C.*
AU  - Forsting, M.*
AU  - Hosten, N.*
AU  - Kaaks, R.*
AU  - Kauczor, H.U.*
AU  - Kroenke, T.*
AU  - Niendorf, T.*
AU  - Peters, A.
AU  - Pischon, T.*
AU  - Stang, A.*
AU  - Berger, K.*
AU  - Völzke, H.*
C1  - 72878
C2  - 56768
SP  - 587-593
TI  - Baseline MRI examination in the NAKO health study-findings on feasibility, participation and dropout rates, comfort, and image quality.
JO  - Dtsch. Arztebl. Int.
VL  - 121
IS  - 18
PY  - 2024
SN  - 1866-0452
ER  - 

TY  - JOUR
AB  - Background: Estimating the excess mortality attributable to heat is a central element of the documentation of the consequences of climate change for human health. Until now, estimates of heat-related deaths in Germany by the Robert Koch Institute (RKI) have been based on weekly mortality records. Methods: Our study is the first to use higher resolution data—i.e. daily all-cause mortality linked to daily mean temperatures—from each of the German federal states to assess the heat-related mortality from 2000 to 2023 in Germany, employing quasi-Poisson models and multivariate meta-regression analyses. We focus our analysis on the extreme summer of 2022. Results: Our analysis yielded an estimate of 9100 (95% CI: [7300; 10 700]) heat-related deaths in Germany for the summer of 2022, whereas previous studies of the RKI estimated the number of heat-related deaths at 4500 [2100; 7000]. When we set a higher temperature threshold in the definition of the heat risk, we arrived at a figure of 6900 [5500; 8100] heat-related deaths in 2022. In other summers that—similarly to 2022—were characterized by large fluctuations in daily mean temperatures, we also robustly estimated higher numbers of heat-related deaths than the RKI did. The exclusion of reported deaths due to COVID-19 had only a minor effect on our estimates. Conclusion: Our findings suggest that previous studies based on weekly mortality data have underestimated the full extent of heat-related mortality in Germany, particularly in the extreme summer of 2022. The monitoring of heat-related mortality should be systematic and as comprehensive as possible if it is to enable the development of effective heat-health action plans.
AU  - Huber, V.
AU  - Breitner-Busch, S.
AU  - He, C.
AU  - Matthies-Wiesler, E.F.
AU  - Peters, A.
AU  - Schneider, A.E.
C1  - 70321
C2  - 55234
CY  - Dieselstrabe 2, Postfach 400265, D-50859 Cologne, Germany
SP  - 79-85
TI  - Heat-related mortality in the extreme summer of 2022. An analysis based on daily data.
JO  - Dtsch. Arztebl. Int.
VL  - 121
IS  - 3
PB  - Deutscher Aerzte-verlag Gmbh
PY  - 2024
SN  - 1866-0452
ER  - 

TY  - JOUR
AB  - BACKGROUND: Obesity is a worldwide health problem. We conducted detailed analyses of anthropometric measures in a comprehensive, population-based, current cohort in Germany. METHODS: In the German National Cohort (NAKO), we analyzed cross-sectional data on body mass index (BMI), waist and hip circumference, subcutaneous (SAT) and visceral adipose tissue (VAT) as measured by ultrasound, and body fat percentage. The data were stratified by sex, age, and self-reported physicians' diagnoses of cardiovascular diseases (CVD), metabolic diseases (MetD), cardiometabolic diseases (CMD), and cancer. RESULTS: Data were available from 204 751 participants (age, 49.9 ± 12.8 years; 50.5% women). Body size measures generally increased with age. Men had a higher BMI, larger waist circumference, and more VAT than women, while women had a larger hip circumference, more SAT, and a higher body fat percentage than men. For example, the mean BMI of participants over age 60 was 28.3 kg/m2 in men and 27.6 kg/m2 in women. CVD, MetD, and CMD were associated with higher anthropometric values, while cancer was not. For example, the mean BMI was 25.3 kg/m2 in healthy women, 29.4 kg/m2 in women with CMD, and 25.4 kg/m2 in women with cancer. CONCLUSION: Obesity is widespread in Germany, with notable differences between the sexes in anthro - pometric values. Obesity was more common in older participants and those with chronic diseases other than cancer. Elevated values were especially common in multimorbid individuals.
AU  - Stein, M.J.*
AU  - Fischer, B.*
AU  - Bohmann, P.*
AU  - Ahrens, W.*
AU  - Berger, K.*
AU  - Brenner, H.*
AU  - Günther, K.*
AU  - Harth, V.*
AU  - Heise, J.K.*
AU  - Karch, A.*
AU  - Klett-Tammen, C.J.*
AU  - Koch-Gallenkamp, L.*
AU  - Krist, L.*
AU  - Lieb, W.*
AU  - Meinke-Franze, C.*
AU  - Michels, K.B.*
AU  - Mikolajczyk, R.*
AU  - Nimptsch, K.*
AU  - Obi, N.*
AU  - Peters, A.
AU  - Pischon, T.*
AU  - Schipf, S.*
AU  - Schmidt, B.*
AU  - Stang, A.*
AU  - Thierry, S.
AU  - Willich, S.N.*
AU  - Wirkner, K.*
AU  - Leitzmann, M.F.*
AU  - Sedlmeier, A.M.*
C1  - 71366
C2  - 56061
SP  - 207-213
TI  - Differences in anthropometric measures based on sex, age, and health status.
JO  - Dtsch. Arztebl. Int.
VL  - 121
IS  - 7
PY  - 2024
SN  - 1866-0452
ER  - 

TY  - JOUR
AB  - BACKGROUND: Refeeding syndrome (RFS) can occur in malnourished patients when normal, enteral, or parenteral feeding is resumed. The syndrome often goes unrecognized and may, in the most severe cases, result in death. The diagnosis of RFS can be crucially facilitated by the use of clinical decision support systems (CDSS). METHODS: The literature in PubMed was searched for current treatment recommendations, randomized intervention studies, and publications on RFS and CDSS. We also took account of insights gained from the development and implementation of our own CDSS for the diagnosis of RFS. RESULTS: The identification of high-risk patients and the recognition of manifest RFS is clinically challenging due to the syndrome's unspecific symptoms and physicians' lack of awareness of the risk of this condition. The literature shows that compared to patients without RFS, malnourished patients with RFS have significantly greater 6-month mortality (odds ratio 1.54, 95% confidence interval: [1.04; 2.28]) and an elevated risk of admission to intensive care (odds ratio 2.71 [1.01; 7.27]). In a prospective testing program, use of our own CDSS led to correct diagnosis in two thirds of cases. CONCLUSION: RFS is difficult to detect and represents a high risk to the patients affected. Appropriate CDSS can identify such patients and ensure proper professional care.
AU  - Heuft, L.*
AU  - Voigt, J.*
AU  - Selig, L.*
AU  - Stumvoll, M.
AU  - Schlögl, H.
AU  - Kaiser, T.*
C1  - 68586
C2  - 53714
CY  - Dieselstrabe 2, Postfach 400265, D-50859 Cologne, Germany
SP  - 107-114
TI  - Refeeding syndrome.
JO  - Dtsch. Arztebl. Int.
VL  - 120
IS  - 7
PB  - Deutscher Aerzte-verlag Gmbh
PY  - 2023
SN  - 1866-0452
ER  - 

TY  - JOUR
AB  - BACKGROUND: Numerous studies have reported an increase in mental disorders during the COVID-19 pandemic, but the exact reasons for this development are not well understood. In this study we investigate whether pandemic-related occupational and financial changes (e.g., reduced working hours, working from home, financial losses) were associated with increased symptoms of depression and anxiety compared with the situation before the pandemic. METHODS: We analyzed data from the German National Cohort (NAKO) Study. Between May and November 2020, 161 849 study participants answered questions on their mental state and social circumstances. Their responses were compared with data from the baseline survey before the pandemic (2014-2019). Linear fixed-effects models were used to determine whether individual changes in the severity of symptoms of depression (PHQ-9) or anxiety (GAD-7) were associated with occupational/financial changes (controlling for various covariates). RESULTS: The prevalence of moderate or severe symptoms of depression and anxiety increased by 2.4% and 1.5%, respectively, during the COVID-19 pandemic compared with the preceding years. The mean severity of the symptoms rose slightly. A pronounced increase in symptoms was observed among those who became unemployed during the pandemic (+ 1.16 points on the depression scale, 95% confidence interval [0.91; 1.41], range 0-27). Increases were also seen for reduced working hours with no short-time allowance, increased working hours, working from home, insecurity regarding employment, and financial strain. The deterioration in mental health was largely statistically explained by the occupational and financial changes investigated in the model. CONCLUSION: Depressive symptoms and anxiety disorders increased slightly in the study population during the first year of the COVID-19 pandemic. Occupational and financial difficulties were an essential contributory factor. These strains should be taken into account both in the care of individual patients and in the planning of targeted prevention measures.
AU  - Dragano, N.*
AU  - Reuter, M.*
AU  - Peters, A.
AU  - Engels, M.*
AU  - Schmidt, B.*
AU  - Greiser, K.H.*
AU  - Bohn, B.*
AU  - Riedel-Heller, S.*
AU  - Karch, A.*
AU  - Mikolajczyk, R.*
AU  - Krause, G.*
AU  - Lang, O.
AU  - Panreck, L.*
AU  - Rietschel, M.*
AU  - Brenner, H.*
AU  - Fischer, B.*
AU  - Franzke, C.W.*
AU  - Gastell, S.*
AU  - Holleczek, B.*
AU  - Jöckel, K.H.*
AU  - Kaaks, R.*
AU  - Keil, T.*
AU  - Kluttig, A.*
AU  - Kuß, O.*
AU  - Legath, N.*
AU  - Leitzmann, M.*
AU  - Lieb, W.*
AU  - Meinke-Franze, C.*
AU  - Michels, K.B.*
AU  - Obi, N.*
AU  - Pischon, T.*
AU  - Feinkohl, I.*
AU  - Rospleszcz, S.
AU  - Schikowski, T.*
AU  - Schulze, M.B.*
AU  - Stang, A.*
AU  - Völzke, H.*
AU  - Willich, S.N.*
AU  - Wirkner, K.*
AU  - Zeeb, H.*
AU  - Ahrens, W.*
AU  - Berger, K.*
C1  - 65058
C2  - 52019
SP  - 179–870
TI  - Zunahme psychischer Störungen während der COVID-19-Pandemie – die Rolle beruflicher und finanzieller Belastungen.
      Eine Analyse der NAKO Gesundheitsstudie.
JO  - Dtsch. Arztebl. Int.
VL  - 119
IS  - 11
PY  - 2022
SN  - 1866-0452
ER  - 

TY  - JOUR
AB  - BACKGROUND: In 2017, the prevalence of obesity (BMI ≥= 30 kg/m2) in Germany was approximately 16%. Obesity increases an individual's risk of developing type 2 diabetes (T2DM) and arterial hypertension; it also increases overall mortality. Consequently, effective treatment is a necessity. Approximately 20 000 bariatric operations are performed in Germany each year. METHODS: This review is based on pertinent publications retrieved by a selective search in the PubMed and Cochrane databases and on current German clinical practice guidelines. RESULTS: The types of obesity surgery most commonly performed in Germany, Roux-en-Y gastric bypass and sleeve gastrectomy, lead to an excess weight loss of 27-69% ≥= 10 years after the procedure. In obese patients with T2DM, the diabetes remission rate ≥= 10 years after these procedures ranges from 25% to 62%. Adjusted regression analyses of data from large registries have shown that the incidence of malignancies is 33% lower in persons who have undergone obesity surgery compared to control subjects with obesity (unadjusted incidence 5.6 versus 9.0 cases per 1000 person-years). The operation can cause vitamin deficiency, surgical complications, gastroesophageal reflux, and dumping syndrome. Therefore, lifelong follow-up is necessary. CONCLUSION: In view of an increasing number of patients undergoing bariatric surgery, it will probably not be feasible in the future for lifelong follow-up to be provided exclusively in specialized centers.
AU  - Fink, J.*
AU  - Seifert, G.*
AU  - Blüher, M.
AU  - Fichtner-Feigl, S.*
AU  - Marjanovic, G.*
C1  - 64856
C2  - 52516
SP  - 70-80
TI  - Obesity surgery.
JO  - Dtsch. Arztebl. Int.
VL  - 119
IS  - 5
PY  - 2022
SN  - 1866-0452
ER  - 

TY  - JOUR
AB  - BACKGROUND: The SARS-CoV-2 pandemic is ongoing in Germany. Children and adolescents are increasingly being infected, and many cases presumably remain undetected and unreported. Sero-epidemiological studies can help estimate the true number of infections. METHODS: From January 2020 to June 2022, 59 786 persons aged 1-17 years were tested for SARS-CoV-2 antibodies as part of a screening program for presymptomatic type 1 diabetes in the German federal state of Bavaria (the Fr1da study). RESULTS: In June 2022, the seroprevalence in the overall population was 73.5%. The seroprevalence was significantly higher in school-age children (from 5 to 10 years of age) than in preschool children (ages 1-4): 84.4% vs. 66.6%, p <0.001. In contrast, in November 2021, before the appearance of the omicron variant, the overall seroprevalence was 14.7% (16.2% of school-age children, 13.0% of preschool children, p = 0.06). In the overall collective, seroprevalence increased fivefold from the fall of 2021 to June 2022 (by a factor of 5.2 in school-age children and 5.1 in preschool children). Similar seroprevalences, with smaller case numbers, were observed in June 2022 in the corresponding Fr1da studies in Saxony and Northern Germany: 87.8% and 76.7%, respectively. CONCLUSION: Monthly case counts reveal a substantial rise in SARS-CoV-2-infections among children and adolescents from late 2021 to mid-2022. The high percentage of preschool and school-age children who have been infected with SARS-CoV-2, in a population that has low vaccination coverage, should be taken into account in the development of health policies.
AU  - Ott, R.
AU  - Achenbach, P.
AU  - Ewald, D.A.*
AU  - Friedl, N.
AU  - Gemulla, G.*
AU  - Hubmann, M.*
AU  - Kordonouri, O.*
AU  - Loff, A.*
AU  - Marquardt, E.*
AU  - Sifft, P.
AU  - Sporreiter, M.S.
AU  - Zapardiel-Gonzalo, J.
AU  - Ziegler, A.-G.
C1  - 67381
C2  - 53545
CY  - Dieselstrabe 2, Postfach 400265, D-50859 Cologne, Germany
SP  - 765-770
TI  - SARS-CoV-2 seroprevalence in preschool and school-age children.
JO  - Dtsch. Arztebl. Int.
VL  - 119
IS  - 45
PB  - Deutscher Aerzte-verlag Gmbh
PY  - 2022
SN  - 1866-0452
ER  - 

TY  - JOUR
AB  - Hintergrund: Der Deutsche Diabetes-Risiko-Test (DRT) ermöglicht bislang die Vorhersage des individuellen Risikos, an Typ-2-Diabetes (T2D) in den folgenden fünf Jahren zu erkranken. Ziel ist es, den DRT-Vorhersagezeitraum einschließlich der nichtklinischen Version und der Hämoglobin A1c(HbA1c)-Erweiterung auf zehn Jahre zu erweitern und extern zu validieren.Methode: In Daten der Brandenburger Ernährungs- und Krebsstudie (European Prospective Investigation into Cancer and Nutrition[EPIC]-Potsdam, n = 25 393) wurden mit Cox-Regression die Punkte zur Berechnung des 5-Jahres-Risikos neu gewichtet. Zwei populationsbasierte prospektive Kohorten (EPIC-Heidelberg: n = 23 624; Bundes-Gesundheitssurvey 1998 [BGS98]-Kohorte: n = 3 717) wurden für die externe Validierung genutzt. Die Diskriminierung wurde anhand von C-Indizes und die Kalibrierung durch Kalibrierungsdiagramme sowie das Verhältnis erwarteter zu beobachteter Fälle (E/O-Ratio) dargestellt.Ergebnisse: Die Vorhersagegüte in EPIC-Potsdam war sehr gut (C-Index nichtklinisches Modell 0,834) und wurde in EPIC-Heidelberg (0,843) sowie der BGS98-Kohorte (0,851) bestätigt. Bei über 10 % vorhergesagter Erkrankungswahrscheinlichkeit haben in der BGS98-Kohorte 14,9 % nach zehn Jahren T2D entwickelt (positiv prädiktiver Wert). Die Modelle waren sehr gut kalibriert in EPIC-Potsdam (E/O-Ratio nichtklinisches Modell: 1,08), überschätzten das Risiko leicht in EPIC-Heidelberg (1,34) und sagten nach einer Rekalibrierung sehr gut in der BGS98-Kohorte voraus (1,06).Schlussfolgerung: Der erweiterte DRT-Vorhersagezeitraum von zehn Jahren mit einer nichtklinischen Version und einer HbA1c-Erweiterung, die zukünftig auf Deutsch und Englisch verfügbar ist, ermöglicht die noch langfristigere evidenzbasierte Identifikation von Hochrisikopersonen in verschiedensten Anwendungsbereichen wie ärztlichen Vorsorgeuntersuchungen.
AU  - Schiborn, C.*
AU  - Paprott, R.*
AU  - Heidemann, C.*
AU  - Kühn, T.*
AU  - Fritsche, A.
AU  - Kaaks, R.*
AU  - Schulze, M.B.*
C1  - 66703
C2  - 53278
CY  - Dieselstrabe 2, Postfach 400265, D-50859 Cologne, Germany
SP  - 651-657
TI  - Deutscher Diabetes-Risiko-Test zur Bestimmung des individuellen Typ-2-Diabetes-Risikos: 10-Jahres-Vorhersage und externe Validierungen.
JO  - Dtsch. Arztebl. Int.
VL  - 119
IS  - 39
PB  - Deutscher Aerzte-verlag Gmbh
PY  - 2022
SN  - 1866-0452
ER  - 

TY  - JOUR
AB  - Das durch Sandmücken übertragene Toskana-Virus (TOSV), ein Phlebovirus 
      aus der Familie der Phenuiviridae, zählt in Endemiegebieten zu den 
      häufigsten Erregern einer Meningoenzephalitis (ME) (1).
       Kenntnisse über regionale Erreger sind im Hinblick auf die initiale 
      Behandlung von besonderer Bedeutung. Zuletzt mehrten sich Meldungen über
       die Ausbreitung von Sandmücken (2), sodass eine endemische Zirkulation des TOSV auch in Deutschland denkbar ist.
AU  - Wenzel, M.*
AU  - Afzali, A.M.*
AU  - Hoffmann, D.
AU  - Zange, S.*
AU  - Georgi, E.*
AU  - Hemmer, B.*
C1  - 66042
C2  - 52598
CY  - Dieselstrabe 2, Postfach 400265, D-50859 Cologne, Germany
SP  - 546-547
TI  - Toskana-Virus-Meningoenzephalitis in Oberbayern.
JO  - Dtsch. Arztebl. Int.
VL  - 119
IS  - 31-32
PB  - Deutscher Aerzte-verlag Gmbh
PY  - 2022
SN  - 1866-0452
ER  - 

TY  - JOUR
AB  - BACKGROUND: Comprehensive data on the frequency of diabetes mellitus among hospitalized patients in Germany have not been published to date. METHODS: Among all inpatient cases aged ≥20 years that were documented in the German DRG statistics for 2015-2017, we analyzed the frequencies of five types of diabetes (type 1, type 2, other/pancreatic diabetes, "rare diabetes" with an ICD code of E12 or E14, gestational diabetes) and of prediabetes, stratified by sex and age group. The presence of any of these conditions was ascertained from the corresponding ICD-10 code among the main diagnoses (reasons for admission) or secondary diagnoses. We also compared the length of hospital stay, in-hospital mortality, and the frequency of various categories of main diagnosis in cases with and without diabetes in each age group. RESULTS: In the period 2015-2017, approximately 18% of the 16.4 to 16.7 million inpatient cases carried a main or secondary diagnosis of diabetes (in 2017: type 2, 17.1%; type 1, 0.5%). Diabetes was more common in male cases than in female cases (in 2017: type 2, 19.7% vs. 14.8%; type 1, 0.5% vs. 0.4%). In 2017, the greatest difference in length of hospital stay between patients with and without diabetes was for patients with type 1 diabetes aged 40-49 (7.3 vs. 4.5 days), while the greatest difference in in-hospital mortality was for patients with type 2 diabetes aged 70-79 (3.7% vs. 2.8%). From the age of 30 (age category 30-39), diseases of the cardiovascular system, and from the age of 50 (age category 50-59), diseases of the respiratory or urogenital systems were more frequently listed as a reason for admission in cases with than in those without diabetes. CONCLUSION: The fact that diabetes is twice as prevalent in hospitalized cases as in the general population underscores the high morbidity associated with the disease and the greater need of persons with diabetes for in-hospital care, as the population of multimorbid diabetes patients continues to grow older.
AU  - Auzanneau, M.*
AU  - Fritsche, A.
AU  - Icks, A.*
AU  - Siegel, E.*
AU  - Kilian, R.*
AU  - Karges, W.*
AU  - Lanzinger, S.*
AU  - Holl, R.W.*
C1  - 62743
C2  - 51033
CY  - Dieselstrabe 2, Postfach 400265, D-50859 Cologne, Germany
SP  - 407-412
TI  - Diabetes in the Hospital.
JO  - Dtsch. Arztebl. Int.
VL  - 118
IS  - 24
PB  - Deutscher Aerzte-verlag Gmbh
PY  - 2021
SN  - 1866-0452
ER  - 

TY  - JOUR
AB  - Hintergrund: Chronische Effekte von Ozon wurden bisher selten in Krankheitslas-tenstudien betrachtet. Unsere Zielsetzung war es, diese Krankheitslast in Deutsch-land für die Jahre 2007–2016 zu berechnen. Ein besonderes Augenmerk galt dabei der Schätzung der Krankheitslast durch Ozon basierend auf Effektschätzern, die für Feinstaub (PM2,5) und Stickstoffdioxid (NO2) adjustiert wurden.Methoden: Basierend auf modellierten Ozon-Daten und Einwohnerzahlen in Deutschland wurde die flächendeckende, räumlich hoch aufgelöste (2 km × 2 km), mittlere bevölkerungsbezogene Exposition gegenüber Ozon während der Sommer-monate („Sommer-Ozon“) berechnet. Unter Verwendung der aus Kohortenstudien vorhandenen Risikoschätzer wurde anschließend die Krankheitslast für chronisch obstruktive Lungenerkrankung (COPD) quantifiziert. Dabei wurden Daten zu Bevöl-kerungszahlen, Lebenserwartung und Mortalität für Deutschland verwendet, um die nationale Situation möglichst adäquat abzubilden. Ergebnisse: Der Schätzer für verlorene Lebensjahre (YLL, Years of Life Lost) auf-grund von Sommer-Ozon lag im Bereich von 18,33 (95-%-Konfidenzintervall: [14,02; 22,08]) (Jahr 2007) bis 35,77 YLL pro 100 000 Einwohner [27,45; 42,98] (Jahr 2015). Die Ergebnisse deuten auf einen von anderen Luftschadstoffen unab-hängigen Effekt von Ozon auf die COPD-Krankheitslast hin. Insgesamt ist im Zeit-raum 2007 bis 2016 kein eindeutiger zeitlicher Trend in der COPD-Krankheitslast zu erkennen.Schlussfolgerung: Langzeitexpositionen gegenüber Ozon tragen in der deutschen Allgemeinbevölkerung zur COPD-Krankheitslast bei. Angesichts einer infolge des Klimawandels möglichen Zunahme der Ozonkonzentration sind intensivere For-schungen zu den Auswirkungen des Ozons auf die Gesundheit erforderlich.
AU  - Breitner-Busch, S.
AU  - Steckling-Muschack, N.*
AU  - Markevych, I.
AU  - Zhao, T.
AU  - Mertes, H.*
AU  - Nowak, D.*
AU  - Heinrich, J.*
C1  - 62783
C2  - 50996
CY  - Dieselstrabe 2, Postfach 400265, D-50859 Cologne, Germany
SP  - 491-496
TI  - Krankheitslast für COPD durch Ozon-Exposition in Deutschland.
JO  - Dtsch. Arztebl. Int.
VL  - 118
IS  - 29-30
PB  - Deutscher Aerzte-verlag Gmbh
PY  - 2021
SN  - 1866-0452
ER  - 

TY  - JOUR
AU  - Fritsche, L.
AU  - Peter, A.
AU  - Hummel, J.
AU  - Wagner, R.
AU  - Häring, H.-U.
AU  - Birkenfeld, A.L.
AU  - Fritsche, A.
AU  - Heni, M.
C1  - 62792
C2  - 51002
CY  - Dieselstrabe 2, Postfach 400265, D-50859 Cologne, Germany
SP  - 432-433
TI  - HbA1c measurement cannot replace an oral glucose tolerance test for the diagnosis of gestational diabetes.
JO  - Dtsch. Arztebl. Int.
VL  - 118
IS  - 25
PB  - Deutscher Aerzte-verlag Gmbh
PY  - 2021
SN  - 1866-0452
ER  - 

TY  - JOUR
AB  - BACKGROUND: Regional deprivation can increase the risk of illness and adversely affect care outcomes. In this study, we investigated for the German state of Rhineland-Palatinate whether spatial-structural disadvantages are associated with an increased frequency of ischemic stroke and with less favorable care outcomes. METHODS: We compared billing data from DRG statistics (2008-2017) and quality assurance data (2017) for acute ischemic stroke with the German Index of Multiple Deprivation 2010 (GIMD 2010) for the 36 districts (Landkreise) and independent cities (i.e., cities not belonging to a district) in Rhineland-Palatinate using correlation analyses, a Poisson regression analysis, and logistic regression analyses. RESULTS: The age-standardized stroke rates (ASR) ranged from 122 to 209 per 100 000 inhabitants, while the GIMD 2010 ranged from 4.6 to 47.5; the two values were positively correlated (Spearman's ρ = 0.47; 95% confidence interval [0.16; 0.85]). In 2017, mechanical thrombectomies were performed more commonly (5.7%) in the first GIMD 2010 quartile of the regional areas (i.e., in the least deprived areas) than in the remaining quartiles (4.2-4.6%). The intravenous thrombolysis rates showed no differences from one GIMD 2010 quartile to another. Severe neurological deficits (National Institutes of Health Stroke Scale ≥ 5) on admission to the hospital were slightly more common in the fourth quartile (i.e., in the most deprived areas), while antiplatelet drugs and statins were somewhat less commonly ordered on discharge in those areas than in the first quartile. CONCLUSION: These findings document a relationship between regional deprivation and the occurrence of acute ischemic stroke. Poorer GIMD 2010 scores were associated with worse care outcomes in a number of variables, but the absolute differences were small.
AU  - Grau, A.J.*
AU  - Dienlin, S.*
AU  - Bartig, D.*
AU  - Maier, W.
AU  - Buggle, F.*
AU  - Becher, H.*
C1  - 62633
C2  - 50967
CY  - Dieselstrabe 2, Postfach 400265, D-50859 Cologne, Germany
SP  - 397-402
TI  - Regional deprivation, stroke incidence, and stroke care.
JO  - Dtsch. Arztebl. Int.
VL  - 118
IS  - 23
PB  - Deutscher Aerzte-verlag Gmbh
PY  - 2021
SN  - 1866-0452
ER  - 

TY  - JOUR
AB  - BACKGROUND: Mitochondrial disorders are among the most common heritable diseases, with an overall lifetime risk of approximately one in 1500. Nonetheless, their diagnosis is often missed because of their extreme phenotypic and genotypic heterogeneity. METHODS: This review is based on publications retrieved by a selective literature search on the clinical features, genetics, pathogenesis, diagnosis, and treatment of mitochondrial diseases. RESULTS: Pathogenic defects of energy metabolism have been described to date in over 400 genes. Only a small number of these genes lie in the mitochondrial DNA; the corresponding diseases are either maternally inherited or of sporadic distribution. The remaining diseaseassociated genes are coded in nuclear DNA and cause diseases that are inherited according to Mendelian rules, mostly autosomal recessive. The most severely involved organs are generally those with the highest energy requirements, including the brain, the sensory epithelia, and the extraocular, cardiac, and skeletal musculature. Typical manifestations include epileptic seizures, stroke-like episodes, hearing loss, retinopathy, external ophthalmoparesis, exercise intolerance, and diabetes mellitus. More than two manifestations of these types should arouse suspicion of a disease of energy metabolism. The severity of mitochondrial disorders ranges from very severe disease, already evident in childhood, to relatively mild disease arising in late adulthood. The diagnosis is usually confirmed with molecular-genetic methods. Symptomatic treatment can improve patients' quality of life. The only disease-modifying treatment that has been approved to date is idebenone for the treatment of Leber hereditary optic neuropathy. Intravitreal gene therapy has also been developed for the treatment of this disease; its approval by the European Medicines Agency is pending. CONCLUSION: Patients with mitochondrial diseases have highly varied manifestations and can thus present to physicians in practically any branch of medicine. A correct diagnosis is the prerequisite for genetic counseling and for the initiation of personalized treatment.
AU  - Klopstock, T.*
AU  - Priglinger, C.*
AU  - Yilmaz, A.*
AU  - Kornblum, C.*
AU  - Distelmaier, F.*
AU  - Prokisch, H.
C1  - 64189
C2  - 51732
CY  - Dieselstrabe 2, Postfach 400265, D-50859 Cologne, Germany
SP  - 741-748
TI  - Mitochondrial disorders.
JO  - Dtsch. Arztebl. Int.
VL  - 118
IS  - 44
PB  - Deutscher Aerzte-verlag Gmbh
PY  - 2021
SN  - 1866-0452
ER  - 

TY  - JOUR
AB  - Hintergrund:
       Bei 30–80 % der Patienten auf Intensivstationen kommt es perioperativ 
      zu einer Hyperglykämie. Diese Stresshyperglykämie wird über 
      inflammatorisch-endokrine sowie iatrogene Stimuli ausgelöst 
      beziehungsweise unterhalten und bedarf regelmäßig therapeutischer 
      Interventionen. Dabei bestehen Unsicherheiten, welche Blutglukoseziele 
      für Patienten mit Diabetes mellitus anzustreben sind.Methode: Es erfolgte eine selektive Literaturrecherche in PubMed und über GoogleScholar.Ergebnisse:
       Intensivmedizinisch versorgte Patienten mit vorbestehendem Diabetes 
      mellitus profitieren nicht im selben Ausmaß von einer Blutglukosesenkung
       wie stoffwechselgesunde, werden aber gleichermaßen einem relevanten 
      Hypoglykämierisiko ausgesetzt. Ein Therapiekorridor zwischen 
      4,4–6,1 mmol/L (79–110 mg/dL) ist für Patienten mit Diabetes mellitus 
      nicht zu rechtfertigen. Perioperativ besteht das wichtigste Therapieziel
       darin, Hypoglykämien in jedem Fall strikt zu vermeiden. Negativfolgen 
      der Hyperglykämie sind unter anderem neurotoxische Effekte und die 
      Begünstigung von Wundheilungsstörungen. Metaanalysen belegen, dass eine 
      obere Blutglukosegrenze von 10 mmol/L (180 mg/dL) mit einem günstigeren 
      Ergebnis für Patienten mit Diabetes mellitus verbunden ist als eine 
      niedrigere Schwelle. Der von Fachgesellschaften für hospitalisierte 
      Menschen mit Diabetes mellitus vorgeschlagene Zielbereich von 
      7,8–10 mmol/L (140–180 mg/dL) scheint der Gratwanderung, einerseits eine
       Hypoglykämie zu vermeiden und andererseits die klinischen Resultate zu 
      optimieren, derzeit am ehesten gerecht zu werden. Mittel der Wahl zur 
      Therapie in der Intensivmedizin ist die kontinuierliche intravenöse 
      Insulingabe, deren Anwendung es erfordert, dezidierte Rahmenbedingungen 
      einzuhalten.Schlussfolgerung:
       In der Intensivmedizin ist eine optimale Blutglukosekontrolle für 
      Patienten mit Diabetes mellitus darauf ausgerichtet, sowohl eine 
      Hypoglykämie zu vermeiden als auch einen Zielbereich bis 10 mmol/L 
      (180 mg/dL) zu erreichen. Die leitliniengerechte Steuerung der 
      Ernährungstherapie ist hierbei eine unabdingbare Voraussetzung.
AU  - Roth, J.*
AU  - Sommerfeld, O.*
AU  - Birkenfeld, A.L.
AU  - Sponholz, C.*
AU  - Müller, U.A.*
AU  - von Loeffelholz, C.*
C1  - 63338
C2  - 51282
CY  - Dieselstrabe 2, Postfach 400265, D-50859 Cologne, Germany
SP  - 629-636
TI  - Blutglukoseziele in der operativen Intensivmedizin.
JO  - Dtsch. Arztebl. Int.
VL  - 118
IS  - 38
PB  - Deutscher Aerzte-verlag Gmbh
PY  - 2021
SN  - 1866-0452
ER  - 

TY  - JOUR
AB  - BACKGROUND: Despite the availability of effective pharmaceutical treatment options, many patients with asthma do not manage to control their illness. This randomized trial with a waiting-list control group examined whether a 3-week course of inpatient pulmonary rehabilitation (PR) improves asthma control (primary endpoint) and other secondary endpoints (e.g., quality of life, cardinal symptoms, mental stress). The subsequent observational segment of the study investigated the long-term outcome after PR. METHODS: After approval of the rehabilitation´ by the insurance providers (T0), 412 adults with uncontrolled asthma (Asthma Control Test [ACT] score < 20 points) undergoing rehabilitation were assigned to either the intervention group (IG) or the waiting-list control group (CG). PR commenced 1 month (T1) after randomization in the IG and 5 months after randomization (T3) in the CG. Asthma control and the secondary endpoints were assessed 3 months after PR in the IG (T3) as an intention-to-treat analysis by means of analyses of covariance. Moreover, both groups were observed for a period of 12 months after the end of PR. RESULTS: At T3 the mean ACT score was 15.76 points in the CG, 20.38 points in the IG. The adjusted mean difference of 4.71 points was clinically relevant (95% confidence interval [3.99; 5.43]; effect size, Cohen's d = 1.27). The secondary endpoints also showed clinically relevant effects in favor of the IG. A year after the end of rehabilitation the mean ACT score was 19.00 points, still clinically relevant at 3.54 points higher than when rehabilitation began. Secondary endpoints such as quality of life and cardinal symptoms (dyspnea, cough, expectoration, pain) and self-management showed moderate to large effects. CONCLUSION: The trial showed that a 3-week course of PR leads to clinically relevant improvement in asthma control and secondary endpoints. Patients who do not achieve control of their asthma despite outpatient treatment therefore benefit from rehabilitation.
AU  - Schultz, K.*
AU  - Wittmann, M.*
AU  - Wagner, R.*
AU  - Lehbert, N.*
AU  - Schwarzkopf, L.
AU  - Szentes, B.L.*
AU  - Nowak, D.*
AU  - Faller, H.*
AU  - Schuler, M.*
C1  - 61693
C2  - 50398
CY  - Dieselstrabe 2, Postfach 400265, D-50859 Cologne, Germany
SP  - 23-30
TI  - In-patient pulmonary rehabilitation to improve asthma control.
JO  - Dtsch. Arztebl. Int.
VL  - 118
IS  - 3
PB  - Deutscher Aerzte-verlag Gmbh
PY  - 2021
SN  - 1866-0452
ER  - 

TY  - JOUR
AB  - BACKGROUND: Diabetic ketoacidosis (DKA) is a potentially life-threatening metabolic disorder that can occur with manifestation of type 1 diabetes mellitus (T1D). The aim of this study was to analyze the incidence of DKA at the time of the diagnosis of T1D in childhood and adolescence, the risk factors, and regional approaches to reduce the incidence of ketoacidosis. METHODS: We investigated the proportion of patients under 18 years of age with DKA (defined as pH <7.3, severe DKA pH <7.1) at the manifestation of T1D in Germany in the period 2000-2019, based on data from the German-Austrian registry of diabetes (Diabetes-Patienten-Verlaufsdokumentation, DPV). The influence of the following factors was evaluated: year of manifestation, age, sex, family history of migration (MiH), and distance from the hospital. Moreover, data from the region with and the region without a pilot screening project from 2015 onwards were compared. RESULTS: Of the 41 189 patients with manifestation of T1D, 19.8% presented with DKA (n = 8154, slight increase [p <0.001] over the study period) and 6.1% (n = 2513) had severe DKA. Children under 6 years of age had DKA more often than adolescents (12-17 years) (21.7% versus 18.6%, OR 1.22 {95% CI: [1.14; 1.30]}). Girls had a higher rate of DKA than boys (20.5% versus 19.2%, OR 1.10 [1.03; 1.14]), and patients with MiH were more likely to have DKA than those without MiH (21.4% versus 18.2%, OR 1.40 [1.32; 1.48]). In the region with a pilot screening project, the DKA rate stayed the same, at 20.6%, while in the control region the rate was 22.7% with a decreasing tendency. CONCLUSION: The frequency of DKA at the time of diagnosis of T1D did not decrease between 2000 and 2019 and increased towards the end of the observation period. Children with MiH, children under 6, and girls were at a higher risk of DKA.
AU  - Segerer, H.*
AU  - Wurm, M.*
AU  - Grimsmann, J.M.*
AU  - Karges, B.*
AU  - Neu, A.*
AU  - Sindichakis, M.*
AU  - Warncke, K.
AU  - Dost, A.*
AU  - Holl, R.W.*
C1  - 62590
C2  - 50963
CY  - Dieselstrabe 2, Postfach 400265, D-50859 Cologne, Germany
SP  - 367-372
TI  - Diabetic ketoacidosis at manifestation of type 1 diabetes in childhood and adolescence.
JO  - Dtsch. Arztebl. Int.
VL  - 118
IS  - 22
PB  - Deutscher Aerzte-verlag Gmbh
PY  - 2021
SN  - 1866-0452
ER  - 

TY  - JOUR
AB  - Background: In clinical medical research. causality is demonstrated by randomized controlled trials (RCTs). Often, however, an RCT cannot be conducted for ethical reasons, and sometimes for practical reasons as well. In such cases, knowledge can be derived from an observational study instead. In this article, we present two methods that have not been widely used in medical research to date.Methods: The methods of assessing causal inferences in observational studies are described on the basis of publications retrieved by a selective literature search.Results: Two relatively new approaches-regression-discontinuity methods and interrupted time series-can be used to demonstrate a causal relationship under certain circumstances. The regression-discontinuity design is a quasi-experimental approach that can be applied if a continuous assignment variable is used with a threshold value. Patients are assigned to different treatment schemes on the basis of the threshold value. For assignment variables that are subject to random measurement error, it is assumed that, in a small interval around a threshold value, e.g.. cholesterol values of 160 mg/dL, subjects are assigned essentially at random to one of two treatment groups. If patients with a value above the threshold are given a certain treatment, those with values below the threshold can serve as control group. Interrupted time series are a special type of regression-discontinuity design in which time is the assignment variable, and the threshold is a cutoff point. This is often an extemal event, such as the imposition of a smoking ban. A before-and-after comparison can be used to determine the effect of the intervention (e.g.. the smoking ban) on health parameters such as the frequency of cardiovascular disease.Conclusion: The approaches described here can be used to derive causal inferences from observational studies. They should only be applied after the prerequisites for their use have been carefully checked.
AU  - Gianicolo, E.A.L.*
AU  - Eichler, M.*
AU  - Muensterer, O.*
AU  - Strauch, K.
AU  - Blettner, M.*
C1  - 58675
C2  - 48354
CY  - Dieselstrabe 2, Postfach 400265, D-50859 Cologne, Germany
SP  - 101-107
TI  - Methods for evaluating causality in observational studies.
JO  - Dtsch. Arztebl. Int.
VL  - 116
IS  - 7
PB  - Deutscher Aerzte-verlag Gmbh
PY  - 2020
SN  - 1866-0452
ER  - 

TY  - JOUR
AB  - BACKGROUND: The pandemic caused by the coronavirus SARS-CoV-2 and the countermeasures taken to protect the public are having a substantial effect on the health of the population. In Germany, nationwide protective measures to halt the spread of the virus were implemented in mid-March for 6 weeks. METHODS: In May, the impact of the pandemic was assessed in the German National Cohort (NAKO). A total of 113 928 men and women aged 20 to 74 years at the time of the baseline examination conducted 1 to 5 years earlier (53%) answered, within a 30-day period, a follow-up questionnaire on SARS-CoV-2 test status, COVID-19- associated symptoms, and self-perceived health status. RESULTS: The self-reported SARS-CoV-2 test frequency among the probands was 4.6%, and 344 participants (0.3%) reported a positive test result. Depressive and anxiety-related symptoms increased relative to baseline only in participants under 60 years of age, particularly in young women. The rate of moderate to severe depressive symptoms increased from 6.4% to 8.8%. Perceived stress increased in all age groups and both sexes, especially in the young. The scores for mental state and self-rated health worsened in participants tested for SARS-CoV-2 compared with those who were not tested. In 32% of the participants, however, self-rated health improved. CONCLUSION: The COVID-19 pandemic and the protective measures during the first wave had effects on mental health and on self-rated general health.
AU  - Peters, A.
AU  - Rospleszcz, S.
AU  - Greiser, K.H.*
AU  - Dallavalle, M.
AU  - Berger, K.*
C1  - 60816
C2  - 49602
CY  - Dieselstrabe 2, Postfach 400265, D-50859 Cologne, Germany
SP  - 861-867
TI  - The impact of the COVID-19 pandemic on self-reported health.
JO  - Dtsch. Arztebl. Int.
VL  - 117
IS  - 50
PB  - Deutscher Aerzte-verlag Gmbh
PY  - 2020
SN  - 1866-0452
ER  - 

TY  - JOUR
AU  - Traidl-Hoffmann, C.
C1  - 60604
C2  - 49885
CY  - Dieselstrabe 2, Postfach 400265, D-50859 Cologne, Germany
SP  - A1556-+
TI  - Climate and health climate resilience - the way of the future.
JO  - Dtsch. Arztebl. Int.
VL  - 117
IS  - 33-34
PB  - Deutscher Aerzte-verlag Gmbh
PY  - 2020
SN  - 1866-0452
ER  - 

TY  - JOUR
AU  - Wjst, M.
C1  - 59676
C2  - 48912
CY  - Dieselstrabe 2, Postfach 400265, D-50859 Cologne, Germany
SP  - 287-287
TI  - Environmental science or environmental activism?
JO  - Dtsch. Arztebl. Int.
VL  - 117
IS  - 16
PB  - Deutscher Aerzte-verlag Gmbh
PY  - 2020
SN  - 1866-0452
ER  - 

TY  - JOUR
AB  - Hintergrund: Erhebliche Anstrengungen müssen unternommen werden, um das von der Pariser UN-Klimakonferenz 2015 beschlossene Klimaabkommen umzusetzen, das die Begrenzung der globalen Erwärmung auf deutlich unter 2 °C, möglichst 1,5 °C im Vergleich zum vorindustriellen Niveau vorsieht. Unsere Zielsetzung war, die Zahl künftiger temperaturbedingter Herzinfarkte (HI) in Augsburg zu prognostizieren, ausgehend von einer globalen Erwärmung um 1,5 °C, 2 °C oder 3 °C. Methoden: Unter Verwendung von täglichen HI-Zeitreihen und Temperaturprojektionen wurde basierend auf zwei Klimaszenarien jeweils die Zahl der temperaturbedingten Herzinfarkte bei unterschiedlichen Erwärmungsleveln prognostiziert. Bevölkerungsstruktur und Adaptationsgrad der Bevölkerung wurden dabei als konstant angenommen. Ergebnisse: In einem emissionsarmen Szenario, das die Erwärmung im 21. Jahrhundert auf unter 2 °C begrenzt, wird die Zahl der temperaturbedingten Herzinfarkte bei einer globalen Erwärmung um 1,5 °C mit −6 Fällen (95-%-Konfidenzintervall: [−60; 50]) pro Jahrzehnt leicht abnehmen. In einem Szenario mit hohen Emissionen, das die Ziele des Übereinkommens von Paris überschreitet, steigt pro Jahrzehnt die Zahl der temperaturbedingten Herzinfarkte bei Erwärmung um 2 °C um 18 [−64; 117] beziehungsweise bei Erwärmung um 3 °C um 63 [−83; 257] Fälle an. Fazit: Die künftige Belastung durch temperaturbedingte Herzinfarkt-Fälle in Augsburg wird bei einer globalen Erwärmung um 2 °C beziehungsweise 3 °C höher liegen als bei einer Erwärmung um 1,5 °C. Die Erfüllung des Übereinkommens von Paris mit Eindämmung der globalen Erwärmung auf 1,5 °C ist daher essenziell, um durch den Klimawandel verursachte zusätzliche Herzinfarkte zu vermeiden.
AU  - Chen, K.
AU  - Breitner-Busch, S.
AU  - Rai, M.*
AU  - Wolf, K.
AU  - Meisinger, C.
AU  - Heier, M.
AU  - Kuch, B.*
AU  - Peters, A.
AU  - Schneider, A.E.
C1  - 56740
C2  - 47244
CY  - Dieselstrabe 2, Postfach 400265, D-50859 Cologne, Germany
SP  - 521-527
TI  - Zukünftige Häufigkeit temperaturbedingter Herzinfarkte in der Region Augsburg.
JO  - Dtsch. Arztebl. Int.
VL  - 116
IS  - 31-32
PB  - Deutscher Aerzte-verlag Gmbh
PY  - 2019
SN  - 1866-0452
ER  - 

TY  - JOUR
AB  - Background: In developed countries, global developmental disorders are encountered in approximately 1% of all children. The causes are manifold, and no exogenous cause can be identified in about half of the affected children. The parallel investigation of the coding sequences of all genes of the affected individual (whole exome sequencing, WES) has developed into a successful diagnostic method for identifying the cause of the problem. It is not yet clear, however, when WES should best be used in routine clinical practice in order to exploit the potential of this method to the fullest.Methods: In an interdisciplinary study, we carried out standardized clinical phenotyping and a systematic genetic analysis (WES of the index patient and his or her parents, so-called trio WES) in 50 children with developmental disturbances of unclear etiology and with nonspecific neurological manifestations.Results: In 21 children (42% of the collective), we were able to identify the cause of the disorder by demonstrating a mutation in a gene known to be associated with disease. Three of these children subsequently underwent specific treatment. In 22 other children (44%), we detected possibly etiological changes in candidate genes not currently known to be associated with human disease.Conclusion: Our detection rate of at least 42% is high in comparison with the results obtained in other studies from Germany and other countries to date and implies that WES can be used to good effect as a differential diagnostic tool in pediatric neurology. WES should be carried out in both the index patient and his or her parents (trio-WES) and accompanied by close interdisciplinary collaboration of human geneticists and pediatricians, by comprehensive and targeted phenotyping (also after the diagnosis is established), and by the meticulous evaluation of all gene variants.
AU  - Mahler, E.A.*
AU  - Johannsen, J.*
AU  - Tsiakas, K.*
AU  - Kloth, K.*
AU  - Lüttgen, S.*
AU  - Mühlhausen, C.*
AU  - Alhaddad, B.*
AU  - Haack, T.B.*
AU  - Strom, T.M.
AU  - Kortüm, F.*
AU  - Meitinger, T.
AU  - Muntau, A.C.*
AU  - Santer, R.*
AU  - Kubisch, C.*
AU  - Lessel, D.*
AU  - Denecke, J.*
AU  - Hempel, M.*
C1  - 55987
C2  - 46736
CY  - Dieselstrabe 2, Postfach 400265, D-50859 Cologne, Germany
SP  - 197-204
TI  - Exome sequencing in children undiagnosed developmental delay and neurological illness.
JO  - Dtsch. Arztebl. Int.
VL  - 116
IS  - 12
PB  - Deutscher Aerzte-verlag Gmbh
PY  - 2019
SN  - 1866-0452
ER  - 

TY  - JOUR
AB  - Background: Air pollutants, especially fine dust, ozone, and nitrogen dioxide, pose a danger to health worldwide. In 2005, the World Health Organization (WHO), in order to protect public health, issued global recommendations for maximum levels of fine dust (10 mu g/m(3) for fine dust particles smaller than 2.5 mu m [PM2.5]), ozone, and nitrogen dioxide. The recommended levels are regularly exceeded in many places in Germany.Methods: This review is based on relevant publications retrieved by a selective search in PubMed and, in part, on an expert statement issued in the name of the International Society for Environmental Epidemiology (ISEE) and the European Respiratory Society (ERS).Results: Air pollutants affect the entire body, from the beginning of intrauterine development all the way to the end of life, causing premature death mainly through lung and heart disease. An epidemiological study has shown, for example, that mortality rises approximately 7% for every incremental long-term exposure to 5 mu g/m(3) PM2.5 (95% confidence interval: [2; 13]). Aside from lung and heart disease, the carcinogenic effect of fine dust is now well established. High fine-dust exposure has also been linked to metabolic diseases. For example, in a meta-analysis of cohort studies, the incidence of type 2 diabetes mellitus was found to be associated with elevated fine dust concentrations, with a 25% relative risk increase [10; 43] for every 10 mu g/m(3) of PM2.5. More recent studies have shown that these substances cause harm even in concentrations that are below the recommended limits.Conclusion: It is very important for public health that the current EU standards for fine dust particles smaller than <2.5 mu g are markedly lowered so that health risks can be further reduced, in accordance with the recommendations of the WHO.
AU  - Ritz, B.*
AU  - Hoffmann, B.*
AU  - Peters, A.
C1  - 57891
C2  - 47992
CY  - Dieselstrabe 2, Postfach 400265, D-50859 Cologne, Germany
SP  - 881-886
TI  - The effects of fine dust, ozone, and nitrogen dioxide on health.
JO  - Dtsch. Arztebl. Int.
VL  - 116
IS  - 51-52
PB  - Deutscher Aerzte-verlag Gmbh
PY  - 2019
SN  - 1866-0452
ER  - 

TY  - JOUR
AU  - Nagel, G.*
AU  - Erdmann, F.*
AU  - Heier, M.
AU  - Meisinger, C.
AU  - Mayer, B.*
AU  - Fallah, M.*
C1  - 51165
C2  - 42693
SP  - A890-A891 and A3
TI  - Registerbasierte Studien: Potenziale noch nicht ausgeschöpft.
JO  - Dtsch. Arztebl. Int.
VL  - 114
IS  - 18
PY  - 2017
SN  - 1866-0452
ER  - 

TY  - JOUR
AB  - BACKGROUND: A number of non-pharmacological methods are available to help elderly people with cognitive impairment. Unstructured and non-evidencebased interventions are commonly used. The multicomponent therapy MAKS (a German acronym for Motor, Activities of daily living, Cognitive, Social) has already been evaluated in nursing homes; in this study, we investigated its use in day care centers (DCCs). METHODS: A cluster-randomized, controlled, single-blinded trial involving a 6-month intervention phase was performed. 362 cognitively impaired persons in 32 DCCs took part in the trial. Multiple regression analyses were used to determine whether MAKS therapy led to any statistically significant and clinically relevant improvement over time (compared to membership in the control group) in these persons' cognitive abilities and activities of daily living (ADL) abilities, as assessed, respectively, with the Mini-Mental State Examination (MMSE) and the Erlangen Test of Activities of Daily Living in Persons with Mild Dementia or Mild Cognitive Impairment (ETAM). A primary per-protocol analysis was supplemented by an intention-to-treat analysis. Two secondary outcomes (social behavior and neuropsychiatric symptoms) were analyzed exploratively as well. Study registration: ISRCTN16412551. RESULTS: In the primary per-protocol analysis at 6 months, the intervention group had significantly better MMSE and ETAM scores than the control group (Cohen's d, 0.26 and 0.21, respectively; p = 0.012 for both). The same was found in the ITT analysis at 6 months (Cohen's d = 0.21, p = 0.033; and Cohen's d = 0.20, p = 0.019, respectively). Neuropsychiatric symptoms, one of the secondary outcomes, also evolved more favorably in the intervention group (Cohen's d = 0.23, p = 0.055). CONCLUSION: MAKS therapy is effective for persons with cognitive impairment ranging from mild cognitive impairment (MCI) to moderate dementia who live at home and regularly visit a day care center. The fact that 32 day care facilities from all over Germany participated in this study gives its findings high external validity.
AU  - Straubmeier, M.
AU  - Behrndt, E.M.
AU  - Seidl, H.*
AU  - Özbe, D.
AU  - Luttenberger, K.
AU  - Graessel, A.
C1  - 52564
C2  - 44050
CY  - Cologne
SP  - 815-821
TI  - Nichtpharmakologische Therapie bei Menschen mit kognitiven Einschränkungen. Ergebnisse der randomisierten kontrollierten German-Day-Care-Studie.
JO  - Dtsch. Arztebl. Int.
VL  - 114
IS  - 48
PB  - Deutscher Aerzte-verlag Gmbh
PY  - 2017
SN  - 1866-0452
ER  - 

TY  - JOUR
AB  - Background: Idiopathic pulmonary fibrosis (IPF) is the most common idiopathic interstitial disease of the lung and has the worst prognosis of all such diseases, with a median survival time of three to four years. Its prevalence is 2-29 per 100 000 persons and its incidence approximately 10 per 100 000 persons per year, with an upward trend. Methods: Selective literature search in the EMBASE and PubMed databases for pertinent publications from 1996 to 2012, with special attention to randomized controlled trials Results: IPF manifests itself clinically with exertional dyspnea, dry cough, and inspiratory crepitations (sclerosiphonia). The diagnosis is confirmed by the demonstration of a usual interstitial pneumonia (UIP) pattern in a high-resolution thin-slice CT (HRCT) of the lungs, or else histologically by lung biopsy, along with the exclusion of other causes such as asbestosis or connective tissue disease. In 15 randomized controlled therapeutic trials carried out since 2004, most of the drugs that were tested, including immune suppressants, were found to be ineffective against IPF or even harmful. Only pirfenidone lessens the annual reduction of pulmonary volume (FVC, forced expiratory vital capacity) and of the distance walked in 6 minutes by about 30%, with corresponding improvement of progression-free survival, but without any significant lessening of overall mortality (placebo, 10%; pirfenidone, 8%). Pirfenidone also commonly causes gastrointestinal and cutaneous side effects. The efficacy of N-acetyldysteine and nintedanib has not yet been definitively demonstrated. Lung transplantation is the only current treatment that enables long-term survival. Conclusion: IPF has a worse prognosis than many types of cancer. Drugs can delay the progression of the disease but probably cannot bring it to a permanent standstill.
AU  - Behr, J.
C1  - 44235
C2  - 36860
CY  - Cologne
SP  - 875-881
TI  - The diagnosis and treatment of idiopathic pulmonary fibrosis.
JO  - Dtsch. Arztebl. Int.
VL  - 110
IS  - 51-52
PB  - Deutscher Aerzte-verlag Gmbh
PY  - 2013
SN  - 1866-0452
ER  - 

TY  - JOUR
AU  - Pfeufer, A.
AU  - Krawczak, M.*
C1  - 28617
C2  - 33489
SP  - A2016-A2017
TI  - Gendiagnostik: Das "1000-Dollar-Genom".
JO  - Dtsch. Arztebl. Int.
VL  - 110
IS  - 43
PB  - Dtsch. Ärzte-Verl.
PY  - 2013
SN  - 1866-0452
ER  - 

TY  - JOUR
AB  - EINLEITUNG: Das Zeitfenster zwischen Symptombeginn und Reperfusion des verschlossenen Gefäßabschnittes des Myokards ist eine entscheidende Determinante des Behandlungsverlaufs. Hierbei macht die Entscheidungszeit der Patienten den Hauptteil der prähospitalen Verzögerungszeit (PHZ) aus. METHODEN: Selektive Literaturrecherche auf Basis der Referenzen einer Metaanalyse, ergänzt durch PubMed-Suche mit den Begriffen "prehospital delay", verknüpft mit "myocardial infarction", "acute coronary syndrome", "psychological factors", "gender" und "public campaign". Es wurden 73 Arbeiten mit die PHZ beeinflussenden Faktoren ausgewählt. ERGEBNISSE: Die Gründe, warum es ubiquitär deutlich über 120 Minuten dauert, bis ein Patient mit Infarktsymptomen die Klinik erreicht, sind nach wie vor nicht ausreichend geklärt. Jedoch scheinen Symptomunklarheit, hohes Alter und weibliches Geschlecht zu den entscheidenden Barrieren im Patientenhandeln zu zählen. DISKUSSION: Die PHZ beeinflussende Faktoren beziehen sich auf folgende Ebenen: Wahrnehmung der Akutsymptomatik, Erkennen der Bedeutung der Beschwerden und die Entscheidung, Hilfe in Anspruch zu nehmen. Interventionsprogramme sollten diese drei Ebenen berücksichtigen und speziell den Anforderungen für klinisch relevante Subpopulationen gerecht werden.
AU  - Gärtner, C.*
AU  - Walz, L.*
AU  - Bauernschmitt, E.*
AU  - Ladwig, K.-H.
C1  - 2773
C2  - 25959
SP  - 286-91
TI  - Patientenbezogene Determinanten der prähospitalen Verzögerung beim akuten Myokardinfarkt.
JO  - Dtsch. Arztebl. Int.
VL  - 105
IS  - 15
PB  - Dt. Ärzte-Verl.
PY  - 2008
SN  - 1866-0452
ER  - 

TY  - JOUR
AU  - Löwel, H.
AU  - Meisinger, C.
AU  - Heier, M.
AU  - Hörmann, A.
AU  - von Scheidt, W.
C1  - 1409
C2  - 23683
SP  - 616-622
TI  - Herzinfarkt und koronare Sterblichkeit in Süddeutschland: Ergebnisse des bevölkerungsbasierten MONICA/KORA-Herzinfarktregisters 1991 bis 1993 und 2001 bis 2003.
JO  - Dtsch. Arztebl. Int.
VL  - 103
PY  - 2006
SN  - 1866-0452
ER  - 

TY  - JOUR
AU  - Völzke, H.*
AU  - Neuhauser, H.*
AU  - Moebus, S.*
AU  - Baumert, J.J.
AU  - Berger, K.*
AU  - Stang, A.*
AU  - Ellert, U.*
AU  - Werner, A.*
AU  - Döring, A.
C1  - 4582
C2  - 24277
SP  - 2784-2790
TI  - Rauchen: Regionale Unterschiede in Deutschland.
JO  - Dtsch. Arztebl. Int.
VL  - 42
PY  - 2006
SN  - 1866-0452
ER  - 

TY  - JOUR
AU  - Wjst, M.
C1  - 4234
C2  - 24064
SP  - S. A3019
TI  - Evidence based medicine - Pragmatische Ansätze.
JO  - Dtsch. Arztebl. Int.
VL  - 103
IS  - 45
PY  - 2006
SN  - 1866-0452
ER  -