Epidemiologische Ansätze zur Klärung wichtiger Forschungsfragen zu COVID-19 – eine Übersicht

Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz - Die Epidemiologie als wissenschaftliche Disziplin ist prädestiniert dafür, Kernfragen der COVID-19-Pandemie zu...     

Evaluation von organisierten Programmen zur Krebsfrüherkennung: Allgemeine Aspekte und aktueller Stand in Deutschland

In the past decades, it has been increasingly recognized that cancer screening is not always or not exclusively beneficial and, in the case of some measures, the negative effects may even outweigh the benefits. This has fundamentally changed the significance and emphasis placed on the evaluation of cancer screening programs. Generally, there is a distinction between an endpoint evaluation, which assesses the effectiveness or risk/benefit ratio, and a process evaluation, which aims to ensure optimum implementation of the program.Prior to the nationwide introduction of a screening measure, proof of effectiveness should ideally be provided by a randomized controlled trial (RCT), in which persons without a screening offer form the control group. From a scientific point of view, this study design is by far the best method to evaluate the endpoint, as it avoids biases that may distort the results in observational studies. RCT evidence on cancer screening measures currently offered by statutory health insurance providers in Germany – if available at all – originates exclusively from other countries.When mammography screening was introduced as the first organized screening program in Germany, comprehensive measures for process evaluation were taken. In April 2013, the legal basis for the transfer of colorectal and cervical cancer screening into organized programs was created. According to the legal provisions, both a process and an endpoint evaluation are planned for the new programs. It remains to be seen how the necessary data flows will be conceptualized and later implemented in practice.     

Rapid volume replacement with warmed blood and fluids

A prospective clinical study was undertaken in 50 consecutive patients suffering from severe traumatic shock to evaluate the clinical efficacy of a set for rapid administration of solutions (RSAS), which allows for rapid infusion and simultaneous warming of blood and fluids. The mechanism of injury was blunt in 37 patients and penetrating in 13. Admission trauma score averaged 7.5, and the injury severity score averaged 46. Average preresuscitation systolic blood pressure was 71 mmHg, pulse was 105 beats/minute, and temperature was 34.3 degrees C. Initial resuscitation was with the RSAS, and total fluid infused in the first twenty-four hours averaged 4,632 mL of blood, 1,914 mL of blood products, and 11,248 mL of crystalloid. The average postresuscitation systolic blood pressure was 120 mmHg, pulse was 96 beats/minute, and temperature averaged 34.9 degrees C. Survival at twenty-four hours was 29/50 (58%). There were no local complications of RSAS use and no evidence of infusion-related coagulopathy. The RSAS provided an effective and safe way to infuse large volumes of blood and fluid at body temperature.     

Seropositivity for pathogens associated with chronic infections is a risk factor for all-cause mortality in the elderly: findings from the Memory and Morbidity in Augsburg Elderly (MEMO) Study

GeroScience - Immunostimulation by chronic infection has been linked to an increased risk for different non-communicable diseases, which in turn are leading causes of death in high- and...     

Breast cancer among Turkish women in Germany - epidemiology and research agenda

Breast cancer is the leading cause of cancer death and morbidity among women worldwide. In Germany an estimated 46,000 women are diagnosed with breast cancer every year, and 18,000 die of the disease. So far, limited information is available on possible epidemiological and clinical differences between women of German origin and other ethnic or national groups in Germany. Such differences between migrants and the general population could hint to underlying causes of disease and to differential access to medical care. In this paper we present epidemiological information on breast cancer among Turkish women in Germany and describe a future research agenda addressing these questions.     

Diesel motor emissions and lung cancer mortality—Results of the second follow‐up of a cohort study in potash miners

International health authorities have graded diesel motor emissions (DME) as probably cancerogenic in human beings. There are gaps in epidemiological evidence regarding exact exposure quantification, confounder control and the investigation of highly exposed populations. We investigated the association of DME and lung cancer mortality in a historical cohort study of 5,862 German potash miners who were followed from 1970 to 2001. Cumulative exposure (CE) was measured by representative concentrations of total carbon multiplied with exposure years from the mines' medical records. Exposure and smoking behavior were validated by interviews of 3,087 participants. We computed standardized mortality ratios (SMR, external comparison) and performed Cox regression (internal comparison). The relative risk estimates (RR) with 95%‐confidence intervals were adjusted for age and smoking. Vital status and causes of death were confirmed for 98.1% of participants. Sixty‐one lung cancer deaths occurred. SMR‐analysis showed lower than expected lung cancer mortality (healthy‐worker‐effect). Internal comparisons revealed risk elevations from moderate to risk doubling depending on the exposure categories used (dichotomized: up to RR 1.43[0.67–3.03] for a CE of 4.90[mg/m³]*years as compared with less exposure; quintiles: RR 1.13[0.46–2.75], 2.47[1.02–6.02], 1.50[0.56–4.04] and 2.28[0.87–5.97] for a CE up to 2.04, 2.73, 3.90 and >3.90, respectively, as compared with the reference of <1.29[mg/m³]*years). Additional adjustment of length of follow‐up leads to further RR increases and indicates healthy‐worker‐survivor‐phenomena. The analyses of a sub‐cohort (n = 3,335) with particularly accurate exposure measurement revealed a nonsignificant dose‐response‐relationship. Our results support an association of DME and lung cancer mortality. © 2008 Wiley‐Liss, Inc.     

The bowel as an ischemic organ

Due to the progress that has been made in intensive care, more and more patients survive shock. It is a clinical observation that their condition improves substantially with the restoration of intestinal function. Different experimental models have been developed to investigate the pathophysiology of the intestine in shock. As noxious periods, both the phase of ischemia and the phase of reperfusion have been identified. Since the experimental models are methodologically very different, the results of the various studies may only be compared with reservations. Nevertheless, it can be stated that reduced intestinal blood flow leads to ischemia and hypoxia of the villous tips. Reperfusion may lead to further mucosal injury. During this period oxygen free radicals and their derivates seem to play an essential role. Xanthine oxidase is thought to be the major source of these radicals in the small intestine. During ischemia ATP is catabolized to hypoxanthine, which is enzymatically transformed to xanthine, a process generating oxygen free radicals. Moreover oxygen free radicals seem to be produced by activated neutrophilic granulocytes. At present, only hypotheses exist concerning the interactions between granulocytes and these radicals. The mechanism of injury produced by oxygen free radicals is based on the peroxidation of the lipid components of the cellular membrane system. The small intestine represents a very vulnerable shock organ: apart from its very important nutritive functions, it provides the necessary barrier between the intestinal pool of endotoxin and the circulation. The loss of these vital functions due to ischemic lesions dramatically worsens the chances for the patient to survive. Therefore, it is necessary to develop therapeutic principles to maintain or restore intestinal function in shock.