Hintergrund: Weltweit berichteten zahlreiche Studien von einer steigenden Inzidenz von Patienten mit angeborenen Bauchwanddefekten. Besonders die Zahl der Gastroschisis-Kinder hat deutlich zugenommen. Auch die Neonatologen der Universitätsklinik Leipzig beschrieben ein gehäuftes Auftreten von Patienten mit Gastroschisis und Omphalocele. Aufgabe der vorliegenden Arbeit war es, die Inzidenz dieser beiden Fehlbildungen am Universitätsklinikum Leipzig zu ermitteln und zu untersuchen, wie sich die Fallzahlen während des Untersuchungszeitraumes (1998-2008) entwickelt hatten. Zudem sollten Parameter identifiziert werden, die die Prognose der betroffenen Kinder bis zur Entlassung beeinflussten. Ein weiteres Anliegen dieser Studie war es, mithilfe einer ausführlichen Literaturrecherche, einen Überblick über die aktuelle Behandlung und Prognose der beiden Fehlbildungen zu geben. Methoden: Im Rahmen einer retrospektiven Untersuchung erfolgte die Erhebung und Auswertung der Daten von 27 Kindern mit Gastroschisis sowie 19 Kindern mit Omphalocele, die zwischen 1998 und 2008 in der Universitätsklinik Leipzig behandelt wurden. Mithilfe des Mann-U-Whitney-Tests sowie des exakten Tests nach Fisher wurden zahlreiche Merkmale hinsichtlich ihrer Auswirkungen auf das Outcome überprüft. Als Parameter, die das Outcome widerspiegelten, galten der Beginn des enteralen Kostaufbaus mit Tee-Glucose-Lösung und Milch, die Dauer der parenteralen Nährstoffzufuhr und des Krankenhausaufenthaltes, sowie Nachoperationen, Komplikationen und die Letalität während des stationären Aufenthaltes. Ergebnisse: An der Universitätsklinik Leipzig betrug die Inzidenz von Gastroschisis 14 pro 10 000 Lebendgeburten und von Omphalocele 9 pro 10 000 Lebendgeburten. Die Inzidenz blieb während des elfjährigen Beobachtungszeitraumes konstant. Der Vergleich früh- und reifgeborener Gastroschisis-Patienten zeigte, dass eine Frühgeburt weder mit einem früheren Beginn der oralen Ernährung mit Tee-Glucose-Lösung (11 d vs. 14 d; p nicht signifikant) und Milch (17 d vs. 17 d; p nicht signifikant), noch mit einer Verkürzung der parenteralen Ernährung (36 d vs. 37 d; p nicht signifikant) und stationären Behandlung (48 d vs. 50 d; p nicht signifikant) einherging. Häufig verkomplizierten Infektionen (12/27) und sekundäre Darmverschlüsse (9/27) mit der Notwendigkeit einer zusätzlichen Operation den postoperativen Verlauf der Gastroschisis-Patienten. Letztgenannte Komplikation führte zu einer erheblich protrahierten parenteralen Ernährung (79 d vs. 31 d; p < 0,05) und stationären Behandlung (101 d vs. 38 d; p < 0,05), während Infektionen kaum Auswirkungen auf das Outcome hatten. Es zeigte sich, dass vorrangig Kinder mit kleinem Defekt (<= 4 cm) sowie mit prolabiertem Magen einen Ileus entwickelten. Neben Darmverschlüssen führten intestinale Begleitfehlbildungen tendenziell zu einer Verlängerung der Hospitalisierungszeit (73 d vs. 48,5 d; p nicht signifikant). Gelang die orale Zufuhr von Milch innerhalb der ersten 14 Lebenstage, so verringerte sich die Dauer der parenteralen Ernährung (30 d vs. 37 d; p < 0,05) und der stationären Behandlung (41 d vs. 67 d; p nicht signifikant). Bei Patienten mit Omphalocele bestimmten vor allem die Größe der Omphalocele, der Inhalt des Bruchsackes sowie der Zeitpunkt des oralen Ernährungsbeginns die Prognose. Ein großer (> 4 cm) Bauchwanddefekt ging mit einer erhöhten Infektionsrate (4/7 vs. 1/11; p < 0,05), prolongierten parenteralen Nahrungszufuhr (26 d vs. 17 d; p < 0,05) sowie stationären Behandlung (46 d vs. 24 d; p nicht signifikant) einher. Extraintestinale Begleitanomalien zeigten sich jedoch häufiger bei Patienten mit kleinem Defekt (5/11 vs. 1/7; p nicht signifikant). Befand sich die Leber außerhalb der Abdominalhöhle, waren zusätzliche Fehlbildungen seltener (3/11 vs. 5/7; p < 0,05). Eine prolabierte Leber verzögerte tendenziell die parenterale Ernährung (24 d vs. 18 d; p nicht signifikant) und die Krankenhausverweildauer (46 d vs. 21 d; p nicht signifikant). Ein frühzeitiger Beginn des enteralen Kostaufbaus mit Milch innerhalb der ersten zehn Lebenstage führte hingegen zu einer Verkürzung der parenteralen Ernährung (17 d vs. 27 d; p < 0,05) und stationären Behandlung (22,5 d vs. 49 d; p nicht signifikant). Schlussfolgerung: Die Inzidenz von Gastroschisis und Omphalocele blieb während des Beobachtungszeitraumes konstant. Die Prognose der Gastroschisis-Patienten wurde durch eine Frühgeburt nicht verbessert, so dass eine Termingeburt angestrebt werden sollte. Die Daten der vorliegenden Arbeit legen nahe, dass ein frühzeitiger Nahrungsaufbau mit der oralen Zufuhr von Tee ab dem achten Lebenstag sowie Milch ab dem zehnten Lebenstag günstig für das Outcome hinsichtlich der Dauer der parenteralen Ernährung und des stationären Aufenthaltes ist. Darmverschlüsse stellten schwerwiegende Komplikationen dar und verschlechterten das Outcome maßgeblich. Eine große Omphalocele sowie eine ausgetretene Leber erhöhten die Morbidität. Ebenso wie bei Gastroschisis-Kindern scheint ein frühzeitiger Beginn der enteralen Ernährung das Outcome der Omphalocele-Patienten hinsichtlich der Dauer der parenteralen Ernährung und Krankenhausbehandlung zu verbessern. Deshalb empfehlen wir ab dem fünften sowie siebten Lebenstag die enterale Ernährung mit Tee sowie Milch zu beginnen. Ein großes Manko der vorliegenden Studie ist die kleine Fallzahl dieser retrospektiven, monozentrischen Erhebung. Zur besseren Erfassung der Patienten mit angeborenen Bauchwanddefekten und um aussagekräftige epidemiologische und prognostische Ergebnisse zu erhalten, bedarf es eines Fehlbildungsregisters in Sachsen, so wie es bereits in anderen Bundesländern angewandt wird.

Background and aims: Heart failure (HF) is a common health problem worldwide. Despite its importance, the epidemiology of HF is incompletely understood. Frequent references to an ‘epidemic of HF’ are at odds with recent reports of a decline in mortality from heart failure. In addition, reports based on admissions to hospital with a diagnosis of HF show that an earlier upward trend levelled off in the late 1990s in most developed countries. However, HF is a heterogeneous condition with multiple underlying causes. A decline in the severity of acute myocardial infarction (AMI), one of the major underlying causes of HF, and improvement in the treatment of patients with AMI as well as of hypertension are factors that might produce contradictory effects on the epidemiology of HF. Recent claims of a major contribution of improved survival after AMI to the reported epidemic of HF in the United States of America need to be examined in other populations. This thesis aims to define more precisely the epidemiological features of heart failure in Australia, and how these have evolved over the last decade. It examines secular trends in mortality, hospital admissions, incidence and survival related to HF. Methods: Trends in mortality from HF and admission to hospital with a diagnosis of HF are examined using computerized records of all deaths occurring in Australia for calendar years 1997-2003 and National Hospital Morbidity Data for financial years 1996-1997 to 2003-2004, obtained from the Australian Institute of Health and Welfare. A death or admission to hospital was defined as involving HF if at least one of the causes of death or one of the diagnoses of each separation was coded to any of the relevant rubrics within the International Classification of Disease, 9th Revision, Clinical Modification (ICD-9-CM) or 10th Revision, Australian Modification (ICD-10-AM). The analyses are based on age- and sex-specific death and hospital separation rates for HF either as underlying cause (or principal diagnosis) or mentioned anywhere on the death certificate (or recorded in any diagnostic position in the hospital electronic file) for each calendar or financial year. The investigation of trends in incidence and outcome of early-onset HF (HF complicating an index AMI within 28 days) and late-onset HF after AMI (HF developing 28 days after an index AMI) was based on the World Health Organization MONItoring trends and determinants of CArdiovascular disease (MONICA) register in Western Australia. The study included all residents aged 25-64 years of Perth, the capital city of Western Australia, who were admitted to hospital between 1988 and 1993 with non-fatal definite AMI and who had no history of AMI or HF in the hospital record. Trends in incidence and outcome of early- and late-onset HF were investigated using appropriate statistical methods. Results: From a total of 907,242 deaths occurring in Australia between 1997 and 2003, heart failure was coded as the underlying cause of death (UCD) for 29,341 (3.2%) and was mentioned anywhere on the death certificate in 135,268 (14.9%). Over this period, in both sexes, there were decreases in the absolute numbers of deaths and in the age-specific and age-standardized mortality rates for HF either as UCD or mentioned anywhere on the death certificate. HF was mentioned in 24.6% and 17.8% of deaths attributed to ischaemic heart disease and circulatory disease respectively, and these proportions remained unchanged over the period of study. In addition, HF as UCD accounted for 8.3% of deaths due to circulatory disease and this did not change from 1997 to 2003. From a total of 48,562,285 separations from hospital between 1996-7 and 2003-4, HF was coded as the principal diagnosis for 344,081 (0.8%) and was mentioned anywhere on the hospital record in 1,212,109 (2.5%). While the number of separations with HF remained stable, the age- and sex-standardized separation rate for HF recorded as principal diagnosis decreased from 2.0 per 1000 population in 1996-1997 to 1.7 per 1000 population in 2003- 2004. The corresponding values for HF recorded in any diagnostic position were 7.8 and 5.0 per 1000 population. From all patients (N = 4006) who met the criteria for first-ever, non fatal ‘definite’ AMI in the Perth MONICA Register, 897 (22.4%) had early-onset HF complicating the index event. After adjustment for age and sex, the odds of developing HF declined by 13% (odds ratio for the period 1989-1993 relative to 1984-1988 = 0.87, 95% confidence interval (95%CI): 0.75 to 1.01). After adjustment for age and history of diabetes and hypertension, the hazard of death in patients with early-onset HF (i.e. case fatality) declined by 26% (HR for the period 1989-1993 relative to 1984-1988 = 0.74, 95%CI: 0.57 to 0.96). Of 3109 patients who did not develop early-onset HF, 406 (13.1%) had at least one subsequent hospital admission with a diagnosis of HF (defined as late-onset HF). Following adjustment for age and sex, the hazard ratio for late-onset HF for the period 1989-1993 relative to 1984-1988 was 0.85 (95% confidence interval (95%CI): 0.69-1.04). History of diabetes and hypertension, current smoking, length of initial admission for AMI, recurrent acute coronary syndrome and coronary artery revascularization procedures were predictors of late-onset HF. After a median follow-up of 3.2 years and adjustment for age (≥70 years) and history of diabetes, the hazard of death in patients with late-onset HF did not change over the period of study (HR for year = 1.02, 95%CI: 0.98 to 1.06). Conclusion: For reasons discussed in the body of the thesis, the observed decline in mortality from HF measured as either number of deaths or rate probably reflects a real change in the epidemiology of HF. In addition, there was no increase in the number of hospital admissions involving HF and standardized rates of hospital separations fell in Australia between 1996 and 2004. These results do not support a major increase in the caseload of HF over recent years. In addition, a decline in the risk of early- and late-onset HF after AMI as well as all the evidence on decline in incidence and severity of coronary artery disease and hypertension argue against an increase in inflow from these two important risk factors of HF. However, taking all of the influences on the epidemiology of HF together, it is likely that because of the increasing number of older people, the number of new cases of HF will rise over the next few years, even if the incidence rate falls.

Diss. Stockholm : Karolinska institutet, 2005.

Thesis (Ph. D.)--Michigan State University. Dept. of Economics, 2008. / Title from PDF t.p. (viewed on March 27, 2009) Includes bibliographical references (p. 93-98). Also issued in print.

Thesis (Ph. D.)--University of Göttingen, 2004. / Description based on print version record. Includes bibliographical references (p. [115]-121) and index.

Thesis (Ph. D.)--University of Göttingen, 2004. / Title from e-book title screen (viewed Oct. 15, 2007). Description based on print version record.

Thesis (Ph. D.)--University of Göttingen, 2004. / Includes bibliographical references (p. [115]-121) and index.

No description available.

Introdução: O envelhecimento populacional é um fenômeno que ocorre mundialmente, caracterizado por aumento do número de idosos nas últimas décadas. Quando os indivíduos de um país passam a ter maior expectativa de vida, surgem novos problemas relacionados com o envelhecimento da população, entre os quais destaca-se o número de pessoas com demência. Informações sobre epidemiologia da demência são fundamentais para o planejamento de ações em saúde. Objetivo: Estimar a taxa de incidência de demência em idosos residentes em Ribeirão Preto-SP. Casuística e métodos: Trata-se de estudo de coorte prospectivo em que foram abordados 1076 sujeitos considerados cognitivamente normais no estudo de prevalência de demência. Um total de 469 idosos foram submetidos aos testes de triagem (1a fase). Todos os sujeitos screening positivo possíveis e alguns screening negativo foram reavaliados na 2a fase diagnóstica. O seguimento médio foi de 9,85 anos. Resultados: Foram identificados 45 casos incidentes de demência. As demências mais encontradas foram doença de Alzheimer (51,11%), vascular (20,0%) e mista (17,18%). As taxas de incidência de demência por 1000 pessoas-ano foram 15,0 (IC 95%=11,13-19,77) para demência em geral, 16,48 (IC 95%=10,44-24,70) para demência devido a doença de Alzheimer e 5,74 (IC 95%=2,47-11,28) para demência vascular e mista. A baixa escolaridade foi associada com maiores taxas de incidência. Pelo modelo de regressão de Cox, o risco de demência é maior com o envelhecimento (>= 80 anos: HR 4,25-6,99) e maior entre as mulheres (HR 1,9, IC 95% 1,01-3,57). Não foi encontrado associação de hipertensão arterial, diabetes mellitus e dislipidemia com o desenvolvimento de demência. Conclusão: A taxa de incidência de demência da população estudada foi semelhante ao estudo brasileiro prévio. Em ambos os gêneros houve aumento da taxa de incidência com a idade. O gênero feminino é fator de risco e alta escolaridade é fator de proteção para o desenvolvimento de demência. A demência por Doença de Alzheimer foi a mais encontrada entre os idosos, seguida pela demência mista e vascular. / Background: Population aging is a phenomenon that occurs worldwide, which is characterized by increasing the number of elderly in recent decades. When individuals in a country have longer life expectancy, it emerges new problems related to the population aging, including the number of people with dementia. Informations about dementia epidemiology are essential for planning health actions. Objective: To estimate the incidence rate of dementia in elderly living in Ribeirão Preto-SP. Methods: This is a prospective cohort study in which 1076 subjects cognitively normal in the dementia prevalence study were addressed. A total of 469 elderly were submitted to screening tests (first phase). All possible positive screening subjects and some negative screening were reassessed in the 2nd diagnostic phase. The mean follow-up was 9.85 years. Results: Forty five incident cases of dementia were identified. The most frequent types of dementia were Alzheimer disease (51.11%), vascular (20.0%) and mixed (17.18%). The incidence rates of dementia per 1000 person-years were 15.0 (95% CI = 11,13 to 19,77) for overall dementia, 16.48 (95% CI = 10.44 to 24.70) for Alzheimer disease dementia and 5.74 (95% CI = 2.47 to 11.28) for vascular and mixed dementia. The low level of education was associated with higher incidence rates. As the Cox regression model, the risk of dementia is higher with age (>= 80 anos = HR 4,25-6,99) and higher among women (HR 1.9, 95% CI 1.01 -3.57). It was not found association of hypertension, diabetes mellitus and dyslipidemia with the development of dementia. Conclusion: The incidence rate of dementia was similar to previous brazilian study. In both genders there was an increase incidence rate with age. The female sex is a risk factor and high education is a protective factor against the development of dementia. Alzheimer disease was the most frequent type of dementia among the elderly, followed by mixed dementia and vascular.

Background The burden of non-communicable diseases (NCDs) is rapidly increasing globally, and particularly in Africa, where the health focus, until recently, has been on infectious diseases. The response to this growing burden of NCDs in Africa has been affected owing to a poor understanding of the burden of NCDs, and the relative lack of data and low level of research on NCDs in the continent. Recent estimates on the burden of NCDs in Africa have been mostly derived from modelling based on data from other countries imputed into African countries, and not usually based on data originating from Africa itself. In instances where few data were available, estimates have been characterized by extrapolation and over-modelling of the scarce data. It is therefore believed that underestimation of NCDs burden in many parts of Africa cannot be unexpected. With a gradual increase in average life expectancy across Africa, the region now experiencing the fastest rate of urbanization globally, and an increase adoption of unhealthy lifestyles, the burden of NCDs is expected to rise. This thesis will, therefore, be focussing on understanding the prevalence, and/or where there are available data, the incidence, of four major NCDs in Africa, which have contributed highly to the burden of NCDs, not only in Africa, but also globally. Methods I conducted a systematic search of the literature on three main databases (Medline, EMBASE and Global Health) for epidemiological studies on NCDs conducted in Africa. I retained and extracted data from original population-based (cohort or cross sectional), and/or health service records (hospital or registry-based studies) on prevalence and/or incidence rates of four major NCDs in Africa. These include: cardiovascular diseases (hypertension and stroke), diabetes, major cancer types (cervical, breast, prostate, ovary, oesophagus, bladder, Kaposi, liver, stomach, colorectal, lung and non-Hodgkin lymphoma), and chronic respiratory diseases (chronic obstructive pulmonary disease (COPD) and asthma). From extracted crude prevalence and incidence rates, a random effect meta-analysis was conducted and reported for each NCD. An epidemiological model was applied on all extracted data points. The fitted curve explaining the largest proportion of variance (best fit) from the model was further applied. The equation generated from the fitted curve was used to determine the prevalence and cases of the specific NCD in Africa at midpoints of the United Nations (UN) population 5-year age-group population estimates for Africa. Results From the literature search, studies on hypertension had the highest publication output at 7680, 92 of which were selected, spreading across 31 African countries. Cancer had 9762 publications and 39 were selected across 20 countries; diabetes had 3701 publications and 48 were selected across 28 countries; stroke had 1227 publications and 19 were selected across 10 countries; asthma had 790 publications and 45 were selected across 24 countries; and COPD had the lowest output with 243 publications and 13 were selected across 8 countries. From studies reporting prevalence rates, hypertension, with a total sample size of 197734, accounted for 130.2 million cases and a prevalence of 25.9% (23.5, 34.0) in Africa in 2010. This is followed by asthma, with a sample size of 187904, accounting for 58.2 million cases and a prevalence of 6.6% (2.4, 7.9); COPD, with a sample size of 24747, accounting for 26.3 million cases and a prevalence of 13.4% (9.4, 22.1); diabetes, with a sample size of 102517, accounting for 24.5 million cases and a prevalence of 4.0% (2.7, 6.4); and stroke, with a sample size of about 6.3 million, accounting for 1.94 million cases and a prevalence of 317.3 per 100000 population (314.0, 748.2). From studies reporting incidence rates, stroke accounted for 496 thousand new cases in Africa in 2010, with a prevalence of 81.3 per 100000 person years (13.2, 94.9). For the 12 cancer types reviewed, a total of 775 thousand new cases were estimated in Africa in 2010 from registry-based data covering a total population of about 33 million. Among women, cervical cancer and breast cancer had 129 thousand and 81 thousand new cases, with incidence rates of 28.2 (22.1, 34.3) and 17.7 (13.0, 22.4) per 100000 person years, respectively. Among men, prostate cancer and Kaposi sarcoma closely follows with 75 thousand and 74 thousand new cases, with incidence rates of 14.5 (10.9, 18.0) and 14.3 (11.9, 16.7) per 100000 person years, respectively. Conclusion This study suggests the prevalence rates of the four major NCDs reviewed (cardiovascular diseases (hypertension and stroke), diabetes, major cancer types, and chronic respiratory diseases (COPD and asthma) in Africa are high relative to global estimates. Due to the lack of data on many NCDs across the continent, there are still doubts on the true prevalence of these diseases relative to the current African population. There is need for improvement in health information system and overall data management, especially at country level in Africa. Governments of African nations, international organizations, experts and other stakeholders need to invest more on NCDs research, particularly mortality, risk factors, and health determinants to have evidenced-based facts on the drivers of this epidemic in the continent, and prompt better, effective and overall public health response to NCDs in Africa.