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Hartlapp I, Valta-Seufzer D, Siveke JT, Algül H, Goekkurt E, Siegler G, Martens UM, Waldschmidt D, Pelzer U, Fuchs M, Kullmann F, Boeck S, Ettrich TJ, Held S, Keller R, Anger F, Germer CT, Stang A, Kimmel B, Heinemann V, Kunzmann V. Corrigendum to "Prognostic and predictive value of CA 19-9 in locally advanced pancreatic cancer treated with multiagent induction chemotherapy: results from a prospective, multicenter phase II trial (NEOLAP-AIO-PAK-0113)": [ESMO Open 7 (2024) 100552]. ESMO Open 2024; 9:103463. [PMID: 38703429 DOI: 10.1016/j.esmoop.2024.103463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2024] Open
Affiliation(s)
- I Hartlapp
- Department of Internal Medicine II, Medical Oncology and Comprehensive Cancer Center Mainfranken, University Hospital Würzburg, Würzburg
| | - D Valta-Seufzer
- Department of Internal Medicine II, Medical Oncology and Comprehensive Cancer Center Mainfranken, University Hospital Würzburg, Würzburg
| | - J T Siveke
- Department of Medical Oncology, Bridge Institute of Experimental Tumor Therapy, University Medicine Essen, Essen; Division of Solid Tumor Translational Oncology (DKTK Partner Site Essen, DKFZ Heidelberg), West German Cancer Center, University Medicine Essen, Essen
| | - H Algül
- Comprehensive Cancer Center München, Klinikum rechts der Isar, Technical University of Munich, School of Medicine and Health, Munich, Bavaria, Germany
| | - E Goekkurt
- Hämatologisch-Onkologische Praxis Eppendorf (HOPE), Hamburg and University Cancer Center Hamburg (UCCH), Hamburg, Germany
| | - G Siegler
- Department of Internal Medicine 5, Hematology and Medical Oncology, Paracelsus Medical University, Nürnberg
| | - U M Martens
- Department of Internal Medicine III, SLK-Clinics Heilbronn GmbH, Heilbronn
| | - D Waldschmidt
- Department of Gastroenterology and Hepatology, University Hospital Cologne, Cologne
| | - U Pelzer
- Division of Oncology and Hematology, Charité Campus Mitte, Charité - Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin
| | - M Fuchs
- Clinic for Gastroenterology, Hepatology and GI-Oncology, München Klinik Bogenhausen, Munich
| | - F Kullmann
- Department of Internal Medicine I, Kliniken Nordoberpfalz AG, Klinikum Weiden, Weiden
| | - S Boeck
- Department of Medical Oncology and Comprehensive Cancer Center, Ludwig Maximilians University-Grosshadern, Munich
| | - T J Ettrich
- Department of Internal Medicine I, Ulm University Hospital, Ulm
| | - S Held
- Department of Biometrics, ClinAssess GmbH, Leverkusen
| | - R Keller
- Clinical Research, AIO Studien gGmbH, Berlin
| | - F Anger
- Department of General, Visceral, Transplantation, Vascular and Pediatric Surgery and Comprehensive Cancer Center Mainfranken Würzburg, University Hospital Würzburg, Würzburg
| | - C T Germer
- Department of General, Visceral, Transplantation, Vascular and Pediatric Surgery and Comprehensive Cancer Center Mainfranken Würzburg, University Hospital Würzburg, Würzburg
| | - A Stang
- Department of Haematology, Oncology and Palliative Care Medicine, Asklepios Hospital Barmbek, Hamburg, Germany
| | - B Kimmel
- Department of Internal Medicine II, Medical Oncology and Comprehensive Cancer Center Mainfranken, University Hospital Würzburg, Würzburg
| | - V Heinemann
- Department of Medical Oncology and Comprehensive Cancer Center, Ludwig Maximilians University-Grosshadern, Munich
| | - V Kunzmann
- Department of Internal Medicine II, Medical Oncology and Comprehensive Cancer Center Mainfranken, University Hospital Würzburg, Würzburg.
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Schramm S, Wilk L, Kowall B, Jöckel KH, Stang A, Schmidt B. Willingness to participate in a COVID-19 follow-up study and symptoms 1.5 years after infection. Eur J Public Health 2022. [DOI: 10.1093/eurpub/ckac131.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
Data on willingness to participate in population-based long-COVID studies are sparse. We invited all citizens of Essen aged 18-74 years with a positive SARS-CoV-2 PCR test between Mar-Aug 2020 and assessed COVID-related symptoms in responders ∼1.5 years after infection.
Methods
The invited population included 1282 infected citizens (48% women). At the time of testing 64% reported symptoms. We asked responders about past and current symptoms, hospitalization, smoking, sport, pre-existing conditions (heart attack, stroke, diabetes), subjective health status as compared to before infection, assessed BMI, and performed descriptive statistics.
Results
We investigated 255 participants (50% women, 19-73 years, response rate 20%) ∼20 month (median) after the PCR test. 95% reported symptoms at the time of testing: 67% fatigue, 58% taste disorders, 56% limb pain, 55% odor disorders, 54% headache, 50% cough, 43% fever; 10% needed hospitalization, 3% intensive care, 1.6% artificial ventilation. Compared to the non-hospitalized the formerly inpatients were more often male (62% vs 49%), older (56±13 vs 49±14 years), less often never smokers (42% vs 53%), had a higher BMI (31±7 vs 28±5 kg/m2), and more pre-existing conditions (23% vs 10%). Compared to before infection, 53% rated their current health worse, with a higher rate among inpatients (81%). After ∼1.5 years, 55% still reported symptoms: 25% fatigue, 20% concentration disorder, 18% breathing problems, 13% odor and 11% taste disorders. Persistent symptoms were more common in inpatients than in non-hospitalized (69% vs 53%).
Conclusions
Symptomatic individuals are more likely to participate in a COVID19 follow-up study than asymptomatic ones. This may overestimate the number of individuals with long-term symptoms in population-based long-COVID study populations. However, persistent symptoms seem to be more likely in formerly inpatients compared to non-hospitalized individuals with former SARS-CoV-2 infection.
Key messages
• Symptomatic individuals are more likely to participate in a COVID19 follow-up study than asymptomatic ones.
• Persistent symptoms seem to be more likely in formerly inpatients compared to non-hospitalized individuals with former SARS-CoV-2 infection.
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Affiliation(s)
- S Schramm
- IMIBE, University Hospital Essen , Essen, Germany
| | - L Wilk
- IMIBE, University Hospital Essen , Essen, Germany
| | - B Kowall
- IMIBE, University Hospital Essen , Essen, Germany
| | - KH Jöckel
- IMIBE, University Hospital Essen , Essen, Germany
| | - A Stang
- IMIBE, University Hospital Essen , Essen, Germany
| | - B Schmidt
- IMIBE, University Hospital Essen , Essen, Germany
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Hageman SHJ, Lu W, Kaptoge S, Lall K, Bobak M, Pikhart H, Kubinova R, Pajak A, Tamosiunas A, Stang A, Schmidt B, Schramm S, Di Angelantonio E, Visseren FLJ, Dorresteijn JAN. Prediction of lifetime cardiovascular risk and individual lifetime treatment benefit in four European risk regions: geographic recalibration of the LIFE-CVD model. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
The life expectancy free of cardiovascular disease (CVD) in individuals without previous CVD can be estimated with the LIFEtime-perspective CardioVascular Disease (LIFE-CVD) model, as recommended by the 2021 ESC CVD prevention guidelines. Our aim was to systematically recalibrate the LIFE-CVD model to four European risk regions using contemporary and representative registry data.
Methods and results
The LIFE-CVD model was systematically recalibrated to four distinct risk regions within Europe, using representative aggregate data on age- and sex-specific expected CVD and non-CVD mortality incidences and risk factor distributions. For external validation, 1,451,077 individuals without previous CVD were included from seven European cohorts, with 53,721 CVD events and 62,902 non-CVD deaths during follow up. After applying the recalibrated risk prediction models to external validation cohorts, C-indices (figure 1) ranged from 0.670 (95% CI 0.650–0.690) to 0.787 (95% CI 0.785–0.789). Predicted risks matched the observed risks in the CPRD data. With the recalibrated LIFE-CVD model, the estimated gain in CVD-free life expectancy from preventive therapy differed per region, for example a 50-year-old smoking women with a systolic blood pressure of 140mm Hg was estimated to gain 0.4 years of CVD-free life from 10 mm Hg SBP reduction in the low risk region, whereas this would be 1.5 years in the very high risk region (figure 2).
Interpretation
By taking into account geographical differences in CVD incidence, the recalibrated LIFE-CVD model provides a more accurate tool for the prediction of lifetime risk and CVD-free life expectancy for individuals without previous CVD, facilitating shared decision-making in cardiovascular prevention options as recommended by the 2021 European Prevention Guidelines.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- S H J Hageman
- University Medical Center Utrecht, Department of vascular medicine , Utrecht , The Netherlands
| | - W Lu
- University College London, Department of Epidemiology and Public Health , London , United Kingdom
| | - S Kaptoge
- University of Cambridge, Department of Public Health and Primary Care , Cambridge , United Kingdom
| | - K Lall
- University of Tartu, Estonian Genome Centre , Tartu , Estonia
| | - M Bobak
- University College London, Department of Epidemiology and Public Health , London , United Kingdom
| | - H Pikhart
- University College London, Department of Epidemiology and Public Health , London , United Kingdom
| | - R Kubinova
- National Institute of Public Health , Prague , Czechia
| | - A Pajak
- Institute of Public Health, Department of Epidemiology and Population Studies , Krakow , Poland
| | - A Tamosiunas
- Lithuanian University of Health Sciences, Institute of Cardiology , Kaunas , Lithuania
| | - A Stang
- Institute for Medical Informatics, Biometry and Epidemiology , Essen , Germany
| | - B Schmidt
- Institute for Medical Informatics, Biometry and Epidemiology , Essen , Germany
| | - S Schramm
- Institute for Medical Informatics, Biometry and Epidemiology , Essen , Germany
| | - E Di Angelantonio
- University of Cambridge, Department of Public Health and Primary Care , Cambridge , United Kingdom
| | - F L J Visseren
- University Medical Center Utrecht, Department of vascular medicine , Utrecht , The Netherlands
| | - J A N Dorresteijn
- University Medical Center Utrecht, Department of vascular medicine , Utrecht , The Netherlands
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4
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Hartlapp I, Valta-Seufzer D, Siveke JT, Algül H, Goekkurt E, Siegler G, Martens UM, Waldschmidt D, Pelzer U, Fuchs M, Kullmann F, Boeck S, Ettrich TJ, Held S, Keller R, Anger F, Germer CT, Stang A, Kimmel B, Heinemann V, Kunzmann V. Prognostic and predictive value of CA 19-9 in locally advanced pancreatic cancer treated with multiagent induction chemotherapy: results from a prospective, multicenter phase II trial (NEOLAP-AIO-PAK-0113). ESMO Open 2022; 7:100552. [PMID: 35970013 PMCID: PMC9434418 DOI: 10.1016/j.esmoop.2022.100552] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 06/30/2022] [Accepted: 07/03/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND The prognostic and predictive value of carbohydrate antigen 19-9 (CA 19-9) in locally advanced pancreatic cancer (LAPC) has not yet been defined from prospective randomized controlled trials (RCTs). PATIENTS AND METHODS A total of 165 LAPC patients were treated within the NEOLAP RCT for 16 weeks with multiagent induction chemotherapy [ICT; either nab-paclitaxel/gemcitabine alone or nab-paclitaxel/gemcitabine followed by FOLFIRINOX (combination of fluorouracil, leucovorin, irinotecan, and oxaliplatin)] followed by surgical exploration of all patients without evidence of disease progression. CA 19-9 was determined at baseline and after ICT and correlated with overall survival (OS) and secondary R0 resection rate. RESULTS From the NEOLAP study population (N = 165) 133 patients (81%) were evaluable for CA 19-9 at baseline and 81/88 patients (92%) for post-ICT CA 19-9 response. Median OS (mOS) in the CA 19-9 cohort (n = 133) was 16.2 months [95% confidence interval (CI) 13.0-19.4] and R0 resection (n = 31; 23%) was associated with a significant survival benefit [40.8 months (95% CI 21.7-59.8)], while R1 resected patients (n = 14; 11%) had no survival benefit [14.0 (95% CI 11.7-16.3) months, hazard ratio (HR) 0.27; P = 0.001]. After ICT most patients showed a CA 19-9 response (median change from baseline: -82%; relative decrease ≥55%: 83%; absolute decrease to ≤50 U/ml: 43%). Robust CA 19-9 response (decrease to ≤50U/ml) was significantly associated with mOS [27.8 (95% CI 18.4-37.2) versus 16.5 (95% CI 11.7-21.2) months, HR 0.49; P = 0.013], whereas CA 19-9 baseline levels were not prognostic for OS. Multivariate analysis demonstrated that a robust CA 19-9 response was an independent predictive factor for R0 resection. Using a CA 19-9 decrease to ≤61 U/ml as optimal cut-off (by receiver operating characteristic analysis) yielded 72% sensitivity and 62% specificity for successful R0 resection, whereas CA 19-9 nonresponders (<20% decrease or increase) had no chance for successful R0 resection. CONCLUSIONS CA 19-9 response after multiagent ICT provides relevant prognostic and predictive information and is useful in selecting LAPC patients for explorative surgery. CLINICAL TRIAL NUMBER ClinicalTrials.govNCT02125136; https://clinicaltrials.gov/ct2/show/NCT02125136; EudraCT 2013-004796-12; https://www.clinicaltrialsregister.eu/ctr-search/trial/2013-004796-12/results.
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Affiliation(s)
- I Hartlapp
- Department of Internal Medicine II, Medical Oncology and Comprehensive Cancer Center Mainfranken, University Hospital Würzburg, Würzburg, Germany
| | - D Valta-Seufzer
- Department of Internal Medicine II, Medical Oncology and Comprehensive Cancer Center Mainfranken, University Hospital Würzburg, Würzburg, Germany
| | - J T Siveke
- Department of Medical Oncology, Bridge Institute of Experimental Tumor Therapy, University Medicine Essen, Essen, Germany; Division of Solid Tumor Translational Oncology (DKTK Partner Site Essen, DKFZ Heidelberg), West German Cancer Center, University Medicine Essen, Essen, Germany
| | - H Algül
- Comprehensive Cancer Center Munich (CCCM(TUM)) at the Klinikum rechts der Isar, Department of Internal Medicine II, Technical University Munich, Munich, Germany
| | - E Goekkurt
- Hämatologisch-Onkologische Praxis Eppendorf (HOPE), Hamburg and University Cancer Center Hamburg (UCCH), Hamburg, Germany
| | - G Siegler
- Department of Internal Medicine 5, Hematology and Medical Oncology, Paracelsus Medical University, Nürnberg, Germany
| | - U M Martens
- Department of Internal Medicine III, SLK-Clinics Heilbronn GmbH, Heilbronn, Germany
| | - D Waldschmidt
- Department of Gastroenterology and Hepatology, University Hospital Cologne, Cologne, Germany
| | - U Pelzer
- Division of Oncology and Hematology, Charité Campus Mitte, Charité - Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
| | - M Fuchs
- Clinic for Gastroenterology, Hepatology and GI-Oncology, München Klinik Bogenhausen, Munich, Germany
| | - F Kullmann
- Department of Internal Medicine I, Kliniken Nordoberpfalz AG, Klinikum Weiden, Weiden, Germany
| | - S Boeck
- Department of Medical Oncology and Comprehensive Cancer Center, Ludwig Maximilians University-Grosshadern, Munich, Germany
| | - T J Ettrich
- Department of Internal Medicine I, Ulm University Hospital, Ulm, Germany
| | - S Held
- Department of Biometrics, ClinAssess GmbH, Leverkusen, Germany
| | - R Keller
- Clinical Research, AIO Studien gGmbH, Berlin, Germany
| | - F Anger
- Department of General, Visceral, Transplantation, Vascular and Pediatric Surgery and Comprehensive Cancer Center Mainfranken Würzburg, University Hospital Würzburg, Würzburg, Germany
| | - C T Germer
- Department of General, Visceral, Transplantation, Vascular and Pediatric Surgery and Comprehensive Cancer Center Mainfranken Würzburg, University Hospital Würzburg, Würzburg, Germany
| | - A Stang
- Department of Haematology, Oncology and Palliative Care Medicine, Asklepios Hospital Barmbek, Hamburg, Germany
| | - B Kimmel
- Department of Internal Medicine II, Medical Oncology and Comprehensive Cancer Center Mainfranken, University Hospital Würzburg, Würzburg, Germany
| | - V Heinemann
- Department of Medical Oncology and Comprehensive Cancer Center, Ludwig Maximilians University-Grosshadern, Munich, Germany
| | - V Kunzmann
- Department of Internal Medicine II, Medical Oncology and Comprehensive Cancer Center Mainfranken, University Hospital Würzburg, Würzburg, Germany.
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5
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Kowall B, Nonnemacher M, Brune B, Brinkmann M, Dudda M, Böttcher J, Schmidt B, Standl F, Stolpe S, Dittmer U, Jöckel KH, Stang A. A model to identify individuals with a high probability of a SARS-CoV-2 infection. J Infect 2020; 82:e32-e34. [PMID: 33245942 PMCID: PMC7686708 DOI: 10.1016/j.jinf.2020.11.028] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 11/21/2020] [Indexed: 01/22/2023]
Affiliation(s)
- B Kowall
- Institute of Medical Informatics, Biometry and Epidemiology, University Hospital Essen, Hufelandstraße 55, 45147 Essen, Germany.
| | - M Nonnemacher
- Institute of Medical Informatics, Biometry and Epidemiology, University Hospital Essen, Hufelandstraße 55, 45147 Essen, Germany
| | - B Brune
- Medical Emergency Service of the City of Essen, Germany; Department for Trauma, Hand and Reconstructive Surgery, University Hospital of Essen, Germany
| | - M Brinkmann
- Center for Clinical Trials, University Hospital Essen, Germany
| | - M Dudda
- Medical Emergency Service of the City of Essen, Germany; Department for Trauma, Hand and Reconstructive Surgery, University Hospital of Essen, Germany
| | - J Böttcher
- Public Health Office of the City of Essen, Germany
| | - B Schmidt
- Institute of Medical Informatics, Biometry and Epidemiology, University Hospital Essen, Hufelandstraße 55, 45147 Essen, Germany
| | - F Standl
- Institute of Medical Informatics, Biometry and Epidemiology, University Hospital Essen, Hufelandstraße 55, 45147 Essen, Germany
| | - S Stolpe
- Institute of Medical Informatics, Biometry and Epidemiology, University Hospital Essen, Hufelandstraße 55, 45147 Essen, Germany
| | - U Dittmer
- Institute for Virology, University Hospital Essen, Germany
| | - K H Jöckel
- Institute of Medical Informatics, Biometry and Epidemiology, University Hospital Essen, Hufelandstraße 55, 45147 Essen, Germany
| | - A Stang
- Institute of Medical Informatics, Biometry and Epidemiology, University Hospital Essen, Hufelandstraße 55, 45147 Essen, Germany; School of Public Health, Department of Epidemiology, Boston University, Boston, United States
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6
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Stang A, Khil L, Kajüter H, Pandeya N, Schmults CD, Ruiz ES, Karia PS, Green AC. Incidence and mortality for cutaneous squamous cell carcinoma: comparison across three continents. J Eur Acad Dermatol Venereol 2020; 33 Suppl 8:6-10. [PMID: 31833607 DOI: 10.1111/jdv.15967] [Citation(s) in RCA: 64] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Accepted: 09/02/2019] [Indexed: 01/31/2023]
Abstract
BACKGROUND Population-based incidence and mortality studies of cutaneous squamous cell carcinoma (SCC) have been few owing to the commonness of the disease, and rare deaths making accurate mortality statistics difficult. OBJECTIVES Our aim was to summarize SCC incidence and mortality in populations across three continents, exemplified by Australia, the United States (US) and Germany. METHODS We estimated age-specific and age-standardized (Australian Standard 2001 Population) incidence and mortality rates per 100 000 person-years. RESULTS Squamous cell carcinoma incidence is plateauing or falling in Australia, stable in the United States (2013-2015) and rising in Germany (2007-2015). Current incidence estimates in men and women are 341 and 209, 497 and 296, and 54 and 26, respectively, for the three countries. Incidence increases strongly with age in all countries. Mortality of non-melanoma skin cancer appears to be increasing in Germany and stable in Australia (unavailable for the US population). CONCLUSIONS Squamous cell carcinoma is an important health issue, particularly among older men, with incidence exceeding most other cancers. More precise and uniform population-based studies of incidence and mortality are needed to better quantify the impact of SCC on healthcare systems worldwide and to gauge the effect of new treatments such as anti-PD1 therapy on mortality.
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Affiliation(s)
- A Stang
- Center of Clinical Epidemiology, Institute of Medical Informatics, Biometry and Epidemiology, University Hospital Essen, Essen, Germany.,Department of Epidemiology, School of Public Health, Boston University, Boston, MA, USA
| | - L Khil
- Cancer Registry of North Rhine-Westphalia, Bochum, Germany
| | - H Kajüter
- Cancer Registry of North Rhine-Westphalia, Bochum, Germany
| | - N Pandeya
- QIMR Berghofer Medical Research Institute, Herston, QLD, Australia
| | - C D Schmults
- Population Health Department, Mohs and Dermatologic Surgery Center, Brigham and Women's Faulkner Hospital, Boston, MA, USA
| | - E S Ruiz
- Population Health Department, Mohs and Dermatologic Surgery Center, Brigham and Women's Faulkner Hospital, Boston, MA, USA
| | - P S Karia
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - A C Green
- QIMR Berghofer Medical Research Institute, Herston, QLD, Australia.,CRUK Manchester Institute and Faculty of Biology, Medicine and Health, Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK
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7
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Kowall B, Lehmann N, Mahabadi AA, Moebus S, Erbel R, Jöckel KH, Stang A. Associations of metabolically healthy obesity with prevalence and progression of coronary artery calcification: Results from the Heinz Nixdorf Recall Cohort Study. Nutr Metab Cardiovasc Dis 2019; 29:228-235. [PMID: 30648599 DOI: 10.1016/j.numecd.2018.11.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Revised: 11/02/2018] [Accepted: 11/07/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND AND AIMS There is controversy on the potentially benign nature of metabolically healthy obesity (MHO), i.e., obese persons with few or no metabolic abnormalities. So far, associations between MHO and coronary artery calcification (CAC), a measure of subclinical atherosclerosis, have mainly been studied cross-sectionally in Asian populations. We assessed cross-sectional and longitudinal MHO CAC associations in a Caucasian population. METHODS AND RESULTS In the Heinz Nixdorf Recall Study, a population-based cohort study in Germany, CAC was assessed by electron-beam tomography at baseline and at 5-year follow-up. For cross-sectional and longitudinal analyses, we included 1585 participants free of coronary heart disease at baseline, with CAC measurements at baseline and at follow-up, and with either normal weight (BMI 18.5-24.9 kg/m2) or obesity (BMI ≥30.0 kg/m2) at baseline. We used four definitions of MHO. In our main analysis, we defined obese persons as metabolically healthy if they met ≤1 of the NCEP ATP III criteria for the definition of the metabolic syndrome - waist circumference was not taken into account because of collinearity with BMI. Persons with MHO had a higher prevalence of CAC than metabolically healthy normal weight (MHNW) persons (prevalence ratio = 1.59 (95% confidence interval 1.38-1.84) for the main analysis). Persons with MHO had slightly larger odds of CAC progression than persons with MHNW (odds ratios ranged from 1.17 (0.69-1.99) to 1.48 (1.02-2.13) depending on MHO definition and statistical approach). CONCLUSION Our analyses on MHO CAC associations add to the evidence that MHO is not a purely benign health condition.
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Affiliation(s)
- B Kowall
- Center of Clinical Epidemiology, Institute of Medical Informatics, Biometry and Epidemiology, Medical Faculty, University Duisburg-Essen, Essen, Germany.
| | - N Lehmann
- Institute for Medical Informatics, Biometry and Epidemiology, University Clinic Essen, University Duisburg-Essen, Essen, Germany
| | - A A Mahabadi
- West-German Heart and Vascular Center Essen, Department of Cardiology, University Clinic Essen, Essen, Germany
| | - S Moebus
- Center for Urban Epidemiology, Institute for Medical Informatics, Biometry and Epidemiology, University Clinic Essen, Essen, Germany
| | - R Erbel
- Institute for Medical Informatics, Biometry and Epidemiology, University Clinic Essen, University Duisburg-Essen, Essen, Germany
| | - K H Jöckel
- Institute for Medical Informatics, Biometry and Epidemiology, University Clinic Essen, University Duisburg-Essen, Essen, Germany
| | - A Stang
- Center of Clinical Epidemiology, Institute of Medical Informatics, Biometry and Epidemiology, Medical Faculty, University Duisburg-Essen, Essen, Germany; School of Public Health, Department of Epidemiology, Boston University, 715 Albany, Street, Talbot Building, Boston, MA 02118, USA
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8
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Stang A, Rusner C, Trabert B, Oosterhuis JW, McGlynn KA, Heidinger O. Incidence of testicular tumor subtypes according to the updated WHO classification, North Rhine-Westphalia, Germany, 2008-2013. Andrology 2018; 7:402-407. [PMID: 30578617 DOI: 10.1111/andr.12565] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 10/18/2018] [Accepted: 10/25/2018] [Indexed: 11/27/2022]
Abstract
BACKGROUND In 2016, the WHO introduced an updated classification for testicular tumors. The application of this updated classification to cancer registry data requires some recoding of tumors. OBJECTIVES The aim of this study was to provide up-to-date population-based incidence estimates of subtypes of testicular germ cell tumors (TGCT) according to the updated classification. MATERIAL AND METHODS We reviewed 2251 pathology reports (42.9%) out of 5252 testicular tumors at the cancer registry of North Rhine-Westphalia for the years 2008-2013. We used population counts to estimate age-standardized incidence rates per million person-years (EUROSTAT revised European Standard Population). RESULTS The application of the updated WHO classification resulted in a recoding of 8.9% of all testicular tumors. While the recodings have no influence on the incidence of seminomatous and non-seminomatous TGCTs that include mixed TGCTs, they influence the incidence of individual histological types of seminomatous and non-seminomatous TGCTs. Among the 4935 testicular germ cell tumors (TGCT), 23.7% were mixed TGCTs. Overall, 46.9% of all mixed TGCTs included seminoma and age-standardized incidence rates were highest for the combination seminoma plus embryonal carcinoma (5.9 per million person-years) and embryonal carcinoma plus teratoma (4.9 per million person-years). The median age at diagnosis was higher for mixed TGCTs including seminoma (31 years) than those that did not include seminoma (28 years). DISCUSSION AND CONCLUSIONS Population-based incidence time trends for seminomatous and non-seminomatous TGCTs that include mixed TGCTs are not distorted by the introduction of the WHO update. Trend distortions can only be expected if time trends of individual histological subtypes of the seminomatous and non-seminomatous TGCTs are examined.
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Affiliation(s)
- A Stang
- Zentrum für Klinische Epidemiologie, Institut für Medizinische Informatik, Biometrie und Epidemiologie, Universitätsklinikum Essen, Essen, Germany.,Department of Epidemiology, School of Public Health, Boston University, Boston, MA, USA
| | - C Rusner
- Zentrum für Klinische Epidemiologie, Institut für Medizinische Informatik, Biometrie und Epidemiologie, Universitätsklinikum Essen, Essen, Germany
| | - B Trabert
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, MD, USA
| | - J W Oosterhuis
- Department of Pathology, Josephine Nefkens Institute, Erasmus MC, Rotterdam, The Netherlands
| | - K A McGlynn
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, MD, USA
| | - O Heidinger
- Cancer Registry of North Rhine-Westphalia, Muenster, Germany
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Stolpe S, Bock E, Scholz C, Stang A, Blume C. Unknown insufficiency of renal function – an almost unnoticed public health issue. Eur J Public Health 2018. [DOI: 10.1093/eurpub/cky218.154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- S Stolpe
- University Hospital Essen, Essen, Germany
| | - E Bock
- University Hospital Essen, Essen, Germany
| | - C Scholz
- University Hospital Cologne, Cologne, Germany
| | - A Stang
- University Hospital Essen, Essen, Germany
| | - C Blume
- Leibniz-University Hannover, Hannover, Germany
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Engel M, Pundt N, Stang A, Erbel R, Moebus S. Intra-individual fluctuation patterns of depressive symptoms assessed over 12 years. Das Gesundheitswesen 2018. [DOI: 10.1055/s-0038-1667809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- M Engel
- Institut für Medizinische Informatik, Biometrie und Epidemiologie, Essen, Deutschland
| | - N Pundt
- Institut für Medizinische Informatik, Biometrie und Epidemiologie, Essen, Deutschland
| | - A Stang
- Institut für Medizinische Informatik, Biometrie und Epidemiologie, Essen, Deutschland
- Zentrum für Klinische Epidemiologie, Essen, Deutschland
| | - R Erbel
- Institut für Medizinische Informatik, Biometrie und Epidemiologie, Essen, Deutschland
| | - S Moebus
- Institut für Medizinische Informatik, Biometrie und Epidemiologie, Essen, Deutschland
- Zentrum für Urbane Epidemiologie, Essen, Deutschland
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Pannier-Fischer F, Bromen K, Schuldt K, Stang A, Poncar C, Wittenhorst M, Bock E, Weber S, Jöckel KH, Rabe E. Bonner Venenstudie der Deutschen Gesellschaft für Phlebologie. Phlebologie 2018. [DOI: 10.1055/s-0037-1617353] [Citation(s) in RCA: 124] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
ZusammenfassungZiel: Die Bonner Venenstudie zur Frage der Häufigkeit und Ausprägung von chronischen Venenkrankheiten in der städtischen und ländlichen deutschen Wohnbevölkerung im Alter von 18-79 Jahren fand zwischen dem 13. 11. 2000 und 15. 3. 2002 statt. Es nahmen insgesamt 3072 Probanden teil, die Response-Proportion lag insgesamt bei 59%. Ergebnisse: Eine Beinschwellung in der Anamnese trat bei jedem 6. Mann (16,2%) und bei nahezu jeder 2. Frau (42,1%) auf. Eine kurz zurückliegende ein- oder beidseitige Beinschwellung in den letzten vier Wochen gab jeder 6. Teilnehmer an. Dies entspricht 14,8% (7,9% der Männer, 20,2% der Frauen). Für Gefäßerkrankungen typische Beinbeschwerden innerhalb der letzten vier Wochen gab insgesamt jeder 2. der Probanden (56,4%) an. Bei der Beurteilung der klinischen Ausprägung gemäß der CEAP-Klassifikation fällt auf, dass lediglich 9,6% der Probanden keinerlei Venenveränderungen aufweisen. Bei 59% bestehen isoliert Teleangiektasien oder retikuläre Venen, bei 14,3% Krampfadern (C2) ohne weitere Zeichen einer chronischen venösen Insuffizienz. Auffällig ist, dass bei 13,4% ein prätibiales Ödem im Rahmen von Venenveränderungen zum Untersuchungszeitpunkt vorlag. Demgegenüber liegt die Zahl der fortgeschrittenen Zeichen der chronischen venösen Insuffizienz bei 3,3%. Die Häufigkeit des floriden oder abgeheilten Ulcus cruris lag bei 0,7%. Schlussfolgerungen: Jeder 6. Mann und jede 5. Frau hat somit chronische Veneninsuffizienz (C3–C6). Die Zahlen zeigen, dass Venenkrankheiten insgesamt nach wie vor eine hohe Prävalenz aufweisen, dass aber die schweren Ausprägungen der chronischen venösen Insuffizienz in den vergangenen 20 Jahren zurückgegangen sind.
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Abstract
SummaryLymphoedema is a disease frequently diagnosed in vascular departments, its origin being primary or secondary after cellulitis or cancer treatment. The prevalence of lower extremity lymphoedema in the general population is largely unknown. The aim of this article is to describe the prevalence of Stemmer's sign as a diagnostic criterium for lymphoedema in an unselected adult German population. Methods: The population for this cross-sectional study was recruited from November 2000 through March 2002 from the general population of the city of Bonn and two surrounding rural communities. 3072 individuals (1145 rural and 1927 urban) could be enrolled in the study. The results of the clinical examination were categorized in four groups: grade 0 normal skin fold at the dorsum of the second toe, grade 1 skin fold enlarged measuring 0.5–1 cm, grade 2 the skin fold >1 cm and grade 3 >1 cm with severe induration or papillomatosis. Results: Among 3055 out of 3072 subjects information on all variables were available. In 15.9% of the population a positive Stemmer sign was found with a slightly higher overall prevalence in women. Most of this group presented as grade 1 Stemmer's sign (14.1%). The more severe grades 2 and 3 were present in 1.8 % of the study population with no clear difference between sexes. We observed a considerably higher prevalence of Stemmer's sign of all grades in the urban population. The prevalence of Stemmer's sign increased with age from 3.2% up to 35.9% in the 70–79 year old population. Prevalence of positive Stemmer's sign was also higher in higher C-stages of the CEAP classification (5.8% in C0 to 100% in C6). Conclusions: The prevalence of lymphoedema in the general population represented by grade 2–3 Stemmer's sign in 1.8% and grade 1 Stemmer's sign in 14% is high. Women have a slightly higher prevalence of positive Stemmer's sign than men. The prevalence of positive Stemmer's sign is associated with age and chronic venous insufficiency.
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Abstract
SummaryThe aim of this study was to assess the prevalence of use of medical compression stockings (MCS) in the general adult population in Germany, to comment the indications for which MCS therapy has been described and the patients’ experience with it. Methods: The survey is based on the Bonn Vein Study. The population of this cross-sectional study was randomly recruited between November 2000 and March 2002 from the registers of residents of the city of Bonn and two rural townships in the area. In total, 3.072 men and women were included in the trial. In addition to clinical examination and duplex-ultrasound, participants were asked whether any phlebological treatment had been carried out due to a leg disorder or disease.. If compression stockings had been worn, we asked for details such as compression class and length of stockings, wearing time, effectiveness, and recognition. Results: In total, 22.9% of people providing information (12.7% of male, 31.0% of female) mentioned having received a specific phlebological treatment in the past. Therapy with compression stockings had the highest prevalence with 14.6% in the general population (7.5% of males, 20.3% of females). The mean age at the first prescription was 45.5 years (SD = 14.3 years). With increasing severity of venous disease, as rated according to the CEAP classification, the prevalence increased from 1% in C0 patients to 82% in C5/C6 patients. Of 450 participants who had used compression stockings in the past, 309 (68.6%) did not wear CS at the time of the survey. The remainder had generally been wearing them on five or more days per week (73.0%) for 8 or more hours per day (89.4%). On average, 71.3% of the participants said that the disease for which MCS were prescribed, had improved as a result of MCS therapy. Improvement concerned a reduction of sensations of swelling (84.2%), of heaviness (89.4%), leg pain after long periods of standing (60.9), and tension in the legs (78.9).
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Lehnich AT, Kowall B, Moebus S, Jöckel KH, Stang A. Einnahme von schlafstörenden und schlafinduzierenden Medikamenten – eine Interaktionsanalyse auf der additiven Skala. Das Gesundheitswesen 2017. [DOI: 10.1055/s-0037-1606013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- AT Lehnich
- Universitätsklinikum Essen, IMIBE, Essen
| | - B Kowall
- Universitätsklinikum Essen, IMIBE, Essen
| | - S Moebus
- Universitätsklinikum Essen, IMIBE, Essen
| | - KH Jöckel
- Universitätsklinikum Essen, IMIBE, Essen
| | - A Stang
- Universitätsklinikum Essen, IMIBE, Essen
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Lehnich AT, Rusner C, Bock E, Katz R, Chodick G, Stang A. CT Scans in der Nachsorge von Hodenkrebs – Fluch oder Segen? Das Gesundheitswesen 2017. [DOI: 10.1055/s-0037-1605973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- AT Lehnich
- Universitätsklinikum Essen, IMIBE, Essen
| | - C Rusner
- Radiologisches Zentrum Bärenkaree, Altenburg
| | - E Bock
- Universitätsklinikum Essen, IMIBE, Essen
| | - R Katz
- Maccabi Health Services, Tel Aviv
| | | | - A Stang
- Universitätsklinikum Essen, IMIBE, Essen
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Kowall B, Lehmann N, Moebus S, Erbel R, Jöckel KH, Stang A. Schlafmerkmale und die Progression des koronararteriellen Verkalkung: Ergebnisse der Heinz Nixdorf Recall Studie. Das Gesundheitswesen 2017. [DOI: 10.1055/s-0037-1605962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- B Kowall
- IMIBE, Zentrum für Klinische Epidemiologie, Essen
| | - N Lehmann
- IMIBE, Zentrum für Klinische Epidemiologie, Essen
| | - S Moebus
- IMIBE, Zentrum für Klinische Epidemiologie, Essen
| | - R Erbel
- IMIBE, Zentrum für Klinische Epidemiologie, Essen
| | - KH Jöckel
- IMIBE, Zentrum für Klinische Epidemiologie, Essen
| | - A Stang
- IMIBE, Zentrum für Klinische Epidemiologie, Essen
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Dragano N, Gerhardus A, Kurth BM, Kurth T, Razum O, Stang A, Teichert U, Wieler LH, Wildner M, Zeeb H. [Public Health: Setting Goals, Establishing Structures and Improving Health for All]. Gesundheitswesen 2016; 78:686-688. [PMID: 27756087 DOI: 10.1055/s-0042-116192] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Public health is a population- and system-based approach that is needed to improve the health of societies and to decrease health inequalities. In the face of global challenges, the public health approach is essential. In Germany, the importance of public health is only partly reflected by its institutions and institutional arrangements. This applies equally to research, teaching and training, as well as to the public health service. Furthermore, the public health perspective is not sufficiently considered in cross-sectional topics that are relevant for health.There have been several initiatives to overcome structural deficits which can partly be traced back to historical circumstances. The White Paper presented here should encourage discussions about future policy options in public health. The authors represent public health in practice, research, and teaching in Germany.
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Affiliation(s)
- N Dragano
- Institut für Medizinische Soziologie, Weiterbildungsstudiengang MSc Public Health, Heinrich-Heine-Universität Düsseldorf
| | - A Gerhardus
- Institut für Public Health und Pflegeforschung, Universität Bremen
| | - B-M Kurth
- Abteilung für Epidemiologie und Gesundheitsmonitoring, Robert Koch-Institut, Berlin
| | - T Kurth
- Institute of Public Health, Charité-Universitätsmedizin Berlin
| | - O Razum
- Fakultät für Gesundheitswissenschaften, Universität Bielefeld
| | - A Stang
- Zentrum für Klinische Epidemiologie, Universitätsklinikum Essen
| | - U Teichert
- Bundesverband der Ärztinnen und Ärzte des Öffentlichen Gesundheitsdienstes, Düsseldorf
| | - L H Wieler
- Abteilung für Epidemiologie und Gesundheitsmonitoring, Robert Koch-Institut, Berlin
| | - M Wildner
- Bayerisches Landesamt für Gesundheit und Lebensmittelsicherheit, Erlangen/Oberschleißheim
| | - H Zeeb
- Leibniz-Institut für Präventionsforschung und Epidemiologie, Bremen
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Weber T, Wassertheurer S, Hametner B, Parragh S, Moebus S, Pundt N, Mahabadi A, Roggenbuck U, Lehmann N, Stang A, Jöckel K, Erbel R. [OP.5B.03] POPULATION-BASED REFERENCE VALUES FOR PULSATILE HEMODYNAMICS IN MIDDLE-AGED AND ELDERLY INDIVIDUALS – RESULTS OF THE HEINZ NIXDORF RECALL STUDY. J Hypertens 2016. [DOI: 10.1097/01.hjh.0000491484.36380.82] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Trottier ED, Gravel J, Ali S, Meckler G, Blanchet M, Stang A, Porter R, Lemay S, Dubrovsky AS, Chan M, Jain R, Principi T, Joubert G, Kam A, Thull-Freedman J, Neto G, Lagacé M. Treating and Reducing Anxiety and Pain in the Paediatric Emergency Department (The Trapped 2 Survey): Time for Action – A Pediatric Emergency Research Canada (Perc) Project. Paediatr Child Health 2016. [DOI: 10.1093/pch/21.supp5.e70b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
BACKGROUND: Multiples barriers to appropriate analgesia provision are reported in the paediatric emergency department (PED), including limited accessibility to effective strategies.
OBJECTIVES: To evaluate the improvement in the accessibility of pain and anxiety management strategies in PEDs in Canada, after the creation of a national pediatric pain quality improvement collaborative, through Pediatric Emergency Research Canada.
DESIGN/METHODS: In 2013, the TRAPPED 1 survey was administered across Canadian PEDs, in order to evaluate the resources in place for pain and anxiety management. Subsequent to the TRAPPED 1, a pain Quality Improvement Collaborative was created to stimulate the implementation of new pain and anxiety management strategies through the sharing of information between PEDs. The TRAPPED 2 survey involved a cross sectional survey similar to TRAPPED 1, after a two year interval. Its main focus was to evaluate the improvement in the accessibility of specific, preferred strategies reported by each centre, after participating in this collaborative between December 2014 to November 2015, and then working to implement change within their own PEDs.
RESULTS: All 15/15 Canadian PEDs responded to TRAPPED 1 in 2013. In 2014, 11/15 agreed to participate in the national pain Quality Improvement Collaborative, with a goal of introducing new pain and anxiety management strategies within their own PEDs. An in-person meeting, email communication, and telephone meetings were employed for information sharing regarding experiences/challenges within each of the participating centres. Newly introduced strategies included education, distraction, nurse-initiated protocols, and policies/education to encourage the use of intranasal (IN) medications. 11/11 centres have responded to the interim follow up surveys in 2015. At the end of the project (Fall 2105), 15/15 Canadian PEDs agreed to complete the final TRAPPED 2 survey. When comparing the results of 2015 with 2013, an increased number of PEDs used face-based pain scales (14/15 vs 6/15) and behavioural scales (5/15 vs 1/15) for pain assessment of school-aged children and infants, respectively. Use of assessment room wall decoration for distraction increased from 7/15 to 11/15. Reminder posters for pain management at triage increased from 4/15 to 6/15. Availability of electronic distraction strategies (e.g. using tablets) increased from 4/15 to 10/15 centres. For skin-piercing procedure, nurses initiated protocols to use topical anesthetic creams and oral sucrose was available in 12/15 centres (compared to 10/15 in 2013), and 14/15 (compared to 12/15 in 2013) respectively. Availability of IN medications increased in the last two years: fentanyl 14/15 (9/15 in 2013) and midazolam in at least 10/15 (8/15 in 2013). 10/11 PEDS involved in the QI strategy reported the implementation of at least one of their strategies identified.
CONCLUSION: This study suggests that the use of a pain Quality Improvement Collaborative may improve the introduction of new strategies in multiple PEDs. It can help guide other centres when introducing new strategies to reduce pain and anxiety for children in community EDs. Future research can focus on the sustainability of the strategies, and as well the effect of the collaborative on the introduction of other pain treatment strategies.
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Todorovich S, Poonai C, Wright B, Ali S, Bhatt C, Todorovich S, Canton K, Mishra A, Speechley K, Stang A, Thompson G, Poonai N. Family Perceptions and Provision of Analgesia for Acutely Painful Conditions in Children: A Multi-Centred Prospective Survey. Paediatr Child Health 2016. [DOI: 10.1093/pch/21.supp5.e70] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
BACKGROUND: More than two-thirds of children who present to the emergency department (ED) complain of pain. It is well known that children’s pain is poorly managed in the ED compared to their adult counterparts. With respect to analgesic administration in the ED, discrepancies exist between physician self-report and institutional audit. Patient refusal of analgesia is a likely explanation. There is good evidence that misconceptions and fears about analgesia in children are common among caregivers and may contribute to withholding pain medication. To date, no study has surveyed caregivers presenting the the ED to assess frequency of analgesic administration and reasons for withholding analgesia. We hypothesize that there will be a significant proportion of care-givers and patients that refuse pain medication in the ED. We also hypothesize that there will be a wide range of reasons for refusal. The insight we gain from this study will help nurses, clinical educators, and physicians provide the appropriate information to parents in an effort to target misconceptions and allay fears.
OBJECTIVES: Our objectives were to characterize the degree of care-giver and patient provision of analgesia prior to arrival, refusal of analgesia in the ED, and reasons behind their decision-making process. We hope to identify specific misconceptions, attitudes, or beliefs that impair the optimal provision of analgesia to children in the ED.
DESIGN/METHODS: A novel survey was designed by a focus group using an iterative approach and implemented over a 16-week period across two Canadian tertiary care paediatric EDs. We included a consecutive sample of caregivers of children aged 4-17 years with an acutely painful condition (headache, abdominal pain, injury, otitis, pharyngitis). Caregivers were asked to answer questions covering five domains: (i) demographics, (ii) analgesia prior to arrival (iii) analgesia offered in the ED and reasons for refusal, (iv) perceptions of analgesia, and (v) caregiver satisfaction at discharge. Children were asked to rate their pain on arrival and at discharge. The primary outcome was the frequency of caregiver provision of analgesia prior to arrival and the proportion of caregivers who accept the offer of analgesia offered in the ED.
RESULTS: Three hundred forty-four caregivers completed the survey. The majority were female (269/339, 79%), aged 36 years or older (256/340, 75%) with a post-secondary education (237/336, 71%). Most (309/339, 91%) reported being able to “tell when their child was in pain”. All respondents rated their child’s maximal pain related to the presenting condition as at least a 6/10. With regards to the primary outcome, 229/338 (68%) of caregivers reported that they did not treat their child’s pain prior to arrival in the ED. Of those who did treat their child’s pain, ibuprofen was the most commonly used analgesic (77/112, 69%). The most common reasons for withholding analgesia was a lack of time (80/210, 38%), fear of masking seriousness of child’s condition (49/210, 23%), fear of masking signs and symptoms (48/210, 23%), and a lack of analgesia at home (47/210, 22%). Analgesia was offered to 186/344 (45%) of children in the ED and the majority of caregivers 157/186 (84%) accepted the offer. The most common reason for not accepting analgesia in the ED was child refusal (15/20, 75%). Most, 231/338 (68%) of caregivers felt that their child’s pain was managed well in the ED.
CONCLUSION: This survey of caregiver perceptions surrounding analgesia for children with acutely painful conditions presenting to the pae-diatric ED suggests that most do not treat their child’s pain prior to arrival, despite high levels of pain. Misconceptions surrounding analgesia prior to arrival are common. Despite this, most caregivers accepted analgesia in the ED. Our results suggest that educational strategies should be directed at caregiver awareness of the impact of pain on children and the need for prompt analgesic therapy, even when an ED visit is planned.
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Abstract
Population attributable risks (PARs) are often used in health sciences because they offer an apparently easy answer to the question as to the proportion of disease cases that could be prevented in a population if one or more risk factors were eliminated. We discuss some problems in the interpretation of PARs that result from the fact that diseases have more than one cause. Moreover, requirements are discussed which have to be met before PARs can give a realistic idea of the proportion of cases of illness that can be avoided.
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Affiliation(s)
- B Kowall
- Zentrum für Klinische Epidemiologie, Institut für Medizinische Informatik, Biometrie und Epidemiologie, Universitätsklinikum Essen, Essen
| | - A Stang
- Zentrum für Klinische Epidemiologie, Institut für Medizinische Informatik, Biometrie und Epidemiologie, Universitätsklinikum Essen, Essen
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Stang A, Trabert B, Rusner C, Poole C, Almstrup K, Rajpert-De Meyts E, McGlynn KA. A survey of etiologic hypotheses among testicular cancer researchers. Andrology 2014; 3:19-26. [PMID: 25538016 DOI: 10.1111/andr.306] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2014] [Revised: 10/22/2014] [Accepted: 10/23/2014] [Indexed: 12/11/2022]
Abstract
Basic research results can provide new ideas and hypotheses to be examined in epidemiological studies. We conducted a survey among testicular cancer researchers on hypotheses concerning the etiology of this malignancy. All researchers on the mailing list of Copenhagen Testis Cancer Workshops and corresponding authors of PubMed-indexed articles identified by the search term 'testicular cancer' and published within 10 years (in total 2750 recipients) were invited to respond to an e-mail-based survey. Participants of the 8th Copenhagen Testis Cancer Workshop in May 2014 were subsequently asked to rate the plausibility of the suggested etiologic hypotheses on a scale of 1 (very implausible) to 10 (very plausible). This report describes the methodology of the survey, the score distributions by individual hypotheses, hypothesis group, and the participants' major research fields, and discuss the hypotheses that scored as most plausible. We also present plans for improving the survey that may be repeated at a next international meeting of experts in testicular cancer. Overall 52 of 99 (53%) registered participants of the 8th Copenhagen Testis Cancer Workshop submitted the plausibility rating form. Fourteen of 27 hypotheses were related to exposures during pregnancy. Hypotheses with the highest mean plausibility ratings were either related to pre-natal exposures or exposures that might have an effect during pregnancy and in post-natal life. The results of the survey may be helpful for triggering more specific etiologic hypotheses that include factors related to endocrine disruption, DNA damage, inflammation, and nutrition during pregnancy. The survey results may stimulate a multidisciplinary discussion about new etiologic hypotheses of testicular cancer.
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Affiliation(s)
- A Stang
- Zentrum für Klinische Epidemiologie, Institut für Medizinische Informatik, Biometrie und Epidemiologie, Universitätsklinikum Essen, Essen, Germany; Department of Epidemiology, School of Public Health, Boston University, Boston, MA, USA
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Stang A. [An introduction to causality principles in biomedical research]. Gesundheitswesen 2014; 76:874-82; quiz 883-4. [PMID: 25525680 DOI: 10.1055/s-0034-1387509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- A Stang
- Universitätsklinikum Essen - Institut für Medizinische Informatik, Biometrie und Epidemiologie
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Kontautiene S, Stang A, Gollnick H, Valiukeviciene S. The role of phenotype, body mass index, parental and sun exposure factors in the prevalence of melanocytic nevi among schoolchildren in Lithuania. J Eur Acad Dermatol Venereol 2014; 29:1506-16. [DOI: 10.1111/jdv.12905] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Accepted: 11/04/2014] [Indexed: 02/03/2023]
Affiliation(s)
- S. Kontautiene
- Department of Skin and Venereal Diseases; Lithuanian University of Health Sciences; Kaunas Lithuania
| | - A. Stang
- Institute for Medical Informatics, Biometry, and Epidemiology; University Hospital of Essen; University Duisburg-Essen; Essen Germany
| | - H. Gollnick
- Department of Dermatology and Venereology; Otto-von-Guericke-University; Magdeburg Germany
| | - S. Valiukeviciene
- Department of Skin and Venereal Diseases; Lithuanian University of Health Sciences; Kaunas Lithuania
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Höbel S, Baumbach R, Dautel P, Oldhafer KJ, Stang A, Feyerabend B, Yahagi N, Faiss S. Single-Center Erfahrung mit der Endoskopischen Submukosa Dissektion (ESD) bei prämalignen und malignen gastrointestinalen Neoplasien. Z Gastroenterol 2014. [DOI: 10.1055/s-0034-1386273] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Höbel S, Baumbach R, Dautel P, Oldhafer KJ, Stang A, Feyerabend B, Yahagi N, Faiss S. [Single centre experience of endoscopic submucosal dissection (ESD) in premalignant and malignant gastrointestinal neoplasia]. Z Gastroenterol 2014; 52:193-9. [PMID: 24526404 DOI: 10.1055/s-0033-1356065] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
INTRODUCTION Worldwide endoscopic submucosal dissection (ESD) of early GI cancers or premalignant neoplasia is becoming increasingly important. In Germany ESD is restricted to larger endoscopic institutions and only a few literature reports are available. The aim of the present study is to describe the results of 46 ESDs conducted in a German endoscopic centre. MATERIAL AND METHODS Between June 2007 and May 2012 46 ESDs in 45 patients (33 men, 12 women, mean age 66.1 years) were performed in the oesophagus (n = 17), stomach (n = 23) and rectum (n = 6). Data were collected for the en-bloc, R0 and R0 en-bloc resection rates as well as for complications, the curative resection and the local recurrence rates. In order to demonstrate a learning curve, results were evaluated for two periods (June 2007 to November 2010 vs. December 2010 to May 2012). RESULTS ESD was technically possible in 93.5%. En-bloc, R0, R0 en-bloc and curative resection rates were 90.7%, 74.4%, 67.4% and 65.1%, respectively. The complication rate was 13%. In the second period en-bloc and R0 en-bloc resection rates increased from 81% to 100% and, respectively, from 52.4% to 81.8%. After a medium follow-up of 11.4 months, local tumour recurrence occurred in 10%. In cases of curative R0 en bloc resection of malignant tumours no tumour recurrence occurred. DISCUSSION Despite the small number of patients, the present data underline the value of ESD, especially in cases of R0 en-bloc resections in the therapy for premalignant and early malignant GI tumours. Due to the required learning curve, ESD should be restricted to larger endoscopic centres in Germany.
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Affiliation(s)
- S Höbel
- Gastroenterolgie & Hepatologie, Asklepios Klinik Barmbek, Hamburg
| | - R Baumbach
- Gastroenterolgie & Hepatologie, Asklepios Klinik Barmbek, Hamburg
| | - P Dautel
- Gastroenterolgie & Hepatologie, Asklepios Klinik Barmbek, Hamburg
| | - K J Oldhafer
- Viszeralchirurgie, Asklepios Klinik Barmbek, Hamburg
| | - A Stang
- Onkologie & Palliativmedizin, Asklepios Klinik Barmbek, Hamburg
| | | | - N Yahagi
- Division of Research and Development for Minor Invasive Treatment, Tumor Center, Keio University School of Medicine, Tokyo
| | - S Faiss
- Gastroenterolgie & Hepatologie, Asklepios Klinik Barmbek, Hamburg
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Kantelhardt EJ, Zerche P, Mathewos A, Trocchi P, Addissie A, Aynalem A, Wondemagegnehu T, Ersumo T, Reeler A, Yonas B, Tinsae M, Gemechu T, Jemal A, Thomssen C, Stang A, Bogale S. Breast cancer survival in Ethiopia: a cohort study of 1,070 women. Int J Cancer 2014; 135:702-9. [PMID: 24375396 DOI: 10.1002/ijc.28691] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2013] [Accepted: 12/11/2013] [Indexed: 11/07/2022]
Abstract
There is little information on breast cancer (BC) survival in Ethiopia and other parts of sub-Saharan Africa. Our study estimated cumulative probabilities of distant metastasis-free survival (MFS) in patients at Addis Ababa (AA) University Radiotherapy Center, the only public oncologic institution in Ethiopia. We analyzed 1,070 females with BC stage 1-3 seen in 2005-2010. Patients underwent regular follow-up; estrogen receptor-positive and -unknown patients received free endocrine treatment (an independent project funded by AstraZeneca Ltd. and facilitated by the Axios Foundation). The primary endpoint was distant metastasis. Sensitivity analysis (worst-case scenario) assumed that patients with incomplete follow-up had events 3 months after the last appointment. The median age was 43.0 (20-88) years. The median tumor size was 4.96 cm [standard deviation (SD) 2.81 cm; n = 709 information available]. Stages 1, 2 and 3 represented 4, 25 and 71%, respectively (n = 644). Ductal carcinoma predominated (79.2%, n = 1,070) as well as grade 2 tumors (57%, n = 509). Median follow-up was 23.1 (0-65.6) months, during which 285 women developed metastases. MFS after 2 years was 74% (69-79%), declining to 59% (53-64%) in the worst-case scenario. Patients with early stage (1-2) showed better MFS than patients with stage 3 (85 and 66%, respectively). The 5-year MFS was 72% for stages 1 and 2 and 33% for stage 3. We present a first overview on MFS in a large cohort of female BC patients (1,070 patients) from sub-Saharan Africa. Young age and advanced stage were associated with poor outcome.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Breast Neoplasms/mortality
- Breast Neoplasms/pathology
- Breast Neoplasms/therapy
- Carcinoma, Ductal, Breast/mortality
- Carcinoma, Ductal, Breast/pathology
- Carcinoma, Ductal, Breast/therapy
- Carcinoma, Lobular/mortality
- Carcinoma, Lobular/pathology
- Carcinoma, Lobular/therapy
- Cohort Studies
- Combined Modality Therapy
- Ethiopia/epidemiology
- Female
- Follow-Up Studies
- Humans
- Middle Aged
- Neoplasm Grading
- Neoplasm Metastasis
- Neoplasm Staging
- Prognosis
- Survival Rate
- Young Adult
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Affiliation(s)
- E J Kantelhardt
- Department of Gynaecology, Martin Luther University, Halle an der Saale, Germany; Institute of Clinical Epidemiology, Martin Luther University, Halle an der Saale, Germany
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Rusner C, Dieckmann KP, Friedel H, Spielmann RP, Stang A. Häufigkeit der Computertomografie in der Nachsorge von Hodentumorpatienten - eine Einschätzung der Versorgungslage in Deutschland. ROFO-FORTSCHR RONTG 2013. [DOI: 10.1055/s-0033-1346416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Stang A, Jansen L, Trabert B, Rusner C, Eberle A, Katalinic A, Emrich K, Holleczek B, Brenner H. Survival after a diagnosis of testicular germ cell cancers in Germany and the United States, 2002-2006: a high resolution study by histology and age. Cancer Epidemiol 2013; 37:492-7. [PMID: 23623488 DOI: 10.1016/j.canep.2013.03.017] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2013] [Revised: 03/25/2013] [Accepted: 03/26/2013] [Indexed: 11/25/2022]
Abstract
INTRODUCTION The aim of this study was to provide detailed age-specific (5-year age groups) and histology-specific (histologic subtypes of seminoma and nonseminoma) relative survival estimates of testicular germ cell cancer patients in Germany and the United States (U.S.) for the years 2002-2006 and to compare these estimates between countries. METHODS We pooled data from 11 cancer registries of Germany and used data from the U.S. (SEER-13 database) including 11,508 and 10,774 newly diagnosed cases (1997-2006) in Germany and the U.S., respectively. We estimated 5-year relative survival (5-year-RS) by histology and age based on period analysis. RESULTS 5-year-RS for testicular germ cell tumors was 96.7% and 96.3% in Germany and the U.S., respectively. 5-Year-RS for spermatocytic seminoma was close to 100% in both countries. 5-Year-RS for nonseminoma was lower than for classical seminoma in Germany (93.3% versus 97.6%) and the U.S. (91.0% versus 98.2%). Among nonseminomas, choriocarcinomas provided the lowest 5-year-RS in both countries (Germany 80.1%, U.S. 79.6%). Age-specific 5-year-RS for seminoma showed only little variation by age. 5-Year-RS for nonseminomas tended to be lower at higher ages, especially for malignant teratoma. DISCUSSION This is the first study that provides up-to-date survival estimates for testicular cancer by histology and age in Germany and the U.S. Survival after a diagnosis of testicular cancer is very comparable between Germany and the U.S. 5-Year-RS for spermatocytic seminoma was close to 100% and the lowest 5-year-RS occurred among choriocarcinoma. Higher age at diagnosis is associated with a poorer prognosis among nonseminoma patients.
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Affiliation(s)
- A Stang
- Institute of Clinical Epidemiology, Medical Faculty, Martin-Luther-University Halle-Wittenberg, Halle, Germany.
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Karciauskiene J, Valiukeviciene S, Gollnick H, Stang A. The prevalence and risk factors of adolescent acne among schoolchildren in Lithuania: a cross-sectional study. J Eur Acad Dermatol Venereol 2013; 28:733-40. [DOI: 10.1111/jdv.12160] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2012] [Accepted: 03/18/2013] [Indexed: 11/29/2022]
Affiliation(s)
- J. Karciauskiene
- Department of Skin and Venereal Diseases; Lithuanian University of Health Sciences; Kaunas Lithuania
| | - S. Valiukeviciene
- Department of Skin and Venereal Diseases; Lithuanian University of Health Sciences; Kaunas Lithuania
| | - H. Gollnick
- Department of Dermatology and Venereology; Otto-von-Guericke-University; Magdeburg Germany
| | - A. Stang
- Institute of Clinical Epidemiology; Martin-Luther-University; Halle Germany
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Stang A, Kantelhardt E. Too many statistical errors for meaningful interpretation. Breast Cancer Res Treat 2013; 138:643-4. [PMID: 23417360 DOI: 10.1007/s10549-013-2438-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2013] [Accepted: 01/29/2013] [Indexed: 10/27/2022]
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Sandhu N, Thomson D, Stang A. In children with chronic suppurative otitis media, should one prescribe topical or systemic antibiotics? Paediatr Child Health 2012; 17:385-6. [PMID: 23904783 PMCID: PMC3448540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/18/2012] [Indexed: 06/02/2023] Open
Affiliation(s)
- N Sandhu
- Alberta Children’s Hospital and Department of Pediatrics, University of Calgary, Calgary
| | - D Thomson
- Cochrane Child Health Field, Department of Pediatrics, University of Alberta, Edmonton, Alberta
| | - A Stang
- Alberta Children’s Hospital and Department of Pediatrics, University of Calgary, Calgary
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Stang A. Impact of hysterectomy on the age-specific incidence of cervical and uterine cancer in Germany and other countries. Eur J Public Health 2012; 23:879-83. [DOI: 10.1093/eurpub/cks080] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Stang A, Trabert B, Wentzensen N, Cook MB, Rusner C, Oosterhuis JW, McGlynn KA. Burden of extragonadal germ cell tumours in Europe and the United States. Eur J Cancer 2012; 48:1116-7. [PMID: 22425262 PMCID: PMC4024829 DOI: 10.1016/j.ejca.2012.02.061] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2012] [Accepted: 02/13/2012] [Indexed: 11/23/2022]
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Weinreich G, Wessendorf T, Erdmann T, Moebus S, Dragano N, Lehmann N, Stang A, Roggenbuck U, Bauer M, Jöckel KH, Erbel R, Teschler H, Möhlenkamp S. Prävalenz von schlafbezogenen Atmungsstörungen in der Allgemeinbevölkerung im mittleren und höheren Erwachsenenalter – Ergebnisse der Heinz Nixdorf Recall Studie. Pneumologie 2012. [DOI: 10.1055/s-0032-1302792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Kantelhardt E, Fuehrer A, Breitenstein E, Zerche P, Trocchi P, Adamu A, Tufa G, Stang A, Thomssen C, Bogale S. 161 Breast Cancer in Ethiopia: the Addis Ababa-Halle University Collaboration Project Studying Incidence, Mortality and Clinical Epidemiology. Eur J Cancer 2012. [DOI: 10.1016/s0959-8049(12)70229-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Stang A, Trabert B, Wentzensen N, Cook MB, Rusner C, Oosterhuis JW, McGlynn KA. Gonadal and extragonadal germ cell tumours in the United States, 1973-2007. ACTA ACUST UNITED AC 2012; 35:616-25. [PMID: 22320869 DOI: 10.1111/j.1365-2605.2011.01245.x] [Citation(s) in RCA: 96] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Germ cell tumours (GCTs) most often arise in the gonads, but some develop extragonadally. The aim of this study was to examine gender- and race-specific trends in incidence and survival of gonadal (GGCTs) and extragonadal GCTs (EGCTs) in the US from 1973 to 2007. We also examined the topographical distribution of EGCTs by race and gender. We estimated age-specific and age-standardized incidence rates and 5-year relative survival rates (RSR) of GCTs using the Surveillance, Epidemiology and End Results (SEER) Program (SEER nine registries). GCTs and their topographical sites were identified using ICD-O morphology and topography codes. Of 21,170 GCTs among males, 5.7% were extragonadal (Whites 5.5%; Blacks 16.3%). Of 2093 GCTs among females, 39.3% were extragonadal (Whites, 36.9%; Blacks 51.0%). The incidence of GGCT was much higher among White (56.3/1,000,000) than Black males (10.0/1,000,000), while there was no difference in incidence between White and Black females (3.2/1,000,000). The rates of EGCT among men and women of both races were similar (range:1.9-3.4/1,000,000). The most frequent extragonadal sites were mediastinum among males and placenta among females. The 5-year RSR of testicular GCT was higher among Whites (97%) than Blacks (90%), as was the 5-year RSR of ovarian GCT (Whites, 92%; Blacks 85%). In general, the 5-year RSRs of EGCTs were lower than the 5-year RSRs of GGCTs. The different incidence trends of GGCTs and EGCTs and distinct age-specific incidence patterns by anatomical site of EGCTs suggest that GGCTs and EGCTs may have different aetiologies.
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Affiliation(s)
- A Stang
- Institut für Klinische Epidemiologie, Medizinische Fakultät, Martin-Luther-Universität Halle-Wittenberg, Halle, Germany.
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Weinreich G, Wessendorf T, Erdmann T, Moebus S, Dragano N, Lehmann N, Stang A, Roggenbuck U, Bauer M, Jöckel KH, Erbel R, Teschler H, Möhlenkamp S. Association of Sleep-disordered Breathing and Subclinical Coronary Atherosclerosis in the General Population – Results of the Heinz Nixdorf Recall Study. ROFO-FORTSCHR RONTG 2012. [DOI: 10.1055/s-0031-1300898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Castell S, Diel R, Loddenkemper R, Glaser-Paschke G, Stang A. [Are alcohol and drug addiction risk factors for default from tuberculosis treatment? - preliminary work for a case-control study including tuberculosis patients from Berlin and Hamburg, 2001-2009]. Gesundheitswesen 2011; 73:909-11. [PMID: 22193904 DOI: 10.1055/s-0031-1291200] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Affiliation(s)
- S Castell
- Deutsches Zentralkomitee zur Bekämpfung, der Tuberkulose (DZK), Berlin.
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Sehrndt A, Stang A, Lehmkuhl E, Regitz-Zagrosek V, Babitsch B. [Investigation of the influence of the socioeconomic status on the health-related quality of life in patients before and after coronary artery bypass grafting - an example of the use of causal diagrams (DAGs)]. Gesundheitswesen 2011; 73:903-5. [PMID: 22193902 DOI: 10.1055/s-0031-1291196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Affiliation(s)
- A Sehrndt
- Berlin School of Public Health, Berlin
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Affiliation(s)
- A. Stang
- Institut für Klinische Epidemiologie, Medizinische Fakultät, Martin-Luther-Universität Halle-Wittenberg
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Abstract
Causal graphs such as directed acyclic graphs (DAGs) are a novel approach in epidemiology to conceptualize confounding and other sources of bias. DAGs visually encode the causal relations based on a priori knowledge among the exposure of interest and the outcome while considering several covariates. The application of formal rules on these diagrams enables the identification of the causal and non-causal structures in the DAG. The causal effects are of interest and require no adjustment. Whereas the non-causal effects have to be checked for confounding and for which covariates adjustment is necessary. The identification of the adjustment set depends on the causal relations among the variables. The consideration of these relations is valuable because adjusting for more variables increases the risk of introducing bias. Considering every single path of a DAG allows the systematic identification of the causal structures in the DAG, and the determination of minimally sufficient adjustment sets for estimating the causal effect of the exposure on the outcome based on the underlying DAG. The aim of this paper is to provide an introduction to the basic assumptions as well as the steps for drawing and applying a DAG.
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Affiliation(s)
- S Schipf
- Institut für Community Medicine, Ernst-Moritz-Arndt-Universität Greifswald, Greifswald.
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Stang A, Keles H, Hentschke S, von Seydewitz CU, Dahlke J, Habermann C, Wessling J. Incidentally detected splenic lesions in ultrasound: does contrast-enhanced ultrasonography improve the differentiation of benign hemangioma/hamartoma from malignant lesions? Ultraschall Med 2011; 32:582-592. [PMID: 22161555 DOI: 10.1055/s-0031-1282034] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
PURPOSE The aim of the study was to identify and validate enhancing features for differentiating benign vascular neoplasms of the hemangioma/hamartoma type from malignant splenic lesions on contrast-enhanced ultrasonography (CEUS). MATERIALS AND METHODS 136 splenic lesions (58 benign vascular neoplasms, 78 malignant) in 136 patients underwent baseline US and pulse-inversion CEUS after sulfur hexafluoride-filled microbubble injection. Two on-site readers assessed lesion enhancement features during arterial and parenchymal phase in consensus. Best predicting CEUS features for lesion diagnosis were identified through univariate and multivariate analyses. Two blinded off-site readers independently issued a confidence rating for lesion diagnosis in baseline US and CEUS using extracted diagnostic CEUS features. Diagnostic performance, receiver operating curves (Az-value), and interreader agreement were calculated. The reference standards were histopathology or CT and/or MR imaging with clinical follow-up. RESULTS Multivariate analysis outlined arterial hyperenhancement or isoenhancement to be an independent CEUS predictor of benign vascular neoplasms (odds ratio, 3.558; p < 0.0017). Within the subgroup of isoechoic or hypoechoic lesions, arterial hyperenhancement was virtually diagnostic for benign vascular neoplasm (odds ratio, 21.333; p < 0.001). The diagnostic accuracy and confidence (Az-value) of the two readers was 63.2 % and 70.6 % (0.785 and 0.818) for baseline US, which improved significantly to 87.5 % and 88.2 % (0.915 and 0.908) for CEUS (p < 0.001). Interreader agreement also increased with CEUS (қ = 0.88) compared to baseline US (қ = 0.52). CONCLUSION Sulfur hexafluoride-enhanced CEUS improves differentiation between benign vascular and malignant splenic tumors and may be especially useful in clinical scenarios in which the incidental hypoechoic splenic lesion is unclear on conventional US.
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Affiliation(s)
- A Stang
- Department of Hematology, Oncology, and Palliative Care, Asklepios Hospital Barmbek, Hamburg, Germany.
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Fuehrer A, Tariku W, Dawit M, Ahrens C, Adamu A, Stang A, Thomssen C, Kantelhardt EJ. Das Ausmaß onkologischer Todesfälle bei Frauen im ländlichen Äthiopien – Ergebnisse von 2500 Interviews mit Angaben zu Frauen und ihren Schwestern; Auswertung von >200 Todesfällen. Geburtshilfe Frauenheilkd 2011. [DOI: 10.1055/s-0031-1286467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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Zerche P, Schneider J, Reeler A, Stang A, Thomssen C, Bogale S, Kantelhardt EJ. Der klinische Verlauf von 1600 PatientInnen mit Mammakarzinom am Tikur Anbessa Universitäts-Krankenhaus Addis Ababa/Äthiopien. Geburtshilfe Frauenheilkd 2011. [DOI: 10.1055/s-0031-1286436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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Abstract
BACKGROUND/OBJECTIVE Surgical therapy of skin cancer includes conventional wide excision and micrographic surgery (MS). Little is known about the population-wide spread of MS for the treatment of skin cancer. The aim was to estimate the in-hospital use of MS for the treatment of skin cancer in Germany. METHODS We used nationwide DRG data from 2005 through 2006. We identified hospitalizations with a main diagnosis of cutaneous malignant melanoma (CMM) (ICD-10: C43) or non-melanoma skin cancer (NMSC) (ICD-10: C44). MS was identified by OPS procedure codes including 5-895.1, 5-895.3, 5-212.1, 5-181.1, 5-181.4, 5-181.6, 5-182.1, 5-091.1, or 5-091.3. RESULTS We identified 52 660 and 98 484 hospitalizations with a primary diagnosis of CMM and NMSC respectively; 54.6% and 36.5% of NMSC and CMM-related admissions with local skin cancer treatment included MS. The relative frequency of MS varied by anatomic subsite of the skin cancer and by region of the hospital. Local infections were the most frequent complications after MS with 3.2-4.0% for NMSC and 2.3-2.9% for CMM followed by haemorrhages. Dehiscence of the operation wound is a rare event with risks ranging between 0.1% and 0.3%. CONCLUSIONS Micrographic surgery is frequently used for the local treatment of NMSC and varies considerably across Federal States of Germany. It is difficult to speculate how many MS might be performed in private or ambulatory settings in Germany. As MS requires surgical expertise, technical support and dermatopathology, we speculate that MS is much less frequently undertaken in private practices in Germany.
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Affiliation(s)
- A Stang
- Institut für Klinische Epidemiologie, Medizinische Fakultät, Martin-Luther-Universität Halle-Wittenberg, Halle, Germany.
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Trabert B, Stang A, Cook MB, Rusner C, McGlynn KA. Impact of classification of mixed germ-cell tumours on incidence trends of non-seminoma. ACTA ACUST UNITED AC 2011; 34:e274-7. [PMID: 21623833 DOI: 10.1111/j.1365-2605.2011.01187.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Seminomas and non-seminomas [embryonal carcinomas, yolk sac tumours, teratomas, choriocarcinomas, mixed germ-cell tumours (MGCT)] are the major histological types of testicular germ-cell tumours (TGCT). TGCTs composed of both seminomatous and non-seminomatous elements have been coded as their non-seminoma component in the World Health Organization classification. In the late 1980s, a provisional International Classification of Diseases for Oncology (ICD-O) morphology code for MGCT was introduced. Using data from the Surveillance, Epidemiology and End Results Program and two population-based German cancer registries, we examined the impact of MGCT classification on TGCT trends. Cases were identified using ICD-O topography (ICD-9: 186; ICD-10: C62) and morphology codes (seminoma=9060-9062, 9064; embryonal carcinoma=9070; yolk sack tumour=9071; teratoma=9080-9084, 9102; choriocarcinoma=9100, 9101; MGCT=9085; all non-seminoma=9065-9102). As MGCTs and teratoma are often grouped as a single histological group, we analysed teratoma both including and excluding MGCTs. Between 1988 and 2007, incidence rates of MGCT in the US increased 407%. Rates of teratoma including MGCT increased 80%, whereas rates of teratoma excluding MGCT decreased 71%. Rates of embryonal carcinoma [-40%] and choriocarcinoma [-22%] also declined, suggesting that the code for MGCT is now being used for any mixed histology. Similar declines in incidence were observed in the German comparison populations. The declines in incidence of teratoma (excluding MGCT), embryonal carcinoma and choriocarcinoma in the US data since 1988 are likely in part because of increases in classifying any TGCT with mixed histology as MGCT. These results suggest that analysis of trends in specific histological types of non-seminoma should be interpreted cautiously.
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Affiliation(s)
- B Trabert
- Hormonal and Reproductive Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, MD 20852-7234, USA.
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48
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Stang A, Merrill R, Kuß O. Population-based hysterectomy rates in Germany from 2005 through 2006. Gesundheitswesen 2010. [DOI: 10.1055/s-0030-1266282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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49
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Erbel R, Möhlenkamp S, Moebus S, Lehmann N, Stang A, Schmermund A, Kälsch H, Grönemeyer D, Seibel R, Mann K, Siegrist R, Jöckel K. Improved risk prediction of myocardial Infarction and coronary death based on quantification of subclinical coronary atherosclerosis – Results of the Heinz Nixdorf Recall study. Gesundheitswesen 2010. [DOI: 10.1055/s-0030-1266236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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50
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Stang A. „Gesundheitlich unbedenklich”: Fakt oder Fiktion? Gesundheitswesen 2010; 72:496-501. [DOI: 10.1055/s-0029-1242794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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