Institut für Klinische Epidemiologie und Biometrie
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- Journal article (114)
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- ischemic stroke (12)
- asthma (7)
- stroke (7)
- secondary prevention (6)
- epidemiology (5)
- mortality (5)
- prevalence (5)
- tinnitus (5)
- Koronare Herzkrankheit (4)
- atrial fibrillation (4)
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- Institut für Klinische Epidemiologie und Biometrie (140)
- Medizinische Klinik und Poliklinik I (19)
- Deutsches Zentrum für Herzinsuffizienz (DZHI) (18)
- Neurologische Klinik und Poliklinik (12)
- Graduate School of Life Sciences (10)
- Klinik und Poliklinik für Thorax-, Herz- u. Thorakale Gefäßchirurgie (8)
- Institut für Psychotherapie und Medizinische Psychologie (3)
- Klinik und Poliklinik für Kinder- und Jugendpsychiatrie, Psychosomatik und Psychotherapie (3)
- Frauenklinik und Poliklinik (2)
- Klinik und Poliklinik für Dermatologie, Venerologie und Allergologie (2)
Sonstige beteiligte Institutionen
- Clinical Trial Center (CTC) / Zentrale für Klinische Studien Würzburg (ZKSW) (3)
- Comprehensive Cancer Center Mainfranken, University Hospital Würzburg, Würzburg, Germany (1)
- Deutsches Zentrum für Herzinsuffizienz (1)
- Interdisziplinäre Zentrum für Klinische Forschung (IZKF) (1)
- Medizinische Klinik und Poliklinik 1, Abteilung Kardiologie (1)
- Medizinische Klinik und Poliklinik 1, Abteilung Nephrologie (1)
- Universitätsklinikum Würzburg (UKW) (1)
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.
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.
Ambalytics: a scalable and distributed system architecture concept for bibliometric network analyses
(2021)
A deep understanding about a field of research is valuable for academic researchers. In addition to technical knowledge, this includes knowledge about subareas, open research questions, and social communities (networks) of individuals and organizations within a given field. With bibliometric analyses, researchers can acquire quantitatively valuable knowledge about a research area by using bibliographic information on academic publications provided by bibliographic data providers. Bibliometric analyses include the calculation of bibliometric networks to describe affiliations or similarities of bibliometric entities (e.g., authors) and group them into clusters representing subareas or communities. Calculating and visualizing bibliometric networks is a nontrivial and time-consuming data science task that requires highly skilled individuals. In addition to domain knowledge, researchers must often provide statistical knowledge and programming skills or use software tools having limited functionality and usability. In this paper, we present the ambalytics bibliometric platform, which reduces the complexity of bibliometric network analysis and the visualization of results. It accompanies users through the process of bibliometric analysis and eliminates the need for individuals to have programming skills and statistical knowledge, while preserving advanced functionality, such as algorithm parameterization, for experts. As a proof-of-concept, and as an example of bibliometric analyses outcomes, the calculation of research fronts networks based on a hybrid similarity approach is shown. Being designed to scale, ambalytics makes use of distributed systems concepts and technologies. It is based on the microservice architecture concept and uses the Kubernetes framework for orchestration. This paper presents the initial building block of a comprehensive bibliometric analysis platform called ambalytics, which aims at a high usability for users as well as scalability.
The ubiquity of mobile devices fosters the combined use of ecological momentary assessments (EMA) and mobile crowdsensing (MCS) in the field of healthcare. This combination not only allows researchers to collect ecologically valid data, but also to use smartphone sensors to capture the context in which these data are collected. The TrackYourTinnitus (TYT) platform uses EMA to track users' individual subjective tinnitus perception and MCS to capture an objective environmental sound level while the EMA questionnaire is filled in. However, the sound level data cannot be used directly among the different smartphones used by TYT users, since uncalibrated raw values are stored. This work describes an approach towards making these values comparable. In the described setting, the evaluation of sensor measurements from different smartphone users becomes increasingly prevalent. Therefore, the shown approach can be also considered as a more general solution as it not only shows how it helped to interpret TYT sound level data, but may also stimulate other researchers, especially those who need to interpret sensor data in a similar setting. Altogether, the approach will show that measuring sound levels with mobile devices is possible in healthcare scenarios, but there are many challenges to ensuring that the measured values are interpretable.
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.
Die Erhebung der alltäglichen Funktionsfähigkeit mithilfe von Skalen zu instrumentellen
Aktivitäten des täglichen 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 für ein geriatrisches Patientenkollektiv entwickelt wurden, haben sie
wichtige Schwächen in der Anwendung bei jüngeren Patientengruppen (insbesondere die
fehlende Erfassung beruflicher Funktionsfähigkeit). Aus diesem Grund wurde im Rahmen der
vorliegenden Arbeit mit dem Functioning Assessment Short Test (FAST) ein bereits in
mehreren Sprachen validiertes, für erwachsene Patienten jedweden Alters konzipiertes
Instrument mit sehr guten psychometrischen Kennwerten ins Deutsche übertragen und
hinsichtlich Validität und Reliabilität untersucht. Die deutschsprachige Variante des FAST
wurde durch standardisierte vorwärts-rückwärts-Übersetzung aus dem Englischen erstellt und
ist als Selbstausfüllerfragebogen konzipiert. Die Skala enthält 23 ordinal skalierte Einzelitems,
aus denen sich ein Summenscore berechnen lässt, wobei höhere Werte für eine schlechtere
alltägliche Funktionsfähigkeit stehen. Der Fragebogen wurde zwischen 2017 und 2018 an
insgesamt 120 Teilnehmern in Würzburg und Münster getestet, von denen 60 aus
bevölkerungsbasierten Kohortenstudien stammten und je 30 Patienten aufgrund eines
ischämischen Schlaganfalls oder einer akuten Depression stationär behandelt wurden. Als Maß
für die Reliabilität des Instrumentes wurde die Übereinstimmung zwischen Selbst- und
Fremdeinschätzung der alltäglichen Funktionsfähigkeit (Fremdeinschätzung durch Angehörige
der Teilnehmer bzw. behandelnde Ärzte / Psychologen) mithilfe des FAST gewählt. Die
Validität der Skala wurde durch die Messung von Korrelationen des FAST Summenscores mit
gängigen Skalen zu Depressivität (PHQ-D-9, CES-D), Angstsymptomatik (PHQ-GAD-7),
gesundheitsbezogener Lebensqualität (SF-12, EQ-5D) und kognitiver Leistungsfähigkeit
(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 Reliabilitätsanalyse zeigte für die Probanden aus der Allgemeinbevölkerung ein moderates
(ICC 0.50 (95%-CI 0.64 – 0.54), für die Patienten mit akutem ischämischem Schlaganfall ein
gutes (ICC 0.65 (95%-CI 0.55 – 0.75) und für die stationär behandelten Patienten mit
Depression ein schlechtes Ergebnis (ICC 0.11 (95%-CI 0.02 – 0.20). Hinsichtlich der
Konstruktvalidität zeigte sich in der bevölkerungsbasierten 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 Rückenschmerz
signifikante Prädiktoren für den FAST Summenscore. In der multivariablen Analyse verblieben
SF-12 und chronischer Rückenschmerz als signifikante Einflussfaktoren. In der Stichprobe von
Patienten mit akutem ischämischem 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 Allgemeinbevölkerung und bei Patienten mit akutem
ischämischem Schlaganfall, während die Ergebnisse bei stationär behandelten Patienten mit
Depression schlecht waren. Aufgrund der kleinen Fallzahl der untersuchten Stichproben und
des fehlenden Assessment von Test-Retest-Reliabilität sollten vor der breiten Anwendung des
FAST im deutschsprachigen Raum weitere psychometrische Prüfungen des Instruments
erfolgen.
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.
Physical activity trajectories among persons of Turkish descent living in Germany — a cohort study
(2020)
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.
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.
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.