Mode Equivalence of Health Indicators Between Data Collection Modes and Mixed-Mode Survey Designs in Population-Based Health Interview Surveys for Children and Adolescents: Methodological Study

Background: The implementation of an Internet option in an existing public health interview survey using a mixed-mode design is attractive because of lower costs and faster data availability. Additionally, mixed-mode surveys can increase response rates and improve sample composition. However, mixed-mode designs can increase the risk of measurement error (mode effects). Objective: This study aimed to determine whether the prevalence rates or mean values of self- and parent-reported health indicators for children and adolescents aged 0-17 years differ between self-administered paper-based questionnaires (SAQ-paper) and self-administered Web-based questionnaires (SAQ-Web), as well as between a single-mode control group and different mixed-mode groups. Methods: Data were collected for a methodological pilot of the third wave of the "German Health Interview and Examination Survey for Children and Adolescents". Questionnaires were completed by parents or adolescents. A population-based sample of 11,140 children and adolescents aged 0-17 years was randomly allocated to 4 survey designs—a single-mode control group with paper-and-pencil questionnaires only (n=970 parents, n=343 adolescents)—and 3 mixed-mode designs, all of which offered Web-based questionnaire options. In the concurrent mixed-mode design, both questionnaires were offered at the same time (n=946 parents, n=290 adolescents); in the sequential mixed-mode design, the SAQ-Web was sent first, followed by the paper questionnaire along with a reminder (n=854 parents, n=269 adolescents); and in the preselect mixed-mode design, both options were offered and the respondents were asked to request the desired type of questionnaire (n=698 parents, n=292 adolescents). In total, 3468 questionnaires of parents of children aged 0-17 years (SAQ-Web: n=708; SAQ-paper: n=2760) and 1194 questionnaires of adolescents aged 11-17 years (SAQ-Web: n=299; SAQ-paper: n=895) were analyzed. Sociodemographic characteristics and a broad range of health indicators for children and adolescents were compared by survey design and data collection mode by calculating predictive margins from regression models. Results: There were no statistically significant differences in sociodemographic characteristics or health indicators between the single-mode control group and any of the mixed-mode survey designs. Differences in sociodemographic characteristics between SAQ-Web and SAQ-paper were found. Web respondents were more likely to be male, have higher levels of education, and higher household income compared with paper respondents. After adjusting for sociodemographic characteristics, only one of the 38 analyzed health indicators showed different prevalence rates between the data collection modes, with a higher prevalence rate for lifetime alcohol consumption among the online-responding adolescents (P<.001). Conclusions: These results suggest that mode bias is limited in health interview surveys for children and adolescents using a mixed-mode design with Web-based and paper questionnaires.Peer Reviewe

Modifiable cardiovascular risk factors in adults aged 40–79 years in Germany with and without prior coronary heart disease or stroke

Background Control of modifiable cardiovascular disease (CVD) risk factors has substantially reduced CVD mortality, but risk factor levels in populations may change and need continuous monitoring. This study aims to provide current estimates of the prevalence of these risk factors in Germany according to sex and history of coronary heart disease (CHD) or stroke. Methods The analyses were based on data from the German Health Interview and Examination Survey for Adults (DEGS1; age 40–79 years, n = 5101), which is a cross-sectional population-based examination survey. CVD risk factors were defined according to recommendations in the European Guidelines on Cardiovascular Disease Prevention in Clinical Practice 2012. Results The mean age was 57 years and 52 % were female; 493 participants had prior CHD and 163 participants a prior stroke. The overall prevalence of behavioural risk factors ranged from 17.9 % for high risk alcohol consumption to 90 % for low vegetable intake. Blood pressure ≥ 140/90 mmHg was found in 21 % and 69 % had total cholesterol ≥ 5.0 mmol/l. Only 16 % met the targets for five behavioural factors combined (smoking, physical activity, fruit intake, alcohol intake and obesity), 13 % of those with and 16 % of those without CHD or stroke. The prevalences of most behavioural risk factors were higher among men compared to women. Conclusions There is a high prevention potential from modifiable cardiovascular risk factors in the general population aged 40–79 years in Germany and among those with prior CHD or stroke. Risk factors are often co-occurring, are interrelated and require combined educational, behavioral, medical and policy approaches

Seroepidemiological study on the spread of SARS-CoV-2 in Germany:

The SARS-CoV-2 coronavirus has spread rapidly across Germany. Infections are likely to be under-recorded in the notification data from local health authorities on laboratory-confirmed cases since SARS-CoV-2 infections can proceed with few symptoms and then often remain undetected. Seroepidemiological studies allow the estimation of the proportion in the population that has been infected with SARS-CoV-2 (seroprevalence) as well as the extent of undetected infections. The ‘CORONA-MONITORING bundesweit’ study (RKI-SOEP study) collects biospecimens and interview data in a nationwide population sample drawn from the German Socio-Economic Panel (SOEP). Participants are sent materials to self-collect a dry blood sample of capillary blood from their finger and a swab sample from their mouth and nose, as well as a questionnaire. The samples returned are tested for SARS-CoV-2 IgG antibodies and SARS-CoV-2 RNA to identify past or present infections. The methods applied enable the identification of SARS-CoV-2 infections, including those that previously went undetected. In addition, by linking the data collected with available SOEP data, the study has the potential to investigate social and health-related differences in infection status. Thus, the study contributes to an improved understanding of the extent of the epidemic in Germany, as well as identification of target groups for infection protection

Socioeconomic Differences in SARS-CoV-2 Infection and Vaccination in Germany: A Seroepidemiological Study After One Year of COVID-19 Vaccination Campaign

Objective: To evaluate the socioeconomic patterns of SARS-CoV-2 antigen contacts through infection, vaccination or both (“hybrid immunity”) after 1 year of vaccination campaign.Methods: Data were derived from the German seroepidemiological Corona Monitoring Nationwide study (RKI-SOEP-2; n = 10,448; November 2021–February 2022). Combining serological and self-report data, we estimated adjusted prevalence ratios (PR) of SARS-CoV-2 infection, COVID-19 vaccination, basic immunization (at least two SARS-CoV-2 antigen contacts through vaccination and/or infection), and three antigen contacts by education and income.Results: Low-education groups had 1.35-times (95% CI 1.01–1.82) the risk of SARS-CoV-2 infection compared to high-education groups. COVID-19 vaccination (at least one dose) and basic immunization decreased with lower education and income. Low-education and low-income groups were less likely to have had at least three antigen contacts (PR low vs. high education: 0.74, 95% CI 0.65–0.84; PR low vs. high income: 0.66, 95% CI 0.57–0.77).Conclusion: The results suggest a lower level of protection against severe COVID-19 for individuals from low and medium socioeconomic groups. Pandemic response and vaccination campaigns should address the specific needs and barriers of these groups

SARS-CoV-2 Transmissibility Within Day Care Centers—Study Protocol of a Prospective Analysis of Outbreaks in Germany

Introduction: Until today, the role of children in the transmission dynamics of SARS-CoV-2 and the development of the COVID-19 pandemic seems to be dynamic and is not finally resolved. The primary aim of this study is to investigate the transmission dynamics of SARS-CoV-2 in child day care centers and connected households as well as transmission-related indicators and clinical symptoms among children and adults. Methods and Analysis: COALA (“Corona outbreak-related examinations in day care centers”) is a day care center- and household-based study with a case-ascertained study design. Based on day care centers with at least one reported case of SARS-CoV-2, we include one- to six-year-old children and staff of the affected group in the day care center as well as their respective households. We visit each child's and adult's household. During the home visit we take from each household member a combined mouth and nose swab as well as a saliva sample for analysis of SARS-CoV-2-RNA by real-time reverse transcription polymerase chain reaction (real-time RT-PCR) and a capillary blood sample for a retrospective assessment of an earlier SARS-CoV-2 infection. Furthermore, information on health status, socio-demographics and COVID-19 protective measures are collected via a short telephone interview in the subsequent days. In the following 12 days, household members (or parents for their children) self-collect the same respiratory samples as described above every 3 days and a stool sample for children once. COVID-19 symptoms are documented daily in a symptom diary. Approximately 35 days after testing the index case, every participant who tested positive for SARS-CoV-2 during the study is re-visited at home for another capillary blood sample and a standardized interview. The analysis includes secondary attack rates, by age of primary case, both in the day care center and in households, as well as viral shedding dynamics, including the beginning of shedding relative to symptom onset and viral clearance. Discussion: The results contribute to a better understanding of the epidemiological and virological transmission-related indicators of SARS-CoV-2 among young children, as compared to adults and the interplay between day care and households.Peer Reviewe

Seroepidemiologische Studie zur bundesweiten Verbreitung von SARS-CoV-2 in Deutschland: Studienprotokoll von CORONA-MONITORING bundesweit (RKI-SOEP-Studie)

Das Coronavirus SARS-CoV-2 hat sich in kurzer Zeit bundesweit ausgebreitet. In den Meldedaten der Gesundheitsämter zu laborbestätigten Infektionsfällen ist von einer Untererfassung des Infektionsgeschehens auszugehen, da Infektionen häufig unentdeckt bleiben, zum Beispiel weil sie symptomarm verlaufen. In seroepidemiologischen Studien kann der Bevölkerungsanteil mit durchgemachter SARS-CoV-2-Infektion (Seroprävalenz) wie auch der Umfang unentdeckter Infektionen abgeschätzt werden. In der Studie CORONA-MONITORING bundesweit (RKI-SOEP-Studie) werden Bioproben und Befragungsdaten in einer deutschlandweiten Bevölkerungsstichprobe des Sozio-oekonomischen Panels (SOEP) erhoben. Den Teilnehmenden werden Materialien zur selbstständigen Gewinnung einer Trockenblutprobe aus Kapillarblut des Fingers und einer Abstrichprobe aus Mund und Nase sowie ein Fragebogen postalisch zugesendet. Die zurückgesendeten Proben werden auf SARS-CoV-2-IgG-Antikörper und SARS-CoV-2-RNA zur Identifikation einer durchgemachten oder aktuellen Infektion untersucht. Die eingesetzten Methoden ermöglichen es, auch solche SARS-CoV-2-Infektionen zu erkennen, die bislang unentdeckt blieben. Durch die Verknüpfung mit bereits vorhandenen SOEP-Daten hat die Studie das Potenzial, auch soziale und gesundheitsbezogene Unterschiede im Infektionsstatus zu untersuchen. So kann die Studie zu einem verbesserten Verständnis des Ausmaßes der Epidemie in Deutschland wie auch zur Identifikation von Zielgruppen für den Infektionsschutz beitragen

Examination survey on health and nutrition of the adult population in Germany between 2019 and 2021 – the current status of planning

Peer Reviewe

Untersuchungssurvey zur Gesundheit und Ernährung der erwach - senen Bevölkerung in Deutschland 2019 – 2021: Planungsstand

Peer Reviewe

Clinical presentation, Diagnosis, Treatment and Outcome of Pulmonary Diseases Caused by Non-tuberculous Mycobacteria in HIV-negative Patients in Berlin 1986 - 1998

Titelblatt, Inhalts-, Abbildungs- und Tabellenverzeichnis, Danksagung 1\. Einleitung 7 2 Definitionen, Klinik, Diagnostik und Therapie 10 3 Material und Methoden 20 4 Ergebnisse 23 5 Diskussion 57 6 Zusammenfassung 93 7 Anhang 96 8 Literaturverzeichnis 107Einleitung: Eine pulmonale Infektion durch "nichttuberkulöse" Mykobakterien (NTM) ist eine seltene Erkrankung, deren Behandlung trotz der Fortschritte in der molekularbiologischen Diagnostik und der Entwicklung neuer hochwirksamer Medikamente (Makrolide und Chinolone) eine Herausforderung für Mikrobiologen und Kliniker darstellt. Über die prädiktive Bedeutung der In-vitro- Empfindlichkeitsprüfungen für die In-vivo-Wirksamkeit einer Kombinationstherapie wird kontrovers diskutiert. Die Fragestellung der vorliegenden Arbeit lautet, ob bei den untersuchten Patienten gut begründete Hinweise auf einen Zusammenhang zwischen den Er-gebnissen der In-vitro- Empfindlichkeitsprüfungen und den Behandlungserfolgen oder -misserfolgen gefunden werden können. Methoden: Retrospektive Auswertung von 62 Fällen, diagnostiziert im Institut für Mikrobiologie, Immunologie und Laboratoriumsmedizin, Zentralklinik Emil von Behring, Department Lungenklinik Heckeshorn, Berlin. Ergebnisse: Es wurden von 8/1986 bis 12/1998 62 pulmonale Infektionen durch NTM nach-gewiesen. Der Verlauf von 51 der 62 Patienten konnte ausgewertet werden. Bei 40 der 51 Pati-enten wurde nur eine medikamentöse Therapie, bei 6 nur eine chirurgische und bei 5 eine kombiniert medikamentös-chirurgische Therapie durchgeführt. Als primäre Behandlungsstrategie erhielten 43 Patienten eine Substanzkombination gemäß den Ergebnissen der In-vitro-Empfindlichkeitsprüfungen. Alle 42 Patienten mit Infektionen durch langsam wachsende Spezies sprachen mit Sputumkonversion (median 2,2 Monate) und klinischer Besserung auf die Therapie an. Eine Patientin mit einer Infektion durch M. chelonae (schnell wachsendes NTM) zeigte ein komplettes Therapieversagen. Bei 3 der 42 Patienten wurde zusätzlich eine Resektion vorgenommen, 2 konnten nach Krankenhausentlassung nicht nachbeobachtet werden. Von den verbleibenden 37 Patienten wurden 30 dauerhaft geheilt (Rezidivfreiheit von 6 - 102 Monaten, mittleres Follow up 26 Monate). Bei 6 Patienten kam es zu Therapieversagen oder Rezidiven. Ein Patient konnte nach Abschluss einer erfolgreichen Behandlung nicht nachbeobachtet werden. Die Rezidive konnten auf zu kurze Behandlungsdauer, vorbestehende schwerwiegende Lungen- und/oder andere Begleiterkrankungen, sowie die Multiresistenz der Erreger zurückgeführt werden. Die Patienten, die nur chirurgisch (n=6) oder kombiniert medikamentös-chirurgisch (n=5) behandelt wurden, zeigten alle einen rezidivfreien Verlauf über mehr als 24 Monate. Schlussfolgerung: Es konnte bei den hier untersuchten Patienten gezeigt werden, dass bei In-vitro-Empfindlichkeit der Mykobakterienspezies für Clarithromycin, Rifamycine, Chinolone sowie Medikamente der zweiten Wahl eine rasche Sputumkonversion (2-3 Monate) und ein langfristiger Behandlungserfolg erwartet werden können. Der Einsatz von EMB ist aufgrund seiner synergistischen Wirkungsweise auch bei In-vitro-Resistenz sinnvoll. Krankheitsstadium, vorbestehende Lungen- und Begleiterkrankungen, sowie die Behandlungsdauer haben einen entscheidenden Einfluss auf das Therapieergebnis. Je nach Spezies, Ausdehnung des Befundes und zusätzlich bestehenden Risikofaktoren sollte 12 bis 24 Monate lang behandelt werden. Bei Therapieversagen unter medikamentöser Therapie ist bei lokalisiertem Krankheitsgeschehen ein chirurgisches Vorgehen eine erfolgversprechende Alternative.Background: Pulmonary disease caused by non-tuberculous mycobacteria (NTM) is a rare disease. Its treatment remains a challenge for microbiologists and clinicians in spite of recent improvement in microbiological diagnostics and development of new macrolids and quinolones. The discussion on the predictive value of in vitro sensitivity testing for clinical response is controversial. The aim of this case study is to analyse, whether well established arguments for a relationship between the in vitro drug susceptibility of NTM and their in vivo response to treatment can be found in the investigated group of patients. Methods: Retrospective analysis of 62 cases of pulmonary disease caused by NTM diagnosed in the Institut für Mikrobiologie, Immunologie und Laboratoriumsmedizin, Zentralklinik Emil von Behring, Department Lungenklinik Heckeshorn, Berlin. Results: In the time span of 8/1986 to 12/1998 62 cases of pulmonary disease caused by NTM were recorded. The outcome of 51 treated patients could be evaluated. Of these 40 were treated by a antimicrobacterial drug combination only, 6 by pulmonary resection and 5 by a combination of both. An antimicrobacterial drug combination according to in vitro drug susceptibility was given to 43 patients as a first strategy. Those patients who were infected by slow growing mycobacteria (n=42) showed sputum conversion within a mean of 2,2 months and clinical improvement, where as one patient infected by M. chelonae (fast-growing NTM) showed no response at all. In 3 of the 42 cases a pulmonary resection was added, 2 further patients could not be followed up after hospital demission. Out of the remaining 37 patients complete resolution without relapse for 6 - 102 months could be registered for 30 patients (mean follow up time: 26 month). In 6 cases relapses or failing resolution were revealed. Most probabale reasons for these outcomes were reduced treatment duration, preexisting severe lungdistructions or other concomitant diseases, as well as multiresistence of mycobacteria species. One patient could not be followed up after end of treatment. Patients treated with pulmonary resection as a first strategy (n=6) and those treated with a combined therapy (n=5) showed disease resolution without relapses within a follow up time of 24 and more months. Conclusions: In this case study of 62 patients good arguments for a relationship between the in vitro drug susceptibility of NTM and their in vivo response to treatment could be established. Sputum conversion within 2-3 months and long term clinical response can be expected if non-tuberculous mycobacteria are susceptible for clarithromycin, rifamycines quinolones and further second line drugs. Ethambutol has a synergistic effect in drug combinations independent of mycobacteria susceptibility. Stage of disease, preexisting severe lungdistructions or other accompaniing diseases as well as treatment duration have an important influence on clinical outcome. Treatment duration should be chosen according to the different mycobacteria species and concomitant factors: 12 to 24 months. In case of failure of response to drug therapy and localised disease pulmonary resection is a promising alternative

Prevalence of myocardial infarction and coronary heart disease in adults aged 40–79 years in Germany

In the German Health Interview and Examination Survey for Adults (DEGS1), data on the prevalence of myocardial infarction and coronary heart disease were collected from 2008–2011 in a representative population-based sample of 5,901 adults aged 40–79 years. The results of DEGS1 were compared with the prevalence estimates from the German National Health Interview and Examination Survey 1998 (GNHIES98). The lifetime prevalence of myocardial infarction amongst 40–79 year olds in DEGS1 is 4.7% (women 2.5%; men 7%). In comparison with GNHIES98 a small increase was observed in men, but not in women. The lifetime prevalence of coronary heart disease in adults aged 40–79years in DEGS1 is 9.3% (women 6.4%; men 12.3%). In comparison to GNHIES98 there is a slight reduction only in women. There is a significant inverse relationship between disease prevalence and socioeconomic status. The trend in prevalence of coronary heart disease is comparable with that in other high-income countries. Given a falling incidence of myocardial infarction and a decrease in the mortality rates due to coronary heart disease, the basically stable prevalence rates indicate a positive development in the field of cardiovascular prevention and therapy