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News Article | April 18, 2017
Site: www.eurekalert.org

The commonly used antibiotic azithromycin is not linked to an increased risk of ventricular arrhythmia, an often life-threatening rapid, irregular heartbeat, according to a large study published in CMAJ (Canadian Medical Association Journal). Azithromycin is an antibiotic commonly used to treat bacterial infections -- mostly respiratory and urinary tract infections -- in people of all ages. It belongs to a class of drugs known as macrolides, of which at least one other drug, erythromycin, is known to disrupt the heart's normal rhythm, leading to a condition known as ventricular arrhythmia. Several recent studies have reported conflicting results over whether azithromycin is linked to an increased risk of death from ventricular arrhythmia in people taking the antibiotic. To provide clarity among these conflicting findings, a team of European researchers looked at data on nearly 29 million people in health care databases from Italy, the United Kingdom, Germany, the Netherlands and Denmark to determine if there is a link between azithromycin and ventricular arrhythmia. Of the more than 14 million new antibiotic users, 0.1% (12 874) people developed ventricular arrhythmia, of whom 30 were new users of azithromycin. When compared to amoxicillin, another commonly used antibiotic, from the penicillin class of drugs, there was no increased risk of this heart condition in people using azithromycin. However, there was an increased risk of ventricular arrhythmia in people taking azithromycin compared to people not using antibiotics at all. "This finding suggests that the risk of ventricular arrhythmia is more likely to be due to a person's poor health and caused by their infection, rather than to azithromycin itself," says Dr. Gianluca Trifirò, Department of Biomedical and Dental Sciences and Morpho-functional Imaging, University of Messina, Italy. "This finding was confirmed in several sensitivity analyses and replicated in single databases participating in the study." The authors note these findings may not be applied in hospital settings as the health of patients and use of antibiotics is quite different in community settings, from which the data were drawn. "Current azithromycin use was associated with an increased risk of ventricular arrhythmia when compared with nonuse of antibiotics, but not when compared with current amoxicillin use. The decreased risk with an active comparator suggests significant confounding by indication," the authors conclude. The study was conducted by researchers from Erasmus University, Rotterdam, Netherlands; University of Messina, Messina, Italy; Italian College of General Practitioners, Florence, Italy; PHARMO Institute for Drug Outcomes Research, Utrecht, Netherlands; Leibniz Institute for Prevention Research and Epidemiology - BIPS Gmbh, Bremen, Germany; University of Bologna, Italy; Aarhus University Hospital, Aarhus, Denmark; and King's College, London, United Kingdom.


PubMed | University of Cologne, University of Marburg, Jülich Research Center, RWTH Aachen and 5 more.
Type: Journal Article | Journal: Journal of neurology, neurosurgery, and psychiatry | Year: 2016

Inconsistent results exist regarding the cognitive profile in patients with Parkinsons disease with mild cognitive impairment (PD-MCI). We aimed at providing data on this topic from a large cohort of patients with PD-MCI.Sociodemographic, clinical and neuropsychological baseline data from patients with PD-MCI recruited in the multicentre, prospective, observational DEMPARK/LANDSCAPE study were analysed.269 patients with PD-MCI (age 67.87.4, Unified Parkinsons Disease Rating Scale (UPDRS-III) scores 23.211.6) were included. PD-MCI subtypes were 39.4% non-amnestic single domain, 30.5% amnestic multiple domain, 23.4% non-amnestic multiple domain and 6.7% amnestic single domain. Executive functions were most frequently impaired. The most sensitive tests to detect cognitive dysfunctions were the Modified Card Sorting Test, digit span backwards and word list learning direct recall. Multiple stepwise regression analyses showed that global cognition, gender and age, but not education or disease-related parameters predicted PD-MCI subtypes.This study with the so far largest number of prospectively recruited patients with PD-MCI indicates that non-amnestic PD-MCI is more frequent than amnestic PD-MCI; executive dysfunctions are the most typical cognitive symptom in PD-MCI; and age, gender and global cognition predict the PD-MCI subtype. Longitudinal data are needed to test the hypothesis that patients with PD-MCI with specific cognitive profiles have different risks to develop dementia.


Buck C.,Leibniz Institute for Prevention Research and Epidemiology | Tkaczick T.,University of Bremen | Pitsiladis Y.,University of Glasgow | Pitsiladis Y.,University of Brighton | And 4 more authors.
Journal of Urban Health | Year: 2015

Features of the built environment that may influence physical activity (PA) levels are commonly captured using a so-called walkability index. Since such indices typically describe opportunities for walking in everyday life of adults, they might not be applicable to assess urban opportunities for PA in children. Particularly, the spatial availability of recreational facilities may have an impact on PA in children and should be additionally considered. We linked individual data of 400 2- to 9-year-old children recruited in the European IDEFICS study to geographic data of one German study region, based on individual network-dependent neighborhoods. Environmental features of the walkability concept and the availability of recreational facilities, i.e. playgrounds, green spaces, and parks, were measured. Relevant features were combined to a moveability index that should capture urban opportunities for PA in children. A gamma log-regression model was used to model linear and non-linear effects of individual variables on accelerometer-based moderate-to-vigorous physical activity (MVPA) stratified by pre-school children (<6 years) and school children (≥6 years). Single environmental features and the resulting indices were separately included into the model to investigate the effect of each variable on MVPA. In school children, commonly used features such as residential density (Formula presented.), intersection density (Formula presented.), and public transit density (Formula presented.) showed a positive effect on MVPA, while land use mix revealed a negative effect on MVPA (Formula presented.). In particular, playground density (Formula presented.) and density of public open spaces, i.e., playgrounds and parks combined (Formula presented.), showed positive effects on MVPA. However, availability of green spaces showed no effect on MVPA. Different moveability indices were constructed based on the walkability index accounting for the negative impact of land use mix. Moveability indices showed also strong effects on MVPA in school children for both components, expanded by playground density (Formula presented.) or by public open space density (Formula presented.), but no effects of urban measures and moveability indices were found in pre-school children. The final moveability indices capture relevant opportunities for PA in school children. Particularly, availability of public open spaces seems to be a strong predictor of MVPA. Future studies involving children should consider quantitative assessment of public recreational facilities in larger cities or urban sprawls in order to investigate the influence of the moveability on childhood PA in a broader sample. © 2014, The New York Academy of Medicine.


Brzoska P.,Bielefeld University | Brzoska P.,TU Chemnitz | Ellert U.,Robert Koch Institute | Kimil A.,Ethnomedizisches Zentrum Hanover e.V | And 5 more authors.
International Journal of Public Health | Year: 2014

Objectives: To review migration and health as a potential new national health target for Germany.Methods: The theme was evaluated along 13 standardized criteria preset by the Health TargetsNetwork. For each of the criteria an expert opinion based on an extensive (but nonsystematic)review of literature is presented.Results: Migrants differ in many health-related aspects from the majority population in Germany.Despite having some health advantages, their health status, on average, is lower thanthat of non-migrants. They also experience barriers in health care and cannotparticipate in the society on equal terms with the majority population. Differentmeasures to improve the health situation of migrants are available, but their currentimplementation in the health system is limited in several ways. Present data on thehealth of migrants is inadequate and limits migrant-sensitive health reporting.Conclusion: The evaluation of potential health targets based on standardized criteria is a valuabletool for health policy formulation. The present documentation can assist other countriesin evaluating migration and health as a national health target. It may also contribute tosimilar activities at the European level. © 2014, Swiss School of Public Health.


News Article | February 15, 2017
Site: news.europawire.eu

European governments must act to help families improve their children’s health and tackle the obesity epidemic. That’s the advice of I.Family researchers who today [9 Feb] revealed the findings of a major international study into the diets and lifestyles of European children. BRISTOL, 15-Feb-2017 — /EuropaWire/ — The I.Family Study – a five-year international scientific study involving academics at 17 institutions including the University of Bristol in 12 different countries – examined the health, diets, physical fitness, local environments and peer and family influences of more than 16,000 children in eight European countries (Belgium, Cyprus, Estonia, Germany, Hungary, Italy, Spain and Sweden). At the Study’s final conference in Brussels, I.Family researchers revealed their key findings to policy-makers, healthcare and children’s health professionals, and health NGOs from all over Europe, aiming to inform policy and practice at local, national and European level. The main topics included dietary patterns, the importance of sleep, food choices, the role of friends, local environments, family influence, metabolic health, genetic factors and community interventions. Professors Angie Page and Ashley Cooper from the University of Bristol presented their findings which measured physical activity in over 5,000 families from 8 European regions. Professor Angie Page from the University’s School for Policy Studies, said: “The I.Family study shows that we need to address inequality in access to physical activity if we want to reduce health inequalities in young people in Europe. Physical activity provides fundamental health benefits for young people. As well as physical fitness, these include healthy development of bones, muscles and joints, a healthy cardiovascular system (heart and lungs), and good coordination and movement control. It also builds self-confidence, social interaction and integration. Our data clearly shows that physical activity seems to run in families – i.e. children are more likely to be active if they live in households where their parents and siblings are more active.” Professor Wolfgang Ahrens from the Leibniz Institute for Prevention Research and Epidemiology, I.Family Study Coordinator, said: “I.Family has shown that many issues need to be addressed to improve children’s health but that families and individuals simply can’t do it alone. Government intervention is vital if we are to stem the tide of obesity across Europe and beyond.” The I.Family study provides the strongest evidence to date that large numbers of young people across Europe have less chance of achieving these health benefits because of their age, gender, where they live or the household they live in. Leading researchers from across Europe and from each of the disciplines and topics covered by the I.Family Study spoke throughout the day. The event was opened by Daciana Octavia Sârbu MEP – vice-chair of the European Parliament’s Committee on the Environment, Public Health and Food Safety (ENVI) – with guest speakers and chairs including Artur Furtado, Deputy Head of Unit at the Health Determinants & Inequality Unit, DG Sante, European Commission, and Dr Charmaine Gauci, Superintendent of Public Health at the Ministry for Health in Malta. Dr Gauci is also Coordinator of the Maltese Presidency thematic lead on childhood obesity – one of two key health priorities chosen by the Maltese Presidency of the Council of the EU. The key findings of the I.Family Study cohorts include: For further details about the Study’s findings and to see our full conference programme please visit the I.Family website at www.ifamilystudy.eu


Koch L.,German Cancer Research Center | Bertram H.,Cancer Registry of North Rhine Westphalia Munster Region | Eberle A.,Leibniz Institute for Prevention Research and Epidemiology | Holleczek B.,Saarland Cancer Registry | And 5 more authors.
Psycho-Oncology | Year: 2014

Background Fear of recurrence (FoR) is a widespread problem among breast cancer survivors. So far, little is known about prevalence, determinants, and consequences of FoR specifically in long-term breast cancer survivors, even though it was found to be one of the most important concerns in this group. Methods Analyses are based on data of several population-based cohorts of long-term breast cancer survivors, recruited by six German cancer registries. Overall, 2671 women were included in the analyses. FoR was assessed using the short form of the Fear of Progression Questionnaire. Potential determinants of moderate/high FoR and the association with depression and quality of life (QoL) were explored via multiple logistic and linear regression. Results Even though the majority of women reported low levels of FoR (82%), a substantial percentage experienced moderate (11%) and high (6%) FoR. Younger age (odds ratio=3.00, confidence intervals=1.91-4.73 for women below age 55years) and considering oneself as a tumor patient (odds ratio=3.36, confidence intervals=2.66-4.25) were found to exhibit the strongest associations with moderate/high FoR. Overall, psychosocial and sociodemographic factors played a far bigger role in FoR than clinical factors. Higher FoR was associated with higher depression and lower QoL. Conclusion Fear of recurrence (mostly low levels) is highly prevalent among long-term breast cancer survivors and can negatively affect QoL and well-being. Therefore, it should be given appropriate consideration in research and clinical practice. As specifically younger women tended to be impacted by FoR, it is crucial to be particularly attentive to specific needs of younger survivors. Copyright © 2013 John Wiley & Sons, Ltd. Copyright © 2013 John Wiley & Sons, Ltd.


Riedel O.,Leibniz Institute for Prevention Research and Epidemiology | Riedel O.,TU Dresden | Klotsche J.,Deutsches Rheumaforschungszentrum | Wittchen H.-U.,TU Dresden
Parkinsonism and Related Disorders | Year: 2014

Introduction: Clinical Global Impression of Severity (CGIS) is a common measure in clinical research on Parkinson's disease (PD). However, patient features that contribute to the impression of the physician remain unclear. In particular, the impact of cognitive impairment and depression is understudied. Methods: In a nationwide study on 1449 outpatients with PD, examined by 315 office-based neurologists, PD severity was documented with the Unified Parkinson's Disease Rating Scale (UPDRS-I, II, and IV). All patients were screened with the Montgomery-Asberg Depression Rating Scale (MADRS) for depression. The diagnosis of dementia was based on Diagnostic and Statistical Manual of Mental Disorders IV Text Revision criteria. Each patient was rated on the CGIS. Results: CGIS ratings were available for 1438 patients, of which 50.8% were rated as "borderline" to "moderately ill" and 49.2% as "markedly" to "extremely ill." Worse ratings were associated with higher age (p<0.001), longer PD duration (p<0.001), and female sex (p<0.001). The impact of patient and physician variables on CGIS rating was calculated with three regression models (A: single bivariate regression; B: multivariate regression; and C: multivariate, multilevel regression, including physician variables). In all models, higher UPDRS-II scores and longer disease duration of PD were the strongest predictors for a worse CGIS rating. In the multivariate models (B and C), neuropsychiatric symptoms were unrelated to the CGIS rating. Conclusion: The additional burden of dementia and depression was underestimated in the CGIS rating, suggesting that they are possibly relativized against the motor impairment. © 2014 Elsevier Ltd.


Friemel J.,University of Zürich | Friemel J.,Leibniz Institute for Prevention Research and Epidemiology | Rechsteiner M.,University of Zürich | Frick L.,University of Zürich | And 7 more authors.
Clinical Cancer Research | Year: 2015

Purpose: Morphologic intratumor heterogeneity is well known to exist in hepatocellular carcinoma (HCC), but very few systematic analyses of this phenomenon have been performed. The aim of this study was to comprehensively characterize morphologic intratumor heterogeneity in HCC. Also, taken into account were well-known immunohistochemical markers and molecular changes in liver cells that are considered in proposed classifications of liver cell neoplasms or discussed as molecular therapeutic targets. Experimental Design: In HCC of 23 patients without medical pretreatment, a total of 120 tumor areas were defined. Analyzed were cell and tissue morphology, expression of the liver cell markers cytokeratin (CK)7, CD44, α-fetoprotein (AFP), epithelial cell adhesion molecule (EpCAM), and glutamine synthetase (GS) along with mutations of TP53 and CTNNB1, assayed by both Sanger and next-generation sequencing. Results: Overall, intratumor heterogeneity was detectable in the majority of HCC cases (20 of 23, 87%). Heterogeneity solely on the level of morphology was found in 6 of 23 cases (26%), morphologic heterogeneity combined with immunohistochemical heterogeneity in 9 of 23 cases (39%), and heterogeneity with respect to morphologic, immunohistochemical, and mutational status of TP53 and CTNNB1 in 5 of 23 cases (22%). Conclusions: Our findings demonstrate that intratumor heterogeneity represents a challenge for the establishment of a robust HCC classification and may contribute to treatment failure and drug resistance in many cases of HCC. ©2014 AACR.


Samkange-Zeeb F.,Leibniz Institute for Prevention Research and Epidemiology | Pottgen S.,Leibniz Institute for Prevention Research and Epidemiology | Zeeb H.,Leibniz Institute for Prevention Research and Epidemiology
PLoS ONE | Year: 2013

Background: Chlamydia and genital human papillomavirus (HPV) are the two most common sexually transmitted infections (STIs) among teens and young adults in industrialised countries. The majority of adolescents, however, have limited or no knowledge of these infections. Within the context of a cross-sectional survey on awareness and knowledge of sexually transmitted infections, secondary school students attending the 8th grade and above in Bremen and Bremerhaven, two cities in northern Germany, were asked to rate the risk of peers to get infected with HIV, HPV or chlamydia. Methods: Between October and December 2011, students aged 12-20 years completed an anonymous, self-administered questionnaire at their school. In addition to answering questions on awareness and knowledge of sexually transmitted infections, all students were also asked to rate the risk of peers to get infected with HIV, HPV or chlamydia. Furthermore, those reporting ever having sexual intercourse were asked to rate their own risk of getting infected with each of the three infections. Results: 1,148 students, 55% female, completed the questionnaire. 27% of the students reported having had sexual intercourse. 68% of all students rated the risk of same-aged students to get infected with HIV/AIDS as high/medium. The corresponding proportions for HPV and chlamydia were 19 and 25% respectively. Those reporting ever having sexual intercourse generally perceived their own risk of getting infected with HIV, chlamydia or HPV as lower than that of their peers. Conclusion: Generally, the risk of getting infected with HIV was perceived as being higher than that of getting infected with HPV or chlamydia, most likely due to the fact that the students were more aware of HIV than of the other two infections. Efforts should be made to improve awareness and knowledge of HPV and chlamydia among school going adolescents, and to make them realize that these are common infections that are preventable. © 2013 Samkange-Zeeb et al.

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