ResearchPad - germany https://www.researchpad.co Default RSS Feed en-us © 2020 Newgen KnowledgeWorks <![CDATA[Time-to-Death approach in revealing Chronicity and Severity of COVID-19 across the World]]> https://www.researchpad.co/article/elastic_article_13808 The outbreak of coronavirus disease, 2019 (COVID-19), which started from Wuhan, China, in late 2019, have spread worldwide. A total of 5,91,971 cases and 2,70,90 deaths were registered till 28th March, 2020. We aimed to predict the impact of duration of exposure to COVID-19 on the mortality rates increment.MethodsIn the present study, data on COVID-19 infected top seven countries viz., Germany, China, France, United Kingdom, Iran, Italy and Spain, and World as a whole, were used for modeling. The analytical procedure of generalized linear model followed by Gompertz link function was used to predict the impact lethal duration of exposure on the mortality rates.FindingsOf the selected countries and World as whole, the projection based on 21st March, 2020 cases, suggest that a total (95% Cl) of 76 (65–151) days of exposure in Germany, mortality rate will increase by 5 times to 1%. In countries like France and United Kingdom, our projection suggests that additional exposure of 48 days and 7 days, respectively, will raise the mortality rates to10%. Regarding Iran, Italy and Spain, mortality rate will rise to 10% with an additional 3–10 days of exposure. World’s mortality rates will continue increase by 1% in every three weeks. The predicted interval of lethal duration corresponding to each country has found to be consistent with the mortality rates observed on 28th March, 2020.ConclusionThe prediction of lethal duration was found to have apparently effective in predicting mortality, and shows concordance with prevailing rates. In absence of any vaccine against COVID-19 infection, the present study adds information about the quantum of the severity and time elapsed to death will help the Government to take necessary and appropriate steps to control this pandemic. ]]> <![CDATA[Effect of moderate elevated intra-abdominal pressure on lung mechanics and histological lung injury at different positive end-expiratory pressures]]> https://www.researchpad.co/article/Nccafa6f6-e83a-4af1-be67-e451f21e0145

Introduction

Intra-abdominal hypertension (IAH) is a well-known phenomenon in critically ill patients. Effects of a moderately elevated intra-abdominal pressure (IAP) on lung mechanics are still not fully analyzed. Moreover, the optimal positive end-expiratory pressure (PEEP) in elevated IAP is unclear.

Methods

We investigated changes in lung mechanics and transformation in histological lung patterns using three different PEEP levels in eighteen deeply anesthetized pigs with an IAP of 10 mmHg. After establishing the intra-abdominal pressure, we randomized the animals into 3 groups. Each of n = 6 (Group A = PEEP 5, B = PEEP 10 and C = PEEP 15 cmH2O). End-expiratory lung volume (EELV/kg body weight (bw)), pulmonary compliance (Cstat), driving pressure (ΔP) and transpulmonary pressure (ΔPL) were measured for 6 hours. Additionally, the histological lung injury score was calculated.

Results

Comparing hours 0 and 6 in group A, there was a decrease of EELV/kg (27±2 vs. 16±1 ml/kg; p<0.05) and of Cstat (42±2 vs. 27±1 ml/cmH2O; p<0.05) and an increase of ΔP (11±0 vs. 17±1 cmH2O; p<0.05) and ΔPL (6±0 vs. 10±1 cmH2O; p<0.05). In group B, there was no significant change in EELV/kg (27±3 vs. 24±3 ml/kg), but a decrease in Cstat (42±3 vs. 32±1 ml/cmH20; p<0.05) and an increase in ΔP (11±1 vs. 15±1 cmH2O; p<0.05) and ΔPL (5±1 vs. 7±0 cmH2O; p<0.05). In group C, there were no significant changes in EELV/kg (27±2 vs. 29±3 ml/kg), ΔP (10±1 vs. 12±1 cmH2O) and ΔPL (5±1 vs. 7±1 cmH2O), but a significant decrease of Cstat (43±1 vs. 37±1 ml/cmH2O; p<0.05). Histological lung injury score was lowest in group B.

Conclusions

A moderate elevated IAP of 10 mmHg leads to relevant changes in lung mechanics during mechanical ventilation. In our study, a PEEP of 10 cmH2O was associated with a lower lung injury score and was able to overcome the IAP induced alterations of EELV.

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<![CDATA[Incorporating environmental costs of ecosystem service loss in political decision making: A synthesis of monetary values for Germany]]> https://www.researchpad.co/article/5c6dca3ad5eed0c48452a911

Germany faces on-going degradation and biodiversity loss. As a consequence, goods and services provided by biodiversity for human well-being, so-called ecosystem services, are being lost. The associated economic costs and benefits are often unknown. To fill this gap, we conducted a literature review and developed a database of monetary values for the changes in ecosystem services that result from ecosystem change in Germany. In total, 109 monetary valuation studies of regulating and cultural ecosystem services were identified, with the majority focusing on forests and wetlands. In collaboration with valuation experts and the German Federal Environment Agency—Umweltbundesamt (UBA), we defined a set of criteria that economic valuation studies should meet in order to qualify for being used in decision making on national policies. Only 6 out of 109 valuation studies (5.5%) fulfilled the quality criteria for informing such decisions. Overall, monetary information on regulating and cultural ecosystem services is scattered and scarce compared to information on provisioning services, which is accounted for in detail in national statistics. This imbalance in information likely contributes to the distortion in land-use policies, giving preference to maximizing provisioning services in agricultural production and forestry, while neglecting the societal relevance of regulating and cultural services. Decision makers have to rely on only a few cost estimates that are scientifically robust, while being pragmatic to include also vague estimates in cases where data is lacking. The transferability of the monetary values included in our database depends on the biophysical and socio-economic site conditions as well as the decision context of the intended application. Case specific adjustments following guidance for benefit transfer are recommended. Given the lack of applicable studies, we call for more decision-relevant economic assessments. Even in cases where monetary estimates are available, we suggest decision makers to consider also other benefit information available to capture the multiple values ecosystems provide to humans.

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<![CDATA[Individual and area-level determinants associated with C-reactive protein as a marker of cardiometabolic risk among adults: Results from the German National Health Interview and Examination Survey 2008-2011]]> https://www.researchpad.co/article/5c6730d2d5eed0c484f381b9

Background

High-sensitivity C-reactive protein (hsCRP) is a sensitive biomarker of systemic inflammation and is related to the development and progression of cardiometabolic diseases. Beyond individual-level determinants, characteristics of the residential physical and social environment are increasingly recognized as contextual determinants of systemic inflammation and cardiometabolic risks. Based on a large nationwide sample of adults in Germany, we analyzed the cross-sectional association of hsCRP with residential environment characteristics. We specifically asked whether these associations are observed independent of determinants at the individual level.

Methods

Data on serum hsCRP levels and individual sociodemographic, behavioral, and anthropometric characteristics were available from the German Health Interview and Examination Survey for Adults (2008–2011). Area-level variables included, firstly, the predefined German Index of Socioeconomic Deprivation (GISD) derived from the INKAR (indicators and maps on spatial and urban development in Germany and Europe) database and, secondly, population-weighted annual average concentration of particulate matter (PM10) in ambient air provided by the German Environment Agency. Associations with log-transformed hsCRP levels were analyzed using random-intercept multi-level linear regression models including 6,768 participants aged 18–79 years nested in 162 municipalities.

Results

No statistically significant association of PM10 exposure with hsCRP was observed. However, adults residing in municipalities with high compared to those with low social deprivation showed significantly elevated hsCRP levels (change in geometric mean 13.5%, 95%CI 3.2%-24.7%) after adjusting for age and sex. The observed relationship was independent of individual-level educational status. Further adjustment for smoking, sports activity, and abdominal obesity appeared to markedly reduce the association between area-level social deprivation and hsCRP, whereas all individual-level variables contributed significantly to the model.

Conclusions

Area-level social deprivation is associated with higher systemic inflammation and the potentially mediating role of modifiable risk factors needs further elucidation. Identifying and assessing the source-specific harmful components of ambient air pollution in population-based studies remains challenging.

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<![CDATA[Have wind turbines in Germany generated electricity as would be expected from the prevailing wind conditions in 2000-2014?]]> https://www.researchpad.co/article/5c648cd6d5eed0c484c818e1

The planning of the energy transition from fossil fuels to renewables requires estimates for how much electricity wind turbines can generate from the prevailing atmospheric conditions. Here, we estimate monthly ideal wind energy generation from datasets of wind speeds, air density and installed wind turbines in Germany and compare these to reported actual yields. Both yields were used in a statistical model to identify and quantify factors that reduced actual compared to ideal yields. The installed capacity within the region had no significant influence. Turbine age and park size resulted in significant yield reductions. Predicted yields increased from 9.1 TWh/a in 2000 to 58.9 TWh/a in 2014 resulting from an increase in installed capacity from 5.7 GW to 37.6 GW, which agrees very well with reported estimates for Germany. The age effect, which includes turbine aging and possibly other external effects, lowered yields from 3.6 to 6.7% from 2000 to 2014. The effect of park size decreased annual yields by 1.9% throughout this period. However, actual monthly yields represent on average only 73.7% of the ideal yields, with unknown causes. We conclude that the combination of ideal yields predicted from wind conditions with observed yields is suitable to derive realistic estimates of wind energy generation as well as realistic resource potentials.

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<![CDATA[Tree rings as a proxy for seasonal precipitation variability and Early Neolithic settlement dynamics in Bavaria, Germany]]> https://www.researchpad.co/article/5c5b52ecd5eed0c4842bd293

Studying the dynamic of Neolithic settlement on a local scale and its connection to climate variability is often difficult due to missing on-site climate reconstructions from natural archives. Here we bring together archaeological settlement data and a regional climate reconstruction from precipitation-sensitive trees. Both archives hold information about regional settlement dynamics and hydroclimate variability spanning the time of the first farming communities, the so called Linearbandkeramik (LBK) in Bavaria, Germany. Precipitation-sensitive tree-ring series from subfossil oak are used to develop a spring-summer precipitation reconstruction (5700–4800 B.C.E.) representative for southern Germany. Early Neolithic settlement data from Bavaria, mainly for the duration of the LBK settlement activities, are critically evaluated and compared to this unique regional hydroclimate reconstruction as well as to reconstructions of Greenland temperature, summer sea surface temperature, delta 18O and global solar irradiance to investigate the potential impact of climate on Neolithic settlers and their settlement dynamic during the LBK. Our hydroclimate reconstruction demonstrates an extraordinarily high frequency of severe dry and wet spring-summer seasons during the entire LBK, with particularly high year-to-year variability from 5400 to 5101 B.C.E. and with lower fluctuations until 4801 B.C.E. A significant influence of regional climate on the dynamic of the LBK is possible (e.g. around 4960 B.C.E.), but should be interpreted very carefully due to asynchronous trends in settlement dynamics. Thus, we conclude that even when a climate proxy such as tree rings that has excellent spatio-temporal resolution is available, it remains difficult to establish potential connections between the settlement dynamic of the LBK and climate variability.

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<![CDATA[Associations between the use of specific psychotropic drugs and all-cause mortality among older adults in Germany: Results of the mortality follow-up of the German National Health Interview and Examination Survey 1998]]> https://www.researchpad.co/article/5c466516d5eed0c48451754a

Background

Use of psychotropic drugs is common among older adults. Population-based studies on the associations of psychotropic drug use with mortality are sparse.

Objectives

To investigate the associations between the use of specific psychotropic drug groups (opioids, antipsychotics, antidepressants and benzodiazepines) and all-cause mortality among community-dwelling older adults in Germany.

Methods

Participants of the German National Health Interview and Examination Survey 1998 were followed up for mortality from 1997 to 2011. Persons aged 60–79 years with complete data on psychotropic drug use at baseline and on mortality follow-up were considered as study population (N = 1,563). Associations between the use of opioids, antipsychotics, antidepressants and benzodiazepines and all-cause mortality were examined by Cox proportional hazards models adjusted for sociodemographics (sex, age, community size, region, socioeconomic status), life style (smoking, sports, risky alcohol drinking) and health conditions (obesity, disability, history of cardiovascular diseases, diabetes, hyperlipidemia, hypertension, any cancers, any mental disorders) at baseline.

Results

After a median follow-up of 11.4 years, 21, 18, 23 and 26 deaths were documented among those who used at baseline opioids (n = 39), antipsychotics (n = 30), antidepressants (n = 53) and benzodiazepines (n = 54) with an unadjusted mortality rate (MR) of 57.7, 59.1, 44.6 and 53.7 per 1000 person-years, respectively. Meanwhile, 400 deaths were documented among 1,406 nonusers of any of the above mentioned psychotropic drugs with a MR of 26.7 per 1000 person-years. The age and sex adjusted mortality rate ratios in comparison with nonusers were 2.20 (95% confidence intervals 1.42–3.41), 1.66(1.03–2.70), 1.56(1.06–2.28), and 1.57(1.07–2.31) for the use of opioids, antipsychotics, antidepressants and benzodiazepines, respectively. In the fully adjusted Cox models, use of opioids (hazardous ratio 2.04, 95% confidence intervals 1.07–3.89), antipsychotics (2.15, 1.11–4.15) and benzodiazepines (1.76, 1.09–2.82), but not antidepressants, were significantly associated with an increased risk of mortality.

Conclusions

Use of opioids, antipsychotics, benzodiazepines is significantly associated with an increased risk of all-cause mortality among community-dwelling older adults in Germany. Clinicians should be careful in prescribing these psychotropic drugs to older adults while patients already under psychotropic therapy should well balance the risks and benefits of drug use. Further studies with a larger sample size and information on specific indications for psychotropic drug use and mental comorbidities are required to confirm the findings of the present study.

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<![CDATA[Operations research meets need related planning: Approaches for locating general practitioners’ practices]]> https://www.researchpad.co/article/5c3fa598d5eed0c484ca6405

Background

In most western countries a shortage of general practitioners (GP) exists. Newly qualified GPs often prefer to work in teams rather than in single-handed practices. Therefore, new practices offering these kinds of working conditions will be attractive in the future. From a health care point of view, the location planning of new practices will be a crucial aspect. In this work we studied solutions for locating GP practices in a defined administrative district under different objectives.

Methods

Using operations research (OR), a research discipline that originated from logistics, different possible locations of GP practices were identified for the considered district. Models were developed under two main basic requirements: that one practice can be reached by as many inhabitants as possible and to cut down the driving time for every district’s inhabitant to the next practice location to less than 15 minutes. Input data included the demand (population), driving times and the current GP locations.

Results

Three different models were analysed ranging from one single practice solution to five different practices. The whole administrative district can reach the central community “A” in at most 23 minutes by car. Considering a maximum driving time of 15 minutes, locations in four different cities in the district would be sufficient.

Conclusion

Operations research methods can be used to determine locations for (new) GP practices. Depending on the concrete problem different models and approaches lead to varying solutions. These results must be discussed with GPs, mayors and patients to find robust locations regarding future developments.

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<![CDATA[Regional variations in serotype distribution and vaccination status in children under six years of age with invasive pneumococcal disease in Germany]]> https://www.researchpad.co/article/5c3fa564d5eed0c484ca3c8d

Overview

The protective effect of infant pneumococcal conjugate vaccine (PCV) recommendation can be seen in Germany as a whole and in smaller regional groups. Comparisons between population-normalized geographic regions of Germany show different serotype distributions after program implementation, particularly in non-vaccine serotypes. The prior distinct differences in serotype distribution in children between the former East and former West German federal states have vanished. Children under six remain a vulnerable group, but the occurrence of vaccine-type (VT) invasive pneumococcal disease (IPD) in children correctly vaccinated (using a three-dose primary series plus one booster dose) with PCV13 was low (9 out of 374 cases, 2.4%). However, only 18.4% of children in Germany with IPD were correctly vaccinated with PCV13 according to the recommended schedule. Continued surveillance and better schedule adherence are essential to definitively establish the most effective PCV administration schedule.

Vaccination effects

For all PCV products used in Germany (PCV7, PCV10, and PCV13), vaccination status was the most common statistically significant predictor of infection with a particular serotype: Unvaccinated children old enough to have received at least one dose of vaccine in the PCV7 group had significantly higher odds (OR: 6.84, 95%CI: 2.66–22.06, adjusted for per capita income and residence in the northeastern federal states) of contracting VT IPD. In the PCV10 group, VT IPD had an OR of 4.52 (95% CI: 1.60–15.62, adjusted for year of infection, median household size, and residence in the southern federal states) in unvaccinated children, and in the PCV13 group, unvaccinated children continued to have higher odds (OR: 6.21, 95%CI: 3.45–11.36, adjusted for year of infection, age of child, per capita income, residence in the southern federal states, and percentage of children using public daycare) of getting vaccine-type IPD. Being unvaccinated was the most frequent significant indicator for infection with vaccine-type serotypes for each analysis group, while geographic groupings showed more limited potential to predict serotype of infection in early childhood IPD in Germany.

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<![CDATA[Recommendation for ophthalmic care in German preschool health examination and its adherence: Results of the prospective cohort study ikidS]]> https://www.researchpad.co/article/5c0ed77ed5eed0c484f1426b

Background

Each child in Germany undergoes a preschool health examination including vision screening and recommendations for further ophthalmic care. This study investigated the frequency of and adherence to these recommendations.

Methods

A population-based prospective cohort study was performed in the area of Mainz-Bingen (Rhineland-Palatinate, Germany). All preschoolers were examined at the statutory preschool health examination, which includes vision testing (Rodenstock vision screener) with available correction in the last preschool year. Based on the results, recommendations for further ophthalmic care were given to the parents. Six weeks prior to school entry, parents were surveyed concerning ophthalmic health care visits, diagnoses, and treatments. Ophthalmic care recommendation frequency and its adherence were investigated using logistic regression analysis adjusted for potential confounders.

Results

1226 children were included in this study, and 109 children received a recommendation for ophthalmic care based on the preschool health examination. At the follow-up, 84% of children who had received a recommendation had visited an ophthalmologist within the preceding year compared to 47% of children who had not received a recommendation. The recommendation for ophthalmic care was clearly associated with a higher number of ophthalmological visits (odds ratio = 7.63; 95% confidence interval: 3.96–14.7). In a subgroup analysis, adherence to a recommendation was lower in children with migrant background (OR = 2.26; 95%-CI: 0.64–7.90, compared to: OR = 11.6; 95%-CI: 4.95–27.4) and in those with low socio-economic status.

Conclusions

Adherence to preschool recommendations for ophthalmic care is high in German preschoolers. However, a migrant background and low socio-economic status may reduce this adherence.

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<![CDATA[A molecular, morphological, and physiological comparison of English and German populations of Calliphora vicina (Diptera: Calliphoridae)]]> https://www.researchpad.co/article/5c0ed75ad5eed0c484f13fa1

The bluebottle blow fly Calliphora vicina is a common species distributed throughout Europe that can play an important role as forensic evidence in crime investigations. Developmental rates of C. vicina from distinct populations from Germany and England were compared under different temperature regimes to explore the use of growth data from different geographical regions for local case work. Wing morphometrics and molecular analysis between these populations were also studied as indicators for biological differences. One colony each of German and English C. vicina were cultured at the Institute of Legal Medicine in Frankfurt, Germany. Three different temperature regimes were applied, two constant (16°C & 25°C) and one variable (17–26°C, room temperature = RT). At seven time points (600, 850, 1200, 1450, 1800, 2050, and 2400 accumulated degree hours), larval lengths were measured; additionally, the durations of the post feeding stage and intrapuparial metamorphosis were recorded. For the morphometric and molecular study, 184 females and 133 males from each C. vicina population (Germany n = 3, England n = 4) were sampled. Right wings were measured based on 19 landmarks and analyzed using canonical variates analysis and discriminant function analysis. DNA was isolated from three legs per specimen (n = 61) using 5% chelex. A 784 bp long fragment of the mitochondrial cytochrome b gene was sequenced; sequences were aligned and phylogenetically analyzed. Similar larval growth rates of C. vicina were found from different geographic populations at different temperatures during the major part of development. Nevertheless, because minor differences were found a wider range of temperatures and sampling more time points should be analyzed to obtain more information relevant for forensic case work. Wing shape variation showed a difference between the German and English populations (P<0.0001). However, separation between the seven German and English populations at the smaller geographic scale remained ambiguous. Molecular phylogenetic analysis by maximum likelihood method could not unambiguously separate the different geographic populations at a national (Germany vs England) or local level.

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<![CDATA[Rhinovirus infections change DNA methylation and mRNA expression in children with asthma]]> https://www.researchpad.co/article/5c23ff95d5eed0c484092a2d

Human rhinovirus infection (HRVI) plays an important role in asthma exacerbations and is thought to be involved in asthma development during early childhood. We hypothesized that HRVI causes differential DNA methylation and subsequently differential mRNA expression in epithelial cells of children with asthma. Primary nasal epithelial cells from children with (n = 10) and without (n = 10) asthma were cultivated up to passage two and infected with Rhinovirus-16 (RV-16). HRVI-induced genome-wide differences of DNA methylation in asthmatics (vs. controls) and resulting mRNA expression were analyzed by the HumanMethylation450 BeadChip Kit (Illumina) and RNA sequencing. These results were further verified by pyrosequencing and quantitative PCR, respectively. 471 CpGs belonging to 268 genes were identified to have HRVI-induced asthma-specifically modified DNA methylation and mRNA expression. A minimum-change criteria was applied to restrict assessment of genes with changes in DNA methylation and mRNA expression of at least 3% and least 0.1 reads/kb per million mapped reads, respectively. Using this approach we identified 16 CpGs, including HLA-B-associated transcript 3 (BAT3) and Neuraminidase 1 (NEU1), involved in host immune response against HRVI. HRVI in nasal epithelial cells leads to specific modifications of DNA methylation with altered mRNA expression in children with asthma. The HRVI-induced alterations in DNA methylation occurred in genes involved in the host immune response against viral infections and asthma pathogenesis. The findings of our pilot study may partially explain how HRVI contribute to the persistence and progression of asthma, and aid to identify possible new therapeutic targets. The promising findings of this pilot study would benefit from replication in a larger cohort.

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<![CDATA[From welcome culture to welcome limits? Uncovering preference changes over time for sheltering refugees in Germany]]> https://www.researchpad.co/article/5b6d94b5463d7e2f79286cbe

Europe recently experienced a large influx of refugees, spurring much public debate about the admission and integration of refugees and migrants into society. Previous research based on cross-sectional data found that European citizens generally favour asylum seekers with high employability, severe vulnerabilities, and Christians over Muslims. These preferences and attitudes were found to be homogeneous across countries and socio-demographic groups. Here, we do not study the general acceptance of asylum seekers, but the acceptance of refugee and migrant homes in citizens’ vicinity and how it changes over time. Based on a repeated stated choice experiment on preferences for refugee and migrant homes, we show that the initially promoted “welcome culture” towards refugees in Germany was not reflected in the views of a majority of a sample of German citizens who rather disapproved refugee homes in their vicinity. Their preferences have not changed between November 2015, the peak of “welcome culture,” and November 2016, after political debates, media reporting and public discourse had shifted towards limiting admission of immigrants. A minority of one fifth of the sample population, who were initially rather approving of refugee and migrant homes being established in their vicinity, were more likely to change their preferences towards a rather disapproving position in 2016. Experience of contact with refugees and migrants, higher education, and general pro-immigration attitudes explain acceptance of refugee and migrant homes as well as preference stability over time. Country of origin and religion of refugees and migrants are considered less important than decent housing conditions and whether refugee and migrants arrive as families or single persons. In this respect our results highlight the importance of humanitarian aspects of sheltering and integration of refugees and other migrants into society.

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<![CDATA[Importation of Human Seoul Virus Infection to Germany from Indonesia]]> https://www.researchpad.co/article/5c03c049d5eed0c4845d7a81

Seoul hantavirus–associated hemorrhagic fever with renal syndrome cases are rare outside Asia and have not yet been found in Germany. We report clinical and molecular evidence for a Seoul virus infection in a patient in Germany. The infection was most likely acquired during a stay in Sulawesi, Indonesia.

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<![CDATA[Impact of Spatial Soil and Climate Input Data Aggregation on Regional Yield Simulations]]> https://www.researchpad.co/article/5989daebab0ee8fa60bbf17b

We show the error in water-limited yields simulated by crop models which is associated with spatially aggregated soil and climate input data. Crop simulations at large scales (regional, national, continental) frequently use input data of low resolution. Therefore, climate and soil data are often generated via averaging and sampling by area majority. This may bias simulated yields at large scales, varying largely across models. Thus, we evaluated the error associated with spatially aggregated soil and climate data for 14 crop models. Yields of winter wheat and silage maize were simulated under water-limited production conditions. We calculated this error from crop yields simulated at spatial resolutions from 1 to 100 km for the state of North Rhine-Westphalia, Germany. Most models showed yields biased by <15% when aggregating only soil data. The relative mean absolute error (rMAE) of most models using aggregated soil data was in the range or larger than the inter-annual or inter-model variability in yields. This error increased further when both climate and soil data were aggregated. Distinct error patterns indicate that the rMAE may be estimated from few soil variables. Illustrating the range of these aggregation effects across models, this study is a first step towards an ex-ante assessment of aggregation errors in large-scale simulations.

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<![CDATA[Clinical and Patient-Related Variables Associated with Initiating GLP-1 Receptor Agonist Therapy in Type 2 Diabetes Patients in Primary Care in Germany]]> https://www.researchpad.co/article/5989db45ab0ee8fa60bd852d

Aims

To investigate real-world clinical and patient-related variables associated with initiating GLP-1 receptor agonist (GLP-1RA) treatment relative to initiation of other glucose-lowering therapies in type 2 diabetes (T2D) patients of primary care in Germany.

Methods

Data for 938 T2D patients who started therapy with a GLP-1RA within 823 practices of primary care throughout Germany were retrospectively analyzed (Disease Analyser: 01/2011–03/2014). 5,197 T2D patients who initiated other non-GLP-1RA antidiabetic therapies were selected as controls. Multivariate logistic regression analyses were applied to identify factors associated with GLP-1RA initiation in primary care.

Results

Mean age (SD) of GLP-1RA users was 57.8 (11.8) years (males: 55.5%) and the average BMI was 36.1 (6.7) kg/m2. 22.8% were in diabetologist care and 12.0% had private health insurance. In multivariate regression, choice of GLP-1RA therapy instead of a different glucose-lowering drug class was associated with obesity (odds ratio: 1.68; 95% CI: 1.34–2.10), private health insurance (2.42; 1.89–3.09), younger age (0.94; 0.93–0.95 per year), male sex (0.85; 0.73–0.99), diabetologist care (2.11; 1.73–2.57), and geographic practice location (East vs. West-Germany; 1.25; 1.05–1.49). Among co-medication, angiotensin II antagonists (increased) and non-steroidal antirheumatic agents (decreased) were related to GLP-1RA prescriptions (both p<0.001).

Conclusions

Consistent with German guidelines, GLP-1RA is mainly prescribed preferentially in T2D patients who are obese. GLP-1RA drugs were more frequently used than other options in privately health insured patients and in patients seeing a diabetologist.

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<![CDATA[20 Years of Pediatric Benchmarking in Germany and Austria: Age-Dependent Analysis of Longitudinal Follow-Up in 63,967 Children and Adolescents with Type 1 Diabetes]]> https://www.researchpad.co/article/5989da55ab0ee8fa60b8ea6f

Background

To investigate changes in diabetes treatment over the last two decades in three age-groups of children and adolescents with type 1 diabetes (T1D) from Germany and Austria.

Methods

63,967 subjects (<18yr) with T1D documented between 1995 and 2014 from the DPV-database were included and stratified according to age (0.5-<6, 6-<12, 12-<18yr). Regression models were applied for insulin regimens (<3 and ≥4 injection time points/day, or continuous subcutaneous insulin infusion (CSII)), use of rapid- and long acting insulin analogues, NPH insulin, and frequency of self-monitoring of blood glucose (SMBG)/day. Models were adjusted for sex, diabetes duration, and migration background. P-value for trend was given.

Findings

The number of subjects with <3 injection time points/day decreased from 1995 to 2014 to <5% in all age-groups (p<0.0001). Proportion of patients with ≥4 injections/day increased until the early 2000s, and then declined until 2014. This trend was not found in 6-<12yr olds (p = 0.3403). CSII increased in all age-groups (p<0.0001) with the highest increase in children <6 years (from 0.4% to 79.2%), and the lowest increase in 12-<18 year olds (from 1.0% to 38.9%). NPH insulin decreased in all age-groups (p<0.0001). Insulin analogues, especially rapid-acting, became more frequent in all age-groups (p<0.0001), accounting for 78.4% in 2014 for all subjects. The highest use was found in the youngest children (in 2014: 85.6%), the lowest use in 6-<12 year olds (in 2014: 72.9%). The number of SMBG/day increased from 2.2 to 6.4 with a similar rise in all age-groups (p<0.0001). Frequency was highest in subjects <6yr.

Conclusions

In all age-groups, T1D treatment was intensified over the last 20 years. Age-specific differences in trends were particularly observed in the number of patients on CSII, in the number of patients with 4 or more injections/day, and in the frequency of SMBG/day.

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<![CDATA[Effect of Health Comparisons on Functional Health and Depressive Symptoms - Results of a Population-Based Longitudinal Study of Older Adults in Germany]]> https://www.researchpad.co/article/5989dae4ab0ee8fa60bbcee2

Objective

To investigate the effect of health comparisons on functional health and depressive symptoms in a longitudinal approach. Gender differences were examined.

Methods

The German Ageing Survey (DEAS) is a nationwide, representative longitudinal study of community dwelling individuals living in Germany aged 40 and older. The surveys in 2008 and 2011 were used, with n = 3,983 respondents taking part in both waves. Health comparisons were quantified by the question “How would you rate your health compared with other people your age” (Much better; somewhat better; the same; somewhat worse, much worse). Functional health was assessed by the subscale “physical functioning” of the 36-Item Short Form Health Survey (SF-36) and depressive symptoms were measured by the Center for Epidemiologic Studies Depression Scale (CES-D).

Results

Adjusting for sociodemographic factors, self-assessed health, social network, self-efficacy and optimism, and morbidity, fixed effects regressions revealed that functional health decreased significantly and considerably with negative health comparisons in the total sample (transitions from ‘the same’ to ‘much worse’: β = -11.8), predominantly in men. The effects of negative health comparisons (transitions from ‘the same’ to ‘much worse’: β = 4.8) on depressive symptoms were comparable (in terms of significance) to the effects on functional health, with stronger effects in women. Positive comparisons did not affect functional health and depressive symptoms.

Conclusion

Our findings underline the relevance of negative health comparisons on functional health (men) and depressive symptoms (women). Comparison effects are asymmetric and mostly upwards.

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<![CDATA[The Quantity and Quality of Illegally Imported Products of Animal Origin in Personal Consignments into the European Union Seized at Two German Airports between 2010 And 2014]]> https://www.researchpad.co/article/5989db29ab0ee8fa60bd0f5a

The import of products of animal origin (POAO) in travellers’ personal consignments presents a considerable risk of introducing animal diseases and emerging zoonoses into the European Union. The current regulation (EU) 206/2009 implements strict measures for illegally imported POAO, whereupon non-complying products have to be seized and destroyed regardless. Especially airports serve as global bottlenecks for illegally imported POAO where passenger controls of non-European flights are performed by customs and veterinary services in collaboration. Results of these control measures have to be submitted in the form of annual reports to the European Commission. However, few data on qualities and quantities of seizures have been published so far. In this study, POAO seized at two German airports between 2010 and 2014 were analysed in terms of quantities, qualitative categories and region of origin. In most years considered, more than 20 tonnes POAO were seized at each airport. However, reported amounts of seizures seem to be only the tip of the iceberg as an all-passenger control is not feasible and therefore travellers are only spot-checked. The analysis suggests that the organisational structures of both customs and official veterinary services and their different risk perceptions interfere in completing an effective ban on the illegal import of POAO.

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<![CDATA[Recalibration of the ACC/AHA Risk Score in Two Population-Based German Cohorts]]> https://www.researchpad.co/article/5989dafaab0ee8fa60bc4476

Background

The 2013 ACC/AHA guidelines introduced an algorithm for risk assessment of atherosclerotic cardiovascular disease (ASCVD) within 10 years. In Germany, risk assessment with the ESC SCORE is limited to cardiovascular mortality. Applicability of the novel ACC/AHA risk score to the German population has not yet been assessed. We therefore sought to recalibrate and evaluate the ACC/AHA risk score in two German cohorts and to compare it to the ESC SCORE.

Methods

We studied 5,238 participants from the KORA surveys S3 (1994–1995) and S4 (1999–2001) and 4,208 subjects from the Heinz Nixdorf Recall (HNR) Study (2000–2003). There were 383 (7.3%) and 271 (6.4%) first non-fatal or fatal ASCVD events within 10 years in KORA and in HNR, respectively. Risk scores were evaluated in terms of calibration and discrimination performance.

Results

The original ACC/AHA risk score overestimated 10-year ASCVD rates by 37% in KORA and 66% in HNR. After recalibration, miscalibration diminished to 8% underestimation in KORA and 12% overestimation in HNR. Discrimination performance of the ACC/AHA risk score was not affected by the recalibration (KORA: C = 0.78, HNR: C = 0.74). The ESC SCORE overestimated by 5% in KORA and by 85% in HNR. The corresponding C-statistic was 0.82 in KORA and 0.76 in HNR.

Conclusions

The recalibrated ACC/AHA risk score showed strongly improved calibration compared to the original ACC/AHA risk score. Predicting only cardiovascular mortality, discrimination performance of the commonly used ESC SCORE remained somewhat superior to the ACC/AHA risk score. Nevertheless, the recalibrated ACC/AHA risk score may provide a meaningful tool for estimating 10-year risk of fatal and non-fatal cardiovascular disease in Germany.

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