@article{RauchSalzwedelBjarnasonWehrensetal.2021, author = {Rauch, Bernhard and Salzwedel, Annett and Bjarnason-Wehrens, Birna and Albus, Christian and Meng, Karin and Schmid, Jean-Paul and Benzer, Werner and Hackbusch, Matthes and Jensen, Katrin and Schwaab, Bernhard and Altenberger, Johann and Benjamin, Nicola and Bestehorn, Kurt and Bongarth, Christa and D{\"o}rr, Gesine and Eichler, Sarah and Einwang, Hans-Peter and Falk, Johannes and Glatz, Johannes and Gielen, Stephan and Grilli, Maurizio and Gr{\"u}nig, Ekkehard and Guha, Manju and Hermann, Matthias and Hoberg, Eike and H{\"o}fer, Stefan and Kaemmerer, Harald and Ladwig, Karl-Heinz and Mayer-Berger, Wolfgang and Metzendorf, Maria-Inti and Nebel, Roland and Neidenbach, Rhoia Clara and Niebauer, Josef and Nixdorff, Uwe and Oberhoffer, Renate and Reibis, Rona and Reiss, Nils and Saure, Daniel and Schlitt, Axel and V{\"o}ller, Heinz and K{\"a}nel, Roland von and Weinbrenner, Susanne and Westphal, Ronja}, title = {Cardiac rehabilitation in German speaking countries of Europe — evidence-based guidelines from Germany, Austria and Switzerland LLKardReha-DACH — Part 1}, series = {Journal of Clinical Medicine}, volume = {10}, journal = {Journal of Clinical Medicine}, number = {10}, issn = {2077-0383}, doi = {10.3390/jcm10102192}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-239709}, year = {2021}, abstract = {Background: Although cardiovascular rehabilitation (CR) is well accepted in general, CR-attendance and delivery still considerably vary between the European countries. Moreover, clinical and prognostic effects of CR are not well established for a variety of cardiovascular diseases. Methods: The guidelines address all aspects of CR including indications, contents and delivery. By processing the guidelines, every step was externally supervised and moderated by independent members of the "Association of the Scientific Medical Societies in Germany" (AWMF). Four meta-analyses were performed to evaluate the prognostic effect of CR after acute coronary syndrome (ACS), after coronary bypass grafting (CABG), in patients with severe chronic systolic heart failure (HFrEF), and to define the effect of psychological interventions during CR. All other indications for CR-delivery were based on a predefined semi-structured literature search and recommendations were established by a formal consenting process including all medical societies involved in guideline generation. Results: Multidisciplinary CR is associated with a significant reduction in all-cause mortality in patients after ACS and after CABG, whereas HFrEF-patients (left ventricular ejection fraction <40\%) especially benefit in terms of exercise capacity and health-related quality of life. Patients with other cardiovascular diseases also benefit from CR-participation, but the scientific evidence is less clear. There is increasing evidence that the beneficial effect of CR strongly depends on "treatment intensity" including medical supervision, treatment of cardiovascular risk factors, information and education, and a minimum of individually adapted exercise volume. Additional psychologic interventions should be performed on the basis of individual needs. Conclusions: These guidelines reinforce the substantial benefit of CR in specific clinical indications, but also describe remaining deficits in CR-delivery in clinical practice as well as in CR-science with respect to methodology and presentation.}, language = {en} } @article{PolatKaiserWohllebenetal.2017, author = {Polat, B{\"u}lent and Kaiser, Philipp and Wohlleben, Gisela and Gehrke, Thomas and Scherzad, Agmal and Scheich, Matthias and Malzahn, Uwe and Fischer, Thomas and Vordermark, Dirk and Flentje, Michael}, title = {Perioperative changes in osteopontin and TGFβ1 plasma levels and their prognostic impact for radiotherapy in head and neck cancer}, series = {BMC Cancer}, volume = {17}, journal = {BMC Cancer}, number = {6}, doi = {10.1186/s12885-016-3024-4}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-157529}, year = {2017}, abstract = {Background: In head and neck cancer little is known about the kinetics of osteopontin (OPN) expression after tumor resection. In this study we evaluated the time course of OPN plasma levels before and after surgery. Methods: Between 2011 and 2013 41 consecutive head and neck cancer patients were enrolled in a prospective study (group A). At different time points plasma samples were collected: T0) before, T1) 1 day, T2) 1 week and T3) 4 weeks after surgery. Osteopontin and TGFβ1 plasma concentrations were measured with a commercial ELISA system. Data were compared to 131 head and neck cancer patients treated with primary (n = 42) or postoperative radiotherapy (n = 89; group B1 and B2). Results: A significant OPN increase was seen as early as 1 day after surgery (T0 to T1, p < 0.01). OPN levels decreased to base line 3-4 weeks after surgery. OPN values were correlated with postoperative TGFβ1 expression suggesting a relation to wound healing. Survival analysis showed a significant benefit for patients with lower OPN levels both in the primary and postoperative radiotherapy group (B1: 33 vs 11.5 months, p = 0.017, B2: median not reached vs 33.4, p = 0.031). TGFβ1 was also of prognostic significance in group B1 (33.0 vs 10.7 months, p = 0.003). Conclusions: Patients with head and neck cancer showed an increase in osteopontin plasma levels directly after surgery. Four weeks later OPN concentration decreased to pre-surgery levels. This long lasting increase was presumably associated to wound healing. Both pretherapeutic osteopontin and TGFβ1 had prognostic impact.}, language = {en} } @article{SeegersZabelGrueteretal.2015, author = {Seegers, Joachim and Zabel, Markus and Gr{\"u}ter, Timo and Ammermann, Antje and Weber-Kr{\"u}ger, Mark and Edelmann, Frank and Gelbrich, G{\"o}tz and Binder, Lutz and Herrmann-Lingen, Christoph and Gr{\"o}schel, Klaus and Hasenfuß, Gerd and Feltgen, Nicolas and Pieske, Burkert and Wachter, Rolf}, title = {Natriuretic peptides for the detection of paroxysmal atrial fibrillation}, series = {Open Heart}, volume = {2}, journal = {Open Heart}, number = {e000182}, doi = {10.1136/openhrt-2014-000182}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-149939}, year = {2015}, abstract = {Background and purpose: Silent atrial fibrillation (AF) and tachycardia (AT) are considered precursors of ischaemic stroke. Therefore, detection of paroxysmal atrial rhythm disorders is highly relevant, but is clinically challenging. We aimed to evaluate the diagnostic value of natriuretic peptide levels in the detection of paroxysmal AT/AF in a pilot study. Methods: Natriuretic peptide levels were analysed in two independent patient cohorts (162 patients with arterial hypertension or other cardiovascular risk factors and 82 patients with retinal vessel disease). N-terminal-pro-brain natriuretic peptide (NT-proBNP) and BNP were measured before the start of a 7-day Holter monitoring period carefully screened for AT/AF. Results: 244 patients were included; 16 had paroxysmal AT/AF. After excluding patients with a history of AT/AF (n=5), 14 patients had newly diagnosed AT/AF (5.8\%) NT-proBNP and BNP levels were higher in patients with paroxysmal AT/AF in both cohorts: (1) 154.4 (IQR 41.7; 303.6) versus 52.8 (30.4; 178.0) pg/mL and 70.0 (31.9; 142.4) versus 43.9 (16.3; 95.2) and (2) 216.9 (201.4; 277.1) versus 90.8 (42.3-141.7) and 96.0 (54.7; 108.2) versus 29.1 (12.0; 58.1). For the detection of AT/AF episodes, NT-proBNP and BNP had an area under the curve in receiver operating characteristic analysis of 0.76 (95\% CI, 0.64 to 0.88; p=0.002) and 0.75 (0.61 to 0.89; p=0.004), respectively. Conclusions: NT-proBNP and BNP levels are elevated in patients with silent AT/AF as compared with sinus rhythm. Thus, screening for undiagnosed paroxysmal AF using natriuretic peptide level initiated Holter monitoring may be a useful strategy in prevention of stroke or systemic embolism.}, language = {en} } @article{WillekeJansonZinketal.2021, author = {Willeke, Kristina and Janson, Patrick and Zink, Katharina and Stupp, Carolin and Kittel-Schneider, Sarah and Bergh{\"o}fer, Anne and Ewert, Thomas and King, Ryan and Heuschmann, Peter U. and Zapf, Andreas and Wildner, Manfred and Keil, Thomas}, title = {Occurrence of mental illness and mental health risks among the self-employed: a systematic review}, series = {International Journal of Environmental Research and Public Health}, volume = {18}, journal = {International Journal of Environmental Research and Public Health}, number = {16}, issn = {1660-4601}, doi = {10.3390/ijerph18168617}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-245085}, year = {2021}, abstract = {We aimed to systematically identify and evaluate all studies of good quality that compared the occurrence of mental disorders in the self-employed versus employees. Adhering to the Cochrane guidelines, we conducted a systematic review and searched three major medical databases (MEDLINE, Web of Science, Embase), complemented by hand search. We included 26 (three longitudinal and 23 cross-sectional) population-based studies of good quality (using a validated quality assessment tool), with data from 3,128,877 participants in total. The longest of these studies, a Swedish national register evaluation with 25 years follow-up, showed a higher incidence of mental illness among the self-employed compared to white-collar workers, but a lower incidence compared to blue-collar workers. In the second longitudinal study from Sweden the self-employed had a lower incidence of mental illness compared to both blue- and white-collar workers over 15 years, whereas the third longitudinal study (South Korea) did not find a difference regarding the incidence of depressive symptoms over 6 years. Results from the cross-sectional studies showed associations between self-employment and poor general mental health and stress, but were inconsistent regarding other mental outcomes. Most studies from South Korea found a higher prevalence of mental disorders among the self-employed compared to employees, whereas the results of cross-sectional studies from outside Asia were less consistent. In conclusion, we found evidence from population-based studies for a link between self-employment and increased risk of mental illness. Further longitudinal studies are needed examining the potential risk for the development of mental disorders in specific subtypes of the self-employed.}, language = {en} } @article{KristDornquastReinholdetal.2021, author = {Krist, Lilian and Dornquast, Christina and Reinhold, Thomas and Icke, Katja and Danquah, Ina and Willich, Stefan N. and Becher, Heiko and Keil, Thomas}, title = {Predictors of changes in physical activity and sedentary behavior during the COVID-19 pandemic in a Turkish migrant cohort in Germany}, series = {International Journal of Environmental Research and Public Health}, volume = {18}, journal = {International Journal of Environmental Research and Public Health}, number = {18}, issn = {1660-4601}, doi = {10.3390/ijerph18189682}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-246176}, year = {2021}, abstract = {The new coronavirus (COVID-19) pandemic and the resulting response measures have led to severe limitations of people's exercise possibilities with diminished physical activity (PA) and increased sedentary behavior (SB). Since for migrant groups in Germany, no data is available, this study aimed to investigate factors associated with changes in PA and SB in a sample of Turkish descent. Participants of a prospective cohort study (adults of Turkish descent, living in Berlin, Germany) completed a questionnaire regarding COVID-19 related topics including PA and SB since February 2020. Changes in PA and SB were described, and sociodemographic, migrant-related, and health-related predictors of PA decrease and SB increase were determined using multivariable regression analyses. Of 106 participants, 69\% reported a decline of PA, 36\% reported an increase in SB. PA decrease and SB increase seemed to be associated with inactivity before the pandemic as well as with the female sex. SB increase appeared to be additionally associated with educational level and BMI. The COVID-19 pandemic and the response measures had persistent detrimental effects on this migrant population. Since sufficient PA before the pandemic had the strongest association with maintaining PA and SB during the crisis, the German government and public health professionals should prioritize PA promotion in this vulnerable group.}, language = {en} } @article{HaydenLimbachSchuleretal.2021, author = {Hayden, Markus C. and Limbach, Matthias and Schuler, Michael and Merkl, Steffen and Schwarzl, Gabriele and Jakab, Katalin and Nowak, Dennis and Schultz, Konrad}, title = {Effectiveness of a three-week inpatient pulmonary rehabilitation program for patients after COVID-19: a prospective observational study}, series = {International Journal of Environmental Research and Public Health}, volume = {18}, journal = {International Journal of Environmental Research and Public Health}, number = {17}, issn = {1660-4601}, doi = {10.3390/ijerph18179001}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-245170}, year = {2021}, abstract = {For COVID-19 patients who remain symptomatic after the acute phase, pulmonary rehabilitation (PR) is recommended. However, only a few studies have investigated the effectiveness of PR, especially considering the duration between the acute phase of COVID-19 and the onset of rehabilitation, as well as the initial severity. This prospective observational study evaluated the efficacy of PR in patients after COVID-19. A total of 120 still-symptomatic patients referred for PR after overcoming acute COVID-19 were asked to participate, of whom 108 (mean age 55.6 ± 10.1 years, 45.4\% female) consented. The patients were assigned to three groups according to the time of referral and initial disease severity (severe acute; severe after interval; mild after interval). The primary outcome was dyspnea. Secondary outcomes included other respiratory disease symptoms, physical capacity, lung function, fatigue, quality of life (QoL), depression, and anxiety. Furthermore, patients rated the overall effectiveness of PR and their subjective change in health status. At the end of PR, we detected improvements with large effect sizes in exertional dyspnea, physical capacity, QoL, fatigue, and depression in the overall group. Other parameters changed with small to medium effect sizes. PR was effective after acute COVID-19 in all three groups analyzed.}, language = {en} } @article{KistThomaschewskiKecketal.2022, author = {Kist, Markus and Thomaschewski, Michael and Keck, Yannick and Abdalla, Thaer S. A. and Zeissig, Sylke Ruth and Kleihues-van Tol, Kees and Wellner, Ulrich Friedrich and Keck, Tobias and Hoeppner, Jens and Hummel, Richard}, title = {Specifics of young gastric cancer patients: a population-based analysis of 46,110 patients with gastric cancer from the German Clinical Cancer Registry Group}, series = {Cancers}, volume = {14}, journal = {Cancers}, number = {23}, issn = {2072-6694}, doi = {10.3390/cancers14235927}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-297473}, year = {2022}, abstract = {Introduction: 2-8\% of all gastric cancer occurs at a younger age, also known as early-onset gastric cancer (EOGC). The aim of the present work was to use clinical registry data to classify and characterize the young cohort of patients with gastric cancer more precisely. Methods: German Cancer Registry Group of the Society of German Tumor Centers—Network for Care, Quality and Research in Oncology (ADT)was queried for patients with gastric cancer from 2000-2016. An approach that stratified relative distributions of histological subtypes of gastric adenocarcinoma according to age percentiles was used to define and characterize EOGC. Demographics, tumor characteristics, treatment and survival were analyzed. Results: A total of 46,110 patients were included. Comparison of different groups of age with incidences of histological subtypes showed that incidence of signet ring cell carcinoma (SRCC) increased with decreasing age and exceeded pooled incidences of diffuse and intestinal type tumors in the youngest 20\% of patients. We selected this group with median age of 53 as EOGC. The proportion of female patients was lower in EOGC than that of elderly patients (43\% versus 45\%; p < 0.001). EOGC presented more advanced and undifferentiated tumors with G3/4 stages in 77\% versus 62\%, T3/4 stages in 51\% versus 48\%, nodal positive tumors in 57\% versus 53\% and metastasis in 35\% versus 30\% (p < 0.001) and received less curative treatment (42\% versus 52\%; p < 0.001). Survival of EOGC was significantly better (five-years survival: 44\% versus 31\% (p < 0.0001), with age as independent predictor of better survival (HR 0.61; p < 0.0001). Conclusion: With this population-based registry study we were able to objectively define a cohort of patients referred to as EOGC. Despite more aggressive/advanced tumors and less curative treatment, survival was significantly better compared to elderly patients, and age was identified as an independent predictor for better survival.}, language = {en} } @phdthesis{Quilitzsch2023, author = {Quilitzsch, Anika}, title = {Charakterisierung der diastolischen Dysfunktion bei Schlaganfallpatienten}, doi = {10.25972/OPUS-32859}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-328597}, school = {Universit{\"a}t W{\"u}rzburg}, year = {2023}, abstract = {Wenige Publikationen besch{\"a}ftigen sich mit der diastolischen Dysfunktion (DD) bei Schlaganfallpatienten. Um diese Datenl{\"u}cke zu bearbeiten, wurden, im Rahmen der SICFAIL-Kohortenstudie, Schlaganfallpatienten hinsichtlich des Vorhandenseins einer diastolischen Funktionsst{\"o}rung in Anlehnung an, zum Zeitpunkt des Verfassens dieser Arbeit, aktuelle Empfehlungen anhand echokardiographischer Parameter eingeteilt und charakterisiert. Zudem konnten Erkenntnisse {\"u}ber Einflussfaktoren gewonnen werden, die mit einer DD assoziiert sind. Dabei zeigte sich, dass Schlaganfallpatienten mit einer diastolischen Funktionsst{\"o}rung {\"a}lter sind als Schlaganfallpatienten ohne DD und dass mit steigendem Lebensalter auch die Chance f{\"u}r eine DD ansteigt. Zudem bestand h{\"a}ufiger eine medikament{\"o}s behandelte aber auch eine unbehandelte arterielle Hypertonie, die mit dem Auftreten einer DD assoziiert ist. Diese Erkenntnisse decken sich mit den Ergebnissen verschiedener Arbeitsgruppen, die sich mit dem Vorkommen der DD in der Allgemeinbev{\"o}lkerung besch{\"a}ftigt haben. Die im Rahmen dieser Arbeit ermittelte Pr{\"a}valenz der diastolischen Funktionsst{\"o}rung bei Schlaganfallpatienten ist deutlich niedriger als diejenige, die in anderen Forschungsarbeiten herausgefunden wurde. Unterschiedliche Definitionen der DD k{\"o}nnen ein Grund daf{\"u}r sein. Es bedarf aber weitere Forschungsarbeit in diese Richtung genauso wie eine st{\"a}rkere Etablierung der aktuellen Definitionsgrundlagen der DD um umfassende und einheitliche Erkenntnisse {\"u}ber die diastolische Funktionsst{\"o}rung bei Schlaganfallpatienten und auch in der Allgemeinbev{\"o}lkerung zu erlangen. Zudem sollte ein weiteres Forschungsziel sein, m{\"o}gliche Einfl{\"u}sse der DD auf das Outcome der Patienten nach isch{\"a}mischem Schlaganfall zu identifizieren, um diese gezielt in die Erarbeitung von Pr{\"a}ventionsmaßnahmen aufzunehmen.}, subject = {Herzinsuffizienz}, language = {de} } @article{GelbrichMorbachDeutschbeinetal.2023, author = {Gelbrich, G{\"o}tz and Morbach, Caroline and Deutschbein, Timo and Fassnacht, Martin and St{\"o}rk, Stefan and Heuschmann, Peter U.}, title = {The population comparison index: an intuitive measure to calibrate the extent of impairments in patient cohorts in relation to healthy and diseased populations}, series = {International Journal of Environmental Research and Public Health}, volume = {20}, journal = {International Journal of Environmental Research and Public Health}, number = {3}, issn = {1660-4601}, doi = {10.3390/ijerph20032168}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-304933}, year = {2023}, abstract = {We assume that a specific health constraint, e.g., a certain aspect of bodily function or quality of life that is measured by a variable X, is absent (or irrelevant) in a healthy reference population (Ref0), and it is materially present and precisely measured in a diseased reference population (Ref1). We further assume that some amount of this constraint of interest is suspected to be present in a population under study (SP). In order to quantify this issue, we propose the introduction of an intuitive measure, the population comparison index (PCI), that relates the mean value of X in population SP to the mean values of X in populations Ref0 and Ref1. This measure is defined as PCI[X] = (mean[X|SP] - mean[X|Ref0])/(mean[X|Ref1] - mean[X|Ref0]) × 100[\%], where mean[X|.] is the average value of X in the respective group of individuals. For interpretation, PCI[X] ≈ 0 indicates that the values of X in the population SP are similar to those in population Ref0, and hence, the impairment measured by X is not materially present in the individuals in population SP. On the other hand, PCI[X] ≈ 100 means that the individuals in SP exhibit values of X comparable to those occurring in Ref1, i.e., the constraint of interest is equally present in populations SP and Ref1. A value of 0 < PCI[X] < 100 indicates that a certain percentage of the constraint is present in SP, and it is more than in Ref0 but less than in Ref1. A value of PCI[X] > 100 means that population SP is even more affected by the constraint than population Ref1.}, language = {en} } @article{HaarmannVollmuthKollikowskietal.2023, author = {Haarmann, Axel and Vollmuth, Christoph and Kollikowski, Alexander M. and Heuschmann, Peter U. and Pham, Mirko and Stoll, Guido and Neugebauer, Hermann and Schuhmann, Michael K.}, title = {Vasoactive soluble endoglin: a novel biomarker indicative of reperfusion after cerebral large-vessel occlusion}, series = {Cells}, volume = {12}, journal = {Cells}, number = {2}, issn = {2073-4409}, doi = {10.3390/cells12020288}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-304995}, year = {2023}, abstract = {Now that mechanical thrombectomy has substantially improved outcomes after large-vessel occlusion stroke in up to every second patient, futile reperfusion wherein successful recanalization is not followed by a favorable outcome is moving into focus. Unfortunately, blood-based biomarkers, which identify critical stages of hemodynamically compromised yet reperfused tissue, are lacking. We recently reported that hypoxia induces the expression of endoglin, a TGF-β co-receptor, in human brain endothelium in vitro. Subsequent reoxygenation resulted in shedding. Our cell model suggests that soluble endoglin compromises the brain endothelial barrier function. To evaluate soluble endoglin as a potential biomarker of reperfusion (-injury) we analyzed its concentration in 148 blood samples of patients with acute stroke due to large-vessel occlusion. In line with our in vitro data, systemic soluble endoglin concentrations were significantly higher in patients with successful recanalization, whereas hypoxia alone did not induce local endoglin shedding, as analyzed by intra-arterial samples from hypoxic vasculature. In patients with reperfusion, higher concentrations of soluble endoglin additionally indicated larger infarct volumes at admission. In summary, we give translational evidence that the sequence of hypoxia and subsequent reoxygenation triggers the release of vasoactive soluble endoglin in large-vessel occlusion stroke and can serve as a biomarker for severe ischemia with ensuing recanalization/reperfusion.}, language = {en} } @article{ThongDoegeWeisseretal.2023, author = {Thong, Melissa S. Y. and Doege, Daniela and Weißer, Linda and Koch-Gallenkamp, Lena and Jansen, Lina and Bertram, Heike and Eberle, Andrea and Holleczek, Bernd and Nennecke, Alice and Waldmann, Annika and Zeissig, Sylke Ruth and Brenner, Hermann and Arndt, Volker}, title = {Persisting deficits in health-related quality of life of colorectal cancer survivors 14-24 years post-diagnosis: a population-based study}, series = {Current Oncology}, volume = {30}, journal = {Current Oncology}, number = {3}, issn = {1718-7729}, doi = {10.3390/curroncol30030257}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-311084}, pages = {3373 -- 3390}, year = {2023}, abstract = {(1) Background: The health-related quality of life (HRQOL) of colorectal cancer (CRC) survivors >10 years post-diagnosis is understudied. We aimed to compare the HRQOL of CRC survivors 14-24 years post-diagnosis to that of age- and sex-matched non-cancer controls, stratified by demographic and clinical factors. (2) Methods: We used data from 506 long-term CRC survivors and 1489 controls recruited from German population-based multi-regional studies. HRQOL was assessed with the European Organization for Research and Treatment of Cancer Quality of Life Core-30 (EORTC QLQ-C30) questionnaire. We estimated differences in the HRQOL of CRC survivors and controls with multiple regression, adjusted for age at survey, sex, and education, where appropriate. (3) Results: CRC survivors reported poorer social functioning but better health status/QOL than controls. CRC survivors, in general, had higher levels of symptom burden, and in particular diarrhea and constipation, regardless of demographic or clinical factors. In stratified analyses, HRQOL differed by age, sex, cancer type, and having a permanent stoma. (4) Conclusions: Although CRC survivors may have a comparable health status/QOL to controls 14-24 years after diagnosis, they still live with persistent bowel dysfunction that can negatively impact aspects of functioning. Healthcare providers should provide timely and adapted follow-up care to ameliorate potential long-term suffering.}, language = {en} } @article{KirikkayisGallikWinteretal.2023, author = {Kirikkayis, Yusuf and Gallik, Florian and Winter, Michael and Reichert, Manfred}, title = {BPMNE4IoT: a framework for modeling, executing and monitoring IoT-driven processes}, series = {Future Internet}, volume = {15}, journal = {Future Internet}, number = {3}, issn = {1999-5903}, doi = {10.3390/fi15030090}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-304097}, year = {2023}, abstract = {The Internet of Things (IoT) enables a variety of smart applications, including smart home, smart manufacturing, and smart city. By enhancing Business Process Management Systems with IoT capabilities, the execution and monitoring of business processes can be significantly improved. Providing a holistic support for modeling, executing and monitoring IoT-driven processes, however, constitutes a challenge. Existing process modeling and process execution languages, such as BPMN 2.0, are unable to fully meet the IoT characteristics (e.g., asynchronicity and parallelism) of IoT-driven processes. In this article, we present BPMNE4IoT—A holistic framework for modeling, executing and monitoring IoT-driven processes. We introduce various artifacts and events based on the BPMN 2.0 metamodel that allow realizing the desired IoT awareness of business processes. The framework is evaluated along two real-world scenarios from two different domains. Moreover, we present a user study for comparing BPMNE4IoT and BPMN 2.0. In particular, this study has confirmed that the BPMNE4IoT framework facilitates the support of IoT-driven processes.}, language = {en} } @article{UngethuemWiedmannWagneretal.2023, author = {Ungeth{\"u}m, K. and Wiedmann, S. and Wagner, M. and Leyh, R. and Ertl, G. and Frantz, S. and Geisler, T. and Karmann, W. and Prondzinsky, R. and Herdeg, C. and Noutsias, M. and Ludwig, T. and K{\"a}s, J. and Klocke, B. and Krapp, J. and Wood, D. and Kotseva, K. and St{\"o}rk, S. and Heuschmann, P. U.}, title = {Secondary prevention in diabetic and nondiabetic coronary heart disease patients: insights from the German subset of the hospital arm of the EUROASPIRE IV and V surveys}, series = {Clinical Research in Cardiology}, volume = {112}, journal = {Clinical Research in Cardiology}, number = {2}, doi = {10.1007/s00392-022-02093-0}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-324037}, pages = {285-298}, year = {2023}, abstract = {Background Patients with coronary heart disease (CHD) with and without diabetes mellitus have an increased risk of recurrent events requiring multifactorial secondary prevention of cardiovascular risk factors. We compared prevalences of cardiovascular risk factors and its determinants including lifestyle, pharmacotherapy and diabetes mellitus among patients with chronic CHD examined within the fourth and fifth EUROASPIRE surveys (EA-IV, 2012-13; and EA-V, 2016-17) in Germany. Methods The EA initiative iteratively conducts European-wide multicenter surveys investigating the quality of secondary prevention in chronic CHD patients aged 18 to 79 years. The data collection in Germany was performed during a comprehensive baseline visit at study centers in W{\"u}rzburg (EA-IV, EA-V), Halle (EA-V), and T{\"u}bingen (EA-V). Results 384 EA-V participants (median age 69.0 years, 81.3\% male) and 536 EA-IV participants (median age 68.7 years, 82.3\% male) were examined. Comparing EA-IV and EA-V, no relevant differences in risk factor prevalence and lifestyle changes were observed with the exception of lower LDL cholesterol levels in EA-V. Prevalence of unrecognized diabetes was significantly lower in EA-V as compared to EA-IV (11.8\% vs. 19.6\%) while the proportion of prediabetes was similarly high in the remaining population (62.1\% vs. 61.0\%). Conclusion Between 2012 and 2017, a modest decrease in LDL cholesterol levels was observed, while no differences in blood pressure control and body weight were apparent in chronic CHD patients in Germany. Although the prevalence of unrecognized diabetes decreased in the later study period, the proportion of normoglycemic patients was low. As pharmacotherapy appeared fairly well implemented, stronger efforts towards lifestyle interventions, mental health programs and cardiac rehabilitation might help to improve risk factor profiles in chronic CHD patients.}, language = {en} } @article{KammererHoppenstedtPryssetal.2019, author = {Kammerer, Klaus and Hoppenstedt, Burkhard and Pryss, R{\"u}diger and St{\"o}kler, Steffen and Allgaier, Johannes and Reichert, Manfred}, title = {Anomaly Detections for Manufacturing Systems Based on Sensor Data—Insights into Two Challenging Real-World Production Settings}, series = {Sensors}, volume = {19}, journal = {Sensors}, number = {24}, issn = {1424-8220}, doi = {10.3390/s19245370}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-193885}, pages = {5370}, year = {2019}, abstract = {o build, run, and maintain reliable manufacturing machines, the condition of their components has to be continuously monitored. When following a fine-grained monitoring of these machines, challenges emerge pertaining to the (1) feeding procedure of large amounts of sensor data to downstream processing components and the (2) meaningful analysis of the produced data. Regarding the latter aspect, manifold purposes are addressed by practitioners and researchers. Two analyses of real-world datasets that were generated in production settings are discussed in this paper. More specifically, the analyses had the goals (1) to detect sensor data anomalies for further analyses of a pharma packaging scenario and (2) to predict unfavorable temperature values of a 3D printing machine environment. Based on the results of the analyses, it will be shown that a proper management of machines and their components in industrial manufacturing environments can be efficiently supported by the detection of anomalies. The latter shall help to support the technical evangelists of the production companies more properly.}, language = {en} } @article{HessMengSchulteetal.2020, author = {Heß, Verena and Meng, Karin and Schulte, Thomas and Neuderth, Silke and Bengel, J{\"u}rgen and Faller, Hermann and Schuler, Michael}, title = {Prevalence and predictors of cancer patients' unexpressed needs in the admission interview of inpatient rehabilitation}, series = {Psycho-Oncology}, volume = {29}, journal = {Psycho-Oncology}, number = {10}, doi = {10.1002/pon.5450}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-228369}, pages = {1549 -- 1556}, year = {2020}, abstract = {Objective The admission interview in oncological inpatient rehabilitation might be a good opportunity to identify cancer patients' needs present after acute treatment. However, a relevant number of patients may not express their needs. In this study, we examined (a) the proportion of cancer patients with unexpressed needs, (b) topics of unexpressed needs and reasons for not expressing needs, (c) correlations of not expressing needs with several patient characteristics, and (d) predictors of not expressing needs. Methods We enrolled 449 patients with breast, prostate, and colon cancer at beginning and end of inpatient rehabilitation. We obtained self-reports about unexpressed needs and health-related variables (quality of life, depression, anxiety, adjustment disorder, and health literacy). We estimated frequencies and conducted correlation and ordinal logistic regression analyses. Results A quarter of patients stated they had "rather not" or "not at all" expressed all relevant needs. Patients mostly omitted fear of cancer recurrence. Most frequent reasons for not expressing needs were being focused on physical consequences of cancer, concerns emerging only later, and not knowing about the possibility of talking about distress. Not expressing needs was associated with several health-related outcomes, for example, emotional functioning, adjustment disorder, fear of progression, and health literacy. Depression measured at the beginning of rehabilitation showed only small correlations and is therefore not sufficient to identify patients with unexpressed needs. Conclusions A relevant proportion of cancer patients reported unexpressed needs in the admission interview. This was associated with decreased mental health. Therefore, it seems necessary to support patients in expressing needs.}, language = {en} } @article{HermSchurigMartineketal.2019, author = {Herm, Juliane and Schurig, Johannes and Martinek, Martin R. and H{\"o}ltgen, Reinhard and Schirdewan, Alexander and Kirchhof, Paulus and Wieczorek, Marcus and P{\"u}rerfellner, Helmut and Heuschmann, Peter U. and Fiebach, Jochen B. and Haeusler, Karl Georg}, title = {MRI-detected brain lesions in AF patients without further stroke risk factors undergoing ablation - a retrospective analysis of prospective studies}, series = {BMC Cardiovascular Disorders}, volume = {19}, journal = {BMC Cardiovascular Disorders}, doi = {10.1186/s12872-019-1035-1}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-201226}, pages = {58}, year = {2019}, abstract = {Background Atrial fibrillation (AF) without other stroke risk factors is assumed to have a low annual stroke risk comparable to patients without AF. Therefore, current clinical guidelines do not recommend oral anticoagulation for stroke prevention of AF in patients without stroke risk factors. We analyzed brain magnetic resonance imaging (MRI) imaging to estimate the rate of clinically inapparent ("silent") ischemic brain lesions in these patients. Methods We pooled individual patient-level data from three prospective studies comprising stroke-free patients with symptomatic AF. All study patients underwent brain MRI within 24-48 h before planned left atrial catheter ablation. MRIs were analyzed by a neuroradiologist blinded to clinical data. Results In total, 175 patients (median age 60 (IQR 54-67) years, 32\% female, median CHA\(_2\)DS\(_2\)-VASc = 1 (IQR 0-2), 33\% persistent AF) were included. In AF patients without or with at least one stroke risk factor, at least one silent ischemic brain lesion was observed in 4 (8\%) out of 48 and 10 (8\%) out of 127 patients, respectively (p > 0.99). Presence of silent ischemic brain lesions was related to age (p = 0.03) but not to AF pattern (p = 0.77). At least one cerebral microbleed was detected in 5 (13\%) out of 30 AF patients without stroke risk factors and 25 (25\%) out of 108 AF patients with stroke risk factors (p = 0.2). Presence of cerebral microbleeds was related to male sex (p = 0.04) or peripheral artery occlusive disease (p = 0.03). Conclusion In patients with symptomatic AF scheduled for ablation, brain MRI detected silent ischemic brain lesions in approximately one in 12 patients, and microbleeds in one in 5 patients. The prevalence of silent ischemic brain lesions did not differ in AF patients with or without further stroke risk factors.}, language = {en} } @phdthesis{Kaes2023, author = {K{\"a}s, Johannes}, title = {Pr{\"a}valenz von chronischer Niereninsuffizienz und Awareness von chronischer Niereninsuffizienz bei Patienten mit koronarer Herzerkrankung - zeitliche Trends in W{\"u}rzburg}, doi = {10.25972/OPUS-32340}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-323407}, school = {Universit{\"a}t W{\"u}rzburg}, year = {2023}, abstract = {Die chronische Niereninsuffizienz (CKD) gilt als wichtiger prognostischer Faktor bei Patienten mit koronarer Herzerkrankung (KHK). Das Bewusstsein (Awareness) f{\"u}r das Vorliegen einer CKD bei {\"A}rzten wie bei Patienten kann bei der Therapie von KHK-Patienten eine entscheidende Rolle spielen. Ziel dieser Arbeit war die Beschreibung der zeitlichen Trends der CKD-Pr{\"a}valenz sowie der Awareness bei KHK-Patienten und {\"A}rzten im Rahmen der EUROASPIRE (EA) V Studie im Studienzentrum W{\"u}rzburg. EA V ist eine multizentrische Querschnittsstudie der European Society of Cardiology (ESC) zur Untersuchung der Qualit{\"a}t der Sekund{\"a}rpr{\"a}vention bei KHK-Patienten, die 6-24 Monate vor dem Studienbesuch station{\"a}r behandelt wurden. Nierenfunktion und Nierenerkrankung wurden mit der glomerul{\"a}ren Filtrationsrate (eGFR) und der Urin Albumin-Kreatinin-Ratio abgesch{\"a}tzt und klassifiziert. Die CKD Awareness der Patienten wurde anhand standardisierter Fragen erhoben. Die CKD Awareness der {\"A}rzte wurde {\"u}ber die ICD-10 Codierung in der Patientenakte sowie die Dokumentation im Entlassungsbrief erfasst. Die Ergebnisse wurden mit der W{\"u}rzburger EUROASPIRE IV (2012/13) Substudie verglichen. In EA V wurden 219 KHK-Patienten (Median 70 Jahre, 81\% M{\"a}nner) in W{\"u}rzburg eingeschlossen. Bei Studienbesuch betrug die Pr{\"a}valenz der CKD 32\%, davon waren sich 30\% der Patienten der CKD bewusst. Bei 26\% der 73 Patienten mit w{\"a}hrend des Index-Krankenhausaufenthaltes apparenter Nierenfunktionseinschr{\"a}nkung wurde diese auch im Entlassungsbrief dokumentiert und bei 80\% korrekt in der Patientenakte codiert. Im Vergleich zu EA IV zeigte sich die eingeschr{\"a}nkte Nierenfunktion w{\"a}hrend des Krankenhausaufenthaltes (p=0,013) und w{\"a}hrend des Studienbesuchs (p=0,056) h{\"a}ufiger. Bez{\"u}glich der CKD Awareness bei {\"A}rzten und Patienten gab es keine signifikanten Unterschiede bezogen auf die gesamten Kohorten. Im Fr{\"u}hstadium G3a zeigte sich eine statistisch signifikant geringere CKD Awareness der Patienten in EA V verglichen mit EA IV. Die CKD ist eine h{\"a}ufige Komorbidit{\"a}t bei KHK-Patienten. Die CKD Awareness ist bei Patienten, aber auch {\"A}rzten niedrig. Aus dieser Konstellation ergeben sich Handlungsauftr{\"a}ge f{\"u}r eine gezielte Aufkl{\"a}rung von Patienten und nachhaltig wirksame Fortbildung der behandelnden {\"A}rzte.}, subject = {Chronische Niereninsuffizienz}, language = {de} } @article{OezkurMagyarThomasetal.2017, author = {Oezkur, Mehmet and Magyar, Attila and Thomas, Phillip and Stork, Tabea and Schneider, Reinhard and Bening, Constanze and St{\"o}rk, Stefan and Heuschmann, Peter U. and Leyh, Rainer G. and Wagner, Martin}, title = {TIMP-2*IGFBP7 (Nephrocheck®) Measurements at Intensive Care Unit Admission After Cardiac Surgery are Predictive for Acute Kidney Injury Within 48 Hours}, series = {Kidney \& Blood Pressure Research}, volume = {42}, journal = {Kidney \& Blood Pressure Research}, doi = {10.1159/000479298}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-157988}, pages = {456-467}, year = {2017}, abstract = {Background/Aims: Acute kidney injury (AKI) is a postoperative complication after cardiac surgery with a high impact on mortality and morbidity. Nephrocheck® [TIMP-2*IGFBP7] determines markers of tubular stress, which occurs prior to tubular damage. It is unknown at which time-point [TIMP-2*IGFBP7] measurement should be performed to ideally predict AKI. We investigated the association of [TIMP-2*IGFBP7] at various time-points with the incidence of AKI in patients undergoing elective cardiac surgery including cardio-pulmonary bypass. Methods: In a prospective cohort study, serial blood and urine samples were collected from 150 patients: pre-operative, at ICU-admission, 24h and 48h post-surgery. AKI was defined as Serum-Creatinine rise >0.3 mg/dl within 48hrs. Urinary [TIMP-2*IGFBP7] was measured at pre-operative, ICU-admission and 24h post-surgery; medical staff was kept blinded to these results. Results: A total of 35 patients (23.5\%) experienced AKI, with a higher incidence in those with high [TIMP-2*IGFBP7] values at ICU admission (57.1\% vs. 10.1\%, p<0.001). In logistic regression [TIMP-2*IGFBP7] at ICU admission was independently associated with the occurrence of AKI (Odds Ratio 11.83; p<0.001, C-statistic= 0.74) after adjustment for EuroSCORE II and CBP-time. Conclusions: Early detection of elevated [TIMP-2*IGFBP7] at ICU admission was strongly predictive for postoperative AKI and appeared to be more precise as compared to subsequent measurements.}, language = {en} } @article{SahitiMorbachCejkaetal.2021, author = {Sahiti, Floran and Morbach, Caroline and Cejka, Vladimir and Albert, Judith and Eichner, Felizitas A. and Gelbrich, G{\"o}tz and Heuschmann, Peter U. and St{\"o}rk, Stefan}, title = {Left Ventricular Remodeling and Myocardial Work: Results From the Population-Based STAAB Cohort Study}, series = {Frontiers in Cardiovascular Medicine}, volume = {8}, journal = {Frontiers in Cardiovascular Medicine}, issn = {2297-055X}, doi = {10.3389/fcvm.2021.669335}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-240480}, year = {2021}, abstract = {Introduction: Left ventricular (LV) dilatation and LV hypertrophy are acknowledged precursors of myocardial dysfunction and ultimately of heart failure, but the implications of abnormal LV geometry on myocardial function are not well-understood. Non-invasive LV myocardial work (MyW) assessment based on echocardiography-derived pressure-strain loops offers the opportunity to study detailed myocardial function in larger cohorts. We aimed to assess the relationship of LV geometry with MyW indices in general population free from heart failure. Methods and Results: We report cross-sectional baseline data from the Characteristics and Course of Heart Failure Stages A-B and Determinants of Progression (STAAB) cohort study investigating a representative sample of the general population of W{\"u}rzburg, Germany, aged 30-79 years. MyW analysis was performed in 1,926 individuals who were in sinus rhythm and free from valvular disease (49.3\% female, 54 ± 12 years). In multivariable regression, higher LV volume was associated with higher global wasted work (GWW) (+0.5 mmHg\% per mL/m\(^2\), p < 0.001) and lower global work efficiency (GWE) (-0.02\% per mL/m\(^2\), p < 0.01), while higher LV mass was associated with higher GWW (+0.45 mmHg\% per g/m\(^2\), p < 0.001) and global constructive work (GCW) (+2.05 mmHg\% per g/m\(^2\), p < 0.01) and lower GWE (-0.015\% per g/m\(^2\), p < 0.001). This was dominated by the blood pressure level and also observed in participants with normal LV geometry and concomitant hypertension. Conclusion: Abnormal LV geometric profiles were associated with a higher amount of wasted work, which translated into reduced work efficiency. The pattern of a disproportionate increase in GWW with higher LV mass might be an early sign of hypertensive heart disease.}, language = {en} } @article{SchicklerReichertGeigeretal.2020, author = {Schickler, Marc and Reichert, Manfred and Geiger, Philip and Winkler, Jens and Funk, Thomas and Weilbach, Micha and Pryss, R{\"u}diger}, title = {Flexible development of location-based mobile augmented reality applications with AREA}, series = {Journal of Ambient Intelligence and Humanized Computing}, volume = {11}, journal = {Journal of Ambient Intelligence and Humanized Computing}, issn = {1868-5137}, doi = {10.1007/s12652-020-02094-9}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-232773}, pages = {5809-5824}, year = {2020}, abstract = {Mobile applications have garnered a lot of attention in the last years. The computational capabilities of mobile devices are the mainstay to develop completely new application types. The provision of augmented reality experiences on mobile devices paves one alley in this field. For example, in the automotive domain, augmented reality applications are used to experience, inter alia, the interior of a car by moving a mobile device around. The device's camera then detects interior parts and shows additional information to the customer within the camera view. Another application type that is increasingly utilized is related to the combination of serious games with mobile augmented reality functions. Although the latter combination is promising for many scenarios, technically, it is a complex endeavor. In the AREA (Augmented Reality Engine Application) project, a kernel was implemented that enables location-based mobile augmented reality applications. Importantly, this kernel provides a flexible architecture that fosters the development of individual location-based mobile augmented reality applications. The work at hand shows the flexibility of AREA based on a developed serious game. Furthermore, the algorithm framework and major features of it are presented. As the conclusion of this paper, it is shown that mobile augmented reality applications require high development efforts. Therefore, flexible frameworks like AREA are crucial to develop respective applications in a reasonable time.}, language = {en} } @article{HolfelderMulanskySchleeetal.2021, author = {Holfelder, Marc and Mulansky, Lena and Schlee, Winfried and Baumeister, Harald and Schobel, Johannes and Greger, Helmut and Hoff, Andreas and Pryss, R{\"u}diger}, title = {Medical device regulation efforts for mHealth apps during the COVID-19 pandemic — an experience report of Corona Check and Corona Health}, series = {J — Multidisciplinary Scientific Journal}, volume = {4}, journal = {J — Multidisciplinary Scientific Journal}, number = {2}, issn = {2571-8800}, doi = {10.3390/j4020017}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-285434}, pages = {206 -- 222}, year = {2021}, abstract = {Within the healthcare environment, mobile health (mHealth) applications (apps) are becoming more and more important. The number of new mHealth apps has risen steadily in the last years. Especially the COVID-19 pandemic has led to an enormous amount of app releases. In most countries, mHealth applications have to be compliant with several regulatory aspects to be declared a "medical app". However, the latest applicable medical device regulation (MDR) does not provide more details on the requirements for mHealth applications. When developing a medical app, it is essential that all contributors in an interdisciplinary team — especially software engineers — are aware of the specific regulatory requirements beforehand. The development process, however, should not be stalled due to integration of the MDR. Therefore, a developing framework that includes these aspects is required to facilitate a reliable and quick development process. The paper at hand introduces the creation of such a framework on the basis of the Corona Health and Corona Check apps. The relevant regulatory guidelines are listed and summarized as a guidance for medical app developments during the pandemic and beyond. In particular, the important stages and challenges faced that emerged during the entire development process are highlighted.}, language = {en} } @article{TuetuencueOlmaKunzeetal.2022, author = {T{\"u}t{\"u}nc{\"u}, Serdar and Olma, Manuel C. and Kunze, Claudia and Kr{\"a}mer, Michael and Dietzel, Joanna and Schurig, Johannes and Filser, Paula and Pfeilschifter, Waltraud and Hamann, Gerhard F. and B{\"u}ttner, Thomas and Heuschmann, Peter U. and Kirchhof, Paulus and Laufs, Ulrich and Nabavi, Darius G. and R{\"o}ther, Joachim and Thomalla, G{\"o}tz and Veltkamp, Roland and Eckardt, Kai-Uwe and Haeusler, Karl Georg and Endres, Matthias}, title = {Levels and dynamics of estimated glomerular filtration rate and recurrent vascular events and death in patients with minor stroke or transient ischemic attack}, series = {European Journal of Neurology}, volume = {29}, journal = {European Journal of Neurology}, number = {9}, doi = {10.1111/ene.15431}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-287271}, pages = {2716 -- 2724}, year = {2022}, abstract = {Background and purpose Impaired kidney function is associated with an increased risk of vascular events in acute stroke patients, when assessed by single measurements of estimated glomerular filtration rate (eGFR). It is unknown whether repeated measurements provide additional information for risk prediction. Methods The MonDAFIS (Systematic Monitoring for Detection of Atrial Fibrillation in Patients with Acute Ischemic Stroke) study randomly assigned 3465 acute ischemic stroke patients to either standard procedures or an additive Holter electrocardiogram. Baseline eGFR (CKD-EPI formula) were dichotomized into values of < versus ≥60 ml/min/1.73 m\(^{2}\). eGFR dynamics were classified based on two in-hospital values as "stable normal" (≥60 ml/min/1.73 m\(^{2}\)), "increasing" (by at least 15\% from baseline, second value ≥ 60 ml/min/1.73 m\(^{2}\)), "decreasing" (by at least 15\% from baseline of ≥60 ml/min/1.73 m\(^{2}\)), and "stable decreased" (<60 ml/min/1.73 m\(^{2}\)). The composite endpoint (stroke, major bleeding, myocardial infarction, all-cause death) was assessed after 24 months. We estimated hazard ratios in confounder-adjusted models. Results Estimated glomerular filtration rate at baseline was available in 2947 and a second value in 1623 patients. After adjusting for age, stroke severity, cardiovascular risk factors, and randomization, eGFR < 60 ml/min/1.73 m\(^{2}\) at baseline (hazard ratio [HR] = 2.2, 95\% confidence interval [CI] = 1.40-3.54) as well as decreasing (HR = 1.79, 95\% CI = 1.07-2.99) and stable decreased eGFR (HR = 1.64, 95\% CI = 1.20-2.24) were independently associated with the composite endpoint. In addition, eGFR < 60 ml/min/1.732 at baseline (HR = 3.02, 95\% CI = 1.51-6.10) and decreasing eGFR were associated with all-cause death (HR = 3.12, 95\% CI = 1.63-5.98). Conclusions In addition to patients with low eGFR levels at baseline, also those with decreasing eGFR have increased risk for vascular events and death; hence, repeated estimates of eGFR might add relevant information to risk prediction.}, language = {en} } @article{JansonWillekeZaibertetal.2022, author = {Janson, Patrick and Willeke, Kristina and Zaibert, Lisa and Budnick, Andrea and Bergh{\"o}fer, Anne and Kittel-Schneider, Sarah and Heuschmann, Peter U. and Zapf, Andreas and Wildner, Manfred and Stupp, Carolin and Keil, Thomas}, title = {Mortality, morbidity and health-related outcomes in informal caregivers compared to non-caregivers: a systematic review}, series = {International Journal of Environmental Research and Public Health}, volume = {19}, journal = {International Journal of Environmental Research and Public Health}, number = {10}, issn = {1660-4601}, doi = {10.3390/ijerph19105864}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-275219}, year = {2022}, abstract = {A systematic overview of mental and physical disorders of informal caregivers based on population-based studies with good methodological quality is lacking. Therefore, our aim was to systematically summarize mortality, incidence, and prevalence estimates of chronic diseases in informal caregivers compared to non-caregivers. Following PRISMA recommendations, we searched major healthcare databases (CINAHL, MEDLINE and Web of Science) systematically for relevant studies published in the last 10 years (without language restrictions) (PROSPERO registration number: CRD42020200314). We included only observational cross-sectional and cohort studies with low risk of bias (risk scores 0-2 out of max 8) that reported the prevalence, incidence, odds ratio (OR), hazard ratio (HR), mean- or sum-scores for health-related outcomes in informal caregivers and non-caregivers. For a thorough methodological quality assessment, we used a validated checklist. The synthesis of the results was conducted by grouping outcomes. We included 22 studies, which came predominately from the USA and Europe. Informal caregivers had a significantly lower mortality than non-caregivers. Regarding chronic morbidity outcomes, the results from a large longitudinal German health-insurance evaluation showed increased and statistically significant incidences of severe stress, adjustment disorders, depression, diseases of the spine and pain conditions among informal caregivers compared to non-caregivers. In cross-sectional evaluations, informal caregiving seemed to be associated with a higher occurrence of depression and of anxiety (ranging from 4 to 51\% and 2 to 38\%, respectively), pain, hypertension, diabetes and reduced quality of life. Results from our systematic review suggest that informal caregiving may be associated with several mental and physical disorders. However, these results need to be interpreted with caution, as the cross-sectional studies cannot determine temporal relationships. The lower mortality rates compared to non-caregivers may be due to a healthy-carer bias in longitudinal observational studies; however, these and other potential benefits of informal caregiving deserve further attention by researchers.}, language = {en} } @article{GrabenhenrichTrendelenburgBellachetal.2020, author = {Grabenhenrich, Linus and Trendelenburg, Val{\´e}rie and Bellach, Johanna and Y{\"u}rek, Song{\"u}l and Reich, Andreas and Fiandor, Ana and Rivero, Daniela and Sigurdardottir, Sigurveig and Clausen, Michael and Papadopoulos, Nikolaos G. and Xepapadaki, Paraskevi and Sprikkelman, Aline B. and Dontje, Bianca and Roberts, Graham and Grimshaw, Kate and Kowalski, Marek L. and Kurowski, Marcin and Dubakiene, Ruta and Rudzeviciene, Odilija and Fern{\´a}ndez-Rivas, Montserrat and Couch, Philip and Versteeg, Serge A. and van Ree, Ronald and Mills, Clare and Keil, Thomas and Beyer, Kirsten}, title = {Frequency of food allergy in school-aged children in eight European countries—The EuroPrevall-iFAAM birth cohort}, series = {Allergy}, volume = {75}, journal = {Allergy}, number = {9}, doi = {10.1111/all.14290}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-214746}, pages = {2294 -- 2308}, year = {2020}, abstract = {Background The prevalence of food allergy (FA) among European school children is poorly defined. Estimates have commonly been based on parent-reported symptoms. We aimed to estimate the frequency of FA and sensitization against food allergens in primary school children in eight European countries. Methods A follow-up assessment at age 6-10 years of a multicentre European birth cohort based was undertaken using an online parental questionnaire, clinical visits including structured interviews and skin prick tests (SPT). Children with suspected FA were scheduled for double-blind, placebo-controlled oral food challenges (DBPCFC). Results A total of 6105 children participated in this school-age follow-up (57.8\% of 10 563 recruited at birth). For 982 of 6069 children (16.2\%), parents reported adverse reactions after food consumption in the online questionnaire. Of 2288 children with parental face-to-face interviews and/or skin prick testing, 238 (10.4\%) were eligible for a DBPCFC. Sixty-three foods were challenge-tested in 46 children. Twenty food challenges were positive in 17 children, including seven to hazelnut and three to peanut. Another seventy-one children were estimated to suffer FA among those who were eligible but refused DBPCFC. This yielded prevalence estimates for FA in school age between 1.4\% (88 related to all 6105 participants of this follow-up) and 3.8\% (88 related to 2289 with completed eligibility assessment). Interpretation In primary school children in eight European countries, the prevalence of FA was lower than expected even though parents of this cohort have become especially aware of allergic reactions to food. There was moderate variation between centres hampering valid regional comparisons.}, language = {en} } @article{HelmerRodemersHottenrottetal.2023, author = {Helmer, Philipp and Rodemers, Philipp and Hottenrott, Sebastian and Leppich, Robert and Helwich, Maja and Pryss, R{\"u}diger and Kranke, Peter and Meybohm, Patrick and Winkler, Bernd E. and Sammeth, Michael}, title = {Evaluating blood oxygen saturation measurements by popular fitness trackers in postoperative patients: a prospective clinical trial}, series = {iScience}, volume = {26}, journal = {iScience}, number = {11}, issn = {2589-0042}, doi = {10.1016/j.isci.2023.108155}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-349913}, year = {2023}, abstract = {Summary Blood oxygen saturation is an important clinical parameter, especially in postoperative hospitalized patients, monitored in clinical practice by arterial blood gas (ABG) and/or pulse oximetry that both are not suitable for a long-term continuous monitoring of patients during the entire hospital stay, or beyond. Technological advances developed recently for consumer-grade fitness trackers could—at least in theory—help to fill in this gap, but benchmarks on the applicability and accuracy of these technologies in hospitalized patients are currently lacking. We therefore conducted at the postanaesthesia care unit under controlled settings a prospective clinical trial with 201 patients, comparing in total >1,000 oxygen blood saturation measurements by fitness trackers of three brands with the ABG gold standard and with pulse oximetry. Our results suggest that, despite of an overall still tolerable measuring accuracy, comparatively high dropout rates severely limit the possibilities of employing fitness trackers, particularly during the immediate postoperative period of hospitalized patients. Highlights •The accuracy of O2 measurements by fitness trackers is tolerable (RMSE ≲4\%) •Correlation with arterial blood gas measurements is fair to moderate (PCC = [0.46; 0.64]) •Dropout rates of fitness trackers during O2 monitoring are high (∼1/3 values missing) •Fitness trackers cannot be recommended for O2 measuring during critical monitoring}, language = {en} } @article{SchmiemannGreserMaunetal.2023, author = {Schmiemann, Guido and Greser, Alexandra and Maun, Andy and Bleidorn, Jutta and Schuster, Angela and Miljukov, Olga and R{\"u}cker, Viktoria and Klingeberg, Anja and Mentzel, Anja and Minin, Vitalii and Eckmanns, Tim and Heintze, Christoph and Heuschmann, Peter and G{\´a}gyor, Ildik{\´o}}, title = {Effects of a multimodal intervention in primary care to reduce second line antibiotic prescriptions for urinary tract infections in women: parallel, cluster randomised, controlled trial}, series = {BMJ}, volume = {383}, journal = {BMJ}, issn = {1756-1833}, doi = {10.1136/bmj-2023-076305}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-349395}, year = {2023}, abstract = {Objectives To evaluate whether a multimodal intervention in general practice reduces the proportion of second line antibiotic prescriptions and the overall proportion of antibiotic prescriptions for uncomplicated urinary tract infections in women. Design Parallel, cluster randomised, controlled trial. Setting General practices in five regions in Germany. Data were collected between 1 April 2021 and 31 March 2022. Participants General practitioners from 128 randomly assigned practices. Interventions Multimodal intervention consisting of guideline recommendations for general practitioners and patients, provision of regional data for antibiotic resistance, and quarterly feedback, which included individual first line and second line proportions of antibiotic prescribing, benchmarking with regional or supra-regional practices, and telephone counselling. Participants in the control group received no information on the intervention. Main outcome measures Primary outcome was the proportion of second line antibiotics prescribed by general practices, in relation to all antibiotics prescribed, for uncomplicated urinary tract infections after one year between the intervention and control group. General practices were randomly assigned in blocks (1:1), with a block size of four, into the intervention or control group using SAS version 9.4; randomisation was stratified by region. The secondary outcome was the prescription proportion of all antibiotics, relative within all cases (instances of UTI diagnosis), for the treatment of urinary tract infections after one year between the groups. Adverse events were assessed as exploratory outcomes. Results 110 practices with full datasets identified 10 323 cases during five quarters (ie, 15 months). The mean proportion of second line antibiotics prescribed was 0.19 (standard deviation 0.20) in the intervention group and 0.35 (0.25) in the control group after 12 months. After adjustment for preintervention proportions, the mean difference was -0.13 (95\% confidence interval -0.21 to -0.06, P\<0.001). The overall proportion of all antibiotic prescriptions for urinary tract infections over 12 months was 0.74 (standard deviation 0.22) in the intervention and 0.80 (0.15) in the control group with a mean difference of -0.08 (95\% confidence interval -0.15 to -0.02, P\<0.029). No differences were noted in the number of complications (ie, pyelonephritis, admission to hospital, or fever) between the groups. Conclusions The multimodal intervention in general practice significantly reduced the proportion of second line antibiotics and all antibiotic prescriptions for uncomplicated urinary tract infections in women. Trial registration German Clinical Trials Register (DRKS), DRKS00020389}, language = {en} } @phdthesis{Allgaier2024, author = {Allgaier, Johannes}, title = {Machine Learning Explainability on Multi-Modal Data using Ecological Momentary Assessments in the Medical Domain}, doi = {10.25972/OPUS-35118}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-351189}, school = {Universit{\"a}t W{\"u}rzburg}, year = {2024}, abstract = {Introduction. Mobile health (mHealth) integrates mobile devices into healthcare, enabling remote monitoring, data collection, and personalized interventions. Machine Learning (ML), a subfield of Artificial Intelligence (AI), can use mHealth data to confirm or extend domain knowledge by finding associations within the data, i.e., with the goal of improving healthcare decisions. In this work, two data collection techniques were used for mHealth data fed into ML systems: Mobile Crowdsensing (MCS), which is a collaborative data gathering approach, and Ecological Momentary Assessments (EMA), which capture real-time individual experiences within the individual's common environments using questionnaires and sensors. We collected EMA and MCS data on tinnitus and COVID-19. About 15 \% of the world's population suffers from tinnitus. Materials \& Methods. This thesis investigates the challenges of ML systems when using MCS and EMA data. It asks: How can ML confirm or broad domain knowledge? Domain knowledge refers to expertise and understanding in a specific field, gained through experience and education. Are ML systems always superior to simple heuristics and if yes, how can one reach explainable AI (XAI) in the presence of mHealth data? An XAI method enables a human to understand why a model makes certain predictions. Finally, which guidelines can be beneficial for the use of ML within the mHealth domain? In tinnitus research, ML discerns gender, temperature, and season-related variations among patients. In the realm of COVID-19, we collaboratively designed a COVID-19 check app for public education, incorporating EMA data to offer informative feedback on COVID-19-related matters. This thesis uses seven EMA datasets with more than 250,000 assessments. Our analyses revealed a set of challenges: App user over-representation, time gaps, identity ambiguity, and operating system specific rounding errors, among others. Our systematic review of 450 medical studies assessed prior utilization of XAI methods. Results. ML models predict gender and tinnitus perception, validating gender-linked tinnitus disparities. Using season and temperature to predict tinnitus shows the association of these variables with tinnitus. Multiple assessments of one app user can constitute a group. Neglecting these groups in data sets leads to model overfitting. In select instances, heuristics outperform ML models, highlighting the need for domain expert consultation to unveil hidden groups or find simple heuristics. Conclusion. This thesis suggests guidelines for mHealth related data analyses and improves estimates for ML performance. Close communication with medical domain experts to identify latent user subsets and incremental benefits of ML is essential.}, subject = {Maschinelles Lernen}, language = {en} } @article{BellingerWehrmannRohdeetal.2023, author = {Bellinger, Daniel and Wehrmann, Kristin and Rohde, Anna and Schuppert, Maria and St{\"o}rk, Stefan and Flohr-Jost, Michael and Gall, Dominik and Pauli, Paul and Deckert, J{\"u}rgen and Herrmann, Martin J. and Erhardt-Lehmann, Angelika}, title = {The application of virtual reality exposure versus relaxation training in music performance anxiety: a randomized controlled study}, series = {BMC Psychiatry}, volume = {23}, journal = {BMC Psychiatry}, doi = {10.1186/s12888-023-05040-z}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-357833}, year = {2023}, abstract = {Background Performance anxiety is the most frequently reported anxiety disorder among professional musicians. Typical symptoms are - on a physical level - the consequences of an increase in sympathetic tone with cardiac stress, such as acceleration of heartbeat, increase in blood pressure, increased respiratory rate and tremor up to nausea or flush reactions. These symptoms can cause emotional distress, a reduced musical and artistical performance up to an impaired functioning. While anxiety disorders are preferably treated using cognitive-behavioral therapy with exposure, this approach is rather difficult for treating music performance anxiety since the presence of a public or professional jury is required and not easily available. The use of virtual reality (VR) could therefore display an alternative. So far, no therapy studies on music performance anxiety applying virtual reality exposure therapy have investigated the therapy outcome including cardiovascular changes as outcome parameters. Methods This mono-center, prospective, randomized and controlled clinical trial has a pre-post design with a follow-up period of 6 months. 46 professional and semi-professional musicians will be recruited and allocated randomly to an VR exposure group or a control group receiving progressive muscle relaxation training. Both groups will be treated over 4 single sessions. Music performance anxiety will be diagnosed based on a clinical interview using ICD-10 and DSM-5 criteria for specific phobia or social anxiety. A behavioral assessment test is conducted three times (pre, post, follow-up) in VR through an audition in a concert hall. Primary outcomes are the changes in music performance anxiety measured by the German B{\"u}hnenangstfragebogen and the cardiovascular reactivity reflected by heart rate variability (HRV). Secondary outcomes are changes in blood pressure, stress parameters such as cortisol in the blood and saliva, neuropeptides, and DNA-methylation. Discussion The trial investigates the effect of VR exposure in musicians with performance anxiety compared to a relaxation technique on anxiety symptoms and corresponding cardiovascular parameters. We expect a reduction of anxiety but also a consecutive improvement of HRV with cardiovascular protective effects. Trial registration This study was registered on clinicaltrials.gov. (ClinicalTrials.gov Number: NCT05735860)}, language = {en} } @article{HornKristLiebetal.2021, author = {Horn, A. and Krist, L. and Lieb, W. and Montellano, F. A. and Kohls, M. and Haas, K. and Gelbrich, G. and Bolay-Gehrig, S. J. and Morbach, C. and Reese, J. P. and St{\"o}rk, S. and Fricke, J. and Zoller, T. and Schmidt, S. and Triller, P. and Kretzler, L. and R{\"o}nnefarth, M. and Von Kalle, C. and Willich, S. N. and Kurth, F. and Steinbeis, F. and Witzenrath, M. and Bahmer, T. and Hermes, A. and Krawczak, M. and Reinke, L. and Maetzler, C. and Franzenburg, J. and Enderle, J. and Flinspach, A. and Vehreschild, J. and Schons, M. and Illig, T. and Anton, G. and Ungeth{\"u}m, K. and Finkenberg, B. C. and Gehrig, M. T. and Savaskan, N. and Heuschmann, P. U. and Keil, T. and Schreiber, S.}, title = {Long-term health sequelae and quality of life at least 6 months after infection with SARS-CoV-2: design and rationale of the COVIDOM-study as part of the NAPKON population-based cohort platform (POP)}, series = {Infection}, volume = {49}, journal = {Infection}, number = {6}, issn = {0300-8126}, doi = {10.1007/s15010-021-01707-5}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-308960}, pages = {1277-1287}, year = {2021}, abstract = {Purpose Over the course of COVID-19 pandemic, evidence has accumulated that SARS-CoV-2 infections may affect multiple organs and have serious clinical sequelae, but on-site clinical examinations with non-hospitalized samples are rare. We, therefore, aimed to systematically assess the long-term health status of samples of hospitalized and non-hospitalized SARS-CoV-2 infected individuals from three regions in Germany. Methods The present paper describes the COVIDOM-study within the population-based cohort platform (POP) which has been established under the auspices of the NAPKON infrastructure (German National Pandemic Cohort Network) of the national Network University Medicine (NUM). Comprehensive health assessments among SARS-CoV-2 infected individuals are conducted at least 6 months after the acute infection at the study sites Kiel, W{\"u}rzburg and Berlin. Potential participants were identified and contacted via the local public health authorities, irrespective of the severity of the initial infection. A harmonized examination protocol has been implemented, consisting of detailed assessments of medical history, physical examinations, and the collection of multiple biosamples (e.g., serum, plasma, saliva, urine) for future analyses. In addition, patient-reported perception of the impact of local pandemic-related measures and infection on quality-of-life are obtained. Results As of July 2021, in total 6813 individuals infected in 2020 have been invited into the COVIDOM-study. Of these, about 36\% wished to participate and 1295 have already been examined at least once. Conclusion NAPKON-POP COVIDOM-study complements other Long COVID studies assessing the long-term consequences of an infection with SARS-CoV-2 by providing detailed health data of population-based samples, including individuals with various degrees of disease severity. Trial registration Registered at the German registry for clinical studies (DRKS00023742).}, language = {en} } @article{TuetuencueOlmaKunzeetal.2022, author = {T{\"u}t{\"u}nc{\"u}, Serdar and Olma, Manuel and Kunze, Claudia and Dietzel, Joanna and Schurig, Johannes and Fiessler, Cornelia and Malsch, Carolin and Haas, Tobias Eberhard and Dimitrijeski, Boris and Doehner, Wolfram and Hagemann, Georg and Hamilton, Frank and Honermann, Martin and Jungehulsing, Gerhard Jan and Kauert, Andreas and Koennecke, Hans-Christian and Mackert, Bruno-Marcel and Nabavi, Darius and Nolte, Christian H. and Reis, Joschua Mirko and Schmehl, Ingo and Sparenberg, Paul and Stingele, Robert and V{\"o}lzke, Enrico and Waldschmidt, Carolin and Zeise-Wehry, Daniel and Heuschmann, Peter U. and Endress, Matthias and Haeusler, Karl Georg}, title = {Off-label-dosing of non-vitamin K-dependent oral antagonists in AF patients before and after stroke: results of the prospective multicenter Berlin Atrial Fibrillation Registry}, series = {Journal of Neurology}, volume = {269}, journal = {Journal of Neurology}, number = {1}, issn = {1432-1459}, doi = {10.1007/s00415-021-10866-2}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-266969}, pages = {470-480}, year = {2022}, abstract = {Aims We aimed to analyze prevalence and predictors of NOAC off-label under-dosing in AF patients before and after the index stroke. Methods The post hoc analysis included 1080 patients of the investigator-initiated, multicenter prospective Berlin Atrial Fibrillation Registry, designed to analyze medical stroke prevention in AF patients after acute ischemic stroke. Results At stroke onset, an off-label daily dose was prescribed in 61 (25.5\%) of 239 NOAC patients with known AF and CHA2DS2-VASc score ≥ 1, of which 52 (21.8\%) patients were under-dosed. Under-dosing was associated with age ≥ 80 years in patients on rivaroxaban [OR 2.90, 95\% CI 1.05-7.9, P = 0.04; n = 29] or apixaban [OR 3.24, 95\% CI 1.04-10.1, P = 0.04; n = 22]. At hospital discharge after the index stroke, NOAC off-label dose on admission was continued in 30 (49.2\%) of 61 patients. Overall, 79 (13.7\%) of 708 patients prescribed a NOAC at hospital discharge received an off-label dose, of whom 75 (10.6\%) patients were under-dosed. Rivaroxaban under-dosing at discharge was associated with age ≥ 80 years [OR 3.49, 95\% CI 1.24-9.84, P = 0.02; n = 19]; apixaban under-dosing with body weight ≤ 60 kg [OR 0.06, 95\% CI 0.01-0.47, P < 0.01; n = 56], CHA2DS2-VASc score [OR per point 1.47, 95\% CI 1.08-2.00, P = 0.01], and HAS-BLED score [OR per point 1.91, 95\% CI 1.28-2.84, P < 0.01]. Conclusion At stroke onset, off-label dosing was present in one out of four, and under-dosing in one out of five NOAC patients. Under-dosing of rivaroxaban or apixaban was related to old age. In-hospital treatment after stroke reduced off-label NOAC dosing, but one out of ten NOAC patients was under-dosed at discharge.}, language = {en} } @article{HerrmannAdamNotzetal.2020, author = {Herrmann, Johannes and Adam, Elisabeth Hannah and Notz, Quirin and Helmer, Philipp and Sonntagbauer, Michael and Ungemach-Papenberg, Peter and Sanns, Andreas and Zausig, York and Steinfeldt, Thorsten and Torje, Iuliu and Schmid, Benedikt and Schlesinger, Tobias and Rolfes, Caroline and Reyher, Christian and Kredel, Markus and Stumpner, Jan and Brack, Alexander and Wurmb, Thomas and Gill-Schuster, Daniel and Kranke, Peter and Weismann, Dirk and Klinker, Hartwig and Heuschmann, Peter and R{\"u}cker, Viktoria and Frantz, Stefan and Ertl, Georg and Muellenbach, Ralf Michael and Mutlak, Haitham and Meybohm, Patrick and Zacharowski, Kai and Lotz, Christopher}, title = {COVID-19 Induced Acute Respiratory Distress Syndrome — A Multicenter Observational Study}, series = {Frontiers in Medicine}, volume = {7}, journal = {Frontiers in Medicine}, issn = {2296-858X}, doi = {10.3389/fmed.2020.599533}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-219834}, year = {2020}, abstract = {Background: Proportions of patients dying from the coronavirus disease-19 (COVID-19) vary between different countries. We report the characteristics; clinical course and outcome of patients requiring intensive care due to COVID-19 induced acute respiratory distress syndrome (ARDS). Methods: This is a retrospective, observational multicentre study in five German secondary or tertiary care hospitals. All patients consecutively admitted to the intensive care unit (ICU) in any of the participating hospitals between March 12 and May 4, 2020 with a COVID-19 induced ARDS were included. Results: A total of 106 ICU patients were treated for COVID-19 induced ARDS, whereas severe ARDS was present in the majority of cases. Survival of ICU treatment was 65.0\%. Median duration of ICU treatment was 11 days; median duration of mechanical ventilation was 9 days. The majority of ICU treated patients (75.5\%) did not receive any antiviral or anti-inflammatory therapies. Venovenous (vv) ECMO was utilized in 16.3\%. ICU triage with population-level decision making was not necessary at any time. Univariate analysis associated older age, diabetes mellitus or a higher SOFA score on admission with non-survival during ICU stay. Conclusions: A high level of care adhering to standard ARDS treatments lead to a good outcome in critically ill COVID-19 patients.}, language = {en} } @article{KippnichSkazelKlingshirnetal.2022, author = {Kippnich, Maximilian and Skazel, Tobias and Klingshirn, Hanna and Gerken, Laura and Heuschmann, Peter and Haas, Kirsten and Schutzmeier, Martha and Brandstetter, Lilly and Weismann, Dirk and Reuschenbach, Bernd and Meybohm, Patrick and Wurmb, Thomas}, title = {Analyse des Weaningprozesses bei Intensivpatienten im Hinblick auf Dokumentation und Verlegung in weiterbehandelnde Einheiten}, series = {Medizinische Klinik, Intensivmedizin und Notfallmedizin}, volume = {118}, journal = {Medizinische Klinik, Intensivmedizin und Notfallmedizin}, doi = {10.1007/s00063-022-00941-5}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-346742}, pages = {269-276}, year = {2022}, abstract = {Hintergrund und Fragestellung Die Entw{\"o}hnung von Beatmungsger{\"a}ten wird nicht immer auf der prim{\"a}r behandelnden Intensivstation abgeschlossen. Die Weiterverlegung in andere Behandlungseinrichtungen stellt einen sensiblen Abschnitt in der Behandlung und Rehabilitation des Weaningpatienten dar. Ziel der vorliegenden Studie war die Untersuchung des {\"U}berleitungsmanagements und des Interhospitaltransfers von Weaningpatienten unter besonderer Ber{\"u}cksichtigung der Dokumentationsqualit{\"a}t. Methodik Es erfolge eine retrospektive Datenanalyse eines Jahrs (2018) auf 2 Intensivstationen eines Universit{\"a}tsklinikums. Eingeschlossen wurden alle beatmeten Patienten mit folgenden Tracerdiagnosen: COPD, Asthma, Polytrauma, Pneumonie, Sepsis, ARDS und Reanimation (Beatmung > 24 h). Ergebnisse Insgesamt konnten 750 Patienten in die Untersuchung eingeschlossen werden (Alter 64 [52, 8-76; Median, IQR]; 32 \% weiblich). Davon waren 48 (6,4 \%) Patienten zum Zeitpunkt der Verlegung nicht entw{\"o}hnt (v. a. Sepsis und ARDS). Die Routinedokumentation war bei den Abschnitten „Spontaneous Breathing Trial", „Bewertung der Entw{\"o}hungsbereitschaft" und „vermutete Entw{\"o}hnbarkeit" ausreichend, um die Erf{\"u}llung der Parameter der S2k-Leitlinie „Prolongiertes Weaning" ad{\"a}quat zu beurteilen. Vorwiegend wurden diese Patienten mit Tracheostoma (76 \%) in Rehabilitationskliniken (44 \%) mittels spezialisierten Rettungsmitteln des arztbegleiteten Patiententransports verlegt (75 \%). Diskussion Die Verlegung nicht entw{\"o}hnter Patienten nach initialem Intensivaufenthalt ist ein relevantes Thema f{\"u}r den Interhospitaltransfer. Die Routinedokumentation eines strukturierten Weaningprozesses ist in Kernelementen ausreichend, um den Weaningprozess l{\"u}ckenlos zu beschreiben. Dies ist f{\"u}r die Kontinuit{\"a}t in der Weiterbehandlung dieser Patienten von großer Bedeutung.}, language = {de} } @article{HerrmannLotzKaragiannidisetal.2022, author = {Herrmann, Johannes and Lotz, Christopher and Karagiannidis, Christian and Weber-Carstens, Steffen and Kluge, Stefan and Putensen, Christian and Wehrfritz, Andreas and Schmidt, Karsten and Ellerkmann, Richard K. and Oswald, Daniel and Lotz, G{\"o}sta and Zotzmann, Viviane and Moerer, Onnen and K{\"u}hn, Christian and Kochanek, Matthias and Muellenbach, Ralf and Gaertner, Matthias and Fichtner, Falk and Brettner, Florian and Findeisen, Michael and Heim, Markus and Lahmer, Tobias and Rosenow, Felix and Haake, Nils and Lepper, Philipp M. and Rosenberger, Peter and Braune, Stephan and Kohls, Mirjam and Heuschmann, Peter and Meybohm, Patrick}, title = {Key characteristics impacting survival of COVID-19 extracorporeal membrane oxygenation}, series = {Critical Care}, volume = {26}, journal = {Critical Care}, number = {1}, doi = {10.1186/s13054-022-04053-6}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-299686}, year = {2022}, abstract = {Background Severe COVID-19 induced acute respiratory distress syndrome (ARDS) often requires extracorporeal membrane oxygenation (ECMO). Recent German health insurance data revealed low ICU survival rates. Patient characteristics and experience of the ECMO center may determine intensive care unit (ICU) survival. The current study aimed to identify factors affecting ICU survival of COVID-19 ECMO patients. Methods 673 COVID-19 ARDS ECMO patients treated in 26 centers between January 1st 2020 and March 22nd 2021 were included. Data on clinical characteristics, adjunct therapies, complications, and outcome were documented. Block wise logistic regression analysis was applied to identify variables associated with ICU-survival. Results Most patients were between 50 and 70 years of age. PaO\(_{2}\)/FiO\(_{2}\) ratio prior to ECMO was 72 mmHg (IQR: 58-99). ICU survival was 31.4\%. Survival was significantly lower during the 2nd wave of the COVID-19 pandemic. A subgroup of 284 (42\%) patients fulfilling modified EOLIA criteria had a higher survival (38\%) (p = 0.0014, OR 0.64 (CI 0.41-0.99)). Survival differed between low, intermediate, and high-volume centers with 20\%, 30\%, and 38\%, respectively (p = 0.0024). Treatment in high volume centers resulted in an odds ratio of 0.55 (CI 0.28-1.02) compared to low volume centers. Additional factors associated with survival were younger age, shorter time between intubation and ECMO initiation, BMI > 35 (compared to < 25), absence of renal replacement therapy or major bleeding/thromboembolic events. Conclusions Structural and patient-related factors, including age, comorbidities and ECMO case volume, determined the survival of COVID-19 ECMO. These factors combined with a more liberal ECMO indication during the 2nd wave may explain the reasonably overall low survival rate. Careful selection of patients and treatment in high volume ECMO centers was associated with higher odds of ICU survival.}, language = {en} } @article{HelmerHottenrottRodemersetal.2022, author = {Helmer, Philipp and Hottenrott, Sebastian and Rodemers, Philipp and Leppich, Robert and Helwich, Maja and Pryss, R{\"u}diger and Kranke, Peter and Meybohm, Patrick and Winkler, Bernd E. and Sammeth, Michael}, title = {Accuracy and Systematic Biases of Heart Rate Measurements by Consumer-Grade Fitness Trackers in Postoperative Patients: Prospective Clinical Trial}, series = {Journal of Medical Internet Research}, volume = {24}, journal = {Journal of Medical Internet Research}, number = {12}, doi = {10.2196/42359}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-299679}, year = {2022}, abstract = {Background: Over the recent years, technological advances of wrist-worn fitness trackers heralded a new era in the continuous monitoring of vital signs. So far, these devices have primarily been used for sports. Objective: However, for using these technologies in health care, further validations of the measurement accuracy in hospitalized patients are essential but lacking to date. Methods: We conducted a prospective validation study with 201 patients after moderate to major surgery in a controlled setting to benchmark the accuracy of heart rate measurements in 4 consumer-grade fitness trackers (Apple Watch 7, Garmin Fenix 6 Pro, Withings ScanWatch, and Fitbit Sense) against the clinical gold standard (electrocardiography). Results: All devices exhibited high correlation (r≥0.95; P<.001) and concordance (rc≥0.94) coefficients, with a relative error as low as mean absolute percentage error <5\% based on 1630 valid measurements. We identified confounders significantly biasing the measurement accuracy, although not at clinically relevant levels (mean absolute error<5 beats per minute). Conclusions: Consumer-grade fitness trackers appear promising in hospitalized patients for monitoring heart rate.}, language = {en} } @article{WeissGruendahlDeckertetal.2023, author = {Weiß, Martin and Gr{\"u}ndahl, Marthe and Deckert, J{\"u}rgen and Eichner, Felizitas A. and Kohls, Mirjam and St{\"o}rk, Stefan and Heuschmann, Peter U. and Hein, Grit}, title = {Differential network interactions between psychosocial factors, mental health, and health-related quality of life in women and men}, series = {Scientific Reports}, volume = {13}, journal = {Scientific Reports}, organization = {STAAB-COVID Study Group}, doi = {10.1038/s41598-023-38525-8}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-357858}, year = {2023}, abstract = {Psychosocial factors affect mental health and health-related quality of life (HRQL) in a complex manner, yet gender differences in these interactions remain poorly understood. We investigated whether psychosocial factors such as social support and personal and work-related concerns impact mental health and HRQL differentially in women and men during the first year of the COVID-19 pandemic. Between June and October 2020, the first part of a COVID-19-specific program was conducted within the "Characteristics and Course of Heart Failure Stages A-B and Determinants of Progression (STAAB)" cohort study, a representative age- and gender-stratified sample of the general population of W{\"u}rzburg, Germany. Using psychometric networks, we first established the complex relations between personal social support, personal and work-related concerns, and their interactions with anxiety, depression, and HRQL. Second, we tested for gender differences by comparing expected influence, edge weight differences, and stability of the networks. The network comparison revealed a significant difference in the overall network structure. The male (N = 1370) but not the female network (N = 1520) showed a positive link between work-related concern and anxiety. In both networks, anxiety was the most central variable. These findings provide further evidence that the complex interplay of psychosocial factors with mental health and HRQL decisively depends on gender. Our results are relevant for the development of gender-specific interventions to increase resilience in times of pandemic crisis.}, language = {en} } @article{HerrmannMuellerNotzetal.2023, author = {Herrmann, Johannes and M{\"u}ller, Kerstin and Notz, Quirin and H{\"u}bsch, Martha and Haas, Kirsten and Horn, Anna and Schmidt, Julia and Heuschmann, Peter and Maschmann, Jens and Frosch, Matthias and Deckert, J{\"u}rgen and Einsele, Hermann and Ertl, Georg and Frantz, Stefan and Meybohm, Patrick and Lotz, Christopher}, title = {Prospective single-center study of health-related quality of life after COVID-19 in ICU and non-ICU patients}, series = {Scientific Reports}, volume = {13}, journal = {Scientific Reports}, doi = {10.1038/s41598-023-33783-y}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-357174}, year = {2023}, abstract = {Long-term sequelae in hospitalized Coronavirus Disease 2019 (COVID-19) patients may result in limited quality of life. The current study aimed to determine health-related quality of life (HRQoL) after COVID-19 hospitalization in non-intensive care unit (ICU) and ICU patients. This is a single-center study at the University Hospital of Wuerzburg, Germany. Patients eligible were hospitalized with COVID-19 between March 2020 and December 2020. Patients were interviewed 3 and 12 months after hospital discharge. Questionnaires included the European Quality of Life 5 Dimensions 5 Level (EQ-5D-5L), patient health questionnaire-9 (PHQ-9), the generalized anxiety disorder 7 scale (GAD-7), FACIT fatigue scale, perceived stress scale (PSS-10) and posttraumatic symptom scale 10 (PTSS-10). 85 patients were included in the study. The EQ5D-5L-Index significantly differed between non-ICU (0.78 ± 0.33 and 0.84 ± 0.23) and ICU (0.71 ± 0.27; 0.74 ± 0.2) patients after 3- and 12-months. Of non-ICU 87\% and 80\% of ICU survivors lived at home without support after 12 months. One-third of ICU and half of the non-ICU patients returned to work. A higher percentage of ICU patients was limited in their activities of daily living compared to non-ICU patients. Depression and fatigue were present in one fifth of the ICU patients. Stress levels remained high with only 24\% of non-ICU and 3\% of ICU patients (p = 0.0186) having low perceived stress. Posttraumatic symptoms were present in 5\% of non-ICU and 10\% of ICU patients. HRQoL is limited in COVID-19 ICU patients 3- and 12-months post COVID-19 hospitalization, with significantly less improvement at 12-months compared to non-ICU patients. Mental disorders were common highlighting the complexity of post-COVID-19 symptoms as well as the necessity to educate patients and primary care providers about monitoring mental well-being post COVID-19.}, language = {en} } @article{SchraderRuckBorgulyaetal.2023, author = {Schrader, Hanna and Ruck, Jessica and Borgulya, G{\´a}bor and Parisi, Sandra and Ehlers-Mondorf, Jana and Kaduszkiewicz, Hanna and Joos, Stefanie and Grau, Anna and Linde, Klaus and G{\´a}gyor, Ildik{\´o}}, title = {Stress experiences of healthcare assistants in family practice at the onset of the COVID-19 pandemic}, series = {Frontiers in Public Health}, volume = {11}, journal = {Frontiers in Public Health}, issn = {2296-2565}, doi = {10.3389/fpubh.2023.1238144}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-327427}, year = {2023}, abstract = {Background: At the beginning of the pandemic in 2020, healthcare assistants in general practices were confronted with numerous new challenges. The aim of the study was to investigate the stress factors of healthcare assistants in March/April 2020 as well as in the further course of the pandemic in 2020. Methods: From August to December 2020, 6,300 randomly selected healthcare assistants in four German states were invited to participate in the study. We performed a mixed methods design using semi-structured telephone interviews and a cross-sectional survey with quantitative and open questions. The feeling of psychological burden was assessed on a 6-point likert-scale. We defined stress factors and categorized them in patient, non-patient and organizational stress factors. The results of the three data sets were compared within a triangulation protocol. Results: One thousand two hundred seventy-four surveys were analyzed and 28 interviews with 34 healthcare assistants were conducted. Of the participants, 29.5\% reported experiences of a very high or high feeling of psychological burden in March/April 2020. Worries about the patients' health and an uncertainty around the new disease were among the patient-related stress factors. Non-patient-related stress factors were problems with the compatibility of work and family, and the fear of infecting relatives with COVID-19. Organizational efforts and dissatisfaction with governmental pandemic management were reported as organizational stress factors. Support from the employer and team cohesion were considered as important resources. Discussion: It is necessary to reduce stress among healthcare assistants by improving their working conditions and to strengthen their resilience to ensure primary healthcare delivery in future health crises.}, language = {en} } @article{BeierlePryssAizawa2023, author = {Beierle, Felix and Pryss, R{\"u}diger and Aizawa, Akiko}, title = {Sentiments about mental health on Twitter — before and during the COVID-19 pandemic}, series = {Healthcare}, volume = {11}, journal = {Healthcare}, number = {21}, issn = {2227-9032}, doi = {10.3390/healthcare11212893}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-355192}, year = {2023}, abstract = {During the COVID-19 pandemic, the novel coronavirus had an impact not only on public health but also on the mental health of the population. Public sentiment on mental health and depression is often captured only in small, survey-based studies, while work based on Twitter data often only looks at the period during the pandemic and does not make comparisons with the pre-pandemic situation. We collected tweets that included the hashtags \#MentalHealth and \#Depression from before and during the pandemic (8.5 months each). We used LDA (Latent Dirichlet Allocation) for topic modeling and LIWC, VADER, and NRC for sentiment analysis. We used three machine-learning classifiers to seek evidence regarding an automatically detectable change in tweets before vs. during the pandemic: (1) based on TF-IDF values, (2) based on the values from the sentiment libraries, (3) based on tweet content (deep-learning BERT classifier). Topic modeling revealed that Twitter users who explicitly used the hashtags \#Depression and especially \#MentalHealth did so to raise awareness. We observed an overall positive sentiment, and in tough times such as during the COVID-19 pandemic, tweets with \#MentalHealth were often associated with gratitude. Among the three classification approaches, the BERT classifier showed the best performance, with an accuracy of 81\% for \#MentalHealth and 79\% for \#Depression. Although the data may have come from users familiar with mental health, these findings can help gauge public sentiment on the topic. The combination of (1) sentiment analysis, (2) topic modeling, and (3) tweet classification with machine learning proved useful in gaining comprehensive insight into public sentiment and could be applied to other data sources and topics.}, language = {en} } @article{TiffeWagnerRueckeretal.2017, author = {Tiffe, Theresa and Wagner, Martin and R{\"u}cker, Viktoria and Morbach, Caroline and Gelbrich, G{\"o}tz and St{\"o}rk, Stefan and Heuschmann, Peter U.}, title = {Control of cardiovascular risk factors and its determinants in the general population - findings from the STAAB cohort study}, series = {BMC Cardiovascular Disorders}, volume = {17}, journal = {BMC Cardiovascular Disorders}, number = {276}, doi = {10.1186/s12872-017-0708-x}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-159391}, year = {2017}, abstract = {Background: While data from primary care suggest an insufficient control of vascular risk factors, little is known about vascular risk factor control in the general population. We therefore aimed to investigate the adoption of adequate risk factor control and its determinants in the general population free of cardiovascular disease (CVD). Methods: Data from the Characteristics and Course of Heart Failure Stages A-B and Determinants of Progression (STAAB) Cohort Study, a population-based study of inhabitants aged 30 to 79 years from the general population of W{\"u}rzburg (Germany), were used. Proportions of participants without established CVD meeting targets for risk factor control recommended by 2016 ESC guideline were identified. Determinants of the accumulation of insufficiently controlled vascular risk factors (three or more) were assessed. Results: Between December 2013 and April 2015, 1379 participants without CVD were included; mean age was 53.1 ± 11.9 years and 52.9\% were female; 30.8\% were physically inactive, 55.2\% overweight, 19.3\% current smokers. Hypertension, dyslipidemia, and diabetes mellitus were prevalent in 31.8\%, 57.6\%, and 3.9\%, respectively. Treatment goals were not reached despite medication in 52.7\% of hypertensive, in 37.3\% of hyperlipidemic and in 44.0\% of diabetic subjects. Insufficiently controlled risk was associated with male sex (OR 1.94, 95\%CI 1.44-2.61), higher age (OR for 30-39 years vs. 70-79 years 4.01, 95\%CI 1.94-8.31) and lower level of education (OR for primary vs. tertiary 2.15, 95\%CI 1.48-3.11). Conclusions: In the general population, prevalence of vascular risk factors was high. We found insufficient identification and control of vascular risk factors and a considerable potential to improve adherence to cardiovascular guidelines for primary prevention. Further studies are needed to identify and overcome patient- and physician-related barriers impeding successful control of vascular risk factors in the general population.}, language = {en} } @article{SahitiMorbachCejkaetal.2022, author = {Sahiti, Floran and Morbach, Caroline and Cejka, Vladimir and Tiffe, Theresa and Wagner, Martin and Eichner, Felizitas A. and Gelbrich, G{\"o}tz and Heuschmann, Peter U. and St{\"o}rk, Stefan}, title = {Impact of cardiovascular risk factors on myocardial work-insights from the STAAB cohort study}, series = {Journal of Human Hypertension}, volume = {36}, journal = {Journal of Human Hypertension}, number = {3}, issn = {1476-5527}, doi = {10.1038/s41371-021-00509-4}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-271770}, pages = {235-245}, year = {2022}, abstract = {Myocardial work is a new echocardiography-based diagnostic tool, which allows to quantify left ventricular performance based on pressure-strain loops, and has been validated against invasively derived pressure-volume measurements. Myocardial work is described by its components (global constructive work [GCW], global wasted work [GWW]) and indices (global work index [GWI], global work efficiency [GWE]). Applying this innovative concept, we characterized the prevalence and severity of subclinical left ventricular compromise in the general population and estimated its association with cardiovascular (CV) risk factors. Within the Characteristics and Course of Heart Failure STAges A/B and Determinants of Progression (STAAB) cohort study we comprehensively phenotyped a representative sample of the population of W{\"u}rzburg, Germany, aged 30-79 years. Indices of myocardial work were determined in 1929 individuals (49.3\% female, mean age 54 ± 12 years). In multivariable analysis, hypertension was associated with a mild increase in GCW, but a profound increase in GWW, resulting in higher GWI and lower GWE. All other CV risk factors were associated with lower GCW and GWI, but not with GWW. The association of hypertension and obesity with GWI was stronger in women. We conclude that traditional CV risk factors impact selectively and gender-specifically on left ventricular myocardial performance, independent of systolic blood pressure. Quantifying active systolic and diastolic compromise by derivation of myocardial work advances our understanding of pathophysiological processes in health and cardiac disease.}, language = {en} } @article{WinterPryssProbstetal.2021, author = {Winter, Michael and Pryss, R{\"u}diger and Probst, Thomas and Reichert, Manfred}, title = {Applying Eye Movement Modeling Examples to guide novices' attention in the comprehension of process models}, series = {Brain Sciences}, volume = {11}, journal = {Brain Sciences}, number = {1}, issn = {2076-3425}, doi = {10.3390/brainsci11010072}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-222966}, year = {2021}, abstract = {Process models are crucial artifacts in many domains, and hence, their proper comprehension is of importance. Process models mediate a plethora of aspects that are needed to be comprehended correctly. Novices especially face difficulties in the comprehension of process models, since the correct comprehension of such models requires process modeling expertise and visual observation capabilities to interpret these models correctly. Research from other domains demonstrated that the visual observation capabilities of experts can be conveyed to novices. In order to evaluate the latter in the context of process model comprehension, this paper presents the results from ongoing research, in which gaze data from experts are used as Eye Movement Modeling Examples (EMMEs) to convey visual observation capabilities to novices. Compared to prior results, the application of EMMEs improves process model comprehension significantly for novices. Novices achieved in some cases similar performances in process model comprehension to experts. The study's insights highlight the positive effect of EMMEs on fostering the comprehension of process models.}, language = {en} } @article{SommerAmrBavendieketal.2022, author = {Sommer, Kim K. and Amr, Ali and Bavendiek, Udo and Beierle, Felix and Brunecker, Peter and Dathe, Henning and Eils, J{\"u}rgen and Ertl, Maximilian and Fette, Georg and Gietzelt, Matthias and Heidecker, Bettina and Hellenkamp, Kristian and Heuschmann, Peter and Hoos, Jennifer D. E. and Keszty{\"u}s, Tibor and Kerwagen, Fabian and Kindermann, Aljoscha and Krefting, Dagmar and Landmesser, Ulf and Marschollek, Michael and Meder, Benjamin and Merzweiler, Angela and Prasser, Fabian and Pryss, R{\"u}diger and Richter, Jendrik and Schneider, Philipp and St{\"o}rk, Stefan and Dieterich, Christoph}, title = {Structured, harmonized, and interoperable integration of clinical routine data to compute heart failure risk scores}, series = {Life}, volume = {12}, journal = {Life}, number = {5}, issn = {2075-1729}, doi = {10.3390/life12050749}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-275239}, year = {2022}, abstract = {Risk prediction in patients with heart failure (HF) is essential to improve the tailoring of preventive, diagnostic, and therapeutic strategies for the individual patient, and effectively use health care resources. Risk scores derived from controlled clinical studies can be used to calculate the risk of mortality and HF hospitalizations. However, these scores are poorly implemented into routine care, predominantly because their calculation requires considerable efforts in practice and necessary data often are not available in an interoperable format. In this work, we demonstrate the feasibility of a multi-site solution to derive and calculate two exemplary HF scores from clinical routine data (MAGGIC score with six continuous and eight categorical variables; Barcelona Bio-HF score with five continuous and six categorical variables). Within HiGHmed, a German Medical Informatics Initiative consortium, we implemented an interoperable solution, collecting a harmonized HF-phenotypic core data set (CDS) within the openEHR framework. Our approach minimizes the need for manual data entry by automatically retrieving data from primary systems. We show, across five participating medical centers, that the implemented structures to execute dedicated data queries, followed by harmonized data processing and score calculation, work well in practice. In summary, we demonstrated the feasibility of clinical routine data usage across multiple partner sites to compute HF risk scores. This solution can be extended to a large spectrum of applications in clinical care.}, language = {en} } @article{JovanovicKlassenHeuschmannetal.2020, author = {Jovanovic, Ana and Klassen, Philipp and Heuschmann, Peter and Sommer, Claudia and Roberts, Mark and {\"U}{\c{c}}eyler, Nurcan}, title = {English version of the self-administered Fabry Pain Questionnaire for adult patients}, series = {Orphanet Journal of Rare Diseases}, volume = {15}, journal = {Orphanet Journal of Rare Diseases}, doi = {10.1186/s13023-020-01580-9}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-230298}, year = {2020}, abstract = {Background Pain is an early symptom of Fabry disease (FD) and is characterized by a unique phenotype with mainly episodic acral and triggerable burning pain. Recently, we designed and validated the first pain questionnaire for adult FD patients in an interview and a self-administered version in German: the Wurzburg Fabry Pain Questionnaire (FPQ). We now report the validation of the English version of the self-administered FPQ (enFPQ). Methods After two forward-backward translations of the FPQ by native German and native English speakers, the enFPQ was applied at The Mark Holland Metabolic Unit, Manchester, UK for validation. Consecutive patients with genetically ascertained FD and current or previous FD pain underwent a face-to-face interview using the enFPQ. Two weeks later, patients filled in the self-administered enFPQ at home. The agreement between entries collected by supervised administration and self-administration of the enFPQ was assessed via Gwet's AC1-statistics (AC1) for nominal-scaled scores and intraclass correlation coefficient (ICC) for interval-scaled elements. Results Eighty-three FD patients underwent the face-to-face interview and 54 patients sent back a completed self-administered version of the enFPQ 2 weeks later. We found high agreement with a mean AC1-statistics of 0.725 for 55 items, and very high agreement with a mean ICC of 0.811 for 9 items. Conclusions We provide the validated English version of the FPQ for self-administration in adult FD patients. The enFPQ collects detailed information on the individual FD pain phenotype and thus builds a solid basis for better pain classification and treatment in patients with FD.}, language = {en} } @article{PryssSchleeHoppenstedtetal.2020, author = {Pryss, R{\"u}diger and Schlee, Winfried and Hoppenstedt, Burkhard and Reichert, Manfred and Spiliopoulou, Myra and Langguth, Berthold and Breitmayer, Marius and Probst, Thomas}, title = {Applying Machine Learning to Daily-Life Data From the TrackYourTinnitus Mobile Health Crowdsensing Platform to Predict the Mobile Operating System Used With High Accuracy: Longitudinal Observational Study}, series = {Journal of Medical Internet Research}, volume = {22}, journal = {Journal of Medical Internet Research}, number = {6}, doi = {10.2196/15547}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-229517}, year = {2020}, abstract = {Background: Tinnitus is often described as the phantom perception of a sound and is experienced by 5.1\% to 42.7\% of the population worldwide, at least once during their lifetime. The symptoms often reduce the patient's quality of life. The TrackYourTinnitus (TYT) mobile health (mHealth) crowdsensing platform was developed for two operating systems (OS)-Android and iOS-to help patients demystify the daily moment-to-moment variations of their tinnitus symptoms. In all platforms developed for more than one OS, it is important to investigate whether the crowdsensed data predicts the OS that was used in order to understand the degree to which the OS is a confounder that is necessary to consider.}, language = {en} } @article{EichnerReisDoresetal.2021, author = {Eichner, Felizitas A. and Reis, Joschua M. and Dores, Joaquim and Pavlovic, Vladimir and Kreß, Luisa and Daneshkhah, Naeimeh and Weinhardt, Renate and Grau, Armin and M{\"u}hler, Johannes and Soda, Hassan and Schwarzbach, Christopher J. and Schuler, Michael and H{\"a}usler, Karl Georg and Heuschmann, Peter U.}, title = {Cross-sectional study on patients' understanding and views of the informed consent procedure of a secondary stroke prevention trial}, series = {European Journal of Neurology}, volume = {28}, journal = {European Journal of Neurology}, number = {8}, doi = {10.1111/ene.14917}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-259404}, pages = {2639-2647}, year = {2021}, abstract = {Background and purpose Improving understanding of study contents and procedures might enhance recruitment into studies and retention during follow-up. However, data in stroke patients on understanding of the informed consent (IC) procedure are sparse. Methods We conducted a cross-sectional study among ischemic stroke patients taking part in the IC procedure of an ongoing cluster-randomized secondary prevention trial. All aspects of the IC procedure were assessed in an interview using a standardized 20-item questionnaire. Responses were collected within 72 h after the IC procedure and analyzed quantitatively and qualitatively. Participants were also asked their main reasons for participation. Results A total of 146 stroke patients (65 ± 12 years old, 38\% female) were enrolled. On average, patients recalled 66.4\% (95\% confidence interval = 65.2\%-67.5\%) of the content of the IC procedure. Most patients understood that participation was voluntary (99.3\%) and that they had the right to withdraw consent (97.1\%); 79.1\% of the patients recalled the study duration and 56.1\% the goal. Only 40.3\% could clearly state a benefit of participation, and 28.8\% knew their group allocation. Younger age, higher graduation, and allocation to the intervention group were associated with better understanding. Of all patients, 53\% exclusively stated a personal and 22\% an altruistic reason for participation. Conclusions Whereas understanding of patient rights was high, many patients were unable to recall other important aspects of study content and procedures. Increased attention to older and less educated patients may help to enhance understanding in this patient population. Actual recruitment and retention benefit of an improved IC procedure remains to be tested in a randomized trial.}, language = {en} } @article{JirůHillmannGabrielSchuleretal.2022, author = {J{\´i}rů-Hillmann, Steffi and Gabriel, Katharina M. A. and Schuler, Michael and Wiedmann, Silke and M{\"u}hler, Johannes and D{\"o}tter, Klaus and Soda, Hassan and Rascher, Alexandra and Benesch, Sonka and Kraft, Peter and Pfau, Mathias and Stenzel, Joachim and von Nippold, Karin and Benghebrid, Mohamed and Schulte, Kerstin and Meinck, Ralf and Volkmann, Jens and Haeusler, Karl Georg and Heuschmann, Peter U.}, title = {Experiences of family caregivers 3-months after stroke: results of the prospective trans-regional network for stroke intervention with telemedicine registry (TRANSIT-Stroke)}, series = {BMC Geriatrics}, volume = {22}, journal = {BMC Geriatrics}, doi = {10.1186/s12877-022-02919-6}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-313330}, year = {2022}, abstract = {Background Long-term support of stroke patients living at home is often delivered by family caregivers (FC). We identified characteristics of stroke patients being associated with receiving care by a FC 3-months (3 M) after stroke, assessed positive and negative experiences and individual burden of FC caring for stroke patients and determined factors associated with caregiving experiences and burden of FC 3 M after stroke. Methods Data were collected within TRANSIT-Stroke, a regional telemedical stroke-network comprising 12 hospitals in Germany. Patients with stroke/TIA providing informed consent were followed up 3 M after the index event. The postal patient-questionnaire was accompanied by an anonymous questionnaire for FC comprising information on positive and negative experiences of FC as well as on burden of caregiving operationalized by the Caregiver Reaction Assessment and a self-rated burden-scale, respectively. Multivariable logistic and linear regression analyses were performed. Results Between 01/2016 and 06/2019, 3532 patients provided baseline and 3 M-follow-up- data and 1044 FC responded to questionnaires regarding positive and negative caregiving experiences and caregiving burden. 74.4\% of FC were older than 55 years, 70.1\% were women and 67.5\% were spouses. Older age, diabetes and lower Barthel-Index in patients were significantly associated with a higher probability of receiving care by a FC at 3 M. Positive experiences of FC comprised the importance (81.5\%) and the privilege (70.0\%) of caring for their relative; negative experiences of FC included financial difficulties associated with caregiving (20.4\%). Median overall self-rated burden was 30 (IQR: 0-50; range 0-100). Older age of stroke patients was associated with a lower caregiver burden, whereas younger age of FC led to higher burden. More than half of the stroke patients in whom a FC questionnaire was completed did self-report that they are not being cared by a FC. This stroke patient group tended to be younger, more often male with less severe stroke and less comorbidities who lived more often with a partner. Conclusions The majority of caregivers wanted to care for their relatives but experienced burden at the same time. Elderly patients, patients with a lower Barthel Index at discharge and diabetes are at higher risk of needing care by a family caregiver. Trial registration The study was registered at "German Clinical Trial Register": DRKS00011696. https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML\&TRIAL_ID=DRKS00011696}, language = {en} } @article{GagyorGreserHeuschmannetal.2021, author = {G{\´a}gyor, Ildik{\´o} and Greser, Alexandra and Heuschmann, Peter and R{\"u}cker, Viktoria and Maun, Andy and Bleidorn, Jutta and Heintze, Christoph and Jede, Felix and Eckmanns, Tim and Klingeberg, Anja and Mentzel, Anja and Schiemann, Guido}, title = {REDuction of Antibiotic RESistance (REDARES) in urinary tract infections using treatments according to national clinical guidelines: study protocol for a pragmatic randomized controlled trial with a multimodal intervention in primary care}, series = {BMC Infectious Diseases}, volume = {21}, journal = {BMC Infectious Diseases}, doi = {10.1186/s12879-021-06660-0}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-264725}, year = {2021}, abstract = {Background: Urinary tract infections (UTIs) are a common cause of prescribing antibiotics in family medicine. In Germany, about 40\% of UTI-related prescriptions are second-line antibiotics, which contributes to emerging resistance rates. To achieve a change in the prescribing behaviour among family physicians (FPs), this trial aims to implement the guideline recommendations in German family medicine. Methods/design: In a randomized controlled trial, a multimodal intervention will be developed and tested in family practices in four regions across Germany. The intervention will consist of three elements: information on guideline recommendations, information on regional resistance and feedback of prescribing behaviour for FPs on a quarterly basis. The effect of the intervention will be compared to usual practice. The primary endpoint is the absolute difference in the mean of prescribing rates of second-line antibiotics among the intervention and the control group after 12 months. To detect a 10\% absolute difference in the prescribing rate after one year, with a significance level of 5\% and a power of 86\%, a sample size of 57 practices per group will be needed. Assuming a dropout rate of 10\%, an overall number of 128 practices will be required. The accompanying process evaluation will provide information on feasibility and acceptance of the intervention. Discussion: If proven effective and feasible, the components of the intervention can improve adherence to antibiotic prescribing guidelines and contribute to antimicrobial stewardship in ambulatory care.}, language = {en} } @article{StrahlGerlichAlpersetal.2018, author = {Strahl, Andr{\´e} and Gerlich, Christian and Alpers, Georg W. and Ehrmann, Katja and Gehrke, J{\"o}rg and M{\"u}ller-Garnn, Annette and Vogel, Heiner}, title = {Development and evaluation of a standardized peer-training in the context of peer review for quality assurance in work capacity evaluation}, series = {BMC Medical Education}, volume = {18}, journal = {BMC Medical Education}, number = {135}, doi = {10.1186/s12909-018-1233-z}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-175738}, year = {2018}, abstract = {Background: The German quality assurance programme for evaluating work capacity is based on peer review that evaluates the quality of medical experts' reports. Low reliability is thought to be due to systematic differences among peers. For this purpose, we developed a curriculum for a standardized peer-training (SPT). This study investigates, whether the SPT increases the inter-rater reliability of social medical physicians participating in a cross-institutional peer review. Methods: Forty physicians from 16 regional German Pension Insurances were subjected to SPT. The three-day training course consist of nine educational objectives recorded in a training manual. The SPT is split into a basic module providing basic information about the peer review and an advanced module for small groups of up to 12 peers training peer review using medical reports. Feasibility was tested by assessing selection, comprehensibility and subjective use of contents delivered, the trainers' delivery and design of training materials. The effectiveness of SPT was determined by evaluating peer concordance using three anonymised medical reports assessed by each peer. Percentage agreement and Fleiss' kappa (κ\(_m\)) were calculated. Concordance was compared with review results from a previous unstructured, non-standardized peer-training programme (control condition) performed by 19 peers from 12 German Pension Insurances departments. The control condition focused exclusively on the application of peer review in small groups. No specifically training materials, methods and trainer instructions were used. Results: Peer-training was shown to be feasible. The level of subjective confidence in handling the peer review instrument varied between 70 and 90\%. Average percentage agreement for the main outcome criterion was 60.2\%, resulting in a κ\(_m\) of 0.39. By comparison, the average percentage concordance was 40.2\% and the κ\(_m\) was 0.12 for the control condition. Conclusion: Concordance with the main criterion was relevant but not significant (p = 0.2) higher for SPT than for the control condition. Fleiss' kappa coefficient showed that peer concordance was higher for SPT than randomly expected. Nevertheless, a score of 0.39 for the main criterion indicated only fair inter-rater reliability, considerably lower than the conventional standard of 0.7 for adequate reliability.}, language = {en} } @article{NandiCrombachElbertetal.2020, author = {Nandi, Corina and Crombach, Anselm and Elbert, Thomas and Bambonye, Manass{\´e} and Pryss, R{\"u}diger and Schobel, Johannes and Weierstall-Pust, Roland}, title = {The cycle of violence as a function of PTSD and appetitive aggression: A longitudinal study with Burundian soldiers}, series = {Aggressive Behavior}, volume = {46}, journal = {Aggressive Behavior}, number = {5}, doi = {10.1002/ab.21895}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-218235}, pages = {391 -- 399}, year = {2020}, abstract = {During deployment, soldiers face situations in which they are not only exposed to violence but also have to perpetrate it themselves. This study investigates the role of soldiers' levels of posttraumatic stress disorder (PTSD) symptoms and appetitive aggression, that is, a lust for violence, for their engaging in violence during deployment. Furthermore, factors during deployment influencing the level of PTSD symptoms and appetitive aggression after deployment were examined for a better comprehension of the maintenance of violence. Semi-structured interviews were conducted with 468 Burundian soldiers before and after a 1-year deployment to Somalia. To predict violent acts during deployment (perideployment) as well as appetitive aggression and PTSD symptom severity after deployment (postdeployment), structural equation modeling was utilized. Results showed that the number of violent acts perideployment was predicted by the level of appetitive aggression and by the severity of PTSD hyperarousal symptoms predeployment. In addition to its association with the predeployment level, appetitive aggression postdeployment was predicted by violent acts and trauma exposure perideployment as well as positively associated with unit support. PTSD symptom severity postdeployment was predicted by the severity of PTSD avoidance symptoms predeployment and trauma exposure perideployment, and negatively associated with unit support. This prospective study reveals the importance of appetitive aggression and PTSD hyperarousal symptoms for the engagement in violent acts during deployment, while simultaneously demonstrating how these phenomena may develop in mutually reinforcing cycles in a war setting.}, language = {en} } @article{ZetzlSchulerRenneretal.2019, author = {Zetzl, Teresa and Schuler, Michael and Renner, Agnes and Jentschke, Elisabeth and van Oorschot, Birgitt}, title = {Yoga intervention and reminder e-mails for reducing cancer-related fatigue - a study protocol of a randomized controlled trial}, series = {BMC Psychology}, volume = {7}, journal = {BMC Psychology}, doi = {10.1186/s40359-019-0339-3}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-202268}, pages = {64}, year = {2019}, abstract = {Background Almost 90\% of cancer patients suffer from symptoms of fatigue during treatment. Supporting treatments are increasingly used to alleviate the burden of fatigue. This study examines the short-term and long-term effects of yoga on fatigue and the effect of weekly reminder e-mails on exercise frequency and fatigue symptoms. Methods The aim of the first part of the study will evaluate the effectiveness of yoga for cancer patients with mixed diagnoses reporting fatigue. We will randomly allocate 128 patients to an intervention group (N = 64) receiving yoga and a wait-list control group (N = 64) receiving yoga 9 weeks later. The yoga therapy will be performed in weekly sessions of 60 min each for 8 weeks. The primary outcome will be self-reported fatigue symptoms. In the second part of the study, the effectiveness of reminder e-mails with regard to the exercise frequency and self-reported fatigue symptoms will be evaluated. A randomized allocated group of the participants ("email") receives weekly reminder e-mails, the other group does not. Data will be assessed using questionnaires the beginning and after yoga therapy as well as after 6  months. Discussion Support of patients suffering from fatigue is an important goal in cancer patients care. If yoga therapy will reduce fatigue, this type of therapy may be introduced into routine practice. If the reminder e-mails prove to be helpful, new offers for patients may also develop from this.}, language = {en} } @article{StanglRauchRauhetal.2021, author = {Stangl, Stephanie and Rauch, Sebastian and Rauh, J{\"u}rgen and Meyer, Martin and M{\"u}ller-Nordhorn, Jacqueline and Wildner, Manfred and W{\"o}ckel, Achim and Heuschmann, Peter U.}, title = {Disparities in Accessibility to Evidence-Based Breast Cancer Care Facilities by Rural and Urban Areas in Bavaria, Germany}, series = {Cancer}, volume = {127}, journal = {Cancer}, number = {13}, doi = {10.1002/cncr.33493}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-239854}, pages = {2319 -- 2332}, year = {2021}, abstract = {Background Breast cancer (BC), which is most common in elderly women, requires a multidisciplinary and continuous approach to care. With demographic changes, the number of patients with chronic diseases such as BC will increase. This trend will especially hit rural areas, where the majority of the elderly live, in terms of comprehensive health care. Methods Accessibility to several cancer facilities in Bavaria, Germany, was analyzed with a geographic information system. Facilities were identified from the national BC guideline and from 31 participants in a proof-of-concept study from the Breast Cancer Care for Patients With Metastatic Disease registry. The timeframe for accessibility was defined as 30 or 60 minutes for all population points. The collection of address information was performed with different sources (eg, a physician registry). Routine data from the German Census 2011 and the population-based Cancer Registry of Bavaria were linked at the district level. Results Females from urban areas (n = 2,938,991 [ie, total of females living in urban areas]) had a higher chance for predefined accessibility to the majority of analyzed facilities in comparison with females from rural areas (n = 3,385,813 [ie, total number of females living in rural areas]) with an odds ratio (OR) of 9.0 for cancer information counselling, an OR of 17.2 for a university hospital, and an OR of 7.2 for a psycho-oncologist. For (inpatient) rehabilitation centers (OR, 0.2) and genetic counselling (OR, 0.3), women from urban areas had lower odds of accessibility within 30 or 60 minutes. Conclusions Disparities in accessibility between rural and urban areas exist in Bavaria. The identification of underserved areas can help to inform policymakers about disparities in comprehensive health care. Future strategies are needed to deliver high-quality health care to all inhabitants, regardless of residence.}, language = {en} } @article{ScheitzLimBroersenetal.2021, author = {Scheitz, Jan F. and Lim, Jess and Broersen, Leonie H. A. and Ganeshan, Ramanan and Huo, Shufan and Sperber, Pia S. and Piper, Sophie K. and Heuschmann, Peter U. and Audebert, Heinrich J. and Nolte, Christian H. and Siegerink, Bob and Endres, Matthias and Liman, Thomas G.}, title = {High-Sensitivity Cardiac Troponin T and Recurrent Vascular Events After First Ischemic Stroke}, series = {Journal of the American Heart Association}, volume = {10}, journal = {Journal of the American Heart Association}, number = {10}, doi = {10.1161/JAHA.120.018326}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-239039}, year = {2021}, abstract = {Background Recent evidence suggests cardiac troponin levels to be a marker of increased vascular risk. We aimed to assess whether levels of high-sensitivity cardiac troponin T (hs-cTnT) are associated with recurrent vascular events and death in patients with first-ever, mild to moderate ischemic stroke. Methods and Results We used data from the PROSCIS-B (Prospective Cohort With Incident Stroke Berlin) study. We computed Cox proportional hazards regression analyses to assess the association between hs-cTnT levels upon study entry (Roche Elecsys, upper reference limit, 14 ng/L) and the primary outcome (composite of recurrent stroke, myocardial infarction, and all-cause death). A total of 562 patients were analyzed (mean age, 67 years [SD 13]; 38.6\% women; median National Institutes of Health Stroke Scale=2; hs-cTnT above upper reference limit, 39.2\%). During a mean follow-up of 3 years, the primary outcome occurred in 89 patients (15.8\%), including 40 (7.1\%) recurrent strokes, 4 (0.7\%) myocardial infarctions, and 51 (9.1\%) events of all-cause death. The primary outcome occurred more often in patients with hs-cTnT above the upper reference limit (27.3\% versus 10.2\%; adjusted hazard ratio, 2.0; 95\% CI, 1.3-3.3), with a dose-response relationship when the highest and lowest hs-cTnT quartiles were compared (15.2 versus 1.8 events per 100 person-years; adjusted hazard ratio, 4.8; 95\% CI, 1.9-11.8). This association remained consistent in sensitivity analyses, which included age matching and stratification for sex. Conclusions Hs-cTnT is dose-dependently associated with an increased risk of recurrent vascular events and death within 3 years after first-ever, mild to moderate ischemic stroke. These findings support further studies of the utility of hs-cTnT for individualized risk stratification after stroke.}, language = {en} } @article{TischerStuppJansonetal.2021, author = {Tischer, Christina and Stupp, Carolin and Janson, Patrick and Willeke, Kristina and Hung, Chu-Wei and Fl{\"o}ter, Jessica and Kirchner, Anna and Zink, Katharina and Eder, Lisa and Hackl, Christina and M{\"u}hle, Ursula and Weidmann, Manfred and Nennstiel, Uta and Kuhn, Joseph and Weidner, Christian and Liebl, Bernhard and Wildner, Manfred and Keil, Thomas}, title = {Evaluation of screening tests in Bavarian healthcare facilities during the second wave of the SARS-CoV-2 pandemic}, series = {International Journal of Environmental Research and Public Health}, volume = {18}, journal = {International Journal of Environmental Research and Public Health}, number = {14}, issn = {1660-4601}, doi = {10.3390/ijerph18147371}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-242637}, year = {2021}, abstract = {Due to the lack of data on asymptomatic SARS-CoV-2-positive persons in healthcare institutions, they represent an inestimable risk. Therefore, the aim of the current study was to evaluate the first 1,000,000 reported screening tests of asymptomatic staff, patients, residents, and visitors in hospitals and long-term care (LTC) facilities in the State of Bavaria over a period of seven months. Data were used from the online database BayCoRei (Bavarian Corona Screening Tests), established in July 2020. Descriptive analyses were performed, describing the temporal pattern of persons that tested positive for SARS-CoV-2 by real-time polymerase chain reaction (RT-PCR) or antigen tests, stratified by facility. Until 15 March 2021, this database had collected 1,038,146 test results of asymptomatic subjects in healthcare facilities (382,240 by RT-PCR, and 655,906 by antigen tests). Of the RT-PCR tests, 2.2\% (n = 8380) were positive: 3.0\% in LTC facilities, 2.2\% in hospitals, and 1.2\% in rehabilitation institutions. Of the antigen tests, 0.4\% (n = 2327) were positive: 0.5\% in LTC facilities, and 0.3\% in both hospitals and rehabilitation institutions, respectively. In LTC facilities and hospitals, infection surveillance using RT-PCR tests, or the less expensive but less sensitive, faster antigen tests, could facilitate the long-term management of the healthcare workforce, patients, and residents.}, language = {en} } @article{GablonskiPryssProbstetal.2019, author = {Gablonski, Thorsten-Christian and Pryss, R{\"u}diger and Probst, Thomas and Vogel, Carsten and Andreas, Sylke}, title = {Intersession-Online: A smartphone application for systematic recording and controlling of intersession experiences in psychotherapy}, series = {J — Multidisciplinary Scientific Journal}, volume = {2}, journal = {J — Multidisciplinary Scientific Journal}, number = {4}, issn = {2571-8800}, doi = {10.3390/j2040031}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-285597}, pages = {480 -- 495}, year = {2019}, abstract = {Mobile health technologies have become more and more important in psychotherapy research and practice. The market is being flooded by several psychotherapeutic online services for different purposes. However, mobile health technologies are particularly suitable for data collection and monitoring, as data can be recorded economically in real time. Currently, there is no appropriate method to assess intersession experiences systematically in psychotherapeutic practice. The aim of our project was the development of a smartphone application framework for systematic recording and controlling of intersession experiences. Intersession-Online, an iOS- and Android-App, offers the possibility to collect data on intersession experiences easily, to provide the results to therapists in an evaluated form and, if necessary, to induce or interrupt intersession experiences with the primary aim to improve outcome of psychotherapy. In general, the smartphone application could be a helpful, evidence-based tool for research and practice. Overall speaking, further research to investigate the efficacy of Intersession-Online is necessary.}, language = {en} } @article{HessMengSchulteetal.2022, author = {Heß, Verena and Meng, Karin and Schulte, Thomas and Neuderth, Silke and Bengel, J{\"u}rgen and Faller, Hermann and Schuler, Michael}, title = {Decreased mental health, quality of life, and utilization of professional help in cancer patients with unexpressed needs: A longitudinal analysis}, series = {Psycho-Oncology}, volume = {31}, journal = {Psycho-Oncology}, number = {5}, doi = {10.1002/pon.5856}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-257662}, pages = {725-734}, year = {2022}, abstract = {Background Cancer patients' mental health and quality of life can be improved through professional support according to their needs. In previous analyses of the UNSAID study, we showed that a relevant proportion of cancer patients did not express their needs during the admission interview of inpatient rehabilitation. We now examine trajectories of mental health, quality of life, and utilization of professional help in cancer patients with unexpressed needs. Methods We enrolled 449 patients with breast, prostate, and colon cancer at beginning (T0) and end (T1) of a 3-week inpatient rehabilitation and 3 (T2) and 9 (T3) months after discharge. We explored depression (PHQ-2), anxiety (GAD-2), emotional functioning (EORTC QLQ-C30), fear of progression (FoP-Q-SF), and global quality of life (EORTC QLQ-C30) using structuring equation models. Furthermore, we evaluated self-reports about expressing needs and utilization of professional help at follow-up. Results Patients with unexpressed needs (24.3\%, n = 107) showed decreased mental health compared to other patients (e.g., depression: d T0 = 0.32, d T1-T3 = 0.39). They showed a significant decline in global quality of life at discharge and follow-up (d = 0.28). Furthermore, they had a higher need for support (Cramer's V T2 = 0.10, T3 = 0.15), talked less about their needs (Cramer's V T2 = 0.18), and made less use of different health care services at follow-up. Conclusion Unexpressed needs in cancer patients may be a risk factor for decreased mental health, quality of life, and non-utilization of professional help in the long term. Further research should clarify causal relationships and focus on this specific group of patients to improve cancer care.}, language = {en} } @article{RohmannHuoSperberetal.2020, author = {Rohmann, Jessica L. and Huo, Shufan and Sperber, Pia S. and Piper, Sophie K. and Rosendaal, Frits R. and Heuschmann, Peter U. and Endres, Matthias and Liman, Thomas G. and Siegerink, Bob}, title = {Coagulation factor XII, XI, and VIII activity levels and secondary events after first ischemic stroke}, series = {Journal of Thrombosis and Haemostasis}, volume = {18}, journal = {Journal of Thrombosis and Haemostasis}, number = {12}, doi = {10.1111/jth.15092}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-217877}, pages = {3316 -- 3324}, year = {2020}, abstract = {Background Though risk for recurrent vascular events is high following ischemic stroke, little knowledge about risk factors for secondary events post-stroke exists. Objectives Coagulation factors XII, XI, and VIII (FXII, FXI, and FVIII) have been implicated in first thrombotic events, and our aim was to estimate their effects on vascular outcomes within 3 years after first stroke. Patients/Methods In the Prospective Cohort with Incident Stroke Berlin (PROSCIS-B) study, we followed participants aged 18 and older for 3 years after first mild to moderate ischemic stroke event or until occurrence of recurrent stroke, myocardial infarction, or all-cause mortality. We compared high coagulation factor activity levels to normal and low levels and also analyzed activities as continuous variables. We used Cox proportional hazards models adjusted for age, sex, and cardiovascular risk factors to estimate hazard ratios (HRs) for the combined endpoint. Results In total, 94 events occurred in 576 included participants, resulting in an absolute rate of 6.6 events per 100 person-years. After confounding adjustment, high FVIII activity showed the strongest relationship with the combined endpoint (HR = 2.05, 95\% confidence interval [CI] 1.28-3.29). High FXI activity was also associated with a higher hazard (HR = 1.80, 95\% CI 1.09-2.98), though high FXII activity was not (HR = 0.86, 95\% CI 0.49-1.51). Continuous analyses yielded similar results. Conclusions In our study of mild to moderate ischemic stroke patients, high activity levels of FXI and FVIII but not FXII were associated with worse vascular outcomes in the 3-year period after first ischemic stroke.}, language = {en} } @article{SchleeSimoesPryss2021, author = {Schlee, Winfried and Simoes, Jorge and Pryss, R{\"u}diger}, title = {Auricular acupressure combined with self-help intervention for treating chronic tinnitus: a longitudinal observational study}, series = {Journal of Clinical Medicine}, volume = {10}, journal = {Journal of Clinical Medicine}, number = {18}, issn = {2077-0383}, doi = {10.3390/jcm10184201}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-246209}, year = {2021}, abstract = {Tinnitus is a phantom sound perception in the ears or head and can arise from many different medical disorders. Currently, there is no standard treatment for tinnitus that reliably reduces tinnitus. Individual patients reported that acupressure at various points around the ear can help to reduce tinnitus, which was investigated here. With this longitudinal observational study, we report a systematic evaluation of auricular acupressure on 39 tinnitus sufferers, combined with a self-help smartphone app. The participants were asked to report on tinnitus, stress, mood, neck, and jaw muscle tensions twice a day using an ecological momentary assessment study design for six weeks. On average, 123.6 questionnaires per person were provided and used for statistical analysis. The treatment responses of the participants were heterogeneous. On average, we observed significant negative trends for tinnitus loudness (Cohen's d effect size: -0.861), tinnitus distress (d = -0.478), stress (d = -0.675), and tensions in the neck muscles (d = -0.356). Comparison with a matched control group revealed significant improvements for tinnitus loudness (p = 0.027) and self-reported stress level (p = 0.003). The positive results of the observational study motivate further research including a randomized clinical trial and long-term assessment of the clinical improvement.}, language = {en} } @article{AllgaierSchleeLangguthetal.2021, author = {Allgaier, Johannes and Schlee, Winfried and Langguth, Berthold and Probst, Thomas and Pryss, R{\"u}diger}, title = {Predicting the Gender of Individuals with Tinnitus based on Daily Life Data of the TrackYourTinnitus mHealth Platform}, series = {Scientific Reports}, volume = {11}, journal = {Scientific Reports}, number = {1}, doi = {10.1038/s41598-021-96731-8}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-261753}, year = {2021}, abstract = {Tinnitus is an auditory phantom perception in the absence of an external sound stimulation. People with tinnitus often report severe constraints in their daily life. Interestingly, indications exist on gender differences between women and men both in the symptom profile as well as in the response to specific tinnitus treatments. In this paper, data of the TrackYourTinnitus platform (TYT) were analyzed to investigate whether the gender of users can be predicted. In general, the TYT mobile Health crowdsensing platform was developed to demystify the daily and momentary variations of tinnitus symptoms over time. The goal of the presented investigation is a better understanding of gender-related differences in the symptom profiles of users from TYT. Based on two questionnaires of TYT, four machine learning based classifiers were trained and analyzed. With respect to the provided daily answers, the gender of TYT users can be predicted with an accuracy of 81.7\%. In this context, worries, difficulties in concentration, and irritability towards the family are the three most important characteristics for predicting the gender. Note that in contrast to existing studies on TYT, daily answers to the worst symptom question were firstly investigated in more detail. It was found that results of this question significantly contribute to the prediction of the gender of TYT users. Overall, our findings indicate gender-related differences in tinnitus and tinnitus-related symptoms. Based on evidence that gender impacts the development of tinnitus, the gathered insights can be considered relevant and justify further investigations in this direction.}, language = {en} } @phdthesis{Nolte2017, author = {Nolte, Kim Christina}, title = {Determinanten der selbstberichteten k{\"o}rperlichen Funktionsf{\"a}higkeit bei Patienten mit Koronarer Herzkrankheit}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-155687}, school = {Universit{\"a}t W{\"u}rzburg}, year = {2017}, abstract = {Diese Schrift befasst sich mit der Fragestellung, welche Determinanten einen signifikanten Zusammenhang mit der selbstberichteten k{\"o}rperlichen Funktionsf{\"a}higkeit der Probanden aufweisen. Es werden im Folgenden die Hintergr{\"u}nde und die Bedeutung der Koronaren Herzkrankheit mit Pathogenese, Klinik und Therapiem{\"o}glichkeiten aufgezeigt. Diese weltweit verbreitete Erkrankung f{\"u}hrt seit Jahren die Statistik der h{\"a}ufigsten Todesursachen nicht nur in Deutschland an. Werden die Hauptrisikofaktoren Diabetes mellitus, Hypercholesterin{\"a}mie, arterielle Hypertonie, Nikotinkonsum und Adipositas nicht beseitigt, k{\"o}nnen sich Arteriosklerose und eine Koronarinsuffizienz entwickeln, die schlimmstenfalls zum Myokardinfarkt oder Tod f{\"u}hren. Im weiteren Verlauf wird erl{\"a}utert, warum nach den Studien EUROASPIRE I bis III noch eine weitere multizentrische Querschnittsstudie notwendig ist. Bei den vorangegangenen Studien hatte sich gezeigt, dass die Ziele zur Minimierung der Risikofaktoren im Alltag von KHK-Patienten noch nicht erreicht wurden, sondern es in der letzten Zeit vielmehr zu einem Anstieg von Risikopatienten gekommen war. Die EUROASPIRE IV Studie wurde daher zur Bewertung der Qualit{\"a}t der Sekund{\"a}rpr{\"a}vention bei KHK-Patienten in der heutigen Zeit initiiert. Des Weiteren wird auf die Definition der selbstberichteten k{\"o}rperlichen Funktionsf{\"a}higkeit eingegangen, die in dieser Arbeit anhand des HeartQoL-Fragebogens bei KHK-Patienten untersucht wird. Dabei ist im Unterschied zu einer objektiven Beurteilung von Bedeutung, dass jeder Patient anhand seiner individuellen Lebensumst{\"a}nde seine eigene physische Verfassung einsch{\"a}tzt. Dass die k{\"o}rperliche Funktionsf{\"a}higkeit von KHK-Patienten tats{\"a}chlich eingeschr{\"a}nkt ist, wird anhand einer Auflistung von Studien belegt, die sich bereits mit diesem Thema auseinandergesetzt haben. In der vorliegenden Promotionsarbeit wurden die Determinanten der selbstberichteten k{\"o}rperlichen Funktionsf{\"a}higkeit von 528 W{\"u}rzburger Teilnehmern der europaweit durchgef{\"u}hrten EUROASPIRE IV Studie anhand von verschiedenen Frageb{\"o}gen ermittelt. Prim{\"a}rer Endpunkt war dabei die k{\"o}rperliche Skala des 14-teiligen HeartQoL-Fragebogens. Die Probanden wurden f{\"u}r die Analyse in Tertile eingeteilt, wobei diejenigen mit der gr{\"o}ßten selbstberichteten k{\"o}rperlichen Funktionsf{\"a}higkeit dem dritten Tertil zugeordnet wurden. In der Analyse der Basisvariablen des Kollektivs zeigte sich, dass unter den Probanden des dritten Tertils die Risikofaktoren Adipositas, Hypertension und Herzinsuffizienz seltener vertreten waren, als bei denen des ersten Tertils. Zudem wurde seltener {\"u}ber Angst und Depressionen berichtet. Bei der k{\"o}rperlichen Untersuchung wiesen die Probanden des dritten Tertils h{\"a}ufiger eine niedrige Herzfrequenz und einen geringeren Taillenumfang auf. Auch die Laborwerte wie niedriges HDL, hohe Triglyceride, ein hoher HbA1c, hohes NT-proBNP, niedriges H{\"a}moglobin und hohe Serum-Insulinwerte traten in dieser Gruppe seltener auf. Medikamente wie Antikoagulantien, Diuretika und Insulin wurden nicht so h{\"a}ufig eingenommen wie bei den Probanden des ersten Tertils. Zudem bestand meist eine bessere Lungenfunktion. In die multiple Regressionsanalyse flossen nur die signifikanten Werte aus der Analyse der Basisvariablen des Kollektivs ein. Betrachtet man die Ergebnisse der multiplen Regressionsanalyse, f{\"a}llt auf, dass die Angstvariable den gr{\"o}ßten Effekt auf die selbstberichtete k{\"o}rperliche Funktionsf{\"a}higkeit der Probanden hatte. Wie auch in der Literatur beschrieben, haben Angst und Depressionen einen stark negativen Einfluss auf die physische Funktion von KHK-Patienten. Als stark negative Pr{\"a}diktoren der k{\"o}rperlichen Funktionsf{\"a}higkeit stellten sich in der Regressionsanalyse auch die Einnahme von Diuretika und ein hoher NT-proBNP-Wert heraus. Herzinsuffizienz-Patienten berichteten folglich h{\"a}ufiger {\"u}ber eine nachlassende physische Fitness. Bestanden eine gute Lungenfunktion und ein niedriger Serum-Insulinwert, wirkte sich dies positiv auf die Funktionsf{\"a}higkeit aus. Ein niedriger H{\"a}moglobinwert oder das Vorhandensein von Depressionen hatten einen negativen Einfluss. Somit kann zusammenfassend festgehalten werden, dass Probanden, die weniger {\"a}ngstlich waren und {\"u}ber eine durch apparative und laboratorisch objektivierte ges{\"u}ndere k{\"o}rperliche Verfassung verf{\"u}gten, ihre k{\"o}rperliche Funktionsf{\"a}higkeit als h{\"o}her einsch{\"a}tzten. In der Korrelationsanalyse wurde beleuchtet, welche der Variablen, die nach der Regressionsanalyse noch im Modell verblieben waren, sich f{\"u}r die Verdr{\"a}ngung der anderen Variablen verantwortlich zeigten. Dabei waren die Einnahme von Diuretika und der Wert f{\"u}r die Lungenfunktion FEV1 diejenigen Variablen, die f{\"u}r die Entfernung der meisten anderen Variablen aus dem Modell verantwortlich waren. Zudem wurde in der Korrelationsanalyse gezeigt, welche Variablen starke Zusammenh{\"a}nge zeigten. Auf der einen Seite stellten sich die psychischen Komponenten wie Angst oder Depressionen als essentiell f{\"u}r die eigene Einsch{\"a}tzung der k{\"o}rperlichen Funktionsf{\"a}higkeit heraus. Zum anderen waren auch objektiv bestimmbare Parameter wie die Blutwerte NT-proBNP, Insulin und H{\"a}moglobin und die Einnahme von Diuretika daf{\"u}r entscheidend. Somit ist es von großer Bedeutung, bei der Therapie von Patienten mit Koronarer Herzkrankheit die {\"A}ngste und Stimmungslage zu ber{\"u}cksichtigen und eine m{\"o}glicherweise vorhandene Depression in die Therapie mit einzubeziehen. Ferner ist es wichtig, diese Patienten ausf{\"u}hrlich {\"u}ber ihre Krankheit mit den Risikofaktoren und m{\"o}glichen Folgesch{\"a}den aufzukl{\"a}ren und sie zu einem gesunden, aktiven Lebensstil zu motivieren.}, subject = {Koronare Herzkrankheit}, language = {de} } @phdthesis{Wagner2019, author = {Wagner, Martin}, title = {Chronic Kidney Disease as an Important Co-morbid Condition in Coronary Heart Disease Patients}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-175498}, school = {Universit{\"a}t W{\"u}rzburg}, year = {2019}, abstract = {In patients with coronary heart disease (CHD) the control of the modifiable "traditional" cardiovascular risk factors such as hypertension, dyslipidemia, diabetes, achieving/maintaining normal body weight and smoking cessation is of major importance to improve prognosis. Guideline recommendations for secondary CHD prevention include specific treatment targets for blood pressure, lipid levels, and markers of glucose metabolism for both younger and older patients. Chronic kidney disease (CKD) has been identified as a "non-traditional" risk factor for worse outcome in CHD patients, as it is associated with a markedly increased risk for subsequent CV events and mortality. The specific objectives of the current thesis-project are to investigate (a) the quality of care in a recent sample of German CHD patients and to investigate variation of risk factor control between younger and elder patients (≤70 versus >70 years), (b) to analyze the prevalence of CKD across Europe in stable CHD patients in the outpatient setting and during a hospital stay for CHD, (c) to investigate the level of awareness of CKD in German CHD patients and their treating physicians. Data from the European-wide EUROASPIRE IV study were used that include data on 7998 CHD patients in the ambulatory setting (study visit) and during a hospital stay for CHD (index). The German EUROASPIRE IV study center in W{\"u}rzburg recruited 536 patients in 2012-2013. Risk factor control was compared against the current recommendations of the European Society of Cardiology. CKD was described by stages of glomerular filtration rate (eGFR) and albuminuria. German patients were asked in an additional kidney specific module whether they have ever been told by a physician about renal impairment. The fact that CKD or acute kidney injury (AKI) was mentioned in prominent parts of the hospital discharge letter as well as correct ICD-coding of CKD or AKI served as a proxy for physician's awareness of CKD. The majority of German CHD patients was treated with the recommended drug therapies including e.g. β-blockers, anti-platelets and statins. However, treatment targets for blood pressure and LDL-cholesterol levels were not achieved in many patients (45\% and 53\%, respectively) and glycemic control in diabetic CHD patients with HbA1-levels <7\% was insufficient (61\%). A minority of patients reported on current smoking (10\%), but unhealthy life-styles e.g. overweight/obesity (85\%/37\%) were frequent. Patterns of care differed between younger and older CHD patients while older patients were less likely to receive the recommended medical CHD-therapy, were more likely to have uncontrolled blood pressure and also to be diabetic. However, a greater proportion of diabetic patients >70 years was achieving the HbA1c target, and less elder patients were current smokers or were obese. About 17\% of patients on average had CKD (eGFR< 60 ml/min/1.73m²) in the entire European sample at the study visit, and an additional 10\% had albuminuria despite preserved eGFR, with considerable variation among countries. Impaired kidney function was observed in every fifth patient admitted for CHD in the entire European dataset of the EUROASPIRE IV study. Of the German CHD patients with CKD at the study visit, only a third were aware of their renal impairment. A minority of these patients was being seen by nephrologists, however, with a higher likelihood of CKD awareness and specialist care in more advanced stages of CKD. About a third of patients admitted for CHD showed either CKD or AKI during the hospital stay, but the discharge letter mentioned chronic or acute kidney disease only in every fifth of these patients. In contrast, correct ICD coding of CKD or AKI was more complete, but still suboptimal. In summary, quality of secondary prevention in German CHD patients indicates considerably room for improvement, with life-style modifications may become an even greater factor in prevention campaigns than medical treatment into certain target ranges. Preventive therapies should also consider different needs in older individuals acknowledging physical and mental potential, other comorbidities and drug-interactions with co-medication. CKD is common in CHD patients, not only in the elderly. Since CHD and CKD affect each other and impact on worse prognosis of each other, raising the awareness of CKD among patients and physicians and considering CKD in medical therapy may improve prognosis and slow disease progression of CHD as well as CKD.}, language = {en} } @article{PrakashUnnikrishnanPryssetal.2021, author = {Prakash, Subash and Unnikrishnan, Vishnu and Pryss, R{\"u}diger and Kraft, Robin and Schobel, Johannes and Hannemann, Ronny and Langguth, Berthold and Schlee, Winfried and Spiliopoulou, Myra}, title = {Interactive system for similarity-based inspection and assessment of the well-being of mHealth users}, series = {Entropy}, volume = {23}, journal = {Entropy}, number = {12}, issn = {1099-4300}, doi = {10.3390/e23121695}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-252333}, year = {2021}, abstract = {Recent digitization technologies empower mHealth users to conveniently record their Ecological Momentary Assessments (EMA) through web applications, smartphones, and wearable devices. These recordings can help clinicians understand how the users' condition changes, but appropriate learning and visualization mechanisms are required for this purpose. We propose a web-based visual analytics tool, which processes clinical data as well as EMAs that were recorded through a mHealth application. The goals we pursue are (1) to predict the condition of the user in the near and the far future, while also identifying the clinical data that mostly contribute to EMA predictions, (2) to identify users with outlier EMA, and (3) to show to what extent the EMAs of a user are in line with or diverge from those users similar to him/her. We report our findings based on a pilot study on patient empowerment, involving tinnitus patients who recorded EMAs with the mHealth app TinnitusTips. To validate our method, we also derived synthetic data from the same pilot study. Based on this setting, results for different use cases are reported.}, language = {en} } @article{GrubisicHaimBhusaletal.2019, author = {Grubisic, Maja and Haim, Abraham and Bhusal, Pramod and Dominoni, Davide M. and Gabriel, Katharina M. A. and Jechow, Andreas and Kupprat, Franziska and Lerner, Amit and Marchant, Paul and Riley, William and Stebelova, Katarina and van Grunsven, Roy H. A. and Zeman, Michal and Zubidat, Abed E. and H{\"o}lker, Franz}, title = {Light Pollution, Circadian Photoreception, and Melatonin in Vertebrates}, series = {Sustainability}, volume = {11}, journal = {Sustainability}, number = {22}, issn = {2071-1050}, doi = {10.3390/su11226400}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-193095}, year = {2019}, abstract = {Artificial light at night (ALAN) is increasing exponentially worldwide, accelerated by the transition to new efficient lighting technologies. However, ALAN and resulting light pollution can cause unintended physiological consequences. In vertebrates, production of melatonin—the "hormone of darkness" and a key player in circadian regulation—can be suppressed by ALAN. In this paper, we provide an overview of research on melatonin and ALAN in vertebrates. We discuss how ALAN disrupts natural photic environments, its effect on melatonin and circadian rhythms, and different photoreceptor systems across vertebrate taxa. We then present the results of a systematic review in which we identified studies on melatonin under typical light-polluted conditions in fishes, amphibians, reptiles, birds, and mammals, including humans. Melatonin is suppressed by extremely low light intensities in many vertebrates, ranging from 0.01-0.03 lx for fishes and rodents to 6 lx for sensitive humans. Even lower, wavelength-dependent intensities are implied by some studies and require rigorous testing in ecological contexts. In many studies, melatonin suppression occurs at the minimum light levels tested, and, in better-studied groups, melatonin suppression is reported to occur at lower light levels. We identify major research gaps and conclude that, for most groups, crucial information is lacking. No studies were identified for amphibians and reptiles and long-term impacts of low-level ALAN exposure are unknown. Given the high sensitivity of vertebrate melatonin production to ALAN and the paucity of available information, it is crucial to research impacts of ALAN further in order to inform effective mitigation strategies for human health and the wellbeing and fitness of vertebrates in natural ecosystems.}, language = {en} } @article{BousquetOnoratoBachertetal.2017, author = {Bousquet, J. and Onorato, G. L. and Bachert, C. and Barbolini, M. and Bedbrook, A. and Bjermer, L. and Correia de Sousa, J. and Chavannes, N. H. and Cruz, A. A. and De Manuel Keenoy, E. and Devillier, P. and Fonseca, J. and Hun, S. and Kostka, T. and Hellings, P. W. and Illario, M. and Ivancevich, J. C. and Larenas-Linnemann, D. and Millot-Keurinck, J. and Ryan, D. and Samolinski, B. and Sheikh, A. and Yorgancioglu, A. and Agache, I. and Arnavielhe, S. and Bewick, M. and Annesi-Maesano, I. and Anto, J. M. and Bergmann, K. C. and Bindslev-Jensen, C. and Bosnic-Anticevich, S. and Bouchard, J. and Caimmi, D. P. and Camargos, P. and Canonica, G. W. and Cardona, V. and Carriazo, A. M. and Cingi, C. and Cogan, E. and Custovic, A. and Dahl, R. and Demoly, P. and De Vries, G. and Fokkens, W. J. and Fontaine, J. F. and Gemicioğlu, B. and Guldemond, N. and Gutter, Z. and Haahtela, T. and Hellqvist-Dahl, B. and Jares, E. and Joos, G. and Just, J. and Khaltaev, N. and Keil, T. and Klimek, L. and Kowalski, M. L. and Kull, I. and Kuna, P. and Kvedariene, V. and Laune, D. and Louis, R. and Magnan, A. and Malva, J. and Mathieu-Dupas, E. and Mel{\´e}n, E. and Menditto, E. and Morais-Almeida, M. and M{\"o}sges, R. and Mullol, J. and Murray, R. and Neffen, H. and O'Hehir, R. and Palkonen, S. and Papadopoulos, N. G. and Passalacqua, G. and P{\´e}pin, J. L. and Portejoie, F. and Price, D. and Pugin, B. and Raciborski, F. and Simons, F. E. R. and Sova, M. and Spranger, O. and Stellato, C. and Todo Bom, A. and Tomazic, P. V. and Triggiani, M. and Valero, A. and Valovirta, E. and VandenPlas, O. and Valiulis, A. and van Eerd, M. and Ventura, M. T. and Wickmann, M. and Young, I. and Zuberbier, T. and Zurkuhlen, A. and Senn, A.}, title = {CHRODIS criteria applied to the MASK (MACVIA-ARIA Sentinel NetworK) Good Practice in allergic rhinitis: a SUNFRAIL report}, series = {Clinical and Translational Allergy}, volume = {2017}, journal = {Clinical and Translational Allergy}, number = {7}, doi = {10.1186/s13601-017-0173-8}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-173527}, year = {2017}, abstract = {A Good Practice is a practice that works well, produces good results, and is recommended as a model. MACVIA-ARIA Sentinel Network (MASK), the new Allergic Rhinitis and its Impact on Asthma (ARIA) initiative, is an example of a Good Practice focusing on the implementation of multi-sectoral care pathways using emerging technologies with real life data in rhinitis and asthma multi-morbidity. The European Union Joint Action on Chronic Diseases and Promoting Healthy Ageing across the Life Cycle (JA-CHRODIS) has developed a checklist of 28 items for the evaluation of Good Practices. SUNFRAIL (Reference Sites Network for Prevention and Care of Frailty and Chronic Conditions in community dwelling persons of EU Countries), a European Union project, assessed whether MASK is in line with the 28 items of JA-CHRODIS. A short summary was proposed for each item and 18 experts, all members of ARIA and SUNFRAIL from 12 countries, assessed the 28 items using a Survey Monkey-based questionnaire. A visual analogue scale (VAS) from 0 (strongly disagree) to 100 (strongly agree) was used. Agreement equal or over 75\% was observed for 14 items (50\%). MASK is following the JA-CHRODIS recommendations for the evaluation of Good Practices.}, language = {en} } @article{KraftBirkReichertetal.2020, author = {Kraft, Robin and Birk, Ferdinand and Reichert, Manfred and Deshpande, Aniruddha and Schlee, Winfried and Langguth, Berthold and Baumeister, Harald and Probst, Thomas and Spiliopoulou, Myra and Pryss, R{\"u}diger}, title = {Efficient processing of geospatial mHealth data using a scalable crowdsensing platform}, series = {Sensors}, volume = {20}, journal = {Sensors}, number = {12}, issn = {1424-8220}, doi = {10.3390/s20123456}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-207826}, year = {2020}, abstract = {Smart sensors and smartphones are becoming increasingly prevalent. Both can be used to gather environmental data (e.g., noise). Importantly, these devices can be connected to each other as well as to the Internet to collect large amounts of sensor data, which leads to many new opportunities. In particular, mobile crowdsensing techniques can be used to capture phenomena of common interest. Especially valuable insights can be gained if the collected data are additionally related to the time and place of the measurements. However, many technical solutions still use monolithic backends that are not capable of processing crowdsensing data in a flexible, efficient, and scalable manner. In this work, an architectural design was conceived with the goal to manage geospatial data in challenging crowdsensing healthcare scenarios. It will be shown how the proposed approach can be used to provide users with an interactive map of environmental noise, allowing tinnitus patients and other health-conscious people to avoid locations with harmful sound levels. Technically, the shown approach combines cloud-native applications with Big Data and stream processing concepts. In general, the presented architectural design shall serve as a foundation to implement practical and scalable crowdsensing platforms for various healthcare scenarios beyond the addressed use case.}, language = {en} } @article{HaertelSpieglerFortmannetal.2020, author = {H{\"a}rtel, Christoph and Spiegler, Juliane and Fortmann, Ingmar and Astiz, Mariana and Oster, Henrik and Siller, Bastian and Viemann, Dorothee and Keil, Thomas and Banaschewski, Tobias and Romanos, Marcel and Herting, Egbert and G{\"o}pel, Wolfgang}, title = {Breastfeeding for 3 months or longer but not probiotics is associated with reduced risk for inattention/hyperactivity and conduct problems in very-low-birth-weight children at early primary school age}, series = {Nutrients}, volume = {12}, journal = {Nutrients}, number = {11}, issn = {2072-6643}, doi = {10.3390/nu12113278}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-216319}, year = {2020}, abstract = {(1) Background: We aimed to evaluate the effect of proposed "microbiome-stabilising interventions", i.e., breastfeeding for ≥3 months and prophylactic use of Lactobacillus acidophilus/ Bifidobacterium infantis probiotics on neurocognitive and behavioral outcomes of very-low-birthweight (VLBW) children aged 5-6 years. (2) Methods: We performed a 5-year-follow-up assessment including a strength and difficulties questionnaire (SDQ) and an intelligence quotient (IQ) assessment using the Wechsler Preschool and Primary Scale of Intelligence (WPPSI)-III test in preterm children previously enrolled in the German Neonatal Network (GNN). The analysis was restricted to children exposed to antenatal corticosteroids and postnatal antibiotics. (3) Results: 2467 primary school-aged children fulfilled the inclusion criteria. In multivariable linear regression models breastfeeding ≥3 months was associated with lower conduct disorders (B (95\% confidence intervals (CI)): -0.25 (-0.47 to -0.03)) and inattention/hyperactivity (-0.46 (-0.81 to -0.10)) as measured by SDQ. Probiotic treatment during the neonatal period had no effect on SDQ scores or intelligence. (4) Conclusions: Prolonged breastfeeding of highly vulnerable infants may promote their mental health later in childhood, particularly by reducing risk for inattention/hyperactivity and conduct disorders. Future studies need to disentangle the underlying mechanisms during a critical time frame of development.}, language = {en} } @article{GabrielJirůHillmannKraftetal.2020, author = {Gabriel, Katharina M. A. and J{\´i}rů-Hillmann, Steffi and Kraft, Peter and Selig, Udo and R{\"u}cker, Victoria and M{\"u}hler, Johannes and D{\"o}tter, Klaus and Keidel, Matthias and Soda, Hassan and Rascher, Alexandra and Schneider, Rolf and Pfau, Mathias and Hoffmann, Roy and Stenzel, Joachim and Benghebrid, Mohamed and Goebel, Tobias and Doerck, Sebastian and Kramer, Daniela and Haeusler, Karl Georg and Volkmann, Jens and Heuschmann, Peter U. and Fluri, Felix}, title = {Two years' experience of implementing a comprehensive telemedical stroke network comprising in mainly rural region: the Transregional Network for Stroke Intervention with Telemedicine (TRANSIT-Stroke)}, series = {BMC Neurology}, volume = {20}, journal = {BMC Neurology}, doi = {10.1186/s12883-020-01676-6}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-229214}, year = {2020}, abstract = {Background Telemedicine improves the quality of acute stroke care in rural regions with limited access to specialized stroke care. We report the first 2 years' experience of implementing a comprehensive telemedical stroke network comprising all levels of stroke care in a defined region. Methods The TRANSIT-Stroke network covers a mainly rural region in north-western Bavaria (Germany). All hospitals providing acute stroke care in this region participate in TRANSIT-Stroke, including four hospitals with a supra-regional certified stroke unit (SU) care (level III), three of those providing teleconsultation to two hospitals with a regional certified SU (level II) and five hospitals without specialized SU care (level I). For a two-year-period (01/2015 to 12/2016), data of eight of these hospitals were available; 13 evidence-based quality indicators (QIs) related to processes during hospitalisation were evaluated quarterly and compared according to predefined target values between level-I- and level-II/III-hospitals. Results Overall, 7881 patients were included (mean age 74.6 years +/- 12.8; 48.4\% female). In level-II/III-hospitals adherence of all QIs to predefined targets was high ab initio. In level-I-hospitals, three patterns of QI-development were observed: a) high adherence ab initio (31\%), mainly in secondary stroke prevention; b) improvement over time (44\%), predominantly related to stroke specific diagnosis and in-hospital organization; c) no clear time trends (25\%). Overall, 10 out of 13 QIs reached predefined target values of quality of care at the end of the observation period. Conclusion The implementation of the comprehensive TRANSIT-Stroke network resulted in an improvement of quality of care in level-I-hospitals.}, language = {en} } @article{BarbieriGardonRuizCastelletal.2016, author = {Barbieri, Flavia L. and Gardon, Jacques and Ruiz-Castell, Mar{\´i}a and Paco V., Pamela and Muckelbauer, Rebecca and Casiot, Corinne and Freydier, R{\´e}mi and Duprey, Jean-Louis and Chen, Chih-Mei and M{\"u}ller-Nordhorn, Jacqueline and Keil, Thomas}, title = {Toxic trace elements in maternal and cord blood and social determinants in a Bolivian mining city}, series = {International Journal of Environmental Health Research}, volume = {26}, journal = {International Journal of Environmental Health Research}, number = {2}, doi = {10.1080/09603123.2015.1061114}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-150385}, pages = {158-174}, year = {2016}, abstract = {This study assessed lead, arsenic, and antimony in maternal and cord blood, and associations between maternal concentrations and social determinants in the Bolivian mining city of Oruro using the baseline assessment of the ToxBol/Mine-Ni{\~n}o birth cohort. We recruited 467 pregnant women, collecting venous blood and sociodemographic information as well as placental cord blood at birth. Metallic/semimetallic trace elements were measured using inductively coupled plasma mass spectrometry. Lead medians in maternal and cord blood were significantly correlated (Spearman coefficient = 0.59; p < 0.001; 19.35 and 13.50 μg/L, respectively). Arsenic concentrations were above detection limit (3.30 μg/L) in 17.9 \% of maternal and 34.6 \% of cord blood samples. They were not associated (Fischer's p = 0.72). Antimony medians in maternal and cord blood were weakly correlated (Spearman coefficient = 0.15; p < 0.03; 9.00 and 8.62 μg/L, respectively). Higher concentrations of toxic elements in maternal blood were associated with maternal smoking, low educational level, and partner involved in mining.}, language = {en} } @article{PadbergKnispelZoellneretal.2016, author = {Padberg, Inken and Knispel, Petra and Z{\"o}llner, Susanne and Sieveking, Meike and Schneider, Alice and Steinbrink, Jens and Heuschmann, Peter U. and Wellwood, Ian and Meisel, Andreas}, title = {Social work after stroke: identifying demand for support by recording stroke patients' and carers' needs in different phases after stroke}, series = {BMC Neurology}, volume = {16}, journal = {BMC Neurology}, number = {111}, doi = {10.1186/s12883-016-0626-z}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-164691}, year = {2016}, abstract = {Background Previous studies examining social work interventions in stroke often lack information on content, methods and timing over different phases of care including acute hospital, rehabilitation and out-patient care. This limits our ability to evaluate the impact of social work in multidisciplinary stroke care. We aimed to quantify social-work-related support in stroke patients and their carers in terms of timing and content, depending on the different phases of stroke care. Methods We prospectively collected and evaluated data derived from a specialized "Stroke-Service-Point" (SSP); a "drop in" center and non-medical stroke assistance service, staffed by social workers and available to all stroke patients, their carers and members of the public in the metropolitan region of Berlin, Germany. Results Enquiries from 257 consenting participants consulting the SSP between March 2010 and April 2012 related to out-patient and in-patient services, therapeutic services, medical questions, medical rehabilitation, self-help groups and questions around obtaining benefits. Frequency of enquiries for different topics depended on whether patients were located in an in-patient or out-patient setting. The majority of contacts involved information provision. While the proportion of male and female patients with stroke was similar, about two thirds of the carers contacting the SSP were female. Conclusion The social-work-related services provided by a specialized center in a German metropolitan area were diverse in terms of topic and timing depending on the phase of stroke care. Targeting the timing of interventions might be important to increase the impact of social work on patient's outcome.}, language = {en} } @article{FischKellerNazmyetal.2016, author = {Fisch, Silvia and Keller, Theresa and Nazmy, Nurina and Stasun, Ulrike and Keil, Thomas and Klapp, Christine}, title = {Evaluation des Babylotse-Plus-Screeningbogens. Untersuchung eines einfachen Instruments zur Identifizierung psychosozial belasteter Eltern von Neugeborenen der Berliner Charit{\´e}}, series = {Bundesgesundheitsblatt-Gesundheitsforschung-Gesundheitsschutz}, volume = {59}, journal = {Bundesgesundheitsblatt-Gesundheitsforschung-Gesundheitsschutz}, number = {10}, doi = {10.1007/s00103-016-2425-5}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-187194}, pages = {1300-1309}, year = {2016}, abstract = {Hintergrund. Die Entwicklung und das Wohl von Kindern aus Familien mit schweren psychosozialen Belastungen k{\"o}nnen schon in der Schwangerschaft und im S{\"a}uglingsalter gef{\"a}hrdet sein. In der Geburtsmedizin in Deutschland fehlen einfache, valide Fr{\"u}hwarnsysteme, um Risikofamilien rechtzeitig zu identifizieren. Zielsetzung. Unser Ziel war es, die diagnostische Genauigkeit eines perinatal eingesetzten, einfachen Screeningbogens zur Identifizierung psychosozial belasteter Familien zu evaluieren. Methoden. F{\"u}r alle Geburten der Berliner Charit{\´e} im Zeitraum 1.1.-31.8.2013 f{\"u}llte medizinisches Personal im Rahmen des Projekts Babylotse-Plus einen 5-min{\"u}tigen Screeningbogen mit 27 Items aus. Ein daraus resultierender Summenscore ≥3 wurde als „auff{\"a}llig" definiert. Anschließend erfolgte zur genauen Erfassung der famili{\"a}ren Ressourcen undm{\"o}glicher psychosozialer Belastungen ein einst{\"u}ndiges, standardisiertes Elterninterview, welches als Referenzstandard f{\"u}r die Evaluation des Screeningbogens verwendet wurde. Ergebnisse. In die vorliegende Analyse konnten 279 Familien eingeschlossen werden. Beim Vergleich der 215 Familien mit „auff{\"a}lligem" Score mit einer Zufallsauswahl von 64 Familien mit „unauff{\"a}lligem" Score <3, zeigte sich f{\"u}r den Screeningbogen eine hervorragende Sensitivit{\"a}t (98,9\%; 95\%- Konfidenzintervall 93,4-99,9\%), jedoch nur eine geringe Spezifit{\"a}t (33,0\%; 95\%- Konfidenzintervall 30,5-33,5\%). Die daraus resultierende positive Likelihood Ratio fiel mit 1,5 schwach, die negative Likelihood Ratio dagegen mit 0,03 sehr gut aus. Schlussfolgerungen. Mithilfe des Screeningbogens konnten psychosoziale Risikofamilien sehr gut identifiziert werden, jedoch wurden auch viele Familien ohne oder mit nur einem geringen Risiko f{\"a}lschlicherweise als unterst{\"u}tzungsbed{\"u}rftig eingestuft. Weitere Studien sollten in anderen Settings und zur Verbesserung der Spezifit{\"a}t bei m{\"o}glichst gleichbleibender Sensitivit{\"a}t des Screeningbogens durchgef{\"u}hrt werden.}, language = {de} } @article{BousquetAntoAkdisetal.2016, author = {Bousquet, J. and Anto, J. M. and Akdis, M. and Auffray, C. and Keil, T. and Momas, I. and Postma, D. S. and Valenta, R. and Wickman, M. and Cambon-Thomsen, A. and Haahtela, T. and Lambrecht, B. N. and Lodrup Carlsen, K. C. and Koppelman, G. H. and Sunyer, J. and Zuberbier, T. and Annesi-Maesano, I. and Arno, A. and Bindslev-Jensen, C. and De Carlo, G. and Forastiere, F. and Heinrich, J. and Kowalski, M. L. and Maier, D. and Melen, E. and Palkonen, S. and Smit, H. A. and Standl, M. and Wright, J. and Asarnoj, A. and Benet, M. and Ballardini, N. and Garcia-Aymerich, J. and Gehring, U. and Guerra, S. and Hohman, C. and Kull, I. and Lupinek, C. and Pinart, M. and Skrindo, I. and Westman, M. and Smagghe, D. and Akdis, C. and Albang, R. and Anastasova, V. and Anderson, N. and Bachert, C. and Ballereau, S. and Ballester, F. and Basagana, X. and Bedbrook, A. and Bergstrom, A. and von Berg, A. and Brunekreef, B. and Burte, E. and Carlsen, K.H. and Chatzi, L. and Coquet, J.M. and Curin, M. and Demoly, P. and Eller, E. and Fantini, M.P. and Gerhard, B. and Hammad, H. and von Hertzen, L. and Hovland, V. and Jacquemin, B. and Just, J. and Keller, T. and Kerkhof, M. and Kiss, R. and Kogevinas, M. and Koletzko, S. and Lau, S. and Lehmann, I. and Lemonnier, N. and McEachan, R. and Makela, M. and Mestres, J. and Minina, E. and Mowinckel, P. and Nadif, R. and Nawijn, M. and Oddie, S. and Pellet, J. and Pin, I. and Porta, D. and Ranci{\`e}re, F. and Rial-Sebbag, A. and Schuijs, M.J. and Siroux, V. and Tischer, C.G. and Torrent, M. and Varraso, R. and De Vocht, J. and Wenger, K. and Wieser, S. and Xu, C.}, title = {Paving the way of systems biology and precision medicine in allergic diseases: the MeDALL success story Mechanisms of the Development of ALLergy; EUFP7-CP-IP; Project No: 261357; 2010-2015}, series = {Allergy}, volume = {71}, journal = {Allergy}, number = {11}, doi = {10.1111/all.12880}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-186858}, pages = {1513-1525}, year = {2016}, abstract = {MeDALL (Mechanisms of the Development of ALLergy; EU FP7-CP-IP; Project No: 261357; 2010-2015) has proposed an innovative approach to develop early indicators for the prediction, diagnosis, prevention and targets for therapy. MeDALL has linked epidemiological, clinical and basic research using a stepwise, large-scale and integrative approach: MeDALL data of precisely phenotyped children followed in 14 birth cohorts spread across Europe were combined with systems biology (omics, IgE measurement using microarrays) and environmental data. Multimorbidity in the same child is more common than expected by chance alone, suggesting that these diseases share causal mechanisms irrespective of IgE sensitization. IgE sensitization should be considered differently in monosensitized and polysensitized individuals. Allergic multimorbidities and IgE polysensitization are often associated with the persistence or severity of allergic diseases. Environmental exposures are relevant for the development of allergy-related diseases. To complement the population-based studies in children, MeDALL included mechanistic experimental animal studies and in vitro studies in humans. The integration of multimorbidities and polysensitization has resulted in a new classification framework of allergic diseases that could help to improve the understanding of genetic and epigenetic mechanisms of allergy as well as to better manage allergic diseases. Ethics and gender were considered. MeDALL has deployed translational activities within the EU agenda.}, language = {en} } @article{FroehlichPinartKelleretal.2017, author = {Fr{\"o}hlich, M. and Pinart, M. and Keller, T. and Reich, A. and Cabieses, B. and Hohmann, C. and Postma, D. S. and Bousquet, J. and Ant{\´o}, J. M. and Keil, T. and Roll, S.}, title = {Is there a sex-shift in prevalence of allergic rhinitis and comorbid asthma from childhood to adulthood? A meta-analysis}, series = {Clinical and Translational Allergy}, volume = {7}, journal = {Clinical and Translational Allergy}, doi = {10.1186/s13601-017-0176-5}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-172508}, year = {2017}, abstract = {Background: Allergic rhinitis and asthma as single entities affect more boys than girls in childhood but more females in adulthood. However, it is unclear if this prevalence sex-shift also occurs in allergic rhinitis and concurrent asthma. Thus, our aim was to compare sex-specifc differences in the prevalence of coexisting allergic rhinitis and asthma in childhood, adolescence and adulthood. Methods: Post-hoc analysis of systematic review with meta-analysis concerning sex-specific prevalence of allergic rhinitis. Using random-effects meta-analysis, we assessed male-female ratios for coexisting allergic rhinitis and asthma in children (0-10 years), adolescents (11-17) and adults (> 17). Electronic searches were performed using MEDLINE and EMBASE for the time period 2000-2014. We included population-based observational studies, reporting coexisting allergic rhinitis and asthma as outcome stratifed by sex. We excluded non-original or non-population-based studies, studies with only male or female participants or selective patient collectives. Results: From a total of 6539 citations, 10 studies with a total of 93,483 participants met the inclusion criteria. The male-female ratios (95\% CI) for coexisting allergic rhinitis and asthma were 1.65 (1.52; 1.78) in children (N = 6 studies), 0.61 (0.51; 0.72) in adolescents (N = 2) and 1.03 (0.79; 1.35) in adults (N = 2). Male-female ratios for allergic rhinitis only were 1.25 (1.19; 1.32, N = 5) in children, 0.80 (0.71; 0.89, N = 2) in adolescents and 0.98 (0.74; 1.30, N = 2) in adults, respectively. Conclusions: The prevalence of coexisting allergic rhinitis and asthma shows a clear male predominance in childhood and seems to switch to a female predominance in adolescents. This switch was less pronounced for allergic rhinitis only.}, language = {en} } @article{GarciaLarsenArthurPottsetal.2017, author = {Garcia-Larsen, Vanessa and Arthur, Rhonda and Potts, James F. and Howarth, Peter H. and Ahlstr{\"o}m, Matti and Haahtela, Tari and Loureiro, Carlos and Bom, Ana Todo and Brożek, Grzegorz and Makowska, Joanna and Kowalski, Marek L. and Thilsing, Trine and Keil, Thomas and Matricardi, Paolo M. and Tor{\´e}n, Kjell and van Zele, Thibaut and Bachert, Claus and Rymarczyk, Barbara and Janson, Christer and Forsberg, Bertil and Niżankowska-Mogilnicka, Ewa and Burney, Peter G. J.}, title = {Is fruit and vegetable intake associated with asthma or chronic rhino-sinusitis in European adults? Results from the Global Allergy and Asthma Network of Excellence (GA\(^2\)LEN) Survey}, series = {Clinical and Translational Allergy}, volume = {7}, journal = {Clinical and Translational Allergy}, doi = {10.1186/s13601-016-0140-9}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-180887}, pages = {9}, year = {2017}, abstract = {Background: Fruits and vegetables are rich in compounds with proposed antioxidant, anti-allergic and anti-inflammatory properties, which could contribute to reduce the prevalence of asthma and allergic diseases. Objective: We investigated the association between asthma, and chronic rhino-sinusitis (CRS) with intake of fruits and vegetables in European adults. Methods: A stratified random sample was drawn from the Global Allergy and Asthma Network of Excellence (GA\(^2\)LEN) screening survey, in which 55,000 adults aged 15-75 answered a questionnaire on respiratory symptoms. Asthma score (derived from self-reported asthma symptoms) and CRS were the outcomes of interest. Dietary intake of 22 subgroups of fruits and vegetables was ascertained using the internationally validated GA\(^2\)LEN Food Frequency Questionnaire. Adjusted associations were examined with negative binomial and multiple regressions. Simes procedure was used to control for multiple testing. Results: A total of 3206 individuals had valid data on asthma and dietary exposures of interest. 22.8\% reported having at least 1 asthma symptom (asthma score ≥1), whilst 19.5\% had CRS. After adjustment for potential confounders, asthma score was negatively associated with intake of dried fruits (β-coefficient -2.34; 95\% confidence interval [CI] -4.09, -0.59), whilst CRS was statistically negatively associated with total intake of fruits (OR 0.73; 95\% CI 0.55, 0.97). Conversely, a positive association was observed between asthma score and alliums vegetables (adjusted β-coefficient 0.23; 95\% CI 0.06, 0.40). None of these associations remained statistically significant after controlling for multiple testing. Conclusion and clinical relevance: There was no consistent evidence for an association of asthma or CRS with fruit and vegetable intake in this representative sample of European adults.}, language = {en} } @article{TanoeyBaechleBrenneretal.2022, author = {Tanoey, Justine and Baechle, Christina and Brenner, Hermann and Deckert, Andreas and Fricke, Julia and G{\"u}nther, Kathrin and Karch, Andr{\´e} and Keil, Thomas and Kluttig, Alexander and Leitzmann, Michael and Mikolajczyk, Rafael and Obi, Nadia and Pischon, Tobias and Schikowski, Tamara and Schipf, Sabine M. and Schulze, Matthias B. and Sedlmeier, Anja and Moreno Vel{\´a}squez, Ilais and Weber, Katharina S. and V{\"o}lzke, Henry and Ahrens, Wolfgang and Gastell, Sylvia and Holleczek, Bernd and J{\"o}ckel, Karl-Heinz and Katzke, Verena and Lieb, Wolfgang and Michels, Karin B. and Schmidt, B{\"o}rge and Teismann, Henning and Becher, Heiko}, title = {Birth order, Caesarean section, or daycare attendance in relation to child- and adult-onset type 1 diabetes: results from the German National Cohort}, series = {International Journal of Environmental Research and Public Health}, volume = {19}, journal = {International Journal of Environmental Research and Public Health}, number = {17}, issn = {1660-4601}, doi = {10.3390/ijerph191710880}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-286216}, year = {2022}, abstract = {(1) Background: Global incidence of type 1 diabetes (T1D) is rising and nearly half occurred in adults. However, it is unclear if certain early-life childhood T1D risk factors were also associated with adult-onset T1D. This study aimed to assess associations between birth order, delivery mode or daycare attendance and type 1 diabetes (T1D) risk in a population-based cohort and whether these were similar for childhood- and adult-onset T1D (cut-off age 15); (2) Methods: Data were obtained from the German National Cohort (NAKO Gesundheitsstudie) baseline assessment. Self-reported diabetes was classified as T1D if: diagnosis age ≤ 40 years and has been receiving insulin treatment since less than one year after diagnosis. Cox regression was applied for T1D risk analysis; (3) Results: Analyses included 101,411 participants (100 childhood- and 271 adult-onset T1D cases). Compared to "only-children", HRs for second- or later-born individuals were 0.70 (95\% CI = 0.50-0.96) and 0.65 (95\% CI = 0.45-0.94), respectively, regardless of parental diabetes, migration background, birth year and perinatal factors. In further analyses, higher birth order reduced T1D risk in children and adults born in recent decades. Caesarean section and daycare attendance showed no clear associations with T1D risk; (4) Conclusions: Birth order should be considered in both children and adults' T1D risk assessment for early detection.}, language = {en} } @article{HellerReiterLeichtetal.2023, author = {Heller, Bianca and Reiter, Florian P. and Leicht, Hans Benno and Fiessler, Cornelia and Bergheim, Ina and Heuschmann, Peter U. and Geier, Andreas and Rau, Monika}, title = {Salt-intake-related behavior varies between sexes and is strongly associated with daily salt consumption in obese patients at high risk for MASLD}, series = {Nutrients}, volume = {15}, journal = {Nutrients}, number = {18}, issn = {2072-6643}, doi = {10.3390/nu15183942}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-363107}, year = {2023}, abstract = {Background: Metabolic dysfunction-associated steatotic liver disease (MASLD) imposes a significant burden on Westernized regions. The Western diet, high in salt intake, significantly contributes to disease development. However, there are a lack of data on salt literacy and salt intake among MASLD patients in Germany. Our study aims to analyze daily salt intake and salt-intake-related behavior in MASLD patients. Methods: 234 MASLD patients were prospectively included. Daily salt intake and salt-intake-related behavior were assessed via a food frequency questionnaire (FFQ—DEGS) and a salt questionnaire (SINU). Statistical analyses were performed using SPSS. Results: Mean daily salt intake was higher in men than in women (7.3 ± 5 g/d vs. 5.3 ± 4 g/d; p \< 0.001). There was significant agreement between increased daily salt intake (6 g/d) and the behavioral salt index (SI) (p \< 0.001). Men exhibited higher SI scores compared to women, indicating lower awareness of salt in everyday life. Multivariate analysis identified specific salt-intake-related behaviors impacting daily salt consumption. Conclusions: Our study reveals a strong link between daily salt intake and salt-intake-related behavior, highlighting sex-specific differences in an MASLD cohort. To enhance patient care in high-cardiovascular-risk populations, specific behavioral approaches may be considered, including salt awareness, to improve adherence to lifestyle changes, particularly in male patients.}, language = {en} } @article{DornquastReinholdSolaketal.2022, author = {Dornquast, Christina and Reinhold, Thomas and Solak, Saliha and Durak, Melike and Becher, Heiko and Riens, Burgi and Icke, Katja and Danquah, Ina and Willich, Stefan N. and Keil, Thomas and Krist, Lilian}, title = {Strategies to Enhance Retention in a Cohort Study Among Adults of Turkish Descent Living in Berlin}, series = {Journal of Immigrant and Minority Health}, volume = {24}, journal = {Journal of Immigrant and Minority Health}, number = {5}, doi = {10.1007/s10903-021-01309-1}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-344776}, pages = {1309-1317}, year = {2022}, abstract = {Retention is important for statistical power and external validity in long-term cohort studies. The aims of our study were to evaluate different retention strategies within a cohort study of adults of Turkish descent in Berlin, Germany, and to compare participants and non-participants. In 2011-2012, a population-based study was conducted among adults of Turkish descent to primarily examine recruitment strategies. 6 years later, the participants were re-contacted and invited to complete a self-report questionnaire regarding their health status, health care utilization, and satisfaction with medical services. The retention strategy comprised letters in both German and Turkish, phone calls, and home visits (by bilingual staff). We calculated the response rate and retention rate, using definitions of the American Association for Public Opinion Research, as well as the relative retention rate for each level of contact. Associations of baseline recruitment strategy, sociodemographic, migration-related and health-related factors with retention were investigated by logistic regression analysis. Of 557 persons contacted, 249 (44.7\%) completed the questionnaire. This was 50.1\% of those whose contact information was available. The relative retention rate was lowest for phone calls (8.9\%) and highest for home visits (18.4\%). Participants were more often non-smokers and German citizens than non-participants. For all remaining factors, no association with retention was found. In this study, among adults of Turkish descent, the retention rate increased considerably with every additional level of contact. Implementation of comprehensive retention strategies provided by culturally matched study personnel may lead to higher validity and statistical power in studies on migrant health issues.}, language = {en} } @article{BuchmannBaumannMengetal.2023, author = {Buchmann, J. and Baumann, N. and Meng, K. and Semrau, J. and Kuhl, J. and Pfeifer, K. and Vogel, H. and Faller, H.}, title = {Volitional Action Control and Depression in Chronic Pain: Does Action versus State Orientation Moderate the Relations of Pain-Related Cognitions to Depression?}, series = {Current Psychology}, volume = {42}, journal = {Current Psychology}, issn = {1046-1310}, doi = {10.1007/s12144-021-01914-1}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-308508}, pages = {7591-7608}, year = {2023}, abstract = {In this study, we examined the conditional indirect and direct relations of pain-related cognitions to depression. Subjective helplessness was included as presumably mediating the relations of catastrophizing and thought suppression to depression due to motivational deficits. In addition, moderating effects of dispositional action versus state orientation were analyzed, whereby state orientation indicates volitional deficits in coping with distress. The study was based on self-report data from 536 patients with chronic non-specific low back pain at the beginning of inpatient rehabilitation. Moderated mediation analyses were performed. The indirect catastrophizing- and thought suppression-depression relations were (partially) mediated by subjective helplessness; and moderated by failure-related action versus state orientation. Moreover, action versus state orientation moderated the direct relation of thought suppression to depression. Results suggest that catastrophizing, thought suppression, and subjective helplessness do not lead to depression unless associated with self-regulatory inability (i.e., state orientation). In contrast, action-oriented patients more effectively self-regulate pain-related emotions, disengage from rumination, and distract from pain and thus better avoid the debilitating effects of negative pain-related cognitions on depression. Future research and treatment may more strongly focus on the role of motivational and volitional deficits underlying learned helplessness and depression in chronic pain.}, language = {en} } @article{KraftSchleeStachetal.2020, author = {Kraft, Robin and Schlee, Winfried and Stach, Michael and Reichert, Manfred and Langguth, Berthold and Baumeister, Harald and Probst, Thomas and Hannemann, Ronny and Pryss, R{\"u}diger}, title = {Combining Mobile Crowdsensing and Ecological Momentary Assessments in the Healthcare Domain}, series = {Frontiers in Neuroscience}, volume = {14}, journal = {Frontiers in Neuroscience}, number = {164}, issn = {1662-453X}, doi = {10.3389/fnins.2020.00164}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-200220}, year = {2020}, abstract = {The increasing prevalence of smart mobile devices (e.g., smartphones) enables the combined use of mobile crowdsensing (MCS) and ecological momentary assessments (EMA) in the healthcare domain. By correlating qualitative longitudinal and ecologically valid EMA assessment data sets with sensor measurements in mobile apps, new valuable insights about patients (e.g., humans who suffer from chronic diseases) can be gained. However, there are numerous conceptual, architectural and technical, as well as legal challenges when implementing a respective software solution. Therefore, the work at hand (1) identifies these challenges, (2) derives respective recommendations, and (3) proposes a reference architecture for a MCS-EMA-platform addressing the defined recommendations. The required insights to propose the reference architecture were gained in several large-scale mHealth crowdsensing studies running for many years and different healthcare questions. To mention only two examples, we are running crowdsensing studies on questions for the tinnitus chronic disorder or psychological stress. We consider the proposed reference architecture and the identified challenges and recommendations as a contribution in two respects. First, they enable other researchers to align our practical studies with a baseline setting that can satisfy the variously revealed insights. Second, they are a proper basis to better compare data that was gathered using MCS and EMA. In addition, the combined use of MCS and EMA increasingly requires suitable architectures and associated digital solutions for the healthcare domain.}, language = {en} } @article{HasenpuschMatterneTischeretal.2022, author = {Hasenpusch, Claudia and Matterne, Uwe and Tischer, Christina and Hrudey, Ilona and Apfelbacher, Christian}, title = {Development and content validation of a comprehensive health literacy survey instrument for use in individuals with asthma during the COVID-19 pandemic}, series = {International Journal of Environmental Research and Public Health}, volume = {19}, journal = {International Journal of Environmental Research and Public Health}, number = {4}, issn = {1660-4601}, doi = {10.3390/ijerph19041923}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-262146}, year = {2022}, abstract = {Individuals with chronic conditions have been faced with many additional challenges during the COVID-19 pandemic. Individual health literacy (HL) as the ability to access, understand, evaluate, and apply pandemic-related information has thus become ever more important in these populations. The purpose of this study was to develop and content-validate a comprehensive HL survey instrument for people with asthma based on an integrated framework, and on previous surveys and other instruments for use in the general population and vulnerable groups. Beside HL, assumed determinants, mediators, and health outcomes were embraced in the framework. A mixed-method design was used. A comprehensive examination of the available literature yielded an initial pool of 398 single items within 20 categories. Based on content validity indices (CVI) of expert ratings (n = 11) and the content analysis of cognitive interviews with participants (n = 9), the item pool was reduced, and individual items/scales refined or modified. The instrument showed appropriate comprehensibility (98.0\%), was judged relevant, and had an acceptable CVI at scale level (S-CVI/Ave = 0.91). The final version comprises 14 categories measured by 38 questions consisting of 116 single items. In terms of content, the instrument appears a valid representation of behavioural and psychosocial constructs pertaining to a broad HL understanding and relevant to individuals with asthma during the COVID-19 pandemic. Regular monitoring of these behavioural and psychosocial constructs during the course of the pandemic can help identify needs as well as changes during the course of the pandemic, which is particularly important in chronic disease populations.}, language = {en} } @phdthesis{Tiffe2019, author = {Tiffe, Theresa}, title = {Pr{\"a}valenz und Determinanten f{\"u}r die Einhaltung der leitliniengerechten Therapie kardiovaskul{\"a}rer Risikofaktoren in der Prim{\"a}r- und Sekund{\"a}rpr{\"a}vention von Herz-Kreislauf-Erkrankungen in Deutschland}, doi = {10.25972/OPUS-19272}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-192723}, school = {Universit{\"a}t W{\"u}rzburg}, year = {2019}, abstract = {Die Einhaltung eines gesunden Lebensstils, einschließlich der Behandlung modifizierbarer kardiovaskul{\"a}rer Risikofaktoren, beeinflusst maßgeblich die Entstehung und Progression von Herz-Kreislauf-Erkrankungen (HKE). So reduziert eine ausgewogene Ern{\"a}hrungsweise, ausreichend k{\"o}rperliche Aktivit{\"a}t, Tabakverzicht, das Halten des Normalgewichtes sowie die Behandlung einer Hypertonie, Hyperlipid{\"a}mie und Diabetes mellitus, die kardiovaskul{\"a}re Morbidit{\"a}t und Mortalit{\"a}t. Die vorliegende Arbeit widmet sich (a) der Pr{\"a}valenz und leitliniengerechten Kontrolle kardiovaskul{\"a}rer Risikofaktoren von Teilnehmern aus der Allgemeinbev{\"o}lkerung der STAAB Kohortenstudie („H{\"a}ufigkeit und Einflussfaktoren auf fr{\"u}he Stadien A und B der Herzinsuffizienz in der Bev{\"o}lkerung") sowie der Sch{\"a}tzung des 10-Jahres Risikos f{\"u}r t{\"o}dliche HKE in diesem Kollektiv. Weiterhin wurde (b) der Einfluss von medikamentenbezogenen {\"U}berzeugungen auf die Blutdruckkontrolle von Teilnehmern der STAAB Kohortenstudie untersucht. Schließlich wurde (c) der Erhalt von {\"a}rztlichen Lebensstilempfehlungen sowie deren Determinanten bei Teilnehmern der STAAB Kohortenstudie sowie der EUROASPIRE IV Studie („European Action on Secondary and Primary Prevention by Intervention to Reduce Events") in Deutschland betrachtet. Die STAAB Kohortenstudie untersucht die fr{\"u}hen asymptomatischen Formen der Herzinsuffizienz-Stadien A und B in einer repr{\"a}sentativen Stichprobe von 5.000 Personen ohne symptomatische Herzinsuffizienz im Alter von 30 bis 79 Jahren aus der Allgemeinbev{\"o}lkerung mit Wohnsitz in der Stadt W{\"u}rzburg. Die EUROASPIRE IV Studie untersuchte bei 7.998 Koronarpatienten im Alter von 18 bis 79 Jahren aus insgesamt 24 Europ{\"a}ischen L{\"a}ndern (536 Patienten aus Deutschland) im Zeitraum 2012 bis 2013 die Risikofaktoren sowie die Umsetzung der leitliniengerechten Versorgung und Pr{\"a}vention von HKE im europ{\"a}ischen Vergleich. Die Datenerhebung beider Studien erfolgte durch ein geschultes Studienpersonal nach standardisierten Vorgaben. Die Pr{\"a}valenz und Kontrolle kardiovaskul{\"a}rer Risikofaktoren nach den aktuellen Vorgaben der „European Society of Cardiology" (ESC) wurde bei insgesamt 1.379 Teilnehmern, die zwischen Dezember 2013 und April 2015 an der STAAB Kohortenstudie teilgenommen haben, untersucht. Es zeigte sich eine hohe Pr{\"a}valenz der kardiovaskul{\"a}ren Risikofaktoren Hypertonie (31.8\%), Hyperlipid{\"a}mie (57.6\%) und Diabetes mellitus (3.5\%). Hierbei erreichten trotz Pharmakotherapie {\"u}ber die H{\"a}lfte der Teilnehmer mit einem Bluthochdruck (52.7\%) oder erh{\"o}hten LDL-Cholesterinwerten (56.7\%) sowie 44.0\% der Personen mit einem Diabetes mellitus die empfohlenen Grenzwerte nicht. Weiterhin wurde erstmalig zu Studienbesuch eine Hypertonie (36.0\%), Hyperlipid{\"a}mie (54.2\%) oder ein Langzeitzuckerwert (HbA1c) >6.5\% (23.3\%) detektiert. In der j{\"u}ngsten Altersgruppe (30-39 Jahre) fand sich der h{\"o}chste Anteil von unbekanntem Bluthochdruck (76.5\%) sowie hohem LDL-Cholesterin (78.0\%) und die Altersgruppe 60-69 Jahren wies mit 43.5\% die h{\"o}chste Pr{\"a}valenz f{\"u}r einen bislang nicht detektierten HbA1c >6.5\% auf. Die Akkumulation von drei oder mehr kardiovaskul{\"a}ren Risikofaktoren war mit dem m{\"a}nnlichen Geschlecht, einem h{\"o}heren Alter und einem niedrigeren Bildungsgrad assoziiert. Von 980 mittels SCORE („Systematic Coronary Risk Evaluation") Risiko-Chart untersuchten Teilnehmern befanden sich jeweils 56.6\%, 35.8\% und 7.5\% in der niedrigen, mittleren und hohen bis sehr hohen SCORE-Risikogruppe f{\"u}r t{\"o}dliche HKE. Das Hochrisiko-Kollektiv f{\"u}r t{\"o}dliche HKE war vorwiegend m{\"a}nnlich und wies h{\"a}ufiger eine Hypertonie oder ein hohes LDL-Cholesterin auf. Der Einfluss von {\"U}berzeugungen gegen{\"u}ber antihypertensiver Medikation auf die Blutdruckkontrolle wurde an 293 Teilnehmern, die von Oktober 2014 bis M{\"a}rz 2017 an der STAAB Kohortenstudie teilgenommen haben, untersucht. Auf ihre Medikamente gesundheitlich angewiesen zu sein gaben 87\% der Teilnehmer an, 78.1\% stimmten der Aussage zu, dass ihre Medikamente sie vor einer Verschlechterung ihrer Gesundheit sch{\"u}tzen. Es zeigte sich ein inverser Zusammenhang zwischen einem h{\"o}heren Maß an Bedenken gegen{\"u}ber der verordneten blutdrucksenkenden Medikation und einer besseren Blutdruckkontrolle bei Frauen. Ein signifikanter Zusammenhang zwischen Bedenken gegen{\"u}ber einer antihypertensiven Medikation und der Blutdruckkontrolle bei M{\"a}nnern ließ sich hingegen nicht feststellen. Es konnten keine statistisch signifikanten Assoziationen f{\"u}r die Notwendigkeit von Medikation in der vorliegen Untersuchung gezeigt werden. Die H{\"a}ufigkeit und Determinanten f{\"u}r die Empfehlung eines {\"a}rztlichen Lebensstils wurde bei 665 Teilnehmern der STAAB Kohortenstudie ohne vorbestehende HKE (Prim{\"a}rpr{\"a}vention) und bei 536 Koronarpatienten der EUROASPIRE IV Studie (Sekund{\"a}rpr{\"a}vention) untersucht. Mit Ausnahme der Empfehlung zum Rauchverzicht erhielten die Patienten der EUROASPIRE IV Studie h{\"a}ufiger {\"a}rztliche Lebensstilempfehlungen verglichen mit Teilnehmern der STAAB Kohortenstudie: (Rauchverzicht: STAAB 44.0\%, EUROASPIRE 36.7\%; Gewichtsreduktion: STAAB 43.9\%, EUROASPIRE 69.2\%; k{\"o}rperliche Aktivit{\"a}t steigern: STAAB 52.1\%, EUROASPIRE 71.4\%; gesundes Ern{\"a}hrungsverhalten: STAAB 43.9\%, EUROASPIRE 73.1\%). Die Chance f{\"u}r den Erhalt von mindestens 50\% aufgrund der individuellen Risikofaktoren ad{\"a}quaten {\"a}rztlichen Lebensstilempfehlungen war bei STAAB Teilnehmern mit offensichtlichen oder beobachtbaren kardiovaskul{\"a}ren Risikofaktoren signifikant erh{\"o}ht (BMI >25kg/m2, Hypertonie, Hyperlipid{\"a}mie und Diabetes mellitus). Hingegen erhielten Patienten mit einer vorbestehenden HKE signifikant h{\"a}ufiger eine {\"a}rztliche Lebensstilempfehlung bei einem Diabetes mellitus, wobei die Empfehlungsh{\"a}ufigkeit mit zunehmendem Alter abnahm. Die weitergehende nicht publizierte Analyse des Interaktions Modells zeigte, dass der Zusammenhang zwischen dem Alter und der Empfehlungsh{\"a}ufigkeit bei Patienten mit bereits bestehender HKE st{\"a}rker ausgepr{\"a}gt war, als bei Teilnehmern der STAAB Kohortenstudie ohne koronare HKE. Weiterhin war der Zusammenhang zwischen einer ad{\"a}quaten Lebensstilempfehlung und Hyperlipid{\"a}mie bei Teilnehmern ohne koronares Ereignis signifikant st{\"a}rker ausgepr{\"a}gt, im Vergleich zu Patienten mit einer bereits bestehender HKE. Die Ergebnisse zeigten ein erhebliches Potenzial f{\"u}r eine verbesserte Umsetzung leitliniengerechter Behandlung modifizierbarer kardiovaskul{\"a}rer Risikofaktoren in der Prim{\"a}r- und Sekund{\"a}rpr{\"a}vention. Vor dem Hintergrund einer hohen Anzahl kardiovaskul{\"a}rer Risikofaktoren bei jungen Erwachsenen sollte die Bedeutung der Langzeitfolgen im Arzt Patienten-Gespr{\"a}ch hervorgehoben und bei der Erarbeitung von Pr{\"a}ventionsstrategien, insbesondere f{\"u}r junge Altersgruppen, Beachtung finden. Geschlechtsspezifische Determinanten hinsichtlich der Kontrolle kardiovaskul{\"a}rer Risikofaktoren sowie Bef{\"u}rchtungen gegen{\"u}ber der Medikation sollten st{\"a}rker im Arzt-Patientengespr{\"a}ch ber{\"u}cksichtigt werden. Zur St{\"a}rkung der Compliance des Patienten bei der Umsetzung eines gesunden Lebensstils, sollte der Arzt hinsichtlich der Bedeutung von Lebensstilintervention, aber auch im Umgang mit schwierigen Situationen, wie die Empfehlung einer Gewichtsreduktion, sensibilisiert und bei der richtigen Handhabung der Leitlinienempfehlung st{\"a}rker unterst{\"u}tzt werden.}, subject = {Kardiovaskul{\"a}re Krankheit}, language = {de} } @phdthesis{JiruHillmann2022, author = {Jir{\`u}-Hillmann, Steffi}, title = {Schlaganfallversorgung: Europ{\"a}ische, deutsche und regionale Perspektiven}, doi = {10.25972/OPUS-26144}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-261445}, school = {Universit{\"a}t W{\"u}rzburg}, year = {2022}, abstract = {Seit Mitte der 1990er Jahre wurden nationale und regionale Schlaganfallregister in Europa etabliert, die Auskunft {\"u}ber die Versorgungsqualit{\"a}t von Schlaganfallpatienten geben. Bislang lagen nur wenige Daten zu zeitlichen Trends der akuten Schlaganfallversorgung vor. Diese sind jedoch essentiell, um beispielsweise Zusammenh{\"a}nge zwischen der Einf{\"u}hrung potentiell qualit{\"a}tsverbessernder Maßnahmen und der Entwicklung der Versorgungsqualit{\"a}t feststellen zu k{\"o}nnen. Die Behandlung von Schlaganfallpatienten auf Stroke Units ist aufgrund der eindeutigen Evidenz aus randomisierten- und Beobachtungsstudien zum Standard geworden. Bislang war unklar, ob demografische und klinische Charakteristika die direkte Aufnahme auf eine Stroke Unit beeinflussen. Zudem war nicht bekannt, ob und wenn ja, in welchem Ausmaß strukturelle Kriterien und der Anteil der Patienten, der auf eine Stroke Unit aufgenommen wurde, die Qualit{\"a}t der Stroke Unit Versorgung beeinflussen. Im Anschluss an die Akutbehandlung im Krankenhaus bzw. nach geeigneten Rehabilitationsmaßnahmen {\"u}bernehmen pflegende Angeh{\"o}rige h{\"a}ufig die Versorgung der Schlaganfallpatienten im h{\"a}uslichen Umfeld. Die aktuelle Situation der pflegenden Angeh{\"o}rigen von Schlaganfallpatienten in Deutschland ist bisher jedoch nur unzureichend evaluiert. In der vorliegenden Dissertation wurden zun{\"a}chst im Rahmen des „European Implementation Score"-Projektes zeitliche Trends der Qualit{\"a}t der akuten Schlaganfallversorgung in f{\"u}nf nationalen europ{\"a}ischen Schlaganfallregistern aus Deutschland, England/Wales/Nordirland, Polen, Schottland und Schweden nach zuvor definierten evidenzbasierten Qualit{\"a}tsindikatoren berechnet. Im zweiten Schritt wurde anhand von Daten der Arbeitsgemeinschaft Deutscher Schlaganfall Register (ADSR) evaluiert, ob demografische und klinische Patientencharakteristika die direkte Aufnahme auf eine Stroke Unit in Deutschland beeinflussen. Weiterhin wurde der Einfluss struktureller Charakteristika auf die Erf{\"u}llung von 11 evidenzbasierter Qualit{\"a}tsindikatoren in Krankenh{\"a}usern, die {\"u}ber eine regionale oder {\"u}berregionale Stroke Unit verf{\"u}gen, untersucht. Abschließend wurden im Rahmen des regionalen Telemedizinnetzwerkes TRANSIT-Stroke demografische und klinische Charakteristika von Schlaganfallpatienten, die 3 Monate nach dem Schlaganfall mit dem Erhalt von Pflege durch einen Angeh{\"o}rigen assoziiert waren, identifiziert. Zus{\"a}tzlich wurden mit standardisierten Erhebungsinstrumenten positive und negative Erfahrungen der Pflege eines Schlaganfallpatienten sowie die selbsteingesch{\"a}tzte Belastung (deutsche Version des Caregiver Reaction Assessment und Self-Rated Burden Scale) ausgewertet sowie Faktoren, die mit den Pflegeerfahrungen und Belastungen assoziiert sind, evaluiert. Auf europ{\"a}ischer Ebene konnten wir einen Zusammenhang zwischen der Einf{\"u}hrung eines neuen Qualit{\"a}tsindikators und der Verbesserung der Qualit{\"a}t beobachten. Dies galt insbesondere f{\"u}r die erstmalige Einf{\"u}hrung des Qualit{\"a}tsindikators Dysphagiescreening im deutschen -(2006) und schwedischen Schlaganfallregister (2007). Somit gibt es Hinweise darauf, dass das Monitoring der Qualit{\"a}t der Schlaganfallversorgung zu Qualit{\"a}tsverbesserungen bzw. auch zu einer vollst{\"a}ndigeren Dokumentation f{\"u}hrt. Insgesamt konnten wir ein qualitativ hohes Niveau der akuten Schlaganfallversorgung auf Stroke Units in Deutschland gem{\"a}ß evidenzbasierter Qualit{\"a}tsindikatoren feststellen. Patienten mit einem isch{\"a}mischen Schlaganfall, die am Wochenende aufgenommen wurden (p<0,0001), innerhalb von 3 Stunden nach Symptombeginn im Krankenhaus aufgenommen wurden (p<0,0001), hypertensiv waren (p<0,0001), unter einer Hyperlipid{\"a}mie (p<0,0001) litten, wurden mit einer h{\"o}heren Wahrscheinlichkeit auf einer Stroke Unit aufgenommen. Dagegen hatten Patienten mit einem schwereren Schlaganfall (NIHSS>15) eine geringere Chance, auf einer Stroke Unit aufgenommen zu werden (p<0,0001). Der Einfluss struktureller Charakteristika auf die Qualit{\"a}t der Stroke Unit Versorgung war gering. Eine Verbesserung der Qualit{\"a}t k{\"o}nnte noch durch einen h{\"o}heren Anteil der auf einer Stroke Unit aufgenommenen Patienten erreicht werden. Im Rahmen der Nachbefragung von Patienten im regionalen Telemedizinnetzwerk TRANSIT-Stroke stellten Frauen mit 70,1\% den gr{\"o}ßten Anteil der pflegenden Angeh{\"o}rigen dar. 74,4\% der pflegenden Angeh{\"o}rigen war {\"a}lter als 55 Jahre. In univariablen und multivariablen logistischen Regressionsanalysen waren ein hohes Alter, ein niedriger Barthel-Index bei Entlassung sowie das Vorliegen von Diabetes signifikant mit einer h{\"o}heren Wahrscheinlichkeit assoziiert, Pflege von einem Angeh{\"o}rigen zu erhalten. Der Großteil der pflegenden Angeh{\"o}rigen m{\"o}chte den Angeh{\"o}rigen pflegen und ist gleichzeitig dem Risiko gesundheitlicher Probleme ausgesetzt. Circa ein F{\"u}nftel der pflegenden Angeh{\"o}rigen berichtete finanzielle Belastungen aufgrund der Pflegesituation. Depressive Symptome der Patienten waren mit einer h{\"o}heren Belastung der pflegenden Angeh{\"o}rigen hinsichtlich der selbsteingesch{\"a}tzten Belastung und den positiven und negativen Erfahrungen assoziiert. J{\"u}ngere, m{\"a}nnliche Schlaganfallpatienten, mit einem milderen Schlaganfall, die mit einer Partnerin oder Ehepartnerin zusammenleben, scheinen sich oft nicht bewusst zu sein, dass sie Pflege erhalten. M{\"o}glich ist hier, dass sie die Unterst{\"u}tzung und Pflege als „normal" betrachten, w{\"a}hrend der Partner bzw. die Partnerin dies als tats{\"a}chliche Pflege wertet. Schlaganfallregister eignen sich, um die Qualit{\"a}t der Akutversorgung im Zeitverlauf zu monitorieren und Zusammenh{\"a}nge zwischen der Einf{\"u}hrung potentiell qualit{\"a}tsverbessernder Maßnahmen und der tats{\"a}chlichen Qualit{\"a}t darstellen zu k{\"o}nnen. Die Qualit{\"a}t der Stroke Unit Versorgung in Deutschland ist auf einem hohen Niveau. Eine Verbesserung der Qualit{\"a}t k{\"o}nnte noch durch einen h{\"o}heren Anteil der auf einer Stroke Unit aufgenommenen Patienten erreicht werden. Ein Großteil der Schlaganfallpatienten lebt im Anschluss an die Akutversorgung im h{\"a}uslichen Umfeld, in dem pflegende Angeh{\"o}rige eine wichtige Rolle bei der Versorgung spielen. Pflegenden Angeh{\"o}rigen ist ihre Aufgabe wichtig, sind jedoch aufgrund der Pflege zugleich Belastungen hinsichtlich ihrer Gesundheit, der Gestaltung ihres t{\"a}glichen Zeitplans und der Finanzen ausgesetzt.}, subject = {Schlaganfall}, language = {de} } @article{AllgaierSchleeProbstetal.2022, author = {Allgaier, Johannes and Schlee, Winfried and Probst, Thomas and Pryss, R{\"u}diger}, title = {Prediction of tinnitus perception based on daily life mHealth data using country origin and season}, series = {Journal of Clinical Medicine}, volume = {11}, journal = {Journal of Clinical Medicine}, number = {15}, issn = {2077-0383}, doi = {10.3390/jcm11154270}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-281812}, year = {2022}, abstract = {Tinnitus is an auditory phantom perception without external sound stimuli. This chronic perception can severely affect quality of life. Because tinnitus symptoms are highly heterogeneous, multimodal data analyses are increasingly used to gain new insights. MHealth data sources, with their particular focus on country- and season-specific differences, can provide a promising avenue for new insights. Therefore, we examined data from the TrackYourTinnitus (TYT) mHealth platform to create symptom profiles of TYT users. We used gradient boosting engines to classify momentary tinnitus and regress tinnitus loudness, using country of origin and season as features. At the daily assessment level, tinnitus loudness can be regressed with a mean absolute error rate of 7.9\% points. In turn, momentary tinnitus can be classified with an F1 score of 93.79\%. Both results indicate differences in the tinnitus of TYT users with respect to season and country of origin. The significance of the features was evaluated using statistical and explainable machine learning methods. It was further shown that tinnitus varies with temperature in certain countries. The results presented show that season and country of origin appear to be valuable features when combined with longitudinal mHealth data at the level of daily assessment.}, language = {en} } @article{WetzelPryssBaumeisteretal.2021, author = {Wetzel, Britta and Pryss, R{\"u}diger and Baumeister, Harald and Edler, Johanna-Sophie and Gon{\c{c}}alves, Ana Sofia Oliveira and Cohrdes, Caroline}, title = {"How come you don't call me?" Smartphone communication app usage as an indicator of loneliness and social well-being across the adult lifespan during the COVID-19 pandemic}, series = {International Journal of Environmental Research and Public Health}, volume = {18}, journal = {International Journal of Environmental Research and Public Health}, number = {12}, issn = {1660-4601}, doi = {10.3390/ijerph18126212}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-241033}, year = {2021}, abstract = {Loneliness and lack of social well-being are associated with adverse health outcomes and have increased during the COVID-19 pandemic. Smartphone communication data have been suggested to help monitor loneliness, but this requires further evidence. We investigated the informative value of smartphone communication app data for predicting subjective loneliness and social well-being in a sample of 364 participants ranging from 18 to 78 years of age (52.2\% female; mean age = 42.54, SD = 13.22) derived from the CORONA HEALTH APP study from July to December 2020 in Germany. The participants experienced relatively high levels of loneliness and low social well-being during the time period characterized by the COVID-19 pandemic. Apart from positive associations with phone call use times, smartphone communication app use was associated with social well-being and loneliness only when considering the age of participants. Younger participants with higher use times tended to report less social well-being and higher loneliness, while the opposite association was found for older adults. Thus, the informative value of smartphone communication use time was rather small and became evident only in consideration of age. The results highlight the need for further investigations and the need to address several limitations in order to draw conclusions at the population level.}, language = {en} } @article{MusekampSchulerSeekatzetal.2017, author = {Musekamp, Gunda and Schuler, Michael and Seekatz, Bettina and Bengel, J{\"u}rgen and Faller, Hermann and Meng, Karin}, title = {Does improvement in self-management skills predict improvement in quality of life and depressive symptoms? A prospective study in patients with heart failure up to one year after self-management education}, series = {BMC Cardiovascular Disorders}, volume = {17}, journal = {BMC Cardiovascular Disorders}, number = {51}, doi = {10.1186/s12872-017-0486-5}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-157501}, year = {2017}, abstract = {Background: Heart failure (HF) patient education aims to foster patients' self-management skills. These are assumed to bring about, in turn, improvements in distal outcomes such as quality of life. The purpose of this study was to test the hypothesis that change in self-reported self-management skills observed after participation in self-management education predicts changes in physical and mental quality of life and depressive symptoms up to one year thereafter. Methods: The sample comprised 342 patients with chronic heart failure, treated in inpatient rehabilitation clinics, who received a heart failure self-management education program. Latent change modelling was used to analyze relationships between both short-term (during inpatient rehabilitation) and intermediate-term (after six months) changes in self-reported self-management skills and both intermediate-term and long-term (after twelve months) changes in physical and mental quality of life and depressive symptoms. Results: Short-term changes in self-reported self-management skills predicted intermediate-term changes in mental quality of life and long-term changes in physical quality of life. Intermediate-term changes in self-reported self-management skills predicted long-term changes in all outcomes.}, language = {en} } @article{StanglHaasEichneretal.2020, author = {Stangl, Stephanie and Haas, Kirsten and Eichner, Felizitas A. and Grau, Anna and Selig, Udo and Ludwig, Timo and Fehm, Tanja and St{\"u}bner, Tanja and Rashid, Asarnusch and Kerscher, Alexander and Bargou, Ralf and Hermann, Silke and Arndt, Volker and Meyer, Martin and Wildner, Manfred and Faller, Hermann and Schrauder, Michael G. and Weigel, Michael and Schlembach, Ulrich and Heuschmann, Peter U. and W{\"o}ckel, Achim}, title = {Development and proof-of-concept of a multicenter, patient-centered cancer registry for breast cancer patients with metastatic disease — the "Breast cancer care for patients with metastatic disease" (BRE-4-MED) registry}, series = {Pilot and Feasibility Studies}, volume = {6}, journal = {Pilot and Feasibility Studies}, doi = {10.1186/s40814-019-0541-3}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-229149}, year = {2020}, abstract = {Background: Patients with metastatic breast cancer (MBC) are treated with a palliative approach with focus oncontrolling for disease symptoms and maintaining high quality of life. Information on individual needs of patients andtheir relatives as well as on treatment patterns in clinical routine care for this specific patient group are lacking or arenot routinely documented in established Cancer Registries. Thus, we developed a registry concept specifically adaptedfor these incurable patients comprising primary and secondary data as well as mobile-health (m-health) data. Methods: The concept for patient-centered "Breast cancer care for patients with metastatic disease"(BRE-4-MED)registry was developed and piloted exemplarily in the region of Main-Franconia, a mainly rural region in Germanycomprising about 1.3 M inhabitants. The registry concept includes data on diagnosis, therapy, progression, patient-reported outcome measures (PROMs), and needs of family members from several sources of information includingroutine data from established Cancer Registries in different federal states, treating physicians in hospital as well as inoutpatient settings, patients with metastatic breast cancer and their family members. Linkage with routine cancerregistry data was performed to collect secondary data on diagnosis, therapy, and progression. Paper and online-basedquestionnaires were used to assess PROMs. A dedicated mobile application software (APP) was developed to monitorneeds, progression, and therapy change of individual patients. Patient's acceptance and feasibility of data collection inclinical routine was assessed within a proof-of-concept study. Results: The concept for the BRE-4-MED registry was developed and piloted between September 2017 and May 2018.In total n= 31 patients were included in the pilot study, n= 22 patients were followed up after 1 month. Recordlinkage with the Cancer Registries of Bavaria and Baden-W{\"u}rttemberg demonstrated to be feasible. The voluntary APP/online questionnaire was used by n= 7 participants. The feasibility of the registry concept in clinical routine waspositively evaluated by the participating hospitals. Conclusion: The concept of the BRE-4-MED registry provides evidence that combinatorial evaluation of PROMs, needsof family members, and raising clinical parameters from primary and secondary data sources as well as m-healthapplications are feasible and accepted in an incurable cancer collective.}, language = {en} } @article{MuellerScholdenKirchhofMorbachetal.2019, author = {M{\"u}ller-Scholden, Lara and Kirchhof, Jan and Morbach, Caroline and Breunig, Margret and Meijer, Rudy and R{\"u}cker, Viktoria and Tiffe, Theresa and Yurdadogan, Tino and Wagner, Martin and Gelbrich, G{\"o}tz and Bots, Michiel L. and St{\"o}rk, Stefan and Heuschmann, Peter U.}, title = {Segment-specific association of carotid-intima-media thickness with cardiovascular risk factors - findings from the STAAB cohort study}, series = {BMC Cardiovascular Disorders}, volume = {19}, journal = {BMC Cardiovascular Disorders}, number = {84}, doi = {10.1186/s12872-019-1044-0}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-200720}, year = {2019}, abstract = {Background The guideline recommendation to not measure carotid intima-media thickness (CIMT) for cardiovascular risk prediction is based on the assessment of just one single carotid segment. We evaluated whether there is a segment-specific association between different measurement locations of CIMT and cardiovascular risk factors. Methods Subjects from the population-based STAAB cohort study comprising subjects aged 30 to 79 years of the general population from W{\"u}rzburg, Germany, were investigated. CIMT was measured on the far wall of both sides in three different predefined locations: common carotid artery (CCA), bulb, and internal carotid artery (ICA). Diabetes, dyslipidemia, hypertension, smoking, and obesity were considered as risk factors. In multivariable logistic regression analysis, odds ratios of risk factors per location were estimated for the endpoint of individual age- and sex-adjusted 75th percentile of CIMT. Results 2492 subjects were included in the analysis. Segment-specific CIMT was highest in the bulb, followed by CCA, and lowest in the ICA. Dyslipidemia, hypertension, and smoking were associated with CIMT, but not diabetes and obesity. We observed no relevant segment-specific association between the three different locations and risk factors, except for a possible interaction between smoking and ICA. Conclusions As no segment-specific association between cardiovascular risk factors and CIMT became evident, one simple measurement of one location may suffice to assess the cardiovascular risk of an individual.}, language = {en} } @article{SchobelProbstReichertetal.2020, author = {Schobel, Johannes and Probst, Thomas and Reichert, Manfred and Schlee, Winfried and Schickler, Marc and Kestler, Hans A. and Pryss, R{\"u}diger}, title = {Measuring mental effort for creating mobile data collection applications}, series = {International Journal of Environmental Research and Public Health}, volume = {17}, journal = {International Journal of Environmental Research and Public Health}, number = {5}, issn = {1660-4601}, doi = {10.3390/ijerph17051649}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-203176}, year = {2020}, abstract = {To deal with drawbacks of paper-based data collection procedures, the QuestionSys approach empowers researchers with none or little programming knowledge to flexibly configure mobile data collection applications on demand. The mobile application approach of QuestionSys mainly pursues the goal to mitigate existing drawbacks of paper-based collection procedures in mHealth scenarios. Importantly, researchers shall be enabled to gather data in an efficient way. To evaluate the applicability of QuestionSys, several studies have been carried out to measure the efforts when using the framework in practice. In this work, the results of a study that investigated psychological insights on the required mental effort to configure the mobile applications are presented. Specifically, the mental effort for creating data collection instruments is validated in a study with N=80 participants across two sessions. Thereby, participants were categorized into novices and experts based on prior knowledge on process modeling, which is a fundamental pillar of the developed approach. Each participant modeled 10 instruments during the course of the study, while concurrently several performance measures are assessed (e.g., time needed or errors). The results of these measures are then compared to the self-reported mental effort with respect to the tasks that had to be modeled. On one hand, the obtained results reveal a strong correlation between mental effort and performance measures. On the other, the self-reported mental effort decreased significantly over the course of the study, and therefore had a positive impact on measured performance metrics. Altogether, this study indicates that novices with no prior knowledge gain enough experience over the short amount of time to successfully model data collection instruments on their own. Therefore, QuestionSys is a helpful instrument to properly deal with large-scale data collection scenarios like clinical trials.}, language = {en} } @phdthesis{Ketterl2018, author = {Ketterl, Ralf Christian}, title = {Der Zusammenhang von Angst und Depressivit{\"a}t mit den Bed{\"u}rfnissen nach Information und psychosozialer Unterst{\"u}tzung bei Patienten mit kolorektalem Karzinom}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-161433}, school = {Universit{\"a}t W{\"u}rzburg}, year = {2018}, abstract = {Bei Patienten mit einer kolorektalen Krebserkrankung zeigt sich ein deutlicher Zusammenhang zwischen Angst und Depressivit{\"a}t und dem psychosozialen Unterst{\"u}tzungsbedarf. Zwischen Angst und Depressivit{\"a}t und unbefriedigten Informationsbed{\"u}rfnissen scheint ebenfalls ein schwacher Zusammenhang zu bestehen. F{\"u}r eine m{\"o}gliche Pr{\"a}ferenz von anonymen Informationsquellen bei Patienten mit Angst oder Depressivit{\"a}t findet sich im Untersuchten Patientenkollektiv kein Anhaltspunkt.}, subject = {Psychoonkologie}, language = {de} } @article{KammererPryssHoppenstedtetal.2020, author = {Kammerer, Klaus and Pryss, R{\"u}diger and Hoppenstedt, Burkhard and Sommer, Kevin and Reichert, Manfred}, title = {Process-driven and flow-based processing of industrial sensor data}, series = {Sensors}, volume = {20}, journal = {Sensors}, number = {18}, issn = {1424-8220}, doi = {10.3390/s20185245}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-213089}, year = {2020}, abstract = {For machine manufacturing companies, besides the production of high quality and reliable machines, requirements have emerged to maintain machine-related aspects through digital services. The development of such services in the field of the Industrial Internet of Things (IIoT) is dealing with solutions such as effective condition monitoring and predictive maintenance. However, appropriate data sources are needed on which digital services can be technically based. As many powerful and cheap sensors have been introduced over the last years, their integration into complex machines is promising for developing digital services for various scenarios. It is apparent that for components handling recorded data of these sensors they must usually deal with large amounts of data. In particular, the labeling of raw sensor data must be furthered by a technical solution. To deal with these data handling challenges in a generic way, a sensor processing pipeline (SPP) was developed, which provides effective methods to capture, process, store, and visualize raw sensor data based on a processing chain. Based on the example of a machine manufacturing company, the SPP approach is presented in this work. For the company involved, the approach has revealed promising results.}, language = {en} } @article{UnnikrishnanSchleicherShahetal.2020, author = {Unnikrishnan, Vishnu and Schleicher, Miro and Shah, Yash and Jamaludeen, Noor and Pryss, Ruediger and Schobel, Johannes and Kraft, Robin and Schlee, Winfried and Spiliopoulou, Myra}, title = {The effect of non-personalised tips on the continued use of self-monitoring mHealth applications}, series = {Brain Sciences}, volume = {10}, journal = {Brain Sciences}, number = {12}, issn = {2076-3425}, doi = {10.3390/brainsci10120924}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-219435}, year = {2020}, abstract = {Chronic tinnitus, the perception of a phantom sound in the absence of corresponding stimulus, is a condition known to affect patients' quality of life. Recent advances in mHealth have enabled patients to maintain a 'disease journal' of ecologically-valid momentary assessments, improving patients' own awareness of their disease while also providing clinicians valuable data for research. In this study, we investigate the effect of non-personalised tips on patients' perception of tinnitus, and on their continued use of the application. The data collected from the study involved three groups of patients that used the app for 16 weeks. Groups A \& Y were exposed to feedback from the start of the study, while group B only received tips for the second half of the study. Groups A and Y were run by different supervisors and also differed in the number of hospital visits during the study. Users of Group A and B underwent assessment at baseline, mid-study, post-study and follow-up, while users of group Y were only assessed at baseline and post-study. It is seen that the users in group B use the app for longer, and also more often during the day. The answers of the users to the Ecological Momentary Assessments are seen to form clusters where the degree to which the tinnitus distress depends on tinnitus loudness varies. Additionally, cluster-level models were able to predict new unseen data with better accuracy than a single global model. This strengthens the argument that the discovered clusters really do reflect underlying patterns in disease expression.}, language = {en} } @article{KristDornquastReinholdetal.2020, author = {Krist, Lilian and Dornquast, Christina and Reinhold, Thomas and Becher, Heiko and Icke, Katja and Danquah, Ina and Willich, Stefan N. and Keil, Thomas}, title = {Physical activity trajectories among persons of Turkish descent living in Germany — a cohort study}, series = {International Journal of Environmental Research and Public Health}, volume = {17}, journal = {International Journal of Environmental Research and Public Health}, number = {17}, issn = {1660-4601}, doi = {10.3390/ijerph17176349}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-211221}, year = {2020}, abstract = {Physical activity (PA) behavior is increasingly described as trajectories taking changes over a longer period into account. Little is known, however, about predictors of those trajectories among migrant populations. Therefore, the aim of the present cohort study was to describe changes of PA over six years and to explore migration-related and other predictors for different PA trajectories in adults of Turkish descent living in Berlin. At baseline (2011/2012) and after six years, sociodemographics, health behavior, and medical information were assessed. Four PA trajectories were defined using data of weekly PA from baseline and follow-up: "inactive", "decreasing", "increasing", and "stable active". Multivariable regression analyses were performed in order to determine predictors for the "stable active" trajectory, and results were presented as adjusted odds ratios (aOR) with 95\% confidence intervals (95\%CI). In this analysis, 197 people (60.9\% women, mean age ± standard deviation 49.9 ± 12.8 years) were included. A total of 77.7\% were first-generation migrants, and 50.5\% had Turkish citizenship. The four PA trajectories differed regarding citizenship, preferred questionnaire language, and marital status. "Stable active" trajectory membership was predicted by educational level (high vs. low: aOR 4.20, 95\%CI [1.10; 16.00]), citizenship (German or dual vs. Turkish only: 3.60 [1.20; 10.86]), preferred questionnaire language (German vs. Turkish: 3.35 [1.05; 10.66]), and BMI (overweight vs. normal weight: 0.28 [0.08; 0.99]). In our study, migration-related factors only partially predicted trajectory membership, however, persons with citizenship of their country of origin and/or with poor language skills should be particularly considered when planning PA prevention programs.}, language = {en} } @article{WinterPryssProbstetal.2020, author = {Winter, Michael and Pryss, R{\"u}diger and Probst, Thomas and Reichert, Manfred}, title = {Towards the applicability of measuring the electrodermal activity in the context of process model comprehension: feasibility study}, series = {Sensors}, volume = {20}, journal = {Sensors}, number = {16}, issn = {1424-8220}, doi = {10.3390/s20164561}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-211276}, year = {2020}, abstract = {Process model comprehension is essential in order to understand the five Ws (i.e., who, what, where, when, and why) pertaining to the processes of organizations. However, research in this context showed that a proper comprehension of process models often poses a challenge in practice. For this reason, a vast body of research exists studying the factors having an influence on process model comprehension. In order to point research towards a neuro-centric perspective in this context, the paper at hand evaluates the appropriateness of measuring the electrodermal activity (EDA) during the comprehension of process models. Therefore, a preliminary test run and a feasibility study were conducted relying on an EDA and physical activity sensor to record the EDA during process model comprehension. The insights obtained from the feasibility study demonstrated that process model comprehension leads to an increased activity in the EDA. Furthermore, EDA-related results indicated significantly that participants were confronted with a higher cognitive load during the comprehension of complex process models. In addition, the experiences and limitations we learned in measuring the EDA during the comprehension of process models are discussed in this paper. In conclusion, the feasibility study demonstrated that the measurement of the EDA could be an appropriate method to obtain new insights into process model comprehension.}, language = {en} } @article{ForchertPotapovaPanettaetal.2022, author = {Forchert, Leandra and Potapova, Ekaterina and Panetta, Valentina and Dramburg, Stephanie and Perna, Serena and Posa, Daniela and Resch-Marat, Yvonne and Lupinek, Christian and Rohrbach, Alexander and Grabenhenrich, Linus and Icke, Katja and Bauer, Carl-Peter and Hoffman, Ute and Forster, Johannes and Zepp, Fred and Schuster, Antje and Wahn, Ulrich and Keil, Thomas and Lau, Susanne and Vrtala, Susanne and Valenta, Rudolf and Matricardi, Paolo Maria}, title = {Der p 23-specific IgE response throughout childhood and its association with allergic disease: A birth cohort study}, series = {Pediatric Allergy and Immunology}, volume = {33}, journal = {Pediatric Allergy and Immunology}, number = {7}, doi = {10.1111/pai.13829}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-287181}, year = {2022}, abstract = {Background The Dermatophagoides pteronyssinus molecule Der p 23 is a major allergen whose clinical relevance has been shown in cross-sectional studies. We longitudinally analysed the trajectory of Der p 23-specific IgE antibody (sIgE) levels throughout childhood and youth, their early-life determinants and their clinical relevance for allergic rhinitis and asthma. Methods We obtained sera and clinical data of 191 participants of the German Multicentre Allergy Study, a prospective birth cohort. Serum samples from birth to 20 years of age with sIgE reactivity to Der p 23 in a customised semiquantitative microarray were newly analysed with a singleplex quantitative assay. Early mite exposure was assessed by measuring the average content of Der p 1 in house dust at 6 and 18 months. Results Der p 23-sIgE levels were detected at least once in 97/191 participants (51\%). Prevalence of Der p 23 sensitisation and mean sIgE levels increased until age 10 years, plateaued until age 13 years and were lowest at age 20 years. Asthma, allergic rhinitis (AR) and atopic dermatitis (AD) were more prevalent in Der p 23-sensitised children, including those with monomolecular but persistent sensitisation (11/97, 11\%). A higher exposure to mites in infancy and occurrence of AD before 5 years of age preceded the onset of Der p 23 sensitisation, which in turn preceded a higher incidence of asthma. Conclusions Der p 23 sensitisation peaks in late childhood and then decreases. It is preceded by early mite exposure and AD. Asthma and AR can occur in patients persistently sensitised to Der p 23 as the only mite allergen, suggesting the inclusion of molecular testing of Der p 23-sIgE for subjects with clinical suspicion of HDM allergy but without sIgE to other major D.pt. allergens.}, language = {en} } @article{MehdiDodePryssetal.2020, author = {Mehdi, Muntazir and Dode, Albi and Pryss, R{\"u}diger and Schlee, Winfried and Reichert, Manfred and Hauck, Franz J.}, title = {Contemporary review of smartphone apps for tinnitus management and treatment}, series = {Brain Sciences}, volume = {10}, journal = {Brain Sciences}, number = {11}, issn = {2076-3425}, doi = {10.3390/brainsci10110867}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-219367}, year = {2020}, abstract = {Tinnitus is a complex and heterogeneous psycho-physiological disorder responsible for causing a phantom ringing or buzzing sound albeit the absence of an external sound source. It has a direct influence on affecting the quality of life of its sufferers. Despite being around for a while, there has not been a cure for tinnitus, and the usual course of action for its treatment involves use of tinnitus retaining and sound therapy, or Cognitive Behavioral Therapy (CBT). One positive aspect about these therapies is that they can be administered face-to-face as well as delivered via internet or smartphone. Smartphones are especially helpful as they are highly personalized devices, and offer a well-established ecosystem of apps, accessible via respective marketplaces of differing mobile platforms. Note that current therapeutic treatments such as CBT have shown to be effective in suppressing the tinnitus symptoms when administered face-to-face, their effectiveness when being delivered using smartphones is not known so far. A quick search on the prominent market places of popular mobile platforms (Android and iOS) yielded roughly 250 smartphone apps offering tinnitus-related therapies and tinnitus management. As this number is expected to steadily increase due to high interest in smartphone app development, a contemporary review of such apps is crucial. In this paper, we aim to review scientific studies validating the smartphone apps, particularly to test their effectiveness in tinnitus management and treatment. We use the PRISMA guidelines for identification of studies on major scientific literature sources and delineate the outcomes of identified studies.}, language = {en} } @article{SchleeNeffSimoesetal.2022, author = {Schlee, Winfried and Neff, Patrick and Simoes, Jorge and Langguth, Berthold and Schoisswohl, Stefan and Steinberger, Heidi and Norman, Marie and Spiliopoulou, Myra and Schobel, Johannes and Hannemann, Ronny and Pryss, R{\"u}diger}, title = {Smartphone-guided educational counseling and self-help for chronic tinnitus}, series = {Journal of Clinical Medicine}, volume = {11}, journal = {Journal of Clinical Medicine}, number = {7}, issn = {2077-0383}, doi = {10.3390/jcm11071825}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-267295}, year = {2022}, abstract = {Tinnitus is an auditory phantom perception in the ears or head in the absence of a corresponding external stimulus. There is currently no effective treatment available that reliably reduces tinnitus. Educational counseling is a treatment approach that aims to educate patients and inform them about possible coping strategies. For this feasibility study, we implemented educational material and self-help advice in a smartphone app. Participants used the educational smartphone app unsupervised during their daily routine over a period of four months. Comparing the tinnitus outcome measures before and after smartphone-guided treatment, we measured changes in tinnitus-related distress, but not in tinnitus loudness. Improvements on the Tinnitus Severity numeric rating scale reached an effect size of 0.408, while the improvements on the Tinnitus Handicap Inventory (THI) were much smaller with an effect size of 0.168. An analysis of user behavior showed that frequent and intensive use of the app is a crucial factor for treatment success: participants that used the app more often and interacted with the app intensively reported a stronger improvement in the tinnitus. Between study allocation and final assessment, 26 of 52 participants dropped out of the study. Reasons for the dropouts and lessons for future studies are discussed in this paper.}, language = {en} } @article{FrickeAvilaKelleretal.2020, author = {Fricke, Julia and {\´A}vila, Gabriela and Keller, Theresa and Weller, Karsten and Lau, Susanne and Maurer, Marcus and Zuberbier, Torsten and Keil, Thomas}, title = {Prevalence of chronic urticaria in children and adults across the globe: Systematic review with meta-analysis}, series = {Allergy}, volume = {75}, journal = {Allergy}, number = {2}, doi = {10.1111/all.14037}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-213700}, pages = {423 -- 432}, year = {2020}, abstract = {Background and objectives: Urticaria is a frequent skin condition, but reliable prevalence estimates from population studies particularly of the chronic form are scarce. The objective of this study was to systematically evaluate and summarize the prevalence of chronic urticaria by evaluating population-based studies worldwide. Methods: We performed a systematic search in PUBMED and EMBASE for population-based studies of cross-sectional or cohort design and studies based on health insurance/system databases. Risk of bias was assessed using a specific tool for prevalence studies. For meta-analysis, we used a random effects model. Results: Eighteen studies were included in the systematic evaluation and 11 in the meta-analysis including data from over 86 000 000 participants. Risk of bias was mainly moderate, whereas the statistical heterogeneity (I\(^{2}\)) between the studies was high. Asian studies combined showed a higher point prevalence of chronic urticaria (1.4\%, 95\%-CI 0.5-2.9) than those from Europe (0.5\%, 0.2-1.0) and Northern American (0.1\%, 0.1-0.1). Women were slightly more affected than men, whereas in children < 15 years we did not find a sex-specific difference in the prevalence. The four studies that examined time trends indicated an increasing prevalence of chronic urticaria over time. Conclusions: On a global level, the prevalence of chronic urticaria showed considerable regional differences. There is a need to obtain more sex-specific population-based and standardized international data particularly for children and adolescents, different chronic urticaria subtypes and potential risk and protective factors.}, language = {en} } @article{TiffeMorbachRueckeretal.2019, author = {Tiffe, Theresa and Morbach, Caroline and R{\"u}cker, Viktoria and Gelbrich, G{\"o}tz and Wagner, Martin and Faller, Hermann and St{\"o}rk, Stefan and Heuschmann, Peter U.}, title = {Impact of patient beliefs on blood pressure control in the general population: findings from the population-based STAAB cohort study}, series = {International Journal of Hypertension}, volume = {2019}, journal = {International Journal of Hypertension}, doi = {10.1155/2019/9385397}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-200992}, pages = {9385397}, year = {2019}, abstract = {Background. Effective antihypertensive treatment depends on patient compliance regarding prescribed medications. We assessed the impact of beliefs related towards antihypertensive medication on blood pressure control in a population-based sample treated for hypertension. Methods. We used data from the Characteristics and Course of Heart Failure Stages A-B and Determinants of Progression (STAAB) study investigating 5000 inhabitants aged 30 to 79 years from the general population of W{\"u}rzburg, Germany. The Beliefs about Medicines Questionnaire German Version (BMQ-D) was provided in a subsample without established cardiovascular diseases (CVD) treated for hypertension. We evaluated the association between inadequately controlled hypertension (systolic RR >140/90 mmHg; >140/85 mmHg in diabetics) and reported concerns about and necessity of antihypertensive medication. Results. Data from 293 participants (49.5\% women, median age 64 years [quartiles 56.0; 69.0]) entered the analysis. Despite medication, half of the participants (49.8\%) were above the recommended blood pressure target. Stratified for sex, inadequately controlled hypertension was less frequent in women reporting higher levels of concerns (OR 0.36; 95\%CI 0.17-0.74), whereas no such association was apparent in men. We found no association for specific-necessity in any model. Conclusion. Beliefs regarding the necessity of prescribed medication did not affect hypertension control. An inverse association between concerns about medication and inappropriately controlled hypertension was found for women only. Our findings highlight that medication-related beliefs constitute a serious barrier of successful implementation of treatment guidelines and underline the role of educational interventions taking into account sex-related differences.}, language = {en} } @article{EdelmannMusialBrightGelbrichetal.2016, author = {Edelmann, Frank and Musial-Bright, Lindy and Gelbrich, Goetz and Trippel, Tobias and Radenovic, Sara and Wachter, Rolf and Inkrot, Simone and Loncar, Goran and Tahirovic, Elvis and Celic, Vera and Veskovic, Jovan and Zdravkovic, Marija and Lainscak, Mitja and Apostolović, Svetlana and Neskovic, Aleksandar N. and Pieske, Burkert and D{\"u}ngen, Hans-Dirk}, title = {Tolerability and feasibility of beta-blocker titration in HFpEF versus HFrEF: Insights from the CIBIS-ELD trial}, series = {JACC: Heart Failure}, volume = {4}, journal = {JACC: Heart Failure}, number = {2}, doi = {10.1016/j.jchf.2015.10.008}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-191022}, pages = {140-149}, year = {2016}, abstract = {OBJECTIVES: This study evaluated the tolerability and feasibility of titration of 2 distinctly acting beta-blockers (BB) in elderly heart failure patients with preserved (HFpEF) and reduced (HFrEF) left ventricular ejection fraction. BACKGROUND: Broad evidence supports the use of BB in HFrEF, whereas the evidence for beta blockade in HFpEF is uncertain. METHODS: In the CIBIS-ELD (Cardiac Insufficiency Bisoprolol Study in Elderly) trial, patients >65 years of age with HFrEF (n = 626) or HFpEF (n = 250) were randomized to bisoprolol or carvedilol. Both BB were up-titrated to the target or maximum tolerated dose. Follow-up was performed after 12 weeks. HFrEF and HFpEF patients were compared regarding tolerability and clinical effects (heart rate, blood pressure, systolic and diastolic functions, New York Heart Association functional class, 6-minute-walk distance, quality of life, and N-terminal pro-B-type natriuretic peptide). RESULTS: For both of the BBs, tolerability and daily dose at 12 weeks were similar. HFpEF patients demonstrated higher rates of dose escalation delays and treatment-related side effects. Similar HR reductions were observed in both groups (HFpEF: 6.6 beats/min; HFrEF: 6.9 beats/min, p = NS), whereas greater improvement in NYHA functional class was observed in HFrEF (HFpEF: 23\% vs. HFrEF: 34\%, p < 0.001). Mean E/e' and left atrial volume index did not change in either group, although E/A increased in HFpEF. CONCLUSIONS: BB tolerability was comparable between HFrEF and HFpEF. Relevant reductions of HR and blood pressure occurred in both groups. However, only HFrEF patients experienced considerable improvements in clinical parameters and Left ventricular function. Interestingly, beta-blockade had no effect on established and prognostic markers of diastolic function in either group. Long-term studies using modern diagnostic criteria for HFpEF are urgently needed to establish whether BB therapy exerts significant clinical benefit in HFpEF. (Comparison of Bisoprolol and Carvedilol in Elderly Heart Failure HF] Patients: A Randomised, Double-Blind Multicentre Study CIBIS-ELD]; ISRCTN34827306).}, language = {en} } @article{BarbieriGardonRuizCastelletal.2016, author = {Barbieri, Flavia L. and Gardon, Jacques and Ruiz-Castell, Mar{\´i}a and Paco V., Pamela and Muckelbauer, Rebecca and Casiot, Corinne and Freydier, R{\´e}mi and Duprey, Jean-Louis and Chen, Chih-Mei and M{\"u}ller-Nordhorn, Jacqueline and Keil, Thomas}, title = {Toxic trace elements in maternal and cord blood and social determinants in a Bolivian mining city}, series = {International Journal of Environmental Health Research}, volume = {26}, journal = {International Journal of Environmental Health Research}, number = {2}, doi = {10.1080/09603123.2015.1061114}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-190703}, pages = {158-174}, year = {2016}, abstract = {This study assessed lead, arsenic, and antimony in maternal and cord blood, and associations between maternal concentrations and social determinants in the Bolivian mining city of Oruro using the baseline assessment of the ToxBol/Mine-Nino birth cohort. We recruited 467 pregnant women, collecting venous blood and sociodemographic information as well as placental cord blood at birth. Metallic/semimetallic trace elements were measured using inductively coupled plasma mass spectrometry. Lead medians in maternal and cord blood were significantly correlated (Spearman coefficient=0.59; p<0.001; 19.35 and 13.50 μg/L, respectively). Arsenic concentrations were above detection limit (3.30 μg/L) in 17.9\% of maternal and 34.6\% of cord blood samples. They were not associated (Fischer's p=0.72). Antimony medians in maternal and cord blood were weakly correlated (Spearman coefficient=0.15; p<0.03; 9.00 and 8.62 μg/L, respectively). Higher concentrations of toxic elements in maternal blood were associated with maternal smoking, low educational level, and partner involved in mining.}, language = {en} } @article{WagnerWannerSchichetal.2017, author = {Wagner, Martin and Wanner, Christoph and Schich, Martin and Kotseva, Kornelia and Wood, David and Hartmann, Katrin and Fette, Georg and R{\"u}cker, Viktoria and Oezkur, Mehmet and St{\"o}rk, Stefan and Heuschmann, Peter U.}, title = {Patient's and physician's awareness of kidney disease in coronary heart disease patients - a cross-sectional analysis of the German subset of the EUROASPIRE IV survey}, series = {BMC Nephrology}, volume = {18}, journal = {BMC Nephrology}, number = {321}, doi = {10.1186/s12882-017-0730-3}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-158387}, year = {2017}, abstract = {Background Chronic kidney disease (CKD) is a common comorbid condition in coronary heart disease (CHD). CKD predisposes the patient to acute kidney injury (AKI) during hospitalization. Data on awareness of kidney dysfunction among CHD patients and their treating physicians are lacking. In the current cross-sectional analysis of the German EUROASPIRE IV sample we aimed to investigate the physician's awareness of kidney disease of patients hospitalized for CHD and also the patient's awareness of CKD in a study visit following hospital discharge. Methods All serum creatinine (SCr) values measured during the hospital stay were used to describe impaired kidney function (eGFR\(_{CKD-EPI}\) < 60 ml/min/1.73m2) at admission, discharge and episodes of AKI (KDIGO definition). Information extracted from hospital discharge letters and correct ICD coding for kidney disease was studied as a surrogate of physician's awareness of kidney disease. All patients were interrogated 0.5 to 3 years after hospital discharge, whether they had ever been told about kidney disease by a physician. Results Of the 536 patients, 32\% had evidence for acute or chronic kidney disease during the index hospital stay. Either condition was mentioned in the discharge letter in 22\%, and 72\% were correctly coded according to ICD-10. At the study visit in the outpatient setting 35\% had impaired kidney function. Of 158 patients with kidney disease, 54 (34\%) were aware of CKD. Determinants of patient's awareness were severity of CKD (OR\(_{eGFR}\) 0.94; 95\%CI 0.92-0.96), obesity (OR 1.97; 1.07-3.64), history of heart failure (OR 1.99; 1.00-3.97), and mentioning of kidney disease in the index event's hospital discharge letter (OR 5.51; 2.35-12.9). Conclusions Although CKD is frequent in CHD, only one third of patients is aware of this condition. Patient's awareness was associated with kidney disease being mentioned in the hospital discharge letter. Future studies should examine how raising physician's awareness for kidney dysfunction may improve patient's awareness of CKD.}, language = {en} } @phdthesis{Riegler2022, author = {Riegler, Christoph Paul}, title = {Eine deutschsprachige Variante des Functioning Assessment Short Test (FAST): {\"U}bereinstimmung zwischen Selbsteinsch{\"a}tzung und Fremdeinsch{\"a}tzung}, doi = {10.25972/OPUS-28893}, url = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-288931}, school = {Universit{\"a}t W{\"u}rzburg}, year = {2022}, abstract = {Die Erhebung der allt{\"a}glichen Funktionsf{\"a}higkeit mithilfe von Skalen zu instrumentellen Aktivit{\"a}ten des t{\"a}glichen Lebens (IADL) ist essenziell zur Erfassung der individuellen und gesellschaftlichen Konsequenzen von klinischen und subklinischen Erkrankungen. Im deutschsprachigen Raum existieren jedoch nur wenige validierte Instrumente zur Erfassung von IADL. Da all diese Skalen f{\"u}r ein geriatrisches Patientenkollektiv entwickelt wurden, haben sie wichtige Schw{\"a}chen in der Anwendung bei j{\"u}ngeren Patientengruppen (insbesondere die fehlende Erfassung beruflicher Funktionsf{\"a}higkeit). Aus diesem Grund wurde im Rahmen der vorliegenden Arbeit mit dem Functioning Assessment Short Test (FAST) ein bereits in mehreren Sprachen validiertes, f{\"u}r erwachsene Patienten jedweden Alters konzipiertes Instrument mit sehr guten psychometrischen Kennwerten ins Deutsche {\"u}bertragen und hinsichtlich Validit{\"a}t und Reliabilit{\"a}t untersucht. Die deutschsprachige Variante des FAST wurde durch standardisierte vorw{\"a}rts-r{\"u}ckw{\"a}rts-{\"U}bersetzung aus dem Englischen erstellt und ist als Selbstausf{\"u}llerfragebogen konzipiert. Die Skala enth{\"a}lt 23 ordinal skalierte Einzelitems, aus denen sich ein Summenscore berechnen l{\"a}sst, wobei h{\"o}here Werte f{\"u}r eine schlechtere allt{\"a}gliche Funktionsf{\"a}higkeit stehen. Der Fragebogen wurde zwischen 2017 und 2018 an insgesamt 120 Teilnehmern in W{\"u}rzburg und M{\"u}nster getestet, von denen 60 aus bev{\"o}lkerungsbasierten Kohortenstudien stammten und je 30 Patienten aufgrund eines isch{\"a}mischen Schlaganfalls oder einer akuten Depression station{\"a}r behandelt wurden. Als Maß f{\"u}r die Reliabilit{\"a}t des Instrumentes wurde die {\"U}bereinstimmung zwischen Selbst- und Fremdeinsch{\"a}tzung der allt{\"a}glichen Funktionsf{\"a}higkeit (Fremdeinsch{\"a}tzung durch Angeh{\"o}rige der Teilnehmer bzw. behandelnde {\"A}rzte / Psychologen) mithilfe des FAST gew{\"a}hlt. Die Validit{\"a}t der Skala wurde durch die Messung von Korrelationen des FAST Summenscores mit g{\"a}ngigen Skalen zu Depressivit{\"a}t (PHQ-D-9, CES-D), Angstsymptomatik (PHQ-GAD-7), gesundheitsbezogener Lebensqualit{\"a}t (SF-12, EQ-5D) und kognitiver Leistungsf{\"a}higkeit (MOCA) erhoben. Daneben erfolgte eine uni- und multivariate Regression zur Erhebung des Einflusses der o.g. Skalen und relevanter Vorerkrankungen auf den Summenscore des FAST. Die Reliabilit{\"a}tsanalyse zeigte f{\"u}r die Probanden aus der Allgemeinbev{\"o}lkerung ein moderates (ICC 0.50 (95\%-CI 0.64 - 0.54), f{\"u}r die Patienten mit akutem isch{\"a}mischem Schlaganfall ein gutes (ICC 0.65 (95\%-CI 0.55 - 0.75) und f{\"u}r die station{\"a}r behandelten Patienten mit Depression ein schlechtes Ergebnis (ICC 0.11 (95\%-CI 0.02 - 0.20). Hinsichtlich der Konstruktvalidit{\"a}t zeigte sich in der bev{\"o}lkerungsbasierten Stichprobe eine signifikante Korrelation des FAST Summenscores mit PHQ-D-9, CES-D, PHQ-GAD-7 und psychischer Summenskala der SF-12. In der univariablen Regression waren PHQ-D9, PHQ-GAD-7, psychische Summenskala des SF-12 und das Vorliegen von chronischem R{\"u}ckenschmerz signifikante Pr{\"a}diktoren f{\"u}r den FAST Summenscore. In der multivariablen Analyse verblieben SF-12 und chronischer R{\"u}ckenschmerz als signifikante Einflussfaktoren. In der Stichprobe von Patienten mit akutem isch{\"a}mischem Schlaganfall zeigte sich eine signifikante, negative Korrelation des FAST Summenscores mit dem MOCA. Zusammenfassend zeigte die deutschsprachige Variante des FAST moderate bis gute psychometrische Kennwerte in der Allgemeinbev{\"o}lkerung und bei Patienten mit akutem isch{\"a}mischem Schlaganfall, w{\"a}hrend die Ergebnisse bei station{\"a}r behandelten Patienten mit Depression schlecht waren. Aufgrund der kleinen Fallzahl der untersuchten Stichproben und des fehlenden Assessment von Test-Retest-Reliabilit{\"a}t sollten vor der breiten Anwendung des FAST im deutschsprachigen Raum weitere psychometrische Pr{\"u}fungen des Instruments erfolgen.}, language = {de} }