TY  - JOUR
AB  - BACKGROUND: Although TB services are free in Ghana, TB case detection remains low and mostly limited to public facilities. To address this, a Public-Private Mix (PPM) Directly Observed Therapy (DOT) model was introduced, involving community private healthcare providers and the National Health Insurance Scheme (NHIS) to boost TB case detection rates. METHODS: This impact evaluation focuses on four key interventions targeting vulnerable populations in Ghana's two largest metropolitan areas between the last quarter of 2018 and the first quarter of 2020. Screening and TB register data were collected from implementing facilities, along with TB case notifications from 2015 to 2022 for both intervention and control areas. Comparative interrupted time series (ITS) analysis was used to evaluate the effect of the interventions on quarterly TB case notifications. RESULTS: During the intervention period, a total of 563,868 persons were screened for TB, 12,121 of these were presumptive for TB and 590 persons were diagnosed with TB. Of the diagnosed TB cases, 95.3% (562) were bacteriologically confirmed. The overall TB screening yield was 104.6 cases per 100,000 population. In the intervention area, TB case notifications increased from 1,392 cases in 2018 to 1,462 cases in 2019 while they decreased from 853 to 778 in the control area. The ITS analyses detected positive post-intervention trend differences in all forms of TB and bacteriologically confirmed TB notification case rates between the intervention and control areas. CONCLUSION: Expanding free TB services through a PPM DOT model and sustained community engagement can increase TB case detection in urban areas. National TB programs should adopt and scale this approach to enhance TB surveillance and control.
AU  - Hayibor, K.M.*
AU  - Kenu, E.*
AU  - Mensah, G.I.*
AU  - Awalime, D.*
AU  - Anaman, J.*
AU  - Asante-Poku, A.*
AU  - Ivanova, O.*
AU  - Abhishek, B.*
AU  - Rachow, A.
AU  - Hanson-Nortey, N.N.*
C1  - 75409
C2  - 57961
CY  - Avenue Du Tribunal Federal 34, Lausanne, Ch-1015, Switzerland
TI  - Scaling up tuberculosis case finding via private providers in Ghana: An impact evaluation using interrupted time series.
JO  - Front. Publ. Health
VL  - 13
PB  - Frontiers Media Sa
PY  - 2025
SN  - 2296-2565
ER  - 

TY  - JOUR
AB  - BACKGROUND: The COVID-19 pandemic prompted a range of studies on mental health, with mixed results. While numerous studies reported worsened conditions in individuals with pre-existing mental disorders, others showed resilience and stability in mental health. However, longitudinal data focusing on the German population are sparse, especially regarding effects of age and pre-existing mental disorders during the early stages of the pandemic. OBJECTIVES: To assess the interplay between psychiatric history, age, and the timing of the pandemic, with a focus on understanding how these factors relate to the severity of depression and anxiety symptoms. METHODS: Exploratory analyses were based on 135,445 individuals aged 20-72 years from the German National Cohort (NAKO). Depressive and anxiety symptoms were assessed before and after the first wave of the pandemic. Inferential statistical analyses and negative binomial regression models were calculated. RESULTS: Persons with a self-reported psychiatric history exhibited comparable levels of depression and anxiety symptom severity after the first wave of the pandemic compared to the time before. In contrast, individuals without a psychiatric history, particularly those in their 20s to 40s, experienced an increase in mental health symptom severity during the first wave of the pandemic. LIMITATIONS: Analyses focuses on the first wave of the pandemic, leaving the long-term mental health effects unexplored. CONCLUSION: Future research should consider age-specific and mental-health-related factors when addressing global health crises. Additionally, it is important to explore factors influencing resilience and adaptation, aiming to develop targeted interventions and informed policies for effective mental health management during pandemics.
AU  - Stein, J.*
AU  - Pabst, A.*
AU  - Berger, K.*
AU  - Karch, A.*
AU  - Teismann, H.*
AU  - Streit, F.*
AU  - Grabe, H.J.*
AU  - Mikolajczyk, R.*
AU  - Massag, J.*
AU  - Lieb, W.*
AU  - Castell, S.*
AU  - Heise, J.K.*
AU  - Schulze, M.B.*
AU  - Gastell, S.*
AU  - Harth, V.*
AU  - Obi, N.*
AU  - Peters, A.
AU  - Huemer, M.-T.
AU  - Bohmann, P.*
AU  - Leitzmann, M.*
AU  - Schipf, S.*
AU  - Meinke-Franze, C.*
AU  - Hebestreit, A.*
AU  - Fuhr, D.C.*
AU  - Michels, K.B.*
AU  - Jaskulski, S.*
AU  - Stocker, H.*
AU  - Koch-Gallenkamp, L.*
AU  - Willich, S.N.*
AU  - Keil, T.*
AU  - Löffler, M.*
AU  - Wirkner, K.*
AU  - Riedel-Heller, S.G.*
C1  - 71949
C2  - 56285
CY  - Avenue Du Tribunal Federal 34, Lausanne, Ch-1015, Switzerland
TI  - Mental health of individuals with pre-existing mental illnesses at the beginning of the COVID-19 pandemic: Results of the German National Cohort (NAKO).
JO  - Front. Publ. Health
VL  - 12
PB  - Frontiers Media Sa
PY  - 2024
SN  - 2296-2565
ER  - 

TY  - JOUR
AB  - During the last years the need to integrate sex and gender in health-related research for better and fairer science became increasingly apparent. Various guidelines and checklists were developed to encourage and support researchers in considering the entangled dimensions of sex/gender in their research. However, a tool for the assessment of sex/gender consideration and its visualization is still missing. We aim to fill this gap by introducing an assessment matrix that can be used as a flexible instrument for comprehensively evaluating the sex/gender consideration in quantitative health-related research. The matrix was developed through an iterative and open process based on the interdisciplinary expertise represented in our research team and currently published guidelines. The final matrix consists of 14 different items covering the whole research process and the publication of results. Additionally, we introduced a method to graphically display this evaluation. By developing the matrix, we aim to provide users with a tool to systematically compare sex/gender consideration qualitatively between different publications and even different fields of study. This way, the assessment matrix represents a tool to identify research gaps and a basis for future research. In the long term, the implementation of this tool to evaluate the consideration of sex/gender should contribute to more sex/gender equitable health-related research.
AU  - Horstmann, S.*
AU  - Hartig, C.*
AU  - Kraus, U.
AU  - Palm, K.*
AU  - Jacke, K.*
AU  - Dandolo, L.*
AU  - Schneider, A.E.
AU  - Bolte, G.*
C1  - 67680
C2  - 53987
CY  - Avenue Du Tribunal Federal 34, Lausanne, Ch-1015, Switzerland
TI  - Consideration of sex/gender in publications of quantitative health-related research: Development and application of an assessment matrix.
JO  - Front. Publ. Health
VL  - 11
PB  - Frontiers Media Sa
PY  - 2023
SN  - 2296-2565
ER  - 

TY  - JOUR
AB  - BACKGROUND: In environmental health research, sex and gender are not yet adequately considered. There is a need to improve data collection in population-based environmental health studies by comprehensively surveying sex/gender-related aspects according to gender theoretical concepts. Thus, within the joint project INGER we developed a multidimensional sex/gender concept which we aimed to operationalize and to test the operationalization for feasibility. METHODS: In an iterative process, we created questionnaire modules which quantitatively captured the requirements of the INGER sex/gender concept. We deployed it in the KORA cohort (Cooperative Health Research in the Region of Augsburg, Germany) in 2019 and evaluated response and missing rates. RESULTS: The individual sex/gender self-concept was surveyed via a two-step approach that asked for sex assigned at birth and the current sex/gender identity. Additionally, we used existing tools to query internalized sex/gender roles and externalized sex/gender expressions. Adapted to the KORA population, we asked for discrimination experiences and care and household activities contributing to explain structural sex/gender relations. Further intersectionality-related social categories (e.g., socio-economic position), lifestyle and psychosocial factors were covered through data available in KORA. We could not identify appropriate tools to assess the true biological sex, sexual orientation and ethnic/cultural identity, which have yet to be developed or improved. The response-rate was 71%, the evaluation of 3,743 questionnaires showed a low missing rate. Prevalence of marginalized groups regarding sex/gender identity and definable by experiences of discrimination was very low. CONCLUSION: We have shown how the multidimensional INGER sex/gender concept can be operationalized according to an European and North American understanding of sex/gender for use in quantitative research. The questionnaire modules proved feasible in an epidemiologic cohort study. Being a balancing act between theoretical concepts and its quantitative implementation our operationalization paves the way for an adequate consideration of sex/gender in environmental health research.
AU  - Kraus, U.
AU  - Jacke, K.*
AU  - Dandolo, L.*
AU  - Dębiak, M.*
AU  - Fichter, S.*
AU  - Groth, K.*
AU  - Kolossa-Gehring, M.*
AU  - Hartig, C.*
AU  - Horstmann, S.*
AU  - Schneider, A.E.
AU  - Palm, K.*
AU  - Bolte, G.*
C1  - 67773
C2  - 54251
CY  - Avenue Du Tribunal Federal 34, Lausanne, Ch-1015, Switzerland
TI  - Operationalization of a multidimensional sex/gender concept for quantitative environmental health research and implementation in the KORA study: Results of the collaborative research project INGER.
JO  - Front. Publ. Health
VL  - 11
PB  - Frontiers Media Sa
PY  - 2023
SN  - 2296-2565
ER  - 

TY  - JOUR
AB  - Screen protector glasses are often used to protect the display screen surface of mobile phones against physical damage. Their dosimetric properties were recently studied by thermoluminescence with the aim of using these items as potential emergency dosimeters in the event of a radiological accident. They are sensitive to ionizing radiation and they could be easily removed and replaced without destroying the phone in case of a dose assessment. However, an intrinsic background signal that partially overlaps with the radiation-induced TL signal is observed. The reconstructed dose could be overestimated if not properly taken into account. The homogeneity of this confounding signal on the surface of several screen protectors was estimated and a chemical treatment with hydrofluoric acid (HF 40%) was tested to minimize its contribution. For most of the samples studied, the intrinsic background signal remained a serious issue for dose reconstruction. Additionally, the TL signals were measured in the red detector range using two different models of red-sensitive photomultiplier tubes. The homogeneity of the intrinsic background signal on the surface of screen protectors was examined and the results of the reduction of this signal by the chemical HF treatment were discussed.
AU  - Bassinet, C.*
AU  - Discher, M.*
AU  - Ristic, Y.*
AU  - Woda, C.
C1  - 66363
C2  - 53150
TI  - Mobile phone screen protector glass: A TL investigation of the intrinsic background signal.
JO  - Front. Publ. Health
VL  - 10
PY  - 2022
SN  - 2296-2565
ER  - 

TY  - JOUR
AB  - Background: Area deprivation has been shown to be associated with various adverse health outcomes including communicable as well as non-communicable diseases. Our objective was to assess potential associations between area deprivation and COVID-19 standardized incidence and mortality ratios in Bavaria over a period of nearly 2 years. Bavaria is the federal state with the highest infection dynamics in Germany and demographically comparable to several other European countries. Methods: In this retrospective, observational ecological study, we estimated the strength of associations between area deprivation and standardized COVID-19 incidence and mortality ratios (SIR and SMR) in Bavaria, Germany. We used official SARS-CoV-2 reporting data aggregated in monthly periods between March 1, 2020 and December 31, 2021. Area deprivation was assessed using the quintiles of the 2015 version of the Bavarian Index of Multiple Deprivation (BIMD 2015) at district level, analyzing the overall index as well as its single domains. Results: Deprived districts showed higher SIR and SMR than less deprived districts. Aggregated over the whole period, the SIR increased by 1.04 (95% confidence interval (95% CI): 1.01 to 1.07, p = 0.002), and the SMR by 1.11 (95% CI: 1.07 to 1.16, p < 0.001) per BIMD quintile. This represents a maximum difference of 41% between districts in the most and least deprived quintiles in the SIR and 110% in the SMR. Looking at individual months revealed clear linear association between the BIMD quintiles and the SIR and SMR in the first, second and last quarter of 2021. In the summers of 2020 and 2021, infection activity was low. Conclusions: In more deprived areas in Bavaria, Germany, higher incidence and mortality ratios were observed during the COVID-19 pandemic with particularly strong associations during infection waves 3 and 4 in 2020/2021. Only high infection levels reveal the effect of risk factors and socioeconomic inequalities. There may be confounding between the highly deprived areas and border regions in the north and east of Bavaria, making the relationship between area deprivation and infection burden more complex. Vaccination appeared to balance incidence and mortality rates between the most and least deprived districts. Vaccination makes an important contribution to health equality.
AU  - Manz, K.M.*
AU  - Schwettmann, L.
AU  - Mansmann, U.*
AU  - Maier, W.
C1  - 65825
C2  - 52925
TI  - Area deprivation and COVID-19 incidence and mortality in Bavaria, Germany: A bayesian geographical analysis.
JO  - Front. Publ. Health
VL  - 10
PY  - 2022
SN  - 2296-2565
ER  - 

TY  - JOUR
AB  - Objectives: To quantify the burden and variation trends of cancers in children under 5 years at the global, regional, and national levels from 1990 to 2019. Methods: Epidemiological data for children under 5 years who were diagnosed with any one childhood cancer were obtained from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) from 1990 to 2019. The outcomes were the absolute numbers and rates of incidence, prevalence, mortality, and disability-adjusted life-years (DALYs) for different types of cancer. Results: In 2019, 8,774,979.1 incident cases (95% uncertainty interval [UI]: 6,243,599.2 to11,737,568.5) and 8,956,583.8 (6,446,323.9 to 12,364,520.8) prevalent cases of cancer in children under 5 years were identified worldwide; these cancers resulted in 44,451.6 (36,198.7 to 53,905.9) deaths and 3,918,014.8 (3,196,454.9 to 4,751,304.2) DALYs. From 1990 to 2019, although the numbers of incident and prevalent cases only decreased by -4.6% (-7.0 to -2.2) and -8.3% (-12.6 to -3.4), respectively, the numbers of deaths and DALYs clearly declined by -47.8% (-60.7 to -26.4) and -47.7% (-60.7 to -26.2), respectively. In 2019, the middle sociodemographic index (SDI) regions had the highest incidence and prevalence, whereas the low SDI regions had the most mortality and DALYs. Although all of the SDI regions displayed a steady drop in deaths and DALYs between 1990 and 2019, the low-middle and low SDI regions showed increasing trends of incidence and prevalence. Leukemia remained the most common cancer globally in 2019. From 1990 to 2019, the burdens of leukemia, liver cancer, and Hodgkin's lymphoma declined, whereas the incidence and prevalence of other cancers grew, particularly testicular cancer. Conclusions: The global childhood cancer burden in young children has been steadily decreasing over the past three decades. However, the burdens and other characteristics have varied across different regions and types of cancers. This highlights the need to reorient current treatment strategies and establish effective prevention methods to reduce the global burden of childhood cancer.
AU  - Ren, H.M.*
AU  - Liao, M.
AU  - Tan, S.X.*
AU  - Cheng, C.*
AU  - Zhu, S.*
AU  - Zheng, L.*
AU  - Ma, J.R.*
AU  - Mu, Y.J.*
AU  - Li, W.L.*
AU  - Zhang, S.W.*
AU  - OuYang, R.Q.*
AU  - Li, S.N.*
AU  - Cui, Y.F.*
AU  - Ke, X.Y.*
AU  - Luo, Z.Y.*
AU  - Xiong, P.*
AU  - Liu, J.*
AU  - Li, L.P.*
AU  - Liang, X.F.*
AU  - Zeng, F.F.*
AU  - Su, X.F.*
AU  - Han, L.Y.*
C1  - 65653
C2  - 52869
TI  - Global, regional, and national burden of cancer in children younger than 5 years, 1990-2019: Analysis of the global burden of disease study 2019.
JO  - Front. Publ. Health
VL  - 10
PY  - 2022
SN  - 2296-2565
ER  - 

TY  - JOUR
AB  - Background and Purpose: Cardiotoxicity is a well-known adverse effect of radiation therapy. Measurable abnormalities in the heart function indicate advanced and often irreversible heart damage. Therefore, early detection of cardiac toxicity is necessary to delay and alleviate the development of the disease. The present study investigated long-term serum proteome alterations following local heart irradiation using a mouse model with the aim to detect biomarkers of radiation-induced cardiac toxicity. Materials and Methods: Serum samples from C57BL/6J mice were collected 20 weeks after local heart irradiation with 8 or 16 Gy X-ray; the controls were sham-irradiated. The samples were analyzed by quantitative proteomics based on data-independent acquisition mass spectrometry. The proteomics data were further investigated using bioinformatics and ELISA. Results: The analysis showed radiation-induced changes in the level of several serum proteins involved in the acute phase response, inflammation, and cholesterol metabolism. We found significantly enhanced expression of proinflammatory cytokines (TNF-α, TGF-β, IL-1, and IL-6) in the serum of the irradiated mice. The level of free fatty acids, total cholesterol, low-density lipoprotein (LDL), and oxidized LDL was increased, whereas that of high-density lipoprotein was decreased by irradiation. Conclusions: This study provides information on systemic effects of heart irradiation. It elucidates a radiation fingerprint in the serum that may be used to elucidate adverse cardiac effects after radiation therapy.
AU  - Azimzadeh, O.
AU  - von Toerne, C.
AU  - Subramanian, V.
AU  - Sievert, W.*
AU  - Multhoff, G.*
AU  - Atkinson, M.J.
AU  - Tapio, S.
C1  - 62559
C2  - 50943
CY  - Avenue Du Tribunal Federal 34, Lausanne, Ch-1015, Switzerland
TI  - Data-independent acquisition proteomics reveals long-term biomarkers in the serum of C57BL/6J mice following local high-dose heart irradiation.
JO  - Front. Publ. Health
VL  - 9
PB  - Frontiers Media Sa
PY  - 2021
SN  - 2296-2565
ER  - 

TY  - JOUR
AB  - Background: Due to the ongoing COVID-19 pandemic, demand for diagnostic testing has increased drastically, resulting in shortages of necessary materials to conduct the tests and overwhelming the capacity of testing laboratories. The supply scarcity and capacity limits affect test administration: priority must be given to hospitalized patients and symptomatic individuals, which can prevent the identification of asymptomatic and presymptomatic individuals and hence effective tracking and tracing policies. We describe optimized group testing strategies applicable to SARS-CoV-2 tests in scenarios tailored to the current COVID-19 pandemic and assess significant gains compared to individual testing. Methods: We account for biochemically realistic scenarios in the context of dilution effects on SARS-CoV-2 samples and consider evidence on specificity and sensitivity of PCR-based tests for the novel coronavirus. Because of the current uncertainty and the temporal and spatial changes in the prevalence regime, we provide analysis for several realistic scenarios and propose fast and reliable strategies for massive testing procedures. Key Findings: We find significant efficiency gaps between different group testing strategies in realistic scenarios for SARS-CoV-2 testing, highlighting the need for an informed decision of the pooling protocol depending on estimated prevalence, target specificity, and high- vs. low-risk population. For example, using one of the presented methods, all 1.47 million inhabitants of Munich, Germany, could be tested using only around 141 thousand tests if the infection rate is below 0.4% is assumed. Using 1 million tests, the 6.69 million inhabitants from the city of Rio de Janeiro, Brazil, could be tested as long as the infection rate does not exceed 1%. Moreover, we provide an interactive web application, available at www.grouptexting.com, for visualizing the different strategies and designing pooling schemes according to specific prevalence scenarios and test configurations. Interpretation: Altogether, this work may help provide a basis for an efficient upscaling of current testing procedures, which takes the population heterogeneity into account and is fine-grained towards the desired study populations, e.g., mild/asymptomatic individuals vs. symptomatic ones but also mixtures thereof. Funding: German Science Foundation (DFG), German Federal Ministry of Education and Research (BMBF), Chan Zuckerberg Initiative DAF, and Austrian Science Fund (FWF).
AU  - Verdun, C.M.*
AU  - Fuchs, T.*
AU  - Harar, P.*
AU  - Elbrächter, D.*
AU  - Fischer, D.S.
AU  - Berner, J.*
AU  - Grohs, P.*
AU  - Theis, F.J.
AU  - Krahmer, F.*
C1  - 62950
C2  - 51200
CY  - Avenue Du Tribunal Federal 34, Lausanne, Ch-1015, Switzerland
TI  - Group testing for SARS-CoV-2 allows for up to 10-fold efficiency increase across realistic scenarios and testing strategies.
JO  - Front. Publ. Health
VL  - 9
PB  - Frontiers Media Sa
PY  - 2021
SN  - 2296-2565
ER  - 

TY  - JOUR
AB  - Health behaviors are of great importance for public health. Previous research shows that health behaviors are clustered and do not occur by chance. The main objective of this study was to investigate and describe the clustering of alcohol consumption, nutrition, physical activity and smoking while also considering the influence of sex, age and education. Using data from the population-based KORA S4/F4 cohort study, latent class regression analysis was undertaken to identify different clusters of health behavior patterns. The clusters were described according to demographics. Furthermore, the clusters were described regarding health-related quality of life at baseline and at a 7 year follow-up. Based on a sample of 4,238 participants, three distinct classes were identified. One overall healthy class and two heterogeneous classes. Classes varied especially according to sex, indicating a healthier behavior pattern for females. No clear association between healthier classes and age, education or physical and mental health-related quality of life was found. This study strengthens the literature on the clustering of health behaviors and additionally describes the identified clusters in association with health-related quality of life. More research on associations between clustering of health behaviors and important clinical outcomes is needed.
AU  - Rabel, M.
AU  - Laxy, M.
AU  - Thorand, B.
AU  - Peters, A.
AU  - Schwettmann, L.
AU  - Mess, F.*
C1  - 55350
C2  - 46339
CY  - Avenue Du Tribunal Federal 34, Lausanne, Ch-1015, Switzerland
TI  - Clustering of health-related behavior patterns and demographics. Results from the population-based KORA S4/F4 cohort study.
JO  - Front. Publ. Health
VL  - 6
PB  - Frontiers Media Sa
PY  - 2019
SN  - 2296-2565
ER  - 

TY  - JOUR
AB  - Introduction: Helicobacter pylori (H. pylori) is a common infection and known risk factor for gastric cancer. We assessed cross-sectional and longitudinal associations to study the impact of H. pylori seropositivity on metabolic diseases.Methods: Helicobacter pylori seropositivity in serum samples of the KORA study was analyzed by multiplex serology. We calculated sex-specific prevalence of H. pylori seropositivity for the year 2007 based on the first follow-up survey (termed F4) of the KORA study S4. We identified factors associated with H. pylori seropositivity in the F4 survey. Further, we assessed relative risks of incident metabolic diseases/risk factors at the time of the second follow-up survey of S4 (termed FF4) and H. pylori seropositivity at the F4 survey as a determinant. Models were adjusted for age, sex, overweight status, physical activity, smoking status, education level, alcohol intake, and other metabolic diseases.Results: Based on 3,037 persons aged 32 to 82 years, the H. pylori prevalence for 2007 was 30.2% in men (n = 1,465) and 28.1% in women (n = 1,572). Increasing age, current smoking, low education and no alcohol intake were significantly associated with H. pylori seropositivity in the F4 survey. However, no association between H. pylori seropositivity and BMI, metabolic diseases (type 2 diabetes, hypertension and dyslipidemia, gout or increased uric acid) and gastrointestinal diseases (gastritis, inflammatory bowel disease, and gastric or duodenal ulcer) was observed. No significant associations between H. pylori seropositivity and one of the five investigated incident metabolic diseases/risk factors were detected in the longitudinal analysis.Conclusion: We identified associations between age, smoking, education and alcohol intake and H. pylori seropositivity but no impact of H. pylori seropositivity on incident metabolic diseases/risk factors.
AU  - Wawro, N.
AU  - Amann, U.
AU  - Butt, J.*
AU  - Meisinger, C.
AU  - Akmatov, M.K.*
AU  - Pessler, F.*
AU  - Peters, A.
AU  - Rathmann, W.*
AU  - Kääb, S.*
AU  - Waterboer, T.*
AU  - Linseisen, J.
C1  - 56026
C2  - 46776
CY  - Avenue Du Tribunal Federal 34, Lausanne, Ch-1015, Switzerland
TI  - Helicobacter pylori seropositivity: Prevalence, associations, and the impact on incident metabolic diseases/risk factors in the population-based KORA study.
JO  - Front. Publ. Health
VL  - 7
PB  - Frontiers Media Sa
PY  - 2019
SN  - 2296-2565
ER  -