Abstract Background National health examination surveys (HES) are rarely carried out due to high costs and high complexity. We piloted more flexible methods such as self-sampling, self-measurements and household visits conducted by a study-nurse replacing physician examinations in study centers. Methods Feasibility of several new methods for the German HES was tested, e.g.: large-scale implementation of unattended self-sampled dried blood spots (DBS) and oral-nasal swabs (ONS) in a countrywide general population panel including a large subsample with migration background (Study 1, n = 15,122); household visits with brief biosampling & examinations (Study 2, n = 470); and unattended blood pressure (BP) self-measurements with mailed devices and video instructions (Study 3, n = 202). Results Among participants consenting to participate, Study 1 showed successful postal self-sampling of DBS for SARS-CoV-2 antibody tests in 98% of participants and 97% valid ONS for SARS-CoV-2 PCR tests. Study 2 showed successful standardized measurements of BP (97%), weight/height (99%) and DBS and venous blood sampling with onsite whole blood centrifugation (97%). Temperature requirements for centrifugation, cooled transport and ATC-coded medication assessment (Anatomical Chemical Classification) proved challenging and needed revised methods to avoid data loss. Nested validation studies confirmed use of a multiplex assay for various antibodies with DBS and of HbA1c analysis with uncooled specimen. The strict and time-consuming BP self-measurement-protocol with 12 measurements in Study 3 was followed only by 54% of participants. Conclusions Self-sampling and biosampling & examinations in households are feasible options for HES but protocols with high complexity may result in low data completeness.
Short sleep duration as a risk factor for higher blood pressure has been reported by several studies on adults. This study aimed to investigate this association in children, considering age-specific effects and distributional aspects.Using data from the German Health Interview and Examination Survey for Children and Adolescents (KiGGS, 2003-2006), information on daily sleeping hours and blood pressure measurements was available for 7701 children between 3 and 10 years of age.Using an age-independent measure for sleep duration, linear regression revealed a -0.80 mmHg (95% confidence interval -1.39; -0.22) mean arterial pressure difference between the children with the longest vs. shortest sleep duration. This effect was independent of age and was no longer significant when adjusted for BMI z-score and reported physical activity. Effect estimates obtained from quantile regression confirmed lack of significant associations over the entire blood pressure distribution.Sleep duration showed no or only marginal association with blood pressure in this large sample of children between 3 and 10 years of age. Further analysis indicated no age dependency or certain groups (e.g. prehypertensive children), in which sleep duration showed a greater effect on blood pressure.
The dataset presents reference centile data for carotid intima-media thickness as well as four carotid stiffness parameters. The reference percentiles are based on data from the German Health Interview and Examination Survey for Children and Adolescents 2003-2006 (KiGGS). KiGGS started as a cross-sectional study conducted between 2003 and 2006 which was based on a nationally representative sample and aimed at obtaining comprehensive data on the health of children and adolescents aged 0 to 17 years living in Germany. Detailed information on study design and conduct has been published in peer reviewed journals as well as detailed papers on individual parameters. The documentation provides relevant references.
11 years later, KiGGS Wave 2 (2014-2017) was conducted as an interview and examination survey. Carotid sonography was attempted at follow-up (KiGGS2) in all 4,798 participants of the KiGGS cohort aged 14 to 28 years. Carotid intima-media thickness (CIMT) was successfully measured in 4,709 participants. Reference centiles for the distensibility coefficient, stiffness index ß, Young's elastic modulus and Peterson's elastic modulus were computed using data on 4,305 adolescents and young adults aged 14 to 28.
In der vorliegenden kumulativen Habilitationsschrift werden Untersuchungen zu verschiedenen Aspekten der klinischen und bevolkerungsbezogenen Epidemiologie von Schwindel, Migrane und Migrane-Schwindel vorgestellt.
Eine neurootologische Querschnittsstudie mit einer fur Deutschland reprasentativen Stichprobe von 4869 Erwachsenen zeigt erstmals, dass vestibularer Schwindel ein haufiges und bislang unterschatztes Symptom in der Allgemeinbevolkerung ist, das zu erheblicher personlicher Beeintrachtigung und hoher Inanspruchnahme arztlicher Leistungen fuhrt. In einer weiteren Studie wird die Epidemiologie der Migrane in der Allgemeinbevolkerung in Deutschland untersucht. Die Assoziation von vestibularem Schwindel und Migrane wird durch mehrere klinische und bevolkerungsbezogene Studien belegt. Zur vestibularen Erkrankung Migrane-Schwindel werden sowohl klinische als auch epidemiologische Daten vorgestellt und erstmals die Pravalenz in der Allgemeinbevolkerung bestimmt. Eine erste placebokontrollierte randomisierte Studie zur Attackenbehandlung des Migrane-Schwindels mit Zolmitriptan belegt die Machbarkeit von randomisierten kontrollierten Studien bei dieser vestibularen Erkrankung, zeigte jedoch bei kleiner Fallzahl keine signifikante Uberlegenheit von Zolmitriptan gegenuber Placebo. Schlieslich zeigt eine klinische Studie eine erhohte Migranepravalenz auch bei Patienten mit einem Morbus Meniere. Ein haufigeres Auftreten von Migranesymptomen wahrend der Meniere-Attacken legt zudem einen pathophysiologischen Zusammenhang zwischen beiden Erkrankungen nahe.%%%%This cumulative habilitation thesis is based on studies on various aspects of the clinical and population-based epidemiology of vertigo, migraine and migrainous vertigo.
A large study of the general population by validated neurotologic interviews shows that vertigo is a frequent and underdiagnosed symptom in the general population. Vertigo has considerable personal impact and leads to a high health care utilisation. Data on the epidemiology of migraine in Germany are presented based on another nationally representative population-based study. The link between vertigo as a vestibular symptom and migraine is shown in several clinical and population-based studies. Furthermore, clinical and epidemiological data on migrainous vertigo as a specific vestibular syndrome are presented. The lifetime prevalence of migrainous vertigo in the adult general population is estimated at approximately 1%. A randomized controlled trial for the acute treatment of migrainous vertigo with zolmitriptan is inconclusive due to a small sample size but proves the feasibility of such trials for migrainous vertigo. Migraine prevalence is also increased in patients with Meniere`s disease. In addition, Meniere patients frequently report migrainous symptoms during their vertigo attacks, suggesting a pathophysiological link between the two conditions.
Sequences within the first intron of the alpha 1(I) collagen gene act both positively and negatively to regulate expression of the gene. We have further characterized a 274 bp intronic sequence that contains an orientation-specific inhibitory activity and represents a constitutive DNase I-hypersensitive site in the gene. We show that this sequence contains two tandem, unique binding elements for the transcription factor Sp1. In addition, an Sp1-like site, capable of competing for protein binding to the intronic elements, resides in the distal promoter of the collagen gene. The results of experiments with site-directed mutations that abolish binding to the intronic elements indicate that these protein-DNA interactions have an inhibitory effect on the transcriptional efficiency of alpha 1(I) collagen-reporter gene constructs in transient transfection analysis. These data support our conclusion that the first intron plays a complex role, involving multiple protein-DNA binding interactions, in the regulation of expression of the alpha 1(I) collagen gene.
Background: Carotid intima-media thickness (cIMT) and stiffness (cS) are predictive markers of early vascular aging and atherosclerotic risk. This study assessed, whether exercise has protective effects on carotid structure and function or on vascular risk in the young. Methods: Volume and change of exercise (recreational and organized sports participation) of German adolescents and young adults was assessed within the prospective population-study KiGGS at KiGGS-Wave-1 (2009-2012) and KiGGS-Wave-2 (2014-2017) using standardized self-reporting questionnaires. CIMT and cS were measured by real-time B-mode ultrasound sequences with semi-automated edge-detection and automatic electrocardiogram-gated quality control in 2,893 participants (14-28 years, 49.6% female). A cumulative index for atherosclerotic risk (CV-R) included z-scores of mean arterial pressure, triglycerides, total/HDL-cholesterol-ratio, body mass index, and HbA1c. Results: At KiGGS-Wave-2 cross-sectional CV-R but not cS and cIMT was lower in all exercise-groups compared to "no exercise" (B = -0.73, 95%-CI = -1.26 to 0.19, p = 0.008). Longitudinal volume of exercise was negatively associated with CV-R (B = -0.37, 95%-CI = -0.74 to 0.00, p = 0.048) but not with cS and cIMT. Cross-sectional relative risk of elevated CV-R but not cS and cIMT was lower in all exercise-groups compared to "no exercise" (RR = 0.80, 95%-CI = 0.66 to 0.98, p = 0.033). High exercise volumes were associated with lower relative risk of elevated CV-R (RR = 0.80, 95%-CI = 0.65-0.97, p = 0.021) and cS in tendency but not with cIMT. Conclusions: Increased levels of exercise are associated with a better cardiovascular risk profile in young individuals, but not with cS and cIMT. Our study confirms previous recommendations on exercise in this age group without demonstrating a clear benefit on surrogate markers of vascular health.
the COVID-19 vaccination offers protection against severe disease progression. Data show that people with a history of migration are less likely to be vaccinated against COVID-19 than people without a history of migration, but are at increased risk of infection.Data were used from the GEDA Fokus interview survey (November 2021 - May 2022), which included people living in Germany with Croatian, Italian, Polish, Syrian or Turkish citizenship (n=5,495). In addition to bivariate analyses, Poisson regressions were used to examine the association between uptake of at least one COVID-19 vaccination and sociodemographic, health- and migration-related factors.90.0% of participants reported having received at least one COVID-19 vaccination. Having visited a general practitioner or specialist in the past 12 months, living in Germany for 31 years or more, and having a greater sense of belonging to society in Germany were associated with vaccination uptake in bivariate analyses. Regression analysis showed that older people and those with higher education were more likely to be vaccinated.Sociodemographic factors are associated with uptake of the COVID-19 vaccine among individuals with selected citizenships. Low-threshold information and vaccination offers are important to ensure equal access to vaccination.
Abstract After having affected the population for two years, the COVID-19 pandemic has reached a phase where a considerable number of people in Germany have been either infected with a SARS-CoV-2 variant, vaccinated, or both. Yet the full extent to which the population has been in contact with either virus or vaccine remains elusive, particularly on a regional level, because (a) infection counts suffer from under-reporting, and (b) the overlap between the vaccinated and recovered subpopulations is unknown. Since previous infection, vaccination, or especially a combination of both reduce the risk of severe disease, a high share of individuals with SARS-CoV-2 immunity lowers the probability of severe outbreaks that could potentially overburden the public health system once again, given that emerging variants do not escape this reduction in susceptibility. Here, we estimate the share of immunologically naïve individuals by age group for each of the 16 German federal states by integrating an infectious disease model based on weekly incidences of SARS-CoV-2 infections in the national surveillance system and vaccine uptake, as well as assumptions regarding under-ascertainment. We estimate a median share of 7.0% of individuals in the German population have neither been in contact with vaccine nor any variant as of March 31, 2022 (quartile range [3.6%– 9.8%]). For the adult population at higher risk of severe disease, this figure is reduced to 3.5% [1.3%–5.5%] for ages 18–59 and 4.3% [2.7%–5.8%] for ages 60 and above. However, estimates vary between German states mostly due to heterogeneous vaccine uptake. Excluding Omicron infections from the analysis, 16.1% [14.0%–17.8%] of the population in Germany, across all ages, are estimated to be immunologically naïve, highlighting the large impact the Omicron wave had until the beginning of spring in 2022.
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