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PubMed2000

Hepatocellular carcinoma in Germany: a retrospective epidemiological study from a low-endemic area.

AIMS/BACKGROUND: This study was undertaken in order to assess the main features of hepatocellular carcinoma in Germany, a country with low incidences of this tumor. METHODS: Two hundred and eighty consecutive patients with hepatocellular carcinomas admitted to the Medical School Hannover between 1993-1997 were retrospectively studied. RESULTS: Reliable data for the assessment of the etiology and the tumor stage of HCC were available for 268 patients. The female/male ratio was 1/4. In 51.9% of the patients, HCC was associated with hepatitis virus B or C (HBV, HCV) infection: 35.1% with HBV, 26.9%) with HCV and 10% coinfection with HBV/HCV This result emphasizes the major impact of HBV and HCV infection in liver cancer in Germany. Of all patients with HCC 74.6%) had liver cirrhosis. The predominant majority of the HCC (87%) were restricted to the liver: in only 5.9% could regional lymph node metastases as well as 8.5%) metastases in other organs be clinically diagnosed by chest X-ray, computed tomography scan or sonography. Data to asses the Okuda tumor stage were available for 166 patients: 47% were classified as stage I, 47% as stage II and only 6% as stage III. Serum AFP were determined in 195 patients. In 66% of the patients, the AFP value was elevated, but only in 30% did the AFP level reach the value of 500 microg/l, which is considered to be significant for HCC diagnosis in patients with liver cirrhosis. The proportion of liver cirrhosis was higher in HCV (97.8%) versus HBV (80.6%) associated HCC, which was the only significant (p<0.05) difference in the characteristics of HCC according to the etiology. CONCLUSION: Our study shows that liver cirrhosis is the prime risk factor for hepatocarcinogenesis in Germany. However, the very high proportion of hepatitis virus related HCC, in particular the high proportion of HBV infections, contradicts the common view that alcohol is by far the most important etiological factor for hepatocarcinogenesis in low hepatitis virus endemic areas such as Germany.

Adult↗
PubMed2006

Trends in overweight and obesity and changes in the distribution of body mass index in schoolchildren of Jena, East Germany.

OBJECTIVE: Data of Jena children (Germany) show increases in the prevalence estimates of overweight and obesity between 1975 and 2001. Our objective was to determine if these increases contribute to changes in the distribution of body mass index (BMI) in the entire population of children. The decade 1985-1995, which includes the time of German reunification, is of particular interest because of the significant socio-economic changes in East Germany, in which Jena is located. DESIGN AND SUBJECTS: The analyses were based on data from four cross-sectional growth studies in 7- to 14-year-old children performed in Jena, Germany, in 1975 (n=2013), 1985 (n=1534), 1995 (n=1906) and 2001 (n=1918). Overweight and obesity were estimated by German reference data and the reference of Cole et al. Mean difference plots were used to investigate the changes in the BMI distributions within sexes between the studies. RESULTS: Between 1985 and 1995, the prevalence of overweight and obesity increased significantly in both sexes, whereas nonsignificant changes were found between 1975 and 1985. Although there is a tendency towards increased overweight between 1995 and 2001, the differences were nonsignificant. Comparing data from 1975 and 1985, the mean difference plots showed virtually no changes in the BMI distribution. In the plots comparing the BMI distribution for 1985 data and 1995 data, the whole distribution tended to shift upwards with a greater shift in the upper BMI range. The entire population of children in Jena gained weight during this period of time. This increase may be linked to a transition towards a more Western lifestyle, that is, usually by lower energy expenditure and nutritional transitions, caused by the process of reunification of Germany in 1989. CONCLUSIONS: Weight gain appears to be a characteristic feature of the entire population studied and does not seem to be a separate problem of the obese children. This suggests that reported changes in the prevalence may be underestimating the looming public health crisis.

Adolescent↗
PubMed1998

Low overall mortality of Turkish residents in Germany persists and extends into a second generation: merely a healthy migrant effect?

OBJECTIVE: To test the hypothesis that as a minority with lower socio-economic status, Turkish residents in Germany might experience a higher mortality than Germans. METHODS: All-cause mortality rates by age group and sex of Turkish and German adults for the time period 1980-94 were calculated from death registry data and mid-year population estimates. RESULTS: The age-adjusted mortality rate (per 100000) of Turkish males aged 25-65 years resident in Germany was 299 in 1980 and 247 in 1990, consistently half that of German males. The mortality of Turkish females in Germany was 140 in 1990, half that of German females. Mortality of Turkish males/females in Ankara was 835 and 426 in 1990. CONCLUSION: In view of the socio-economic status of Turkish residents in Germany the large mortality difference compared to Germans is unexpected. It cannot be fully explained by a selection at the time of hiring (healthy migrant effect) because it lasts over decades and extends into the second generation. A healthy worker effect is unlikely because Turkish residents have a lower employment rate than Germans. There is little evidence for movement of gravely ill persons back to Turkey. An 'unhealthy re-migration effect' in which socially successful migrants with a lower mortality risk stay in the host country while less successful ones return home even before becoming manifestly ill would partly explain our findings.

Adult↗
PubMed2003

Eradication of Aujeszky's disease in Germany.

Aujeszky's disease (AD) manifested itself in both German states in 1960. Owing to the historical development, in the subsequent two decades, the development of the disease and of its control in the Western and Eastern parts of Germany went different ways. This article describes differences and particularities in the development of AD in Germany leading to the establishment of a national AD eradication programme after re-unification of the two German states at the beginning of the last decade. The basic principles of the German AD eradication programme are described, and the results of 10 years of efforts to control the disease are presented and discussed. Without any doubt, as in other European countries, implementation of the national eradication programme resulted in a considerable progress in the eradication of AD. Since the eradication programme has been established in 1989, particularly in West Germany, the number of AD outbreaks has decreased steadily from about 2000 cases in 1987 to 0 cases recorded in 2001. Recently, Germany has been declared as officially AD-free by the European Commission.

Animals↗
PubMed2002

Increased incidence of pemphigus vulgaris in southern Europeans living in Germany compared with native Germans.

BACKGROUND: The two major subtypes of pemphigus include: pemphigus vulgaris (PV) and pemphigus foliaceus. Only limited data are available on the epidemiology of these diseases. OBJECTIVE: The aim of the present study was to estimate the gender- and age-specific incidences of PV in two well-defined regions of Germany and to compare the incidences among native Germans with those in citizens from other countries living in Germany. METHODS: We performed a retrospective review of records from all patients that were diagnosed with PV at the Departments of Dermatology in Würzburg and Mannheim between 1989 and 1997. RESULTS: During the observation period, 14 patients were diagnosed with PV coming from an area with 1.46 million residents. With regard to the patients' age, the highest incidence for women was found in the 51-65-year-old-age group with 2.34 [95% confidence interval (CI): 0.36; 7.76] new cases per 1 million inhabitants per year. The highest incidence for men was observed in the over 65-year-old age group with 3.72 (95% CI: 0.95; 9.8) cases/million peryear. In the 51-65-year-old age group,we found a 25-foldhigher incidence of PV in foreigners living in Germany compared with native Germans. The age-adjusted incidence of PV was ninefold higher in foreigners compared with native Germans. Interestingly, all non-German patients came from two southern European countries (Turkey and Italy). CONCLUSIONS: The age-adjusted incidence of PV differs between native Germans and foreigners living in Germany. Further studies are necessary to address the risk factors (genetic and/or environmental) that contribute to this difference.

Aged↗
PubMed2001

Incidence of status epilepticus in adults in Germany: a prospective, population-based study.

PURPOSE: To determine the incidence and case-fatality rate of status epilepticus (SE) in adults in Hessen, Germany, we performed a prospective, population-based study from July 1997 through June 1999. METHODS: All adult patients residing within the zip-code area 35 (area-35) with SE were included. Area-35 had 743.285 adult inhabitants, including 123.353 adult inhabitants of the primary service area of the University Hospital Marburg (PS-area). Patients were reported by 16 hospitals in the area and were prospectively identified and carefully reviewed within 5 days by one of the authors. Based on the crude annual incidence of SE and a rate of underascertainment of 10% determined for the PS-area, the corrected, age-adjusted incidence of SE in area 35, more representative of the population of Germany, was calculated. RESULTS: The crude annual incidence in the PS-area was 15.8/100,000 [95% confidence interval (CI), 11.2-21.6]. The calculated, corrected, age-adjusted incidence of SE in area 35 was 17.1/100,000. It was higher for men compared with women (26.1 vs. 13.7) and for those aged 60 years and older (54.5 vs. 4.2/100,000, p < 0.0001). The etiology was mainly remote symptomatic due to cerebrovascular disease. Epilepsy was previously diagnosed in only 50% of the patients. The case-fatality rate was 9.3%. CONCLUSIONS: Based on our data, at least 14,000 patients would be affected by SE in Germany, associated with approximately 1,300 deaths annually. The incidence of SE in Germany is similar to that found in the white United States population. Furthermore, this study confirms the higher incidence of SE in male patients and in the elderly population. This may be due to a higher incidence of cerebrovascular disease in these subpopulations.

Adult↗
PubMed2001

[Analysis of the proportion of women at different qualification levels in departments of human medicine in Germany].

BACKGROUND AND OBJECTIVE: In Germany leadership positions in medicine are characterized by an almost complete lack of women. The goal of this study was to determine the representation of women among different career ranks during medical school, residency and academic advancement during the past 20 years. METHODS: The annual reports of the German Federal Statistic Office in Wiesbaden were checked for the numbers of medical students, dissertations, physicians, internists, fellows and trainees at universities, habilitations and professorships. RESULTS: Among medical students, final examination, dissertation, physicians, internists and trainees at universities a proportion of women can be found nowadays which is at a 15% higher percentage level than 20 years ago. Among assistant professors and habilitations at universities there is a very low proportion of women, which did increase only slightly from 5 to 10% during the past 20 years. Within the same period of time the total number of professors and the proportion of female professors were nearly unchanged. Reunification of East and West Germany led to an increase of the representation of women among all levels of qualification which is due to the much higher proportion of female physicians in the former GDR. CONCLUSIONS: The lack of women in leadership positions in medicine in Germany is not due to a general lack of women in medicine. Among all other career ranks the proportion of women increased by 15%. The completely unchanged number and composition of the professors during the past 20 years suggests that the lack of women among this professional group has to do with conservatism which is an inherent trait of university professors in Germany.

Career Mobility↗
PubMed2001

[What do medical students know about cause and epidemiology of the Creutzfeldt-Jakob disease in Germany?].

Due to the increase of patients with the variant Creutzfeldt-Jakob disease (vCJD) in Great Britain and the first cases of autochthonous BSE cases in Germany, the study tried to investigate the knowledge of medical students about the epidemiology of CJD in Germany and how they assess the influence of different factors on the etiology of CJD. Altogether 63 first year medical students, 96 third year medical students and 50 nurses were included in an anonymous questionnaire survey. They were asked to estimate the annually incidence of CJD in Germany and to assess, by using analogue-scales, the influence of different factors on the risk of contracting CJD. For the medical students the median was 100 and for the nurses the median was 10 annual CJD cases. All participants, and especially the males, emphasised the influence of "risk behaviour" and "environmental factors" on the risk of contracting CJD, the factor "stress/ emotional strain" was seen as most unimportant. No significant differences between female and male participants in the knowledge about the incidence of CJD in Germany were found. It becomes obvious, that epidemiological knowledge about CJD in medical staff is associated with different and gender-specific views on the etiology. Medical education should consider this to avoid endangering medical staff and patients due to overprotection or insufficient precautions.

Adult↗
PubMed2002

[The state of tuberculosis in Germany in 2000].

Tuberculosis is one of the leading infectious diseases globally besides HIV/AIDS and malaria. Around 8 million people per year develop active tuberculosis, of whom 2 million eventually die of the disease. Of special importance to Germany is the epidemiologic situation in the former Soviet Union, where new infections are rising steeply. This region is also a hot spot for the development of multidrug-resistant tuberculosis. In 2000, the WHO registered already 273 000 cases of multidrug-resistant tuberculosis worldwide. In Germany the tuberculosis situation is stable. 9 064 persons (910 less than 1999) had tuberculosis in the year 2000. 5 271 cases were tuberculosis of the respiratory tract with detection of Mycobacteria tuberculosis. In 2 264 cases registered as tuberculosis of the respiratory tract, Mycobacteria tuberculosis could not be detected. 1 529 persons developed extrapulmonary tuberculosis. The highest incidences were found among the elderly. One third of the tuberculosis patients were born outside Germany. Resistance to antituberculous drugs also increased slowly in Germany. A study of the DZK, although with small numbers, demonstrated an increase of multidrug-resistant tuberculosis from 1.2 % (1996) to 1.7 % (2000), which also influenced the treatment outcome. With rising resistance rates, the treatment success decreased from 77.5 % in fully susceptible to 59.5 % in multidrug-resistant cases.

Antimalarials↗
PubMed2003

[Intraoperative radiotherapy in Germany].

BACKGROUND: Intraoperative radiotherapy (IORT) represents an attractive method for local tumour control after surgical resection. IORT was introduced into multimodal treatment protocols in the 1980s. Aim of this study was to analyse the actual clinical and scientific activity of IORT in Germany. METHODS: Questionnaires were sent to 102 centres in Germany. The analysis was focussed on indications in general surgery including bone tumours to evaluate the activity of IORT. The literature was analysed by a medline search for the years 1975 to 2001. RESULTS: Questionnaires were answered by 92% of the centres. 24 departments are working with IORT in Germany (16 of them are university hospitals). Main Indications for IORT treatment are rectum carcinoma and soft tissue sarcoma. Furthermore, IORT is used in patients suffering from gastric, pancreatic and bile duct malignancies. Some IORT programs are also targeting on patients with head and neck malignancies and brain tumours. German institutions published within the last 5 years about 14% of all " Medline"-listed publications concerning IORT. CONCLUSION: There is an profound activity of IORT in Germany, which is concentrated on a few centres. A need for better national and international cooperation of centres performing IORT for clinical trials and to collect significant numbers of patients seems to be evident.

Bile Duct Neoplasms↗
PubMed2004

[Integrated delivery systems in California--success and failure determining factors for the first 10 years and impetus for Germany].

Since the coming into effect of the Health Care Modernization Act (Gesundheitsmodernisierungsgesetz) the conditions for integrated health care delivery are favourable in Germany. However, comprehensive approaches are a long time in coming. In contrast, integrated health care delivery as an integral part of the spreading of managed care entered a further stage of development, which enables health care decision makers to draw conclusions regarding the further development of integrated health care delivery in Germany. Based on case studies integrated delivery systems in the San Francisco Bay Area have been analyzed with the objective to evaluate pitfalls and successful strategies for integrated health care delivery. The major pitfalls refer to an insufficient local focus, a lack of actual integration and the application of per capita reimbursement (which is a key subject on the political agenda in Germany as well) within integrated delivery systems. On the contrary, successful strategies include achieving a dynamic tension between centralized and decentralized coordination, internal and external relationship management, well organised human resource management including a well-defined corporate policy and a comprehensive implementation of information technology. Based on US experiences with integrated delivery systems implications for the design of integrated health care delivery in Germany are discussed.

California↗
PubMed2005

[American influences on the development of anaesthesiology in the Federal Republic of Germany between 1949 and 1960].

In anaesthesia, relations between the Federal Republic of Germany and the United States as well as Great Britain are traditionally good and long established. Political conditions have not interfered with the scientific exchange. In the years after World War II, these contacts helped to establish anaesthesia as a special field of medicine in Germany. Today, these contacts are mutual and indispensable. Important steps in establishing anaesthesiology in Germany were the support of the USA and Great Britain in reconstructing the field in general and enabling the education and advanced training of physicians. The participation of Sir Robert Macintosh in the German Surgeons' Congress in 1950 and his presentation there contributed decisively to the professionalization of anaesthesia. This was the starting point for the consolidation of anaesthesia as a special discipline of medicine in Germany in the 1960s.

Anesthesiology↗
PubMed2004

[Chances for advancement of outpatient rehabilitation in Germany].

Rehabilitation has a long tradition in Germany compared to other countries and is based upon a differentiated, social law foundation. Rehabilitative offers are provided as standard benefits by different social insurance schemes (pension insurance, health insurance, accident insurance, etc.) and are an independent task of care not included in acute care. A high degree of institutionalisation and specialisation are specific characteristics of rehabilitation in Germany. A country-wide network of indication specific, mostly larger institutions is available for medical rehabilitation in Germany. This emergence of centres and the location of many institutions in more rural regions give rise to the fact that rehabilitation often cannot take place close to the places of residence of those who are in need of rehabilitative offers. Until the mid-nineties, rehabilitative benefits have been performed almost exclusively on an inpatient basis, which is another characteristic of medical rehabilitation in Germany. Since then the discussion about ambulant rehabilitation has been increasing. Several initiatives are aimed at supplementing the present in-patient offers through ambulant measures. This article describes and analyses the present efforts for the development of ambulant rehabilitation. In reference to the guidelines of the BAR (Federal Rehabilitation Council) concerning ambulant medical rehabilitation, adopted by all institutions involved in 2000, the current situation and the state of implementation are discussed, and advancements necessary in the authors' view are considered.

Ambulatory Care↗
PubMed2005

[Tuberculosis in Germany in 2001 and 2002].

The implementation of the new law on infectious diseases in 2001 and the resulting notification of more detailed variables has led to a better knowledge about the epidemiology of tuberculosis (TB) in Germany. 7,515 new cases of active tuberculosis were notified to the Robert Koch Institute in 2001, and 7,684 cases in 2002, corresponding to an incidence of 9.1 (2001) and 9.3 (2002) per 100,000 inhabitants (as per 1 October, 2003). The slight increase in new cases in 2002 is most likely due to under-notification in 2001 because of the new system, considering that the previous decline over many consecutive years is continued according to the incidence for 2003 (8.7/100,000; n = 7,184). In 2001 as well as in 2002 42 % of new TB patients were born outside Germany, and those of foreign nationality have a five-fold higher incidence on the average than German citizens. The lung remains the most affected organ (80 %). 4,230 (2001) and 4,267 (2002) were cases of open, i. e., bacteriologically confirmed, pulmonary tuberculosis potentially contagious to their immediate contacts. The resistance rates are stable in the indigenous population, while patients coming from countries with high resistance rates reflect the situation in their countries of origin. Over two thirds of TB patients in Germany are hospitalized at some point during their disease. The treatment results (78 % on the average in 2001) do not reach the WHO target of 85 %. Approximately 7 % of TB patients in Germany still die because of this infectious disease.

Disease Notification↗
PubMed2005

[The direct costs of depressive disorders in Germany].

OBJECTIVE: The purpose of this study was to estimate the direct costs of depression in Germany from the social perspective. METHODS: The data came from the European Study of the Epidemiology of Mental Disorders (ESEMeD), in which a representative sample of 3555 non-institutionalised adults aged 18 years or older was interviewed in Germany. Using the most recent version of the Composite International Diagnostic Interview (WMH-CIDI), 131 persons with a 12-month prevalence of major depression, minor depression and dysthymia were identified. These patients reported their mental health care consumption of the last 12 months retrospectively, which was valued by prices of 2002. RESULTS: The average direct costs for treating depressive disorders were 686 EUR per patient and year. The total direct costs of depression in Germany was estimated at approximately 1.6 billion EUR. CONCLUSIONS: Because the sample was restricted to the non-institutionalised population, calculated costs may be underestimated. The costs per inhabitant in Germany exceed those reported by studies from the United Kingdom but are lower than those reported for the USA.

Adult↗
PubMed2005

[Does migration from high and intermediate endemic regions increase the prevalence of hepatitis B infection in Germany?].

BACKGROUND AND OBJECTIVE: Germany is one of the low endemic areas for hepatitis B. There are 7,3 million foreign citizens and 3,2 million migrants from the former USSR and Eastern Europe with German roots, the "Resettlers" (Aussiedler), who migrated to Germany mostly from countries with moderate or high HBsAg prevalence. The aim of this study was to determine the HBsAg prevalence in adult foreign citizens and resettlers compared with that among the adult German population. METHODS: Adult foreign citizens and resettlers were categorized according to their country of origin into groups with low, intermediate or high HBsAg prevalence, using data from the WHO. Statistics of the Federal Office for Statistics, the Federal Office for Administration and the Federal Ministry of the Interior were used for the demographic analysis. The number of chronic HBsAg carriers for the different population groups and the whole population was then calculated. RESULTS: 84% of the adult migrant population in Germany migrated from countries with intermediate and high HBsAg endemicity. For 2003 we calculated 503 040 HBsAg carriers in Germany. 42% of these have a migratory background, even though migrants represent only 12.7% of the whole population. The risk for chronic infection with HBsAg is 7.1 (4.8-13.2) for the resettlers and is 4.3 (3.0-8.1) times higher for foreign citizens than for the German population. CONCLUSIONS: These remarkable differences in prevalence make it important that migrants and their close contacts be vaccinated properly, pregnant women be included in screening programs and cases of chronic hepatitis B be treated adequately.

Adult↗
PubMed1998

[Regional distribution of predisposition to maligant hyperthermia in Germany: tate in 1997].

Malignant hyperthermia (MH) is a rare autosomally dominantly hereditary and potentially life-threatening disease. The prevalence of the genetic MH predisposition is estimated as 1:10,000 to 1:20,000. In Germany no data on the regional distribution are available. Therefore, the purpose of this investigation is to summarise and present the epidemiological data of all German MH laboratories. Nine German hospitals offer the specific in vitro contracture test to diagnose the MH predisposition. All German MH laboratories carry out the examination in accordance with the standardised protocol of the European Malignant Hyperthermia Group. The laboratories were asked to provide the number of all patients investigated, excluding those suffering from other neuromuscular diseases, separated according to diagnostic groups and their places of residence, the number of the identified MH-families as well as the number of the clinically suspected and investigated MH cases with their places of residence. Eight MH laboratories provided the requested data. Until September 1997 a total of 2620 patients were investigated. In 865 patients (34%) MH suspicion was confirmed (diagnosis: MHS). 1494 patients (56%) were released by investigation from MH-suspicion (diagnosis: MHN). In 261 patients (10%) the MH-predisposition remained unsolved (diagnosis: MHE). 580 MH families were identified. Among 2620 patients 757 were clinically suspected MH cases. 35% of these suspected MH cases were classified as MHS, 10% as MHE and 55% as MHN. The documentation of the patients places of residence classified as MHS and MHE into a map of Germany demonstrates an exhaustive distribution with an increased regional prevalence in the areas of the MH laboratories. This concentration in the area of the MH laboratories becomes even more evident, when the places of residence of the MH suspected cases are demonstrated. In conclusion, the distribution of the MH predisposition is uniform and exhaustive in Germany. The presented regional concentration of clinically suspected MH cases among the MH laboratories is mainly interpreted as an expression of effective regional education and information. Considering the overall incidence of the MH predisposition as described above only 15-20% of the MH patients have so far been identified. The MH laboratories have already released about 10,000 patients from the suspicion of MH predisposition. A preliminary prevalence of at least 1:60,000 to 1:80,000 in Germany can be estimated according to the presented data.

Epidemiologic Studies↗
PubMedDate not supplied

[Initial results of the evaluation study of ultrasound hip screening in Germany].

AIM OF STUDY: To assess the effectiveness of a universal sonographic screening of developmental dysplasia of the hip (DDH) established in Germany since 1996. METHODS: Currently a national survey is being performed in Germany to identify infants and young children who receive inpatient treatment for DDH. Between May, 1997 and October, 1997 monthly questionnaires were sent to all pediatric orthopaedic surgeons (active surveillance) and they were asked to report all inpatient cases between 10 weeks of age and 5 years with current closed or open reduction and/or osteotomies due to DDH. Information on time and results of previous ultrasound screening as well as treatment modalities was obtained in reported cases. RESULTS: 129 children (mean age at hospital admission 15.9 months, range 1.1 to 57.1 months) underwent closed reduction (n = 51), open reduction (n = 40) and osteotomies of the hip (n = 38) in the 6-month study period. Ultrasound screening has been performed too late and not at all in 45 children (35.1%). While in 18 cases (13.7%) no information could be obtained on screening results, the majority of children (n = 66, 51.2%) had completed DDH screening prior to the sixth week of life as recommended. Preliminary calculation of the unadjusted incidence of inpatient treatment for DDH in Germany was 0.33 per 1000 livebirths. CONCLUSION: DDH cases are still identified after introduction of an universal ultrasound hip screening in Germany. Continued evaluation must show, whether the incidence will decrease throughout the next few years.

Child, Preschool↗