Relative survival of patients with non-malignant central nervous system tumours: a descriptive study by the Austrian Brain Tumour Registry.

BACKGROUND: Unlike malignant primary central nervous system (CNS) tumours outcome data on non-malignant CNS tumours are scarce. For patients diagnosed from 1996 to 2002 5-year relative survival of only 85.0% has been reported. We investigated this rate in a contemporary patient cohort to update information on survival. METHODS: We followed a cohort of 3983 cases within the Austrian Brain Tumour Registry. All patients were newly diagnosed from 2005 to 2010 with a histologically confirmed non-malignant CNS tumour. Vital status, cause of death, and population life tables were obtained by 31 December 2011 to calculate relative survival. RESULTS: Overall 5-year relative survival was 96.1% (95% CI 95.1-97.1%), being significantly lower in tumours of borderline (90.2%, 87.2-92.7%) than benign behaviour (97.4%, 96.3-98.3%). Benign tumour survival ranged from 86.8 for neurofibroma to 99.7% for Schwannoma; for borderline tumours survival rates varied from 83.2 for haemangiopericytoma to 98.4% for myxopapillary ependymoma. Cause of death was directly attributed to the CNS tumour in 39.6%, followed by other cancer (20.4%) and cardiovascular disease (15.8%). CONCLUSION: The overall excess mortality in patients with non-malignant CNS tumours is 5.5%, indicating a significant improvement in survival over the last decade. Still, the remaining adverse impact on survival underpins the importance of systematic registration of these tumours.

The Neonatal Pain, Agitation and Sedation Scale reliably detected oversedation but failed to differentiate between other sedation levels.

AIM: The aim of this study was to analyse the sedation subscale of the Neonatal Pain, Agitation and Sedation Scale (N-PASS), because the N-PASS has only been validated for the assessment of acute and prolonged pain. METHODS: The nurses' expert opinion regarding the level of sedation of the study patients was used as reference scale. Paired assessments of both the N-PASS sedation subscale and the nurses' expert opinion were performed in 50 sedated neonates from 23 to 44 weeks of postmenstrual age. RESULTS: A total set of 503 paired observations was included into analysis. The median N-PASS sedation subscale scores were significantly different for the three nurses' expert opinion categories, with minus eight for oversedation, minus two for adequate sedation and zero for undersedation (p < 0.0001). Interobserver agreement for the N-PASS sedation subscale was excellent - linearly weighted Cohen's Kappa was 0.93 - as was the internal consistency of 0.88, estimated by a Cronbach's alpha. The internal consistency increased to 0.90 if the vital sign item of the subscale was deleted. CONCLUSION: The N-PASS sedation subscale reliably detected oversedation, but failed to differentiate between adequate and undersedation. We therefore recommend using additional methods to ensure adequate assessment of sedation in neonates.

Mental health over nine months during the SARS-CoV2 pandemic: Representative cross-sectional survey in twelve waves between April and December 2020 in Austria.

BACKGROUND: There is accumulating evidence about detrimental impacts of the pandemic on population mental health, but knowledge on risk of groups specifically affected by the pandemic and variations across time is still limited. METHODS: We surveyed approximately n=1,000 Austrian residents in 12 waves between April and December 2020 (n=12,029). Outcomes were suicidal ideation (Beck Suicidal Ideation Scale), depressive symptoms (Patient Health Questionnaire-9), anxiety (Hospital Anxiety Depression Scale), and domestic violence. We also assessed the perceived burden from the pandemic. Demographic and Covid-19 specific occupational and morbidity-related variables were used to explain outcomes in multivariable regression analyses, controlling for well-established risk factors of mental ill-health, and variations over time were analyzed. RESULTS: Young age, working in healthcare or from home, and own Covid-19 illness were consistent risk factors controlling for a wide range of known mental health risk factors. Time patterns in the perceived burden from Covid-19-related measures were consistent with the time sequence of restrictions and relaxations of governmental measures. Depressive and anxiety symptoms were relatively stable over time, with some increase of depression during the second phase of lockdowns. Domestic violence increased immediately after both hard lockdowns. Suicidal ideation decreased slightly over time, with a low during the second hard lockdown. Mental health indicators for women and young people showed some deterioration over time, whereas those reporting own Covid-19 illness improved. LIMITATIONS: Data from before the pandemic were not available. CONCLUSIONS: Among mental health outcomes, increases in domestic violence and, to some smaller extent, depressive symptoms, appeared most closely related to the timing of hard lockdowns. Healthcare staff, individuals working from home, those with Covid-19, as well as young people and women are non-traditional risk groups who warrant heightened attention in prevention during and in the aftermath of the pandemic.

Time trends of the prevalence of asthma and allergic disease in Austrian children.

After a substantial increase in the prevalence of atopic disease in Europe, recent studies indicate that a plateau has been reached. However, variation across countries and age groups exists. We studied the prevalence and time trends of asthma and allergic disease among schoolchildren in Austria, a country with traditionally low rates of asthma, hay fever, and eczema. As part of the International Study of Asthma and Allergies in Childhood (ISAAC), symptoms and physician diagnoses of asthma and allergic disease of 13,399 Austrian children aged 6-7 yr and 1516 children aged 12-14 yr were surveyed between 1995 and 1997. A similar survey was conducted between 2001 and 2003. Among children aged 6-7 yr, significant increases were seen in the prevalence of physician-diagnosed asthma (+16%; p = 0.013), hay fever (+22%; p < 0.001), and eczema (+37%; p < 0.001) between 1995 and 2003. These changes were paralleled by an increase in the prevalence of symptoms typical for hay fever (itchy eyes and runny nose), but not by an increase in wheeze. Among children aged 12-14 yr, the lifetime prevalence of diagnosed asthma increased by 32%, of hay fever by 19%, and of eczema by 28% (all, p < 0.001). These changes were paralleled by increases in the prevalence of wheezing as documented by both questions before and after a video showing wheezing children but not by symptoms typical for hay fever such as itchy eyes and runny nose. In conclusion, in Austria, contrary to other European countries, the prevalence of asthma and allergic disease increased among schoolchildren. Additional studies are needed to continue monitoring the dynamics of the prevalence of asthma and allergic disease in Austria and to explore trends in their risk factors.

Increasing incidence of IDDM in Austrian children. A nationwide study 1979-1993. Austrian Diabetes Incidence Study Group.

OBJECTIVE: A nationwide population-based study was conducted to assess the insulin-dependent diabetes mellitus (IDDM) incidence in childhood over a 15-year period (1979-1993). RESEARCH DESIGN AND METHODS: A questionnaire was sent to all Austrian pediatric departments and diabetologists. The secondary data source was based on patient organization lists and hospital administration data. The data from 1979-1987 were collected retrospectively, while from 1988 to 1993 the registration of cases was performed prospectively in the same network. Estimates of probability of ascertainment were calculated according to the capture-recapture method. RESULTS: The achieved ascertainment was 94% . The overall annual incidence was 7.9/100,000 person-years in children 0-14 years old. During the observation period, the incidence rose by 2.4% annually. CONCLUSIONS: The incidence of childhood IDDM in Austria, a European country with an intermediate risk for IDDM, showed a proportionally similar increase to that of Northern European countries over the past decade. The increase seems to be continuous, following mainly a linear trend with superimposed sudden outbreaks indicating environmental causative factors.

Insulin, insulin-like growth factor-binding protein-1, and sex hormone-binding globulin in patients with Turner's syndrome: course over age in untreated patients and effect of therapy with growth hormone alone and in combination with oxandrolone.

We have studied the course over age of fasting insulin, sex hormone-binding globulin (SHBG), and insulin-like growth factor (IGF)-binding protein-1 (IGFBP-1) in untreated children with Turner's syndrome (TS) and measured the course of these parameters during therapy with GH alone and in combination with oxandrolone. Forty patients with TS, aged 3.7-16.4 yr, were investigated before any therapy. Fasting insulin levels increased significantly with chronological age, whereas SHBG and IGFBP-1 decreased with chronological age, and serum concentrations of these parameters were in the normal range. SHBG and IGFBP-1 were not coregulated by insulin in TS as previously reported under physiological conditions; IGFBP-1 was inversely correlated with insulin, but SHBG was not, and neither parameter was correlated with the other. Twenty-eight patients were further investigated 3, 6, 9, and 12 months after the start of GH monotherapy (12-18 IU/m2-week) and 3, 6, 9, and 12 months after the addition of oxandrolone (0.0625 mg/kg.day; n = 16). There was a significant increase in insulin levels during GH monotherapy and a further increase during combination therapy, with peak levels 3 months after the start of GH and combination therapy, respectively. Both SHBG and IGFBP-1 levels decreased significantly during GH monotherapy, with a further dramatic decrease after the addition of oxandrolone. Levels of free testosterone were unaffected by both treatment regimens. IGFBP-1 was inversely correlated with insulin concentrations at all time points after the start of therapy. SHBG was inversely correlated with IGF-I concentrations, but showed no relation to insulin concentrations during GH monotherapy. In conclusion, there were no abnormalities in serum concentrations of insulin, SHBG, and IGFBP-1 in untreated patients that could help to explain the retarded growth in patients with TS. All effects of combined GH and oxandrolone therapy on endocrine parameters such as insulin, SHBG, IGFBP-1 and IGF-I mimic the endocrine pattern normally observed during the pubertal growth spurt. Our data confirm the importance of insulin in the regulation of IGFBP-1, but do not point to a coregulation of IGFBP-1 and SHBG by insulin in patients with TS.

Extracorporeal photochemotherapy in patients with steroid-dependent Crohn's disease: a prospective pilot study.

BACKGROUND: Extracorporeal photochemotherapy has been proven effective in selected T-cell mediated diseases. AIM: To evaluate the safety and efficacy of extracorporeal photochemotherapy in patients with steroid-dependent Crohn's disease by an open, monocentric trial in three phases of 24 weeks each. METHODS: In phase 1 standardized steroid tapering was initiated in patients with a history of steroid-dependent Crohn's disease. Those with a prospectively evaluated maintenance dose of at least 10 mg/day prednisolone continued steroid-withdrawal under the application of extracorporeal photochemotherapy in phase 2. The duration of remission or response was followed during phase 3. Colonic tissue bioptically obtained before and after extracorporeal photochemotherapy was studied by immunofluorescence microscopy for the presence of photoadduct positive cells. RESULTS: Out of 24 patients included in phase 1, 10 entered phase 2 for extracorporeal photochemotherapy. Four subjects achieved remission and four others response. Significant reductions in serum C-reactive protein levels and intestinal permeability were measured, as well as increases in quality of life and plasma adrenocorticotropic hormone levels. No major side-effects were observed. Remission remained stable in three out of four patients during phase 3. In three patients, positive nuclear stainings of photoadducts were detected in colonic mononuclear cells after extracorporeal photochemotherapy. CONCLUSIONS: Extracorporeal photochemotherapy represents a safe steroid-sparing approach in patients with Crohn's disease and is associated with intestinal homing of photopheresed cells.

The prevalence of IDDM in the first degree relatives of children newly diagnosed with IDDM in Austria--a population-based study. Austrian Diabetes Incidence Study Group.

Insulin dependent diabetes mellitus shows a strong familial predisposition and an unexplained geographical variation in incidence. It is not known whether the risk of IDDM in first degree relatives depends on the risk in the background population. The aim of the study was to assess the prevalence of IDDM in parents and siblings of newly diagnosed children with IDDM in Austria, a known area of low risk for IDDM. The family history data of all diabetic children (< 15 years) diagnosed between 1988-1994 in Austria were analysed. The cumulative incidence of IDDM in siblings of newly diagnosed diabetic children was 0.0026772 cases/year, this means 29.7 times increased risk compared to the background population. Of the diabetic children 5.8% had at least one parent with IDDM and the prevalence of IDDM in fathers (3.9%) was higher (p = 0.015) compared to mothers (1.9%). The risk of IDDM tended to be higher for offsprings of diabetic fathers (OR 3.8, p < 0.003) in families with 2 or more children than in single child families, where the prevalence was 4.2% both in fathers and mothers. In conclusion the prevalence of IDDM in parents of diabetic children in Austria was lower than reported in populations with high IDDM incidence. This may reflect a lesser degree of genetic predisposition of the Austrian population. The prevalence of IDDM in siblings was similar to that in high risk populations. We saw an interaction of gender of the diabetic parent and diabetic offspring and the family size.

Prevalence of overweight and obesity in male adolescents in Austria between 1985 and 2000. A population based study.

OBJECTIVE: To analyse the prevalence of overweight and obesity in young Austrian men, to describe a possible time trend during the observation period 1985-2000 and to define regional differences within the country. DESIGN: Epidemiological population based investigation (conscript health investigation) comparing aggregated data of four cross-sectional studies. SUBJECTS: Four cohorts of 18 year-old males (1985: n = 50,475, 1990: n = 47,463, 1995: n 39,275, 2000: n = 43,503), in total n = 180,716. METHODS: Measurements of height and weight were performed during the nationwide conscript health investigation. BMI was calculated and overweight was defined as BMI > or = 25.00 kg/m2 and obesity as BMI > or = 30.00 kg/m2. Besides height and weight data, information on place of residence of the young men was used for the study. Chi-squared and Student's t-test were calculated to test group differences with respect to their statistical significance. RESULTS: The prevalence of overweight increased from 10.9% to 15.5% and of obesity from 1.8% to 4.9% during the observation period. A significant regional trend was found with the highest prevalence of overweight and obesity in the Eastern part of Austria (p < 0.001). BMI was 22.12 +/- 0.34 kg/m2 (mean +/- SD) in 1985 and showed a significant increase (p < 0.001) during the study period to 22.71 +/- 0.25 kg/m2. CONCLUSION: Overweight and obesity increased remarkably in young males in Austria between the years 1985 and 2000. The steepest increase was found in the prevalence of obesity and in the Western part of Austria. A significant regional difference could be documented during the whole study period.

Development of birth weight in Austria from 1970-1995.

We analysed the development of birth weight of all Austrian live births in the period 1970-1995. The relationship between birth weight and the variables maternal age, length and sex of the newborn and year of birth is described by means of a linear regression model. Over the 26 years an increase of up to 60 g was observed in the mean birth weight. This positive trend may partly be due to the extensive use of the maternity care program ("mother-and-child Passport") introduced in 1974. Maternity payment was made to the mother it she underwent at least five examinations within the antenatal care program. This payment was reduced from 15,000 AS in 1996 to 2000 AS as from January 1st 1997, a measure which may lead to a reduction in the use of this maternity care program, with consequent negative implications for the morbidity of both mother and child and for the positive trend of birth weight development over the past decades.

Indoor factors and their association to respiratory symptoms suggestive of asthma in Austrian children aged 6-9 years.

The ISAAC (International Study of Asthma and Allergy in Childhood) was founded in 1990 in order to maximise the value of epidemiological research into asthma and allergic diseases, to describe the prevalence of asthma and allergic disease in children living in different locations, to make comparisons within and between countries, to provide a framework for further etiological research and to find prevention strategies. We analysed a sub-sample of a population-based study (1995 to 1997) in Upper Austria. The aim of our study was to investigate the influence of indoor risk factors on wheezing in children 6-9 years old. Our calculations were based on the results of a questionnaire answered by parents about their children's indoor environment at home. Smoking of the mother during pregnancy and/or during breastfeeding (OR 1.28; 95% CI 1.08-1.48), smoking of the mother at the present time (OR 1.25; 95% CI 1.12-1.41), a bird (OR 1.40; 95% CI 1.06-1.85) or rabbit (OR 1.37; 95% CI 1.03-1.82) as a domestic pet, synthetic bedding (OR 1.33; 95% CI 1.18-1.49) and dampness or mould at home (OR 1.43; 95% CI 1.24-1.65) are associated with a significantly increased risk of childhood wheezing in the last 12 months. Other variables such as "smoking of the father", "cooking with gas", "gas central heating" and other "pets" do not achieve statistical significance.

[Prevalence of smoking habits of Upper Austria students of the 7th and 8th grade and effect of smoking habits of family and peers]. / Prävalenz der Rauchgewohnheiten von oberösterreichischen Schülern der 7. und 8. Schulstufe und Einfluss der Rauchgewohnheiten von Familie und Peers.

The aim of the study was to explore the prevalence of different smoking habits in a population of Austrian pupils, 12 to 15 years old, and the relationship of familial and peer group smoking customs with these habits. In 1997 a population-based survey (International Study of Asthma and Allergies in Childhood, ISAAC) was conducted of all 7th and 8th grade school children of a district of Upper Austria. Information on the smoking habits of the adolescents, the family members, and of the peer as well as smoking habits of the teacher, gender, and age of the children was collected. The overall-prevalence of having ever smoked in this population is 57.8%. The percentage of eversmokers among the 12-year-olds is 50%. This amount increases to 63.8% among the 14- to 15-year-olds. The odds ratios for smoking daily is highest among those whose best friend smokes (OR: 70.63, CI: 9.19, 542.40). The risk of daily smoking increases also if the siblings of the juvenile (OR: 4.71, CI: 1.15, 19.35) or the mother (OR: 4.95, CI: 1.67, 14.70) smoke. If the father smokes the risk to smoke monthly is increased (OR: 2.09, CI: 1.28, 3.40). These results point to the fact that smoking prevention programes should take into account the influence of peers and family of the adolescents.

[Frequency of cesarean sections in Austria]. / Die Häufigkeit von Kaiserschnitten in Osterreich (1996-1998).

OBJECTIVE: While there exist detailed reports on the frequency of cesarean sections in many European countries, there are only selective data of single centers available in Austria. Thus this study aims at evaluating the present frequency of cesarean sections in Austria. METHODS: To achieve this aim, we analyzed all births during the years 1996 (n = 89,208), 1997 (n = 84,408) and 1998 (n = 81,568). Along with the general mean rate of sections, we also describe the influences of the duration of pregnancy, of the birth weight, and of the number of paturitions. The data were statistically evaluated by chi-square test. RESULTS: During the study period, the frequence of sections rose from 13.08% (1996) to 14.0% (1997) and to 14.55% (1998). This rise proved to be statistically significant (p = 0.0001). 47% of premature births (< or = 35th week of gestation) are delivered by cesarean section. This rate drops to only 13.24% after the 35th week of gestation. Yet, more than half of pregnancies with dystrophic children (<2,000 g) are delivered by cesarean section even after the 35th week of gestation. Primigravidae have to expect section in 17% of the cases (1998); the section rate diminishes continuously, however, with increasing number of pregnancies. CONCLUSIONS: Following the general trend, the frequency of cesarean sections is continuously rising in Austria too. The present study can serve as a basis for international comparisons as well as for measures of intradepartmental quality control.

[The role of nitric oxide in reproduction]. / Die Rolle des Stickstoffmonoxids bei der Reproduktion.

Nitrix oxide (NO) is a highly reactive and short-lived radical (half-life time: 10-12 s), which is derived from L-arginine by the NO synthases (NOS) in several organ systems. The release of NO by endothelial cells leads to rapid relaxation of vascular smooth muscle cells, whereas release by several neuronal cells causes neurotransmission. When NOS is actively induced in immune cells or certain epithelia it causes cytotoxicity and/or apoptosis of these cells. In the reproductive organs NO is now considered to be an important trigger molecule for several physiological mechanisms. Follicular synthesized NO is involved in rupture of the follicle during ovulation. Moreover, NO participates in the acrosome reaction of spermatozoa during capacitation. Apoptosis and collagenolysis of the functional endometrium may be involved in endometrial shedding during menstruation. Since NO induces both apoptosis and collagenolysis, the newly discovered production of NO in late secretory endometrium could act as a key mechanism in the process of menstrual disintegration of the endometrium. Additionally, NO is necessary to support and maintain the decidualization process and plays a pivotal role in implantation.

Measurement of placental bed vascularization in the first trimester, using 3D-power-Doppler, for the detection of pregnancies at-risk for fetal and maternal complications.

OBJECTIVE: To evaluate the performance of placental bed vascularization in a low-risk population to predict severe pregnancy risks. Vascularization was measured in the first trimester, using 3D power-Doppler vascularization index. METHODS: All women who registered during a period of 3 years for delivery in our hospital were prospectively screened in the first trimester. Power Doppler vascularization index of the placental bed (PBVI) was measured in 4325 women and correlated to 7 outcome groups: 1) normal, 2) IUGR ≤ 3rd centile, 3) delivery ≤ 34 weeks, 4) pregnancy induced hypertension (PIH), 5) all pre-eclampsia (PE), 6) severe PE, 7) severe pregnancy problems (SPP i.e. PIH or PE plus IUGR ≤ 3rd centile and/or delivery ≤ 34 weeks). In addition, measurements of mean uterine artery Doppler at 12 and 22 weeks, placental volume and PAPP-A were also performed on all women and their predictive strength for pregnancy risks was compared with the PBVI. RESULTS: Severe PE and SPP occurred in 0.6 vs. 1.5% of all pregnancies. First trimester PBVI below the 10th centile detected 60% of severe PE and 66.2% of SPP, the odds ratio being 4.48 (95th CI 1.98-11.82) for severe PE and 9.92 (95th CI 5.55-17.71) for SPP. Second trimester uterine artery Doppler detected 72% of PE and 50.8% of SPP, the odds ratio being 14.58 (95th CI 5.78-36.79) and 5.46 (95th CI 3.18-9.36) respectively. All other measured parameters performed much worse compared to PBVI and 22 weeks uterine artery Doppler. CONCLUSION: Placental bed vascularization index could be used for a quick and reliable first trimester assessment of severe pregnancy risks.

Austrian national carotid intervention numbers prompt improvement in secondary stroke prevention.

BACKGROUND: As recent data suggest a variable benefit of carotid endarterectomy (CEA) or stenting (CAS), a careful selection of patients is mandatory for efficient stroke prevention. This retrospective study analyzed carotid intervention rates from 1999-2008 in Austria. The aim was to assess whether interventions for carotid stenosis were performed with respect to epidemiological trends and published data taking into account intervention type, age and gender. METHODS: Intervention numbers for internal carotid artery (ICA)-stenosis from a 10 years period (1999 to 2008) were retrieved from the national Austrian registry for hospital funding. Patients were grouped by gender, age (0-64, 65-74, older than 75 years) and intervention type. RESULTS: CEA rates amounted to 32.2±1.4 per 100000 persons annually (female: 22.1±0.7, male: 43.0±2.3). Each year 9.1 CAS±1.6 per 100000 Austrians were performed (female: 9.3±1.8, male 8.9±1.7). CAS numbers increased (P<0.05), whereas CEA numbers stagnated, especially in older age groups. Women were more likely to undergo CAS than CEA compared to men. CONCLUSION: Relative intervention rates for carotid stenosis have rather stagnated, although stroke incidence increases continuously in an overaging society. Despite controversial data, CAS rates have been rising constantly in elderly women. Secondary stroke prevention in Austria can be improved by a careful selection of future patients, especially with regard to female gender and type of intervention.

Comparison of enoxaparin and unfractionated heparin in endovascular interventions for the treatment of peripheral arterial occlusive disease: a randomized controlled trial.

BACKGROUND: Although unfractionated heparin (UFH) is an effective antithrombotic agent in endovascular interventions for the treatment of peripheral occlusive arterial disease (PAOD), it produces a highly variable anticoagulant response. Intravenous (i.v.) enoxaparin might be an effective and safe alternative. PATIENTS AND METHODS: In a prospective, open-label, randomized, single-center trial, 210 patients with PAOD (Fontaine stage IIb to IV) were randomly assigned in a 1 (UFH): 2 (enoxaparin) fashion to receive an i.v. bolus of 60 units UFH per kg body weight or 0.5 mg enoxaparin per kg body weight, respectively, before endovascular intervention. The primary composite endpoint assessed the clinical performance of enoxaparin by comparing the peri-interventional rate of thromboembolia/occlusion (efficacy) of endovascularly reconstructed areas, of bleeding according to the Global Utilization of Streptokinase and t-PA for Occluded Coronary Arteries (GUSTO) criteria (safety) and of any necessary re-intervention for any percutaneous transluminal angioplasty (PTA)-related bleeding. The secondary endpoint evaluated anti-factor (F)Xa levels during intervention. RESULTS: The primary composite endpoint showed a better performance of enoxaparin (10.5% vs. 2.5% absolute difference - 8.0%; P < 0.05). The concomitant use of acetylsalicylic acid (ASA) significantly (P < 0.05) increased the risk of a complication in the UFH group, but not in the enoxaparin group. Within 15 min, anti-Xa levels were reached by 63.7% of patients treated with enoxaparin and only by 39.1% with UFH. CONCLUSION: Enoxaparin has a better performance than UFH in endovascular interventions for the treatment of PAOD. In patients with concomitant use of ASA, the risk of complications with UFH increases significantly compared with enoxaparin.

First trimester placental and myometrial blood perfusion measured by 3D power Doppler in normal and unfavourable outcome pregnancies.

INTRODUCTION: To evaluate whether 3D placental and myometrial power Doppler blood perfusion in the first trimester can be used to detect risk pregnancies. METHODS: 3D power Doppler vascularization index (VI) and flow index (FI) of the entire placenta and the neighbouring myometrium were separately measured in the first trimester in all women with singleton pregnancies during a period of three months. In addition we measured placental volume, placental quotient, PAPP-A, as well as uterine artery at 12 and 22 weeks (mean PI and mean notch) and compared those data with the pregnancy outcome. RESULTS: Data from 383 women could be evaluated. 10 developed pre-eclampsia (PE). Both flow and vascularization were markedly lower in the placentas compared to the adjoining decidua and myometria. There was some correlation between placental vascularization Index (PVI) as well as deciduo-myometrial vascularization index (MVI) and placental volume, PAPP-A and number of pregnancies and a marked correlation between PVI and especially MVI to mean notch at 12 weeks and 22 weeks (PVI: -0.215, -0.274 MVI: -0.316,-0.322). PVI and MVI were significantly reduced in women with pregnancy problems and showed the greatest reduction in PE-pregnancies (p: 0.0018, 0.0004). Of all measured parameters MVI showed the best sensitivity for the detection of PE. CONCLUSION: The correlation between PVI and MVI in the first trimester and mean notch in the second shows that they provide valuable information at as early as 12 weeks which normally so far is only available at 22 weeks by uterine artery Doppler flow. As MVI measures the percentage of vessels in the deciduo-myometrial area it could also provide information on trophoblast invasion. This hypothesis is supported in particular by a marked decrease of the MVI in pregnancy problems especially in PE-pregnancies.

Comparison between three-dimensional placental volume at 12 weeks and uterine artery impedance/notching at 22 weeks in screening for pregnancy-induced hypertension, pre-eclampsia and fetal growth restriction in a low-risk population.

OBJECTIVES: To compare the value of three-dimensional placental volume at 12 weeks and uterine artery Doppler at 22 weeks for predicting pregnancy-induced hypertension (PIH), pre-eclampsia and fetal growth restriction in a low-risk population. METHODS: Over a 20-month period we calculated the placental quotient (PQ = placental volume/crown-rump length) at 11-13 weeks' gestation in all women with singleton pregnancies who booked for delivery in our hospital. At 22 weeks, in the same population, we calculated the mean pulsatility index (PI) of both uterine arteries and the presence of an early diastolic notch was noted. Logistic regression models, the PQ and Doppler parameters were used to compare the two screening methods for subgroups of pregnancy outcome. RESULTS: Complete outcome data were obtained in 2489 consecutive singleton pregnancies. Logistic regression models for the detection of pre-eclampsia had a sensitivity of 38.5% (PQ) vs. 44.8% (Doppler); for the detection of small-for-gestational age (SGA) the sensitivity was 27.1% (PQ) vs. 28.1% (Doppler) at a specificity of 90%. Taking a PQ of or= 90th centile and a bilateral notch, the sensitivity for detection of SGA was 25.0%, 20.2% and 22.0%, respectively; for PIH it was 9.5%, 4.8% and 4.8%; for pre-eclampsia without SGA it was 20.0%, 28%, 12%; for PIH/pre-eclampsia with SGA it was 30.8%, 46.1% and 69.2%. In the group with the most severe complications, in which delivery took place before 34 weeks, the sensitivity was 50.0%, 50.0% and 38.9%, respectively. CONCLUSIONS: PQ at 12 weeks and uterine artery Doppler at 22 weeks have similar sensitivities for predicting pre-eclampsia and fetal growth restriction, although uterine artery Doppler is marginally more sensitive for the prediction of pre-eclampsia. While both methods are insufficient for screening in a low-risk population, the PQ method has the potential advantage of being performed in the first trimester.

The spatial autocorrelation coefficient Moran's I under heteroscedasticity.

The spatial distribution of rates used in epidemiology often raises questions concerning the randomness of the observed pattern. In order to provide a first answer to this kind of question, the well-known spatial autocorrelation coefficient Moran's I is frequently used. Unfortunately, under heteroscedasticity, that is, unequal variances of the rates due to different population sizes, the moments of the test distribution of Moran's I under H(0) differ from the usually used moments. To obtain a less biased test, it is proposed in this paper and validated by simulation results, to approximate the moments of Moran's I by means of incorporating population size into the covariance matrix of the rates.