Epidemiologische Studien zu Strahlenexposition und Gesundheit

Radiation epidemiology investigates the effects on human health of ionizing and non-ionizing radiation. Of particular interest is the carcinogenicity of radiation exposure. In Germany, numerous epidemiological studies on these topics have been conducted in the recent past, many of them in international collaboration. For example, studies assessing cancer risk in children living near nuclear installations, as well as a large case-control study on the risk of mobile telephone use and investigations on the UV radiation – skin cancer link have been performed. Medical practitioners are responsible for the practical implementation of radiation protection, especially in medical diagnostics and therapy. In addition, practitioners require knowledge of radiation health effects for consultation with their patients. This article provides an overview of the fundamentals of radiation epidemiology and of major radiation epidemiology studies in Germany.     

Mortality among pilots and cabin crew in Greece, 1960-1997

BACKGROUND: Specific health hazards, among them radiation of cosmic origin, have caused some concern among aircrew in civil aviation in recent years. Several cohort studies in Northern countries have investigated mortality and cancer incidence among aircrew. Our goal was to study the pattern of mortality among Greek commercial airline cockpit and cabin crew. METHODS: We performed a retrospective cohort study including 843 Olympic Airways cockpit crew and 1835 cabin attendants. Standardized mortality ratios (SMR) were calculated based on death rates of the Greek population. Duration of employment as a proxy for occupational exposure was used to stratify the cohort. RESULTS: For cockpit crew, the overall SMR was 0.7 (n = 65, 95% CI: 0.5-0.9). The SMR for all cancers was also significantly decreased (n = 17; SMR = 0.6; 95% CI: 0.3-0.9). Most of this reduction was due to a large deficit in lung cancer deaths (SMR = 0.1; 95% CI: 0.0-0.5). Slight but non-significant increases were noted for brain and liver cancer. The SMR for cardiovascular death was close to unity. Among female cabin attendants the SMR for all causes was 0.8 (95% CI: 0.4-1.3). The SMR for all cancers was 0.8 (95% CI: 0.3-1.7). Mortality from breast cancer was not increased. Among male cabin crew, SMR for all causes was 0.5 (95% CI: 0.3-0.9). Analyses according to duration of employment showed no pattern. CONCLUSIONS: In this first-ever occupational cohort study in Greece, Greek aircrew had a low overall and cancer mortality. Due to the small number of events, the strength of our study is limited. The Greek data will be included in a pooled analysis of European studies.     

Licit and illicit substance use patterns among university students in Germany using cluster analysis

Background

The use of multiple licit and illicit substances plays an important role in many university students’ lives. Previous research on multiple substance use patterns of university students, however, often fails to examine use of different illicit substances and/or hookah. Our objective was to complement and advance the current knowledge about common consumption patterns regarding illicit substances and hookah use in this group.

Methods

Students from eight German universities completed an online survey as part of the INSIST study (‘INternet-based Social norms Intervention for the prevention of substance use among STudents’) regarding their consumption of alcohol, tobacco, hookah, cannabis and other illicit substances. Cluster analysis identified distinct consumption patterns of concurrent and non-concurrent substance use and multinomial logistic regressions described key sociodemographic factors associated with these clusters.

Results

Six homogeneous groups were identified: ‘Alcohol Abstainers’ (10.8%), ‘Drinkers Only’ (48.2%), ‘Drinkers and Cigarette Smokers’ (14.6%), ‘Cannabis and Licit Substance Users’ (11.2%), ‘Hookah Users with Co-Use’ (9.8%) and ‘Illicit Substance Users with Co-Use’ (5.4%). Illicit substance use clustered with the consumption of alcohol, tobacco and cannabis. Hookah use was regularly associated with alcohol consumption, less commonly associated with tobacco or cannabis use and very rarely associated with use of other illicit substances. Individuals consuming licit and illicit substances or hookah were mostly male and lived together with other students. Characteristics such as the number of years an individual had spent studying at a university, subject of study, immigrant background and religious affiliation were less commonly associated with cluster membership.

Conclusions

Although we found substance use patterns in our sample largely similar to previous reports, we identified an important subgroup of individuals using both illicit and licit substances. These individuals may benefit especially from targeted interventions that focus on modifying addictive behavior patterns.

Trial registration

DRKS00007635. Registered 17 December 2014 (retrospectively registered).

     

Ergebnisse der Prozessevaluation eines Programms zur Gesundheitsförderung von 3- bis 6-jährigen Kita-Kindern: „JolinchenKids – Fit und gesund in der Kita“

Background

Apart from the family setting, daycare facilities represent a key setting for health promotion among children under the age of 6 years. “JolinchenKids—fit and healthy in daycare” is a new program for health promotion among preschoolers developed by the health insurance AOK. This program was pilot tested and implementation was monitored for 2 months at daycare facilities in three regions in Germany before its nationwide roll-out.

Objectives

The study aims were to (1) assess previous health promotion activities at daycare facilities, (2) document the state of program implementation after 2 months, and (3) identify factors facilitating or impeding implementation from the perspective of daycare staff.

Materials and methods

A quantitative and qualitative process evaluation, which included structured telephone interviews and focus groups with daycare staff (n?=?50, n?=?13, respectively), was conducted. Daycare staff were asked questions regarding previous health promotion activities/projects at daycare facilities, the state of implementation after 2 months, and facilitating and impeding factors during program implementation. Suggestions for program changes were also explored.

Results

Previous experiences regarding the promotion of a healthy diet and physical activity facilitated program implementation and program modules addressing these topics were implemented by the majority of daycare facilities during the first 2 months. Content and materials of the program appealed to daycare staff and were deemed child-friendly and easy to use. Facilitating factors included the modular program structure as well as the external supervision provided to daycare staff by health insurance staff during implementation. Parental participation was deemed important with regard to health promotion among children but was identified as a potential barrier to implementation because parents lacked time to participate in program activities.

Conclusions

Previous experiences in health promotion, the availability of hands-on program materials, and external supervision appear to facilitate the implementation of new programs in this setting. Parental participation in health promotion activities may often not be realizable due to time constraints of parents.

     

Fabrication of ZIF-71/Fe3O4/polythionine nanoarray-functionalized carbon cotton cloth for simultaneous extraction and quantitation of febuxostat and diclofenac

A sustainable hybrid material based on carbonized cotton cloth/zeolite imidazolate framework-71/Fe₃O₄/polythionine (CC/ZIF-71/Fe₃O₄/PTh) was synthesized and applied in ultrasound-assisted dispersive magnetic solid-phase extraction (USA-DMSPE) followed with high performance liquid chromatography-ultraviolet detection (HPLC-UV) for simultaneous quantitation of diclofenac (DIC) and febuxostat (FEB) in human plasma. The surface of CC was modified with nanoarrays of zeolite imidazolate framework-71/Fe₃O₄/Polythionine. At first, an in situ synthesis of ZIF-71 in the presence of CC was carried out, and followed with magnetization process and oxidative polymerization of thionine. The nano-modifier agents improved the merits of the sorbent involving stability, porosity, mast transfer, π–π interactions and selectivity of CC. Characterizations of the hybrid sorbent were examined with different instrumental techniques. The limits of detection (LODs, S/N = 3) were recognized 2.1 ng mL⁻¹ for DIC and 3.7 ng mL⁻¹ for FEB. Acceptable linearity (0.992 ≤ r² ≤0.996) and relatively broad dynamic ranges of 10.0–1800.0 ng mL⁻¹ and 15.0–2500.0 ng mL⁻¹ were achieved for DIC and FEB, respectively. Reasonable intra-assay (≤7.2%, n = 9) and inter-assay (≤7.5%, n = 9) precisions as well as appropriate accuracies (≤8.0%) were provided illustrating applicability of the current approach for analytical purposes. Eventually, CC/ZIF-71/Fe₃O₄/PTh was employed as four-part sorbent for the assessment of DIC and FEB in human plasma at trace levels and subsequently main pharmacokinetic data such as T_1/2, T_max,C_max, and AUC_0–24 of these drugs were comprehensively investigated.

Synthesis of a material based on carbonized cotton cloth/zeolite imidazolate framework was applied to ultrasound-assisted dispersive magnetic solid-phase extraction and high-performance liquid chromatography-ultraviolet to detect diclofenac and febuxostat in human plasma.     

Steigende Inzidenz und Mortalit?t der Non-Hodgkin-Lymphome Eine epidemiologische übersicht über neuere Studien zu Risikofaktoren des Non-Hodgkin-Lymphoms

Zusammenfassung Hintergrund: Die Non-Hodgkin-Lymphome gehören zu den wenigen malignen Tumoren, für die in den letzten Jahrzehnten ein deutlicher Aufwärtstrend in Inzidenz und Mortalität zu verzeichnen ist. Dieser Trend ist insbesondere in Industrieländern zu beobachten. Die Gründe für diesen Anstieg sind noch unklar. Material und Methoden: Basierend auf einer Medline-Recherche identifizierten wir Fallkontroll- und Kohortenstudien zu medizinisch-biologischen und ausgewählten Umweltrisikofaktoren für Non-Hodgkin-Lymphome, die in den Jahren 1992 bis 1998 publiziert wurden. Die wichtigsten methodischen Aspekte und Ergebnisse dieser Arbeiten werden tabellarisch dargestellt, und es wird der Beitrag verschiedener Risikofaktoren zu den ansteigenden Inzidenzraten des Non-Hodgkin-Lymphoms diskutiert. Ergebnisse: Aus den insgesamt 64 identifizierten Studien ergab sich, dass die medikamentöse Immunsuppression sowie verschiedene Erkrankungen, die mit einer gestörten Funktion des Immunsystems einhergehen, als gesicherte Risikofaktoren für Non-Hodgkin-Lymphome gelten können. Sie erklären die ansteigenden Raten jedoch nur zu einem sehr geringen Teil. Der Verlauf der HIV/AIDS-Epidemie in Deutschland trägt ebenfalls wenig zu den Trends bei Non-Hodgkin-Lymphomen bei, andere virale Erreger werden derzeit nur mit bestimmten Non-Hodgkin-Lymphom-Subtypen assoziiert. Rauchen und Ernährungskomponenten sind allenfalls schwache Risikofaktoren mit geringem Einfluss auf die Non-Hodgkin-Lymphom-Morbidität. Schlussfolgerung: Nur ein Teil des beobachteten Anstiegs der Inzidenz und Mortalität der Non-Hodgkin-Lymphome ist derzeit erklärbar. Neue epidemiologische Studien sollten Faktoren mit Einfluss auf das Immunsystem und mögliche Interaktionen zwischen verschiedenen ätiologischen Faktoren untersuchen. Abstract Background: Non-Hodgkin's lymphoma (NHL) are among the smaller number of malignant tumors with markedly increasing incidence and mortality rates in the recent past. This trend is particularly obvious in industrialized countries. The causes of the observed increase remain unclear. Methods: We conducted a Medline search to identify case control and cohort studies on medical, biological and selected environmental risk factors of non-Hodgkin's lymphoma published between 1992 and 1998. Methodologial aspects and results of identified studies are presented in tabular form. We furthermore discuss the role of various risk factors for the observed trends in non-Hodgkin's lymphoma. Results: We identified a total of 64 studies. Iatrogenic immunosuppression as well as numerous diseases associated with an impaired immune system have clearly been recognized as etiological factors for non-Hodgkin's lymphoma. However, they can explain only a small percentage of the rate increases of non-Hodgkin's lymphoma. Similarly, the HIV/AIDS epidemic in Germany is responsible only for a small proportion of the rising figures of non-Hodgkin's lymphoma; other viral agents are currently being associated with a few distinct subtypes of non-Hodgkin's lymphoma. Smoking and nutritional factors are weakly or not at all associated with non-Hodgkin's lymphoma and can not account for the disease trends. Conclusion: The observed secular rise in incidence and mortality of non-Hodgkin's lymphoma can only partly be explained. New epidemiologic studies should focus on risk factors associated with the function of the immune system and on possible interactions between different etiological factors.     

Cancer incidence among Chernobyl cleanup workers from Estonia: A 34-year follow-up

From 1986 to 1991, 4831 men from Estonia were sent to clean up radioactively contaminated areas near Chernobyl (Chornobyl). Their cancer incidence during 1986 to 2019 was compared to that of the male population of Estonia. The cohort of cleanup workers was linked to national population and cancer registers based on unique personal identification numbers. Nineteen (0.4%) workers could not be traced. A total of 4812 men contributing 120 770 person-years of follow-up were eligible for the analyses. Standardized incidence ratios (SIR) and adjusted relative risks (ARR, expressed as ratios of SIRs) with 95% confidence intervals (CI) were calculated. A total of 687 incident cancer cases were registered in the cohort (SIR 1.11, 95% CI 1.03-1.19). Presumptive radiation-related cancers combined were in excess, but not when smoking- and alcohol-related cancers were excluded (SIR 0.92, 95% CI 0.71-1.18). For smoking-related cancers, the SIR was 1.24 (95% CI 1.13-1.36) and for alcohol-related cancer the SIR was 1.53 (95% CI 1.31-1.75). Less educated workers had a higher risk of all cancers (ARR = 1.21, 95% CI 1.02-1.44) and smoking-related cancers (ARR = 1.42, 95% CI 1.14-1.76). An elevated risk of alcohol-related cancers was evident 15 to 24 years (vs <15 years) after return from the Chernobyl area. This updated register-based follow-up of Chernobyl cleanup workers from Estonia revealed an excess of radiation-related cancer sites combined, but the excess was not apparent after excluding cancers associated with smoking and alcohol.     

Digitization and Health in Germany: Cross-sectional Nationwide Survey

BackgroundDigital technologies are shaping medicine and public health.ObjectiveThe aim of this study was to investigate the attitudes toward and the use of digital technologies for health-related purposes using a nationwide survey.MethodsWe performed a cross-sectional study using a panel sample of internet users selected from the general population living in Germany. Responses to a survey with 28 items were collected using computer-assisted telephone interviews conducted in October 2020. The items were divided into four topics: (1) general attitudes toward digitization, (2) COVID-19 pandemic, (3) physical activity, and (4) perceived digital health (eHealth) literacy measured with the eHealth Literacy Scale (eHEALS; sum score of 8=lowest to 40=highest perceived eHealth literacy). The data were analyzed in IBM-SPSS24 using relative frequencies. Three univariate multiple regression analyses (linear or binary logistic) were performed to investigate the associations among the sociodemographic factors (age, gender, education, and household income) and digital technology use.ResultsThe participants included 1014 internet users (n=528, 52.07% women) aged 14 to 93 years (mean 54, SD 17). Among all participants, 66.47% (674/1014) completed up to tertiary (primary and secondary) education and 45.07% (457/1017) reported a household income of up to 3500 Euro/month (1 Euro=US $1.18). Over half (579/1014, 57.10%) reported having used digital technologies for health-related purposes. The majority (898/1014, 88.56%) noted that digitization will be important for therapy and health care, in the future. Only 25.64% (260/1014) reported interest in smartphone apps for health promotion/prevention and 42.70% (433/1014) downloaded the COVID-19 contact-tracing app. Although 52.47% (532/1014) reported that they come across inaccurate digital information on the COVID-19 pandemic, 78.01% (791/1014) were confident in their ability to recognize such inaccurate information. Among those who use digital technologies for moderate physical activity (n=220), 187 (85.0%) found such technologies easy to use and 140 (63.6%) reported using them regularly (at least once a week). Although the perceived eHealth literacy was high (eHEALS mean score 31 points, SD 6), less than half (43.10%, 400/928) were confident in using digital information for health decisions. The use of digital technologies for health was associated with higher household income (odds ratio [OR] 1.28, 95% CI 1.11-1.47). The use of digital technologies for physical activity was associated with younger age (OR 0.95, 95% CI 0.94-0.96) and more education (OR 1.22, 95% CI 1.01-1.46). A higher perceived eHealth literacy score was associated with younger age (β=–.22, P<.001), higher household income (β=.21, P<.001), and more education (β=.14, P<.001).ConclusionsInternet users in Germany expect that digitization will affect preventive and therapeutic health care in the future. The facilitators and barriers associated with the use of digital technologies for health warrant further research. A gap exists between high confidence in the perceived ability to evaluate digital information and low trust in internet-based information on the COVID-19 pandemic and health decisions.