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Werner C, Bauknecht L, Heldmann P, Hummel S, Günther-Lange M, Bauer JM, Hauer K. Mobility outcomes and associated factors of acute geriatric care in hospitalized older patients: results from the PAGER study. Eur Geriatr Med 2024; 15:139-152. [PMID: 37777992 PMCID: PMC10876756 DOI: 10.1007/s41999-023-00869-9] [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] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Accepted: 09/13/2023] [Indexed: 10/03/2023]
Abstract
PURPOSE To examine distinct mobility outcomes (locomotor capacity, physical activity, life-space mobility) of acute geriatric care (AGC) in acutely hospitalized older adults and identify predictors associated with these outcomes. METHODS The PAGER study was designed as a prospective observational study. Mobility outcomes of 107 hospitalized older patients (age = 83.2 ± 6.4 years, female: n = 68, 63.6%) receiving AGC were measured at hospital admission and discharge. Locomotor capacity was assessed with the Short Physical Performance Battery (SPPB), 24-h physical activity (step count) with an activity monitor, and life-space mobility with the Life-Space Assessment in Institutionalized Settings (LSA-IS). Baseline demographical, clinical, physical, cognitive, and psychological characteristics were analyzed as candidate predictors of mobility outcomes. RESULTS SPPB (median [interquartile range] 4.0 [2.8-5.0] pt. vs. 5.0 [3.0-6.3] pt.), step count (516 [89-1806] steps vs. 1111 [228-3291] steps), and LSA-IS total score (10.5 [6.0-15.0] pt. vs. 16.3 [12.0-24.1] pt.) significantly improved during AGC (all p < 0.001). Adjusting for baseline status, frailty was identified as an independent negative predictor of SPPB, step count, and LSA-IS at discharge (p = 0.003-0.005). Barthel Index was also independently positively associated with step count (p = 0.017) at discharge, as was the mean daily PA level with SPPB (p = 0.027) at discharge, both independent of baseline status. CONCLUSION AGC improves distinct mobility outcomes in hospitalized older patients. Frailty was consistently found to be an independent negative predictor of all mobility outcomes. Frailty assessment in AGC may be important to identify patients at risk for decreased treatment gains in mobility. Early PA promotion in AGC seems to be beneficial in improving patients' locomotor capacity.
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Affiliation(s)
- Christian Werner
- Geriatric Center, Heidelberg University Hospital, Agaplesion Bethanien Hospital Heidelberg, Rohrbacher Str. 149, 69216, Heidelberg, Germany.
| | - Laura Bauknecht
- Medical Faculty Heidelberg, Heidelberg University, Im Neuenheimer Feld 672, 69120, Heidelberg, Germany
| | - Patrick Heldmann
- Network Aging Research (NAR), Heidelberg University, Bergheimer Str. 20, 69115, Heidelberg, Germany
- Division of Physiotherapy, Department of Applied Health Sciences, Hochschule für Gesundheit (University of Applied Sciences), Gesundheitscampus 6-8, 44801, Bochum, Germany
| | - Saskia Hummel
- Medical Faculty Heidelberg, Heidelberg University, Im Neuenheimer Feld 672, 69120, Heidelberg, Germany
| | - Michaela Günther-Lange
- Geriatric Center, Heidelberg University Hospital, Agaplesion Bethanien Hospital Heidelberg, Rohrbacher Str. 149, 69216, Heidelberg, Germany
| | - Jürgen M Bauer
- Geriatric Center, Heidelberg University Hospital, Agaplesion Bethanien Hospital Heidelberg, Rohrbacher Str. 149, 69216, Heidelberg, Germany
- Network Aging Research (NAR), Heidelberg University, Bergheimer Str. 20, 69115, Heidelberg, Germany
| | - Klaus Hauer
- Geriatric Center, Heidelberg University Hospital, Agaplesion Bethanien Hospital Heidelberg, Rohrbacher Str. 149, 69216, Heidelberg, Germany
- Department of Clinical Gerontology, Robert-Bosch-Hospital, Auerbachstraße 110, 70376, Stuttgart, Germany
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Mayer G, Hummel S, Zafar A, Schultz JH. Konzepte der Personalisierung in der Behandlung psychischer
Erkrankungen: Ein Herangehensmodell für ein Scoping Review und erste
Ergebnisse. Das Gesundheitswesen 2022. [DOI: 10.1055/s-0042-1753749] [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: 12/12/2022]
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Deis T, Wolsk E, Mujkanovic J, Komtebedde J, Burkhoff D, Kaye D, Hasenfuß G, Hayward C, Van der Heyden J, Petrie MC, Shah SJ, Borlaug BA, Kahwash R, Litwin S, Hoendermis E, Hummel S, Gustafsson F. Resting and exercise haemodynamic characteristics of patients with advanced heart failure and preserved ejection fraction. ESC Heart Fail 2021; 9:186-195. [PMID: 34877822 PMCID: PMC8788022 DOI: 10.1002/ehf2.13697] [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: 06/19/2021] [Revised: 09/07/2021] [Accepted: 10/29/2021] [Indexed: 01/03/2023] Open
Abstract
Aims This study aimed to describe haemodynamic features of patients with advanced heart failure with preserved ejection fraction (HFpEF) as defined by the Heart Failure Association (HFA) of the European Society of Cardiology (ESC). Methods and results We used pooled data from two dedicated HFpEF studies with invasive exercise haemodynamic protocols, the REDUCE LAP‐HF (Reduce Elevated Left Atrial Pressure in Patients with Heart Failure) trial and the REDUCE LAP‐HF I trial, and categorized patients according to advanced heart failure (AdHF) criteria. The well‐characterized HFpEF patients were considered advanced if they had persistent New York Heart Association classification of III–IV and heart failure (HF) hospitalization < 12 months and a 6 min walk test distance < 300 m. Twenty‐four (22%) out of 108 patients met the AdHF criteria. On evaluation, clinical characteristics and resting haemodynamics were not different in the two groups. Patients with AdHF had lower work capacity compared with non‐advanced patients (35 ± 16 vs. 45 ± 18 W, P = 0.021). Workload‐corrected pulmonary capillary wedge pressure normalized to body weight (PCWL) was higher in AdHF patients compared with non‐advanced (112 ± 55 vs. 86 ± 49 mmHg/W/kg, P = 0.04). Further, AdHF patients had a smaller increase in cardiac index during exercise (1.1 ± 0.7 vs. 1.6 ± 0.9 L/min/m2, P = 0.028). Conclusions A significantly higher PCWL and lower cardiac index reserve during exercise were observed in AdHF patients compared with non‐advanced. These differences were not apparent at rest. Therapies targeting the haemodynamic compromise associated with advanced HFpEF are needed.
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Affiliation(s)
- T Deis
- Department of Cardiology, Rigshospitalet, University of Copenhagen, 9 Blegdamsvej, Copenhagen, 2100, Denmark
| | - E Wolsk
- Department of Cardiology, Rigshospitalet, University of Copenhagen, 9 Blegdamsvej, Copenhagen, 2100, Denmark.,Department of Cardiology, Herlev-Gentofte Hospital, Hellerup, Denmark
| | - J Mujkanovic
- Department of Cardiology, Rigshospitalet, University of Copenhagen, 9 Blegdamsvej, Copenhagen, 2100, Denmark
| | | | - D Burkhoff
- Cardiovascular Research Foundation, New York, NY, USA
| | - D Kaye
- Department of Cardiology, Alfred Hospital, Melbourne, Victoria, Australia
| | - G Hasenfuß
- Georg-August Universität, Heart Centre, Gottingen, Germany
| | - C Hayward
- Department of Cardiology, St-Jan Hospital, Bruges, Belgium
| | | | - M C Petrie
- Institute of Cardiovascular and Medical Sciences, British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
| | - S J Shah
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - B A Borlaug
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - R Kahwash
- The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - S Litwin
- Medical University of South Carolina, Charleston, SC, USA
| | - E Hoendermis
- University Medical Center, Groningen, The Netherlands
| | - S Hummel
- University of Michigan Frankel Cardiovascular Center, Ann Arbor, MI, USA.,Ann Arbor Veterans Affairs Health System, Ann Arbor, MI, USA
| | - F Gustafsson
- Department of Cardiology, Rigshospitalet, University of Copenhagen, 9 Blegdamsvej, Copenhagen, 2100, Denmark
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Heinrichs K, Schultz K, Hummel S, Jütjens O, Angerer P, Loerbroks A. Mögliche Interventionen zur Verbesserung von Asthma-Selbstmanagement am Arbeitsplatz. Das Gesundheitswesen 2021. [DOI: 10.1055/s-0041-1732126] [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: 10/20/2022]
Affiliation(s)
- K Heinrichs
- Institut für Gesundheits- und Pflegewissenschaft, Charité - Universitätsmedizin Berlin
- Institut für Arbeits-, Sozial- und Umweltmedizin, Heinrich-Heine-Universität Düsseldorf
| | - K Schultz
- Klinik Bad Reichenhall der DRV Bayern Süd
| | | | - O Jütjens
- Nordseeklinik Borkum der DRV Rheinland
| | - P Angerer
- Institut für Arbeits-, Sozial- und Umweltmedizin, Heinrich-Heine-Universität Düsseldorf
| | - A Loerbroks
- Institut für Arbeits-, Sozial- und Umweltmedizin, Heinrich-Heine-Universität Düsseldorf
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Hauer K, Ullrich P, Heldmann P, Bauknecht L, Hummel S, Abel B, Bauer JM, Lamb SE, Werner C. Psychometric Properties of the Proxy-Reported Life-Space Assessment in Institutionalized Settings (LSA-IS-Proxy) for Older Persons with and without Cognitive Impairment. Int J Environ Res Public Health 2021; 18:ijerph18083872. [PMID: 33917097 PMCID: PMC8067867 DOI: 10.3390/ijerph18083872] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 03/31/2021] [Accepted: 03/31/2021] [Indexed: 12/17/2022]
Abstract
(1) Background: Life-space mobility assessments for institutionalized settings are scarce and there is a lack of comprehensive validation and focus on persons with cognitive impairment (CI). This study aims to evaluate the psychometric properties of the Life-Space Assessment for Institutionalized Settings by proxy informants (LSA-IS-proxy) for institutionalized, older persons, with and without CI. (2) Methods: Concurrent validity against the self-reported version of the LSA-IS, construct validity with established construct variables, test-retest reliability, sensitivity to change during early multidisciplinary geriatric rehabilitation treatment, and feasibility (completion rate, floor/ceiling effects) of the LSA-IS-proxy, were assessed in 94 hospitalized geriatric patients (83.3 ± 6.1 years), with and without CI. (3) Results: The LSA-IS-proxy total score showed good-to-excellent agreement with the self-reported LSA-IS (Intraclass Correlations Coefficient, ICC3,1 = 0.77), predominantly expected small-to-high correlations with construct variables (r = 0.21–0.59), good test–retest reliability (ICC3,1 = 0.74), significant sensitivity to change over the treatment period (18.5 ± 7.9 days; p < 0.001, standardized response mean = 0.44), and excellent completion rates (100%) with no floor/ceiling effects. These results were predominantly confirmed for the sub-scores of the LSA-IS-proxy and were comparable between the sub-groups with different cognitive status. (4) Conclusions: The LSA-IS-proxy has proven to be feasible, valid, reliable, and sensitive to change in hospitalized, geriatric patients with and without CI.
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Affiliation(s)
- Klaus Hauer
- Agaplesion Bethanien Hospital Heidelberg/Geriatric Center at the Heidelberg University, and Center of Geriatric Medicine, Heidelberg University, 69126 Heidelberg, Germany; (P.U.); (B.A.); (J.M.B.); (C.W.)
- Correspondence: ; Tel.: +49-6221-319-1532
| | - Phoebe Ullrich
- Agaplesion Bethanien Hospital Heidelberg/Geriatric Center at the Heidelberg University, and Center of Geriatric Medicine, Heidelberg University, 69126 Heidelberg, Germany; (P.U.); (B.A.); (J.M.B.); (C.W.)
| | - Patrick Heldmann
- Network Aging Research (NAR), Heidelberg University, 69115 Heidelberg, Germany;
| | - Laura Bauknecht
- Medical Faculty, Heidelberg University, 69120 Heidelberg, Germany; (L.B.); (S.H.)
| | - Saskia Hummel
- Medical Faculty, Heidelberg University, 69120 Heidelberg, Germany; (L.B.); (S.H.)
| | - Bastian Abel
- Agaplesion Bethanien Hospital Heidelberg/Geriatric Center at the Heidelberg University, and Center of Geriatric Medicine, Heidelberg University, 69126 Heidelberg, Germany; (P.U.); (B.A.); (J.M.B.); (C.W.)
| | - Juergen M. Bauer
- Agaplesion Bethanien Hospital Heidelberg/Geriatric Center at the Heidelberg University, and Center of Geriatric Medicine, Heidelberg University, 69126 Heidelberg, Germany; (P.U.); (B.A.); (J.M.B.); (C.W.)
| | - Sarah E. Lamb
- Institute of Health Research, University of Exeter, South Cloisters, St. Luke’s Campus, Exeter EX1 2LU, UK;
| | - Christian Werner
- Agaplesion Bethanien Hospital Heidelberg/Geriatric Center at the Heidelberg University, and Center of Geriatric Medicine, Heidelberg University, 69126 Heidelberg, Germany; (P.U.); (B.A.); (J.M.B.); (C.W.)
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Heldmann P, Hummel S, Bauknecht L, Bauer JM, Werner C. Construct Validity, Test-Retest Reliability, Sensitivity to Change, and Feasibility of the Patient-Specific Functional Scale in Acutely Hospitalized Older Patients With and Without Cognitive Impairment. J Geriatr Phys Ther 2021; 45:134-144. [PMID: 33734156 DOI: 10.1519/jpt.0000000000000303] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND AND PURPOSE The Patient-Specific Functional Scale (PSFS) as an individualized patient-reported outcome measure may allow to assess limitations and changes in self-determined functional activities most important to an older patient in the acute care setting. However, its clinimetric properties have not yet been evaluated in these patients. The study aimed to investigate the construct validity, test-retest reliability, sensitivity to change, and feasibility of the PSFS in acutely hospitalized older patients with and without cognitive impairment (CI). METHODS The clinimetric properties of the PSFS were investigated by secondary data analysis from a prospective observational cohort study examining physical activity and mobility in acutely hospitalized older patients. In this analysis, 120 older patients-83.0 (6.4) years-with (Mini-Mental State Examination [MMSE] 18-23, n = 52) and without CI (MMSE ≥24, n = 68) receiving early multidisciplinary geriatric rehabilitation in acute care were included. Construct validity was assessed by Spearman correlations (rs) with the Activity-specific Balance Confidence Scale (ABC-6), Short Falls Efficacy Scale-International (Short FES-I), EuroQoL-5 Dimensions (EQ-5D), Short Physical Performance Battery (SPPB), de Morton Mobility Index (DEMMI), and Barthel Index (BI); test-retest reliability within 24 hours by intraclass correlation coefficients (ICCs); sensitivity to change by standardized response means (SRMs) calculated for treatment effects, and feasibility by completion rates/times and floor/ceiling effects. RESULTS The PSFS showed fair to moderate correlations with all construct variables in patients with CI (rs = 0.31 to 0.53). In patients without CI, correlations were fair for the ABC-6, FES-I, EQ-5D, and BI (rs = |0.27 to 0.36|), but low for the SPPB and DEMMI (rs = -0.04 to 0.14). Test-retest reliability (both: ICC = 0.76) and sensitivity to change (CI: SRM = 1.10, non-CI: SRM = 0.89) were excellent in both subgroups. Excellent feasibility was documented by high completion rates (>94%), brief completion times (<8 min), and no floor/ceiling effects in both subgroups. CONCLUSIONS The PSFS has adequate clinimetric properties for assessing patient-specific functional limitations and changes in acutely hospitalized older patients with and without CI. It might be an appropriate complement to traditional functional scales to enhance patient-centeredness in clinical geriatric assessment.
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Affiliation(s)
- Patrick Heldmann
- Network Aging Research, Heidelberg University, Heidelberg, Germany. Medical Faculty, Heidelberg University, Heidelberg, Germany. Agaplesion Bethanien Hospital Heidelberg, Geriatric Center at the Heidelberg University, Heidelberg, Germany. Center for Geriatric Medicine, Heidelberg University, Heidelberg, Germany
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Schaefer H, Sheytanov V, Narr A, Liebrich M, Hummel S, Beridze T, Roehl T, Schweigmann U, Nossal R, Ocker V, Uhlemann F, Seeburger J, Tzanavaros I. Clinical Impact of Residual Shunts after Septal Defect Closure: Do Small Residual Defects under 2 mm Really Matter? Thorac Cardiovasc Surg 2021. [DOI: 10.1055/s-0041-1725807] [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: 10/21/2022]
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8
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Hauer K, Ullrich P, Heldmann P, Hummel S, Bauer JM, Werner C. Validation of the interview-based life-space assessment in institutionalized settings (LSA-IS) for older persons with and without cognitive impairment. BMC Geriatr 2020; 20:534. [PMID: 33302883 PMCID: PMC7726908 DOI: 10.1186/s12877-020-01927-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 11/23/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Self-reported life-space assessment methods so far focus on community-dwelling persons, with a lack of validated assessment methods for institutionalized settings. This study evaluated construct validity, test-retest reliability, sensitivity to change, and feasibility of a new Life-Space Assessment for Institutionalized Settings (LSA-IS) in geriatric patients. METHODS Psychometric properties of the LSA-IS in 119 hospitalized geriatric patients (83.0 ± 6.2 years) with and without cognitive impairment (CI) [Mini-Mental State Examination: 22.4 ± 4.9 scores] were evaluated within a comprehensive validation design. For the total group and subgroups according to cognitive status, construct validity was assessed by calculating Spearman's rank correlation coefficients (rho) with established construct variables, test-retest reliability by intra-class correlation coefficients (ICCs), sensitivity to change by standardized response means (SRMs) calculated for effects of early ward-based rehabilitation during hospital stay. RESULTS The LSA-IS (total score) demonstrated good test-retest reliability (ICC = .704), and large sensitivity to change (SRM = .806), while construct validity was small to high indicated by significant correlations of the LSA-IS to construct variables (rho = .208-716), depending on relative construct association. On average results of LSA-IS sub-scores confirmed results of the total score. Subgroups according to cognitive status did not differ for most analyzed variables. A completion rate of 100% and a completion time of 3.2 ± 1.2 min documented excellent feasibility. CONCLUSIONS The interview-based LSA-IS has proven to be valid, reliable, sensitive, and feasible in hospitalized, multi-morbid, geriatric patients with and without CI documenting good psychometric properties for institutionalized settings. TRIAL REGISTRATION DRKS00016028.
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Affiliation(s)
- Klaus Hauer
- AGAPLESION Bethanien Hospital Heidelberg/Geriatric Centre of the University of Heidelberg, Rohrbacher Str. 149, 69126, Heidelberg, Germany. .,Center of Geriatric Medicine, Heidelberg University, Heidelberg, Germany.
| | - Phoebe Ullrich
- AGAPLESION Bethanien Hospital Heidelberg/Geriatric Centre of the University of Heidelberg, Rohrbacher Str. 149, 69126, Heidelberg, Germany
| | - Patrick Heldmann
- Network Aging Research (NAR), Heidelberg University, Heidelberg, Germany
| | - Saskia Hummel
- Medical Faculty of the Heidelberg University, Heidelberg, Germany
| | - Jürgen M Bauer
- AGAPLESION Bethanien Hospital Heidelberg/Geriatric Centre of the University of Heidelberg, Rohrbacher Str. 149, 69126, Heidelberg, Germany.,Center of Geriatric Medicine, Heidelberg University, Heidelberg, Germany
| | - Christian Werner
- Center of Geriatric Medicine, Heidelberg University, Heidelberg, Germany
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Werner C, Heldmann P, Hummel S, Bauknecht L, Bauer JM, Hauer K. Concurrent Validity, Test-Retest Reliability, and Sensitivity to Change of a Single Body-Fixed Sensor for Gait Analysis during Rollator-Assisted Walking in Acute Geriatric Patients. Sensors (Basel) 2020; 20:s20174866. [PMID: 32872168 PMCID: PMC7506931 DOI: 10.3390/s20174866] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 08/20/2020] [Accepted: 08/26/2020] [Indexed: 11/16/2022]
Abstract
Body-fixed sensor (BFS) technology offers portable, low-cost and easy-to-use alternatives to laboratory-bound equipment for analyzing an individual's gait. Psychometric properties of single BFS systems for gait analysis in older adults who require a rollator for walking are, however, unknown. The study's aim was to evaluate the concurrent validity, test-retest-reliability, and sensitivity to change of a BFS (DynaPort MoveTest; McRoberts B.V., The Hague, The Netherlands) for measuring gait parameters during rollator-assisted walking. Fifty-eight acutely hospitalized older patients equipped with the BFS at the lower back completed a 10 m walkway using a rollator. Concurrent validity was assessed against the Mobility Lab (APDM Inc.; Portland, OR, USA), test-retest reliability over two trials within a 15 min period, and sensitivity to change in patients with improved, stable and worsened 4 m usual gait speed over hospital stay. Bland-Altman plots and intraclass correlation coefficients (ICC) for gait speed, cadence, step length, step time, and walk ratio indicate good to excellent agreement between the BFS and the Mobility Lab (ICC2,1 = 0.87-0.99) and the repeated trials (ICC2,1 = 0.83-0.92). Moderate to large standardized response means were observed in improved (gait speed, cadence, step length, walk ratio: 0.62-0.99) and worsened patients (gait speed, cadence, step time: -0.52 to -0.85), while those in stable patients were trivial to small (all gait parameters: -0.04-0.40). The BFS appears to be a valid, reliable and sensitive instrument for measuring spatio-temporal gait parameters during rollator-assisted walking in geriatric patients.
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Affiliation(s)
- Christian Werner
- Center for Geriatric Medicine, Heidelberg University, 69117 Heidelberg, Germany;
- AGAPLESION Bethanien Hospital Heidelberg, Geriatric Center at the Heidelberg University, 69126 Heidelberg, Germany;
- Correspondence: ; Tel.: +49-6221-319-1760
| | - Patrick Heldmann
- Network Aging Research (NAR), Heidelberg University, 69117 Heidelberg, Germany;
| | - Saskia Hummel
- Medical Faculty Heidelberg, Heidelberg University, 69117 Heidelberg, Germany; (S.H.); (L.B.)
| | - Laura Bauknecht
- Medical Faculty Heidelberg, Heidelberg University, 69117 Heidelberg, Germany; (S.H.); (L.B.)
| | - Jürgen M. Bauer
- Center for Geriatric Medicine, Heidelberg University, 69117 Heidelberg, Germany;
- AGAPLESION Bethanien Hospital Heidelberg, Geriatric Center at the Heidelberg University, 69126 Heidelberg, Germany;
| | - Klaus Hauer
- AGAPLESION Bethanien Hospital Heidelberg, Geriatric Center at the Heidelberg University, 69126 Heidelberg, Germany;
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Schütz SG, Nguyen-Phan A, Konerman M, Hummel S, Chervin RD. 0602 Daytime Sleepiness in Heart Failure with Preserved Versus Reduced Ejection Fraction. Sleep 2020. [DOI: 10.1093/sleep/zsaa056.599] [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: 11/12/2022] Open
Abstract
Abstract
Introduction
Sleep apnea is common in patients with heart failure, though often not associated with significant daytime sleepiness in heart failure with reduced ejection fraction (HFrEF). The clinical presentation of sleep apnea in patients who have heart failure with borderline or preserved ejections fraction (HFbEF and HFpEF, respectively) is not well characterized.
Methods
Eighty patients with heart failure were identified retrospectively in data from University of Michigan Sleep Disorders Laboratories. Heart failure was categorized as heart failure with reduced ejection fraction (HFrEF)/systolic heart failure, heart failure with borderline ejection fraction (HFbEF) or heart failure with preserved ejection fraction (HFpEF)/diastolic heart failure. Clinical information and Epworth Sleepiness Scale (ESS) scores were extracted from medical records. A subset of subjects underwent a diagnostic polysomnogram. ANOVA was used to compare clinical characteristics in subjects with different heart failure types.
Results
ESS scores trended higher in 49 subjects with HFpEF (ESS mean 10.9±4.7 [sd]) compared to 9 with HFbEF (ESS 8.0±3.4) and 22 with HFrEF (ESS 8.4±5.0) (p=0.058). Among the 40 subjects who underwent diagnostic polysomnography, no statistically significant difference emerged in apnea-hypopnea index between subjects with HFpEF, HFbEF, and HFrEF (p=0.43). No significant differences emerged for the central apnea index (p=0.16), despite magnitudes of discrepancy that suggested a larger sample size might show different
results
CAI in participants with HFrEF showed a mean of 9.0±14.6/h, compared to 0.1±0.1/h in HFbEF and 3.1±6.3/h in HFpEF.
Conclusion
Among these patients with HFpEF, HFbEF, and HFrEF, subjects with HFpEF showed a trend towards increased subjective daytime sleepiness, though overall apnea and central apnea severity did not differ between groups. Further examination of clinical phenotypes in larger cohorts may help guide care in heterogeneous heart failure populations.
Support
National Institutes of Health grant NS107158
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Affiliation(s)
| | | | | | - S Hummel
- University of Michigan, Ann Arbor, MI
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Ungethüm K, Jolink M, Hippich M, Lachmann L, Haupt F, Winkler C, Hummel S, Pitchika A, Kordonouri O, Ziegler AG, Beyerlein A. Physical activity is associated with lower insulin and C-peptide during glucose challenge in children and adolescents with family background of diabetes. Diabet Med 2019; 36:366-375. [PMID: 30242901 DOI: 10.1111/dme.13819] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/19/2018] [Indexed: 01/03/2023]
Abstract
AIMS Children and adolescents with a family history of diabetes are at increased risk of overweight, but little is known about the potentially beneficial effects of physical activity on these children. The objective of this study was to investigate the association between moderate to vigorous physical activity (MVPA) and metabolic and inflammatory risks in children and adolescents with a family background of Type 1 diabetes or gestational diabetes. METHODS Valid MVPA measurements, made with accelerometers, were available from 234 participants (median age, 10.2 years) who had a first-degree relative with either Type 1 or gestational diabetes. Anthropometric and metabolic measurements were made and cytokines measured, and were correlated with MVPA measurements, with stepwise adjustment for confounding factors, in a cross-sectional analysis. RESULTS MVPA was negatively associated with insulin and C-peptide during challenge with an oral glucose tolerance test. MVPA was also significantly positively associated with the insulin sensitivity index, whereas no consistently significant associations were found between MVPA and BMI, blood pressure or cytokine levels. DISCUSSION Our findings indicate that physical activity may have beneficial effects on insulin and C-peptide metabolism in children and adolescents with a family background of diabetes, but show no evidence of a protective association with other health-related outcomes.
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Affiliation(s)
- K Ungethüm
- Institute of Diabetes Research, Helmholtz Zentrum München, Neuherberg and Forschergruppe Diabetes der Technischen Universität München, Munich
| | - M Jolink
- Institute of Diabetes Research, Helmholtz Zentrum München, Neuherberg and Forschergruppe Diabetes der Technischen Universität München, Munich
| | - M Hippich
- Institute of Diabetes Research, Helmholtz Zentrum München, Neuherberg and Forschergruppe Diabetes der Technischen Universität München, Munich
| | - L Lachmann
- Institute of Diabetes Research, Helmholtz Zentrum München, Neuherberg and Forschergruppe Diabetes der Technischen Universität München, Munich
| | - F Haupt
- Institute of Diabetes Research, Helmholtz Zentrum München, Neuherberg and Forschergruppe Diabetes der Technischen Universität München, Munich
| | - C Winkler
- Institute of Diabetes Research, Helmholtz Zentrum München, Neuherberg and Forschergruppe Diabetes der Technischen Universität München, Munich
- Forschergruppe Diabetes e.V. am Helmholtz Zentrum München, Neuherberg
| | - S Hummel
- Institute of Diabetes Research, Helmholtz Zentrum München, Neuherberg and Forschergruppe Diabetes der Technischen Universität München, Munich
- Forschergruppe Diabetes e.V. am Helmholtz Zentrum München, Neuherberg
| | - A Pitchika
- Institute of Diabetes Research, Helmholtz Zentrum München, Neuherberg and Forschergruppe Diabetes der Technischen Universität München, Munich
| | - O Kordonouri
- Kinder- und Jugendkrankenhaus AUF DER BULT, Hannover, Germany
| | - A-G Ziegler
- Institute of Diabetes Research, Helmholtz Zentrum München, Neuherberg and Forschergruppe Diabetes der Technischen Universität München, Munich
- Forschergruppe Diabetes e.V. am Helmholtz Zentrum München, Neuherberg
| | - A Beyerlein
- Institute of Diabetes Research, Helmholtz Zentrum München, Neuherberg and Forschergruppe Diabetes der Technischen Universität München, Munich
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Toomey S, Sartori A, Irwin D, Hummel S, Carr A, Lee C, Armstrong P, Farrelly A, El-Masry S, McNamara D, Morris P, Grogan L, Breathnach O, O’Sullivan L, Bradshaw S, Rashed A, Smyth R, Workman J, O’Neill B, Hennessy B. Non-invasive genotyping and monitoring of tumor evolution in locally advanced rectal cancer (LARC) patients using circulating tumor DNA (ctDNA). Ann Oncol 2018. [DOI: 10.1093/annonc/mdy281.097] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Stilwell JL, Hobeida A, Birse RT, Ericson N, Ramirez AB, Hummel S, Irwin D, Kaldjian EP, Lyerly HK. Abstract P3-02-03: Detection of mutations in single tumor cells collected by fine needle aspiration in a mouse xenograft breast cancer model using MALDI-TOF. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-p3-02-03] [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: 11/16/2022]
Abstract
Abstract
Background: Breast fine needle aspiration (FNA) is less invasive than a core needle biopsy and reduces the risk of infection or injury to the patient. However, less tissue is available for analysis than with biopsy. The ability to detect and analyze single atypical cells for molecular abnormalities would allow the consideration of more widely adopting FNA for diagnosis. Here we demonstrate the feasibility of this approach in a mouse xenograft model of breast cancer.
Methods: Human-into-mouse MBA-MD-231 breast cancer xenograft tumors were aspirated using a technique that approximates the clinical procedure in patients. Cells from the FNA were prepared by two methods: 1) mixing the aspirate with transfer fluid and spreading onto a Superfrost® Plus slide using RareCyte's AccuCyte® process, and 2) spraying the aspirate directly onto a Superfrost Plus slide, then drying and fixing in ethanol. A single tumor was also disaggregated into suspension, filtered, mixed with transfer fluid and spread on to slides as in method 1 above as a control. Slides were fixed in formalin, stained on an automated immunostainer and imaged using the CyteFinder® digital fluorescence scanning microscope. Tumor cells were identified by positive nuclear, EpCAM, and cytokeratin staining, and negative CD45 staining. Tumor cells were picked from the slides and put into PCR tubes using the CytePicker® module. DNA from individual cells was amplified using the PicoPLEX® (Rubicon) whole genome amplification (WGA) kit. Quality control (QC) of the WGA reactions was performed by PCR of amplicons on eight different chromosomes. Specific gene regions surrounding 5 mutations present in MBA-MD-231 cells were amplified from the WGA products and scored for the mutations using a single PCR reaction iPLEX® Pro panel using the MassARRAY® platform (Agena Bioscience). A lung tumor panel was also run as a negative control.
Results: FNA tumor cells stained with epithelial markers similarly to cells from the disaggregated tumor control and were easily identified. Slides prepared by method 1 above spread into a uniform monolayer making it easier to pick individual cells. Cells from method 2 tended to clump making it more difficult to pick individual cells. Cells were thus picked only from method 1 slides. QC measurements of WGA products from individual cells demonstrated broad genome coverage of amplification; 10 of 14 cells exhibited 7 or more QC products out of 8. Point mutations in four genes (BRAF, KRAS, NF2, and TP53) and a deletion in one gene (CDKN2A) were measured in these cells by iPLEX® Pro chemistry on the MassARRAY® system and found in all cells picked, with all mutations identified in most cells. These mutations and the deletion were not detected in control WBCs.
Conclusions: Individual breast cancer cells were identified in FNA samples from xenograft tumors and molecularly characterized, verifying that the cells identified by positive staining were tumor cells. These results demonstrate the feasibility of detecting and verifying tumor cells in FNA samples in breast and other cancers.
Citation Format: Stilwell JL, Hobeida A, Birse RT, Ericson N, Ramirez AB, Hummel S, Irwin D, Kaldjian EP, Lyerly HK. Detection of mutations in single tumor cells collected by fine needle aspiration in a mouse xenograft breast cancer model using MALDI-TOF [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P3-02-03.
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Affiliation(s)
- JL Stilwell
- RareCyte, Inc, Seattle, WA; Duke University Medical Center, Durham, NC; Agena Bioscience, Inc, San Diego, CA
| | - A Hobeida
- RareCyte, Inc, Seattle, WA; Duke University Medical Center, Durham, NC; Agena Bioscience, Inc, San Diego, CA
| | - RT Birse
- RareCyte, Inc, Seattle, WA; Duke University Medical Center, Durham, NC; Agena Bioscience, Inc, San Diego, CA
| | - N Ericson
- RareCyte, Inc, Seattle, WA; Duke University Medical Center, Durham, NC; Agena Bioscience, Inc, San Diego, CA
| | - AB Ramirez
- RareCyte, Inc, Seattle, WA; Duke University Medical Center, Durham, NC; Agena Bioscience, Inc, San Diego, CA
| | - S Hummel
- RareCyte, Inc, Seattle, WA; Duke University Medical Center, Durham, NC; Agena Bioscience, Inc, San Diego, CA
| | - D Irwin
- RareCyte, Inc, Seattle, WA; Duke University Medical Center, Durham, NC; Agena Bioscience, Inc, San Diego, CA
| | - EP Kaldjian
- RareCyte, Inc, Seattle, WA; Duke University Medical Center, Durham, NC; Agena Bioscience, Inc, San Diego, CA
| | - HK Lyerly
- RareCyte, Inc, Seattle, WA; Duke University Medical Center, Durham, NC; Agena Bioscience, Inc, San Diego, CA
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Gard E, Nanayakkara S, Shah S, Borlaug B, Silvestry F, Hanff T, Hummel S, Litwin S, Petrie M, Komtebedde J, Kaye D. Impact of Left Atrial Size and Function on Exercise Haemodynamics in Patients With Heart Failure With Mid-Range and Preserved Ejection Fraction. Heart Lung Circ 2018. [DOI: 10.1016/j.hlc.2018.06.146] [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]
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Hummel S, Kirchner P, Kahle B. Korrelationsindex des Stromzeitvolumens in der Arteria und Vena femoralis communis »SV-VA-Index« bei verschiedenen Stadien der Varikosis. Phlebologie 2017. [DOI: 10.1055/s-0037-1617323] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Zusammenfassung
Ziel der Arbeit war, das Ausmaß der hämodynamischen Störung bei Varikosis mittels der duplexsonographischen Messung arterieller und venöser Stromzeitvolumina zu quantifizieren. Methode: Bei 46 Patienten mit Stammvarikosis der V. saphena magna; 30 Patienten mit inkompletter Stammvarikosis und 40 venengesunden Patienten wurde duplexsonographisch unter standardisierten Bedingungen das venöse (VSV) und arterielle (ASV) Stromzeitvolumen gemessen. Vergleichende Meßgröße war der Quotient aus VSV und ASV (SV-VAIndex). Ergebnisse: Die drei Kollektive unterschieden sich signifikant in der Höhe des SV-VA-Index (p <0,005) und in der Höhe des VSV (p <0,005) nicht jedoch das ASV betreffend. Der SV-VA-Index lag bei Gesunden unter 1 (0,8–0,9), bei inkompletter Varikosis zwischen 1,1–1,2 und bei kompletter Varikosis zwischen 1,5–2,0. Schlußfolgerung: Durch den SV-VA-Index ist die quantitative Erfassung einer Veneninsuffizienz infolge primärer Varikosis möglich.
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Hummel S, Kirchner P, Kahle B. Quantifizierung des Effekts von Varizenoperationen auf die venöse Hämodynamik mittels des veno-arteriellen Flow-Index (VAFI). Phlebologie 2017. [DOI: 10.1055/s-0037-1617261] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Zusammenfassung
Ziel: Quantifizierung des Effekts von Varizenoperationen auf die venöse Hämodynamik anhand des Quotienten der Stromzeitvolumina aus Vena und Arteria femoralis communis (VSV, ASV). Methode: 46 Patienten wurden in drei Kollektive eingeteilt. Von 22 Patienten mit kompletter Stammvarikosis der V. saphena magna erhielten 12 eine Krossektomie mit Stripping-Operation (Kollektiv 1) und 10 Patienten auf Wunsch eine Exhärese der Varikosis am Unterschenkel (Kollektiv 2). 24 Patienten mit inkompletter Stammvarikosis (Kollektiv 3) erhielten die selektive Exhärese ihrer Varizen. Bei allen Patienten wurde jeweils unter standardisierten Bedingungen VSV und ASV direkt präoperativ, 2 und 8 Wochen postoperativ duplexsonographisch gemessen und der Korrelationsindex (VAFI) als Quotient aus VSV und ASV berechnet. Verwendet wurde das Gerät Apogee 800 (Advanced Technologies Laboratories) mit 7,5-MHz- Linearschallkopf. Ergebnisse: Präoperativ war das mittlere VSV des Gesamtkollektivs 0,42 l/min, postoperativ nach 2 Wochen 0,30 l/min und 0,28 l/min nach 8 Wochen (p<0,001). ASV zeigte keine signifikante Änderung. Der VAFI des Gesamtkollektivs nahm signifikant von 1,19 auf 0,86 und 0,77 nach 8 Wochen ab (p<0,001). Die einzelnen Kollektive zeigten in der Höhe des VAFI deutliche Unterschiede. Kollektiv 1: 1,28 präoperativ, 0,83 und 0,73 postoperativ – Kollektiv 2: 1,34 präoperativ, 1,01 und 0,87 postoperativ, und Kollektiv 3: 1,02 präoperativ, 0,86 und 0,73 postoperativ. Schlussfolgerung: Varizenoperationen bewirken eine signifikante Abnahme von VSV und VAFI. Der bessere Parameter zur Quantifizierung des hämodynamischen Effekts ist der VAFI.
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Hummel S, Rosenthal D, Zilkens C, Hefter H, Krauspe R, Westhoff B. Gait deviations in transverse plane after SCFE in dependence on the femoral offset. Gait Posture 2017; 58:358-362. [PMID: 28866455 DOI: 10.1016/j.gaitpost.2017.08.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Revised: 07/29/2017] [Accepted: 08/21/2017] [Indexed: 02/02/2023]
Abstract
Residual deformity of the femoral head after slipped capital femoral epiphysis (SCFE) may be accompanied by a loss of femoral offset and lead to femoro-acetabular impingement (FAI), especially during hip flexion. It is hypothesized that during phases of the gait cycle, when the hip is flexed, the offset-loss is compensated by an increased external rotation. The gait pattern of 36 patients suffering from SCFE, who were treated by pinning-in-situ, were compared to a control group of 40 healthy adults by an instrumented 3D-gait analysis. Total patient group was subdivided into 3 subgroups in dependence on the offset (offset groups (OG)) quantified by the angle α according to Nötzli: OG1: α-angle <55°, OG2: α-angle between 55 and 75°, OG3: α-angle >75°. Comparisons were made at 3 instants: initial foot contact (0% gait cycle (GC)), 40-60% GC and 90-100% GC. Patients showed an increased external hip rotation during all 3 periods of the GC with a tendency of increasing external rotation in association with offset-loss. Only during hip extension (40-60% GC) there was a weak correlation between angle α and hip rotation (r=-0.375, p=0.024). In conclusion, the offset-loss does not lead to a functional relevant impingement during walking which needs compensation strategies like increasing external rotation during periods of hip flexion.
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Affiliation(s)
- S Hummel
- University of Duesseldorf, Medical Faculty, Department of Orthopaedics, Moorenstr. 5, D-40225 Duesseldorf, Germany.
| | - D Rosenthal
- University of Duesseldorf, Medical Faculty, Department of Orthopaedics, Moorenstr. 5, D-40225 Duesseldorf, Germany
| | - C Zilkens
- University of Duesseldorf, Medical Faculty, Department of Orthopaedics, Moorenstr. 5, D-40225 Duesseldorf, Germany
| | - H Hefter
- University of Duesseldorf, Medical Faculty, Department of Orthopaedics, Moorenstr. 5, D-40225 Duesseldorf, Germany
| | - R Krauspe
- University of Duesseldorf, Medical Faculty, Department of Orthopaedics, Moorenstr. 5, D-40225 Duesseldorf, Germany
| | - B Westhoff
- University of Duesseldorf, Medical Faculty, Department of Orthopaedics, Moorenstr. 5, D-40225 Duesseldorf, Germany
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Heinrichs K, Vu-Eickmann P, Hummel S, Gholami J, Loerbroks A. Was erschwert bzw. erleichtert Asthma-Selbstmanagement am Arbeitsplatz? – Eine qualitative Studie. Das Gesundheitswesen 2017. [DOI: 10.1055/s-0037-1605712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- K Heinrichs
- Heinrich-Heine-Universität Düsseldorf, Institut für Arbeits-, Sozial- und Umweltmedizin, Düsseldorf
| | - P Vu-Eickmann
- Heinrich-Heine-Universität Düsseldorf, Institut für Arbeits-, Sozial- und Umweltmedizin, Düsseldorf
| | - S Hummel
- Median Klinik Heiligendamm, Bad Doberan
| | | | - A Loerbroks
- Heinrich-Heine-Universität Düsseldorf, Institut für Arbeits-, Sozial- und Umweltmedizin, Düsseldorf
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Hummel S, Hummel E, Wenzlaff U, Velikovska A, Beiersdorff M. Rauchstopp als Ziel einer stationären pulmologischen Rehabilitation-Methodik und (lungenfunktionelle) Ergebnisse. Pneumologie 2017. [DOI: 10.1055/s-0037-1598576] [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: 10/20/2022]
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Much D, Beyerlein A, Kindt A, Krumsiek J, Stückler F, Rossbauer M, Hofelich A, Wiesenäcker D, Hivner S, Herbst M, Römisch-Margl W, Prehn C, Adamski J, Kastenmüller G, Theis F, Ziegler AG, Hummel S. Lactation is associated with altered metabolomic signatures in women with gestational diabetes. DIABETOL STOFFWECHS 2016. [DOI: 10.1055/s-0036-1580927] [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: 10/21/2022]
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Much D, Jaschinski H, Lack N, Hummel S, Füchtenbusch M, Hummel M, Ziegler AG, Beyerlein A. Risk Stratification in Women with Gestational Diabetes According to and Beyond Current WHO Criteria. Horm Metab Res 2016; 48:16-9. [PMID: 26566100 DOI: 10.1055/s-0035-1565084] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The pregnancy outcomes in women with gestational diabetes mellitus (GDM) and 'overt diabetes in pregnancy' were compared and the need for further subclassification was investigated with respect to postpartum outcome risk. Data from 944 women who had been uniformly diagnosed as having GDM in Munich, Germany, between 1998 and 2010, were re-classified into GDM and 'overt diabetes in pregnancy'. Pregnancy related outcomes in the offspring were derived from Bavarian birth registry data. Classification and regression trees were used to identify further GDM sub-phenotypes. In total, 88 women (9.3%) were re-classified as having 'overt diabetes in pregnancy'. Compared to women with GDM, women with 'overt diabetes in pregnancy' used insulin more frequently, and were at increased risk for large for gestational age infants [odds ratio 2.50 (95% confidence interval 1.02, 6.13)], preterm delivery [odds ratio 3.28 (1.02, 10.50)], and low APGAR-score at 5 min [odds ratio 12.70 (1.58, 102.2)]. In the 856 women with GDM, classification and regression tree analyses provided further risk stratification in that a combination of fasting glucose>5.3 mmol/l and 1-h glucose>11.1 mmol/l at GDM diagnosis predicted insulin requirement [OR 5.57 (3.75, 8.27) compared to the rest], and maternal body mass index (BMI)≥35 kg/m(2) predicted large for gestational age status. The new differentiation between GDM and 'overt diabetes in pregnancy' is a first step towards refining classification relevant to fetal and maternal postpartum risk. A combination of glucose levels and maternal BMI at diagnosis of GDM may provide further improvement.
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Affiliation(s)
- D Much
- Institute of Diabetes Research, Helmholtz Zentrum München, and Forschergruppe Diabetes, Klinikum rechts der Isar, Technische Universität München, Ingolstädter Landstraße, Neuherberg, Germany
| | - H Jaschinski
- Institute of Diabetes Research, Helmholtz Zentrum München, and Forschergruppe Diabetes, Klinikum rechts der Isar, Technische Universität München, Ingolstädter Landstraße, Neuherberg, Germany
| | - N Lack
- Bavarian Quality Assurance Institute for Medical Care, Munich, Germany
| | - S Hummel
- Institute of Diabetes Research, Helmholtz Zentrum München, and Forschergruppe Diabetes, Klinikum rechts der Isar, Technische Universität München, Ingolstädter Landstraße, Neuherberg, Germany
| | - M Füchtenbusch
- Institute of Diabetes Research, Helmholtz Zentrum München, and Forschergruppe Diabetes, Klinikum rechts der Isar, Technische Universität München, Ingolstädter Landstraße, Neuherberg, Germany
| | - M Hummel
- Institute of Diabetes Research, Helmholtz Zentrum München, and Forschergruppe Diabetes, Klinikum rechts der Isar, Technische Universität München, Ingolstädter Landstraße, Neuherberg, Germany
| | - A-G Ziegler
- Institute of Diabetes Research, Helmholtz Zentrum München, and Forschergruppe Diabetes, Klinikum rechts der Isar, Technische Universität München, Ingolstädter Landstraße, Neuherberg, Germany
| | - A Beyerlein
- Institute of Diabetes Research, Helmholtz Zentrum München, and Forschergruppe Diabetes, Klinikum rechts der Isar, Technische Universität München, Ingolstädter Landstraße, Neuherberg, Germany
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Henneberger L, Hummel S, Lachmann L, Oberhoffer R, Ziegler AG. Determinants of physical activity before and during pregnancy and impact of physical activity intervention on perinatal outcome in mothers with GDM and their offspring. DIABETOL STOFFWECHS 2015. [DOI: 10.1055/s-0035-1549699] [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: 10/23/2022]
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Buhr-Schinner H, Braune R, Quadder B, Buchbender W, Heitmann R, Hummel S, Tönnesmann U, van der Meyden J, Schultz K, Ernst S, Großhennig A, Schleef T, Lingner H. Sozialmedizinische Aspekte der Rehabilitation bei Sarkoidose Ergebnisse der ProKaSaRe-Studie (Prospektive multizentrische Katamnesestudie Sarkoidose in der pneumologischen Rehabilitation). Pneumologie 2015. [DOI: 10.1055/s-0035-1544679] [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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Carroll C, Hummel S, Leaviss J, Ren S, Stevens JW, Cantrell A, Michaels J. Systematic review, network meta-analysis and exploratory cost-effectiveness model of randomized trials of minimally invasive techniques versus surgery for varicose veins. Br J Surg 2014; 101:1040-52. [PMID: 24964976 DOI: 10.1002/bjs.9566] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2014] [Revised: 02/27/2014] [Accepted: 04/17/2014] [Indexed: 12/31/2022]
Abstract
BACKGROUND A Health Technology Assessment was conducted to evaluate the relative clinical effectiveness and cost-effectiveness of minimally invasive techniques (foam sclerotherapy (FS), endovenous laser ablation (EVLA) and radiofrequency ablation (RFA)) for managing varicose veins, in comparison with traditional surgery. METHODS A systematic review of randomized clinical trials (RCTs) was undertaken to assess the effectiveness of minimally invasive techniques compared with other treatments, principally surgical stripping, in terms of recurrence of varicose veins, Venous Clinical Severity Score (VCSS), pain and quality of life. Network meta-analysis and exploratory cost-effectiveness modelling were performed. RESULTS The literature search conducted in July 2011 identified 1453 unique citations: 31 RCTs (51 papers) satisfied the criteria for effectiveness review. Differences between treatments were negligible in terms of clinical outcomes, so the treatment with the lowest cost appears to be most cost-effective. Total FS costs were estimated to be lowest, and FS was marginally more effective than surgery. However, relative effectiveness was sensitive to the model time horizon. Threshold analysis indicated that EVLA and RFA might be considered cost-effective if their costs were similar to those for surgery. These findings are subject to various uncertainties, including the risk of bias present in the evidence base and variation in reported costs. CONCLUSION This assessment of currently available evidence suggests there is little to choose between surgery and the minimally invasive techniques in terms of efficacy or safety, so the relative cost of the treatments becomes one of the deciding factors. High-quality RCT evidence is needed to verify and further inform these findings.
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Affiliation(s)
- C Carroll
- School of Health and Related Research, University of Sheffield, Sheffield, UK
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Carroll C, Hummel S, Leaviss J, Ren S, Stevens JW, Everson-Hock E, Cantrell A, Stevenson M, Michaels J. Clinical effectiveness and cost-effectiveness of minimally invasive techniques to manage varicose veins: a systematic review and economic evaluation. Health Technol Assess 2014; 17:i-xvi, 1-141. [PMID: 24176098 DOI: 10.3310/hta17480] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Varicose veins are enlarged, visibly lumpy knotted veins, usually in the legs. Uncomplicated varicose veins can cause major discomfort and some complications. They are part of chronic venous disease (CVD), which is reported to have a substantial negative impact on health-related quality of life (HRQoL). Traditional treatments for varicose veins involve surgical stripping and ligation and liquid sclerotherapy (LS), but can be invasive and painful. New minimally invasive treatments offer an alternative. These treatments typically involve use of laser, radiofrequency or foam sclerosant. They are increasingly widely used and offer potential benefits such as reduced complications, faster recovery, fewer physical limitations and improved quality of life. OBJECTIVE The aim of this report is to evaluate the clinical effectiveness, safety and cost-effectiveness of the minimally invasive techniques of foam sclerotherapy (FS), endovenous laser ablation (EVLA) and radiofrequency ablation (RFA) in comparison with other techniques, including traditional surgical techniques, LS and conservative management, in the management of varicose veins. DATA SOURCES A systematic search was made of 11 bibliographic databases of published and unpublished literature from their inception to July 2011: MEDLINE; EMBASE; Cumulative Index to Nursing and Allied Health Literature; The Cochrane Library; Biological Abstracts; Science Citation Index (SCI); Social Sciences Citation Index; Conference Proceedings Citation Index-Science; UK Clinical Research Network; Current Controlled Trials; and ClinicalTrials.gov. REVIEW METHODS A systematic review of randomised controlled trials (RCTs) to assess the clinical effectiveness of minimally invasive techniques compared with other treatments, principally surgical stripping, in terms of recurrence of varicose veins, retreatment and clinical symptoms, as measured by the Venous Clinical Severity Score (VCSS), pain and quality of life. Network meta-analysis and exploratory cost-effectiveness modelling were performed. RESULTS The literature search identified 1453 unique citations, of which 34 RCTs (54 papers) satisfied the criteria for the clinical effectiveness review. The minimally invasive techniques reported clinical outcomes similar to surgery. Rates of recurrence were slightly lower for EVLA, RFA and FS, especially for longer follow-up periods; VCSS score was lower for EVLA and FS than for stripping, but slightly higher for RFA; short-term pain was less for FS and RFA but higher for EVLA; higher quality-of-life scores were reported for all evaluated interventions than for stripping. Differences between treatments were therefore negligible in terms of clinical outcomes, so the treatment with the lowest cost appears to be most cost-effective. Our central estimate is that total FS costs were lowest and FS is marginally more effective than stripping. However, this result was sensitive to the model time horizon. Threshold analysis indicated that EVLA and RFA might be considered cost-effective if their costs are equivalent to stripping. These findings are subject to uncertainty on account of the risk of bias present in the evidence base and the variation in costs. LIMITATIONS The relative clinical effectiveness and cost-effectiveness of the techniques are principally based on rates of post-operative technical recurrence rather than symptomatic recurrence, as this was the reported outcome in all trials. The true proportion of treated individuals who are likely to present with symptoms of recurrence requiring retreatment is therefore not certain. A figure reflecting the likely proportion of treated individuals who would experience symptomatic recurrence requiring retreatment (with its associated costs), therefore, had to be calculated by the authors based on a small number of studies. The findings of this report also need to be verified by data from future trials with longer follow-up and using more standardised outcome measures. CONCLUSIONS This assessment of the currently available evidence suggests there is little to choose between the minimally invasive techniques in terms of efficacy or cost, and each offers a viable, clinically effective alternative to stripping. FS might offer the most cost-effective alternative to stripping, within certain time parameters. High-quality RCT evidence is needed. Future trials should aim to measure and report outcomes in a standardised manner, which would permit more efficient pooling of their results. STUDY REGISTRATION PROSPERO number CRD42011001355. FUNDING The National Institute for Health Research Health Technology Assessment programme.
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Affiliation(s)
- C Carroll
- School of Health and Related Research (ScHARR) Technology Assessment Group, University of Sheffield, Sheffield, UK
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Mirgeler B, Much D, Beyerlein A, Hummel S, Keller S, Höllriegl V, Fedrigo M, Ziegler AG, Hummel M, Szymczak W. Das Potential der Atemgasanalyse zur Früherkennung von Typ-2-Diabetes nach einem Schwangerschaftsdiabetes. DIABETOL STOFFWECHS 2014. [DOI: 10.1055/s-0034-1374939] [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: 10/25/2022]
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Roßbauer M, Rothballer M, Endesfelder D, Hartmann A, Hummel S, Ziegler AG. Die Rolle des Darm-Mikrobioms bei der postpartalen Entwicklung von Typ 2 Diabetes bei Müttern mit GDM und Übergewicht bei deren Kindern. DIABETOL STOFFWECHS 2014. [DOI: 10.1055/s-0034-1374935] [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: 10/25/2022]
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Lingner H, Großhennig A, Buchbender W, Buhr-Schinner H, Heitmann R, Hummel S, Tönnesmann U, van der Meyden J, Braune R, Quadder B, Schultz K. Dyspnoe, Lebensqualität, psychische Belastung und Fatigue 6 Monate nach pneumologischer Rehabilitation bei Sarkoidose – Halbjahresdaten der multizentrischen ProKaSaRe-Studie. Pneumologie 2014. [DOI: 10.1055/s-0034-1367997] [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: 10/25/2022]
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Schultz K, Braune R, Quadder B, Buchbender W, Buhr-Schinner H, Heitmann RH, Hummel S, Tönnesmann U, van der Meyden J, Ernst S, Großhennig A, Schleef T, Lingner H. Effektivität pneumologischer Rehabilitation bei Sarkoidose - Erste Langzeitdaten der multizentrischen ProKaSaRe-Studie. Pneumologie 2013. [DOI: 10.1055/s-0033-1334501] [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: 10/27/2022]
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Giannopoulou E, Wallner M, Boerschmann H, Bunk M, Hummel S, Warncke K, Teichert von Lüttichau I, Haller MJ, Schatz DA, Lampeter EF, Ziegler AG. Transfusion von autologem Nabelschnurblut bei Kindern mit neu diagnostiziertem Typ 1 Diabetes zur Verbesserung der Blutzuckerkontrolle. DIABETOL STOFFWECHS 2012. [DOI: 10.1055/s-0032-1314462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Harsunen MH, Hummel S, Joslowski G, Meyer AV, Wosch A, Ramminger C, Pflüger M, Ziegler AG. Kurzkettige Fettsäuren und neutrophile Granulozyten in der Pathogenese des Typ 1 Diabetes. DIABETOL STOFFWECHS 2012. [DOI: 10.1055/s-0032-1314481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Schultz K, Braune R, Quadder B, Buchbender W, Buhr-Schinner H, Heitmann RH, Hummel S, Tönnesmann U, Lingner H. Rehabilitation bei Sarkoidose – Erste Zwischenergebnisse der multizentrischen ProKaSaRe-Studie. Pneumologie 2012. [DOI: 10.1055/s-0032-1302570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Simonen-Tikka ML, Pflueger M, Klemola P, Savolainen-Kopra C, Smura T, Hummel S, Kaijalainen S, Nuutila K, Natri O, Roivainen M, Ziegler AG. Human enterovirus infections in children at increased risk for type 1 diabetes: the Babydiet study. Diabetologia 2011; 54:2995-3002. [PMID: 21932150 DOI: 10.1007/s00125-011-2305-3] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2011] [Accepted: 08/12/2011] [Indexed: 12/15/2022]
Abstract
AIMS/HYPOTHESIS The aim of this study was to examine human enteroviruses (HEVs) and other intestinal viruses derived from children who participated in the Babydiet intervention study and to analyse the findings according to the appearance of islet autoantibodies, dietary intervention, maternal type 1 diabetes and clinical symptoms. METHODS In the Babydiet study the influence of first gluten exposure (6 or 12 months) on the development of islet autoimmunity was investigated in 150 children with increased genetic and familial risk for type 1 diabetes. Blood and stool samples were collected at 3 monthly intervals until the age of 3 years and yearly thereafter. Infections and clinical symptoms were recorded daily for the first year. In the present study, 339 stool samples collected from 104 children during the first year of life were analysed for HEVs and a certain proportion of the samples were analysed for other intestinal viruses. RESULTS HEV was detected in 32 (9.4%) samples from 24 (23.1%) children. Altogether 13 serotypes were identified, with HEV-A species being the most common. Children with gastrointestinal symptoms had norovirus (3/11) and sapovirus (1/11) infections in addition to HEV (1/11). Of the 104 children, 22 developed islet autoantibodies. HEV infections were detected in 18% (4/22) and 24% (20/82) of islet-autoantibody-positive and -negative children, respectively (p = 0.5). The prevalence of HEV was similar in the gluten-exposed groups and in children from mothers with type 1 diabetes or from affected fathers and/or siblings (p = 1.0 and 0.6, respectively). CONCLUSIONS/INTERPRETATION No correlation was found between the presence of HEV in the first year of life and the development of islet autoantibodies. There was no association between HEV infections and dietary intervention, maternal diabetes or clinical symptoms.
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Affiliation(s)
- M-L Simonen-Tikka
- Intestinal Viruses Unit, National Institute for Health and Welfare, P.O. Box 30, FI-00271, Helsinki, Finland
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Roßbauer M, Adler K, Winkler C, Grallert H, Illig T, Ziegler AG, Hummel S. Einfluss von Typ 2 assoziierten Polymorphismen auf die Gewichtsentwicklung bei Nachkommen von Müttern mit Gestationsdiabetes. DIABETOL STOFFWECHS 2011. [DOI: 10.1055/s-0031-1277393] [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: 10/18/2022]
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Hummel S, Simpson EL, Hemingway P, Stevenson MD, Rees A. Intensity-modulated radiotherapy for the treatment of prostate cancer: a systematic review and economic evaluation. Health Technol Assess 2011; 14:1-108, iii-iv. [PMID: 21029717 DOI: 10.3310/hta14470] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Prostate cancer (PC) is the most common cancer in men in the UK. Radiotherapy (RT) is a recognised treatment for PC and high-dose conformal radiotherapy (CRT) is the recommended standard of care for localised or locally advanced tumours. Intensity-modulated radiotherapy (IMRT) allows better dose distributions in RT. OBJECTIVE This report evaluates the clinical effectiveness and cost-effectiveness of IMRT for the radical treatment of PC. DATA SOURCES The following databases were searched: MEDLINE (1950-present), EMBASE (1980-present), Cumulative Index to Nursing and Allied Health Literature (CINAHL) (1982-present), BIOSIS (1985-present), the Cochrane Database of Systematic Reviews (1991-present), the Cochrane Controlled Trials Register (1991-present), the Science Citation Index (1900-present) and the NHS Centre for Reviews and Dissemination databases (Database of Abstracts of Reviews of Effects, NHS Economic Evaluation Database, Health Technology Assessment) (1991-present). MEDLINE In-Process & Other Non-Indexed Citations was searched to identify any studies not yet indexed on MEDLINE. Current research was identified through searching the UK Clinical Research Network, National Research Register archive, the Current Controlled Trials register and the Medical Research Council Clinical Trials Register. In addition, abstracts of the American Society of Clinical Oncology, the American Society for Therapeutic Radiology and Oncology, and European Society for Therapeutic Radiology and Oncology conferences were browsed. REVIEW METHODS A systematic literature review of the clinical effectiveness and cost-effectiveness of IMRT in PC was conducted. Comparators were three-dimensional conformal radiotherapy (3DCRT) or radical prostatectomy. Outcomes sought were overall survival, biochemical [prostate-specific antigen (PSA)] relapse-free survival, toxicity and health-related quality of life (HRQoL). Fifteen electronic bibliographic databases were searched in January 2009 and updated in May 2009, and the reference lists of relevant articles were checked. Studies only published in languages other than English were excluded. An economic model was developed to examine the cost-effectiveness of IMRT in comparison to 3DCRT. Four scenarios were modelled based on the studies which reported both PSA survival and late gastrointestinal (GI) toxicity. In two scenarios equal PSA survival was assumed for IMRT and 3DCRT, the other two having greater PSA survival for the IMRT cohort. As there was very limited data on clinical outcomes, the model estimates progression to clinical failure and PC death from the surrogate outcome of PSA failure. RESULTS No randomised controlled trials (RCTs) of IMRT versus 3DCRT in PC were available, but 13 non-randomised studies comparing IMRT with 3DCRT were found, of which five were available only as abstracts. One abstract reported overall survival. Biochemical relapse-free survival was not affected by treatment group, except where there was a dose difference between groups, in which case higher dose IMRT was favoured over lower dose 3DCRT. Most studies reported an advantage for IMRT in GI toxicity, attributed to increased conformality of treatment compared with 3DCRT, particularly with regard to volume of rectum treated. There was some indication that genitourinary toxicity was worse for patients treated with dose escalated IMRT, although most studies did not find a significant treatment effect. HRQoL improved for both treatment groups following radiotherapy, with any group difference resolved by 6 months after treatment. No comparative studies of IMRT versus prostatectomy were identified. No comparative studies of IMRT in PC patients with bone metastasis were identified. LIMITATIONS The strength of the conclusions of this review are limited by the lack of RCTs, and any comparative studies for some patient groups. CONCLUSIONS The comparative data of IMRT versus 3DCRT seem to support the theory that higher doses, up to 81 Gy, can improve biochemical survival for patients with localised PC, concurring with data on CRT. The data also suggest that toxicity can be reduced by increasing conformality of treatment, particularly with regard to GI toxicity, which can be more easily achieved with IMRT than 3DCRT. Whether differences in GI toxicity between IMRT and 3DCRT are sufficient for IMRT to be cost-effective is uncertain, depending on the difference in incidence of GI toxicity, its duration and the cost difference between IMRT and 3DCRT.
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Affiliation(s)
- S Hummel
- School of Health and Related Research, The University of Sheffield, Sheffield, UK
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Spencer PBS, Schmidt D, Hummel S. Identification of historical specimens and wildlife seizures originating from highly degraded sources of kangaroos and other macropods. Forensic Sci Med Pathol 2010; 6:225-32. [PMID: 19890738 PMCID: PMC3128748 DOI: 10.1007/s12024-009-9119-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/25/2009] [Indexed: 11/22/2022]
Abstract
Forensic investigations are an important area in the regulation of food mis-description, wildlife seizures and the international trade in wildlife and its products. An early, but important stage in dealing with many biological materials that are submitted for forensic scrutiny is species identification. We describe a method and new primers to amplify three small DNA fragments of the cytochrome b region of the mitochondrial DNA that are suitable for marsupial species identification from degraded sources, such as wildlife seizures. They were designed as consensus sequences from a comparison of 21 marsupial species. The primers also contained sequences intended specifically not to amplify human DNA, thereby reducing the likelihood of amplifying contaminants. Examples of the utility of these primers are given using a range of conditions that may be applied using such an approach, including (1) field-collected sub-fossil bones, (2) an example of museum mis-identification from a specimen collected in 1930 and (3) a skull collected from Bernier Island, in the harsh mid-west of Western Australia.
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Affiliation(s)
- P B S Spencer
- School of Biological Sciences and Biotechnology, Wildlife Forensic Laboratory, Murdoch University, Perth, Western Australia, Australia.
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Abstract
Infant diet affects health and development. The aim of our study was to investigate WHO infant feeding compliance in children who have a first degree family history of type 1 diabetes (T1D). One hundred and fifty children who were first degree relatives of patients with T1D were intensively followed from birth in the BABYDIET intervention study. Infant feeding, infections, and medication were recorded daily by participating families. Weight and length of children were obtained from paediatric records. Only 5% of the families followed the WHO recommendations for infant feeding that include full breastfeeding for at least 6 months (18.8% of children) and introduction of complementary foods under continued breastfeeding thereafter (22.2% of children). Maternal age in the first quartile (<29 years; p<0.0001), and maternal smoking (p<0.0001) were associated with an earlier introduction of solid food and reduced breastfeeding. Full breastfeeding > or =6 months was associated with reduced frequency of gastrointestinal infections (12 vs. 38%, p=0.02) and antibiotic treatment (24 vs. 48%, p=0.04). Our findings indicate that WHO infant feeding recommendations were poorly followed by families with a family history of T1D. Action to improve levels of infant feeding behaviour is essential, especially among young mothers with T1D.
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Affiliation(s)
- M Pflüger
- Forschergruppe Diabetes der Technischen Universität München, Munich, Germany
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Hummel S. Branch and Crown Dimensions of Douglas-Fir Trees Harvested from Old-Growth Forests in Washington, Oregon, and California During the 1960s. Northwest Science 2009. [DOI: 10.3955/046.083.0307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Sutcliffe P, Hummel S, Simpson E, Young T, Rees A, Wilkinson A, Hamdy F, Clarke N, Staffurth J. Use of classical and novel biomarkers as prognostic risk factors for localised prostate cancer: a systematic review. Health Technol Assess 2009; 13:iii-iv, ix-xii, 1-315. [PMID: 19128541 DOI: 10.3310/hta13050] [Citation(s) in RCA: 81] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVES To provide an evidence-based perspective on the prognostic value of novel markers in localised prostate cancer and to identify the best prognostic model including the three classical markers and investigate whether models incorporating novel markers are better. DATA SOURCES Eight electronic bibliographic databases were searched during March-April 2007. The reference lists of relevant articles were checked and various health services research-related resources consulted via the internet. The search was restricted to publications from 1970 onwards in the English language. METHODS Selected studies were assessed, data extracted using a standard template, and quality assessed using an adaptation of published criteria. Because of the heterogeneity regarding populations, outcomes and study type, meta-analyses were not undertaken and the results are presented in tabulated format with a narrative synthesis of the results. RESULTS In total 30 papers met the inclusion criteria, of which 28 reported on prognostic novel markers and five on prognostic models. A total of 21 novel markers were identified from the 28 novel marker studies. There was considerable variability in the results reported, the quality of the studies was generally poor and there was a shortage of studies in some categories. The marker with the strongest evidence for its prognostic significance was prostate-specific antigen (PSA) velocity (or doubling time). There was a particularly strong association between PSA velocity and prostate cancer death in both clinical and pathological models. In the clinical model the hazard ratio for death from prostate cancer was 9.8 (95% CI 2.8-34.3, p < 0.001) in men with an annual PSA velocity of more than 2 ng/ml versus an annual PSA velocity of 2 ng/ml or less; similarly, the hazard ratio was 12.8 (95% CI 3.7-43.7, p < 0.001) in the pathological model. The quality of the prognostic model studies was adequate and overall better than the quality of the prognostic marker studies. Two issues were poorly dealt with in most or all of the prognostic model studies: inclusion of established markers and consideration of the possible biases from study attrition. Given the heterogeneity of the models, they cannot be considered comparable. Only two models did not include a novel marker, and one of these included several demographic and co-morbidity variables to predict all-cause mortality. Only two models reported a measure of model performance, the C-statistic, and for neither was it calculated in an external data set. It was not possible to assess whether the models that included novel markers performed better than those without. CONCLUSIONS This review highlighted the poor quality and heterogeneity of studies, which render much of the results inconclusive. It also pinpointed the small proportion of models reported in the literature that are based on patient cohorts with a mean or median follow-up of at least 5 years, thus making long-term predictions unreliable. PSA velocity, however, stood out in terms of the strength of the evidence supporting its prognostic value and the relatively high hazard ratios. There is great interest in PSA velocity as a monitoring tool for active surveillance but there is as yet no consensus on how it should be used and, in particular, what threshold should indicate the need for radical treatment.
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Affiliation(s)
- P Sutcliffe
- The University of Sheffield, School of Health and Related Research (ScHARR), UK
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Hummel S. Spiroergometrische Untersuchungen zur Wirkung einer gerätegestützten Krankengymnastik (KGG) bei COPD (Stadium III-IV) im Rahmen einer stationären Rehabilitation. Pneumologie 2009. [DOI: 10.1055/s-0029-1213857] [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: 10/21/2022]
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Winkler C, Mollenhauer U, Hummel S, Bonifacio E, Ziegler AG. Exposure to environmental factors in drinking water: risk of islet autoimmunity and type 1 diabetes--the BABYDIAB study. Horm Metab Res 2008; 40:566-71. [PMID: 18500677 DOI: 10.1055/s-2008-1073165] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Type 1 diabetes (T1D) is characterized by autoimmunity against pancreatic islets, and autoantibodies may be present for years before diagnosis. Environmental factors during early life, including drinking water, may play a role in pathogenesis of T1D. The German BABYDIAB study is a prospective observational study that followed newborn offspring of mothers or fathers with T1D from birth to 17 years of age. The present study was a nested case-control analysis, where subjects with islet autoimmunity were defined as cases (n=95), those without as controls (n=139). Drinking water quality was obtained from the German Water Supply Authorities for the participating families for the first year of the child's life. There was no significant association between water acidity or drinking water quality (concentration of minerals and elements) and islet autoimmunity risk. Increased progression to diabetes in islet autoantibody-positive children was associated with exposure to water with lower pH values (less than cohort median, 7.62; odds ratio [OR]: 2.5; 95% confidence interval [CI]: 1.1-5.7; p=0.03) but was not significant after correction for multiple comparisons. Concentrations of nitrate, nitrite, iron, aluminum, and manganese were not associated with risk of T1D progression. This is the first prospective study with water quality measured before the onset of islet autoimmunity and T1D. Consistent with a previous cross-sectional case-control study, we found an association between drinking water pH and the rate of T1D development in at-risk children. The association is marginal and requires validation in other prospective cohorts.
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Affiliation(s)
- C Winkler
- Diabetes Research Institute and Academic Hospital Schwabing, Munich, Germany
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Kreichauf S, Pflüger M, Hummel S, Ziegler AG. Einfluss des Stillens auf das Risiko für Übergewicht bei Kindern von Müttern mit Typ-1-Diabetes. Dtsch Med Wochenschr 2008; 133:1173-7. [DOI: 10.1055/s-2008-1077234] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Abstract
BACKGROUND AND OBJECTIVE Children born to mothers with gestational diabetes are at an increased risk of developing obesity. Breastfeeding is acknowledged as beneficial for child development and it is suggested that breastfeeding protects against becoming obese. The aim of this study was to document breastfeeding habits of women with gestational diabetes and to identify factors that affect breastfeeding habits. METHODS Breastfeeding habits (breastfeeding of any duration) were recorded of 257 mothers with gestational diabetes (mean age 31.4 +/- 4.8 years) who participated in a prospective post-partum study between 1989 and 1999 and compared to breastfeeding habits of 527 healthy mothers (mean age 30.3 +/- 4.2 years), all enrolled in the prospective BABYDIAB study between the years 1989 and 2000. Breastfeeding data were prospectively obtained by questionnaire and interview. RESULTS Compared to children of healthy mothers, fewer children of mothers with gestational diabetes were breastfed (75% vs 86%; P<0.0001). Among breastfed children the duration of full or any breastfeeding was shorter in children of mothers with gestational diabetes (median for full breastfeeding 9 weeks. [mothers with gestational diabetes] vs. 17 weeks. [healthy mothers]; p<0.0001; median duration of any breastfeeding 16 weeks. vs. 26 weeks.; p<0.0001). After stratification for other risk factors the duration of breastfeeding significantly differed between mothers with gestational DM and those who were healthy (hazard ratio [HR] 1.4; p<0.05 for full breastfeeding; HR 1.5; p<0.0001 for any breastfeeding). Full and any breastfeeding was shorter in women with insulin-dependent gestational diabetes than in those with diet-controlled gestational diabetes (full breast-feeding 4 weeks. vs. 12 weeks.; p<0.01 and any breastfeeding 10 weeks. vs. 20 weeks,; p<0.0001). Fewer women with gestational diabetes and a body weight index (BMI) >30 kg/m2 breastfed (65% vs 80%; p=0.01) and for a shorter duration than women with a BMI <30 kg/m2 (any breastfeeding 12 weeks. vs. 17 weeks; p=0.02). The type of DM therapy independently correlated with reduced breastfeeding duration (HR 1.7; p=0<0.01). CONCLUSIONS Mothers with gestational diabetes, especially mothers with insulin-dependent gestational diabetes, and obese mothers breastfed their children significantly less and for a shorter duration than healthy mothers. These findings could explain the higher risk of their children developing obesity later in life and should be considered when counselling women with gestational diabetes.
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Affiliation(s)
- S Hummel
- Institut für Diabetesforschung, München
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Pflüger M, Hummel S, Ziegler AG. Der Zeitpunkt der Einführung von Beikost beeinflusst das Risiko der Inselautoimmunität bei Kindern der Interventionsstudie BABYDIÄT. DIABETOL STOFFWECHS 2008. [DOI: 10.1055/s-2008-1076231] [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: 10/21/2022]
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Kreichauf S, Pflüger M, Hummel S, Ziegler AG. Einfluss des Stillens auf das Risiko für Übergewicht bei Kindern von Müttern mit Typ-1-Diabetes. DIABETOL STOFFWECHS 2008. [DOI: 10.1055/s-2008-1076159] [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: 10/21/2022]
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Hummel S, Schoen S, Norris JM, Virtanen SM, Mc Leod W, Andren-Aronsson C, Gesualdo P. Ernährungsverhalten im ersten Lebensjahr bei Kindern von Müttern mit und ohne Typ-1-Diabetes: Ergebnisse der TEDDY (The Environmental Determinants of Diabetes in the Young)-Studie. DIABETOL STOFFWECHS 2008. [DOI: 10.1055/s-2008-1076165] [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: 10/21/2022]
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Wüllner U, Buhmann C, Hilker R, Hummel S, Korchounov A, Müller T, Paulus W, Schwartz A. Therapie der Zukunft. Akt Neurol 2007. [DOI: 10.1055/s-2007-970940] [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: 10/23/2022]
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Babilas P, Knobler R, Hummel S, Gottschaller C, Maisch T, Koller M, Landthaler M, Szeimies RM. Variable pulsed light is less painful than light-emitting diodes for topical photodynamic therapy of actinic keratosis: a prospective randomized controlled trial. Br J Dermatol 2007; 157:111-7. [PMID: 17542980 DOI: 10.1111/j.1365-2133.2007.07959.x] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Photodynamic therapy (PDT) of actinic keratosis (AK) using methylaminolaevulinate (MAL) is an effective and safe treatment option, but the procedure is painful. OBJECTIVES To evaluate the efficacy and pain associated with variable pulsed light (VPL), a prospective, randomized, controlled split-face study was performed. METHODS Topical MAL-PDT was conducted in 25 patients with AK (n = 238) who were suitable for two-sided comparison. After incubation with MAL, irradiation was performed with a light-emitting diode (LED) (50 mW cm(-2); 37 J cm(-2)) vs. VPL (80 J cm(-2), double pulsed at 40 J cm(-2), pulse train of 15 impulses each with a duration of 5 ms, 610-950 nm filtered hand piece) followed by re-evaluation up to 3 months. RESULTS The pain during and after therapy was significantly lower with VPL irradiation [t (d.f. = 24) = 4.42, P < 0.001]. The overall mean +/- SD infiltration and keratosis score at 3 months after treatment was 0.86 +/- 0.71 (LED system) vs. 1.05 +/- 0.74 (VPL device) (no statistically significant difference; P = 0.292). Patient satisfaction following both treatment modalities did not significantly differ at the 3-month follow up (P = 0.425). CONCLUSIONS VPL used for MAL-PDT is an efficient alternative for the treatment of AK that results in complete remission and cosmesis equivalent to LED irradiation but causes significantly less pain.
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Affiliation(s)
- P Babilas
- Department of Dermatology, University of Regensburg, Regensburg, Germany
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Abstract
AIMS Breastfeeding is acknowledged to be beneficial for child development. Women with diabetes may be more likely not to breastfeed their children because of neonatal morbidity and instability in diabetes control. The aim of this study was to assess the effect of maternal Type 1 diabetes on breastfeeding habits. METHODS Full breastfeeding and any breastfeeding were reported in the first year of life in 1560 children born in Germany between 1989 and 2004. Of those, 997 children had a mother with Type 1 diabetes, and the remaining 563 children had a father or sibling with Type 1 diabetes. RESULTS Fewer children of mothers with Type 1 diabetes were breastfed than children of non-diabetic mothers (77 vs. 86%; P < 0.0001) and, amongst breastfed children, there was a shorter duration of full breastfeeding (12 vs. 17 weeks; P < 0.0001) and any breastfeeding (20 vs. 26 weeks, P < 0.0001) in children of mothers with Type 1 diabetes compared with children of non-diabetic mothers. Other factors associated with reduced frequency and duration of breastfeeding were pre-term delivery (P < 0.0001), young maternal age (P < 0.0001), and firstborn children (P < 0.0001). After stratification for each of these factors, breastfeeding remained significantly less frequent and of less duration in children of mothers with Type 1 diabetes as compared with children of non-diabetic mothers. CONCLUSIONS Mothers with Type 1 diabetes breastfeed their children less than international recommendations. Counselling to increase frequency and duration of breastfeeding may be warranted in this population.
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Affiliation(s)
- S Hummel
- Diabetes Research Institute and Academic Hospital Schwabing, Munich, Germany
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Hummel M, Baumgarten A, Hummel S, König S, Ziegler AG. Rauchverhalten während der Schwangerschaft bei Frauen mit Typ-1-Diabetes oder Gestationsdiabetes. Dtsch Med Wochenschr 2007; 132:1153-8. [PMID: 17506009 DOI: 10.1055/s-2007-979390] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND AND OBJECTIVE Smoking and diabetes mellitus (DM) are both risk factors for complications during pregnancy and disorders in the newborn. Smoking behavior during pregnancy was investigated in German families where either the pregnant woman or her spouse had diabetes. The relationship between maternal smoking during pregnancy, her metabolic state and the child's birth weight was analysed. PATIENTS AND METHODS Data on smoking behavior during pregnancy of women and their spouses were obtained by questionnaire. 2 498 families were included: 1,439 women and 1,010 men with type 1 diabetes (T1D) and 1,059 women and 1,488 men without T1D, deliveries having taken place between 1989 and 2005 (no account was taken of the amount smoked or whether stopped during pregnancy). Also collected were data on 308 women with gestational diabetes (GDM), who delivered a baby between 1989 and 1997. RESULTS Significantly more pregnant women with T1D and GDM smoked than pregnant women without diabetes (13.2% and 15.2% vs 8.7%, p=0.001). Children of smoking pregnant women with T1D had a significantly lower birth weight than those of non-smoking pregnant women with T1D (median 54th percentile vs 71st percentile, p<0.001), although smoking pregnant women had a higher HbA (1c) than non-smoking pregnant women with T1D (median 6.1% vs 5.7%, p<0.001). The number of women and men who smoked during pregnancy declined between 1989 and 2005 (women: 17.5% vs. 8.9%, p=0.02, men: 38.0% vs 24.7%, p<0.001). CONCLUSIONS The lower birth weight of children of mothers who smoked demonstrates the detrimental consequences of smoking during pregnancy. Pregnant woman with diabetes are a high risk group that should be targeted with programmes that aim to stop smoking during pregnancy.
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Affiliation(s)
- M Hummel
- Institut für Diabetesforschung, München, Germany
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