• An adjustable fetal weight standard for twins: a statistical modeling study

      Zhang, Jun; Mikolajczyk, Rafael; Lei, Xiaoping; Sun, Luming; Yu, Hongping; Cheng, Weiwei (2015-07-03)
      Abstract Background It is a common practice to use a singleton fetal growth standard to assess twin growth. We aim to create a twin fetal weight standard which is also adjustable for race/ethnicity and other factors. Methods Over half a million twin births of low risk pregnancies in the US, from 1995 to 2004, were used to construct a fetal weight standard. We used the Hadlock’s fetal growth standard and the proportionality principle to make the standard adjustable for other factors such as race/ethnicity. We validated the standard in different race/ethnicities in the US and against previously published curves from around the world. Results The adjustable fetal weight standard has an excellent match with the observed birthweight data in non-Hispanic White, non-Hispanic Black, Hispanics, and Asian from 24 to 38 weeks gestation. It also had a very good fit with cross-sectional data from Australia and Norway, and a longitudinal standard from Brazil. However, our model-based 10th and 90th percentiles differed substantially from studies in Japan and US that used the last menstrual period for estimate of gestational age. Conclusion The adjustable fetal weight standard for twins is a flexible tool and can be used in different populations.
    • An adjustable fetal weight standard for twins: a statistical modeling study.

      Zhang, Jun; Mikolajczyk, Rafael; Lei, Xiaoping; Sun, Luming; Yu, Hongping; Cheng, Weiwei; Helmholtz Centre for Infection Research, Inhoffenstraße 7, 38124 Braunschweig, Germany. (2015)
      It is a common practice to use a singleton fetal growth standard to assess twin growth. We aim to create a twin fetal weight standard which is also adjustable for race/ethnicity and other factors.
    • Adolescent health in the Eastern Mediterranean Region: findings from the global burden of disease 2015 study.

      Karch, Andre; GBD 2015 Eastern Mediterranean Region Adolescent Health Collaborators.; Helmholtz-Zentrum für Infektionsforschung GmbH, Inhoffenstr. 7, 38124 Braunschweig, Germany. (2018-05-01)
      The 22 countries of the East Mediterranean Region (EMR) have large populations of adolescents aged 10-24 years. These adolescents are central to assuring the health, development, and peace of this region. We described their health needs. Using data from the Global Burden of Disease Study 2015 (GBD 2015), we report the leading causes of mortality and morbidity for adolescents in the EMR from 1990 to 2015. We also report the prevalence of key health risk behaviors and determinants. Communicable diseases and the health consequences of natural disasters reduced substantially between 1990 and 2015. However, these gains have largely been offset by the health impacts of war and the emergence of non-communicable diseases (including mental health disorders), unintentional injury, and self-harm. Tobacco smoking and high body mass were common health risks amongst adolescents. Additionally, many EMR countries had high rates of adolescent pregnancy and unmet need for contraception. Even with the return of peace and security, adolescents will have a persisting poor health profile that will pose a barrier to socioeconomic growth and development of the EMR.
    • Advising vaccinations for the elderly: a cross-sectional survey on differences between general practitioners and physician assistants in Germany.

      Klett-Tammen, Carolina Judith; Krause, Gerard; von Lengerke, Thomas; Castell, Stefanie; Helmholtz Centre for infection research, Inhoffenstr. 7, 38124 Braunschweig, Germany. (2016)
      In Germany, the coverage of officially recommended vaccinations for the elderly is below a desirable level. It is known that advice provided by General Practitioners and Physician Assistants influences the uptake in patients ≥60 years. Therefore, the predictors of advice-giving behavior by these professions should be investigated to develop recommendations for possible actions for improvement.
    • Alcohol Drinking in University Students Matters for Their Self-Rated Health Status: A Cross-sectional Study in Three European Countries.

      Mikolajczyk, Rafael T; Sebena, Rene; Warich, Julia; Naydenova, Vihra; Dudziak, Urszula; Orosova, Olga; Helmholtz Centre for infection research, Inhoffenstr. 7, 38124 Braunschweig, Germany. (2016)
      Alcohol drinking was linked to self-rated health in different populations, but the observed association was inconsistent. We studied the association among university students across three European countries with different patterns of drinking.
    • Analysis of Practical Identifiability of a Viral Infection Model.

      Nguyen, Van Kinh; Klawonn, Frank; Mikolajczyk, Rafael; Hernandez-Vargas, Esteban Abelardo; Helmholtz Centre for infection research, Inhoffenstr. 7, 38124 Braunschweig, Germany. (2016)
      Mathematical modelling approaches have granted a significant contribution to life sciences and beyond to understand experimental results. However, incomplete and inadequate assessments in parameter estimation practices hamper the parameter reliability, and consequently the insights that ultimately could arise from a mathematical model. To keep the diligent works in modelling biological systems from being mistrusted, potential sources of error must be acknowledged. Employing a popular mathematical model in viral infection research, existing means and practices in parameter estimation are exemplified. Numerical results show that poor experimental data is a main source that can lead to erroneous parameter estimates despite the use of innovative parameter estimation algorithms. Arbitrary choices of initial conditions as well as data asynchrony distort the parameter estimates but are often overlooked in modelling studies. This work stresses the existence of several sources of error buried in reports of modelling biological systems, voicing the need for assessing the sources of error, consolidating efforts in solving the immediate difficulties, and possibly reconsidering the use of mathematical modelling to quantify experimental data.
    • Anosmia in COVID-19 patients.

      Hornuss, D; Lange, B; Schröter, N; Rieg, S; Kern, W V; Wagner, D; HZI,Helmholtz-Zentrum für Infektionsforschung GmbH, Inhoffenstr. 7,38124 Braunschweig, Germany. (Elsevier, 2020-05-22)
      No abstract available.
    • Anthropometric measures in the German National Cohort—more than weight and height

      Fischer, Beate; Sedlmeier, Anja M.; Hartwig, Saskia; Schlett, Christopher L.; Ahrens, Wolfgang; Bamberg, Fabian; Baurecht, Hansjörg; Becher, Heiko; Berger, Klaus; Binder, Hans; et al. (Springer, 2020-01-01)
      High levels of adiposity in the population have a major impact on various diseases, but previous epidemiologic studies have largely been restricted to simple anthropometric measures such as the body mass index (BMI), an imperfect predictor of disease risk. There is a critical need for the use of improved measures of relative weight and body composition in large-scale, population-based research. The current article presents initial descriptive results of body composition and fat distribution based on the midterm baseline dataset of the German National Cohort, which included 101,817 participants who were examined in 18 study centers in Germany between March 2014 and March 2017. The anthropometric measures encompassed body weight, height, waist and hip circumference, bioelectrical impedance analysis (BIA), sonography of abdominal adipose tissue, 3D-body scanning, and magnetic resonance imaging. BMI analyses showed that 46.2% of men and 29.7% of women were overweight and 23.5% of men and 21.2% of women were obese. On average, women in almost all age groups demonstrated more subcutaneous adipose tissue layer thickness than men. The mean values of visceral adipose tissue layer thickness, on the other hand, were higher among men than among women in all age groups and increased continuously across age groups in both sexes. The comprehensive assessment of body composition and fat distribution provides novel future opportunities for detailed epidemiologic analyses of overweight and adiposity in relation to the development of chronic diseases. © 2020, The Author(s).
    • Anti-nuclear autoantibodies in the general German population: prevalence and lack of association with selected cardiovascular and metabolic disorders-findings of a multicenter population-based study.

      Akmatov, Manas K; Röber, Nadja; Ahrens, Wolfgang; Flesch-Janys, Dieter; Fricke, Julia; Greiser, Halina; Günther, Kathrin; Kaaks, Rudolf; Kemmling, Yvonne; Krone, Bastian; et al. (2017-06-06)
      We determined the prevalence of anti-nuclear autoantibodies (ANAs) in the German adult population and examined the association between ANAs and cardiovascular and metabolic disorders.
    • Antibiotic susceptibility profiles of neonatal invasive isolates of Escherichia coli from a 2-year nationwide surveillance study in Germany, 2009-2010.

      Heideking, M; Lander, F; Hufnagel, M; Pfeifer, Y; Wicker, E; Krause, Gerard; Berner, R; Helmholtz Centre for infection research, Inhoffenstr. 7, D-38124 Braunschweig, Germany. (2013-09)
      A nationwide 2-year surveillance study on invasive neonatal Escherichia coli infections in Germany was conducted. A total of 158 isolates were tested for antibiotic susceptibility. The empirical treatment regimen of ampicillin plus gentamicin for neonatal sepsis appears to remain effective, but emerging resistance needs to be closely monitored.
    • Antibiotic use on paediatric inpatients in a teaching hospital in the Gambia, a retrospective study.

      Chaw, Pa Saidou; Schlinkmann, Kristin Maria; Raupach-Rosin, Heike; Karch, André; Pletz, Mathias W; Huebner, Johannes; Nyan, Ousman; Mikolajczyk, Rafael; Helmholtz-Zentrum für Infektionsforschung GmbH, Inhoffenstr. 7, 38124 Braunschweig, Germany. (2018-01-01)
      Antibiotics are useful but increasing resistance is a major problem. Our objectives were to assess antibiotic use and microbiology testing in hospitalized children in the Gambia. We conducted a retrospective analysis of paediatric inpatient data at The Edward Francis Small Teaching Hospital in Banjul, The Gambia. We extracted relevant data from the admission folders of all patients (aged > 28 days to 15 years) admitted in 2015 (January-December), who received at least one antibiotic for 24 h. We also reviewed the microbiology laboratory record book to obtain separate data for the bacterial isolates and resistance test results of all the paediatric inpatients during the study period. Over half of the admitted patients received at least one antibiotic during admission (496/917) with a total consumption of 670.7 Days of Antibiotic Therapy/1000 Patient-Days. The clinical diagnoses included an infectious disease for 398/496, 80.2% of the patients on antibiotics, pneumonia being the most common (184/496, 37.1%). There were 51 clinically relevant bacterial isolates, More than half of the admitted patients received antibiotics. The reported antibiotic resistance was highest to the most commonly used antibiotics such as ampicillin. Efforts to maximize definitive antibiotic indication such as microbiological testing prior to start of antibiotics should be encouraged where possible for a more rational antibiotic use.
    • Assessing the Concepts and Designs of 58 Mobile Apps for the Management of the 2014-2015 West Africa Ebola Outbreak: Systematic Review.

      Tom-Aba, Daniel; Nguku, Patrick Mboya; Arinze, Chinedu Chukwujekwu; Krause, Gerard; HZI,Helmholtz-Zentrum für Infektionsforschung GmbH, Inhoffenstr. 7,38124 Braunschweig, Germany. (2018-10-29)
      The use of mobile phone information technology (IT) in the health sector has received much attention especially during the 2014-2015 Ebola virus disease (EVD) outbreak. mHealth can be attributed to a major improvement in EVD control, but there lacks an overview of what kinds of tools were available and used based on the functionalities they offer. We aimed to conduct a systematic review of mHealth tools in the context of the recent EVD outbreak to identify the most promising approaches and guide further mHealth developments for infectious disease control. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we searched for all reports on mHealth tools developed in the context of the 2014-2015 EVD outbreak published between January 1, 2014 and December 31, 2015 on Google Scholar, MEDLINE, CAB Abstracts (Global Health), POPLINE, and Web of Science in any language using the search strategy: ("outbreak" OR "epidemic") AND ("mobile phone" OR "smartphone" OR "smart phone" OR "mobile phone" OR "tablet" OR "mHealth") AND ("Ebola" OR "EVD" OR "VHF" OR "Ebola virus disease" OR "viral hemorrhagic fever") AND ("2014" OR "2015"). The relevant publications were selected by 2 independent reviewers who applied a standardized data extraction form on the tools' functionalities. We identified 1220 publications through the search strategy, of which 6.31% (77/1220) were original publications reporting on 58 specific mHealth tools in the context of the EVD outbreak. Of these, 62% (34/55) offered functionalities for surveillance, 22% (10/45) for case management, 18% (7/38) for contact tracing, and 6% (3/51) for laboratory data management. Only 3 tools, namely Community Care, Sense Ebola Followup, and Surveillance and Outbreak Response Management and Analysis System supported all four of these functionalities.
    • [Assessment of self-reported cardiovascular and metabolic diseases in the German National Cohort (GNC, NAKO Gesundheitsstudie): methods and initial results].

      Jaeschke, Lina; Steinbrecher, Astrid; Greiser, Karin Halina; Dörr, Marcus; Buck, Thomas; Linseisen, Jakob; Meisinger, Christa; Ahrens, Wolfgang; Becher, Heiko; Berger, Klaus; et al. (Springer, 2020-03-10)
      BACKGROUND: Asthma is one of the most common chronic diseases in both children and adults. Asthma first occurring in adulthood (adult-onset asthma, AOA) is associated with poorer prognosis compared to childhood-onset asthma (COA), which urgently calls for more research in this area. The aim of this work was to analyze the data on asthma collected in the German National Cohort and compare it with the German Health Interview and Examination Survey for Adults (DEGS), in particular regarding AOA. MATERIAL AND METHODS: Our analysis was based on the dataset of the main questionnaire at mid-term of the German National Cohort baseline examination, comprising 101,723 participants. Variables considered in the analyses were self-reported diagnosis of asthma, age at first diagnosis, asthma treatment in the past 12 months, age, and sex. RESULTS: In the midterm dataset, 8.7% of women and 7.0% of men in the German National Cohort reported that they had ever been diagnosed with asthma. Approximately one third of participants with asthma received their initial diagnosis before their 18th birthday. COA affected 2.2% of women and 2.8% of men, whereas AOA affected 6.5% of women and 4.2% of men. During the previous 12 months, 33% of COA cases and 60% of AOA cases were medically treated. CONCLUSION: The proportion of persons affected by asthma in the German National Cohort, as well as observed patterns regarding age and gender, corresponds to other data sources such as DEGS. However, in our analysis, the proportion of individuals with AOA was higher than described in the literature. The increase in cumulative asthma diagnoses with age is markedly steeper in younger participants, indicating a rising trend over time.
    • Association between Embolic Stroke Patterns, ESUS Etiology, and New Diagnosis of Atrial Fibrillation: A Secondary Data Analysis of the Find-AF Trial.

      Maier, Ilko L; Schregel, Katharina; Karch, André; Weber-Krueger, Mark; Mikolajczyk, Rafael T; Stahrenberg, Raoul; Gröschel, Klaus; Bähr, Mathias; Knauth, Michael; Psychogios, Marios-Nikos; et al. (2017)
      Background. Atrial fibrillation (AF) is an important cause of embolic stroke of undetermined source (ESUS). Imaging-patterns like multiple infarcts, simultaneous involvement of different circulations, infarcts of different ages, and isolated cortical infarcts are likely to indicate cardioembolic stroke. The aim of our study was to evaluate the association between embolic stroke patterns, ESUS, and the new diagnosis of AF. Methods. Stroke etiology and imaging characteristics from patients included in the Find-AF study were obtained. Embolic stroke patterns in CT- or MR-imaging were correlated with the diagnosis of ESUS as well as the short- (on baseline ECG and during 7-day Holter) and long-term (12-month follow-up) diagnosis of AF. Results. From 281 patients included in the Find-AF study, 127 (45.2%) patients with ischemic lesions detected in CT or MRI were included. 26 (20.5%) of these patients had ESUS. At least one embolic stroke pattern was detected in 67 (52.7%) patients. Embolic stroke patterns were not associated with ESUS (OR 1.57, 0.65-3.79, p = 0.317), the short-term (OR 0.64, 0.26-1.58, p = 0.327) or long-term diagnosis of AF (OR 0.72, 0.31-1.68, p = 0.448). Conclusions. This secondary data analysis of the Find-AF study could not provide evidence for an association between embolic stroke patterns, ESUS, and the new diagnosis of AF.
    • Association between rates of caesarean section and maternal and neonatal mortality in the 21st century: a worldwide population-based ecological study with longitudinal data.

      Ye, J; Zhang, J; Mikolajczyk, Rafael; Torloni, M R; Gülmezoglu, A M; Betran, A P; Helmholtz Centre for Infectoion Research; Inhoffenstr.7 38124 Braunschweig; Germany. (2015-08-24)
      Caesarean section was initially performed to save the lives of the mother and/or her baby. Caesarean section rates have risen substantially worldwide over the past decades. In this study, we set out to compile all available caesarean section rates worldwide at the country level, and to identify the appropriate caesarean section rate at the population level associated with the minimal maternal and neonatal mortality.
    • Autoimmune thyroiditis as a risk factor for stroke: A historical cohort study

      Karch, André; Thomas, S. L.; Research group epidemiological and statistical methods, Helmholtz Centre for infection research, Inhoffenstr. 7, 38124 Braunschweig, Germany (2014-06-20)
    • Availability of indicators of migration in the surveillance of HIV, tuberculosis and hepatitis B in the European Union – a short note

      Akmatov, Manas K; Mikolajczyk, Rafael; Krumkamp, Ralf; Wörmann, Tanja; Chu, Janet JunQing; Paetzelt, Gunnar; Reintjes, Ralf; Pessler, Frank; Krämer, Alexander; Department of Public Health Medicine, School of Public Health, University of Bielefeld, Bielefeld, Germany (Springer, 2012-10)
    • Bacterial community structure and effects of picornavirus infection on the anterior nares microbiome in early childhood.

      Caputo, Mahrrouz; Zoch-Lesniak, Beate; Karch, André; Vital, Marius; Meyer, Frederic; Klawonn, Frank; Baillot, Armin; Pieper, Dietmar H; Mikolajczyk, Rafael T; HZI,Helmholtz-Zentrum für Infektionsforschung GmbH, Inhoffenstr. 7,38124 Braunschweig, Germany. (BMC, 2019-01-07)
      Little is known regarding the nasal microbiome in early childhood and the impact of respiratory infection on the infants' nasal microbial composition. Here we investigated the temporal dynamics and diversity of the bacterial composition in the anterior nares in children attending daycare centers. For our investigation, we considered 76 parental-taken nasal swabs of 26 children (aged 13 to 36 months) collected over a study period of 3 months. Overall, there was no significant age-specific effect or seasonal shift in the nasal bacterial community structure. In a sub-sample of 14 healthy children the relative abundance of individual taxa as well as the overall diversity did not reveal relevant changes, indicating a stable community structure over the entire study period. Moreover, the nasal bacterial profiles clustered subject-specific with Bray-Curtis similarities being elevated in intra-subject calculations compared to between-subject calculations. The remaining subset of 12 children provided samples taken during picornavirus infection (PVI) and either before or after a PVI. We detected an association between the relative abundance of members of the genus Streptococcus and PV when comparing both (i) samples taken during PVI with samples out of 14 healthy children and (ii) samples taken during PVI with samples taken after PVI within the same individual. In addition, the diversity was higher during PVI than after infection. Our findings suggest that a personalized structure of the nasal bacterial community is established already in early childhood and could be detected over a timeframe of 3 months. Studies following infants over a longer time with frequent swab sampling would allow investigating whether certain parameter of the bacterial community, such as the temporal variability, could be related to viral infection.
    • [The baseline assessment of the German National Cohort (NAKO Gesundheitsstudie): participation in the examination modules, quality assurance, and the use of secondary data].

      Schipf, Sabine; Schöne, Gina; Schmidt, Börge; Günther, Kathrin; Stübs, Gunthard; Greiser, Karin H; Bamberg, Fabian; Meinke-Franze, Claudia; Becher, Heiko; Berger, Klaus; et al. (Springer, 2020-02-11)
      BACKGROUND: The German National Cohort (NAKO) is an interdisciplinary health study aimed at elucidating causes for common chronic diseases and detecting their preclinical stages. This article provides an overview of design, methods, participation in the examinations, and their quality assurance based on the midterm baseline dataset (MBD) of the recruitment. METHODS: More than 200,000 women and men aged 20-69 years derived from random samples of the German general population were recruited in 18 study centers (2014-2019). The data collection comprised physical examinations, standardized interviews and questionnaires, and the collection of biomedical samples for all participants (level 1). At least 20% of all participants received additional in-depth examinations (level 2), and 30,000 received whole-body magnet resonance imaging (MRI). Additional information will be collected through secondary data sources such as medical registries, health insurances, and pension funds. This overview is based on the MBD, which included 101,839 participants, of whom 11,371 received an MRI. RESULTS: The mean response proportion was 18%. The participation in the examinations was high with most of the modules performed by over 95%. Among MRI participants, 96% completed all 12 MRI sequences. More than 90% of the participants agreed to the use of complementary secondary and registry data. DISCUSSION: Individuals selected for the NAKO were willing to participate in all examinations despite the time-consuming program. The NAKO provides a central resource for population-based epidemiologic research and will contribute to developing innovative strategies for prevention, screening and prediction of chronic diseases.
    • [Blood pressure measurement in the NAKO German National Cohort (GNC) - differences in methods, distribution of blood pressure values, and awareness of hypertension compared to other population-based studies in Germany].

      Schikowski, Tamara; Wigmann, Claudia; Fuks, Kateryna B; Schipf, Sabine; Heier, Margit; Neuhauser, Hannelore; Sarganas, Giselle; Ahrens, Wolfgang; Becher, Heiko; Berger, Klaus; et al. (Springer, 2020-03-13)
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