Stefan Dahm

German health interview and examination survey for adults (DEGS) - design, objectives and implementation of the first data collection wave

BackgroundThe German Health Interview and Examination Survey for Adults (DEGS) is part of the recently established national health monitoring conducted by the Robert Koch Institute. DEGS combines a nationally representative periodic health survey and a longitudinal study based on follow-up of survey participants. Funding is provided by the German Ministry of Health and supplemented for specific research topics from other sources.Methods/designThe first DEGS wave of data collection (DEGS1) extended from November 2008 to December 2011. Overall, 8152 men and women participated. Of these, 3959 persons already participated in the German National Health Interview and Examination Survey 1998 (GNHIES98) at which time they were 18–79 years of age. Another 4193 persons 18–79 years of age were recruited for DEGS1 in 2008–2011 based on two-stage stratified random sampling from local population registries. Health data and context variables were collected using standardized computer assisted personal interviews, self-administered questionnaires, and standardized measurements and tests. In order to keep survey results representative for the population aged 18–79 years, results will be weighted by survey-specific weighting factors considering sampling and drop-out probabilities as well as deviations between the design-weighted net sample and German population statistics 2010.DiscussionDEGS aims to establish a nationally representative data base on health of adults in Germany. This health data platform will be used for continuous health reporting and health care research. The results will help to support health policy planning and evaluation. Repeated cross-sectional surveys will permit analyses of time trends in morbidity, functional capacity levels, disability, and health risks and resources. Follow-up of study participants will provide the opportunity to study trajectories of health and disability. A special focus lies on chronic diseases including asthma, allergies, cardiovascular conditions, diabetes mellitus, and musculoskeletal diseases. Other core topics include vaccine-preventable diseases and immunization status, nutritional deficiencies, health in older age, and the association between health-related behavior and mental health.

Von regionalen Daten zu bundesweiten Aussagen

Despite having achieved nationwide registry coverage in addition to substantial improvements in data on the epidemiology of cancer in Germany, the Centre for Cancer Registry Data continues to estimate national statistics on incidence, survival, and prevalence instead of calculating these directly from available data. The methods used for evaluations are based initially on estimates of registration completeness or, for survival analyses, an assessment of the quality of follow-up data. The completeness of incident case registration is estimated on the basis of the mortality/incidence procedure, which assumes a largely constant relationship between the mortality and incidence of a cancer type among people of the same age and sex across federal states. Inclusion criteria for consideration of registry data in national survival analyses are less than 15% of death certificate only (DCO) cases and plausible survival for patients with pancreatic cancer or metastatic lung cancer. Of the 477,300 incident cancer cases estimated for 2010, 429,900 were reported by the cancer registries (90%), and ten federal states contributed data to national survival estimates.

Subsequent malignancies among long-term survivors of Hodgkin lymphoma and non-Hodgkin lymphoma: a pooled analysis of German cancer registry data (1990-2012).

The increased risk of subsequent primary malignancies (SPM) in survivors of adult‐onset Hodgkin lymphoma (HL) and non‐Hodgkin lymphoma (NHL) remains a challenging clinical problem worldwide. The German cancer registry database, pooled from 14 federal states, was used to calculate the standardized incidence ratio (SIR) and excess absolute risk (EAR) of SPM in 128 587 patients registered with first primary HL/NHL between 1990 and 2012. Conversely, SIRs were also calculated for a subsequent HL/NHL following other first cancers. The risk of developing SPM was significantly increased over twofold for HL survivors (SIR = 2·14, EAR = 51·87 cases/10 000 person‐years) and 1·5‐fold for NHL survivors (SIR = 1·48, EAR = 55·23) compared with the general German population. For solid cancers, SIRs were significantly elevated (1·6‐ and 1·4‐fold; respectively) and were highest (threefold) in patients below 30 years of age upon initial diagnosis. Overall, SIRs were consistently elevated for lip/oral cavity, colon/rectum, lung, skin melanoma, breast, kidney and thyroid. Significantly increased SIRs for oesophagus, stomach, liver, pancreas, testis, prostate, and brain/central nervous system were observed following NHL only. For certain SPM, SIRs remained significantly elevated more than 10 years following HL/NHL diagnosis. Positive reciprocal associations were demonstrated between HL/NHL and several solid cancers mentioned above; for some, common aetiological mechanisms seem plausible.

Differences of 25-hydroxyvitamin D3 concentrations in children and adults with neurofibromatosis type 1.

OBJECTIVES Neurofibromatosis type 1 (NF1) is an autosomal dominant genetic disorder, frequently associated with reduced bone mineral density. Serum 25-hydroxyvitamin D3 concentrations in NF1 adults are lower than in healthy controls in autumn respectively winter and are inversely correlated with the number of dermal neurofibromas. We investigated 25-hydroxyvitamin D3 levels in children and adults with neurofibromatosis type 1 in winter and summer and compared them to healthy controls to get more pathogenic insights in vitamin D3 metabolism in NF1 patients. DESIGN AND METHODS NF1 patients were clinically examined and serum 25-hydroxyvitamin D3 concentrations were measured in 58 NF1 adults and 46 children in winter as well as in summer and compared to sex-, age- and month-matched controls. RESULTS 52 adults suffered from 10 to 5000 dermal neurofibromas, whereas none of the children presented neurofibromas. 25-Hydroxyvitamin D3 increased from winter to summer (mean: 21.0 to 46.5nmol/l) in NF1 adults. This increase was even larger (p=0.0001) than in healthy controls (mean: 50.5 to 60.5nmol/l). However, there were no differences of 25-hydroxyvitamin D3 concentrations in NF1 children and healthy controls both in winter and in summer. CONCLUSIONS Only adults with NF1 showed lower 25-hydroxyvitamin D3 levels in winter and summer, which are unlikely due to impaired UV-dependent dermal synthesis, but rather might be caused by an accelerated catabolism.

Asthma management practices in adults – findings from the German Health Update (GEDA) 2010 and the German National Health Interview and Examination Survey (DEGS1) 2008–2011

Abstract Objectives: In Germany, population-wide data on adherence to national asthma management guidelines are lacking, and performance measures (PM) for quality assurance in asthma care are systematically monitored for patients with German national asthma disease management program (DMP) enrollment only. We used national health survey data to assess variation in asthma care PM with respect to patient characteristics and care context, including DMP enrollment. Methods: Among adults 18–79 years with self-reported physician-diagnosed asthma in the past 12 months identified from a recent German National Health Interview Survey (GEDA 2010: N = 1096) and the German National Health interview and Examination Survey 2008–2011 (DEGS1: N = 333), variation in asthma care PM was analyzed using logistic regression analysis. Results: Overall, 38.4% (95% confidence interval: 32.5–44.6%) of adults with asthma were on current inhaled corticosteroid therapy. Regarding non-drug asthma management, low coverage was observed for inhaler technique monitoring (35.2%; 31.2–39.3%) and for provision of an asthma management plan (27.3%; 24.2–30.7%), particularly among those with low education. Specific PM were more complete among persons with than without asthma DMP enrollment (adjusted odds ratios ranging up to 10.19; 5.23–19.86), even if asthma patients were regularly followed in a different care context. Conclusions: Guideline adherence appears to be suboptimal, particularly with respect to PM related to patient counseling. Barriers to the translation of recommendations into practice need to be identified and continuous monitoring of asthma care PM at the population level needs to be established.

[Nationwide statements from regional data: methods of the Center for Cancer Registry Data].

Despite having achieved nationwide registry coverage in addition to substantial improvements in data on the epidemiology of cancer in Germany, the Centre for Cancer Registry Data continues to estimate national statistics on incidence, survival, and prevalence instead of calculating these directly from available data. The methods used for evaluations are based initially on estimates of registration completeness or, for survival analyses, an assessment of the quality of follow-up data. The completeness of incident case registration is estimated on the basis of the mortality/incidence procedure, which assumes a largely constant relationship between the mortality and incidence of a cancer type among people of the same age and sex across federal states. Inclusion criteria for consideration of registry data in national survival analyses are less than 15% of death certificate only (DCO) cases and plausible survival for patients with pancreatic cancer or metastatic lung cancer. Of the 477,300 incident cancer cases estimated for 2010, 429,900 were reported by the cancer registries (90%), and ten federal states contributed data to national survival estimates.

Von regionalen Daten zu bundesweiten Aussagen@@@Nationwide statements from regional data: Die Methoden im Zentrum für Krebsregisterdaten@@@Methods of The Center for Cancer Registry Data

Despite having achieved nationwide registry coverage in addition to substantial improvements in data on the epidemiology of cancer in Germany, the Centre for Cancer Registry Data continues to estimate national statistics on incidence, survival, and prevalence instead of calculating these directly from available data. The methods used for evaluations are based initially on estimates of registration completeness or, for survival analyses, an assessment of the quality of follow-up data. The completeness of incident case registration is estimated on the basis of the mortality/incidence procedure, which assumes a largely constant relationship between the mortality and incidence of a cancer type among people of the same age and sex across federal states. Inclusion criteria for consideration of registry data in national survival analyses are less than 15% of death certificate only (DCO) cases and plausible survival for patients with pancreatic cancer or metastatic lung cancer. Of the 477,300 incident cancer cases estimated for 2010, 429,900 were reported by the cancer registries (90%), and ten federal states contributed data to national survival estimates.

Associate Editor Hirohisa Saito

Prof. Hirohisa Saito, Deputy Director of the National Research Institute for Child Health and Development, serves as a board member of the Japanese Society of Allergology (JSA), Editor in Chief of Allergology International (official journal of the JSA) and Associate Editor of the Journal of Allergy and Clinical Immunology . He graduated from Jikei University School of Medicine in 1977 and started his career as a Pediatrician. After receiving his PhD, he taught immunology, especially mast cell biology, at the Johns Hopkins University, under the supervision of Prof. Teruko Ishizaka, from 1986 until 1988. In 1996, after serving as a clinical allergy specialist, he was appointed as Director of the Department of Allergy and Immunology, National Children’s Medical Research Center. In 2002, his Institute was unified and renamed as National Research Institute for Child Health and Development. Since 2003, he has been Professor of Pediatrics at Jikei University, Toho University and Juntendo University. He was concurrently serving as Leader of the Allergy Transcriptome Unit at the Research Center for Allergy and Immunology, RIKEN, from 2002 until 2006. In 2010, he was promoted to Deputy Director of the Research Institute for Child Health and Development. In 2013, he was elected President of the Japanese Society of Allergology. Published online: September 5, 2013

Associate Editor Andreas Radbruch

A biologist by education, Andreas Radbruch did his PhD at the Genetics Institute of the Cologne University with Klaus Rajewsky. He later became Associate Professor there and was a visiting scientist with Max Cooper and John Kearney at the University of Alabama, Birmingham. In 1996, Andreas Radbruch became Director of the German Rheumatism Research Center in Berlin, a Leibniz Institute, and in 1998, Professor of Rheumatology at the Charité Medical Center and Humboldt University of Berlin. Andreas Radbruch has been President of the German Society for Rheumatology, the German Society for Immunology and is incoming President of the International Society for Advancement of Cytometry (ISAC). He serves on a number of advisory and editorial boards and is a fellow of many academic organizations. He is Editorial Chair of the European Journal of Immunology . Most recently, he was awarded the Carol Nachman Prize and an advanced research grant of the European Research Council. Andreas Radbruch has authored more than 250 original publications on immunological memory, antibody class switching, T and B lymphocyte differentiation, cytometry and cell sorting. His research group described the organization of memory plasma cells and memory T helper (Th) lymphocytes in bone marrow and identified memory plasma cells secreting pathogenic antibodies as novel target in chronic immune-mediated diseases. Andreas Radbruch demonstrated, by targeted mutagenesis, that antibody class switch recombination in activated B lymphocytes is targeted to distinct switch regions by transcription. His group contributed significantly to our current understanding of Th1 and Th2 cytokine memory, its imprinting and plasticity and, more recently, has identified critical molecular adaptations of Th effector memory cells to chronic inflammation. Radbruchs group developed the MACS technology and the cytometric secretion assay. Published online: September 5, 2013