Medical care and treatment of children with asthmatic or wheezing health outcomes and urban-rural differences in Bavaria - a cross-sectional study

Introduction: Asthma is among the most common chronic conditions in children. The aim of this publication is to describe prevalence rates and factors associated with asthmatic or wheezing preschoolers and to evaluate medical care and treatment with regard to urban-rural differences.Methods: Data for this cross-sectional study were collected through a questionnaire, which was distributed to parents within the Health Monitoring Units in Bavaria (HMU), Germany. Data from 4767 children were available (2016/17). Those children were classified into four diagnostic groups: Unremitting Wheeze, International Study of Asthma and Allergies in Children (ISAAC) Asthma, Physician-diagnosed Asthma, and healthy control group. Urban-rural differences were tested by Pearson's chi-squared test or by Fisher's exact test. Independent variables were factors associated with health outcomes, for example, residency or migrant status. To examine associations between independent and outcome variables multivariate logistic regression analysis was performed.Results: Prevalence rates were 6.3% for 'Unremitting Wheeze', 5.2% for 'ISAAC Asthma', and 1.2% for 'Physician-diagnosed Asthma'. Factors associated with health outcomes were the occurrence of asthma in first-degree relatives, male sex, and migrant status. Generally, higher rates of doctor's visits, positive allergy tests, and corticosteroids intake in the diagnostic groups in rural compared to urban areas were observed. Rates of performed allergy tests were 55.6% for 'ISAAC Asthma' and 74.6% for 'Physician-diagnosed Asthma'.Conclusions: Prevalence rates of the diagnostic groups decreased compared to the HMU 2014/15. According to previous studies, factors associated with asthmatic or wheezing health outcomes could be confirmed. Children in rural areas generally received more medical care.Key pointsChildren's prevalence rates of asthma or wheezing disorders decreased in the past 2 years within Bavaria.This study is consistent with risk factors for asthma from the literature: asthma in the family, male gender, and migrant status.Children in rural areas receive more medical care than children in urban areas.There should me more allergy tests among children with medical diagnosis in Bavaria as low rates indicate gaps in care.

Exposure to leisure noise and intermittent tinnitus among young adults in Bavaria: longitudinal data from a prospective cohort study

OBJECTIVES

To investigate the association between total leisure noise exposure and intermittent tinnitus among young adults.

DESIGN

Data were obtained from the Ohrkan study, an ongoing prospective cohort study conducted in South Germany since 2009. Information about exposure to impulse and leisure noise, tinnitus occurrences, sociodemographic variables, and self-rated hearing ability were analysed at four time points over a period of seven and a half years.

STUDY SAMPLE

Participants of the Ohrkan cohort study, who provided data about the occurrence of tinnitus for all surveys (n = 1028).

RESULTS

Intermittent tinnitus was reported in the majority of the sample (60%). The risk for intermittent tinnitus increased with higher sound pressure levels from exposure to leisure noise (full model (Odds Ratio, 95%CI): 80-<85dB(A): 1.41 [1.13-1.78], 85-<90dB(A): 1.73 [1.38-2.16], >90dB(A): 2.04 [1.59-2.61]). Visiting nightclubs was a major contributor to this relationship. Of the considered covariables, self-rated hearing as "poor", and growing up in a single-parent household were significantly associated with intermittent tinnitus.

CONCLUSION

Intermittent tinnitus is very frequent among young adults and is associated with high levels of leisure noise exposure. To prevent intermittent tinnitus, reduced sound pressure levels and the use of hearing protection are necessary.

Poststratification as a suitable approach to generalize findings of two cross-sectional studies along the Bavarian compulsory school entrance examination: An exemplary poststratified analysis for asthma, hay fever and wheezing

BACKGROUND

A compulsory school entrance examination of pre-school children (SEU) is administered in the German state of Bavaria. Every second year since 2004, the examinations are expanded in six study regions using a cross-sectional survey design (GME). However, the extent to which the results of the GME surveys are generalizable to the SEU population is unknown. Therefore, this study carried out a poststratification of two different GME surveys. The aim was to observe the impact of poststratification on an exemplary analysis of influencing factors for three allergy and asthma related outcomes (hay fever, asthma, wheezing) and thus to better understand this important question.

METHODS

First, poststratification was applied to correct for deviances of the GME sample in comparison to the SEU population. Logistic regression was used to determine the auxiliary variables for the poststratification. Following this, a composite variable as a linear combination was created to calculate weighting factors. Next, logistic regression analyses were applied to analyze possible influencing factors for three allergy and asthma related outcomes (hay fever, asthma and wheezing) in two GME surveys (2005/2006 and 2012/2013). Subsequently, the differences arising from poststratification were examined in more detail.

RESULTS

This study supports the hypothesis that the GME sample deviates from the SEU population. Mother tongue other than German of at least one parent, complete vaccination status and conspicuous visuomotor test results were positively associated with participation in both GME surveys. The prevalence for hay fever, asthma and frequent wheeze did not change statistically significant from 2005/2006 to 2012/2013. In the twelve analyses before and after poststratification, male sex was statistically significant associated with the three allergy and asthma related outcomes (e.g. asthma 2005/2006 after poststratification, aOR: 2.06, 95%-CI: 1.56-2.71). A high body mass index was positively associated with asthma (e.g. 2005/2006 after poststratification, aOR: 1.12, 95%-CI: 1.05-1.20). Poststratification caused a significant change in the sample composition.

CONCLUSIONS

It might be suggested that a poststratification should be performed for each GME survey. Poststratification tended to make results more comparable with previous research. In accordance with previous research, this study confirmed that male sex and high BMI are associated with asthma.

Threshold-dependent iodine imaging and spectral separation in a whole-body photon-counting CT system

OBJECTIVE

To evaluate the dual-energy (DE) performance and spectral separation with respect to iodine imaging in a photon-counting CT (PCCT) and compare it to dual-source CT (DSCT) DE imaging.

METHODS

A semi-anthropomorphic phantom extendable with fat rings equipped with iodine vials is measured in an experimental PCCT. The system comprises a PC detector with two energy bins (20 keV, T) and (T, eU) with threshold T and tube voltage U. Measurements using the PCCT are performed at all available tube voltages (80 to 140 kV) and threshold settings (50-90 keV). Further measurements are performed using a conventional energy-integrating DSCT. Spectral separation is quantified as the relative contrast media ratio R between the energy bins and low/high images. Image noise and dose-normalized contrast-to-noise ratio (CNRD) are evaluated in resulting iodine images. All results are validated in a post-mortem angiography study.

RESULTS

R of the PC detector varies between 1.2 and 2.6 and increases with higher thresholds and higher tube voltage. Reference R of the EI DSCT is found as 2.20 on average overall phantoms. Maximum CNRD in iodine images is found for T = 60/65/70/70 keV for 80/100/120/140 kV. The highest CNRD of the PCCT is obtained using 140 kV and is decreasing with decreasing tube voltage. All results could be confirmed in the post-mortem angiography study.

CONCLUSION

Intrinsically acquired DE data are able to provide iodine images similar to conventional DSCT. However, PCCT thresholds should be chosen with respect to tube voltage to maximize image quality in retrospectively derived image sets.

KEY POINTS

• Photon-counting CT allows for the computation of iodine images with similar quality compared to conventional dual-source dual-energy CT. • Thresholds should be chosen as a function of the tube voltage to maximize iodine contrast-to-noise ratio in derived image sets. • Image quality of retrospectively computed image sets can be maximized using optimized threshold settings.

Photon-counting detectors in computed tomography: from quantum physics to clinical practice

Over the last decade, a fundamentally new type of computed tomography (CT) detectors has proved its superior capabilities in both physical and preclinical evaluations and is now approaching the stage of clinical practice. These detectors are able to discriminate single photons and quantify their energy and are hence called photon-counting detectors. Among the promising benefits of this technology are improved radiation dose efficiency, increased contrast-to-noise ratio, reduced metal artifacts, improved spatial resolution, simultaneous multi-energy acquisitions, and the prospect of multi-phase imaging within a single acquisition using multiple contrast agents. Taking the conventional energy-integrating detectors as a reference, the authors demonstrate the technical principles of this new technology and provide phantom and patient images acquired by a whole-body photon-counting CT. These images serve as a basis for discussing the potential future of clinical CT.

Extreme weather events in europe and their health consequences - A systematic review

BACKGROUND

Due to climate change, the frequency, intensity and severity of extreme weather events, such as heat waves, cold waves, storms, heavy precipitation causing wildfires, floods, and droughts are increasing, which could adversely affect human health. The purpose of this systematic review is therefore to assess the current literature about the association between these extreme weather events and their impact on the health of the European population.

METHODS

Observational studies published from January 1, 2007 to May 17, 2020 on health effects of extreme weather events in Europe were searched systematically in Medline, Embase and Cochrane Central Register of Controlled Trials. The exposures of interest included extreme temperature, heat waves, cold waves, droughts, floods, storms and wildfires. The health impacts included total mortality, cardiovascular mortality and morbidity, respiratory mortality and morbidity, and mental health. We conducted the systematic review following PRISMA (Preferred Reporting Items for Systematic Review and Meta-analysis). The quality of the included studies was assessed using the NICE quality appraisal checklist (National Institute for Health and Care Excellence).

RESULTS

The search yielded 1472 articles, of which 35 met the inclusion criteria and were included in our review. Studies regarding five extreme weather events (extreme heat events, extreme cold events, wildfires, floods, droughts) were found. A positive association between extreme heat/cold events and overall, cardiovascular and respiratory mortality was reported from most studies. Wildfires are likely to increase the overall and cardiovascular mortality. Floods might be associated with the deterioration of mental health instead of mortality. Depending on their length, droughts could have an influence on both respiratory and cardiovascular mortality. Contradictory evidence was found in heat-associated morbidity and wildfire-associated respiratory mortality. The associations are inconclusive due to the heterogeneous study designs, study quality, exposure and outcome assessment.

CONCLUSIONS

Evidence from most of the included studies showed that extreme heat and cold events, droughts, wildfires and floods in Europe have negative impacts on human health including mental health, although some of the associations are not conclusive. Additional high-quality studies are needed to confirm our results and further studies regarding the effects of other extreme weather events in Europe are to be expected.

An operational robotic pollen monitoring network based on automatic image recognition

There is high demand for online, real-time and high-quality pollen data. To the moment pollen monitoring has been done manually by highly specialized experts. Here we evaluate the electronic Pollen Information Network (ePIN) comprising 8 automatic BAA500 pollen monitors in Bavaria, Germany. Automatic BAA500 and manual Hirst-type pollen traps were run simultaneously at the same locations for one pollen season. Classifications by BAA500 were checked by experts in pollen identification, which is traditionally considered to be the "gold standard" for pollen monitoring. BAA500 had a multiclass accuracy of over 90%. Correct identification of any individual pollen taxa was always >85%, except for Populus (73%) and Alnus (64%). The BAA500 was more precise than the manual method, with less discrepancies between determinations by pairs of automatic pollen monitors than between pairs of humans. The BAA500 was online for 97% of the time. There was a significant correlation of 0.84 between airborne pollen concentrations from the BAA500 and Hirst-type pollen traps. Due to the lack of calibration samples it is unknown which instrument gives the true concentration. The automatic BAA500 network delivered pollen data rapidly (3 h delay with real-time), reliably and online. We consider the ability to retrospectively check the accuracy of the reported classification essential for any automatic system.

Stacking-Dependent Spin Interactions in Pd/Fe Bilayers on Re(0001)

Using spin-polarized scanning tunneling microscopy and density functional theory, we have studied the magnetic properties of Pd/Fe atomic bilayers on Re(0001). Two kinds of magnetic ground states are discovered due to different types of stacking of the Pd adlayer on Fe/Re(0001). For fcc stacking of Pd on Fe/Re(0001), it is a spin spiral propagating along the close-packed (ΓK[over ¯]) direction with a period of about 0.9 nm, driven by frustrated exchange and Dzyaloshinskii-Moriya interactions. For the hcp stacking, the four-site four-spin interaction stabilizes an up-up-down-down state propagating perpendicular to the close-packed direction (along ΓM[over ¯]) with a period of about 1.0 nm. Our work shows how higher-order exchange interactions can be tuned at interfaces.

Prevalence of methicillin-sensitive, methicillin-resistant Staphylococcus aureus, and extended-spectrum beta-lactamase-producing Escherichia coli in newborns: a cross-sectional study

BACKGROUND

The prevalence of antimicrobial-resistant bacteria and methicillin-sensitive Staphylococcus aureus (MSSA) in healthy newborns and the role of maternal transmission are scarcely discussed.

OBJECTIVES

The objective of this study was to evaluate the prevalence of MSSA, MRSA, and ESBL among healthy newborns. Additionally, mother-to-newborn transmission rates were investigated as well as antibiotic susceptibility of MSSA, MRSA, and ESBL isolates.

METHODS

Swabs of 658 newborns and their mothers were collected to investigate the presence of MSSA, MRSA, and ESBL. Swabs were taken from the nose and umbilicus immediately after birth. Additional swabs were taken from the nose, perianal area, and umbilicus 3 days after birth. Samples were screened and further characterized using culture and molecular methods.

RESULTS

Prevalence of MSSA, MRSA, and ESBL colonization was 10.9, 0.5, and 2.6%, respectively. There was no association between the colonization status of the newborn and infections at any time point. Mother-to-newborn transmission rates (confirmed by PFGE) were 53.6% for MSSA/MRSA and 100% for ESBL. Maternal carriage of MSSA, MRSA, or ESBL was a risk factor for colonization of the newborn. Some isolates were resistant to the antibiotics recommended for therapy, including clindamycin and daptomycin for MSSA/MRSA isolates and ertapenem, fosfomycin, and tigecyclin for ESBL isolates.

CONCLUSION

No association between infections and the newborns' colonization status could be detected. Maternal colonization played an important role in newborn colonization, but not every case of colonization could be explained by mother-to-newborn transmission. General screening of pregnant women and healthy newborns in the absence of other risk factors is not necessary. To prevent the possibility of transmission in the healthcare setting, professionals, pregnant women, parents, hospital visitors, and obstetricians should receive regular training on appropriate hygiene measures. With regard to the emergence of resistance to recommended antibiotics, an antibiogram should be conducted before treating MSSA/MRSA/ESBL infections to ensure the efficacy of the antibiotics.

Revised criteria system for a national assessment of threatened habitats in Germany

The Red List of threatened habitat types in Germany was first published in 1994 and it is updated approximately every ten years. In 2017 the third version was published by the German Federal Agency for Nature Conservation. In the course of the revision, the criteria system was also extended. In doing so, an attempt was made to find a compromise between the consideration of international developments that had taken place and existing national requirements. In particular, short-term developments should become visible through the German Red List status. In addition to ‘National long-term Threat’, the valuation now also includes ‘Current Trend’ and ‘Rarity’. Following the IUCN’s approach, the collapse risk is now represented on the basis of several criteria. However, in contrast to the IUCN procedure, where the worst evaluated criterion is determinative for Red List status, in our procedure all criteria are included in the evaluation. To counteract misleading signal-effects for management decisions, all significant criteria have an influence on the resulting German Red List status (RLG). They are combined in an assessment scheme. In order to map the overall risk of loss, both the long-term threat as a historical reference value and furthermore the current trend must have an influence on RLG. As a result, 65% of habitat types have differing risk of loss.

Building an automatic pollen monitoring network (ePIN): Selection of optimal sites by clustering pollen stations

Airborne pollen is a recognized biological indicator and its monitoring has multiple uses such as providing a tool for allergy diagnosis and prevention. There is a knowledge gap related to the distribution of pollen traps needed to achieve representative biomonitoring in a region. The aim of this manuscript is to suggest a method for setting up a pollen network (monitoring method, monitoring conditions, number and location of samplers etc.). As a case study, we describe the distribution of pollen across Bavaria and the design of the Bavarian pollen monitoring network (ePIN), the first operational automatic pollen network worldwide. We established and ran a dense pollen monitoring network of 27 manual Hirst-type pollen traps across Bavaria, Germany, during 2015. Hierarchical cluster analysis of the data was then performed to select the locations for the sites of the final pollen monitoring network. According to our method, Bavaria can be clustered into three large pollen regions with eight zones. Within each zone, pollen diversity and distribution among different locations does not vary significantly. Based on the pollen zones, we opted to place one automatic monitoring station per zone resulting in the ePIN network, serving 13 million inhabitants. The described method defines stations representative for a homogeneous aeropalynologically region, which reduces redundancy within the network and subsequent costs (in the study case from 27 to 8 locations). Following this method, resources in pollen monitoring networks can be optimized and allergic citizens can then be informed in a timely and effective way, even in larger geographical areas.

Prädiktoren der Teilnahmebereitschaft von Jugendlichen in Langzeitstudien: Ergebnisse der Ohrkan Kohortenstudie zur Freizeitlärmexposition

Hintergrund und Ziel In Kohortenstudien kann der Verlust von Teilnehmern während der Nachbeobachtungsphasen zu Verzerrungen führen, wenn sich Teilnehmer und Nichtteilnehmer unterscheiden. Viele Studien haben den Einfluss soziodemografischer und gesundheitlicher Faktoren auf die Teilnahmebereitschaft untersucht, es liegen jedoch nur relativ wenige Studien für schulbasierte Kohorten vor. Ziel dieser Arbeit ist die Bestimmung von Prädiktoren der Teilnahmebereitschaft im Rahmen der Ohrkan Kohortenstudie, die die Exposition von Jugendlichen gegenüber Freizeitlärm und mögliche Effekte auf das Hörvermögen im Zeitverlauf untersucht.

Methoden Die Daten dieser Studie basieren auf den Angaben der Ohrkankohorte (n=2148), die 2009–2011 (O-I) unter den Neuntklässlern weiterführender Schulen in Regensburg rekrutiert und 2012–14 (O-II) und 2015–16 (O-III) nachbefragt wurde.

Ergebnisse Die Teilnahmewahrscheinlichkeit in O-II und O-III war höher für Personen ohne Migrationshintergrund, die zu Studienbeginn das Gymnasium besuchten und deren Eltern ein höheres Bildungsniveau hatten oder zusammenlebten. Auch nahmen Personen, die in den letzten 2,5 Jahren ihren Wohnort nicht gewechselt hatten, 3-mal so häufig teil wie Befragte mit Wohnortwechsel.

Schlussfolgerung Die Kenntnis von Merkmalen der Studienteilnehmer, die die Teilnahmebereitschaft vorhersagen, ermöglicht durch gezielte Ansprache den Verlust von Studienteilnehmern zu reduzieren bzw. die statistische Korrektur von fehlenden Daten.

Clinical relevance of colonization with antimicrobial-resistant bacteria (AMRB) and methicillin susceptible Staphylococcus aureus (MSSA) for mothers during pregnancy

PURPOSE

The impact of colonization with antimicrobial-resistant bacteria (AMRB) and methicillin-sensitive Staphylococcus aureus (MSSA) of healthy pregnant women is not described in detail in Germany. In this study, we screened for MSSA and AMRB, especially for methicillin-resistant S. aureus (MRSA) as well as extended-spectrum beta-lactamase (ESBL)-producing E. coli. Potential risk factors for colonization with AMRB/MSSA and the potential effects of colonization with these on the obstetric population were investigated.

METHODS

From October 2013 until December 2015 pregnant women were screened before birth for colonization with AMRB/MSSA from the mammillae, nose, perianal and vaginal area. Before birth, the expectant mother was administered a standardized interview questionnaire by a trained interviewer. Data from the hospital admission records were also included.

RESULTS

Samples from 651 pregnant women were analyzed. Colonization with MSSA was detected in 14.3% (n = 93), AMRB in 3.5% [(n = 23); MRSA: n = 3/ESBL: n = 20]. Significantly more colonization of AMRB/MSSA could be detected in women who had previously given birth compared to women who were nulliparous (p < 0.05). MSSA colonization was significantly associated with self-reported respiratory diseases during pregnancy (p < 0.05), but AMRB/MSSA colonization was not statistically associated with other types of infection.

CONCLUSION

Our results demonstrate a low overall rate of colonization with AMRB/MSSA, as well as a low percentage of colonized pregnant women who developed infections. Multiparous women are at higher risk for colonization with MSSA/MRSA or ESBL. Because the prevalence of AMRB/MSSA is low, this study suggests that general screening of pregnant women without risk factors is not recommended.

Audiometric notch and extended high-frequency hearing threshold shift in relation to total leisure noise exposure: An exploratory analysis

BACKGROUND

Studies investigating leisure noise effect on extended high frequency hearing are insufficient and they have inconsistent results. The aim of this study was to investigate if extended high-frequency hearing threshold shift is related to audiometric notch, and if total leisure noise exposure is associated with extended high-frequency hearing threshold shift.

MATERIALS AND METHODS

A questionnaire of the Ohrkan cohort study was used to collect information on demographics and leisure time activities. Conventional and extended high-frequency audiometry was performed. We did logistic regression between extended high-frequency hearing threshold shift and audiometric notch as well as between total leisure noise exposure and extended high-frequency hearing threshold shift. Potential confounders (sex, school type, and firecrackers) were included.

RESULTS

Data from 278 participants (aged 18-23 years, 53.2% female) were analyzed. Associations between hearing threshold shift at 10, 11.2, 12.5, and 14 kHz with audiometric notch were observed with a higher prevalence of threshold shift at the four frequencies, compared to the notch. However, we found no associations between total leisure noise exposure and hearing threshold shift at any extended high frequency.

CONCLUSION

This exploratory analysis suggests that while extended high-frequency hearing threshold shifts are not related to total leisure noise exposure, they are strongly associated with audiometric notch. This leads us to further explore the hypothesis that extended high-frequency threshold shift might be indicative of the appearance of audiometric notch at a later time point, which can be investigated in the future follow-ups of the Ohrkan cohort.

Residential crowding and asthma in preschool children, a cross-sectional study

BACKGROUND

Asthma is the most common chronic disease in children, and associations with crowding have been reported. The aim of this study was to explore possible associations of crowding with asthma in children.

METHODS

Seven cross-sectional surveys with preschool children were conducted within the framework of the health monitoring units in Bavaria, Germany, from 2004 to 2014. Residential crowding was defined as habitation of more than one person per room or less than 20m² living space per person. Logistic regression models examined temporal changes in crowding, applying the first survey as reference. The relationship between crowding and physician-diagnosed asthma, asthma defined by the International Study of Asthma and Allergies in Childhood (ISAAC) and asthma symptoms were analyzed.

RESULTS

Analyzing temporal changes of crowding rates did not reveal any differences over the years. However, the stratified descriptive analysis indicated a crowding increase in time in urban households where parents had a low education level (47.9% in 2004/05, 55.8% in 2014/15). No association was found between crowding and the variables "physician-diagnosed asthma" in 2014/15, "asthma defined by ISAAC" in 2014/15, or "wheezing" in 2014/15. A positive association with cough was identified in 2014/15 after adjusting for confounders (aOR=1.42 [95% CI: 1.20-1.69]).

CONCLUSIONS

In general, residential crowding did not change from 2004 to 2014; however, there seems to be a small upsurge for children with low-educated parents, living in urban areas over the years. A statistically significant association between crowding and cough was only found in the survey from 2014/15.

The effect of biochar amendments on phenanthrene sorption, desorption and mineralisation in different soils

The contamination of soils and waters with organic pollutants, such as polycyclic aromatic hydrocarbons (PAHs), affect a large number of sites worldwide that need remediation. In this context soils amendments can be used to immobilise PAHs while maintaining soil functioning, with biochar being a promising amendment. In this experiment, phenantrene (Phe) was used as a frequent PAH contaminating soils and we studied the effect of three biochars at 1% applications to three different substrates, two agricultural topsoils and pure sand. We evaluated the changes in soil properties, sorption-desorption of Phe, and mineralisation of Phe in all treatments. Phe in pure sand was effectively sorbed to olive pruning (OBC) and rice husk (RBC) biochars, but pine biochar (PBC) was not as effective. In the soils, OBC and RBC only increased sorption of Phe in the silty soil. Desorption was affected by biochar application, RBC and OBC decreased water soluble Phe independently of the soil, which may be useful in preventing leaching of Phe into natural waters. Contrastingly, OBC and RBC slightly decreased the mineralisation of Phe in the soils, thus indicating lower bioavailability of the contaminant. Overall, biochar effects in the two tested soils were low, most likely due to the rather high soil organic C (SOC) contents of 2.2 and 2.8% with Koc values in the same range as those of the biochars. However, OBC and RBC additions can substantially increase adsorption of Phe in soils poor in SOC.