Maria Blettner

• Johannes Gutenberg University Mainz

Increased incidence rates for childhood leukaemia have been reported in municipalities close to the nuclear power plant (NPP) Krümmel (Geesthacht, Germany). Methodological challenges arise when analysing this association at ecological level. They include the use of an appropriate reference population, unstable estimates of standardised incidence ra...

Background A persisting high-risk human papillomavirus (HR-HPV) infection is causal for cervical cancer; however, there is limited population-based data on the prevalence of HPV infections in Germany. We assessed the age and type-specific HPV prevalence, and associated risk factors in HPV unvaccinated women aged 30 and above. Methods The MARZY pro...

Hintergrund Titandioxid (TiO2) ist ein weißer anorganischer Stoff, der u.a. in der Produktion von Farben, Lebensmitteln oder Sonnenschutz zur Anwendung kommt. Höheren Expositionen sind vor allem Arbeiter in TiO2-verarbeitenden Fabriken ausgesetzt, die die Substanz als Staub einatmen können, was mit einem erhöhten Lungenkrebsrisiko verbunden sein kö...

Objective: In Germany, articles on the association between childhood leukaemia incidence and residential distance to nuclear power plants (NPPs) have been published since the 1990s [1]. Increased incidence rates were reported in the late 1990s among children residing in several municipalities within ten kilometres from the NPP-Krümmel, located in t...

Background On September 1976, due to the explosion of an ammonia-washing column at the petrochemical plant in Manfredonia (Italy), 39 tonnes of arsenic were released into the atmosphere, contaminating the plants and the neighbourhoods close to it. The aim of this study is to present the results of a 45-year follow up of exposed workers with a focus...

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Background: Men make use of outpatient cancer counseling less commonly than women, even when they stand to benefit from it. Methods: In a cluster-randomized trial (registered under DRKS00032181), we studied whether measures on multiple levels (information for referring physicians, public information, structural changes, offerings specifically f...

International comparisons of the disease burden of the coronavirus disease 2019 (COVID-19) pandemic often used excess mortality as an important criterion for assessing the effectiveness of interventional measures. For Germany there were strong discrepancies between the excess mortality estimates from various studies. As the estimates were based on...

Over one million European children undergo computed tomography (CT) scans annually. Although moderate- to high-dose ionizing radiation exposure is an established risk factor for hematological malignancies, risks at CT examination dose levels remain uncertain. Here we followed up a multinational cohort (EPI-CT) of 948,174 individuals who underwent C...

In Deutschland wurden zwischen 1966 und 1988 19 Kernkraftwerke (KKW) in Betrieb genommen, für viele lief die Genehmigung nach der Wiedervereinigung 1990 und der Katastrophe von Fukushima 2011 aus. Aufgrund von Befürchtungen von gesundheitlichen Auswirkungen bei Kindern durch eine Strahlenexposition, wurden in verschiedenen Ländern epidemiologische...

Background Subsequent primary neoplasms (SPN) are among the most severe late effects and the second most frequent cause of death in childhood cancer patients. In this paper we introduce method and properties of the STATT-SCAR study (Second Tumor After Tumor Therapy, Second Cancer After Radiotherapy), which is a joint nested matched case–control stu...

Titanium dioxide (TiO 2) is an inorganic compound with many applications, for example in paint, sunscreen or as food coloring. There have been concerns regarding its safety and according to IARC, the existing evidence is not substantial enough to rule them out, leading to the substance being classified as possibly carcinogenic to humans (2B). This...

Introduction: Long non-coding ribonucleic acids (lncRNAs) are involved in the cellular damage response following exposure to ionizing radiation as applied in radiotherapy. However, the role of lncRNAs in radiation response concerning intrinsic susceptibility to late effects of radiation exposure has not been examined in general or in long-term surv...

Background Childhood cancer survivors (CCS) are at particularly high risk for therapy-related late sequelae, with secondary primary neoplasms (SPN) being the most detrimental. Since there is no standardized questionnaire for retrospective assessment of associations between prior cancer treatments and late health effects, we developed a self-adminis...

Background: Epidemiological research on late effects of therapy shows the necessity to aggregate chemotherapy agents to substance classes. This requires using conversion factors by substance classes. Aims: The aim of this study was to identify previously used conversion factors from the literature, to present a novel approach for additional fact...

Background To assess the hysterectomy probability by calendar period and age, the overall and the age-specific prevalence of hysterectomy in women aged 30–65 years. Methods Baseline data (2005–2007) from the population-based MARZY study conducted in Mainz and Mainz-Bingen, Germany, were analysed. 6429 women aged 30–65 years were asked whether they...

Background The European EPI-CT study aims to quantify cancer risks from CT examinations of children and young adults. Here, we assess the risk of brain cancer. Methods We pooled data from nine European countries for this cohort study. Eligible participants had at least one CT examination before age 22 years documented between 1977 and 2014, had no...

Background Improved treatments for childhood cancer result in a growing number of long-term childhood cancer survivors (CCS). The diagnosis and the prevalence of comorbidities may, however, influence their lifestyle later in life. Nonetheless, little is known about differences in late effects between CCS of a first primary neoplasm (FPN) in childho...

Background: Differential expression analysis is usually adjusted for variation. However, most studies that examined the expression variability (EV) have used computations affected by low expression levels and did not examine healthy tissue. This study aims to calculate and characterize an unbiased EV in primary fibroblasts of childhood cancer survi...

Introduction The association between paediatric leukaemia and proximity to nuclear power plants has been assessed in several countries with inconsistent and inconclusive results. A previous case-control study from Germany had shown an increased risk for childhood leukaemia near nuclear power plants (NPPs) (2008). A cluster of leukaemia cases was de...

Introduction Since the COVID-19 vaccine rollout in December 2020 the Division of Vaccine Documentation of Rhineland-Palatinate has been responsible for the central registration of most vaccinations administered in the state. Vaccinees can provide information on self-reported adverse events (SRAEs) and their perceived intensity. We analyzed the fre...

Introduction The COVID-19 pandemic can increase mental health burden through stressors such as sustained health worries, loss of social interactions, and economic uncertainty. Possible negative effects on mental health such as depression, eating disorders, and substance abuse have been discussed, raising concerns about potentially higher suicide r...

Introduction: Estimating COVID-19 mortality is impeded by uncertainties in cause of death coding. In contrast, excess all-cause mortality can be a robust indicator of how the COVID-19 pandemic impacts public health. However, correctly predicting baseline mortality is crucial for estimating excess mortality. Therefore, we modeled baseline mortality...

Background: In Rhineland-Palatinate, most COVID-19 vaccinations are centrally recorded by the Rhineland-Palatinate Division of Vaccine Documentation, which includes self-reported vaccination reactions (SRVR) and their level of perceived intensity. We analyzed the occurrence of SBIR reported between 12/2020 and 12/2021 in relation to the different v...

Despite recent achievements in reducing the contribution of road traffic to air pollution, agreed pollutant standards are exceeded frequently in large parts of Europe. Previous studies assessed the effectiveness of traffic interventions in improving local air quality. However, little research exists on the effect of closures of short road sections...

Purpose We aimed at exploring the quality of life (QOL) of lung cancer survivors with proven tyrosine-kinase receptor (RTK) genetic alterations and targeted tyrosine-kinase inhibitors (TKI) therapy, compared to lung cancer survivors with no-RTK alterations and no-TKI therapy. Methods Data were collected in a cross-sectional multi-centre study. Pri...

PURPOSE The increasing cancer burden calls for reliable data on current and future associated hospitalizations to enable health care resource planning, especially in low- and middle-income countries. We provide nationwide estimates of the current and future burden of hospitalization because of neoplasms in Ghana. METHODS We conducted secondary dat...

Background A considerable proportion of cervical cancer diagnoses in high-income countries are due to lack of timely follow-up of an abnormal screening result. We estimated colposcopy non-attendance, examined the potential factors associated and described non-attendance reasons in a population-based screening study. Methods Data from the MARZY pro...

Background Previous studies with the majority of breast cancer (BC) patients treated up to 2000 provided evidence that radiation dose to the heart from radiotherapy (RT) was linearly associated with increasing risk for long-term cardiac disease. RT techniques changed substantially over time. This study aimed to investigate the dose-dependent cardia...

We investigated the association of allergic diseases and epilepsy with risk of brain tumours, in Interphone, a 13-country case–control study. Data were obtained from 2693 glioma cases, 2396 meningioma cases, and 1102 acoustic neuroma cases and their 6321 controls. Conditional logistic regression models were used to estimate pooled odds ratios (ORs)...

Purpose Radiotherapy (RT) was identified as a risk factor for long-term cardiac effects in breast cancer patients treated until the 1990s. However, modern techniques reduce radiation exposure of the heart, but some exposure remains unavoidable. In a retrospective cohort study, we investigated cardiac mortality and morbidity of breast cancer survivo...

We have read with interest the correspondence by Subramanian and Kumar [1] and found some major methodological issues which are worth discussing. The authors use an ecological approach to investigate the association of the percentage of population fully vaccinated with the trend in newly reported cases of positive SARS-Cov-2 tests between two conse...

Purpose Cardiac effects after breast cancer radiation therapy potentially affect more patients as survival improves. The heart’s heterogeneous radiation exposure and composition of functional structures call for establishing individual relationships between structure dose and specific late effects. However, valid dosimetry requires reliable contour...

Vaccination is among the measures implemented by authorities to control the spread of the COVID-19 pandemic. However, real-world evidence of population-level effects of vaccination campaigns against COVID-19 are required to confirm that positive results from clinical trials translate into positive public health outcomes. Since the age group 80 + ye...

Background: Estimating COVID-19 mortality is impeded by uncertainties in cause of death coding. In contrast, age-adjusted excess all-cause mortality is a robust indicator of how the COVID-19 pandemic impacts public health. However, in addition to COVID-19 deaths, excess mortality potentially also reflects indirect negative effects of public health...

Background The World Health Organization (WHO) has an ongoing project to assess potential health effects of exposure to radiofrequency electromagnetic fields (RF-EMF) in the general and working population. Here we present the protocol for a systematic review of the scientific literature on cancer hazards from exposure to RF-EMF in humans, commissio...

Background This study explores sociodemographic and health factors associated with hospitalizing diabetes mellitus (DM) patients and estimates the number of future hospitalizations for DM in Ghana. Methods We conducted a secondary analysis using nationally representative patient hospitalization data provided by the Ghana Health Service and project...

Die COVID-19-Pandemie hat über Stressoren, wie anhaltende Gesundheitssorgen, soziale Isolation, Arbeitslosigkeit oder wirtschaftliche Verluste, potenziell Auswirkungen auch auf die psychische Gesundheit. Insbesondere können Risikofaktoren für Suizidalität in gesellschaftlichen Ausnahmezuständen verstärkt werden. Für frühere pandemische Lagen wurden...

Objective Data on asthma hospitalisations are a useful source of patient morbidity information. In Ghana, the length of stay (LoS) and sociodemographic factors of patients hospitalised for asthma and its exacerbation are understudied. We aimed to investigate the time to discharge and assessed factors associated with length of hospital stays of asth...

Background In an industrial area, the asymmetry between the weights of the economic interests compared to the public-health needs can determine which interests are represented in decision-making processes. This might lead to partial interventions, whose impacts are not always evaluated. This study focuses on two interventions implemented in Taranto...

Background: Exposure to high doses of ionizing radiation is among the few well-established brain tumour risk factors. We used data from the Interphone study to evaluate the effects of exposure to low-dose radiation from diagnostic radiological examinations on glioma, meningioma and acoustic neuroma risk. Methods: Brain tumour cases (2644 gliomas...

Objective Patients with sickle cell disease (SCD) are prone to multiple episodes resulting in frequent hospital visits. We determined the time trends, sociodemographic and health factors associated with length of stay (LoS) for patients with SCD in Ghana. Design, participants, setting We retrospectively analysed SCD hospitalisation records of 22 6...

Einleitung: In Deutschland erhalten 80% der Patientinnen mit prognostisch günstigem Mammakarzinom eine Radiotherapie [1]. In epidemiologischen Untersuchungen konnte gezeigt werden, dass die Strahlenexposition des Herzens zu einem erhöhten kardialen Mortalitätsrisiko führt [2]. In den 1990er Jahren wurde die Strahlentherapie stark verbessert. Der Ei...

Background Cervical cancer screening can be conducted with cytology and Human Papillomavirus (HPV) testing but few studies have compared the latter directly to concomitant testing (co-testing). We compared these strategies to determine appropriate screening. Methods Within a randomised population-based cohort study conducted around Mainz, Germany,...

Background Therapy for a first primary neoplasm (FPN) in childhood with high doses of ionizing radiation is an established risk factor for second primary neoplasms (SPN). An association between exposure to low doses and childhood cancer is also suggested; however, results are inconsistent. As only subgroups of children with FPNs develop SPNs, an in...

BACKGROUND Therapy for a first primary neoplasm (FPN) in childhood with high doses of ionizing radiation is an established risk factor for second primary neoplasms (SPN). An association between exposure to low doses and childhood cancer is also suggested; however, results are inconsistent. As only subgroups of children with FPNs develop SPNs, an in...

Interrupted time series analysis (ITSA) is a method that can be applied to evaluate health outcomes in populations exposed to ionizing radiation following major radiological events. Using aggregated time series data, ITSA evaluates whether the time trend of a health indicator shows a change associated with the radiological event. That is, ITSA chec...

Purpose To investigate the work situation of lung cancer survivors and to identify the factors associated with their returning to work. Methods Descriptive analysis and logistic regression were used to evaluate study population characteristics and independent factors of subsequently returning to work. To analyze time to return to work, Cox regress...

Background Current research in breast cancer focuses on individualization of local and systemic therapies with adequate escalation or de-escalation strategies. As a result, about two-thirds of breast cancer patients can be cured, but up to one-third eventually develop metastatic disease, which is considered incurable with currently available treatm...

Young age at school entry (ASE) is related to attention-deficit/hyperactivity disorder in higher grades. The reason for this association is unclear, but medical oversupply and stress-related factors are discussed. We aimed to investigate whether ASE is associated with reported symptoms of attention-deficit/hyperactivity (ADH) already in first grade...

Previous meta-analyses have suggested an increased risk of amyotrophic lateral sclerosis (ALS) associated with occupational exposure to extremely low-frequency magnetic fields (ELF-MF). However, results should be interpreted with caution since studies were methodologically heterogeneous. Here, we assessed the feasibility of a pooling study to harmo...

Since the beginning of the COVID-19 pandemic, data have been accumulated to examine excess mortality in the first half of 2020. Mortality in the preceding year or years is used to calculate the expected number of deaths, which is then compared with the actual number of deaths in 2020. We calculated weekly age- and sex-specific mortality rates for 9...

jats:sec> Background Therapy for a first primary neoplasm (FPN) in childhood with high doses of ionizing radiation is an established risk factor for second primary neoplasms (SPN). An association between exposure to low doses and childhood cancer is also suggested; however, results are inconsistent. As only subgroups of children with FPNs develop S...

Background Some countries have implemented stand-alone human papillomavirus (HPV) testing while others consider cotesting for cervical cancer screening. We compared both strategies within a population-based study. Methods The MARZY cohort study was conducted in Germany. Randomly selected women from population registries aged ≥30 years (n = 5,275)...

Letters to the Editor Epidemiological Measures in the Context of the COVID-19 Pandemic by Dr. rer. physiol. Emilio Gianicolo, Nicola Riccetti, Prof. Dr. rer. nat. Maria Blettner, and Prof. Dr. med. André Karch, MSc in issue 19/2020 https://www.aerzteblatt.de/int/archive/article/216409

Introduction: Airport apron workers are occupationally exposed to jet exhaust and major concern is related to the exposure to ultrafine particles (UFP) from aircrafts. To date, little attention has been given to occupational exposures to aircraft-related UFP, although aircraft engines have high emissions of ultrafine particles, which are orders of...

Introduction From January 12 to February 4, 2020, one of the main bridges connecting Mainz and Wiesbaden was closed for individual car traffic due to maintenance work. The aim of this study is to evaluate how this shutdown affected air pollution levels and mobility patterns. Methods Two monitoring stations were installed to measure meteorological a...

Introduction Traffic limitation is both a political and environmental epidemiologic issue. However, little is known about the determinants for changes in mobility behaviours among people facing traffic limitations. Between January, 12th and February, 4th, 2020 the main bridge between the cities of Mainz and Wiesbaden, was closed to car traffic. The...

Abstract Background Exposure to ionizing radiation induces complex stress responses in cells, which can lead to adverse health effects such as cancer. Although a variety of studies investigated gene expression and affected pathways in human fibroblasts after exposure to ionizing radiation, the understanding of underlying mechanisms and biological e...

We welcome the comments by Schmitz-Feuerhake on our study on childhood cancer after exposure to postnatal diagnostic x-ray and the opportunity to explain some points in more detail.

Childhood cancer therapies are known risk factors for the development of second primary cancers. They are also suggested risk factors for late adverse health effects. Until now, there is no established questionnaire to retrospectively assess exposure to cancer therapies in childhood among adults. Therefore, we aim to validate a new self-administere...

Purpose: In radiation risk analysis the state-of-the-art approach is based on descriptive models which link excess rates of cancer incidence and mortality to radiation exposure by statistical association. To estimate the number of sporadic and radiation-induced cases descriptive models apply parametric dose response function which directly determi...

Background: Patients with high-grade gliomas (HGG) often suffer from high distress and require psychosocial support. However, due to neurological and neurocognitive deficits, adequate assessment of distress and support needs remains challenging in clinical practice. The objective of the present study is to investigate whether a systematic implemen...

After political sovereignty, Uzbekistan’s industry is growing fast. However, no investigation was performed so far, to evaluate whether an environmental risk, associated with the industry, is also increasing. Our aim was to investigate whether the distance from factories, as a surrogate measurement for environmental exposure to community, has any i...

Background: The various epidemiological indicators used to communicate the impact of COVID-19 have different strengths and limitations. Methods: We conducted a selective literature review to identify the indicators used and to derive appropriate definitions. We calculated crude and age-adjusted indicators for selected countries. Results: The propor...

Background: Symptoms of depersonalization (DP) and derealization (DR) have a high prevalence in patient and community samples. Previous studies suggested that DP/DR symptoms might represent a marker of disease severity and poor prognosis. However, population-based studies investigating the impact of DP/DR symptoms on the course of depression and an...

Purpose There is a strong association between severe hyperhomocysteinemia and myopia. Thus we studied the hypothesis that even moderately increased levels of homocysteine (Hcy) might be a potentially treatable risk factor for myopia. Methods The Gutenberg Health Study (GHS) is a population-based, prospective, observational cohort study in Germany,...

Background: Patients with high-grade gliomas (HGG) often suffer from high distress and require psychosocial support. However, due to neurological and neurocognitive deficits, adequate assessment of distress and support needs remains a challenging unmet clinical need. The objective of the present study is to investigate whether a systematic implemen...

Background: Patients with high-grade gliomas (HGG) often suffer from high distress and require psychosocial support. However, due to neurological and neurocognitive deficits, adequate assessment of distress and support needs remains a challenging unmet clinical need. The objective of the present study is to investigate whether a systematic implemen...

Objectives To determine cancer mortality compared with the general population and to examine dose-response relationships between cumulative occupational radiation dose and specific cancer outcomes in the German aircrew cohort. Methods For a cohort of 26 846 aircrew personnel, standardised mortality ratios (SMR) were calculated. Dose-response analy...

Background: In clinical medical research, causality is demonstrated by randomized controlled trials (RCTs). Often, however, an RCT cannot be conducted for ethical reasons, and sometimes for practical reasons as well. In such cases, knowledge can be derived from an observational study instead. In this article, we present two methods that have not be...

Background Choroidal thickness is associated with several cardiovascular parameters in case–control studies including patients with manifest disease. So far, it was unclear whether underlying cardiovascular risk factors or the continuum of heart failure may lead to alterations of the choroid. Therefore, our hypothesis was to test in a population-ba...

Purpose: To determine whether amblyopia interferes with cognitive functions requiring visuospatial processing, measured by the Tower of London (ToL) test. Methods: The current study was based on a sub-cohort from the population-based Gutenberg Health Study and included 1,569 participants aged 35 to 44 years. Amblyopia was defined as a visual acu...

Background In secondary data there are often unstructured free texts. The aim of this study was to validate a text mining system to extract unstructured medical data for research purposes. Methods From a radiological department, 1,000 out of 7,102 CT findings were randomly selected. These were manually divided into defined groups by 2 physicians...

We assessed the feasibility of an epidemiological study on the risk of radiation-related lens opacities among interventional physicians in Germany. In a regional multi-centre pilot study associated with a European project, we tested the recruitment strategy, a European questionnaire on work history for the latter dosimetry calculation and the endpo...

Background: Breast cancer patients' self-understanding of their disease can impact their quality of life (QoL); the relationship between compliance and QoL is poorly understood. Patients and methods: The Patient's Anastrozole Compliance to Therapy (PACT) program, a prospective, randomized study, investigated the effect of additional patient info...

Purpose Fatigue has found increasing attention as a debilitating and lasting condition of cancer patients. However, it has remained unclear to what degree long-term survivors of malignant melanoma suffer from fatigue. Therefore, this study aimed to determine fatigue and its link with quality of life, aftercare behavior, and mental and physical symp...

Studies on children exposed to ionizing radiation by computed tomography (CT) indicate an increased risk of leukemia and central nervous system (CNS) tumors. Evidence of the risks associated with diagnostic X-ray examinations, the most frequent examination in pediatric radiology, in which the radiation dose is up to 750 times lower compared to CT e...

Background: Depression is the second most common psychiatric illness in old people. Up to 30% of nursing home residents have minor or major depression. Although depressive disorders in old age can be improved and even cured with adequate therapy, they often go unnoticed in nursing home residents and remain untreated. This highlights a striking def...

Purpose Little is known about the use of psychosocial services in lung cancer survivors and patients who have survived the diagnosis for at least one year. We investigated the frequency of use, stratified by radiation therapy received, its associated factors, and the reasons for non-use of those services. Methods We performed a multicenter (n = 6...

Background In this study based on the BRENDA data, we investigated the impact of endocrine ± chemotherapy for luminal A, nodal positive breast cancer on recurrence free (RFS) and overall survival (OS). In addition, we analysed if tumor size of luminal A breast cancer influences survival in patients with the same number of positive lymph nodes. Met...

Background: The stepped-wedge design (SWD) of clinical trials has become very popular in recent years, particularly in health services research. Typically, study participants are randomly allotted in clusters to the different treatment options. Methods: The basic principles of the stepped wedge design and related statistical techniques are descr...

Background Depression is the second most common psychiatric illness in old people. Up to 30% of nursing home residents suffer from minor or major depression. Although depressive disorders in old age can be improved and even cured with adequate therapy, they often go unnoticed in nursing home residents and remain untreated. This highlights a strikin...