Design und Qualitätskontrolle der zahnmedizinischen Untersuchung in der NAKO Gesundheitsstudie [Design and quality control of the oral health status examination in the German National Cohort (GNC)]

BACKGROUND: Caries and periodontitis are highly prevalent worldwide. Because detailed data on these oral diseases were collected within the framework of the German National Cohort (GNC), associations between oral and systemic diseases and conditions can be investigated. OBJECTIVES: The study protocol for the oral examination was designed to ensure a comprehensive collection of dental findings by trained non-dental staff within a limited examination time. At the mid-term of the GNC baseline examination, a first quality evaluation was performed to check the plausibility of results and to propose measures to improve the data quality. MATERIALS AND METHODS: A dental interview, saliva sampling and oral diagnostics were conducted. As part of the level‑1 examination, the number of teeth and prostheses were recorded. As part of the level‑2 examination, detailed periodontal, cariological and functional aspects were examined. All examinations were conducted by trained non-dental personnel. Parameters were checked for plausibility and variable distributions were descriptively analysed. RESULTS: Analyses included data of 57,967 interview participants, 56,913 level‑1 participants and 6295 level‑2 participants. Percentages of missing values for individual clinical parameters assessed in level 1 and level 2 ranged between 0.02 and 3.9%. Results showed a plausible distribution of the data; rarely, implausible values were observed, e.g. for measurements of horizontal and vertical overbite (overjet and overbite). Intra-class correlation coefficients indicated differences in individual parameters between regional clusters, study centres and across different examiners. CONCLUSIONS: he results confirm the feasibility of the study protocol by non-dental personnel and its successful integration into the GNC's overall assessment program. However, rigorous dental support of the study centres is required for quality management

Validierung des TeleForm Scan-Workflows in der NAKO Gesundheitsstudie am Beispiel des Fragebogens zur körperlichen Aktivität

Electronic data capture (EDC) is an important tool for the digitalisation of paper-based documents such as questionnaires and for the identification of errors before values are finally saved in a database. The data acquisition software TeleForm is one example for an EDC system which is used to digitise paper-based documents. TeleForm checks the data of the scanned document and gives indications of possibly incorrectly read data. In the German National Cohort (GNC) this software is among other things applied to digitalise questionnaires.The following questions are addressed in this article: Is the scan workflow referring to the questionnaires in the GNC and in particular the data acquisition software TeleForm (with the settings chosen for the GNC) reliable? How much loss of data quality is acceptable to reduce the amount of work? Can artificial intelligence replace human inspection sufficiently or will the latter continue to play an indispensable role in the scan workflow of the GNC in the future? By answering these questions, the strengths and the limitations of the scan workflow in the GNC using the TeleForm software will be discussed.The current work uses data collected in the GNC centre in Dusseldorf. 300 questionnaires on physical activity were validated and checked twice, first by the system TeleForm and second by a visual assessment. The data acquisition software TeleForm shows high error rates in interpreting free text fields as well as in reading handwritten numbers. Especially the digit "0" was misinterpreted most often.In order to save time and thus make work easier, some shortcomings must be remedied. This can be achieved, for example, by putting special emphasis on the expansion of the reading areas of TeleForm and on the improved reproduction and reading of numerical values.Die elektronische Datenerfassung (EDC) ist ein wichtiges Instrument zur Digitalisierung von papierbasierten Dokumenten wie beispielsweise Fragebögen. Ebenso ist es für die Identifizierung von Fehlern hilfreich, bevor die Werte endgültig in einer Datenbank gespeichert werden. Die Datenerfassungssoftware TeleForm ist ein Beispiel für ein EDC-System, das zur Digitalisierung von papierbasierten Dokumenten eingesetzt wird. TeleForm prüft die Daten des eingescannten Dokumentes und gibt Hinweise auf möglicherweise fehlerhaft gelesene Daten. In der NAKO Gesundheitsstudie wird diese Software unter anderem zur Digitalisierung von Fragebögen eingesetzt.In diesem Artikel werden die folgenden Fragen behandelt: Ist der Scan-Workflow bezogen auf die Fragebögen in der NAKO Gesundheitsstudie und insbesondere die Datenerfassungssoftware TeleForm (mit den für die NAKO gewählten Einstellungen) zuverlässig? Wieviel Verlust an Datenqualität ist akzeptabel, um den Arbeitsaufwand zu reduzieren? Kann künstliche Intelligenz die menschliche Überprüfung ausreichend ersetzen oder wird letztere auch in Zukunft eine unverzichtbare Rolle im Scan-Workflow der NAKO spielen? Durch die Beantwortung dieser Fragen sollen die Stärken und Grenzen des Scan-Workflows in der NAKO Gesundheitsstudie unter Verwendung der TeleForm-Software diskutiert werden.Die aktuelle Arbeit verwendet Daten, die im NAKO-Zentrum in Düsseldorf erhoben wurden. 300 Fragebögen zur körperlichen Aktivität wurden validiert und zweimal überprüft, zum einen durch das System TeleForm und zum anderen durch eine visuelle Kontrolle. Die Datenerfassungssoftware TeleForm zeigt hohe Fehlerquoten bei der Interpretation von Freitextfeldern sowie beim Lesen von handgeschriebenen Zahlen. Insbesondere die Ziffer "0" wurde am häufigsten falsch interpretiert.Um Zeit zu sparen und damit die Arbeit zu erleichtern, müssen einige Defizite behoben werden. Dies kann zum Beispiel durch die Erweiterung der Lesebereiche sowie die Verbesserung des Lesens von Zahlenwerten erzielt werden

Airway inflammation in adolescents and elderly women: Chronic air pollution exposure and polygenic susceptibility.

BACKGROUND AND AIM: The fractional exhaled nitric oxide (FeNO) concentration in the exhaled breath is a biomarker for eosinophilic airway inflammation. We explored the interplay between chronic air pollution exposure and polygenic susceptibility to airway inflammation at different critical age stages. METHODS: Adolescents (15 yr) enrolled in the GINIplus/LISA birth cohorts (n = 2434) and 220 elderly women (75 yr on average) enrolled in the SALIA cohort with FeNO measurements available were investigated. Environmental main effects of the mean of ESCAPE land-use regression air pollutant concentrations within a time window of 15 years and main effects of the polygenic risk scores (PRS) using internal weights from elastic net regression of genome-wide derived single nucleotide polymorphisms were investigated. Furthermore, we examined gene-environment interaction (GxE) effects on natural log-transformed FeNO levels by adjusted linear regression models. RESULTS: While we observed no significant environmental and polygenic main effects on airway inflammation in either age group, we found robust harmful effects of chronic nitrogen dioxide (NO2) exposure in the GxE models for elderly women (16.2 % increase in FeNO, p-value = 0.027). Stratified analyses found GxE effects between the PRS and chronic NO2 exposure in never-smoker elderly women and in adolescents without any inflammatory respiratory conditions. CONCLUSIONS: FeNO measurement is a useful biomarker to detect higher risk of NO2-induced eosinophilic airway inflammation in the elderly. There was limited evidence for GxE effects on airway inflammation in adolescents or the elderly. Further GxE studies in subpopulations should be conducted to investigate the assumption that susceptibility to airway inflammation differs between age stages

Nächtliche Verkehrslärmbelästigung in Deutschland: individuelle und regionale Unterschiede in der NAKO Gesundheitsstudie

BACKGROUND: Noise annoyance is associated with adverse health-related conditions and reduced wellbeing. Thereby, subjective noise annoyance depends on the objective noise exposure and is modified by personal and regional factors. OBJECTIVE: How many participants of the German National Cohort Study (GNC; NAKO Gesundheitsstudie) were annoyed by transportation noise during nighttime and what factors were associated with noise annoyance? MATERIALS AND METHODS: This cross-sectional analysis included 86,080 participants from 18 study centers, examined from 2014 to 2017. We used multinomial logistic regression to investigate associations of personal and regional factors to noise annoyance (slightly/moderately or strongly/extremely annoyed vs. not annoyed) mutually adjusting for all factors in the model. RESULTS: Two thirds of participants were not annoyed by transportation noise during nighttime and one in ten reported strong/extreme annoyance with highest percentages for the study centers Berlin-Mitte and Leipzig. The strongest associations were seen for factors related to the individual housing situation like the bedroom being positioned towards a major road (OR of being slightly/moderately annoyed: 4.26 [95% CI: 4.01;4.52]; OR of being strongly/extremely annoyed: 13.36 [95% CI: 12.47;14.32]) compared to a garden/inner courtyard. Participants aged 40-60 years and those in low- and medium-income groups reported greater noise annoyance compared to younger or older ones and those in the high-income group. CONCLUSION: In this study from Germany, transportation noise annoyance during nighttime varied by personal and regional factors

Blood pressure measurement in the NAKO German National Cohort (GNC) - differences in methods, distribution of blood pressure values, and awareness of hypertension compared to other population-based studies in Germany.

BACKGROUND: Arterial hypertension is animportant risk factor for cardiovascular diseases. Epidemiological studies typically perform three consecutive blood pressure measurements. The first measurement is discarded in subsequent analyses, as this value may be strongly affected by previous activities. Due to time constraints the German National Cohort (GNC NAKO) performed only two blood pressure measurements. OBJECTIVES: The present analysis examined the possible effects of methodological differences in blood pressure measurement by comparing the first 101,816 GNC participants (two blood pressure measurements) with those of five German population-based studies (three measurements). MATERIALS AND METHODS: Blood pressure data from participants aged 20 to 79 years from the GNC, the German Health Interview and Examination Survey for Adults by the Robert Koch Institute (DEGS1), and four regional population-based cohort studies (CARLA, HNR, KORA, SHIP) were used to calculate age- and sex-specific mean blood pressure values and hypertension frequencies based on the second blood pressure measurement, the arithmetic mean of the first and second value and of the second and third (the latter not available in the GNC). RESULTS: The mean blood pressure values of the two most recent studies (GNC, DEGS1) were very similar and lower than in the other studies. The difference of the second measurement and the mean of second and third measurement was small (maximum mean difference: 1.5mm Hg systolic blood pressure), but leads to higher estimated hypertension frequencies. CONCLUSIONS: The current results show that using the second blood pressure measurement should be recommended for scientific analyses of GNC data