German Database Research Articles

Reduction of coronary risk factors immediately and one year after inpatient rehabilitation in a highly motivated patient cohort

Purpose: To investigate if adherence to medical advice driven by high patient motivation can lead to a significant reduction in coronary risk factors during and up to 1 year after in-patient rehabilitation. Although cardiac rehabilitation has proven positive effects on survival and reinfarction, it often reduces coronary risk factors unsatisfactorily. Design: 1,195 highly motivated patients (13.2%; age 64.6 years, SD 9.8; 74% men) recruited from a total of 9,082 patients admitted to 6 Austrian specialised cardiac rehabilitation centres during 1 year were selected for the study based on reliable completion of a survey of cardiac risk factors (i.e. ≥80% of data documented). Methods: Risk factors were determined when patients were admitted and discharged, and were reassessed by a general practitioner every 3 months and documented by the patient for up to 1 year. Changes of risk factors were analysed at discharge and after one year. Results: Patients had lower coronary risk factors at admission than those reported in a contemporary German database of 117,983 cardiac rehabilitation patients with similar demographic characteristics. Risk factors were further reduced at discharge. The changes were still significant and clinically meaningful after one year. View this table: Coronary risk factors Conclusion: Highly motivated patients could significantly lower their risk factors during rehabilitation and this change was sustained over 1 vear. The results of cardiac rehabilitation seem to strongly depend on the motivation of patients leading to adherence to medical advice.

SAT0432 Development of Positive Antinuclear Antibodies and Rheumatoid Factor in Systemic Juvenile Idiopathic Arthritis Points toward an Autoimmune Phenotype Later in the Disease Course

BackgroundSystemic onset Juvenile Idiopathic Arthritis (JIA) is now commonly considered part of the group of autoinflammatory diseases. However, systemic inflammation tends to decrease over time, leading to a phenotype of...

SAT0433 Hyaluronic Acid is a Marker of Active Arthritis, but not Systemic Inflammation in Systemic Juvenile Idiopathic Arthritis

BackgroundSystemic juvenile idiopathic arthritis (JIA) is a subtype of childhood arthritis associated with significant systemic inflammation as well as arthritis. Hyaluronic acid as a constituent of connective tissue has previously...

Resource Consumption and Costs of Treatment in Patients with Type 1 Diabetes under Intensified Conventional Therapy under German Real-Life Conditions

The aim of this study was to compare, from the perspective of the statutory health insurance, resource consumption and the associated adjusted treatment costs of intensified conventional therapy (ICT) with long-acting insulins in patients with type 1 diabetes mellitus (T1DM). We identified patients with T1DM who started ICT with either insulin glargine or neutral protamine Hagedorn (NPH) insulin between July 2000 and February 2008 using a representative German database (IMS® Disease Analyzer). The variables age, gender, insurance status, diabetes duration, hemoglobin A1c level, body mass index, and geographic region and specialization of practice were collected. Resource consumption was evaluated over a time period of 12 months and included the quantities of applied basal and bolus insulin, blood glucose test strips, lancets and needles, physician visits (general practitioner, specialist), hospitalization, and antihypoglycemic therapy (intravenous glucose/glucagon). A total of 2297 patients with T1DM were included; 1079 received ICT with insulin glargine and 1218 with NPH insulin. After adjustment, annual cost savings in favor of insulin glargine amounted to €423.94 compared with NPH insulin (p = .3019). The adjusted results show that an ICT with insulin glargine results in lower annual costs than ICT with NPH insulin (this difference was not statistically significant). However, in the context of glucose-lowering effect and a lower hypoglycemia rate, insulin glargine is preferred to NPH insulin for patients with T1DM undergoing ICT.

Annual cost of hospitalization, inpatient rehabilitation, and sick leave for head and neck cancers in Germany

BackgroundData on the economic burden of head and neck cancers (HNCs) in Germany is scarce. About 16%–28% of these cancers are associated with human papillomavirus (HPV) infection. Therefore, the study reported here aimed to assess the annual costs of HPV-related HNCs incurred by hospitalization, inpatient rehabilitation, and sick leave in Germany in 2008.MethodsA cross-sectional retrospective analysis of five German databases covering hospital treatment, inpatient rehabilitation, and sick leave in 2008 was performed. All hospital, inpatient rehabilitation, and sick leave cases due to HNCs in 2008 were analyzed. Associated numbers of HNC hospitalizations, health care resource use, and costs were identified and extracted using the International Classification of Diseases, tenth revision (ICD-10; World Health Organization, Geneva, 1990) codes C01–C06, C09–C14, and C32 as the main diagnoses. Resources were valued with German official prices in 2008 euros (€). The annual costs of HPV-related HNCs were estimated based on the percentage of HNCs likely to be attributable to HPV infection.ResultsIn 2008, there were 63,857 hospitalizations, 4898 inpatient rehabilitations, and 17,494 sick leaves due to HNCs, representing costs of €365.78 million. The estimated annual costs associated with HPV-related HNCs were €78.22 million, mainly attributed to males (80%). Direct costs accounted for 84% (80% for hospital treatment, 4% for inpatient rehabilitation) and indirect costs due to sick leave accounted for 16% of HPV-related HNC costs.ConclusionThe economic burden of HPV-related HNCs in Germany in 2008 has been underestimated, since costs incurred by outpatient management, outpatient chemotherapy, long-term care, premature retirement, and premature death were not included. However, as far as we are aware, this study is the first analysis to investigate the economic burden of HNCs in Germany. The estimated annual costs of HPV-related HNCs contribute to a significant economic burden in Germany and should be considered when assessing the health and economic benefits of HPV vaccination in both sexes.

Allele frequencies for the 16 short tandem repeats of the Powerplex® ESX17 kit in a population from Turkey

Allele frequencies for those short tandem repeats (STRs) used in forensic routine analysis are necessary for any biostatistical calculation. In this study, allele frequencies for the STRs of the Powerplex ESX kit including the five STRs D1S1656, D2S441, D10S1248, D12S391 and D22S1045 only recently added to the German database standard in an admixed population from Turkey are presented.

Annual cost of hospitalization, inpatient rehabilitation and sick leave of anal cancer in Germany

Objective:Literature on the economic burden of anal cancer in Germany is scarce. About 84% of these cancers are associated with human papillomavirus infection. This study, therefore, aimed to assess the annual costs of human papillomavirus-related anal cancer incurred by hospitalization, inpatient rehabilitation, and sick leave in 2008 in Germany.Methods:A cross-sectional retrospective analysis of five German databases covering hospital treatment, inpatient rehabilitation, and sick leave in 2008 was performed. All hospital, inpatient rehabilitation, and sick leave cases due to anal cancer in 2008 were analyzed. Associated numbers of anal cancer hospitalizations, healthcare resource use, and costs were identified and extracted using the ICD-10 code C21 as the main diagnosis. The annual cost of human papillomavirus-related anal cancer was estimated based on the percentage of anal cancer likely to be attributable to human papillomavirus.Results:In 2008, there were 5774 hospitalizations (39% males, 61% females), 517 inpatient rehabilitations, and 897 sick leaves due to anal cancer representing costs of €34.11 million. The estimated annual costs associated with human papillomavirus-related anal cancer were €28.72 million, mainly attributed to females (62%). Direct costs accounted for 90% (86% for hospital treatment, 4% for inpatient rehabilitation) and indirect costs due to sick leave accounted for 10% of human papillomavirus-related costs.Conclusions:The economic burden of human papillomavirus-related anal cancer in 2008 in Germany is under-estimated, since costs incurred by outpatient management, outpatient chemotherapy, long-term care, premature retirement, and premature death were not included. However, this study is the first analysis to investigate the economic burden of anal cancer in Germany. The estimated annual costs of human papillomavirus-related anal cancer contribute to a significant economic burden in Germany and should be considered when assessing health and economic benefits of human papillomavirus vaccination in both genders.

Population Level Survival of Patients with Chronic Myeloid Leukemia in Germany in the Early 21st Century

AbstractAbstract 759 Background:Chronic myeloid leukemia (CML) is a rare but highly treatable form of leukemia. Recent advances in the treatment of CML have dramatically improved survival in clinical trials. Prior work using the Surveillance, Epidemiology, and End Results (SEER) database in the United States (US) suggest that survival on the population level has increased, but still lags behind that seen in clinical trials1. In the past, evaluation of population level survival in other countries has been hampered by the lack of high quality data from a large enough population to evaluate trends in survival in this rare disease. Recently, a collaborative effort between the German Cancer Research Center and several German cancer registries has provided the chance to evaluate population level survival for rare cancers. Here, we examine survival for patients with CML in Germany in the early 21st century, comparing it to survival in the US. Methods:Data was extracted from the SEER13 database in the US and 13 epidemiologic cancer registries in Germany. Patients diagnosed with CML between 1997 and 2006 were included in the analysis. Data quality analysis showed an excessive level of cases diagnosed by death certificate only in older patients (age 70+) so analysis was restricted to patients age 15–69. Patients diagnosed by death certificate only were excluded from the analysis. Period analysis was used to provide the most up-to-date possible estimates of five year relative survival. Results:1848 cases of CML were identified in the German database and 2910 cases in the SEER database. More cases were seen in younger patients in the US, whereas each age group was roughly equal in size in Germany (see table). Five year relative survival was 68.7% overall in Germany and 72.7% in the US. Survival was higher in the US for all age groups except for age 15–39, but the difference was only significant for ages 50–59, where a difference of 10.2 percentage units was seen (see table). Survival decreased with age, ranging from 83.1% and 81.9%, respectively, in Germany and the US for patients age 15–39 to 54.2% and 54.5%, respectively, in patients age 65–69. Conclusions:Estimated five year survival increased in the US compared to previous estimates of survival in the 2000–2004 period1. Five year survival estimates were higher in the US than in Germany overall, but the difference was only significant for age 50–59. These results are the first detailing survival in CML on the population level in Germany and providing an international comparison. Survival did not equal that seen in clinical trials of tyrosine kinase inhibitors2 for either country, but comparison with previous estimates in earlier time periods suggests that improvement in survival is ongoing. Greater concentration on treatment of CML in older patients may help improve survival for this population, for which survival lags.Table:Five year relative survival of patients diagnosed with CML in Germany and the US by age.GermanyUSGermany - USAgeNRSSENRSSEDiffP (Model)15-3932483.13.081881.92.0+1.20.940340-4932878.03.468082.82.2−4.80.177750-5942367.53.569777.72.6−10.20.001860-6436165.33.834070.34.1−5.00.206565-6941254.24.037554.54.2−0.30.5093Overalla184868.71.6291072.71.5−4.00.0036a=age adjusted using the percentage of cases in each age group in GermanyN=Number of casesRS=Relative SurvivalSE=Standard ErrorDiff=Difference between survival in Germany and the US Disclosures:No relevant conflicts of interest to declare.

P2-34: Similar Dimensions Underlie Emotional and Conversational Expressions in Korean and German Cultural Contexts

Although facial expressions are one of the most important ways of communication in human society, most studies in the field focus only on the emotional aspect of facial expressions. The communicative/conversational aspects of expressions remain largely neglected. In addition, whereas it is known that there are culturally universal emotional expressions, less is known about how conversational expressions are perceived across cultures. Here, we investigate the underlying dimensions of the complex space of emotional and conversational expressions in a cross-cultural context. For the experiments, we used 620 video sequences of the KU facial expression database (62 expressions of 10 Korean actors), and 540 video sequences of the MPI facial expression database (54 expressions of 10 German actors). Four groups of native German and Korean participants were asked to group the sequences of the German or Korean databases into clusters based on similarity, yielding a fully crossed design across cultural contexts and ...

Risk of diabetic foot ulceration during treatment with insulin glargine and NPH insulin

To evaluate the effect of the long-acting basal insulin analog glargine compared with neutral protamine Hagedorn (NPH) insulin on the incidence of diabetic foot ulceration (DFU) in patients with diabetes in Germany. A retrospective cohort study was performed using a representative German database (IMS Disease Analyzer) of patients with type 2 diabetes, who started a basal insulin therapy with either insulin glargine or NPH insulin, between July 2000 and September 2007, and continued this therapy for at least 24 months, and whose data were continuously documented.The occurrence of DFU was recorded beginning in the third year after therapy initiation and Kaplan-Meier curves were generated and compared using log-rank tests. Cox proportional hazard models were used to estimate the adjusted hazard ratio (HR) and 95% confidence intervals (CI) for the incidence of DFU. Patients who fulfilled the inclusion criteria (n=23 395) had started either on insulin glargine (n=9638) or on NPH insulin (n= 13 757).After adjustment for demographic and clinical variables, it was demonstrated that the relative risk to diabetes patients of developing DFS is 64% lower with insulin glargine than with NPH insulin therapy (HR=0.6 I; p=0.0405). The results suggest that, compared with NPH insulin, insulin glargine therapy significantly reduces the risk of DFS in patients with diabetes under real life conditions. Prospective long-term trials are needed to confirm these secondary data analysis results. There were no external sources of funding for this study.The authors have no conflicts of interest to declare.

The German Aortic Valve Registry (GARY): A Nationwide Registry for Patients Undergoing Invasive Therapy for Severe Aortic Valve Stenosis

Background The increasing prevalence of severe aortic valve defects correlates with the increase of life expectancy. For decades, surgical aortic valve replacement (AVR), under the use of extracorporeal circulation, has been the gold standard for treatment of severe aortic valve diseases. In Germany ~12,000 patients receive isolated aortic valve surgery per year. For some time, percutaneous balloon valvuloplasty has been used as a palliative therapeutic option for very few patients. Currently, alternatives for the established surgical procedures such as transcatheter aortic valve implantation (TAVI) have become available, but there are only limited data from randomized studies or low-volume registries concerning long-time outcome. In Germany, the implementation of this new technology into hospital care increased rapidly in the past few years. Therefore, the German Aortic Valve Registry (GARY) was founded in July 2010 including all available therapeutic options and providing data from a large quantity of patients.Methods The GARY is assembled as a complete survey for all invasive therapies in patients with relevant aortic valve diseases. It evaluates the new therapeutic options and compares them to surgical AVR. The model for data acquisition is based on three data sources: source I, the mandatory German database for external performance measurement; source II, a specific registry dataset; and source III, a follow-up data sheet (generated by phone interview). Various procedures will be compared concerning observed complications, mortality, and quality of life up to 5 years after the initial procedure. Furthermore, the registry will enable a compilation of evidence-based indication criteria and, in addition, also a comparison of all approved operative procedures, such as Ross or David procedures, and the use of different mechanical or biological aortic valve prostheses.Results Since the launch of data acquisition in July 2010, almost all institutions performing aortic valve procedures in Germany joined the registry. By now, 91 sites which perform TAVI in Germany participate and more than 15,000 datasets are already in the registry.Conclusion The implementation of new or innovative medical therapies needs supervision under the conditions of a well-structured scientific project. Up to now relevant data for implementation of TAVI and long-term results are missing. In contrast to randomized controlled trials, GARY is a prospective, controlled, 5-year observational multicenter registry, and a real world investigation with only one exclusion criterion, the absence of patients' written consent.

Persistence and compliance of medications used in the treatment of osteoporosis – analysis using a large scale, representative, longitudinal German database

Osteoporosis can be effectively treated with a number of medications. However, high persistence and compliance are required to assure efficacy. This study analyses persistence and compliance with a variety of medical interventions including p.o., i.v. and s.c. administrations in Germany. This retrospective cohort study used a representative longitudinal database (IMS® LRx) comprising longitudinal prescription data for Germany from almost 80% of all German prescriptions of members of the German statutory health insurance system. Persistence is defined as the proportion of patients who remained on their initially prescribed therapy at 1 year. Compliance is measured indirectly based on the medication possession ratio (MPR). A total of more than 1 million patients (1,107,482) for the period 07/2007 - 06/2009 was identified in the database who received a prescription for a bisphosphonate, strontium or PTH. Of these, 268,568 patients fulfilled further inclusion criteria and were included in the persistence and compliance analysis. At 12 months the proportion of patients that remained on treatment were 65.6% for zoledronate 5 mg; 56.6% for ibandronate i.v. 3 mg; 54.7% for PTH (teriparatide and 1-84 PTH), 51.0% for ibandronate 150 mg p.o.; 44.8% for alendronate 70 mg; 43.4% for etidronate. Other values were risedronate plus calcium 42.3%; alendronate plus vitamin D 37.8%; risedronate 35 mg 35.2%; risedronate 5 mg 30.6%; strontium ranelate 31.4% and alendronate 10 mg 17.3%. Persistence and compliance during the treatment of osteoporosis were found to be insufficient. Treatment using the intravenous route and PTH showed the highest persistence and compliance rates and daily oral bisphosphonates the lowest. More effort to improve treatment compliance and persistence is needed to assure clinical efficacy.

Earnings Inequality – Does the Accounting Period Matter?

Under mild assumptions, Shorrocks (1978) has proved that measured inequality must decrease when the period over which income is measured, the accounting period, increases. The present work seeks to shed light on the quantitative size of this effect using a huge representative German database for the period 1975–2004. Our results indicate that the choice of the accounting period not only seriously affects the level of inequality. We can also show that the size of the effect varies over time. JEL Classification: D31, D63, O15

Critical narrative review to identify educational strategies promoting physical activity in preschool

The aim of this narrative review is critically to evaluate educational strategies promoting physical activity that are used in the preschool setting in the context of obesity prevention programmes. Literature search was conducted between April and August 2010 in English and German databases (PubMED, PsychINFO, PSYNDEX, ERIC, FIS Bildung). Outcomes considered were time and intensity of physical activity, motor skills or measures of body composition. A total of 19 studies were included. Ten studies added physical activity lessons into their curriculum, one study provided more time for free play, eight studies focused on the social and play environment. Studies reporting positive outcomes implemented physical activity sessions that lasted at least 30 min d(-1). Several studies showed that children are most active in the first 10-15 min. The existence or installation of playground markings or fixed play equipment had no effect, whereas the presence or addition of portable play equipment was positively correlated with moderate-to-vigorous physical activity. Teacher training may be a key element for successful interventions. To overcome time constraints, a suggested solution is to integrate physical activity into daily routines and other areas of the preschool curriculum.

Auditory Affective Norms for German: Testing the Influence of Depression and Anxiety on Valence and Arousal Ratings

BackgroundThe study of emotional speech perception and emotional prosody necessitates stimuli with reliable affective norms. However, ratings may be affected by the participants' current emotional state as increased anxiety and depression have been shown to yield altered neural responding to emotional stimuli. Therefore, the present study had two aims, first to provide a database of emotional speech stimuli and second to probe the influence of depression and anxiety on the affective ratings.Methodology/Principal FindingsWe selected 120 words from the Leipzig Affective Norms for German database (LANG), which includes visual ratings of positive, negative, and neutral word stimuli. These words were spoken by a male and a female native speaker of German with the respective emotional prosody, creating a total set of 240 auditory emotional stimuli. The recordings were rated again by an independent sample of subjects for valence and arousal, yielding groups of highly arousing negative or positive stimuli and neutral stimuli low in arousal. These ratings were correlated with participants' emotional state measured with the Depression Anxiety Stress Scales (DASS). Higher depression scores were related to more negative valence of negative and positive, but not neutral words. Anxiety scores correlated with increased arousal and more negative valence of negative words.Conclusions/SignificanceThese results underscore the importance of representatively distributed depression and anxiety scores in participants of affective rating studies. The LANG-audition database, which provides well-controlled, short-duration auditory word stimuli for the experimental investigation of emotional speech is available in Supporting Information S1.

Body Fat Percentiles for German Children and Adolescents

Objective: The aim of this study was to define body fat percentiles for German children and adolescents aged 3–16 years using the largest German database. Methods: The study population included 11,632 girls and 11,604 boys. Data were pooled from: i) Kiel Obesity Prevention Study (KOPS), acquisition period: 1996–2008, n = 12,237; ii) ‘Better diet. More exercise. KINDERLEICHT-REGIONS’, acquisition period: 2007, n = 9,405; and iii) examination of Jena schoolchildren, acquisition period: 2005, n = 1,594. Body fat mass was measured by bioelectrical impedance analysis using a population-specific algorithm. Data were weighted to achieve a representative sample for Germany. Percentile curves were constructed by the LMS method and proved by Worm plots and Q-statistic. Results: In both genders, the higher body fat percentile curves sloped downwards to age 7 years, whereas the lower percentiles declined up to 8.5 years. Thereafter fat mass remained nearly constant with age in boys and increased in girls. The 10th percentile achieved a minimum of 10–11% body fat in both genders, whereas the 90th percentile curve fluctuated between 29 and 44% in boys or 30–43% in girls. The association between fat mass and blood pressure was too weak to define disease-related cut-offs. Conclusion: These body fat percentiles are suitable reference values for German children and adolescents.

German norms for semantic typicality, age of acquisition, and concept familiarity

The present study introduces the first substantial German database with norms for semantic typicality, age of acquisition, and concept familiarity for 824 exemplars of 11 semantic categories, including four natural (ANIMALS, BIRDS, FRUITS,: and VEGETABLES: ) and five man-made (CLOTHING, FURNITURE, VEHICLES, TOOLS: , and MUSICAL INSTRUMENTS: ) categories, as well as PROFESSIONS: and SPORTS: . Each category exemplar in the database was collected empirically in an exemplar generation study. For each category exemplar, norms for semantic typicality, estimated age of acquisition, and concept familiarity were gathered in three different rating studies. Reliability data and additional analyses on effects of semantic category and intercorrelations between age of acquisition, semantic typicality, concept familiarity, word length, and word frequency are provided. Overall, the data show high inter- and intrastudy reliabilities, providing a new resource tool for designing experiments with German word materials. The full database is available in the supplementary material of this file and also at www.psychonomic.org/archive .

Effectiveness of nasopharyngoscopic biofeedback in clients with cleft palate speech—a systematic review

Objective. To conduct a systematic review analyzing the effectiveness of nasopharyngoscopic biofeedback in clients with cleft lip and palate and velopharyngeal dysfunction. Method. Extensive electronic search and analysis of the databases of Cochrane Library, MEDLINE, EMBASE, ERIC, PsycInfo, CINAHL, AMED, Journals@Ovid, and German Databases, including all papers published since 1970 plus a manual search of the Cleft Palate-Craniofacial Journal (1970-3/2010). Results. Six studies met the inclusion criteria. Their analysis reflects a low level of evidence and a broad heterogeneity concerning age range, intervention methods, and outcome measurement. Conclusion. The analyzed studies show that nasopharyngoscopy may be effective only in combination with traditional speech therapy in helping patients with cleft palate speech optimize their velopharyngeal closure in articulation, but the quantity and quality of studies are limited.

PDB5 Micro- and Macrovascular Outcomes in Primary Care Patients with Type 2 Diabetes Treated with Insulin Glulisine or Human Regular Insulin: A Retrospective German Database Analysis

PDB5 Micro- and Macrovascular Outcomes in Primary Care Patients with Type 2 Diabetes Treated with Insulin Glulisine or Human Regular Insulin: A Retrospective German Database Analysis

Mammography and cervical cancer screening--a systematic review about women's knowledge, attitudes and participation in Germany

In the German statutory health insurance system, women can take part in free mammography and cervical cancer screening. The aim of this study is to investigate women's knowledge of, attitudes to and participation in these screening measures as well as the determinants of eligible women living in Germany. We conducted a systematic literature search, supplemented by an Internet search, of Medline and other German and English databases for the period 2000-2010. Data extraction and quality assessment were carried out by 2 independent reviewers. Data synthesis was qualitative. We identified 12 studies on mammography and cervical cancer screening. Most women were found to be aware of the option of free screening. The majority of women were able to name risk factors for breast cancer correctly. This was not the case in cervical cancer, where women said they were insufficiently informed. To a significant extent, they were also uninformed about the benefits of screening and incidence of false-positive and false-negative test results in mammography. In 2007, 54% of the invited women took part in the organised mammography screening program with large variations in participation rate among the Federal states. It appears that better educated women or those with a private health insurance participate in the programme less frequently. However, one third of the non-participants attend a mammography outside the screening program. Data for participation in cervical cancer screening are inconsistent. There is some evidence that younger women, married women and those with higher education are more likely to participate in the screening. The interviewees' substantial lack of knowledge underscores the need for optimising communication on the aims, benefits and risks of screening tests to enable women to make an informed decision. It is desirable to continuously monitor women's knowledge about and participation in screening and determinants thereof with a view to laying the foundations for target group-specific information strategies.