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ABSTRACT: Posterior urethral valves (PUV) associated with renal dysplasia are one of the most common causes of end stage kidney disease (ESKD) in childhood. In order to identify risk factors for the progression of this condition to early renal failure, we have retrospectively analyzed the clinical course, renal function, and first postnatal renal ultrasound in a sample of 42 young male patients with PUV, who were followed at a single center. Twelve (28.6%) were diagnosed with ESKD at a median age of 11.3 years. Our comparison of PUV patients without decreased estimated glomerular filtration rate (eGFR) (group A; K/DOQI CKD stage 0-1) with PUV patients showing a decreased eGFR (group B; K/DOQI CKD stage 2-5) revealed the following significant risk factors for loss of eGFR: renal volume <3rd percentile (P < 0.001), elevated echogenicity (P = 0.001), pathologic corticomedullary differentiation (P < 0.001), >3 febrile urinary tract infections (P = 0.012), and decreased eGFR at 1 year of age (P < 0.001). Receiver operating characteristic curve analysis in the cohort confirms that patients showing a renal volume >88.2 ml/m(2) body surface area (BSA) are not at risk to develop K/DOQI CKD stage 5 (sensitivity 75%, specificity 77.3%, positive/negative predictive value 37.5/94.4%). Ultrasound promises to be a valuable tool for identifying endangered patients.
Pediatric Nephrology 03/2012; 27(3):443-50. · 2.52 Impact Factor
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ABSTRACT: In the present study, antibody response to seasonal influenza vaccination and to the adjuvanted one-shot influenza A H1N1 vaccine (Pandemrix(®)) was investigated in 57 hemodialysis (HD) patients and 48 renal transplant (RT) recipients. Specific antibodies were measured by hemagglutination inhibition (HI) test using a pandemic H1N1 strain and a seasonal H3N2 virus. HI titers of ≥1:40 were considered as protective. Hemodialysis patients showed seroprotection against pandemic H1N1 in 35.1%, against seasonal influenza in 36.8% and against both in 14.0%. In comparison, renal transplant recipients developed protective antibody titers against the pandemic H1N1 virus in 47.9%, against the seasonal H3N2 strain in 31.3% and against both in 18.8%. HD patients and renal transplant recipients younger than 60 years developed protective antibody response to the pandemic influenza H1N1 vaccine in 50.0% of the HD patients and 55.2% of the RT recipients and against seasonal influenza in 45.0/20.7% (HD/RT) of the cases. Patients aged ≥60 years showed seroprotection against pandemic influenza in 27.0/36.8% (HD/RT) and against seasonal influenza in 32.4/47.4% (HD/RT). Side effects were reported in only four patients. In hemodialysis patients and renal transplant recipients, vaccination against pandemic H1N1 and seasonal influenza is well tolerated. However, more than a half of these patients did not develop seroprotective antibody levels. Thus, new vaccines and altered vaccination regimes are likely necessary to achieve relevant antibody levels in these patient groups.
Medical Microbiology and Immunology 02/2012; 201(3):297-302. · 3.83 Impact Factor
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ABSTRACT: There is a growing need for studies to measure how patients feel supported in their autonomy. The Health Care Climate Questionnaire (HCCQ) is an instrument to assess the physician's support to motivate the patient to take personal responsibility for his/her health. The aim of this study was to translate the HCCQ into German and validate the translated version, called the HCCQ-Deutschland (HCCQ-D).
In a cross-sectional study, we translated and culturally adapted the HCCQ, then administered the questionnaire to primary care patients from nine general practices in Germany. We used the European Task Force on Patient Evaluations of General Practice questionnaire (EUROPEP) to assess convergent validity. Subsequently, we performed Cronbach α to assess internal consistency and exploratory factor analysis to evaluate the underlying factor structure of the items.
Of 450 questionnaires, we included 351 (78%) in the final analysis. Internal consistency was high, with Cronbach α=0.97. We found one major underlying factor similar to the English version: all items showed a scale correlation above 0.7. The mean values of the HCCQ correlated moderately (-0.5) with those of the EUROPEP.
This study shows similar psychometric properties of the HCCQ-D as of the original English instrument. The HCCQ-D may be appropriate to explore German-speaking patients' perceived autonomy support in primary care settings.
Journal of clinical epidemiology 08/2011; 65(2):206-11. · 2.96 Impact Factor
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ABSTRACT: Due to the increasing number of non-travel-associated hepatitis E virus (HEV) infections observed in several industrialised countries including Germany, there is a substantial interest in the characterisation of risk factors and transmission routes relevant to autochthonous HEV infections. Autochthonous cases are believed to be the result of a zoonotic HEV transmission from pigs, wild boars and deer. Recently, a high prevalence of HEV-specific antibodies in the German domestic pig population has been demonstrated. Thus, one may assume a higher prevalence of HEV-specific antibodies in humans with occupational exposure to pigs. In this study, sera obtained from 24 slaughterers, 14 meat inspectors, 46 pig farmers and 22 veterinarians were tested for the presence of HEV-specific antibodies using a line immunoassay. For comparison, sera obtained from 116 age- and gender-matched blood donors were also included. Twenty eight per cent (28.3%; 30/106) of the swine-exposed humans and 15.5% (18/116) of the blood donors without contact to pigs exhibited IgG-antibodies determined as reactive (i.e. borderline or positive) against HEV. Thus, an increased risk of HEV infection in humans occupationally exposed to pigs and particularly for slaughterers (41.7%; 10/24) was demonstrated.
Medical Microbiology and Immunology 07/2011; 201(2):239-44. · 3.83 Impact Factor
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ABSTRACT: Several studies have investigated the orthonasal detection threshold for carbon dioxide (CO(2)) in humans. The aim of current study was to investigate whether 24 healthy young subjects exhibited differences of CO(2) detection thresholds during orthonasal or retronasal stimulation. As nasal mucosa is believed to desensitize to CO(2) concentrations at or below 4% (v/v) during expiration, the second aim of the study was to explore the influence during nasal versus oral breathing on the detection thresholds. CO(2) stimuli of varying concentrations and a duration of 1000 ms were applied with an air-dilution olfactometer in either the anterior nasal cavity or the nasopharynx during nasal respectively oral breathing. In these 4 conditions, the mean CO(2) detection thresholds using the staircase forced-choice procedure were between 3.9% and 5.3% (v/v). Statistical analysis revealed a significant difference between orthonasal and retronasal stimulation. The CO(2) detection threshold was lower in retronasal stimulation. The nasopharyngeal mucosa is more sensitive to perithreshold CO(2) stimuli than the nasal mucosa. The breathing route had no influence on the detection thresholds. The results of this study indicate that the natural contact of the nasal mucosa with approximately 4% (v/v) CO(2) during nasal expiration does not influence CO(2) detection thresholds.
Chemical Senses 03/2011; 36(5):435-41. · 2.60 Impact Factor
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ABSTRACT: Frequency analyses of EEG data yield large data sets, which are high-dimensional and have to be evaluated statistically without a large number of false positive statements. There exist several methods to deal with this problem in multiple comparisons. Knowing the number of true hypotheses increases the power of some multiple test procedures, however the number of true hypotheses is unknown, in general, and must be estimated. In this paper, we derive two new multiple test procedures by using an upper bound for the number of true hypotheses. Our first procedure controls the generalized family-wise error rate, and thus is an improvement of the step-down procedure of Hommel and Hoffmann [Hommel G., Hoffmann T. Controlled uncertainty. In: Bauer P. Hommel G. Sonnemann E., editors. Multiple Hypotheses Testing, Heidelberg: Springer 1987;ISBN 3540505598:p. 154-61]. The second new procedure controls the false discovery proportion and improves upon the approach of Lehmann and Romano [Lehmann E.L., Romano J.P. Generalizations of the familywise error rate. Ann. Stat. 2005;33:1138-54]. By Monte-Carlo simulations, we show how the gain in power depends upon the accuracy of the estimate of the number of true hypotheses. The gain in power of our procedures is demonstrated in an example using EEG data on the processing of memorized lexical items.
Journal of Neuroscience Methods 06/2008; 170(1):158-64. · 1.98 Impact Factor
