@article{RothMauerObingeretal.2010,
  author    = {Roth, Kristina and Mauer, Sonja and Obinger, Matthias and Ruf, Katharina C. and Graf, Christine and Kriemler, Susi and Lenz, Dorothea and Lehmacher, Walter and Hebestreit, Helge},
  title     = {Prevention through Activity in Kindergarten Trial (PAKT): A cluster randomised controlled trial to assess the effects of an activity intervention in preschool children},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-67972},
  year      = {2010},
  abstract  = {Background: Physical activity and motor skills acquisition are of high importance for health-related prevention and a normal development in childhood. However, few intervention studies exist in preschool children focussing on an increase in physical activity and motor skills. Proof of positive effects is available but not consistent. Methods/Design: The design, curriculum, and evaluation strategy of a cluster randomised intervention study in preschool children are described in this manuscript. In the Prevention through Activity in Kindergarten Trial (PAKT), 41 of 131 kindergartens of Wuerzburg and Kitzingen, Germany, were randomised into an intervention and a control group by a random number table stratified for the location of the kindergarten in an urban (more than 20.000 inhabitants) or rural area. The aims of the intervention were to increase physical activity and motor skills in the participating children, and to reduce health risk factors as well as media use. The intervention was designed to involve children, parents and teachers, and lasted one academic year. It contained daily 30-min sessions of physical education in kindergarten based on a holistic pedagogic approach termed the "early psychomotor education". The sessions were instructed by kindergarten teachers under regular supervision by the research team. Parents were actively involved by physical activity homework cards. The kindergarten teachers were trained in workshops and during the supervision. Assessments were performed at baseline, 3-5 months into the intervention, at the end of the intervention and 2-4 months after the intervention. The primary outcomes of the study are increases in physical activity (accelerometry) and in motor skills performance (composite score of obstacle course, standing long jump, balancing on one foot, jumping sidewise to and fro) between baseline and the two assessments during the intervention. Secondary outcomes include decreases in body adiposity (BMI, skin folds), media use (questionnaire), blood pressure, number of accidents and infections (questionnaire), increases in specific motor skills (throwing, balancing, complex motor performance, jumping) and in flexibility. Discussion: If this trial proofs the effectiveness of the multilevel kindergarten based physical activity intervention on preschooler's activity levels and motor skills, the programme will be distributed nationwide in Germany. Trial Registration: ClinicalTrials.gov Identifier: NCT00623844},
  subject      = {Vorschulkind},
  language  = {en}
}
@article{vonKriesWeissFalkenhorstetal.2011,
  author    = {von Kries, R{\"u}diger and Weiss, Susanne and Falkenhorst, Gerhard and Wirth, Stephan and Kaiser, Petra and Huppertz, Hans-Iko and Tenenbaum, Tobias and Schroten, Horst and Streng, Andrea and Liese, Johannes and Shai, Sonu and Niehues, Tim and Girschick, Hermann and Kuscher, Ellen and Sauerbrey, Axel and Peters, Jochen and Wirsing von Koenig, Carl Heinz and R{\"u}ckinger, Simon and Hampl, Walter and Michel, Detlef and Mertens, Thomas},
  title     = {Post-Pandemic Seroprevalence of Pandemic Influenza A (H1N1) 2009 Infection (Swine Flu) among Children < 18 Years in Germany},
  series = {PLoS ONE},
  volume    = {6},
  journal   = {PLoS ONE},
  number    = {9},
  doi       = {10.1371/journal.pone.0023955},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-141698},
  pages     = {e23955},
  year      = {2011},
  abstract  = {Background: We determined antibodies to the pandemic influenza A (H1N1) 2009 virus in children to assess: the incidence of (H1N1) 2009 infections in the 2009/2010 season in Germany, the proportion of subclinical infections and to compare titers in vaccinated and infected children. Methodology/Principal Findings: Eight pediatric hospitals distributed over Germany prospectively provided sera from in-or outpatients aged 1 to 17 years from April 1(st) to July 31(st) 2010. Vaccination history, recall of infections and sociodemographic factors were ascertained. Antibody titers were measured with a sensitive and specific in-house hemagglutination inhibition test (HIT) and compared to age-matched sera collected during 6 months before the onset of the pandemic in Germany. We analyzed 1420 post-pandemic and 300 pre-pandemic sera. Among unvaccinated children aged 1-4 and 5-17 years the prevalence of HI titers (>= 1:10) was 27.1\% (95\% CI: 23.5-31.3) and 53.5\% (95\% CI: 50.9-56.2) compared to 1.7\% and 5.5\%, respectively, for pre-pandemic sera, accounting for a serologically determined incidence of influenza A (H1N1) 2009 during the season 2009/2010 of 25,4\% (95\% CI : 19.3-30.5) in children aged 1-4 years and 48.0\% (95\% CI: 42.6-52.0) in 5-17 year old children. Of children with HI titers >= 1: 10, 25.5\% (95\% CI: 22.5-28.8) reported no history of any infectious disease since June 2009. Among vaccinated children, 92\% (95\%-CI: 87.0-96.6) of the 5-17 year old but only 47.8\% (95\%-CI: 33.5-66.5) of the 1-4 year old children exhibited HI titers against influenza A virus (H1N1) 2009. Conclusion: Serologically determined incidence of influenza A (H1N1) 2009 infections in children indicates high infection rates with older children (5-17 years) infected twice as often as younger children. In about a quarter of the children with HI titers after the season 2009/2010 subclinical infections must be assumed. Low HI titers in young children after vaccination with the AS03(B)-adjuvanted split virion vaccine need further scrutiny.},
  language  = {en}
}
@article{StrengGroteLiese2011,
  author    = {Streng, Andrea and Grote, Veit and Liese, Johannes G.},
  title     = {Severe influenza cases in paediatric intensive care units in Germany during the pre-pandemic seasons 2005 to 2008},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-69120},
  year      = {2011},
  abstract  = {Background: Data on complications in children with seasonal influenza virus infection are limited. We initiated a nation-wide three-year surveillance of children who were admitted to a paediatric intensive care unit (PICU) with severe seasonal influenza. Methods: From October 2005 to July 2008, active surveillance was performed using an established reporting system for rare diseases (ESPED) including all paediatric hospitals in Germany. Cases to be reported were hospitalized children < 17 years of age with laboratory-confirmed influenza treated in a PICU or dying in hospital. Results: Twenty severe influenza-associated cases were reported from 14 PICUs during three pre-pandemic influenza seasons (2005-2008). The median age of the patients (12 males/8 females) was 7.5 years (range 0.1-15 years). None had received vaccination against influenza. In 14 (70\%) patients, the infection had been caused by influenza A and in five (25\%) by influenza B; in one child (5\%) the influenza type was not reported. Patients spent a median of 19 (IQR 12-38) days in the hospital and a median of 11 days (IQR 6-18 days) in the PICU; 10 (50\%) needed mechanical ventilation. Most frequent diagnoses were influenza-associated pneumonia (60\%), bronchitis / bronchiolitis (30\%), encephalitis / encephalopathy (25\%), secondary bacterial pneumonia (25\%), and ARDS (25\%). Eleven (55\%) children had chronic underlying medical conditions, including 8 (40\%) with chronic pulmonary diseases. Two influenza A- associated deaths were reported: i) an 8-year old boy with pneumococcal encephalopathy following influenza infection died from cerebral edema, ii) a 14-year-old boy with asthma bronchiale, cardiac malformation and Addison's disease died from cardiac and respiratory failure. For nine (45\%) patients, possibly permanent sequelae were reported (3 neurological, 3 pulmonary, 3 other sequelae). Conclusions: Influenza-associated pneumonia and secondary bacterial infections are relevant complications of seasonal influenza in Germany. The incidence of severe influenza cases in PICUs was relatively low. This may be either due to the weak to moderate seasonal influenza activity during the years 2005 to 2008 or due to underdiagnosis of influenza by physicians. Fifty \% of the observed severe cases might have been prevented by following the recommendations for vaccination of risk groups in Germany.},
  subject      = {Deutschland},
  language  = {en}
}
@article{WiegeringSchickBeeretal.2011,
  author    = {Wiegering, Verena and Schick, Judith and Beer, Meinrad and Gattenl{\"o}hner, Stefan and Girschick, Hermann and Liese, Johannes and Schlegel, Paul and Eyrich, Matthias},
  title     = {Varicella-zoster virus infections in immunocompromised patients - a single centre 6-years analysis},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-68723},
  year      = {2011},
  abstract  = {Background: Infection with varicella-zoster virus (VZV) contemporaneously with malignant disease or immunosuppression represents a particular challenge and requires individualized decisions and treatment. Although the increasing use of varicella-vaccines in the general population and rapid initiation of VZVimmunoglobulins and acyclovir in case of exposure has been beneficial for some patients, immunocompromised individuals are still at risk for unfavourable courses. Methods: In this single center, 6-year analysis we review incidence, hospitalization and complication rates of VZVinfections in our center and compare them to published data. Furthermore, we report three instructive cases. Results: Hospitalization rate of referred children with VZV-infections was 45\%, among these 17\% with malignancies and 9\% under immunosuppressive therapy. Rate of complications was not elevated in these two high-risk cohorts, but one ALL-patient died due to VZV-related complications. We report one 4-year old boy with initial diagnosis of acute lymphoblastic leukemia who showed a rapidly fatal outcome of his simultaneous varicella-infection, one 1.8-year old boy with an identical situation but a mild course of his disease, and an 8.5-year old boy with a steroiddependent nephrotic syndrome. This boy developed severe hepatic involvement during his varicella-infection but responded to immediate withdrawl of steroids and administration of acyclovir plus single-dose cidofovir after nonresponse to acyclovir after 48 h. Conclusion: Our data show that patients with malignant diseases or immunosuppressive therapy should be hospitalized and treated immediately with antiviral agents. Despite these measures the course of VZV-infections can be highly variable in these patients. We discuss aids to individual decision-making for these difficult situations.},
  subject      = {Varizellen-Virus},
  language  = {en}
}
@article{RieberGrafHartletal.2011,
  author    = {Rieber, Nikolaus and Graf, Anna and Hartl, Dominik and Urschel, Simon and Belohradsky, Bernd H. and Liese, Johannes},
  title     = {Acellular Pertussis Booster in Adolescents Induces Th1 and Memory CD8+ T Cell Immune Response},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-68960},
  year      = {2011},
  abstract  = {In a number of countries, whole cell pertussis vaccines (wcP) were replaced by acellular vaccines (aP) due to an improved reactogenicity profile. Pertussis immunization leads to specific antibody production with the help of CD4+ T cells. In earlier studies in infants and young children, wcP vaccines selectively induced a Th1 dominated immune response, whereas aP vaccines led to a Th2 biased response. To obtain data on Th1 or Th2 dominance of the immune response in adolescents receiving an aP booster immunization after a wcP or aP primary immunization, we analyzed the concentration of Th1 (IL-2, TNF-a, INF-c) and Th2 (IL-4, IL-5, IL-10) cytokines in supernatants of lymphocyte cultures specifically stimulated with pertussis antigens. We also investigated the presence of cytotoxic T cell responses against the facultative intracellular bacterium Bordetella pertussis by quantifying pertussis-specific CD8+ T cell activation following the aP booster immunization. Here we show that the adolescent aP booster vaccination predominantly leads to a Th1 immune response based on IFNgamma secretion upon stimulation with pertussis antigen, irrespective of a prior whole cell or acellular primary vaccination. The vaccination also induces an increase in peripheral CD8+CD69+ activated pertussis-specific memory T cells four weeks after vaccination. The Th1 bias of this immune response could play a role for the decreased local reactogenicity of this adolescent aP booster immunization when compared to the preceding childhood acellular pertussis booster. Pertussis-specific CD8+ memory T cells may contribute to protection against clinical pertussis.},
  subject      = {Jugend},
  language  = {en}
}
@article{ReinardsAlbersBrinkmanetal.2011,
  author    = {Reinards, THCM and Albers, HM and Brinkman, DMC and Kamphuis, SSM and van Rossum, MAJ and Hoppenreijs, EPAH and Girschick, HJ and Wouters, C and Saurenmann, RK and Houwing-Duistermaat, JJ and Toes, REM and Huizinga, TWJ and ten Cate, R and Schilham, MW},
  title     = {Association of the CCR5Δ32 variant with juvenile idiopathic arthritis in a meta-analysis},
  series = {Pediatric Rheumatology},
  volume    = {9},
  journal   = {Pediatric Rheumatology},
  number    = {Suppl. 1},
  doi       = {10.1186/1546-0096-9-S1-P287},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-133763},
  pages     = {P287},
  year      = {2011},
  abstract  = {No abstract available.},
  language  = {en}
}
@article{ReinardsAlbersBrinkmanetal.2011,
  author    = {Reinards, THCM and Albers, HM and Brinkman, DMC and Kamphuis, SSM and van Rossum, MAJ and Hoppenreijs, EPAH and Girschick, HJ and Wouters, C and Saurenmann, RK and Houwing-Duistermaat, JJ and Toes, REM and Huizinga, TWJ and ten Cate, R and Schilham, MW},
  title     = {Association of the CD226 (DNAM-1) Gly307Ser polymorphism with juvenile idiopathic arthritis},
  series = {Pediatric Rheumatology},
  volume    = {9},
  journal   = {Pediatric Rheumatology},
  number    = {Suppl. 1},
  doi       = {10.1186/1546-0096-9-S1-P286},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-133773},
  pages     = {P286},
  year      = {2011},
  abstract  = {No abstract available.},
  language  = {en}
}
@article{Prelog2012,
  author    = {Prelog, Martina},
  title     = {Differential Approaches for Vaccination from Childhood to Old Age},
  series = {Gerontology},
  volume    = {59},
  journal   = {Gerontology},
  number    = {3},
  issn      = {0304-324X},
  doi       = {10.1159/000343475},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-196602},
  pages     = {230-239},
  year      = {2012},
  abstract  = {Primary prevention strategies, such as vaccinations at the age extremes, in neonates and elderly individuals, demonstrate a challenge to health professionals and public health specialists. The aspects of the differentiation and maturation of the adaptive immune system, the functional implications of immunological immaturity or immunosenescence and its impact on vaccine immunogenicity and efficacy will be highlighted in this review. Several approaches have been undertaken to promote Th1 responses in neonates and to enhance immune functions in elderly, such as conjugation to carrier proteins, addition of adjuvants, concomitant vaccination with other vaccines, change in antigen concentrations or dose intervals or use of different administration routes. Also, early protection by maternal vaccination seems to be beneficial in neonates. However, it also appears necessary to think of other end points than antibody concentrations to assess vaccine efficacy in neonates or elderly, as also the cellular immune response may be impaired by the mechanisms of immaturity, underlying health conditions, immunosuppressive treatments or immunosenescence. Thus, lifespan vaccine programs should be implemented to all individuals on a population level not only to improve herd protection and to maintain protective antibody levels and immune memory, but also to cover all age groups, to protect unvaccinated elderly persons and to provide indirect protection for neonates and small infants.},
  language  = {en}
}
@article{RufFehnBachmannetal.2012,
  author    = {Ruf, Katharina C. and Fehn, Sonja and Bachmann, Mich{\`e}le and Moeller, Alexander and Roht, Kristina and Kriemler, Susi and Hebestreit, Helge},
  title     = {Validation of activity questionnaires in patients with cystic fibrosis by accelerometry and cycle ergometry},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-75083},
  year      = {2012},
  abstract  = {Background: The objective of this study was to validate physical activity questionnaires for cystic fibrosis (CF) against accelerometry and cycle ergometry. Methods: 41 patients with CF (12-42 years) completed the Habitual Activity Estimation Scale (HAES), the 7-Day Physical Activity Recall questionnaire (7D-PAR) and the Lipid Research Clinics questionnaire (LRC) and performed an incremental exercise test according to the Godfrey protocol up to volitional fatigue. Time spent in moderate and vigorous physical activity (MVPA) assessed objectively by accelerometry was related to the time spent in the respective activity categories by correlation analyses and calculating intraclass correlation coefficients (ICC). Furthermore, the results of the exercise test were correlated with the results of the questionnaires. Results: Time spent in the categories 'hard','very hard' and 'hard \& very hard' of the 7D-PAR (0.41 < r < 0.56) and 'active' (r = 0.33) of the HAES correlated significantly with MVPA. The activity levels of the LRC were not related to objectively determined physical activity. Significant ICCs were only observed between the 7D-PAR activitiy categories and MVPA (ICC = 0.40-0.44). Only the LRC showed moderate correlations with the exercise test (Wmax: r = 0.46, p = 0.002; VO2peak: r = 0.32, p = 0.041). Conclusions: In conclusion, the activity categories 'hard' and 'very hard' of the 7D-PAR best reflected objectively measured MVPA. Since the association was at most moderate, the 7D-PAR may be selected to describe physical activity within a population. None of the evaluated questionnaires was able to generate valid physical activity data exercise performance data at the individual level. Neither did any of the questionnaires provide a valid assessment of aerobic fitness on an invidual level.},
  subject      = {Medizin},
  language  = {en}
}
@article{d'AlquenDeBoeckBradleyetal.2012,
  author    = {d'Alquen, Daniela and De Boeck, Kris and Bradley, Judy and V{\´a}vrov{\´a}, Věra and Dembski, Brigit and Wagner, Thomas O.F. and Pfalz, Annette and Hebestreit, Helge},
  title     = {Quality assessment of expert answers to lay questions about cystic fibrosis from various language zones in Europe: the ECORN-CF project},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-75072},
  year      = {2012},
  abstract  = {Background: The European Centres of Reference Network for Cystic Fibrosis (ECORN-CF) established an Internet forum which provides the opportunity for CF patients and other interested people to ask experts questions about CF in their mother language. The objectives of this study were to: 1) develop a detailed quality assessment tool to analyze quality of expert answers, 2) evaluate the intra- and inter-rater agreement of this tool, and 3) explore changes in the quality of expert answers over the time frame of the project. Methods: The quality assessment tool was developed by an expert panel. Five experts within the ECORN-CF project used the quality assessment tool to analyze the quality of 108 expert answers published on ECORN-CF from six language zones. 25 expert answers were scored at two time points, one year apart. Quality of answers was also assessed at an early and later period of the project. Individual rater scores and group mean scores were analyzed for each expert answer. Results: A scoring system and training manual were developed analyzing two quality categories of answers: content and formal quality. For content quality, the grades based on group mean scores for all raters showed substantial agreement between two time points, however this was not the case for the grades based on individual rater scores. For formal quality the grades based on group mean scores showed only slight agreement between two time points and there was also poor agreement between time points for the individual grades. The inter-rater agreement for content quality was fair (mean kappa value 0.232 ± 0.036, p < 0.001) while only slight agreement was observed for the grades of the formal quality (mean kappa value 0.105 ± 0.024, p < 0.001). The quality of expert answers was rated high (four language zones) or satisfactory (two language zones) and did not change over time. Conclusions: The quality assessment tool described in this study was feasible and reliable when content quality was assessed by a group of raters. Within ECORN-CF, the tool will help ensure that CF patients all over Europe have equal possibility of access to high quality expert advice on their illness.},
  subject      = {ECORN-CF Projekt},
  language  = {en}
}