Disease In Germany Research Articles

Regional Variation of Chronic Kidney Disease in Germany: Results From Two Population-Based Surveys

Background/Aims: Due to the increasing prevalence of risk factors for chronic kidney disease (CKD), kidney dysfunction becomes a major public health problem. We investigated the CKD prevalence and determined to what extent the variation of risk factors explains the different CKD prevalence in Germany. Methods: We analyzed data from 6,054 participants, aged 31 to 82 years, from the Study of Health in Pomerania (SHIP-1) in Northeast Germany and the Cooperative Health Research in the Region of Augsburg (KORA F4) Study in Southern Germany. Regional differences in selected percentiles corresponding to the cutpoints for estimated glomerular filtration rate (eGFR, <60 ml/min per 1.73 m²) and albumin-to-creatinine ratio (ACR, ≥30 mg/g) were tested using quantile regression models that adjusted for CKD risk factors. Results: The prevalence of decreased eGFR_{creatinine-cystatinC} (5.9 vs. 3.1 %, p <0.001) and albuminuria (20.2 vs. 8.8 %, p<0.001) were higher in SHIP-1 than in KORA F4. The differential distribution of risk factors explained 18-21% of the regional differences of decreased eGFR_{creatinine-cystatinC} and high ACR. Conclusions: The CKD prevalence is higher in Northeast than in Southern Germany. Differences in the prevalence of risk factors partly explain the higher disease burden of CKD in Northeast than in Southern Germany.

The impact of economic recession on the use of treatment technology for peripheral arterial disease

ObjectivesThere is broad concern that economic recessions may have adversely affected both population health and healthcare. This study investigates whether economic changes may have affected the treatment of one of the major diseases in Germany, peripheral arterial disease (PAD), using femoropopliteal stent angioplasty. MethodsThis retrospective longitudinal study uses multivariate linear regression to examine associations between changes of five principal economic indicators between 2000 and 2010 and the demand for femoropopliteal stents in Germany between 2005 and 2010, controlling for the prevalence of PAD risk factors, cardiovascular drug demand, reimbursement of healthcare providers for stent implantation, stent selling prices of manufacturers and evidence from clinical studies. ResultsUnemployment in the population aged 25–74 years and the harmonized index of consumer price indices were associated with femoropopliteal stent demand in Germany with a time lag of 2.5 and 3 years, respectively. ConclusionsThere was an association between economic change and femoropopliteal stent demand. Results suggest a role of practice related variables at a center and individual physician level. More research is needed at this center and individual level to examine changes in decision making in PAD treatment following economic change.

Infectious diseases and injuries of bladder and urinary tract

Urinary tract infections are the most common infectious diseases in Germany. In most cases clarification does not rely on imaging techniques other than sonography and is made mostly based on clinical symptoms. Computed tomography (CT) and magnetic resonance imaging (MRI) can be used in selected cases to find the cause and detection or exclusion of complications, e.g. recurrent or atypical and complicated courses. The method of choice for clarification of urolithiasis is CT. Using low-dose techniques, detection or exclusion of urinary stones can be achieved with a high sensitivity and specificity as well as an acceptable level of radiation exposure. Native stone CT supplies additional fundamental information that can substantially influence further therapy planning. The diagnosis of ureteral injuries is clinically and radiologically not trivial and clarification is aided by urographic contrast media. The method of CT cystography has an important role in the diagnostics of urinary bladder injuries.

Inpatient Case-Related Treatment Costs For Different Cardiovascular Diseases In Germany.

Inpatient Case-Related Treatment Costs For Different Cardiovascular Diseases In Germany.

Should Cost-Effectiveness Analysis Include The Cost Of Consumption Activities? An Empirical Investigation.

There has been a debate on whether cost-effectiveness analysis should consider the cost of consumption and leisure time activities when using the quality-adjusted life year as a measure of health outcome under a societal perspective. The purpose of this study was to investigate whether the effects of ill health on consumptive activities are spontaneously considered in a health state valuation exercise and how much this matters. The survey enrolled patients with inflammatory bowel disease in Germany (n = 104). Patients were randomized to explicit and no explicit instruction for the consideration of consumption and leisure effects in a time trade-off (TTO) exercise. Explicit instruction to consider non-health-related utility in TTO exercises did not influence TTO scores. However, spontaneous consideration of non-health-related utility in patients without explicit instruction (60% of respondents) led to significantly lower TTO scores. Results suggest an inclusion of consumption costs in the numerator of the cost-effectiveness ratio, at least for those respondents who spontaneously consider non-health-related utility from treatment. Results also suggest that exercises eliciting health valuations from the general public may include a description of the impact of disease on consumptive activities. Copyright © 2015 John Wiley & Sons, Ltd.

Infectious pulmonary diseases

ZusammenfassungInfektiöse Lungenerkrankungen oder Pneumonien sind die Haupttodesursache innerhalb der Infektionskrankheiten in Deutschland. Hierbei ist die bakterielle Verursachung am häufigsten. Die Form der Entzündung wird meist durch das schädigende Agens bestimmt, jedoch sind häufig verschiedene Reaktionen anzutreffen. Morphologisch kann nur in wenigen Fällen der Erreger konkret bestimmt werden, sodass meist eine zusätzliche mikrobiologische Erregerdiagnostik notwendig ist. Klinisch erfolgt eine Einteilung in ambulant erworbene und nosokomiale Pneumonien, Pneumonien bei Immunsuppression und die Mykobakteriosen. Histologisch ist eine Einteilung gemäß der bevorzugten Ausbreitung in alveoläre und interstitielle bzw. in lobäre und herdförmige Pneumonien möglich.

Evaluation of a questionnaire to assess selected infectious diseases and their risk factors : findings of a multicenter study.

Background/objectivesThe risk to die from an infectious disease in Germany has been continuously decreasing over the last century. Since infections are, however, not only causes of death but risk factors for diseases like cardiovascular diseases, it is essential to monitor and analyze their prevalence and frequency, especially in consideration of the increased life expectancy. To gain more knowledge about infectious diseases as risk factors and their implications on the condition and change of the immune status, the German National Cohort (GNC), a population-based prospective cohort study, will recruit 200,000 subjects between 2014 and 2017. In Pretest 1, a feasibility study for the GNC, we evaluated a self-administered and self-report questionnaire on infectious diseases and on the use of health care facilities (hereinafter called “ID Screen”) for feasibility and validity.MethodsFrom August–November 2011, 435 participants between the ages of 20–69 completed the ID Screen. All subjects had been recruited via a random sample from the local residents’ registration offices by 4 of the 18 participating study centers. The questionnaire encompasses 77 variables in six sections assessing items such as 12-month prevalence of infections, cumulative prevalence of infectious diseases, visit of health care facilities and vaccination. The feasibility was amongst others evaluated by assessing the completeness and comprehensiveness of the questionnaire. To assess the questionnaires ability to measure “immune status” and “susceptibility to infections”, multivariate analysis was used.ResultsThe overall practicability was good and most items were well understood, demonstrated by < 2/33 missing questions per questionnaire and only three variables: vaccination for influenza and pneumococci and infection with chickenpox had a frequency > 5 % of missing values. However, direct comparison of the items 12-month prevalence and lifetime prevalence of nephritis/pyelitis showed poor agreement and thereby poor understanding by 80 % of the participants, illustrating the necessity for a clear, lay person appropriate description of rare diseases to increase comprehensibility. The questionnaire will be used to support the assessment of immune dysfunction and frequency of infection. An analysis of these constructs in an exploratory factor analysis revealed limited applicability due to low interitem correlation (Cronbach’s α < 0.5). This is corroborated by the extraction of more than one factor with a Kaiser–Meyer–Olkin measure of 0.6 instead of a unidimensional latent construct for “immune status”.ConclusionAll in all, the ID Screen is a good and reliable tool to measure infectious diseases as risk factors and outcome in general, but requires a better translation of infection specific terms into lay person terms. For the assessment of the overall immune status, the tool has strong limitations. Vaccinations status should also rather be assessed based on vaccination certificates than on participants’ recall.Electronic supplementary materialThe online version of this article (doi: 10.1007/s00103-014-2052-y) contains supplementary material, which is available to authorized users.

Hantavirus disease in Germany due to infection with Dobrava-Belgrade virus genotype Kurkino

Members of the Dobrava-Belgrade virus (DOBV) species are hantaviruses carried by different Apodemus mice as reservoir hosts and causing haemorrhagic fever with renal syndrome (HFRS) in humans. In Central Europe, the Kurkino genotype of DOBV, associated with the striped field mouse, Apodemus agrarius, is prevalent. This paper presents the first extensive study of the serological and molecular diagnostics, epidemiology and clinics of DOBV-Kurkino infections in Central Europe. Serum samples from 570 German patients living in the habitat of A. agrarius (north and northeast Germany) and exhibiting febrile disease, were analysed. All samples were tested by ELISA, subsets of samples were also analysed by immunoblot, neutralization assay, and RT-PCR. A group of 86 individuals was confirmed as DOBV-infected. The virus neutralization assay allowed a reliable identification of DOBV antibodies during both acute and convalescent phases of infection. However, differentiation of relevant DOBV genotypes was not possible by neutralization test but required molecular analysis. Whereas DOBV IgM antibodies tend to persist in the infected organism, RNAaemia seems to be short. Nucleotide sequences were amplified from four patients, and their analysis demonstrated infection by DOBV-Kurkino. With respect to the initial results, the high degree of identity of local patient-derived and A. agrarius-derived virus sequences may allow a closer allocation of the geographical place where the human infection occurred. In contrast to moderate/severe HFRS caused by the DOBV genotypes Dobrava or Sochi, all available data showed a mild clinical course of HFRS caused by DOBV-Kurkino infection without lethal outcomes.

Power-law models for infectious disease spread

Short-time human travel behaviour can be described by a power law with respect to distance. We incorporate this information in space-time models for infectious disease surveillance data to better capture the dynamics of disease spread. Two previously established model classes are extended, which both decompose disease risk additively into endemic and epidemic components: a spatio-temporal point process model for individual-level data and a multivariate time-series model for aggregated count data. In both frameworks, a power-law decay of spatial interaction is embedded into the epidemic component and estimated jointly with all other unknown parameters using (penalised) likelihood inference. Whereas the power law can be based on Euclidean distance in the point process model, a novel formulation is proposed for count data where the power law depends on the order of the neighbourhood of discrete spatial units. The performance of the new approach is investigated by a reanalysis of individual cases of invasive meningococcal disease in Germany (2002-2008) and count data on influenza in 140 administrative districts of Southern Germany (2001-2008). In both applications, the power law substantially improves model fit and predictions, and is reasonably close to alternative qualitative formulations, where distance and order of neighbourhood, respectively, are treated as a factor. Implementation in the R package surveillance allows the approach to be applied in other settings.

Influence of Heat Waves on Ischemic Heart Diseases in Germany

The impact of heat waves on ischemic heart disease (IHD) mortality and morbidity in Germany during 2001–2010 is analyzed. Heat waves are defined as periods of at least three consecutive days with daily mean temperature above the 97.5th percentile of the temperature distribution. Daily excess mortality and morbidity rates are used. All calculations were performed separately for 19 regions to allow for the investigation of regional differences. The results show that IHD mortality during heat waves is significantly increased (+15.2% more deaths on heat wave days). In stark contrast, no heat wave influence on hospital admissions due to IHD could be observed. Regional differences in heat wave IHD mortality are present, with the strongest impact in Western Germany and weaker than average effects in the Southeastern and Northwestern regions. The increase in mortality during heat waves is generally stronger for females (+18.7%) than for males (+11.4%), and for chronic ischemic diseases (+18.4%) than for myocardial infarctions (+12.2%). Longer and more intense heat waves feature stronger effects on IHD mortality, while timing in season seems to be less important. Since climate change will most likely enhance the number and intensity of heat waves, the obtained results point to public adaptation strategies to reduce the future heat wave impact on mortality.

Chronic and vaccine-preventable diseases in children and adolescents in Germany: results of the KiGGS study: first follow up (KiGGS wave 1)

The German Health Interview and Examination Survey for Children and Adolescents (KiGGS) 2003-2006 is the first nationwide comprehensive study on the health of children and adolescents living in Germany. The KiGGS first interview follow-up is a telephone interview study that collected, among other things, data on a number of chronic and vaccine-preventable diseases in 2009-2012 and is a combined cross-sectional and longitudinal study based on a population registry sample from the 167 KiGGS study points. The analysis is based on 12,368 respondents (7913 KiGGS follow-up participants aged 7-17 years, response 72 % and 4455 newly recruited 0- to 6-year-olds, response 42 %). Based on parent reports the lifetime prevalence of both chickenpox and pertussis has decreased in the population targeted by recently changed vaccination recommendations. For measles the prevalence remained unsatisfactorily high in each investigated age group. Of the children and adolescents aged 0-17 years 16 % (95 % confidence interval CI 15.2-17.0 %) had a long-standing chronic health condition according to the parents. Of these, however, only one in five was affected in their routine daily activities. The lifetime prevalence in 7- to 17-year-olds was 1.2 % (0.9-1.6) for epilepsy (0.4 % for the past 12 months), 5.0 % (4.4-5.7) for migraine, 0.2 % (0.1-0.3) for diabetes and in 0 to 6-year-olds 2.0 % (1.5-2.6) for heart conditions and 3.1 % (2.5-3.8) for febrile seizures with a -prevalence in 0 to 2-year-olds which are most affected of 1.0 % (0.6-1.6) in the past 12 months. The vast majority of children and adolescents in Germany are in good or very good health as suggested by other results reported in this issue; however, chronic conditions are not rare and need continuous monitoring. These results confirm that implementation of the vaccination recommendations of the German Standing Committee on Vaccination (STIKO) can lead to effective prevention of infectious diseases in Germany.

Invasive pneumococcal disease in Germany in the era of pneumococcal conjugate vaccination

Pneumococci remain a major cause of bacterial pneumonia, sepsis and meningitis globally. The German National Reference Center for Streptococci at the Institute for Medical Microbiology of the University Hospital RWTH Aachen, Germany, has carried out surveillance studies on invasive pneumococcal disease (IPD) since 1992. This report is based on IPD-cases from adults and children, received between July 1992 and June 2013 and July 1997 and June 2013 respectively. From 1997-2006 the proportion of infections among children ≤ 23 months of age with serotypes included in the 7-valent vaccine was about 65%. Since the start of childhood vaccination in 2006 the percentage has continuously decreased, reaching < 5% in 2012 /2013. Also among adults, for whom conjugate vaccination was not indicated, this percentage decreased from 40-45% in 1992-2006 to about 8% in 2012 /2013. This phenomenon is denoted as herd protection. The resistance rate against Penicillin G remained under 4% among children and under 2.5% among adults over the whole study period. Since 2005 /2006 macrolide resistance levels have decreased to about 5% among children and 8% among adults. The continuous decrease of vaccine serotypes as well as the decreasing IPD incidence since the beginning of childhood vaccination document the success of pneumococcal conjugate vaccination.

Role of orthopedic rheumatologist in the therapy of rheumatic diseases with biologics

The international strategies in the treatment of rheumatic diseases have changed dramatically in the last 10 years. In addition to the prescription of a basic medication as soon as possible, biologics are increasingly being used for drug treatment of rheumatic diseases in Germany. The domains of orthopedic surgeons and orthopedic rheumatologists are still the extended conservative and surgical treatment of inflammatory systemic diseases, which continue to play an important role despite the improved drug therapy options. Orthopedic surgeons should principally be familiar with the use of antirheumatic drugs, especially with respect to the perioperative management. However, there is also a role for the orthopedic surgeon in the early detection of inflammatory systemic diseases and in cooperation with rheumatologists in the medicinal treatment of selected diseases. Because patients with initial stages of joint pain, e.g. from rheumatoid arthritis (RA), spondyloarthritis (SpA) or psoriatic arthropathy often present first to an orthopedic surgeon, recognition of the early stages by the primary treating physician, including the necessary rapid induction of drug therapy is especially important. In addition there is a shortage of internist rheumatologists in Germany so that selective referral and close cooperation between the two physicians become of great importance.

Occupational skin cancer due to UV-irradiation--Analyses of notified cases as "virtually-certain" occupational disease in Germany between 2005 and 2011.

UV-induced skin cancer is not yet included in the German ordinance on occupational diseases and can only be notified and recognized acknowledged as "virtually-certain" occupational disease. The objective of the study was to analyze notified and acknowledged cases of occupational skin cancer due to UV-irradiation in Germany between 2005 and 2011. All notified cases of occupational skin cancer due to UV-irradiation have been analyzed which have been registered by the German Statutory accident insurance as of May 2012 were analyzed. The data analyze was descriptive stratified annually for presenting time trends.Data analysis was descriptive, stratified by year to defect time trends. Notified cases have increased annually with a total of 548 registered cases of occupational skin cancer induced by UV-irradiation between 2005 and 2011, and 74 recognized acknowledged cases. In 56 cases the procedure was not yet finished. Squamous cell carcinoma (SCC) and in-situ squamous cell carcinoma (actinic keratosis, Bowen's disease) were most frequent and have been the most frequentlyobserved in 333 notified cases. and between 15.6 % and 24.9 % have been recognizedof cases with SCC and actinic keratosis were recognized, respectively. 184 patients with basal cell carcinoma were notified but only 6.5 % recognized acknowledged and only 3 cases with exclusive basal cell carcinoma. Out of 50 notified patients with Mmelanoma only one was recognizedacknowledged. The results are in good agreement with the proposal of the German Minister of labor to establish UV-induced skin cancer as a new occupational disease.

Public health pests. Arthropods and rodents as causative disease agents as well as reservoirs and vectors of pathogens

Globally, infectious diseases pose the most important cause of death. Among known human pathogenic diseases, approximately 50 % are zoonoses. When considering emerging infectious diseases separately 73 % currently belong to the group of zoonoses. In Central Europe, hard ticks show by far the biggest potential as vectors of agents of human disease. Lyme borreliosis, showing an estimated annual incidence between 60,000 and 214,000 cases is by far the most frequent tick-borne disease in Germany. Continually, formerly unknown disease agents could be discovered in endemic vector species. Additionally, introduction of new arthropod vectors and/or agents of disease occur constantly. Recently, five mosquito species of the genus Aedes have been newly introduced to Europe where they are currently spreading in different regions. Uncommon autochthonous transmission of dengue and chikungunya fever viruses in Southern Europe could be directly linked to these vector species and of these Ae. albopictus and Ae. japonicus are currently reported to occur in Germany. The German Protection against Infection Act only covers the control of public health pests which are either active hematophagous vectors or mechanical transmitters of agents of diseases. Use of officially recommended biocidal products aiming to interrupt transmission cycles of vector-borne diseases, is confined to infested buildings only, including sewage systems in the case of Norway rat control. Outdoor vectors, such as hard ticks and mosquitoes, are currently not taken into consideration. Additionally, adjustments of national public health regulations, detailed arthropod vector and rodent reservoir mapping, including surveillance of vector-borne disease agents, are necessary in order to mitigate future disease risks.

Re: Lange R, Hoerer J, Schreiber C. What are the obstacles to training in surgery for congenital heart disease in Germany? Thorac Cardiovasc Surg 2013;61:273–277

Re: Lange R, Hoerer J, Schreiber C. What are the obstacles to training in surgery for congenital heart disease in Germany? Thorac Cardiovasc Surg 2013;61:273–277

Re: Lange R, Hoerer J, Schreiber C. What are the obstacles to training in surgery for congenital heart disease in Germany? Thorac Cardiovasc Surg 2013;61:273–277

Re: Lange R, Hoerer J, Schreiber C. What are the obstacles to training in surgery for congenital heart disease in Germany? Thorac Cardiovasc Surg 2013;61:273–277

Endophthalmitis, Leberabszess sowie zerebrale und pulmonale Embolien bei einem 48-jährigen Vietnamesen

We present the case of a 48-year-old Vietnamese man with endophthalmitis, liver abscess, and pulmonary and cerebral septic emboli. Klebsiella pneumoniae was isolated as the causative organism; there were no laboratory findings suggestive of invasive fungal infection. Klebsiella pneumoniae invasive syndrome is a rare disease in Germany. This case report exemplifies the necessity of a dedicated diagnostic approach that takes into consideration factors such as ethnic origin and accompanying diseases of the patient.

Trends in surveillance data of human Lyme borreliosis from six federal states in eastern Germany, 2009–2012

Lyme borreliosis (LB) is the most frequent vector-borne disease in Germany. For more than 10 years, data from mandatory notifications have been available from 6 federal states in the eastern part of Germany. A common case definition was applied. Clinical manifestations of erythema migrans, neuroborreliosis (radiculoneuritis, cranial neuritis, meningitis), and Lyme arthritis were notifiable. From 2009 to 2012, altogether 18,894 cases were notified. The overall incidence varied between 34.9 cases/100,000 inhabitants in 2009 and 19.54 cases/100,000 persons in 2012. LB in eastern Germany showed a pronounced seasonality with a peak in August. Decreasing as well as increasing trends were observed in different federal states. Females predominated among all cases (55.3%). The age distribution was bimodal with incidence peaks in children 5–9 years old (32.4 cases/100,000 persons in 2011) and in adults aged 60–69 years (56.7 cases/100,000 persons in 2011). Erythema migrans affected 95.4% of the patients and acute neuroborreliosis 3.3%. Among the latter, the most common manifestation was radiculoneuritis (n=316). Neuritis cranialis was more common in children than in adults (p<0.01). The same was true for meningitis (p<0.01). Altogether 2.0% of the LB cases developed Lyme arthritis. LB has a significant disease burden in the study area. Different levels of under-ascertainment in the surveillance system could explain parts of the differences in the incidence. Furthermore, there may be discrepancies in disease awareness among patients and physicians. Changes in time and differences among geographical regions could result from variations in risk factors related to human behaviour (e.g., outdoor activity). Additionally, vector-related risk factors may have varied (e.g., landscape, climate). Public health strategies with a particular focus on the high-incidence age groups should promote daily checks for ticks and prompt removal of ticks after exposure to avoid infection. Physicians should be able to recognize LB patients with early manifestations and promptly treat those appropriately.

Stationäre rheumatologische Versorgung in Deutschland

Acute inpatient treatment plays an important role in the care of patients with rheumatic diseases in Germany. Inpatient facilities are usually departments in general hospitals or highly specialized clinics. The introduction of the diagnosis-related groups (DRG) system has led to a change in form which is most obviously characterized by more homogeneous structures and shorter hospital stays. Many rheumatic patients are, however, treated in general hospitals due to a lack of specialized clinics. The presence of a department of rheumatology in medical schools is deficient which therefore leads to only a small number of specialists in rheumatology. The rheumatologists in inpatient facilities are also involved in the care of outpatients, whereby the number of licensed internal medical rheumatologists is declining. Further possibilities in outpatient treatment in hospitals were created with new governmental regulations (§116b). Changes are expected with the implementation of the new outpatient specialist medical care (ASV).