Marien Hospital Wesel

Wesel, Germany

Marien Hospital Wesel

Wesel, Germany

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Tischer C.,Helmholtz Center for Environmental Research | Standl M.,Helmholtz Center for Environmental Research | Lehmann I.,Helmholtz Center for Environmental Research | Von Berg A.,Marien Hospital Wesel | Heinrich J.,Helmholtz Center for Environmental Research
European Respiratory Journal | Year: 2015

Animal furs might represent a "proxy" for high and diverse microbial exposures within a critical time window of immune development. We assessed whether sleeping on animal fur shortly after birth is associated with asthma and atopy up to the age of 10 years. LISAplus participants (n=2441) from Munich and Leipzig, Germany, were included in the analysis. Animal fur exposure, cofactors and health outcomes were obtained periodically up to 10 years of age by parental questionnaires. Information on specific IgE to aeroallergens was available at 10 years. Cytokineproducing peripheral T-cells were assessed in a subgroup of children at 2 and 3 years. Confounderadjusted associations were evaluated using logistic regression analyses. Sleeping on animal fur was very common (55%). In adjusted logistic regression analyses, sleeping on animal fur was inversely associated with recurrent early wheezing at 4 years (adjusted OR 0.75, 95% CI 0.61-0.93) and current asthma at 6 years (adjusted OR 0.56, 95% CI 0.31-1.01). Furthermore, sleeping on animal fur during the first 3 months of life was significantly associated with a persistently stimulated interferon-γ response until the age of 3 years. Animal fur could be an effective measure of creating environments associated with higher microbial exposure. Copyright © ERS 2015.


Thiering E.,Helmholtz Center for Environmental Research | Thiering E.,German Center for Diabetes Research | Cyrys J.,Helmholtz Center for Environmental Research | Cyrys J.,University of Augsburg | And 9 more authors.
Diabetologia | Year: 2013

Aims/hypothesis: Epidemiological studies that have examined associations between long-term exposure to traffic-related air pollution and type 2 diabetes mellitus in adults are inconsistent, and studies on insulin resistance are scarce. We aimed to assess the association between traffic-related air pollution and insulin resistance in children. Methods: Fasting blood samples were collected from 397 10-year-old children in two prospective German birth cohort studies. Individual-level exposures to traffic-related air pollutants at the birth address were estimated by land use regression models. The association between air pollution and HOMA of insulin resistance (HOMA-IR) was analysed using a linear model adjusted for several covariates including birthweight, pubertal status and BMI. Models were also further adjusted for second-hand smoke exposure at home. Sensitivity analyses that assessed the impact of relocating, study design and sex were performed. Results: In all crude and adjusted models, levels of insulin resistance were greater in children with higher exposure to air pollution. Insulin resistance increased by 17.0% (95% CI 5.0, 30.3) and 18.7% (95% CI 2.9, 36.9) for every 2SDs increase in ambient NO2 and particulate matter ≤10 μm in diameter, respectively. Proximity to the nearest major road increased insulin resistance by 7.2% (95% CI 0.8, 14.0) per 500 m. Conclusions/interpretation: Traffic-related air pollution may increase the risk of insulin resistance. Given the ubiquitous nature of air pollution and the high incidence of insulin resistance in the general population, the associations examined here may have potentially important public health effects despite the small/moderate effect sizes observed. © 2013 The Author(s).


Grzeskowiak L.,University of Turku | Gronlund M.-M.,University of Turku | Beckmann C.,Marien Hospital Wesel | Salminen S.,University of Turku | And 2 more authors.
Anaerobe | Year: 2012

Specific probiotic combinations during early feeding, via the mother or incorporated in early formula-feeding, mold the intestinal microbiota composition in infants. The objective was to analyze the impact of probiotic administration to mother or infant on gut microbiota composition in 6-month-old Finnish and German infants. In Finland probiotics were given to mothers (n=79) for 2 months prior to and 2 months after delivery. In Germany probiotics were started in infants (n=81) at weaning, at the latest at 1 month of age, and continued for 4 months. A breast-fed group of 6-month-old infants (22 from Finland, 8 from Germany) were compared. Gut microbiota were analyzed by FCM-FISH and qPCR methods. In breast-fed infants a trend toward higher counts of bifidobacteria was detected in Finland (p=0.097) as against Germany, where a more diverse microbiota was reflected in higher Akkermansia (p=0.003), Clostridium histolyticum (p=0.035) and Bacteroides-Prevotella (p=0.027) levels and a higher percentage of Akkermansia (p=0.004). Finnish LPR+BL999 intervention group (Lactobacillus rhamnosus LPR and Bifidobacterium longum BL999) had higher percentages of fecal Lactobacillus-Enterococcus (9.0% vs. 6.1% placebo, p=0.003) and lower bifidobacteria levels (10.03logcells/g vs. 10.68logcells/g placebo, p=0.018). Probiotic treatment had different impacts on gut microbiota composition in Finnish and German infants due to differences in mode of feeding and the early commensal microbiota. Probiotic treatment had different impacts on gut microbiota composition in Finnish and German infants due to differences in mode of feeding and the basic commensal microbiota. © 2011 Elsevier Ltd.


Pei Z.,Institute of Epidemiology i | Pei Z.,Ludwig Maximilians University of Munich | Heinrich J.,Institute of Epidemiology i | Fuertes E.,Institute of Epidemiology i | And 8 more authors.
Journal of Pediatrics | Year: 2014

Objective To investigate whether birth by cesarean delivery rather than vaginal delivery is a risk factor for later childhood obesity. Study design Healthy, full-term infants were recruited. Overweight and obesity were defined using measured weight and height according to World Health Organization reference data. Associations between cesarean delivery and being overweight or obese were investigated at age 2, 6, and 10 years (n = 1734, 1244, and 1170, respectively) by multivariate logistic regression models adjusted for socioeconomic status, child characteristics, and maternal prepregnancy characteristics. Results Mothers who gave birth by cesarean delivery (∼17%) had a higher mean prepregnancy body mass index (23.7 kg/m2 vs 22.5 kg/m2), greater mean gestational weight gain (15.3 kg vs 14.5 kg), and shorter mean duration of exclusive breastfeeding (3.4 months vs 3.8 months) compared with those who delivered vaginally. The proportion of obese children was greater in the cesarean delivery group compared with the vaginal delivery group at age 2 years (13.6% vs 8.3%), but not at older ages. Regression analyses revealed a greater likelihood of obesity at age 2 years in the cesarean delivery group compared with the vaginal delivery group at age 2 years (aOR, 1.68; 95% CI, 1.10-2.58), but not at age 6 years (aOR, 1.49; 95% CI, 0.55-4.05) or age 10 years (aOR, 1.16; 95% CI, 0.59-2.29). Conclusion Cesarean delivery may increase the risk of obesity in early childhood. Our results do not support the hypothesis that an increasing rate of cesarean delivery contributes to obesity in childhood. © 2014 The Authors.


Schmitt J.,TU Dresden | Chen C.-M.,Helmholtz Center for Environmental Research | Apfelbacher C.,University of Heidelberg | Romanos M.,University of Würzburg | And 8 more authors.
Allergy: European Journal of Allergy and Clinical Immunology | Year: 2011

Background: Cross-sectional studies suggest an association between eczema and mental health problems, possibly modified by sleeping problems, but prospective evidence is missing. We aimed to prospectively investigate the relationship between infant eczema (within first 2 years of age), infant sleeping problems (within first 2 years of age), and the risk of mental health problems at 10 years of age. Methods: Between 1997 and 1999, a population-based birth cohort was recruited in Munich, Leipzig, Wesel, and Bad Honnef, Germany, and followed until 10 years of age. Physician-diagnosed eczema, parent-reported sleeping problems, and known environmental risk factors for atopy were regularly assessed until 10 years of age. Mental health was measured using the Strengths and Difficulties Questionnaire (parent version) at 10 years of age. We applied logistic regression modeling adjusting for environmental and lifestyle factors, allergic comorbidity, and family history of eczema. Results: From the original cohort of 3097 neonates, 1658 (54%) were followed until age 10, while 1578 (51%) were eligible for analysis. In the fully adjusted model, children with infant eczema were at increased risk of hyperactivity/inattention at 10 years of age [odds ratio (OR) 1.78; 95% confidence interval (95% CI) 1.02-3.09]. Infant eczema with concurrent sleeping problems predicted emotional problems [OR 2.63; 95% confidence interval (95% CI) 1.20-5.76] and conduct problems (OR 3.03; 95% CI 1.01-9.12) at 10 years of age. Conclusions: Infant eczema with concurrent sleeping problems appears to be a risk factor for the development of mental health problems. © 2010 John Wiley & Sons A/S.


Von Berg A.,Marien Hospital Wesel | Filipiak-Pittroff B.,Marien Hospital Wesel | Filipiak-Pittroff B.,Ludwig Maximilians University of Munich | Kramer U.,Heinrich Heine University Düsseldorf | And 13 more authors.
Journal of Allergy and Clinical Immunology | Year: 2013

Background: The long-term effect of nutritional intervention with hydrolysate infant formulas on allergic manifestations in high-risk children is uncertain. Objective: We sought to investigate the effect of hydrolysate infant formulas on allergic phenotypes in children with family history of allergies at school age. Methods: We analyzed data from participants of the prospective German Infant Nutritional Intervention study after 10 years of follow-up. At birth, children were randomly assigned to receive, for the first 4 months, one of 4 blinded formulas as breast milk substitute, if necessary: partially hydrolyzed whey formula (pHF-W), extensively hydrolyzed whey formula (eHF-W), extensively hydrolyzed casein formula (eHF-C), or standard cow's milk formula. Outcomes were parent-reported, physician-diagnosed allergic diseases. Log-binomial regression models were used for statistical analysis. Results: The relative risk for the cumulative incidence of any allergic disease in the intention-to-treat analysis (n = 2252) was 0.87 (95% CI, 0.77-0.99) for pHF-W, 0.94 (95% CI, 0.83-1.07) for eHF-W, and 0.83 (95% CI, 0.72-0.95) for eHF-C compared with standard cow's milk formula. The corresponding figures for atopic eczema/dermatits (AD) were 0.82 (95% CI, 0.68-1.00), 0.91 (95% CI, 0.76-1.10), and 0.72 (95% CI, 0.58-0.88), respectively. In the per-protocol analysis (n = 988) effects were stronger. The period prevalence of AD at 7 to 10 years was significantly reduced with eHF-C in this analysis, but there was no preventive effect on asthma or allergic rhinitis. Conclusion: The significant preventive effect on the cumulative incidence of allergic diseases, particularly AD, with pHF-W and eHF-C persisted until 10 years without rebound, whereas eHF-W showed no significant risk reduction. There is insufficient evidence of ongoing preventive activity at 7 to 10 years of age. © 2013 American Academy of Allergy, Asthma & Immunology.


Markevych I.,Helmholtz Center for Environmental Research | Markevych I.,Ludwig Maximilians University of Munich | Fuertes E.,Helmholtz Center for Environmental Research | Fuertes E.,University of British Columbia | And 8 more authors.
Health and Place | Year: 2014

Aim: We investigated the association between surrounding greenness at the mother's residential address at the time of delivery and birth weight in two German birth cohorts and explored potential underlying hypotheses. Methods: Complete data on 3203 newborns, recruited in Munich between 1996 and 1999, were available. Surrounding greenness was defined using the mean of the Normalized Difference Vegetation Index, which was derived from Landsat 5. TM satellite images. Results: An interquartile increase of surrounding greenness in a 500-m buffer was associated with an average birth weight increase of 17.6g (95% CI=0.5 to 34.6). The effect strengthened after individual adjustment for NO2, PM2.5, distance to major road and population density. The strongest association was found for mothers with less than 10 years of school education. The results remained robust when additionally adjusted for noise or maternal stress during pregnancy. Neighbourhood green spaces were not associated with birth weight. Conclusions: Surrounding greenness at the birth address was positively associated with birth weight in two birth cohorts in Munich. The mechanisms driving this association remain unclear and warrant further investigation. © 2013 Elsevier Ltd.


Rezek D.,Marien Hospital Wesel
Journal fur Asthetische Chirurgie | Year: 2015

Congenital bony and muscular malformations as well as malformations affecting the mammary glands can occur in the chest region. After excision of benign, but in particular malignant tumors of the female breast, volume, contour and skin covering defects can often occur due to radiation and/or surgery. Autologous fat transplantation is an operative procedure in which own body fat is transferred in order to improve the shape, volume and surface structure of the recipient region. A moderate breast enlargement is also possible. A low number of complications can be expected if each individual step is meticulously carried out in addition to correct interpretation of the indications and patient selection. The characteristics of the fat transplant itself should also be taken into consideration. Especially in women after breast cancer, residual diseased tissue should also be excluded with certainty and the time interval between oncological surgery and fat transfer should be sufficiently long. The success of the operation depends on profound knowledge of the method and meticulously carrying out each individual step in the treatment. Outcome success is measured by parameters, such as volume stability, unimpeded assessment of the breast in imaging procedures and oncological safety. © 2015, Springer-Verlag Berlin Heidelberg.


Autologous fat grafting is considered a secondary reconstructive procedure and has the goal of improving quality of life. When lipofilling, autologous fat is transferred to the receiver location to optimize soft tissue contour of the recipient region. Breast cancer is the most common cancer in women. Thanks to individualized treatment methods, the cure rate continues to increase; however, increasingly more women must live many years with the consequences of surgery. Although the surgical procedures are becoming more individualized and are increasingly adapted to the individual situation, patients often have scars, defects, asymmetry, and volume loss of the breast, which are often enhanced by radiotherapy. Autologous fat is suitable for volume replacement of soft tissue and to improve the contour, skin perfusion, as well as augmentation of volume loss. Thereby, fat is suitable for breast reconstruction after mastectomy, flap surgery, or nipple/skin-sparing mastectomy followed by implant-based breast reconstruction. After breast-conserving therapy for breast cancer, asymmetry and scar tissue can also be treated with autologous fat. It should be noted that fat can only be transplanted into a healthy breast. Prior to autologous fat grafting, potential residual tumor or recurrence should be excluded. The longer the time interval between oncology surgery and fat grafting, the greater the safety. The success of this method is based on sound knowledge of the method, careful design of each treatment step, and depends on parameters, such as ability to analyze the breast by imaging, volume stability, and oncological safety. © 2016, Springer-Verlag Berlin Heidelberg.


Von Berg A.,Marien Hospital Wesel
World Review of Nutrition and Dietetics | Year: 2013

Allergen exposure in the early postnatal life of an infant with a genetic predisposition for allergy is regarded as at least one essential risk factor for later development of allergic diseases. The most important allergen exposure in early life derives from the early nutrition of the baby. Thus, intervention based on the concept of reducing the allergen load in the diet is one approach for primary allergy prevention in children at risk. This includes breastfeeding, allergen-reduced diet of the pregnant and lactating mother, cow milk protein hydrolysate infant formulas (= hypoallergenic infant formula or HA formulas) and time of introduction of complementary food. Data on breastfeeding regarding allergy prevention are inconsistent: preventive with regard to atopic eczema and cow milk allergy in the first 2 years, but contradictory regarding wheezing beyond the first years of life. Allergen-reduced diet of the pregnant mother is not recommended because there is no evidence for a preventive benefit, but instead for unwanted effects on the child's intrauterine development. Data on a restrictive diet during lactation are also inconsistent. If breastfeeding is insufficient in the first 4-6 months, both partially and extensively hydrolyzed formulas have been successfully used to reduce the risk for atopic eczema, but not for asthma or allergic rhinitis, until school age. However, from the available data it is suggested that the preventive potential of a formula is not only dependent on the degree of hydrolyzation and the protein source, but also from other factors like the process of manufacturing the formula. Recommendations for a certain formula should therefore be based on its proven efficacy in controlled clinical trials. For all healthy children with and without risk for allergy, more recent findings support complementary food introduction in the 5th and 6th months -independent of the kind of milk feeding -according to the nutritional needs and abilities of a baby. Delayed introduction of complementary food beyond the 6th month is no longer recommended. Copyright © 2013 S. Karger AG, Basel.

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