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Thom J, Jonas B, Reitzle L, Mauz E, Hölling H, Schulz M. Trends in the Diagnostic Prevalence of Mental Disorders, 2012-2022—Using Nationwide Outpatient Claims Data for Mental Health Surveillance. Dtsch Arztebl Int 2024:arztebl.m2024.0052. [PMID: 38686592 DOI: 10.3238/arztebl.m2024.0052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 05/02/2024]
Abstract
BACKGROUND Evaluations by the statutory health insurance carriers in Germany have revealed a rising prevalence of diagnoses of mental disorders, at varying levels and to varying extents. For mental health surveillance purposes, we analyzed prevalence trends across health insurance carriers, before and during the COVID-19 pandemic and stratified by diagnosis group, sex and age. METHODS Nationwide outpatient claims data of all statutorily insured individuals for the years 2012-2022 (Nmin = 68.7 million people, Nmax = 73.7 million people) were used to determine the diagnostic prevalence of mental disorders (ICD-10 F00-F99 and five selected diagnosis groups), with stratification by sex and age. Changes over time in the spectrum of all documented mental disorders are described. RESULTS Over the period 2012-2022, the percentage of people with outpatient diagnoses of mental disorders rose from 33.4% to 37.9% (a relative increase of 13.4%). In the selected diagnosis groups, the trends ranged from -11.6% to +115.8% and were generally steady over time, though stronger or stagnating trends were seen in some groups from 2020 onward. Diagnostic prevalence rose to a greater extent in male (+18.3%) than in female individuals (+10.8%) over the period 2012-2022. The greatest increases (> +15%) were seen among 11- to 17-year-olds and in 60- to 84-year-olds. The composition of the diagnosis spectrum was more stable in adults than in children and adolescents. CONCLUSION Trends in diagnostic prevalence differ across mental disorders and population subgroups and have changed in some diagnosis groups since the COVID-19 pandemic. Contextualizing research is needed for a better understanding of these developments.
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Schaumann A, Hammar C, Alsleben S, Schulz M, Grün A, Lankes E, Tietze A, Koch A, Hernáiz Driever P, Thomale UW. Neurosurgical treatment of pediatric brain tumors - results from a single center multidisciplinary setup. Childs Nerv Syst 2024; 40:381-393. [PMID: 37730915 PMCID: PMC10837233 DOI: 10.1007/s00381-023-06123-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Accepted: 08/09/2023] [Indexed: 09/22/2023]
Abstract
OBJECTIVE The challenge of pediatric brain tumor surgery is given due to a relative low prevalence but high heterogeneity in age, localization, and pathology. Improvements of long-term overall survival rates were achieved during the past decades stressing the importance of a multidisciplinary decision process guided by a national treatment protocol. We reviewed the entire spectrum of pediatric brain tumor surgeries from the perspective of an interdisciplinary pediatric neuro-oncology center in Germany. METHODS Every patient who underwent brain tumor surgery from January 2010 to June 2017 in our Pediatric Neurosurgery department was retrospectively included and evaluated regarding the course of treatment. Perioperative data such as tumor localization, timing of surgery, extent of resection, neuropathological diagnosis, transfusion rates, oncologic and radiation therapy, and neurological follow-up including morbidity and mortality were evaluated. RESULTS Two hundred ninety-three pediatric brain tumor patients were applicable (age: 8.28 ± 5.62 years, 1.22:1.0 m:f). A total of 531 tumor surgical interventions was performed within these patients (457 tumor resections, 74 tumor biopsies; mean interventions per patient 1.8 ± 1.2). Due to a critical neurologic status, 32 operations (6%) were performed on the day of admission. In 65.2% of all cases, tumor were approached supratentorially. Most frequent diagnoses of the cases were glial tumors (47.8%) and embryonal tumors (17.6%). Preoperative planned extent of resection was achieved in 92.7%. Pre- and postoperative neurologic deficits resolved completely in 30.7%, whereas symptom regressed in 28.6% of surgical interventions. New postoperative neurologic deficit was observed in 10.7%, which resolved or improved in 80% of these cases during 30 days. The mortality rate was 1%. CONCLUSION We outlined the center perspective of a specialized pediatric neuro-oncological center describing the heterogeneous distribution of cases regarding age-related prevalence, tumor localization, and biology, which requires a high multidisciplinary expertise. The study contributes to define challenges in treating pediatric brain tumors and to develop quality indicators for pediatric neuro-oncological surgery. We assume that an adequate volume load of patients within a interdisciplinary infrastructure is warranted to aim for effective treatment and decent quality of life for the majority of long-term surviving pediatric tumor patients.
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Affiliation(s)
- A Schaumann
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Pediatric Neurosurgery, Augustenburger Platz 1, 13353, Berlin, Germany
| | - C Hammar
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Pediatric Neurosurgery, Augustenburger Platz 1, 13353, Berlin, Germany
| | - S Alsleben
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Pediatric Neurosurgery, Augustenburger Platz 1, 13353, Berlin, Germany
| | - M Schulz
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Pediatric Neurosurgery, Augustenburger Platz 1, 13353, Berlin, Germany
| | - A Grün
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department for Radiation Oncology and Radiotherapy, Augustenburger Platz 1, 13353, Berlin, Germany
| | - E Lankes
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Pediatric Endocrinology and Diabetes, Augustenburger Platz 1, 13353, Berlin, Germany
| | - A Tietze
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Neuroradiology, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Arend Koch
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Neuropathology, Berlin, Germany
| | - P Hernáiz Driever
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Pediatric Hematology and Oncology, Augustenburger Platz 1, 13353, Berlin, Germany
| | - U-W Thomale
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Pediatric Neurosurgery, Augustenburger Platz 1, 13353, Berlin, Germany.
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Kaba HEJ, Hasenkamp J, Tas H, Schulz M, Streit F, Eiffert H, Wulf G, Truemper L, Binder L, Kaase M, Scheithauer S. Drug monitoring during ciprofloxacin prophylaxis of allogeneic stem cell transplant patients: associations with bacterial infections through a monocentric observational prospective study. J Hosp Infect 2024; 143:160-167. [PMID: 37939885 DOI: 10.1016/j.jhin.2023.10.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 04/05/2023] [Revised: 10/13/2023] [Accepted: 10/30/2023] [Indexed: 11/10/2023]
Abstract
BACKGROUND Bacterial infection ranks amongst the most common causes of morbidity and mortality in patients undergoing allogeneic haematopoietic stem cell transplantation (alloHSCT). Although ciprofloxacin (CIP) prophylaxis is recommended, information on serum levels and clinical course is lacking. AIM To investigate relationships between CIP level and failure of prophylaxis, particularly in terms of whether different pharmacokinetic (PK) indices [area under the concentration-time curve (AUC0-24h) vs single time samples] correlate differently with the outcome. METHODS This prospective observational monocentric study was conducted at a 1500-bed teaching hospital (March 2018-March 2019), including 63 adult patients with alloHSCT receiving CIP prophylaxis. Blood samples were drawn at three sampling times (1, 6 and 12 h post-administration), twice per week, and measured via high performance liquid chromatography. The onset of febrile episodes (FEBs) indicated suspected failure of CIP prophylaxis. Positive blood cultures [bloodstream infection (BSI)] indicated confirmed failure of prophylaxis. FINDINGS Seven of 63 patients died without significant differences in their average CIP levels compared with survivors, with patients experiencing FEBs (54/63) displaying a 13% [95% confidence interval (CI) 4-22%] lower probability of survival. In total, 225 sets of three values (triplets) were obtained from 58 primary CIP episodes. Triplets preceding BSI with Gram-negative bacteria (GNB-BSI) showed lower AUC0-24h on average, but similar single time sample indices. An AUC0-24h of ≤21.61 mgh/L resulted in four-fold higher odds of GNB-BSI (adjusted odds ratio 3.96, 95% CI 1.21-13.00). These results were independent of the administration route, patient demographics or sampling protocol deviations, indicating reduced CIP exposure upon GNB-BSI events. CONCLUSION Monitoring CIP levels, using multiple sampling times, may be useful to reduce alloHSCT-associated bacterial infections. Further analysis is needed to investigate causality.
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Affiliation(s)
- H E J Kaba
- Department of Infection Control and Infectious Diseases, University Medical Centre Göttingen, Georg-August University of Göttingen, Göttingen, Germany
| | - J Hasenkamp
- Department of Haematology and Medical Oncology, Göttingen Comprehensive Cancer Centre, University Medical Centre Göttingen, Georg-August University of Göttingen, Göttingen, Germany
| | - H Tas
- Department of Infection Control and Infectious Diseases, University Medical Centre Göttingen, Georg-August University of Göttingen, Göttingen, Germany; Department of Haematology and Medical Oncology, Göttingen Comprehensive Cancer Centre, University Medical Centre Göttingen, Georg-August University of Göttingen, Göttingen, Germany
| | - M Schulz
- Department of Infection Control and Infectious Diseases, University Medical Centre Göttingen, Georg-August University of Göttingen, Göttingen, Germany
| | - F Streit
- Institute for Clinical Chemistry, University Medical Centre Göttingen, Georg-August University of Göttingen, Göttingen, Germany
| | - H Eiffert
- Institute of Medical Microbiology and Virology, University Medical Centre Göttingen, Georg-August University of Göttingen, Göttingen, Germany; mbeds Holding GmbH, Göttingen, Germany
| | - G Wulf
- Department of Haematology and Medical Oncology, Göttingen Comprehensive Cancer Centre, University Medical Centre Göttingen, Georg-August University of Göttingen, Göttingen, Germany
| | - L Truemper
- Department of Haematology and Medical Oncology, Göttingen Comprehensive Cancer Centre, University Medical Centre Göttingen, Georg-August University of Göttingen, Göttingen, Germany
| | - L Binder
- Institute for Clinical Chemistry, University Medical Centre Göttingen, Georg-August University of Göttingen, Göttingen, Germany
| | - M Kaase
- Department of Infection Control and Infectious Diseases, University Medical Centre Göttingen, Georg-August University of Göttingen, Göttingen, Germany
| | - S Scheithauer
- Department of Infection Control and Infectious Diseases, University Medical Centre Göttingen, Georg-August University of Göttingen, Göttingen, Germany.
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Rathmann W, Seidel-Jacobs E, Hering R, Schulz M, Hoyer A, Tönnies T. Age at type 2 diabetes diagnosis among adults in Germany in 2014, 2019 and 2020. Acta Diabetol 2023; 60:1591-1593. [PMID: 37482567 PMCID: PMC10520177 DOI: 10.1007/s00592-023-02162-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 07/16/2023] [Indexed: 07/25/2023]
Affiliation(s)
- Wolfgang Rathmann
- Institute for Biometrics and Epidemiology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University, Auf'm Hennekamp 65, 40225, Düsseldorf, Germany.
- German Center for Diabetes Research, Partner Düsseldorf, Munich-Neuherberg, Germany.
| | - Esther Seidel-Jacobs
- Institute for Biometrics and Epidemiology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University, Auf'm Hennekamp 65, 40225, Düsseldorf, Germany
- German Center for Diabetes Research, Partner Düsseldorf, Munich-Neuherberg, Germany
| | - Ramona Hering
- Department of Data Science and Healthcare Analyses, Central Research Institute for Ambulatory Healthcare in Germany (Zi), Berlin, Germany
| | - Mandy Schulz
- Department of Data Science and Healthcare Analyses, Central Research Institute for Ambulatory Healthcare in Germany (Zi), Berlin, Germany
| | - Annika Hoyer
- Biostatistics and Medical Biometry, Medical School EWL, Bielefeld University, Bielefeld, Germany
| | - Thaddäus Tönnies
- Institute for Biometrics and Epidemiology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University, Auf'm Hennekamp 65, 40225, Düsseldorf, Germany
- German Center for Diabetes Research, Partner Düsseldorf, Munich-Neuherberg, Germany
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Messiha D, Petrikhovich O, Lortz J, Pinsdorf D, Hogrebe K, Knuschke R, Hering R, Schulz M, Rassaf T, Rammos C. Underutilization of guideline-recommended therapy in patients 80 years and older with peripheral artery diseases. VASA 2023; 52:379-385. [PMID: 37867477 DOI: 10.1024/0301-1526/a001094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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] [Indexed: 10/24/2023]
Abstract
Background: Ageing is a major cardiovascular risk factor with detrimental changes that culminate in a high atherosclerotic burden. Peripheral artery disease (PAD) is a major manifestation of atherosclerosis with high mortality. Guideline-recommended treatment is essential, however implementation is inadequate. With an ageing society, age-related inequalities are important and have not been elucidated in a high-risk PAD population on a nation-wide scale. We sought to analyse outpatient treatment structures and guideline adherence in treatment of PAD patients older than 80 years. Patients and methods: The study is based on ambulatory claims data comprising 70.1 million statutorily insured patients per year in Germany from 2009 to 2018. We analysed age-related differences in prevalence, pharmacotherapy and specialized outpatient care in PAD patients. Results: Of 17,633,970 PAD patients included, 28% were older than 80 years. PAD prevalence increased between 2008 and 2018 (1.85% vs. 3.14%), with the proportion of older patients increasing by a third (24.4% vs. 31.2%). Octogenarians were undertreated regarding guideline-recommended statin pharmacotherapy compared to younger patients while antiplatelets were prescribed more often (statins 2016: 46.5% vs. 52.4%; antiplatelets 2016 30.6% vs. 29.3%; p<.05). Furthermore, octogenarians received less specialized outpatient care (angiology: 6.4% vs. 9.5%, vascular surgery: 8.1% vs. 11.8%, cardiology: 25.2% vs. 29.2%, p<.05). Conclusions: Our results demonstrate that age-related differences in pharmacotherapy and specialized outpatient care of PAD patients are evident. While overall guideline-recommended outpatient treatment is low, patients 80 years and older are less likely to receive both, leaving age-related health inequalities a challenge of our future.
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Affiliation(s)
- Daniel Messiha
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center, University of Duisburg-Essen, Germany
| | - Olga Petrikhovich
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center, University of Duisburg-Essen, Germany
| | - Julia Lortz
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center, University of Duisburg-Essen, Germany
| | - David Pinsdorf
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center, University of Duisburg-Essen, Germany
| | - Kristina Hogrebe
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center, University of Duisburg-Essen, Germany
| | - Ramtin Knuschke
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center, University of Duisburg-Essen, Germany
| | - Ramona Hering
- Department of Data Science and Healthcare Analyses, Central Research Institute for Ambulatory Healthcare in Germany (Zi), Berlin, Germany
| | - Mandy Schulz
- Department of Data Science and Healthcare Analyses, Central Research Institute for Ambulatory Healthcare in Germany (Zi), Berlin, Germany
| | - Tienush Rassaf
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center, University of Duisburg-Essen, Germany
| | - Christos Rammos
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center, University of Duisburg-Essen, Germany
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Früh A, Schaumann A, Cohrs G, Pennacchietti V, Schulz M, Hernáiz Driever P, Koch A, Thomale UW. Biopsies of caudal brainstem tumors in pediatric patients - a single center retrospective case series. World Neurosurg 2023:S1878-8750(23)00754-4. [PMID: 37271255 DOI: 10.1016/j.wneu.2023.05.108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 03/20/2023] [Revised: 05/26/2023] [Accepted: 05/27/2023] [Indexed: 06/06/2023]
Abstract
OBJECTIVE The indication for performing biopsies in patients with diffuse lesions in the brain stem is controversial. Possible risks associated with the technical challenging interventions need to be balanced against clarifying the diagnosis and possible therapeutic options. We reviewed the feasibility, risk profile and diagnostic yield of different biopsy techniques in a pediatric cohort. METHODS We retrospectively included all patients under 18 years of age that received a biopsy of the caudal brainstem region (pons, medulla oblongata) at our pediatric neurosurgical center from 2009-2022. RESULTS We identified 27 children. Biopsies were performed using frameless stereotactic (Varioguide) (n=12), robotic assisted (Autoguide) (n=4), endoscopic (n=3) and open biopsy (n=8) technique. Intervention related mortality was not observed. Three patients experienced transient post-surgical neurological deficit. No patient showed intervention related permanent morbidity. Biopsy yielded histopathological diagnosis in all cases. Molecular analysis was feasible in 97% of cases. Most common diagnosis was H3K27M mutated diffuse midline glioma (60%). Low-grade gliomas were identified in 14%. Overall survival was 62.5% after 24 months of follow up. CONCLUSION Biopsies of the caudal brainstem in children were feasible and safe in the presented setup. The amount of acquired tumor material allowing integrated diagnosis and was obtained at reasonable risk. The selection of the surgical technique depends on tumor location and growth pattern. We recommend brainstem tumor biopsies in children being performed at specialized centers to better understand the biology and enable possible novel therapeutic options.
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Affiliation(s)
- A Früh
- Pediatric Neurosurgery, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Augustenburger Platz 1, 13353, Berlin, German; Department of Neurosurgery, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - A Schaumann
- Pediatric Neurosurgery, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Augustenburger Platz 1, 13353, Berlin, German
| | - G Cohrs
- Pediatric Neurosurgery, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Augustenburger Platz 1, 13353, Berlin, German
| | - V Pennacchietti
- Pediatric Neurosurgery, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Augustenburger Platz 1, 13353, Berlin, German
| | - M Schulz
- Pediatric Neurosurgery, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Augustenburger Platz 1, 13353, Berlin, German
| | - P Hernáiz Driever
- Department of Pediatric Oncology/Hematology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - A Koch
- Department of Neuropathology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - U-W Thomale
- Pediatric Neurosurgery, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Augustenburger Platz 1, 13353, Berlin, German.
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Enners S, Gradl G, Kieble M, Iliescu O, Freudewald L, Said A, Schulz M. Increased Demand for Pharmaceutical Drugs Containing Potassium Iodide In Connection with the Russia-Ukraine Conflict. Pharmazie 2023; 78:17-19. [PMID: 37138408 DOI: 10.1691/ph.2023.2541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
The current conflict between Russia and Ukraine increased concerns in the German population of a release of radioactive substances, e.g.radioactive iodine. A high dose of potassium iodide (PI) may prevent accumulation of radioactive iodine in the thyroid gland. Therefore, the German government keeps a sufficient quantity of PI in stock for public supply in case of an emergency. We investigated ambulatory drug dispensing rates of PI and found that the total dispensing of PI (statutory health insurance (SHI), private health insurance (PHI), and overthe-counter (OTC)) increased by 106% from February to March 2022. Changes in PI dispensing were mainly due to an increase in OTC sales, where PI as an antidote showed a sevenfold increase from around 930 packages (February 2022) to 6,500 packages (March 2022), while SHI and PHI dispensing remained relatively low. Furthermore, we investigated whether these changes in dispensing raised the number of suspected adverse drug reactions (ADR). We found no increase of ADR reports related to the use of PI-containing medicinal products between February and September 2022, neither in our national pharmacovigilance nor in the European EudraVigilance database. The data suggest that the mere possibility of a nuclear disaster in Ukraine raised the demand of PI in Germany. Thus, timely and proactive information and reassurance of the public of supply reliability by the Government in a case of a nuclear emergency could be helpful in preventing potential drug shortages and unfounded concern.
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Affiliation(s)
- S Enners
- German Institute for Drug Use Evaluation (DAPI), Freie Universität Berlin, Berlin, Germany; German Institute for Drug Use Evaluation (DAPI), Heidestr. 7, 10557 Berlin, Germany;,
| | - G Gradl
- German Institute for Drug Use Evaluation (DAPI), Freie Universität Berlin, Berlin, Germany
| | - M Kieble
- German Institute for Drug Use Evaluation (DAPI), Freie Universität Berlin, Berlin, Germany
| | - O Iliescu
- Drug Commission of German Pharmacists (AMK), Freie Universität Berlin, Berlin, Germany
| | - L Freudewald
- Drug Commission of German Pharmacists (AMK), Freie Universität Berlin, Berlin, Germany
| | - A Said
- Drug Commission of German Pharmacists (AMK), Freie Universität Berlin, Berlin, Germany
| | - M Schulz
- German Institute for Drug Use Evaluation (DAPI), Freie Universität Berlin, Berlin, Germany; Drug Commission of German Pharmacists (AMK), Freie Universität Berlin, Berlin, Germany; Institute of Pharmacy, Freie Universität Berlin, Berlin, Germany; German Institute for Drug Use Evaluation (DAPI), Heidestr. 7, 10557 Berlin, Germany;,
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Sandoval C, Villagrán F, Recabarren B, Schulz M, Souza-Mello V. Effectiveness of supplementation to potentiate lean mass gain during resistance training: A systematic review. Sci Sports 2023. [DOI: 10.1016/j.scispo.2022.05.008] [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: 04/05/2023]
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9
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Tönnies T, Hoyer A, Brinks R, Kuss O, Hering R, Schulz M. Spatio-Temporal Trends in the Incidence of Type 2 Diabetes in Germany-Analysis of the Claims Data of 63 Million Persons With Statutory Health Insurance From 2014 to 2019. Dtsch Arztebl Int 2023; 120:173-179. [PMID: 36647586 DOI: 10.3238/arztebl.m2022.0405] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 09/08/2022] [Accepted: 12/14/2022] [Indexed: 01/18/2023]
Abstract
BACKGROUND There are no data on recent trends in the incidence rate of type 2 diabetes (T2D) in Germany. The aim of this study was to determine the sex-, age-, and region-specific trends in the T2D incidence rate between 2014 and 2019. METHODS Based on nationwide data from statutorily insured persons in Germany, negative binomial regression models were used to analyze age- and sex-specific trends in the T2D incidence rate. Ageand sex-adjusted trends were calculated for 401 administrative districts using a Bayesian spatiotemporal regression model. RESULTS During the period concerned, approximately 450 000 new cases of T2D were observed each year among some 63 million persons. Taking all age groups together, the incidence rate decreased in both women and men, from 6.9 (95% confidence interval [6.7; 7.0]) and 8.4 [8.2; 8.6] respectively per 1000 persons in 2014 to 6.1 [5.9; 6.3] and 7.7 [7.5; 8.0] per 1000 persons in 2019. This corresponds to an annual reduction of 2.4% [1.5; 3.2] for women and 1.7% [0.8; 2.5] for men. The incidence rate increased in the age group 20-39 years. The age- and sex-adjusted incidence rate decreased in almost all districts, although regional differences persisted. CONCLUSION The T2D incidence rate should be closely monitored to see whether the decreasing trend continues. One must not forget that the prevalence can rise despite decreasing incidence. For this reason, the findings do not necessarily mean a decrease in the disease burden of T2D and the associated demand on healthcare resources.
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March S, Hoffmann F, Andrich S, Gothe H, Icks A, Meyer I, Nimptsch U, Scholten N, Schulz M, Semler SC, Stallmann C, Swart E, Ihle P. [Research Data Center on Health - Vision for Further Development from the Research Perspective]. Gesundheitswesen 2023; 85:S145-S153. [PMID: 36940696 PMCID: PMC10103700 DOI: 10.1055/a-1999-7436] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
The German research data center for health will provide claims data of statutory health insurances. The data center was set up at the medical regulatory body BfArM pursuant to the German data transparency regulation (DaTraV). The data provided by the center will cover about 90% of the German population, supporting research on healthcare issues, including questions of care supply, demand and the (mis-)match of both. These data support the development of recommendations for evidence-based healthcare. The legal framework for the center (including §§ 303a-f of Book V of the Social Security Code and two subsequent ordinances) leaves a considerable degree of freedom when it comes to organisational and procedural aspects of the center's operation. The present paper addresses these degrees of freedom. From the point of view of researchers, ten statements show the potential of the data center and provide ideas for its further and sustainable development.
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Affiliation(s)
- Stefanie March
- Fachbereich Soziale Arbeit, Gesundheit und Medien, Hochschule Magdeburg-Stendal, Magdeburg, Germany
| | - Falk Hoffmann
- Fakultät für Medizin und Gesundheitswissenschaft, Department für Versorgungsforschung, Carl von Ossietzky Universität Oldenburg, Oldenburg, Germany
| | - Silke Andrich
- Institut für Versorgungsforschung und Gesundheitsökonomie, Centre for Health and Society, Medizinische Fakultät und Universitätsklinikum Düsseldorf, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Germany
- Institut für Versorgungsforschung und Gesundheitsökonomie, Deutsches Diabetes-Zentrum (DDZ), Leibniz-Zentrum für Diabetes-Forschung an der Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Germany
| | - Holger Gothe
- Lehrstuhl Gesundheitswissenschaften/Public Health, Medizinische Fakultät Carl Gustav Carus, TU Dresden, Dresden, Germany
- Department für Public Health, Versorgungsforschung und Health Technology Assessment, UMIT, Hall in Tirol, Austria
- Abteilung Information und Kommunikation (IK), Hochschule Hannover, Fakultät III, Hannover, Germany
| | - Andrea Icks
- Institut für Versorgungsforschung und Gesundheitsökonomie, Centre for Health and Society, Medizinische Fakultät und Universitätsklinikum Düsseldorf, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Germany
- Institut für Versorgungsforschung und Gesundheitsökonomie, Deutsches Diabetes-Zentrum (DDZ), Leibniz-Zentrum für Diabetes-Forschung an der Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Germany
| | - Ingo Meyer
- PMV forschungsgruppe an der Medizinischen Fakultät und Uniklinik Köln, Universität zu Köln, Köln, Germany
| | - Ulrike Nimptsch
- Fachgebiet Management im Gesundheitswesen, Technische Universität (TU) Berlin, Berlin, Germany
| | - Nadine Scholten
- Universität zu Köln, Medizinische Fakultät und Uniklinik Köln, Institut für Medizinsoziologie, Versorgungsforschung und Rehabilitationswissenschaft, Lehrstuhl für Versorgungsforschung, Köln, Germany
| | - Mandy Schulz
- Fachbereich Versorgungsanalysen, Zentralinstitut für die kassenärztliche Versorgung in Deutschland (Zi), Berlin, Germany
| | - Sebastian Claudius Semler
- TMF - Technologie- und Methodenplattform für die vernetzte medizinische Forschung e.V., Berlin, Germany
| | - Christoph Stallmann
- Institut für Sozialmedizin und Gesundheitssystemforschung, Medizinische Fakultät der Otto-von-Guericke-Universität Magdeburg, Magdeburg, Germany
| | - Enno Swart
- Institut für Sozialmedizin und Gesundheitssystemforschung, Medizinische Fakultät der Otto-von-Guericke-Universität Magdeburg, Magdeburg, Germany
| | - Peter Ihle
- PMV forschungsgruppe an der Medizinischen Fakultät und Uniklinik Köln, Universität zu Köln, Köln, Germany
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11
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Messiha D, Petrikhovich O, Lortz J, Mahabadi AA, Hering R, Schulz M, Rassaf T, Rammos C. Income-Related Peripheral Artery Disease Treatment: A Nation-Wide Analysis from 2009-2018. J Cardiovasc Dev Dis 2022; 9:392. [PMID: 36421927 PMCID: PMC9697322 DOI: 10.3390/jcdd9110392] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 10/23/2022] [Revised: 11/09/2022] [Accepted: 11/12/2022] [Indexed: 08/24/2023] Open
Abstract
Economic status has a measurable and significant effect on cardiovascular health. Socioeconomic- and income-related disparities worsen cardiovascular risk factors. Peripheral artery disease (PAD) remains a major risk factor for morbidity and mortality. Not all patients benefit equally from recent advances in outpatient healthcare. The implementation of guideline recommendations regarding treatment is inadequate. Income-related disparities for PAD treatment are unknown. We aimed to analyse income-stratified PAD prevalence, outpatient treatment and pharmacotherapy. Associations of statutory health insurance physicians at the regional level, income-stratified PAD prevalence and differences in outpatient care and pharmacotherapy were analysed in 70.1 million statutorily insured patients/year between 2009 and 2018. Analysis was based on claims data (§295 of the social code (SGB V)) and drug-prescription data (§300 SGB V). The diagnosis of PAD was defined by ICD I70.2-9. Regional income data were derived from the German Census Bureau. PAD prevalence was higher in low-income than in high-income areas. Low-income patients more often presented to angiology outpatient care and more frequently received guideline recommended pharmacotherapy. High-income patients more often presented to outpatient vascular surgery. This was true for statins, antiplatelets, intermittent claudication and critical limb ischemia alike. These data indicate that PAD and income are associated. Regional income is related to insufficiencies in guideline-recommended treatment and contact to vascular specialists. Our results aim to encourage medical professionals to implement PAD guideline recommendations, especially in high-income areas. Further studies on associations between spatial-level income and healthcare in PAD are needed.
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Affiliation(s)
- Daniel Messiha
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Centre, University of Duisburg-Essen, 45147 Essen, Germany
| | - Olga Petrikhovich
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Centre, University of Duisburg-Essen, 45147 Essen, Germany
| | - Julia Lortz
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Centre, University of Duisburg-Essen, 45147 Essen, Germany
| | - Amir Abbas Mahabadi
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Centre, University of Duisburg-Essen, 45147 Essen, Germany
| | - Ramona Hering
- Department of Data Science and Healthcare Analyses, Central Research Institute for Ambulatory Healthcare in Germany (Zi), 10587 Berlin, Germany
| | - Mandy Schulz
- Department of Data Science and Healthcare Analyses, Central Research Institute for Ambulatory Healthcare in Germany (Zi), 10587 Berlin, Germany
| | - Tienush Rassaf
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Centre, University of Duisburg-Essen, 45147 Essen, Germany
| | - Christos Rammos
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Centre, University of Duisburg-Essen, 45147 Essen, Germany
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12
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Lerret N, Owaja C, Schulz M, Roback-Navarro E. Hyperglycemia Alters the CD27:CD70 Axis of Human Immune Cells. Am J Clin Pathol 2022. [DOI: 10.1093/ajcp/aqac126.085] [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: 11/11/2022] Open
Abstract
Abstract
Introduction/Objective
The exact mechanism that inflammation plays in the pathogenesis from obesity to Type 2 diabetes is unclear, however, activated immune cells and pro-inflammatory cytokines have been found in the adipose tissue of Type 2 diabetics, implicating their role in the disease process. While the CD27-CD70 axis is being explored in other models of chronic inflammation, such as rheumatoid arthritis and colitis, the role played in Type 2 diabetes remains unknown.
Objective
Evaluate whether hyperglycemia alters immune cells phenotype and effector function, specifically of the CD27:CD70 axis on human immune cells.
Methods/Case Report
Human peripheral blood from donors was divided into three groups. n=40 total those that have a healthy blood glucose value and are without any co-morbidities (normoglycemic), patients identified as having pre-diabetes per their hemoglobin A1c (HgbA1c) value (5.6-6.5%), and patients with diabetes, having an elevated blood glucose and HgbA1c value (> 6.5%). The blood was then stained with monoclonal antibodies towards cell surface markers associated with inflammation, including CD27/CD70 and analyzed via flow cytometry. Previous data using cell cultures of human PBMC-derived T cells and autologous dendritic cells exposed to varing concentrations of glucose to simulate hyperglycemia and pre-diabetes was compared to this data.
Results (if a Case Study enter NA)
1) T cells directly analyzed from pre-diabetic and hyperglycemia individuals down-regulate their CD27 expression. CD70 is up-regulated on immune cells directly analyzed from pre-diabetic individual when compared to immune cells from normoglycemic individuals. In accordance with the above resutls, CD4 T cells have an activated effector phenotype after co-culture with glucose stimulated dendritic cells. This includes down-regulation of CD27 on T cells and up-regulation of CD70 on dendritic cells.
Conclusion
Our data shows that certain markers of inflammation are up-regulated on the surface of immune cells from pre-diabetic and/or diabetic patients. Specifically, we demonstrate novel evidence that the CD27-CD70 axis is activated in diabetes or hyperglycemic conditions. These molecules may offer a potential target for therapeutics. Alternatively, our findings would allow a further way to characterize where a patient with an elevated blood glucose value is on the spectrum between pre-diabetes and full-blown diabetes.
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Affiliation(s)
- N Lerret
- Medical Laboratory Science, Rush University , Chicago, Illinois , United States
| | - C Owaja
- Medical Laboratory Science, Rush University , Chicago, Illinois , United States
| | - M Schulz
- Medical Laboratory Science, Rush University , Chicago, Illinois , United States
| | - E Roback-Navarro
- Medical Laboratory Science, Rush University , Chicago, Illinois , United States
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13
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Messiha D, Petrikhovich O, Lortz J, Mahabadi AA, Hering R, Schulz M, Rassaf T, Rammos C. Income-based differences in outpatient care of peripheral artery diseases in Germany. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1960] [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
Peripheral artery disease (PAD) is a major manifestation of atherosclerosis and a risk factor for morbidity and mortality. Guideline-recommended therapy and specialized outpatient care are essential for optimal treatment. Income-based inequalities in diagnosis and treatment of cardiovascular diseases are present, while differences for PAD are scarse. Knowledge of the treatment structures in the outpatient setting are essential to identify and solve income-based inequalities in this high-risk population.
Purpose
Aim of the study was to identify income-based inequalities in outpatient treatment care and pharmacotherapy in PAD patients.
Methods
We analyzed income-based differences in PAD prevalence, pharmacotherapy (statins, antiplatelets) and treatment by specialized outpatient care (angiology, vascular surgery, cardiology) in all statutorily insured patients with PAD presenting to outpatient care facilities in Germany between 2009 and 2018. The study is based on ambulatory claims data of the panel doctors' services according to §295 SGB V and drug prescription data according to §300 SGB V. Diagnosis of PAD was defined upon medical diagnoses of PAD ICD I70.2-9. Statistical analysis was performed with chi-squared test for trend and two-way Anova.
Results
Overall, 17,633,970 patients were included in the study. Prevalence of PAD was higher in low-income states. This income-driven gap widened between 2009 (2.3% vs 1.7%) and 2018 (4.4% vs 2.8%). Angiology outpatient care density was higher in low-income states, whereas vascular surgery and cardiology outpatient care density was higher in high-income states (p<0.05). While overall specialised outpatient care was underutilized, patients in low-income states were more likely to present to angiologists, while patients in high-income states more frequently presented to vascular surgeons. Patients with more progressed PAD stages were less likely to present to a specialist and to receive guideline recommended medical therapy, irrespective of the income-structure.
Pharmacotherapy also showed income-based differences. While overall prescription rates of statins and antiplatelet drugs were low, patients in low-income states had higher prescription rates than patients in high-income states. The income-driven gap decreased between 2009 and 2016 (statins: 2009 60% vs 48%; 2016 68% vs 65%; antiplatelets: 2009 50% vs 39%; 2016 53% vs 51%).
Conclusion
Our results demonstrate that income-based differences in pharmacotherapy and specialized outpatient care of PAD patients are evident in Germany. While overall outpatient treatment by vascular specialists and guideline recommended medical therapy with antiplatelets and statins are low, German low-income states have higher PAD prevalence, a higher angiology than vascular surgery density and higher prescription rates of guideline recommended pharmacotherapy.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- D Messiha
- University of Duisburg-Essen - West-German Heart and Vascular Center , Essen , Germany
| | - O Petrikhovich
- University of Duisburg-Essen - West-German Heart and Vascular Center , Essen , Germany
| | - J Lortz
- University of Duisburg-Essen - West-German Heart and Vascular Center , Essen , Germany
| | - A A Mahabadi
- University of Duisburg-Essen - West-German Heart and Vascular Center , Essen , Germany
| | - R Hering
- Central Research Institute for Ambulatory Healthcare in Germany, Department of Data Science and Healthcare Analyses , Berlin , Germany
| | - M Schulz
- Central Research Institute for Ambulatory Healthcare in Germany, Department of Data Science and Healthcare Analyses , Berlin , Germany
| | - T Rassaf
- University of Duisburg-Essen - West-German Heart and Vascular Center , Essen , Germany
| | - C Rammos
- University of Duisburg-Essen - West-German Heart and Vascular Center , Essen , Germany
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14
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Cremer S, Katsaouni N, Abplanalp WT, Berkowitsch A, Kirschbaum K, Rieger M, Rapp S, Wild P, Dimmeler S, Schulz M, Zeiher A. Interaction of inherited genetic variants in the NLRP3 inflammasome/IL-6 pathway with acquired clonal hematopoiesis to modulate mortality risk in patients with HFrEF. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.832] [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: 11/14/2022] Open
Abstract
Abstract
Aims
Clonal hematopoiesis (CH), defined as the presence of an expanded somatic blood cell clone due to acquired mutations in leukemia driver genes, was shown to be associated with increased mortality in patients with chronic ischemic heart failure with reduced ejection fraction (HFrEF). Mechanistically, circulating monocytes of mutation carriers display increased expression of proinflammatory genes involved in inflammasome and IL-6 signaling. Inherited single nucleotide variants (SNPs) in the IL-6 pathway are well known to affect inflammatory activation. Therefore, we investigated whether known SNPs in genes encoding for components of the inflammasome/IL-6 signaling pathway modulate fatal outcomes in HFrEF patients with CH.
Methods and results
In a total of 446 patients with chronic HFrEF, peripheral blood or bone marrow mononuclear cells were analyzed for the CH driver mutations DNMT3A and TET2 as well as 40 preselected SNPs affecting genes in the NLRP3 inflammasome/IL-6 signaling pathway. The 103 patients carrying a CH driver mutation demonstrated significantly increased mortality compared to the 343 patients without CH mutations (25,24% vs 13.99% at five years; p=0.0064). We identified three commonly occurring variants known to disrupt IL-6 signaling (rs2228145, rs4129267 and rs4537545) which are in strong linkage disequilibrium and present in more than 50% of CH carriers. As illustrated in Figure 1A, harboring one of those SNPs abrogated the increased mortality risk in patients with HFrEF and CH (p≤0.05 for each SNP). On the contrary, three different SNPs namely rs2250417, which is associated with increased IL-18 levels as well as rs4722172 and rs4845625, which are known to activate IL-6 signaling, were identified to mediate fatal outcomes in patients with HFrEF and CH (p<0.05 for each; Figure 1B). None of the assessed SNPs influenced outcomes in patients without CH. Single cell RNA-sequencing of circulating monocytes of patients with HFrEF revealed increased inflammatory signaling in DNMT3A mutation carriers without protective SNPs with genes upregulated in pathways such as “Cellular response to stress” (FDR −log 24.3), “Regulation of cell activation” (FDR −log 22.7) or “Cytokine signaling in the immune system” (FDR −log18.2).
Conclusion
Among CHIP carriers with HFrEF, inherited variants in loci encoding for genes involved in inflammatory signaling associate with mortality. These data not only provide mechanistic insights into inflammatory mechanisms contributing to fatal outcome of HFrEF in CH carriers but may also inform trials evaluating precision-targeted anti-inflammatory therapy in patients with DNMT3A and TET2 mutations and chronic HFrEF.
Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): German Center of Cardiovascular Research;Cardiopulmonary Institute, Frankfurt, Germany
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Affiliation(s)
- S Cremer
- Johann Wolfgang Goethe University , Frankfurt , Germany
| | - N Katsaouni
- Johann Wolfgang Goethe University , Frankfurt , Germany
| | - W T Abplanalp
- Johann Wolfgang Goethe University , Frankfurt , Germany
| | - A Berkowitsch
- Johann Wolfgang Goethe University , Frankfurt , Germany
| | - K Kirschbaum
- Johann Wolfgang Goethe University , Frankfurt , Germany
| | - M Rieger
- Johann Wolfgang Goethe University , Frankfurt , Germany
| | - S Rapp
- Center for Thrombosis and Hemostasis , Mainz , Germany
| | - P Wild
- Center for Thrombosis and Hemostasis , Mainz , Germany
| | - S Dimmeler
- Johann Wolfgang Goethe University , Frankfurt , Germany
| | - M Schulz
- Johann Wolfgang Goethe University , Frankfurt , Germany
| | - A Zeiher
- Johann Wolfgang Goethe University , Frankfurt , Germany
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15
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Klein F, Schleithoff J, Schulz M, Webel K, Foullois H, Loehr M, Kronmueller KT. Development and validation of the German translation of the views on inpatient care (VOICE-DE) outcome measure to assess service users’ perceptions of inpatient psychiatric care. J Ment Health 2022; 32:560-566. [DOI: 10.1080/09638237.2022.2118691] [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)
- F. Klein
- Department of Psychiatry and Psychotherapy, LWL-Klinikum Gütersloh, Gütersloh, Germany
| | - J. Schleithoff
- Department of Psychiatry and Psychotherapy, LWL-Klinikum Gütersloh, Gütersloh, Germany
| | - M. Schulz
- Department of Psychiatry and Psychotherapy, LWL-Klinikum Gütersloh, Gütersloh, Germany
- Diaconic University of Applied Sciences, Bielefeld, Germany
- Institute of Health and Nursing sciences, Martin-Luther-University Halle Wittenberg, Halle, Germany
| | - K. Webel
- Department of Psychiatry and Psychotherapy, LWL-Klinikum Gütersloh, Gütersloh, Germany
| | - H. Foullois
- Department of Hospitals and Healthcare, Landschaftsverband Westfalen-Lippe, Münster, Germany
| | - M. Loehr
- Department of Psychiatry and Psychotherapy, LWL-Klinikum Gütersloh, Gütersloh, Germany
- Diaconic University of Applied Sciences, Bielefeld, Germany
| | - K.-T. Kronmueller
- Department of Psychiatry and Psychotherapy, LWL-Klinikum Gütersloh, Gütersloh, Germany
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16
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Simon M, Kuschel LP, von Hoff K, Hernáiz Driever P, Hain EG, Koch A, Capper D, Schulz M, Thomale U, Euskirchen P. P04.03.B Rapid DNA methylation-based classification of pediatric brain tumors from ultrasonic aspirate specimens. Neuro Oncol 2022. [DOI: 10.1093/neuonc/noac174.118] [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
Cavitating ultrasonic aspirator (CUSA) devices are commonly used in neurosurgical procedures to carefully debulk tumor from adjacent healthy brain tissue. Here, we explore the feasibility of using ultrasonic minced tumor tissue to classify otherwise discarded sample material by DNA methylation according to the respective World Health Organization (WHO) Classification of Tumors of the Central Nervous System (CNS) using low pass nanopore whole genome sequencing.
Material and Methods
21 ultrasonic aspirated specimens from patients undergoing surgery in the department of pediatric neurosurgery at the Charité-Universitätsmedizin Berlin with either newly diagnosed cerebral lesions or pre-treated lesions were processed by nanopore sequencing to generate copy number profiles and ad-hoc random forest classification. Results were compared to microarray-based routine profiling. Tumor purity was assessed.
Results
In 19/21 (90.5 %) samples the minimum amount of 1,000 CpG sites were sequenced. In 20/21 (95.2 %) cases copy number variation profiles could be generated and matched microarray derived copy number profiles, allowing for identification of diagnostically or therapeutically relevant pathognomonic alterations. 12/17 (70.6 %) samples were concordantly classified to the corresponding microarray-based diagnosis by routine neuropathological workup. Applying recently defined thresholds for nanopore-based classification resulted in sensitivity of 64.7 % and specificity of 100 %.
Conclusion
CUSA referred sample material of pediatric brain tumors allows for methylation-based classification according to the respective WHO classification of CNS tumors with acceptable sensitivity and high specificity. Hereby, a promising opportunity for accurate classification of pediatric brain tumors by a time- and cost-efficient advanced molecular technique is offered using otherwise discarded tumor tissue.
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Affiliation(s)
- M Simon
- Charité Universitätsmedizin Berlin - Department of Pediatric Oncology and Hematology , Berlin , Germany
| | - L P Kuschel
- Charité Universitätsmedizin Berlin - Department of Neurology with Experimental Neurology , Berlin , Germany
| | - K von Hoff
- Charité Universitätsmedizin Berlin - Department of Pediatric Oncology and Hematology , Berlin , Germany
| | - P Hernáiz Driever
- Charité Universitätsmedizin Berlin - Department of Pediatric Oncology and Hematology , Berlin , Germany
| | - E G Hain
- Charité Universitätsmedizin Berlin - Department of Neuropathology , Berlin , Germany
| | - A Koch
- Charité Universitätsmedizin Berlin - Department of Neuropathology , Berlin , Germany
| | - D Capper
- Charité Universitätsmedizin Berlin - Department of Neuropathology , Berlin , Germany
- German Cancer Consortium (DKTK), Partner Site Berlin, German Cancer Research Center (DKFZ) , Heidelberg , Germany
| | - M Schulz
- Charité Universitätsmedizin Berlin - Department of Pediatric Neurosurgery , Berlin , Germany
| | - U Thomale
- Charité Universitätsmedizin Berlin - Department of Pediatric Neurosurgery , Berlin , Germany
| | - P Euskirchen
- Charité Universitätsmedizin Berlin - Department of Neurology with Experimental Neurology , Berlin , Germany
- German Cancer Consortium (DKTK), Partner Site Berlin, German Cancer Research Center (DKFZ) , Heidelberg , Germany
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17
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Weih M, Köhler S, Schöll N, Schulz M, Hering R. Mental, Neurological, and Somatic Comorbidities and Their Treatment in Persons With Intellectual Disability. Dtsch Arztebl Int 2022; 119:418-414. [PMID: 35506265 PMCID: PMC9533706 DOI: 10.3238/arztebl.m2022.0193] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 11/03/2021] [Accepted: 04/05/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Persons with intellectual disability (ID) often suffer from significant comorbidities. As data have been lacking until now, the present report is the first one containing outpatient data on the prevalence of ID in Germany, its comorbidities, and outpatient (drug) treatment. METHODS This study is based on the nationwide outpatient billing data and drug prescription data of all SHI-insured adults (SHI, statutory health insurance) (age 18-109) who were seen at least once in an outpatient medical practice in 2018. Patients with at least two F70-F79 diagnoses in two quarters were included in the study group (SG) (n = 324 428). A random sample of patients without ID served as the control/comparison group (CG) (n = 648 856). The odds ratios (SG vs. CG) for comorbidities, prescriptions of selected classes of drugs, and involvement of medical specialties were each analyzed by multivariate logistic regression. RESULTS The prevalence of ID was 0.55%. ID was found to be associated with a variety of comorbidities. The highest odds ratios [OR] were for infantile cerebral palsy (OR: 121.71; 95% confidence interval: [111.67; 132.67]), autism spectrum disorders (OR: 83.85 [75.54; 93.08]), and developmental disabilities (OR: 61.34 [58.86; 63.94]). The most frequently prescribed drug categories (as classified by the anatomic-therapeutic-chemical (ATC) convention) were psychoactive drugs (antipsychotic, anxiolytic, and hypnotic drugs and sedatives) and antiepileptic drugs (OR: 10.40 [10.27; 10.53] and 9.90 [9.75; 10.05], respectively). Both general practitioners (OR: 2.64 [2.59; 2.69]) and medical specialists were consulted by the SG more frequently than by the CG; the type of specialist most commonly consulted was in the neuropsychiatric field, i.e., a neurologist or psychiatrist (OR: 6.85 [6.77; 6.92]). CONCLUSION A diagnosis of ID frequently appears in outpatient billing data. Future analyses should be devoted to the specific care of people with intellectual disability, who constitute an especially multimorbid and vulnerable patient group.
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Affiliation(s)
- Markus Weih
- Medic-Center: Prof. Dr. med. Markus Weih, Facharzt für Neurologie, Psychiatrie-Psychotherapie Professional Association of German Psychiatrists (BVDN)
| | - Sabine Köhler
- Medic-Center: Prof. Dr. med. Markus Weih, Facharzt für Neurologie, Psychiatrie-Psychotherapie Professional Association of German Psychiatrists (BVDN)
| | | | - Mandy Schulz
- Central Research Institute of Ambulatory Health Care in Germany (ZI), Berlin
| | - Ramona Hering
- Central Research Institute of Ambulatory Health Care in Germany (ZI), Berlin
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18
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Gaetano LC, Abdala F, Seoane FD, Tartaglione A, Schulz M, Otero A, Leardi JM, Apaldetti C, Krapovickas V, Steimbach E. A new cynodont from the Upper Triassic Los Colorados Formation (Argentina, South America) reveals a novel paleobiogeographic context for mammalian ancestors. Sci Rep 2022; 12:6451. [PMID: 35468982 PMCID: PMC9038739 DOI: 10.1038/s41598-022-10486-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 03/31/2022] [Indexed: 11/09/2022] Open
Abstract
Probainognathia is a derived lineage of cynodonts which encompass Mammalia as their crown-group. The rich record of probainognathians from the Carnian of Argentina contrasts with their Norian representation, with only one named species. Here we describe a new probainognathian, Tessellatia bonapartei gen. et sp. nov., from the Norian Los Colorados Formation of the Ischigualasto-Villa Unión Basin of Argentina. The new taxon, represented by a partial cranium with associated lower jaws, was analyzed through neutron and X-rays micro-tomography (μCT). The high-resolution neutron μCT data allowed the identification of a unique character combination, including features inaccessible through traditional techniques. We constructed the largest phylogenetic data matrix of non-mammalian cynodonts. The new species and its sister taxon, the Brazilian Therioherpeton cargnini, are recovered as probainognathians, closely related to Mammaliamorpha. We conducted the first quantitative paleobiogeographic analysis of non-mammalian cynodonts, focusing in probainognathians. The results indicate that Probainognathia and Mammaliamorpha originated in southwestern Gondwana (in the Brazilian Paraná Basin), which was an important center of diversification during the Triassic. Finally, the Chinese Lufeng Basin is identified as the ancestral area of Mammaliaformes. These new findings, besides adding to the knowledge of the poorly represented Norian cynodonts from the Los Colorados Formation, are significant to improve our understanding of probainognathian diversity, evolution, and paleobiogeographic history.
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Affiliation(s)
- L C Gaetano
- Instituto de Estudios Andinos "Don Pablo Groeber" (IDEAN, UBA-CONICET), C1428EGA, Ciudad Autónoma de Buenos Aires, Argentina. .,Evolutionary Studies Institute, University of the Witwatersrand, WITS, Johannesburg, 2050, South Africa.
| | - F Abdala
- Evolutionary Studies Institute, University of the Witwatersrand, WITS, Johannesburg, 2050, South Africa.,Unidad Ejecutora Lillo, CONICET-Fundación Miguel Lillo, T4000JFE, San Miguel de Tucumán, Argentina
| | - F D Seoane
- Instituto de Estudios Andinos "Don Pablo Groeber" (IDEAN, UBA-CONICET), C1428EGA, Ciudad Autónoma de Buenos Aires, Argentina
| | - A Tartaglione
- Forschungs-Neutronenquelle Heinz Maier-Leibnitz (FRM II), Technische Universität München, 85747, Garching, Germany
| | - M Schulz
- Forschungs-Neutronenquelle Heinz Maier-Leibnitz (FRM II), Technische Universität München, 85747, Garching, Germany
| | - A Otero
- División Paleontología de Vertebrados (Anexo Laboratorios), Facultad de Ciencias Naturales Y Museo, Universidad Nacional de La Plata, B1900AVW, La Plata, Argentina
| | - J M Leardi
- Instituto de Estudios Andinos "Don Pablo Groeber" (IDEAN, UBA-CONICET), C1428EGA, Ciudad Autónoma de Buenos Aires, Argentina.,Departamento de Biodiversidad y Biología Experimental, Facultad de Ciencias Exactas y Naturales, Universidad de Buenos Aires, C1428EGA, Ciudad Autónoma de Buenos Aires, Argentina
| | - C Apaldetti
- Instituto y Museo de Ciencias Naturales, Universidad Nacional de San Juan, J5400DNQ, San Juan, Argentina
| | - V Krapovickas
- Instituto de Estudios Andinos "Don Pablo Groeber" (IDEAN, UBA-CONICET), C1428EGA, Ciudad Autónoma de Buenos Aires, Argentina
| | - E Steimbach
- Instituto de Estudios Andinos "Don Pablo Groeber" (IDEAN, UBA-CONICET), C1428EGA, Ciudad Autónoma de Buenos Aires, Argentina
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Schulz M, Brinkhuis R, Crean C, Sear RP, Keddie JL. Suppression of self-stratification in colloidal mixtures with high Péclet numbers. Soft Matter 2022; 18:2512-2516. [PMID: 35297936 DOI: 10.1039/d2sm00194b] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
The non-equilibrium assembly of bimodal colloids during evaporative processes is an attractive means to achieve gradient or stratified layers in thick films. Here, we show that the stratification of small colloids on top of large is prevented when the viscosity of the continuous aqueous phase is too high. We propose a model where a too narrow width of the gradient in concentration of small colloids suppresses the stratification.
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Affiliation(s)
- M Schulz
- Department of Physics, University of Surrey, Guildford, Surrey, GU2 7XH, UK.
| | - R Brinkhuis
- Allnex, Nieuwe Kanaal 7N, 6709 PA Wageningen, The Netherlands
| | - C Crean
- Department of Chemistry, University of Surrey, Guildford, Surrey, GU2 7XH, UK
| | - R P Sear
- Department of Physics, University of Surrey, Guildford, Surrey, GU2 7XH, UK.
| | - J L Keddie
- Department of Physics, University of Surrey, Guildford, Surrey, GU2 7XH, UK.
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Schulz M, Mangiapane S, Scherer M, Karagiannidis C, Czihal T. Post-Acute Sequelae of SARS-CoV-2 Infection. Dtsch Arztebl Int 2022; 119:177-178. [PMID: 35583040 PMCID: PMC9215269 DOI: 10.3238/arztebl.m2022.0134] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 12/15/2021] [Accepted: 12/07/2022] [Indexed: 06/15/2023]
Affiliation(s)
- Mandy Schulz
- Central Research Institute for Ambulatory Healthcare in Germany (Zi), Berlin, Germany
| | - Sandra Mangiapane
- Central Research Institute for Ambulatory Healthcare in Germany (Zi), Berlin, Germany
| | - Martin Scherer
- Department of General Practice and Primary Care, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Christian Karagiannidis
- Department of Pneumology and Critical Care Medicine, Cologne-Merheim Hospital, ARDS and ECMO Centre, Kliniken der Stadt Köln, Witten/Herdecke University Hospital, Cologne, Germany
| | - Thomas Czihal
- Central Research Institute for Ambulatory Healthcare in Germany (Zi), Berlin, Germany
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Wilson HHK, Schulz M, Mills L, Lintzeris N. Feasibility and outcomes of a general practice and specialist alcohol and other drug collaborative care program in Sydney, Australia. Aust J Prim Health 2022; 28:158-163. [PMID: 35105435 DOI: 10.1071/py20197] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 05/25/2021] [Indexed: 11/23/2022]
Abstract
Alcohol and other drug (AoD) use is an important health and community issue and may be positively affected by collaborative care programs between specialist AoD services and general practice. This paper describes the feasibility, model of care and patient outcomes of a pilot general practice and specialist AoD (GP-AoD) collaborative care program, in Sydney, Australia, based on usual care data, the minimum data set, service utilisation information and the Australian Treatment Outcome Profile (ATOP), a patient-reported outcome measure. There were 367 referrals to the collaborative care program. GPs referred 210 patients, whereas the AoD service referred 157 patients. Most GP referrals (91.9%) were for AoD problems, whereas nearly half the AoD service referrals were for other issues. The primary drugs of concern in the GP group were either opioids or non-opioids (mostly alcohol). The AoD service-referred patients were primarily using opioids. An ATOP was completed for 152 patients. At the time of referral, those in the GP-referred non-opioid group were significantly less likely to be abstinent, used their primary drug of concern more days and were more likely to be employed (all P < 0.001). A second ATOP was completed for 93 patients. These data showed a significant improvement in the number of days the primary drug of concern was used (P = 0.026) and trends towards abstinence, improved quality of life and physical and psychological well-being for patients in the program. There are few studies of GP-AoD collaborative care programs and nothing in the Australian context. This study suggests that GP-AoD collaborative care programs in Australia are feasible and improve drug use.
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Affiliation(s)
- H H K Wilson
- Drug & Alcohol Services, South East Sydney Local Health District, 591 South Dowling Street, Surry Hills, NSW 2010, Australia; and School of Public Health and Community Medicine, UNSW Sydney, High Street, Kensington, NSW 2052, Australia; and Corresponding author
| | - M Schulz
- Drug & Alcohol Services, South East Sydney Local Health District, 591 South Dowling Street, Surry Hills, NSW 2010, Australia
| | - L Mills
- Drug & Alcohol Services, South East Sydney Local Health District, 591 South Dowling Street, Surry Hills, NSW 2010, Australia; and Division Addiction Medicine, University of Sydney, NSW 2006, Australia
| | - N Lintzeris
- Drug & Alcohol Services, South East Sydney Local Health District, 591 South Dowling Street, Surry Hills, NSW 2010, Australia; and Division Addiction Medicine, University of Sydney, NSW 2006, Australia
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Brunner E, Schaumann A, Pennacchietti V, Schulz M, Thomale UW. Retrospective single-center historical comparative study between proGAV and proGAV2.0 for surgical revision and implant duration. Childs Nerv Syst 2022; 38:1155-1163. [PMID: 35353205 PMCID: PMC9156487 DOI: 10.1007/s00381-022-05490-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 03/03/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Cerebrospinal fluid (CSF) diversion shunt systems remain to be the most common treatment for pediatric hydrocephalus. Different valve systems are used to regulate CSF diversion. Preventing complications such as occlusions, ruptures, malpositioning, and over- or underdrainage are the focus for further developments. The proGAV and proGAV2.0 valve system are compared in this retrospective study for revision-free survival and isolated valve revision paradigms. METHODS In the first part of the study, the shunt and valve revision-free survival rates were investigated in a retrospective historical comparison design for a period of 2 years in which each valve was used as standard valve (proGAV: July 2012-June 2014; proGAV2.0: January 2015-December 2016) with subsequent 30-month follow-up period, respectively. In the second part of the study, the implant duration was calculated by detecting isolated valve (valve-only) revisions together with another valve explantation during the entire period of the first study and its follow-up period. RESULTS Two hundred sixty-two patients (145 male and 117 female, mean age 6.2 ± 6.1 years) were included in the cohort of revision-free survival. During the 30-month follow-up period, 41 shunt revisions, including 27 valve revisions (shunt survival rate: 72.1%, valve survival rate: 81.6%) were performed in the proGAV cohort and 37 shunt revisions, including 21 valve revisions (shunt survival rate: 74.8% and valve survival rate: 85.0%) were performed in the proGAV2.0 cohort without showing statistically significant differences. In the second part of the study, 38 cases (mean age 4.0 ± 3.9 years) met the inclusion criteria of receiving a valve-only-revision. In those patients, a total of 44 proGAV and 42 proGAV2.0 were implanted and explanted during the entire study time. In those, a significantly longer implant duration was observed for proGAV (mean valve duration 961.9 ± 650.8 days) compared to proGAV2.0 (mean length of implantation period 601.4 ± 487.8 days; p = 0.004). CONCLUSION The shunt and valve revision-free survival rates were found to be similar among the groups during 30 month follow-up. In patients who received "valve only" revisions and a subsequent explanation, the implant duration was significantly longer in the proGAV. Although the amount of patients with valve-only-revisions are small compared to the entire cohort certain patients seem to be at higher risk for repeated valve revisions.
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Affiliation(s)
- E Brunner
- grid.6363.00000 0001 2218 4662Present Address: Pediatric Neurosurgery, Charité Universitaetsmedizin Berlin, Campus Virchow Klinikum, Augustenburger Platz 1, 13353 Berlin, Germany
| | - A Schaumann
- grid.6363.00000 0001 2218 4662Present Address: Pediatric Neurosurgery, Charité Universitaetsmedizin Berlin, Campus Virchow Klinikum, Augustenburger Platz 1, 13353 Berlin, Germany
| | - V Pennacchietti
- grid.6363.00000 0001 2218 4662Present Address: Pediatric Neurosurgery, Charité Universitaetsmedizin Berlin, Campus Virchow Klinikum, Augustenburger Platz 1, 13353 Berlin, Germany
| | - M Schulz
- grid.6363.00000 0001 2218 4662Present Address: Pediatric Neurosurgery, Charité Universitaetsmedizin Berlin, Campus Virchow Klinikum, Augustenburger Platz 1, 13353 Berlin, Germany
| | - UW Thomale
- grid.6363.00000 0001 2218 4662Present Address: Pediatric Neurosurgery, Charité Universitaetsmedizin Berlin, Campus Virchow Klinikum, Augustenburger Platz 1, 13353 Berlin, Germany
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Losko AS, Han Y, Schillinger B, Tartaglione A, Morgano M, Strobl M, Long J, Tremsin AS, Schulz M. New perspectives for neutron imaging through advanced event-mode data acquisition. Sci Rep 2021; 11:21360. [PMID: 34725403 PMCID: PMC8560941 DOI: 10.1038/s41598-021-00822-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 10/15/2021] [Indexed: 11/09/2022] Open
Abstract
Imaging using scintillators is a widespread and cost-effective approach in radiography. While different types of scintillator and sensor configurations exist, it can be stated that the detection efficiency and resolution of a scintillator-based system strongly depend on the scintillator material and its thickness. Recently developed event-driven detectors are capable of registering spots of light emitted by the scintillator after a particle interaction, allowing to reconstruct the Center-of-Mass of the interaction within the scintillator. This results in a more precise location of the event and therefore provides a pathway to overcome the scintillator thickness limitation and increase the effective spatial resolution of the system. Utilizing this principle, we present a detector capable of Time-of-Flight imaging with an adjustable field-of-view, ad-hoc binning and re-binning of data based on the requirements of the experiment including the possibility of particle discrimination via the analysis of the event shape in space and time. It is considered that this novel concept might replace regular cameras in neutron imaging detectors as it provides superior detection capabilities with the most recent results providing an increase by a factor 3 in image resolution and an increase by up to a factor of 7.5 in signal-to-noise for thermal neutron imaging.
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Affiliation(s)
- A S Losko
- Forschungs-Neutronenquelle Heinz Maier-Leibnitz, 85748, Garching, Germany.
| | - Y Han
- Forschungs-Neutronenquelle Heinz Maier-Leibnitz, 85748, Garching, Germany
| | - B Schillinger
- Forschungs-Neutronenquelle Heinz Maier-Leibnitz, 85748, Garching, Germany
| | - A Tartaglione
- Forschungs-Neutronenquelle Heinz Maier-Leibnitz, 85748, Garching, Germany
| | - M Morgano
- Paul Scherrer Institute, 5232, Villigen, Switzerland
| | - M Strobl
- Paul Scherrer Institute, 5232, Villigen, Switzerland
| | - J Long
- Amsterdam Scientific Instruments, 1098XG, Amsterdam, The Netherlands
| | - A S Tremsin
- Space Sciences Laboratory, University of California at Berkeley, Berkeley, CA, 94720, USA
| | - M Schulz
- Forschungs-Neutronenquelle Heinz Maier-Leibnitz, 85748, Garching, Germany
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Petrikhovich O, Messiha D, Lortz J, Mahabadi AA, Hering R, Schulz M, Rassaf T, Rammos C. Regional differences in outpatient care of peripheral artery diseases in Germany. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2021] [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: 11/14/2022] Open
Abstract
Abstract
Background
Peripheral arterial disease (PAD) is one of the most common diseases worldwide and affected patients have an increased risk for cardiovascular events. The main goals of PAD treatment include modification of risk factors and prevention of cardiovascular events by means of guideline-recommended and specialized ambulatory care. Knowledge on treatment regimens and outpatient care structures in different German states is essential to improve the overall quality of medical care as well as patient outcome.
Aim
The aim of this study was to analyze the care of PAD patients with emphasis on pharmacotherapy and outpatient treatment patterns with special focus on regional differences in Germany.
Methods
This study included data of 17.633.970 patients collected in Germany between 2009 and 2018. This data was provided by analyzing all statutory health insured patients with PAD in Germany. Ambulatory care structure included treatments by vascular surgeons, angiologists, cardiologist, internal medicine physician and primary care physicians. Furthermore, prescription of guideline-recommended pharmacotherapy (statins and antiplatelets) was analyzed for the period of 2012–2016. For our analysis we used chi-squared test and two-way Anova.
Results
Nationwide, prescription frequency of statins increased from 40% in 2009 to 50% (p<0,0001) in 2016. Similar results were seen in the prescription frequency of antiplatelet agents, which increased from 26% in 2009 to 30% (p<0,0001) in 2016. In fact, prescription frequency of both statins and antiplatelet drugs remained insufficient in every federal state (p>0,05), despite wide access to general practitioners. Nevertheless, there is a significant difference between rural and urban regions (Bavaria 46% vs. North Rhine-Westphalia 44%, p<0,05). However, in every federal state, treatment by the vascular specialist is low. In 2018 only 10% of patients were treated by vascular surgeons and 9% by angiologists.
Conclusion
Our study shows that, for PAD patients, outpatient care as well as prescription frequency of guideline-based therapy is insufficient in every federal German state. According to our data, there is a need to establish regional structures for PAD patients that can improve current care and ultimately reduce mortality in this high-risk population.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- O Petrikhovich
- University of Duisburg-Essen - West-German Heart and Vascular Center, Essen, Germany
| | - D Messiha
- University of Duisburg-Essen - West-German Heart and Vascular Center, Essen, Germany
| | - J Lortz
- University of Duisburg-Essen - West-German Heart and Vascular Center, Essen, Germany
| | - A A Mahabadi
- University of Duisburg-Essen - West-German Heart and Vascular Center, Essen, Germany
| | - R Hering
- Central Research Institute for Ambulatory Healthcare in Germany, Department of Data Science and Healthcare Analyses, Berlin, Germany
| | - M Schulz
- Central Research Institute for Ambulatory Healthcare in Germany, Department of Data Science and Healthcare Analyses, Berlin, Germany
| | - T Rassaf
- University of Duisburg-Essen - West-German Heart and Vascular Center, Essen, Germany
| | - C Rammos
- University of Duisburg-Essen - West-German Heart and Vascular Center, Essen, Germany
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25
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Messiha D, Petrikhovich O, Lortz J, Mahabadi AA, Hering R, Schulz M, Rassaf T, Rammos C. Gender-based differences in outpatient care of peripheral artery diseases in Germany. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2019] [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: 11/14/2022] Open
Abstract
Abstract
Background
Peripheral artery disease (PAD) is a major manifestation of atherosclerosis and a risk factor for morbidity and mortality. Guideline-recommended therapy and specialized outpatient care are essential for optimal treatment. Gender-based inequalities in diagnosis and treatment of cardiovascular diseases are still present, despite clear guideline recommendations. Knowledge of the treatment structures in the outpatient setting are essential to identify and solve gender-based inequalities in this high-risk population.
Purpose
Aim of the study was to identify gender-based inequalities in an outpatient clinic setting in terms of treatment structures and pharmacotherapy in patients with PAD.
Methods
We analyzed gender-based differences in pharmacotherapy (statins, antiplatelets) and treatment by specialized outpatient care (angiology, vascular surgery, internal medicine, cardiology) in 17.633.970 patients with PAD and statutorily insurance presenting to outpatient care facilities in Germany between 2009 and 2018. The study is based on the ambulatory claims data of the panel doctors' services according to § 295 SGB V and drug prescription data according to § 300 SGB V. Diagnosis of PAD was defined upon medical diagnoses of PAD ICD I70.2–9. Statistical analysis was performed with chi-squared test for trend and two-way Anova.
Results
Overall, 17.633.970 patients were included in the study and 53% were female. Only a minority of 37,1% presented to a vascular specialist (8,5% angiology, 10,2% vascular surgery, 24,6% cardiology) with no significant change over the course between 2009 and 2018. Interestingly, female patients were less likely to present to a vascular specialist and less likely to receive guideline recommended medical therapy.
The gender gap between male and female patients presenting to a vascular specialist, however, narrowed in the observed time frame (angiology in 2009 1,8% vs 2018 1,0%, p<0,0001; vascular surgery 2009 3,2% vs 2018 1,5%, p<0,0001).
Pharmacotherapy also significantly differed between female and male patients over the course of time. While prescription rates of statins and antiplatelet drugs increased in the observed time period (statins 42,8% vs 55,7% (male), 35,1% vs 45% (female); antiplatelets 29,2% vs 34,4% (male), 20,2 vs 24,3% (female)), the gender gap also increased between 2009 and 2018 (7,7% vs 10,7%, p<0,0001 (statins); 8,9% vs 10%, p<0,0001 (antiplatelets)).
Conclusion
Our results demonstrate that gender-based differences in pharmacotherapy and specialized outpatient care of patients with PAD are still evident in Germany. While overall outpatient treatment by a vascular specialist and guideline recommended medical therapy of PAD with antiplatelets and statins are overall remarkably low, female patients are even less likely to receive both, compared to male patients. While adherence to guideline recommended therapy is increasing, the gender-gap still continues to widen over the course of time.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- D Messiha
- University hospital Essen, Essen, Germany
| | | | - J Lortz
- University hospital Essen, Essen, Germany
| | | | - R Hering
- Central Research Institute for Ambulatory Healthcare in Germany, Department of Data Science and Healthcare Analyses, Berlin, Germany
| | - M Schulz
- Central Research Institute for Ambulatory Healthcare in Germany, Department of Data Science and Healthcare Analyses, Berlin, Germany
| | - T Rassaf
- University hospital Essen, Essen, Germany
| | - C Rammos
- University hospital Essen, Essen, Germany
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Dubrall D, Leitzen S, Toni I, Stingl J, Schulz M, Schmid M, Neubert A, Sachs B. Descriptive analysis of adverse drug reaction reports in children and adolescents from Germany: frequently reported reactions and suspected drugs. BMC Pharmacol Toxicol 2021; 22:56. [PMID: 34620231 PMCID: PMC8499510 DOI: 10.1186/s40360-021-00520-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 09/06/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Adverse drug reactions (ADRs) in the pediatric population may differ in types and frequencies compared to other populations. Respective studies analyzing ADR reports referring to children have already been performed for certain countries. However, differences in drug prescriptions, among others, complicate the transferability of the results from other countries to Germany or were rarely considered. Hence, the first aim of our study was to analyze the drugs and ADRs reported most frequently in ADR reports from Germany referring to children contained in the European ADR database (EudraVigilance). The second aim was to set the number of ADR reports in relation to the number of drug prescriptions. These were provided by the Research Institute for Ambulatory Health Care in Germany. METHODS For patients aged 0-17 years 20,854 spontaneous ADR reports were received between 01/01/2000-28/2/2019. The drugs and ADRs reported most frequently were identified. Stratified analyses with regard to age, sex and drugs used "off-label" were performed. Reporting rates (number of ADR reports/number of drug prescriptions) were calculated. RESULTS Methylphenidate (5.5%), ibuprofen (2.3%), and palivizumab (2.0%) were most frequently reported as suspected. If related to the number of drug prescriptions, the ranking changed (palivizumab, methylphenidate, ibuprofen). Irrespective of the applied drugs, vomiting (5.4%), urticaria (4.6%) and dyspnea (4.2%) were the ADRs reported most frequently. For children aged 0-1 year, drugs for the treatment of nervous system disorders and foetal exposure during pregnancy were most commonly reported. In contrast, methylphenidate ranked first in children older than 6 years and referred 3.5 times more often to males compared to females. If age- and sex-specific exposure was considered, more ADR reports for methylphenidate referred to children 4-6 years and females 13-17 years. Drugs for the treatment of nervous system disorders ranked first among "off-label" ADR reports. CONCLUSIONS Our analysis underlines the importance of putting the number of ADR reports of a drug in context with its prescriptions. Additionally, differences in age- and sex-stratified analysis were observed which may be associated with age- and sex-specific diseases and, thus, drug exposure. The drugs most frequently included in "off-label" ADR reports differed from those most often used according to literature.
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Affiliation(s)
- Diana Dubrall
- Institute for Medical Biometry, Informatics and Epidemiology, University Hospital of Bonn, Bonn, Germany. .,Research Division, Federal Institute for Drugs and Medical Devices, Bonn, Germany.
| | - Sarah Leitzen
- Research Division, Federal Institute for Drugs and Medical Devices, Bonn, Germany.,Department of Physics, Chemistry and Pharmacy, University of Southern Denmark, Odense, Denmark
| | - Irmgard Toni
- Department of Paediatrics and Adolescent Medicine, University Hospital Erlangen, Erlangen, Germany
| | - Julia Stingl
- Institute of Clinical Pharmacology, University Hospital of the RWTH Aachen, Aachen, Germany
| | - M Schulz
- Central Research Institute of Ambulatory Health Care in Germany, Berlin, Germany
| | - Matthias Schmid
- Institute for Medical Biometry, Informatics and Epidemiology, University Hospital of Bonn, Bonn, Germany
| | - Antje Neubert
- Department of Paediatrics and Adolescent Medicine, University Hospital Erlangen, Erlangen, Germany
| | - Bernhardt Sachs
- Research Division, Federal Institute for Drugs and Medical Devices, Bonn, Germany.,Department for Dermatology and Allergy, University Hospital Aachen, Aachen, Germany
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27
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Rammos C, Steinmetz M, Lortz J, Mahabadi AA, Petrikhovich O, Kirsch K, Hering R, Schulz M, Rassaf T. Peripheral artery disease in Germany (2009-2018): Prevalence, frequency of specialized ambulatory care and use of guideline-recommended therapy - A population-based study. Lancet Reg Health Eur 2021; 5:100113. [PMID: 34557822 PMCID: PMC8454876 DOI: 10.1016/j.lanepe.2021.100113] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Background Peripheral artery disease (PAD) patients have high morbidity and mortality rates, demonstrating a need for improved treatment strategies. While underuse and undertreatment have been reported, there is no clear picture of patterns in population-level disease prevalence, prescription of guideline-recommended pharmacotherapy, or frequency of contact with dedicated specialists. We present population-level data on changes in prevalence, care and treatment of PAD from 2009 to 2018 in Germany. Methods We analyzed the ambulatory claims data for all statutorily insured patients comprising 70.1 million patients each year and 87% of the German population. Prevalence was assessed by documentation of PAD and stratified by age and sex within the 10-year study timeframe. In addition, current ambulatory care, stratified by vascular specialists (vascular surgeons or angiologists), internists, cardiologists and primary care physicians, were examined. Findings Prevalence increased from 1·85% in 2009 to 3·14% in 2018, affecting 2·3 million patients in 2018 and more males (55%) than females (45%). A low level of visits to vascular specialists, with 11·1% receiving care from vascular surgeons and 8·1% from angiologists, was shown. Moreover, analysis of guideline-recommended prescriptions revealed increasing, but still insufficient, prescription frequencies among PAD patients between 2009 and 2016, from 42·6% to 56% for statins and from 40·2% to 48·0% for antiplatelets. Interpretation Our results show that the prevalence of PAD in Germany, as assessed by outpatient PAD documentation, is increasing and PAD patients are underutilizing specialized vascular care; moreover, the prescription frequency of guideline-recommended therapies remains low. There is a clear need to improve the referral and treatment algorithms in the high-risk PAD population. Funding None.
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Affiliation(s)
- Christos Rammos
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center Essen, University of Duisburg-Essen, Hufelandstraße 55, 45147 Essen, Germany
| | - Martin Steinmetz
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center Essen, University of Duisburg-Essen, Hufelandstraße 55, 45147 Essen, Germany
| | - Julia Lortz
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center Essen, University of Duisburg-Essen, Hufelandstraße 55, 45147 Essen, Germany
| | - Amir A Mahabadi
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center Essen, University of Duisburg-Essen, Hufelandstraße 55, 45147 Essen, Germany
| | - Olga Petrikhovich
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center Essen, University of Duisburg-Essen, Hufelandstraße 55, 45147 Essen, Germany
| | - Kristina Kirsch
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center Essen, University of Duisburg-Essen, Hufelandstraße 55, 45147 Essen, Germany
| | - Ramona Hering
- Department of Data Science and Healthcare Analyses, Central Research Institute for Ambulatory Healthcare in Germany (Zi), Germany
| | - Mandy Schulz
- Department of Data Science and Healthcare Analyses, Central Research Institute for Ambulatory Healthcare in Germany (Zi), Germany
| | - Tienush Rassaf
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center Essen, University of Duisburg-Essen, Hufelandstraße 55, 45147 Essen, Germany
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Maul K, Fieblinger D, Heppenheimer A, Kreutz J, Liebsch M, Luch A, Pirow R, Poth A, Strauch P, Dony E, Schulz M, Wolf T, Reisinger K. Validation of the hen's egg test for micronucleus induction (HETMN): Detailed protocol including scoring atlas, historical control data and statistical analysis. Mutagenesis 2021; 37:76-88. [PMID: 34313790 PMCID: PMC9071076 DOI: 10.1093/mutage/geab026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 08/03/2021] [Indexed: 11/14/2022] Open
Abstract
A validation exercise of the hen's egg test for micronucleus induction (HET-MN) was finalised with a very good predictivity based on the analysis of micronuclei in peripheral erythrocytes of fertilised chicken eggs [1]. For transparency reasons this complementary publication provides further details on the assay especially as this was the first validation study in the field of genotoxicity testing involving the use of chicken eggs. Thus, the experimental protocol is described in detail and is complemented by a scoring atlas for microscopic analysis of blood cells. In addition, general characteristics of the test system, which is able to mirror the systemic availability of test compounds, are delineated: the test compound passes the egg membrane and is taken up by the blood vessels of the underlying chorioallantoic membrane. Subsequently, it is distributed by the circulating blood, metabolised by the developing liver and the yolk sac membrane, and finally excreted into the allantois, a bladder equivalent. In specific, the suitability of the test system for genotoxicity testing is shown by, inter alia, a low background DNA damage in a comprehensive historical control database. In addition, the state-of-the-art statistical method used to evaluate obtained data is delineated. It combines laboratory-specific effect threshold with the Umbrella-Williams test a statistical model also of interest for other genotoxicity test methods.
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Affiliation(s)
- K Maul
- German Federal Institute for Risk Assessment (BfR), Department of Chemical and Product Safety, Berlin, Germany
| | - D Fieblinger
- German Federal Institute for Risk Assessment (BfR), Department of Chemical and Product Safety, Berlin, Germany
| | - A Heppenheimer
- ICCR-Roßdorf GmbH (former: Harlan Cytotest Cell Research, Envigo CRS), Roßdorf, Germany
| | - J Kreutz
- Henkel AG & Co KGaA, Duesseldorf, Germany
| | - M Liebsch
- German Federal Institute for Risk Assessment (BfR), Department of Chemical and Product Safety, Berlin, Germany
| | - A Luch
- German Federal Institute for Risk Assessment (BfR), Department of Chemical and Product Safety, Berlin, Germany
| | - R Pirow
- German Federal Institute for Risk Assessment (BfR), Department of Chemical and Product Safety, Berlin, Germany
| | - A Poth
- ICCR-Roßdorf GmbH (former: Harlan Cytotest Cell Research, Envigo CRS), Roßdorf, Germany
| | - P Strauch
- ICCR-Roßdorf GmbH (former: Harlan Cytotest Cell Research, Envigo CRS), Roßdorf, Germany
| | - E Dony
- ICCR-Roßdorf GmbH (former: Harlan Cytotest Cell Research, Envigo CRS), Roßdorf, Germany
| | - M Schulz
- ICCR-Roßdorf GmbH (former: Harlan Cytotest Cell Research, Envigo CRS), Roßdorf, Germany
| | - T Wolf
- University of Osnabrueck, Osnabrueck, Germany
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Dürrbeck C, Pflaum L, Schulz M, Kallis K, Geimer T, Abu-Hossin N, Strnad V, Maier A, Fietkau R, Bert C. OC-0109 Implant-based CT estimation towards adaptive breast brachytherapy. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)06313-1] [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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Kang YS, Pennacchietti V, Schulz M, Schwarz K, Thomale UW. Biparietal meander expansion technique for sagittal suture synostosis in patients older than 1 year of age-technical note. Childs Nerv Syst 2021; 37:2039-2044. [PMID: 33682045 PMCID: PMC8184553 DOI: 10.1007/s00381-021-05105-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 02/26/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Sagittal suture synostosis (SSS) is the most common form of craniosynostosis. For older patients, the strategy for surgical correction needs to consider diminished growth dynamics of the skull and an active reconstruction cranioplasty aims to sustain stability for the active child. We describe our technique of biparietal meander expansion (BME) technique for SSS for patients older than 1 year and retrospectively reviewed the perioperative course as well as the subjective experience of patients and caregivers during follow-up. METHODS The BME technique incorporates bilateral serpentine craniotomies and fixation of the consecutively expanded bone tongues with crossing sutures for patients with SSS older than 12 months of age at surgery. We reviewed patients undergoing this surgical technique for correction of SSS and collected data about the clinical course and performed a patients reported outcome measure (PROM) for patients or caregivers to evaluate subjective experience and outcome after surgical treatment. RESULTS BME was performed in 31 patients (8 females; median age: 43 months; range 13-388). The mean length of operation was 172.7±43 minutes (range 115-294). Patients experienced no immediate complications or neurological morbidity after surgery. Considering a total of 21 completed PROM questionnaires, the head shape after surgery was evaluated as either "better" (57%) or "much better" (43%) compared to preoperatively. Eighty-one percent of patients or caregivers answered that the patient experiences no limitation in daily activities. Although 42.8% perceived the hospital as strenuous, 90.5% would choose to undergo this treatment again. CONCLUSION BME is a feasible technique for older SSS patients resulting in immediate stability of the remodelled calvarium with a more normal head shape. The survey among caregivers or patients revealed a favourable subjectively experienced outcome after this type of surgical treatment of SSS in the more complex context of an older patient cohort.
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Affiliation(s)
- Y. S. Kang
- Pediatric Neurosurgery, Charité–Universitätsmedizin Berlin, Campus Virchow Klinikum, Augustenburger Platz 1, D-13353 Berlin, Germany ,Neurosurgical Department, Kiel Universitätsmedizin, Kiel, Germany
| | - V. Pennacchietti
- Pediatric Neurosurgery, Charité–Universitätsmedizin Berlin, Campus Virchow Klinikum, Augustenburger Platz 1, D-13353 Berlin, Germany
| | - M. Schulz
- Pediatric Neurosurgery, Charité–Universitätsmedizin Berlin, Campus Virchow Klinikum, Augustenburger Platz 1, D-13353 Berlin, Germany
| | - K. Schwarz
- Pediatric Neurosurgery, Charité–Universitätsmedizin Berlin, Campus Virchow Klinikum, Augustenburger Platz 1, D-13353 Berlin, Germany
| | - U-W. Thomale
- Pediatric Neurosurgery, Charité–Universitätsmedizin Berlin, Campus Virchow Klinikum, Augustenburger Platz 1, D-13353 Berlin, Germany
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Alves da Costa F, Henman M, Hughes C, Leufkens H, Babar Z, McElnay J, Schulz M. Impact of a global leader on pharmaceutical practice and policy around the world. J Pharm Policy Pract 2020. [PMCID: PMC7441560 DOI: 10.1186/s40545-020-00253-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
This commentary describes the contributions of a Dutch pharmacist who contributed in a unique manner to the development of community pharmacy practice in Europe, to the evolution of practice-based research and to its publication. With an interest in pharmaceutical care and in clinical pharmacy, Dr. van Mil changed practice and policy in Europe over the last decades in a very visible way, here documented through a summary of some of his main written contributions. We write this to honour his memory and contribute to the preservation of his legacy.
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Stöver T, Zeh R, Gängler B, Plontke SK, Ohligmacher S, Deitmer T, Hupka O, Welkoborsky HJ, Schulz M, Delank W, Strobel M, Guntinas-Lichius O, Lang S, Dietz A, Dazert S, Diensthuber M. [Regional distribution of the cochlear implant (CI) centers in Germany]. Laryngorhinootologie 2020; 99:863-871. [PMID: 33167056 DOI: 10.1055/a-1302-0368] [Citation(s) in RCA: 3] [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: 10/23/2022]
Abstract
The treatment of patients with severe hearing loss or deafness with a cochlear implant (CI) represents a standard in Germany today. However, there is hardly any data on the current number of clinical CI centers (CI clinics) and their geographical distribution. The patient self-help organization, German Cochlear Implant Society (DCIG), and the German Society for Otorhinolaryngology, Head and Neck Surgery (DGHNO-KHC) have therefore initiated a survey to determine the regional distribution, the range of services, the consideration of existing quality standards and cooperation with patient self-help organizations of the individual clinical CI centers.For this purpose, a total number of 170 ENT departments or their directors (37 professors and 133 chief physicians), respectively, were contacted by e-mail and provided with a questionnaire. The survey took place from October 2019 to February 2020.Of the 170 departments contacted, 71 (41.8 %) took part in the survey. Of these, 70 departments (98.6 %) confirmed to perform CI surgeries. Thus, 41.8 % of all clinics contacted reported to perform CI surgeries (70 of 170 clinics), while this information was not available from 99 clinics. All 70 clinical CI centers (100 %) reported to conduct CI surgeries on adults, 60 centers (85.7 %) also on children (< 18 years). 36 departments (51.4 %) reported that the total number of CI surgeries at their facility in 2018 was more than 50. In 64 departments (91.4 %), the recommendations of the DGHNO-KHC on CI care (according to the White Paper CI care 2018) were followed. A collaboration between the department and patient self-help organization was confirmed by 67 institutions (95.7 %). The geographical distribution of the clinical CI centers showed a heterogeneous distribution pattern between the individual federal states and also within the respective federal state.The work presented here is a first assessment of the situation with regard to the regional distribution of clinical CI centers in Germany. A clustering of CI centers was noticeable in metropolitan areas, sometimes with several facilities in one city. The predominant attention to quality-related aspects, such as the consideration of the DGHNO-KHC white paper and the cooperation with patient self-help, is gratifying. The limitations of the study result from limited participation in the survey (41.8 % of the contacted clinics).
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Affiliation(s)
- T Stöver
- Klinik für Hals-Nasen-Ohrenheilkunde, Universitätsklinikum Frankfurt a. M
| | - R Zeh
- Deutsche Cochlea Implantat Gesellschaft (DCIG) e. V., Senden
| | - B Gängler
- Deutsche Cochlea Implantat Gesellschaft (DCIG) e. V., Senden
| | - S K Plontke
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Universitätsklinikum Halle (Saale)
| | - S Ohligmacher
- Deutsche Cochlea Implantat Gesellschaft (DCIG) e. V., Senden
| | - T Deitmer
- Deutsche Gesellschaft für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie e. V., Bonn
| | - O Hupka
- Deutsche Cochlea Implantat Gesellschaft (DCIG) e. V., Senden
| | | | - M Schulz
- Deutsche Cochlea Implantat Gesellschaft (DCIG) e. V., Senden
| | - W Delank
- HNO-Klinik, Klinikum der Stadt Ludwigshafen, Ludwigshafen
| | - M Strobel
- Deutsche Cochlea Implantat Gesellschaft (DCIG) e. V., Senden
| | | | - S Lang
- Klinik für Hals-Nasen-Ohrenheilkunde, Universitätsklinikum Essen
| | - A Dietz
- Klinik für Hals-Nasen-Ohrenheilkunde, Universitätsklinikum Leipzig
| | - S Dazert
- Klinik für Hals-, Nasen- und Ohrenheilkunde, Kopf- und Halschirurgie, St.-Elisabeth-Hospital, Klinikum der Ruhr-Universität Bochum
| | - M Diensthuber
- Klinik für Hals-Nasen-Ohrenheilkunde, Universitätsklinikum Frankfurt a. M
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Rammos C, Petrikhovich O, Mahabadi A, Steinmetz M, Lortz J, Hering R, Schulz M, Rassaf T. Prevalence, specialized ambulatory care and guideline-recommended therapy of peripheral vascular diseases in Germany. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2361] [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: 11/12/2022] Open
Abstract
Abstract
Background
Cardiovascular diseases are the leading causes of death in the industrialized world. In addition to coronary heart disease, PAD defines morbidity and is associated with increased mortality. Guideline-recommended therapy and specialized ambulatory care is essential for optimal treatment. Knowledge of the treatment structures, contact with dedicated specialists and pharmacotherapy in the outpatient area are essential for improving treatment, reducing symptoms and finally improve mortality in this high-risk population.
Methods
The study is based on the ambulatory claims data of the panel doctors services according to § 295 SGB V and drug prescription data according to § 300 SGB V. The prevalence of PAD in Germany (medical diagnoses of PAD ICD I70.2–9) was analyzed by age and gender-specific characteristics with a timeframe of 10 years (2009–2018). In addition, the current ambulatory care structure was examined subdivided by vascular specialist (vascular surgeons or angiologists) and primary care physicians (internal medicine or general practitioners). Additionally, the prescription of guideline-recommended pharmacotherapy like statins and antiplatelet inhibitors was analyzed for the years 2009–2016.
Results
An increase of PAD diagnosis was observed with a maximum in 2018 with 2.280.000 patients in Germany. The rise of PAD patients strongly correlates with increased age (age group 50–59: 243.000, age group 60–69: 533.000, age group 70–79: 735.000, age group 75–79: 438.000, age group 80–89: 710.000) and more commonly affects males (55%) than females (45%). Access to vascular specialist was low for all age groups with only 11% of patients receiving care from vascular surgeons and only 9% from angiologists. However, 99% received care by a primary care physician.
The prescription of lipid-lowering drugs and platelet aggregation inhibitors in the current analysis period from 2009–2016 is insufficient, with only 46% receiving statins and 29% receiving antiplatelets and 15% oral anticoagulation,
Conclusion
There are relevant differences in age and gender-specific prevalence of PAD in Germany. In addition to the regular care provided by primary care physicians, PAD patients are in need for specialized vascular care. Guideline recommended prescriptions are alarmingly low in PAD patients. There is a clear need to improve the treatment algorithms in the high-risk PAD population.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- C Rammos
- University of Duisburg-Essen, West German Heart Center, Essen, Germany
| | - O Petrikhovich
- University of Duisburg-Essen, West German Heart Center, Essen, Germany
| | - A Mahabadi
- University of Duisburg-Essen, West German Heart Center, Essen, Germany
| | - M Steinmetz
- University of Duisburg-Essen, West German Heart Center, Essen, Germany
| | - J Lortz
- University of Duisburg-Essen, West German Heart Center, Essen, Germany
| | - R Hering
- Central Research Institute for Ambulatory Healthcare in Germany (Zi), Department of Data Science and Healthcare Analyses, Berlin, Germany
| | - M Schulz
- Central Research Institute for Ambulatory Healthcare in Germany (Zi), Department of Data Science and Healthcare Analyses, Berlin, Germany
| | - T Rassaf
- University of Duisburg-Essen, West German Heart Center, Essen, Germany
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March S, Andrich S, Drepper J, Horenkamp-Sonntag D, Icks A, Ihle P, Kieschke J, Kollhorst B, Maier B, Meyer I, Müller G, Ohlmeier C, Peschke D, Richter A, Rosenbusch ML, Scholten N, Schulz M, Stallmann C, Swart E, Wobbe-Ribinski S, Wolter A, Zeidler J, Hoffmann F. Good Practice Data Linkage (GPD): A Translation of the German Version. Int J Environ Res Public Health 2020; 17:ijerph17217852. [PMID: 33120886 PMCID: PMC7663300 DOI: 10.3390/ijerph17217852] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 10/16/2020] [Accepted: 10/22/2020] [Indexed: 12/14/2022]
Abstract
The data linkage of different data sources for research purposes is being increasingly used in recent years. However, generally accepted methodological guidance is missing. The aim of this article is to provide methodological guidelines and recommendations for research projects that have been consented to across different German research societies. Another aim is to endow readers with a checklist for the critical appraisal of research proposals and articles. This Good Practice Data Linkage (GPD) was already published in German in 2019, but the aspects mentioned can easily be transferred to an international context, especially for other European Union (EU) member states. Therefore, it is now also published in English. Since 2016, an expert panel of members of different German scientific societies have worked together and developed seven guidelines with a total of 27 practical recommendations. These recommendations include (1) the research objectives, research questions, data sources, and resources; (2) the data infrastructure and data flow; (3) data protection; (4) ethics; (5) the key variables and linkage methods; (6) data validation/quality assurance; and (7) the long-term use of data for questions still to be determined. The authors provide a rationale for each recommendation. Future revisions will include new developments in science and updates of data privacy regulations.
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Affiliation(s)
- Stefanie March
- Institute for Social Medicine and Health Systems Research (ISMHSR), Medical Faculty, Otto von Guericke University Magdeburg, 39120 Magdeburg, Germany; (S.M.); (C.S.); (E.S.)
- Department of Social Work, Health and Media, Magdeburg-Stendal University of Applied Sciences, 39114 Magdeburg, Germany
| | - Silke Andrich
- Institute for Health Services Research and Health Economics, Centre for Health and Society, Faculty of Medicine, Heinrich-Heine-University Düsseldorf, 40225 Dusseldorf, Germany; (S.A.); (A.I.)
- Institute for Health Services Research and Health Economics, German Diabetes Center, Leibniz Center for Diabetes Research at the Heinrich-Heine-University Düsseldorf, 40225 Dusseldorf, Germany
| | - Johannes Drepper
- TMF—Technology, Methods, and Infrastructure for Networked Medical Research, 10117 Berlin, Germany;
| | | | - Andrea Icks
- Institute for Health Services Research and Health Economics, Centre for Health and Society, Faculty of Medicine, Heinrich-Heine-University Düsseldorf, 40225 Dusseldorf, Germany; (S.A.); (A.I.)
- Institute for Health Services Research and Health Economics, German Diabetes Center, Leibniz Center for Diabetes Research at the Heinrich-Heine-University Düsseldorf, 40225 Dusseldorf, Germany
| | - Peter Ihle
- PMV Research Group, University of Cologne, 50931 Cologne, Germany; (P.I.); (I.M.)
| | - Joachim Kieschke
- Epidemiological Cancer Registry of Lower Saxony, Register Center, 26121 Oldenburg, Germany;
| | - Bianca Kollhorst
- Leibniz Institute for Prevention Research and Epidemiology—BIPS Department Biometry and Data Management, 28359 Bremen, Germany;
| | - Birga Maier
- Berlin-Brandenburg Myocardial Infarction Registry e. V., 10317 Berlin, Germany;
| | - Ingo Meyer
- PMV Research Group, University of Cologne, 50931 Cologne, Germany; (P.I.); (I.M.)
| | - Gabriele Müller
- Center for Evidence-Based Healthcare (ZEGV), University Hospital and Faculty of Medicine Carl Gustav Carus, Technical University of Dresden, 01307 Dresden, Germany;
| | | | - Dirk Peschke
- Institute for Public Health and Nursing Research (IPP), University of Bremen, 28359 Bremen, Germany;
- Department of Applied Health Sciences, University of Health Bochum, 44801 Bochum, Germany
| | - Adrian Richter
- Institute for Community Medicine, Department SHIP-KEF, Greifswald University Medical Center, 17475 Greifswald, Germany;
| | - Marie-Luise Rosenbusch
- Central Research Institute for Ambulatory Healthcare in Germany (Zi), Department of Data Science and Healthcare Analyses, 10587 Berlin, Germany; (M.-L.R.); (M.S.)
| | - Nadine Scholten
- Institute of Medical Sociology, Health Services Research and Rehabilitation Science (IMVR), Faculty of Human Sciences and Faculty of Medicine, University of Cologne, 50933 Cologne, Germany;
| | - Mandy Schulz
- Central Research Institute for Ambulatory Healthcare in Germany (Zi), Department of Data Science and Healthcare Analyses, 10587 Berlin, Germany; (M.-L.R.); (M.S.)
| | - Christoph Stallmann
- Institute for Social Medicine and Health Systems Research (ISMHSR), Medical Faculty, Otto von Guericke University Magdeburg, 39120 Magdeburg, Germany; (S.M.); (C.S.); (E.S.)
| | - Enno Swart
- Institute for Social Medicine and Health Systems Research (ISMHSR), Medical Faculty, Otto von Guericke University Magdeburg, 39120 Magdeburg, Germany; (S.M.); (C.S.); (E.S.)
| | - Stefanie Wobbe-Ribinski
- DAK Gesundheit, Health Services Research and Innovation, 20097 Hamburg, Germany; (S.W.-R.); (A.W.)
| | - Antke Wolter
- DAK Gesundheit, Health Services Research and Innovation, 20097 Hamburg, Germany; (S.W.-R.); (A.W.)
| | - Jan Zeidler
- Center for Health Economics Research Hanover (CHERH), Leibniz University Hanover, 30159 Hanover, Germany;
| | - Falk Hoffmann
- Faculty of Medicine and Health Sciences, Department of Healthcare Research, Carl von Ossietzky University Oldenburg, 26129 Oldenburg, Germany
- Correspondence:
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Castro A, Holenya P, Eckey M, Teck T, Zerweck J, Knaute T, Schulz M, Schnatbaum K, Reimer U, Wenschuh H, Kern F. Peptide pools for target antigen identification, immune monitoring, and cellular therapy. Cytotherapy 2020. [DOI: 10.1016/j.jcyt.2020.03.222] [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: 10/24/2022]
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Bellouin N, Quaas J, Gryspeerdt E, Kinne S, Stier P, Watson‐Parris D, Boucher O, Carslaw KS, Christensen M, Daniau A, Dufresne J, Feingold G, Fiedler S, Forster P, Gettelman A, Haywood JM, Lohmann U, Malavelle F, Mauritsen T, McCoy DT, Myhre G, Mülmenstädt J, Neubauer D, Possner A, Rugenstein M, Sato Y, Schulz M, Schwartz SE, Sourdeval O, Storelvmo T, Toll V, Winker D, Stevens B. Bounding Global Aerosol Radiative Forcing of Climate Change. Rev Geophys 2020; 58:e2019RG000660. [PMID: 32734279 PMCID: PMC7384191 DOI: 10.1029/2019rg000660] [Citation(s) in RCA: 80] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 09/30/2019] [Accepted: 10/03/2019] [Indexed: 05/04/2023]
Abstract
Aerosols interact with radiation and clouds. Substantial progress made over the past 40 years in observing, understanding, and modeling these processes helped quantify the imbalance in the Earth's radiation budget caused by anthropogenic aerosols, called aerosol radiative forcing, but uncertainties remain large. This review provides a new range of aerosol radiative forcing over the industrial era based on multiple, traceable, and arguable lines of evidence, including modeling approaches, theoretical considerations, and observations. Improved understanding of aerosol absorption and the causes of trends in surface radiative fluxes constrain the forcing from aerosol-radiation interactions. A robust theoretical foundation and convincing evidence constrain the forcing caused by aerosol-driven increases in liquid cloud droplet number concentration. However, the influence of anthropogenic aerosols on cloud liquid water content and cloud fraction is less clear, and the influence on mixed-phase and ice clouds remains poorly constrained. Observed changes in surface temperature and radiative fluxes provide additional constraints. These multiple lines of evidence lead to a 68% confidence interval for the total aerosol effective radiative forcing of -1.6 to -0.6 W m-2, or -2.0 to -0.4 W m-2 with a 90% likelihood. Those intervals are of similar width to the last Intergovernmental Panel on Climate Change assessment but shifted toward more negative values. The uncertainty will narrow in the future by continuing to critically combine multiple lines of evidence, especially those addressing industrial-era changes in aerosol sources and aerosol effects on liquid cloud amount and on ice clouds.
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Affiliation(s)
- N. Bellouin
- Department of MeteorologyUniversity of ReadingReadingUK
| | - J. Quaas
- Institute for MeteorologyUniversität LeipzigLeipzigGermany
| | - E. Gryspeerdt
- Space and Atmospheric Physics GroupImperial College LondonLondonUK
| | - S. Kinne
- Max Planck Institute for MeteorologyHamburgGermany
| | - P. Stier
- Atmospheric, Oceanic and Planetary Physics, Department of PhysicsUniversity of OxfordOxfordUK
| | - D. Watson‐Parris
- Atmospheric, Oceanic and Planetary Physics, Department of PhysicsUniversity of OxfordOxfordUK
| | - O. Boucher
- Institut Pierre‐Simon Laplace, Sorbonne Université/CNRSParisFrance
| | - K. S. Carslaw
- School of Earth and EnvironmentUniversity of LeedsLeedsUK
| | - M. Christensen
- Atmospheric, Oceanic and Planetary Physics, Department of PhysicsUniversity of OxfordOxfordUK
| | - A.‐L. Daniau
- EPOC, UMR 5805, CNRS‐Université de BordeauxPessacFrance
| | - J.‐L. Dufresne
- Laboratoire de Météorologie Dynamique/IPSL, CNRS, Sorbonne Université, Ecole Normale Supérieure, PSL Research University, Ecole PolytechniqueParisFrance
| | - G. Feingold
- NOAA ESRL Chemical Sciences DivisionBoulderCOUSA
| | - S. Fiedler
- Max Planck Institute for MeteorologyHamburgGermany
- Now at Institut für Geophysik und MeteorologieUniversität zu KölnKölnGermany
| | - P. Forster
- Priestley International Centre for ClimateUniversity of LeedsLeedsUK
| | - A. Gettelman
- National Center for Atmospheric ResearchBoulderCOUSA
| | - J. M. Haywood
- CEMPSUniversity of ExeterExeterUK
- UK Met Office Hadley CentreExeterUK
| | - U. Lohmann
- Institute for Atmospheric and Climate ScienceETH ZürichZürichSwitzerland
| | | | - T. Mauritsen
- Department of MeteorologyStockholm UniversityStockholmSweden
| | - D. T. McCoy
- School of Earth and EnvironmentUniversity of LeedsLeedsUK
| | - G. Myhre
- Center for International Climate and Environmental Research‐Oslo (CICERO)OsloNorway
| | - J. Mülmenstädt
- Institute for MeteorologyUniversität LeipzigLeipzigGermany
| | - D. Neubauer
- Institute for Atmospheric and Climate ScienceETH ZürichZürichSwitzerland
| | - A. Possner
- Department of Global EcologyCarnegie Institution for ScienceStanfordCAUSA
- Now at Institute for Atmospheric and Environmental SciencesGoethe UniversityFrankfurtGermany
| | | | - Y. Sato
- Department of Applied Energy, Graduate School of Engineering, Nagoya UniversityNagoyaJapan
- Now at Faculty of Science, Department of Earth and Planetary SciencesHokkaido UniversitySapporoJapan
| | - M. Schulz
- Climate Modelling and Air Pollution Section, Research and Development DepartmentNorwegian Meteorological InstituteOsloNorway
| | - S. E. Schwartz
- Brookhaven National Laboratory Environmental and Climate Sciences DepartmentUptonNYUSA
| | - O. Sourdeval
- Institute for MeteorologyUniversität LeipzigLeipzigGermany
- Laboratoire d'Optique AtmosphériqueUniversité de LilleVilleneuve d'AscqFrance
| | - T. Storelvmo
- Department of GeosciencesUniversity of OsloOsloNorway
| | - V. Toll
- Department of MeteorologyUniversity of ReadingReadingUK
- Now at Institute of PhysicsUniversity of TartuTartuEstonia
| | - D. Winker
- NASA Langley Research CenterHamptonVAUSA
| | - B. Stevens
- Max Planck Institute for MeteorologyHamburgGermany
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Abstract
HL-LHC will confront the WLCG community with enormous data storage, management and access challenges. These are as much technical as economical. In the WLCG-DOMA Access working group, members of the experiments and site managers have explored different models for data access and storage strategies to reduce cost and complexity, taking into account the boundary conditions given by our community.Several of these scenarios have been evaluated quantitatively, such as the Data Lake model and incremental improvements of the current computing model with respect to resource needs, costs and operational complexity.To better understand these models in depth, analysis of traces of current data accesses and simulations of the impact of new concepts have been carried out. In parallel, evaluations of the required technologies took place. These were done in testbed and production environments at small and large scale.We will give an overview of the activities and results of the working group, describe the models and summarise the results of the technology evaluation focusing on the impact of storage consolidation in the form of Data Lakes, where the use of streaming caches has emerged as a successful approach to reduce the impact of latency and bandwidth limitation.We will describe the experience and evaluation of these approaches in different environments and usage scenarios. In addition we will present the results of the analysis and modelling efforts based on data access traces of the experiments.
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39
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Gruber S, Vorhauer N, Schulz M, Hilmer M, Peters J, Tsotsas E, Foerst P. Estimation of the local sublimation front velocities from neutron radiography and tomography of particulate matter. Chem Eng Sci 2020. [DOI: 10.1016/j.ces.2019.115268] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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40
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Bohlken J, von Stillfried D, Schulz M. [Prevalence Rates of Mild Cognitive Impairment and of Dementia in the German Outpatient Health Care Sector 2009-2016]. Psychiatr Prax 2019; 47:e1. [PMID: 31784972 DOI: 10.1055/a-1071-3613] [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] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Jens Bohlken
- Praxis für Neurologie und Psychiatrie, Berlin.,Institut für Sozialmedizin, Arbeitsmedizin und Public Health (ISAP) der Medizinischen Fakultät der Universität Leipzig
| | | | - Mandy Schulz
- Zentralinstitut für die kassenärztliche Versorgung in Deutschland (Zi), Berlin
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41
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Al-Hakim S, Schaumann A, Tietze A, Schulz M, Thomale UW. Endoscopic third ventriculostomy in children with third ventricular pressure gradient and open ventricular outlets on MRI. Childs Nerv Syst 2019; 35:2319-2326. [PMID: 31654263 DOI: 10.1007/s00381-019-04383-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Accepted: 09/20/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Patients with non-communicating hydrocephalus due to aqueductal stenosis are often successfully treated with endoscopic third ventriculocisternostomy (ETV). In hydrocephalus, due to other locations of obstruction of the major CSF pathways, endoscopic treatment may also be a good option. We investigated our cohort of patients treated by ETV with patent ventricular outflow but pressure gradient signs at the third ventricle in a single-center retrospective study. METHODS We retrospectively reviewed records and imaging studies of 137 patients who underwent an ETV in our department in the time period of June 2010 to March 2018. We included patients who showed the following findings in MRI: 1st: open Sylvian aqueduct, 2nd: open outlets of the 4th ventricle, 3rd: open spinal canal, 4th: intra-/extraventricular pressure gradient seen at the 3rd ventricle and excluded patients with history of CSF infection or hemorrhage. Perioperative clinical state and possible complications or reoperations were recorded. Shunt dependency and changes in ventricular dilatation were measured as frontal and occipital horn ratio (FOHR) before surgery and during follow-up. RESULTS A total of 21 patients met the defined criteria. During the mean follow-up time of 40.7 ± 30 months (range; 5-102 months), two children had to undergo a re-ETV, and six children (all < 1 year of age) received a VP shunt. ETV shunt-free survival was 100% for children > 1 year of age. The ventricular width measured as FOHR was significantly reduced after ETV 0.5 ± 0.08 (range 0.42-0.69; p < 0.05). FOHR was significantly reduced at last follow-up shunt independent patients (0.47 ± 0.05; range 0.41-0.55; p < 0.001) CONCLUSION: We conclude that ETV seems to be a successful treatment option for patients with MRI signs of intra-/extraventricular pressure gradient at the 3rd ventricle and patent aqueduct and fourth ventricular outlets in children older than 1 year of age. This condition is observed only rarely and warrants further research on a multicenter basis in order to get more solid data of its pathophysiology.
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Affiliation(s)
- S Al-Hakim
- Pediatric Neurosurgery, Charité Universitätsmedizin Berlin, Campus Virchow Klinikum, Augustenburger Platz 1, D-13353, Berlin, Germany
| | - A Schaumann
- Pediatric Neurosurgery, Charité Universitätsmedizin Berlin, Campus Virchow Klinikum, Augustenburger Platz 1, D-13353, Berlin, Germany
| | - A Tietze
- Institute for Neuroradiology, Charité Universitätsmedizin Berlin, Campus Virchow Klinikum, Berlin, Germany
| | - M Schulz
- Pediatric Neurosurgery, Charité Universitätsmedizin Berlin, Campus Virchow Klinikum, Augustenburger Platz 1, D-13353, Berlin, Germany
| | - U-W Thomale
- Pediatric Neurosurgery, Charité Universitätsmedizin Berlin, Campus Virchow Klinikum, Augustenburger Platz 1, D-13353, Berlin, Germany.
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Stroka J, Doncheva I, Spangenberg B, Bouten K, Braemer R, Caemmerer B, Dzido T, Grosse-Damhues J, Kemme J, Koch A, Kraus S, Morlock G, Schneider R, Schulz M, Vega M, Widmer V. Determination of Sucralose in Soft Drinks by High-Performance Thin-Layer Chromatography: Interlaboratory Study. J AOAC Int 2019. [DOI: 10.1093/jaoac/92.4.1153] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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]
Abstract
Abstract
An interlaboratory comparison was carried out to evaluate the effectiveness of a method based on HPTLC in which reagent-free derivatization is followed by UV/fluorescence detection. The method was tested for the determination of sucralose (C12H19Cl3O8; (2R,3R,4R,5S,6R)-2- [(2R,3S,4S,5S)-2,5-bis(chloromethyl)-3,4-dihydroxyoxolan- 2-yl]oxy-5-chloro-6-hydroxymethyl)oxane-3, 4-diol; CAS Registry No. 56038-13-2) in carbonated and still beverages at the proposed European regulatory limits. For still beverages, a portion of the sample was diluted with methanolwater. For carbonated beverages, a portion of the sample was degassed in an ultrasonic bath before dilution. Turbid beverages were filtered after dilution through an HPLC syringe filter. The separation of sucralose was performed by direct application on amino-bonded (NH2) silica gel HPTLC plates (no cleanup needed) with the mobile phase acetonitrilewater. Sucralose was determined after reagent-free derivatization at 190C; it was quantified by measurements of both UV absorption and fluorescence. The samples, both spiked and containing sucralose, were sent to 14 laboratories in five different countries. Test portions of a sample found to contain no sucralose were spiked at levels of 30.5, 100.7, and 299 mg/L. Recoveries ranged from 104.3 to 124.6 and averaged 112 for determination by UV detection; recoveries ranged from 98.4 to 101.3 and averaged 99.9 for determination by fluorescence detection. On the basis of the results for spiked samples (blind duplicates at three levels), as well as sucralosecontaining samples (blind duplicates at three levels and one split level), the values for the RSDr ranged from 10.3 to 31.4 for determinations by UV detection and from 8.9 to 15.9 for determinations by fluorescence detection. The values for the RSDR values ranged from 13.5 to 31.4 for determinations by UV detection and from 8.9 to 20.7 for determinations by fluorescence detection.
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Affiliation(s)
- Joerg Stroka
- European CommissionJoint Research Centre, Institute for Reference Materials and Measurements, Food Safety and Quality Unit, Retieseweg 111, B-2440 Geel, Belgium
| | - Ivanka Doncheva
- European CommissionJoint Research Centre, Institute for Reference Materials and Measurements, Food Safety and Quality Unit, Retieseweg 111, B-2440 Geel, Belgium
| | - Bernd Spangenberg
- University of Applied Science Offenburg, Badstrasse 24, D-77652 Offenburg, Germany
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Hofmann GA, Gradl G, Schulz M, Haidinger G, Tanew A, Weber B. The frequency of photosensitizing drug dispensings in Austria and Germany: a correlation with their photosensitizing potential based on published literature. J Eur Acad Dermatol Venereol 2019; 34:589-600. [PMID: 31520553 PMCID: PMC7065208 DOI: 10.1111/jdv.15952] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 08/23/2019] [Indexed: 01/15/2023]
Abstract
Background Drug‐induced photosensitivity refers to the development of cutaneous adverse events due to interaction between a pharmaceutical compound and sunlight. Although photosensitivity is a very commonly listed side‐effect of systemic drugs, reliable data on its actual incidence are lacking so far. Objectives A possible approach to evaluate the real‐life extent of drug‐induced photosensitivity would be an analysis of the frequency of exposure to a given photosensitizing drug combined with an indicator of its photosensitizing potential. This could serve as a basis for developing a pharmaceutical ‘heatmap’ of photosensitivity. Methods The present study investigated the number of reimbursed dispensed packages of potentially photosensitizing drugs in Germany (DE) and Austria (AT) between 2010 and 2017 based on nationwide health insurance‐based databases. In addition, an indicator for the photosensitizing potential was established for each drug based on the number of reports on photosensitivity in the literature. Results This analysis includes means of 632 826 944 (+/−14 894 918) drug dispensings per year in DE and 113 270 754 (+/−1 964 690) in AT. Out of these, the mean percentage of drugs that enlist photosensitivity as a potential side‐effect was 49.5% (±0.7) in DE and 48.2% (±1.2) in AT. When plotting the number of reimbursed dispensed packages vs. the number of reports on photosensitivity, two categories of drugs show high numbers for both parameters, that is diuretics and non‐steroidal anti‐inflammatory drugs (NSAIDs). Conclusions Diuretics and NSAIDs appear to be responsible for the greatest part of exposure to photosensitizing drugs with potential implication on public health.
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Affiliation(s)
- G A Hofmann
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - G Gradl
- German Institute for Drug Use Evaluation (DAPI), Berlin, Germany
| | - M Schulz
- German Institute for Drug Use Evaluation (DAPI), Berlin, Germany.,Department of Medicine, ABDA - Federal Union of German Associations of Pharmacists, Berlin, Germany.,Institute of Pharmacy, Freie Universitaet Berlin, Berlin, Germany
| | - G Haidinger
- Department of Epidemiology, Center for Public Health, Medical University of Vienna, Vienna, Austria
| | - A Tanew
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - B Weber
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
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44
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Myhre G, Alterskjær K, Stjern CW, Hodnebrog Ø, Marelle L, Samset BH, Sillmann J, Schaller N, Fischer E, Schulz M, Stohl A. Frequency of extreme precipitation increases extensively with event rareness under global warming. Sci Rep 2019; 9:16063. [PMID: 31690736 PMCID: PMC6831572 DOI: 10.1038/s41598-019-52277-4] [Citation(s) in RCA: 66] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Accepted: 10/15/2019] [Indexed: 11/10/2022] Open
Abstract
The intensity of the heaviest extreme precipitation events is known to increase with global warming. How often such events occur in a warmer world is however less well established, and the combined effect of changes in frequency and intensity on the total amount of rain falling as extreme precipitation is much less explored, in spite of potentially large societal impacts. Here, we employ observations and climate model simulations to document strong increases in the frequencies of extreme precipitation events occurring on decadal timescales. Based on observations we find that the total precipitation from these intense events almost doubles per degree of warming, mainly due to changes in frequency, while the intensity changes are relatively weak, in accordance to previous studies. This shift towards stronger total precipitation from extreme events is seen in observations and climate models, and increases with the strength - and hence the rareness - of the event. Based on these results, we project that if historical trends continue, the most intense precipitation events observed today are likely to almost double in occurrence for each degree of further global warming. Changes to extreme precipitation of this magnitude are dramatically stronger than the more widely communicated changes to global mean precipitation.
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Affiliation(s)
- G Myhre
- CICERO Center for International Climate Research - Oslo, 0318, Oslo, Norway.
| | - K Alterskjær
- CICERO Center for International Climate Research - Oslo, 0318, Oslo, Norway
| | - C W Stjern
- CICERO Center for International Climate Research - Oslo, 0318, Oslo, Norway
| | - Ø Hodnebrog
- CICERO Center for International Climate Research - Oslo, 0318, Oslo, Norway
| | - L Marelle
- CICERO Center for International Climate Research - Oslo, 0318, Oslo, Norway
| | - B H Samset
- CICERO Center for International Climate Research - Oslo, 0318, Oslo, Norway
| | - J Sillmann
- CICERO Center for International Climate Research - Oslo, 0318, Oslo, Norway
| | - N Schaller
- CICERO Center for International Climate Research - Oslo, 0318, Oslo, Norway
| | - E Fischer
- Institute for Atmospheric and Climate Science, ETH Zurich, 8092, Zurich, Switzerland
| | - M Schulz
- Norwegian Meteorological Institute, 0313, Oslo, Norway
| | - A Stohl
- NILU - Norwegian Institute for Air Research, Kjeller, Norway
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45
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Bohlken J, von Stillfried D, Schulz M. [Prevalence Rates of Mild Cognitive Impairment and of Dementia in the German Outpatient Health Care Sector 2009-2016]. Psychiatr Prax 2019; 47:16-21. [PMID: 31671469 DOI: 10.1055/a-1012-9502] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [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
OBJECTIVE In Germany, the number of patients with dementia is expected to increase from 1.7 (2017) to more than 3 million people (2050). Preventive and therapeutic measures target at early stages of dementia such as mild cognitive impairment (MCI). Aim of the study is to compare prevalence rates of MCI and dementia over time. METHODS The study was based on the complete nation-wide outpatient claims data of the panel doctors services according to § 295 SGB V. We identified prevalent patients with MCI (PwMCI) and with dementia (PwD) in the years 2009 to 2016 treated by general practitioners or neuropsychiatric specialists. RESULTS The number of prevalent PwMCI/PwD increased from 50,760/1,014,381 (2009) to 166,919/1,416,319 (2016) and the corresponding prevalence rates from 0.13 % to 0.42 % (MCI) and from 2.52 % to 3.55 % (dementia), resp. CONCLUSION Despite the significant prevalence gain, the number of PwMCI identified in outpatient health claims data is much lower than the expected number of 2,8 to 3,7 million people at the population level. Therefore, we anticipate a further increase in the number of PwMCI being treated in the outpatient sector over the coming years.
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Affiliation(s)
- Jens Bohlken
- Praxis für Neurologie und Psychiatrie, Berlin.,Institut für Sozialmedizin, Arbeitsmedizin und Public Health (ISAP) der Medizinischen Fakultät der Universität Leipzig
| | | | - Mandy Schulz
- Zentralinstitut für die kassenärztliche Versorgung in Deutschland (Zi), Berlin
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46
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Hermes N, Jewell KS, Schulz M, Müller J, Hübner U, Wick A, Drewes JE, Ternes TA. Elucidation of removal processes in sequential biofiltration (SBF) and soil aquifer treatment (SAT) by analysis of a broad range of trace organic chemicals (TOrCs) and their transformation products (TPs). Water Res 2019; 163:114857. [PMID: 31336207 DOI: 10.1016/j.watres.2019.114857] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 07/10/2019] [Accepted: 07/11/2019] [Indexed: 06/10/2023]
Abstract
Many chemicals with different physico-chemical properties are present in municipal wastewater. In this study, the removal of a broad range of trace organic chemicals (TOrCs) was determined in two biological treatment processes differing in hydraulic retention time: sequential biofiltration (SBF) and soil-aquifer treatment (SAT), operated in Germany and Spain. Occurrence and the degree of removal of more than 150 TOrCs with different physico-chemical properties were analysed, including precursors as well as human metabolites and environmental transformation products (TPs). Ninety TOrCs were detected in the feed water of the SBF system, 40% of these showed removal efficiencies of higher than 30% during biological treatment. In SAT, 70 TOrCs were detected in the feed water, 60% of these could be reduced by more than 30% after approximately 3 days of subsurface treatment. For uncharged and negatively charged TOrCs biological degradation was mainly responsible for the removal, while positively charged TOrCs were most likely also removed by ionic interactions. The detections of TPs confirmed that biodegradation was a major removal process in both systems. The analysis of positively and negatively charged, neutral and zwitterionic TOrCs and the simultaneous analysis of precursors and their biologically formed TPs enabled a detailed understanding of underlying mechanisms of their removal in the two systems. On this basis, criteria for site-specific indicator selection were proposed.
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Affiliation(s)
- N Hermes
- Federal Institute of Hydrology, Mainzer Tor 1, 56068, Koblenz, Germany
| | - K S Jewell
- Federal Institute of Hydrology, Mainzer Tor 1, 56068, Koblenz, Germany
| | - M Schulz
- Federal Institute of Hydrology, Mainzer Tor 1, 56068, Koblenz, Germany
| | - J Müller
- Technical University of Munich, Chair of Urban Water Systems Engineering, Am Coulombwall 3, 85748, Garching, Germany
| | - U Hübner
- Technical University of Munich, Chair of Urban Water Systems Engineering, Am Coulombwall 3, 85748, Garching, Germany
| | - A Wick
- Federal Institute of Hydrology, Mainzer Tor 1, 56068, Koblenz, Germany
| | - J E Drewes
- Technical University of Munich, Chair of Urban Water Systems Engineering, Am Coulombwall 3, 85748, Garching, Germany
| | - T A Ternes
- Federal Institute of Hydrology, Mainzer Tor 1, 56068, Koblenz, Germany.
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March S, Andrich S, Drepper J, Horenkamp-Sonntag D, Icks A, Ihle P, Kieschke J, Kollhorst B, Maier B, Meyer I, Müller G, Ohlmeier C, Peschke D, Richter A, Rosenbusch ML, Scholten N, Schulz M, Stallmann C, Swart E, Wobbe-Ribinski S, Wolter A, Zeidler J, Hoffmann F. [Good Practice Data Linkage]. Gesundheitswesen 2019; 81:636-650. [PMID: 31394579 DOI: 10.1055/a-0962-9933] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Individual data linkage of different data sources for research purposes is being increasingly used in Germany in recent years. However, generally accepted methodological guidance is missing. The aim of this article is to define such methodological standards for research projects. Another aim is to provide readers with a checklist for critical appraisal of research proposals and articles. Since 2016, an expert panel of members of different German scientific societies have worked together and developed 7 guidelines with a total of 27 practical recommendations. These recommendations include (1) research aims, questions, data sources and resources, (2) infrastructure and data flow, (3) data privacy, (4) ethics, (5) key variables and type of linkage, (6) data validation/quality assurance and (7) long-term use for future research questions. The authors provide a rationale for each recommendation. Future revisions will include any new developments in science and data privacy.
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Affiliation(s)
- Stefanie March
- Institut für Sozialmedizin und Gesundheitsökonomie (ISMG), Medizinische Fakultät, Otto-von-Guericke-Universität Magdeburg, Magdeburg
| | - Silke Andrich
- Institut für Versorgungsforschung und Gesundheitsökonomie, Centre for Health and Society, Medizinische Fakultät, Heinrich-Heine-Universität Düsseldorf, Düsseldorf.,Institut für Versorgungsforschung und Gesundheitsökonomie, Deutsches Diabetes-Zentrum (DDZ), Leibniz-Zentrum für Diabetes-Forschung an der Heinrich-Heine-Universität Düsseldorf, Düsseldorf
| | - Johannes Drepper
- TMF - Technologie- und Methodenplattform für die vernetzte medizinische Forschung e. V., Berlin
| | | | - Andrea Icks
- Institut für Versorgungsforschung und Gesundheitsökonomie, Centre for Health and Society, Medizinische Fakultät, Heinrich-Heine-Universität Düsseldorf, Düsseldorf.,Institut für Versorgungsforschung und Gesundheitsökonomie, Deutsches Diabetes-Zentrum (DDZ), Leibniz-Zentrum für Diabetes-Forschung an der Heinrich-Heine-Universität Düsseldorf, Düsseldorf
| | - Peter Ihle
- PMV forschungsgruppe, Universität zu Köln, Köln
| | - Joachim Kieschke
- Epidemiologisches Krebsregister Niedersachsen, Registerstelle, Oldenburg
| | - Bianca Kollhorst
- Leibniz-Institut für Präventionsforschung und Epidemiologie - BIPS, Abteilung Biometrie und EDV, Bremen
| | - Birga Maier
- Berlin-Brandenburger Herzinfarktregister e. V., Berlin-Brandenburger Herzinfarktregister, Berlin
| | - Ingo Meyer
- PMV forschungsgruppe, Universität zu Köln, Köln
| | - Gabriele Müller
- Zentrum für Evidenzbasierte Gesundheitsversorgung (ZEGV), Universitätsklinikum und Medizinische Fakultät Carl Gustav Carus, TU Dresden, Dresden
| | | | - Dirk Peschke
- Institut für Public Health und Pflegeforschung (IPP), Universität Bremen, Bremen.,Department für Angewandte Gesundheitswissenschaften, Studienbereich Physiotherapie, Hochschule für Gesundheit Bochum, Bochum
| | - Adrian Richter
- Institut für Community Medicine, Universitätsmedizin Greifswald, Greifswald
| | - Marie-Luise Rosenbusch
- Zentralinstitut für die kassenärztliche Versorgung in Deutschland (Zi), Fachbereich Versorgungsforschung, Systemanalyse und Data Science, Berlin
| | - Nadine Scholten
- Institut für Medizinsoziologie, Versorgungsforschung und Rehabilitationswissenschaft (IMVR), Humanwissenschaftliche Fakultät und Medizinische Fakultät, Universität zu Köln, Köln
| | - Mandy Schulz
- Zentralinstitut für die kassenärztliche Versorgung in Deutschland (Zi), Fachbereich Versorgungsforschung, Systemanalyse und Data Science, Berlin
| | - Christoph Stallmann
- Institut für Sozialmedizin und Gesundheitsökonomie (ISMG), Medizinische Fakultät, Otto-von-Guericke-Universität Magdeburg, Magdeburg
| | - Enno Swart
- Institut für Sozialmedizin und Gesundheitsökonomie (ISMG), Medizinische Fakultät, Otto-von-Guericke-Universität Magdeburg, Magdeburg
| | | | - Antke Wolter
- DAK Gesundheit, Vorstandsreferat Versorgungsforschung, Hamburg
| | - Jan Zeidler
- Center for Health Economics Research Hannover (CHERH), Leibniz Universität Hannover, Hannover
| | - Falk Hoffmann
- Fakultät für Medizin und Gesundheitswissenschaften, Department für Versorgungsforschung, Carl von Ossietzky Universität Oldenburg, Oldenburg
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KHANDAKER M, Taha L, Schulz M. MON-178 A COMPARISON BETWEEN MDRD eGFR AND CREATININE CLEARANCE IN RENAL TRANSPLANT PATIENTS. Kidney Int Rep 2019. [DOI: 10.1016/j.ekir.2019.05.973] [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: 11/30/2022] Open
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Schütze M, Wriege-Bechtold A, Zinati T, Söbke H, Wißmann I, Schulz M, Veser S, Londong J, Barjenbruch M, Alex J. Simulation and visualization of material flows in sanitation systems for streamlined sustainability assessment. Water Sci Technol 2019; 79:1966-1976. [PMID: 31294713 DOI: 10.2166/wst.2019.199] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
New and alternative sanitation systems are increasingly discussed and find their way into implementation. However, discussions on sanitation concepts often are held in a rather emotional way. Furthermore, not all the available sanitation concepts might be known to the decision maker. The work presented here attempts to contribute to a good discussion and decision making process by compiling available technologies, by defining easy-to-implement criteria for a sustainability assessment method and by integrating these results into a simulation tool which allows to visualize the related resource fluxes (e.g. those on nutrients, such as N, P and K) and to analyse different sanitation options with regard to their capital and operational costs and with regard to environmental impact criteria such as greenhouse gas emissions. Whilst the calculations are to be considered as being approximate in their nature (due to uncertainties or lack of suitable input data), this tool allows the planners, with sometimes little modelling experience, to consider the characteristics of sanitation systems. Whilst starting from earlier work, such as Eawag's Sanitation Compendium and work on material flow analysis, work described in this contribution merges resource flux modelling, easy-to-use simulation and visualization and methods of life cycle assessment and life cycle costing. The simulation tool is freely available on https://www.ifak.eu/en/products/sampsons.
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Affiliation(s)
- M Schütze
- ifak e. V., Werner-Heisenberg-Str. 1, 39106 Magdeburg, Germany E-mail:
| | - A Wriege-Bechtold
- Technical University Berlin, Gustav-Meyer-Allee 25, 13355 Berlin, Germany
| | - T Zinati
- Technical University Berlin, Gustav-Meyer-Allee 25, 13355 Berlin, Germany
| | - H Söbke
- Bauhaus-Universität Weimar, Coudraystr. 7, 99423 Weimar, Germany
| | - I Wißmann
- BCE Björnsen Consulting Engineers, Distelfeldstr. 15, 71229 Leonberg, Germany
| | - M Schulz
- BCE Björnsen Consulting Engineers, Distelfeldstr. 15, 71229 Leonberg, Germany
| | - S Veser
- BCE Björnsen Consulting Engineers, Distelfeldstr. 15, 71229 Leonberg, Germany
| | - J Londong
- Bauhaus-Universität Weimar, Coudraystr. 7, 99423 Weimar, Germany
| | - M Barjenbruch
- Technical University Berlin, Gustav-Meyer-Allee 25, 13355 Berlin, Germany
| | - J Alex
- ifak e. V., Werner-Heisenberg-Str. 1, 39106 Magdeburg, Germany E-mail:
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50
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Kuchenbuch HS, Schulz M, Becker S, Cramer B, Humpf HU. Thermal Reactions and the Formation of Degradation Products of T-2 and HT-2 Toxin during Processing of Oats. ACTA ACUST UNITED AC 2019. [DOI: 10.1021/bk-2019-1306.ch007] [Citation(s) in RCA: 1] [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: 02/19/2023]
Affiliation(s)
- H. S. Kuchenbuch
- Westfälische Wilhelms-Universität Münster, Institute of Food Chemistry, Corrensstrasse 45, 48149 Münster, Germany
| | - M. Schulz
- Westfälische Wilhelms-Universität Münster, Institute of Food Chemistry, Corrensstrasse 45, 48149 Münster, Germany
| | - S. Becker
- Westfälische Wilhelms-Universität Münster, Institute of Food Chemistry, Corrensstrasse 45, 48149 Münster, Germany
| | - B. Cramer
- Westfälische Wilhelms-Universität Münster, Institute of Food Chemistry, Corrensstrasse 45, 48149 Münster, Germany
| | - H.-U. Humpf
- Westfälische Wilhelms-Universität Münster, Institute of Food Chemistry, Corrensstrasse 45, 48149 Münster, Germany
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