Survey of Neonates in Pomerania (SNiP): a population-based birth study--objectives, design and population coverage.

Neonatal health is of major concern to parents, midwives, physicians and society as a whole, yet a prospective population-based birth cohort to collect comprehensive data on multiple issues including medical, social, environmental and genetic aspects remains to be established in Germany. The survey of newborns in Pomerania (SNiP) described in this paper attempts to take up this goal. The objectives of SNiP are to establish (a) a population-based birth cohort providing detailed information about neonatal health, morbidity and mortality, (b) a biobank with newborn DNA and serum from cord blood, placenta tissue samples and DNA obtained from oral mucosal swabs of the mothers, (c) a prospective study design by re-examination of the SNiP population prior to attendance at primary school. From March 2003 until November 2008 all childbearing mothers in a well-defined region in North-Eastern Germany were asked to participate with their newborns. Detailed data on health status of the newborn, pregnancy, medical and family history, socio-economic status and maternal life style were obtained via face-to-face interview, standardised questionnaires and medical records. Placental tissue samples, cord blood plasma and DNA were continuously collected; sampling of maternal DNA from mouth swabs started in 2007. As a result, during the study period n = 6747 births and n = 6828 babies were enrolled. A population coverage of 95% was achieved. The active participation rate was 75%. A non-responder analysis revealed no meaningful selection bias. Thus, SNiP is a population-based, representative study in Germany that is able to describe the health and living conditions of newborns and their families comprehensively. It can contribute to existing knowledge and to similar cohort studies since data are accessible by researchers.

A descriptive analysis of relations between parents' self-reported smoking behavior and infants' daily exposure to environmental tobacco smoke.

BACKGROUND: The aims of the present study were to examine relations between parents' self-reported smoking behavior and infants' daily exposure to environmental tobacco smoke, as assessed by urinary cotinine-to-creatinine ratio (CCR), and to describe the CCR over seven days among infants at home. METHODS: A convenience sample of 27 households was drawn. Each household had to have at least one daily tobacco smoker and one child up to three years of age. Over a seven-day period, urine samples were obtained from the child daily. To examine relations between parents' self-reported smoking and infants' daily CCR, generalized estimating equation (GEE) analysis was used. RESULTS: The data revealed that infants from households with indoor smoking had higher CCRs than infants in households with outdoor smoking. CCRs were higher in girls than in boys. Older infants had lower CCRs than younger infants. Smoking outside the home versus inside the home, infant's gender, and infants' age accounted for 68% of the variance in CCR in a GEE data analysis model. No increase or decrease of CCR over time was found. CONCLUSION: The findings suggest that parents' self-reported smoking indoors at home versus outdoors is predictive of CCR among infants three and younger. Higher CCR concentrations in girls' urine need further examination. Furthermore, significant fluctuations in daily CCR were not apparent in infants over a seven-day time period.

The exposure to environmental tobacco smoke and attitudes towards tobacco control measures--a comparison of 5 European countries.

OBJECTIVES: (a) to examine exposure to ETS in 5 European countries that differ in their tobacco control (TC) activity, (b) to examine attitudes towards TC measures and (c) to relate these results to sociodemographic and smoking related variables. METHODS: population-based, representative sample of n = 3,500 participants age 16-59, in Germany, Greece, Poland, Sweden, UK. RESULTS: most never smokers are exposed to ETS in leisure time (55.74%); chances of being exposed to ETS at home or outside of the home are dependent on sex, smoking status, country, whether there are smokers in the households, what the status of the relationship is (single vs. not single); results differ significantly between countries. CONCLUSION: smoking restrictions are associated with lower levels of actual exposure to ETS. non-smokers want governmental regulation.

Intention to change smoking in pregnant and postpartum women according to number of pregnancies.

BACKGROUND: The status of a pregnant woman might add to the motivation to stop smoking. However, little is known about whether women who are pregnant for the first time (primigravidae) show a motivation to quit smoking that is different from women who are pregnant at least the second time (multigravidae). The goal of the current study was to compare smoking status, urge to smoke and intention to change smoking behaviour of primigravidae and multigravidae. We hypothesized that amongst primigravidae there are less current smokers, that the smokers consume less cigarettes per day, have less urge to smoke and that more stop smoking after delivery when compared with multigravidae. METHODS: Among 642 women postpartum who had smoked before pregnancy smoking status, the Fagerström Test for Nicotine Dependence and intention to change smoking behaviour were assessed. The data were analysed with the Chi-square test, Mann-Whitney's U-test and the Sign-test. RESULTS: Primigravidae smoked less cigarettes (P < 0.01) and showed less urge to smoke (P < 0.05) than multigravidae. They did not differ according to the intention to change smoking behaviour (P > 0.05). CONCLUSION: Experience of first pregnancy does not seem to automatically induce more smoking cessation compared to multigravidae. Prevention measures are needed for primigravida women and multigravida women to the same extent.

Potential Role of Neuroimaging Markers for Early Diagnosis of Dementia in Primary Care.

BACKGROUND: The use of imaging markers for the diagnosis of predementia and early dementia stages of Alzheimer's disease (AD) has widely been explored in research settings and specialized care. The use of these markers in primary care has yet to be established. OBJECTIVE: Summarize current evidence for the usefulness of imaging markers for AD in primary compared to specialized care settings. METHOD: Selective overview of the literature, and pilot data on the use of MRI-based hippocampus and basal forebrain volumetry for the discrimination of AD dementia and mild cognitive impairment (MCI) cases from healthy controls in 58 cases from a primary care cohort and 58 matched cases from a memory clinic's sample. RESULTS: Molecular imaging marker of amyloid pathology, and volumetric markers of regional and whole brain atrophy support the diagnosis of AD dementia and MCI due to AD, and contribute to confidence in the differential diagnosis of AD and non-AD related dementias in specialized care. Limited evidence from the literature and our primary care cohort suggests that the diagnostic accuracy of volumetric imaging markers may be similar in the dementia stage of AD, but may be inferior for cases with MCI in primary compared with specialized care. CONCLUSION: Evidence is still widely lacking on the use of imaging markers for early and differential diagnosis of AD dementia, and detection of prodromal AD in primary care. Further progress to fill this gap will depend on the availability of international multimodal data from well-defined primary care cohorts.

Hippocampal Mean Diffusivity for the Diagnosis of Dementia and Mild Cognitive Impairment in Primary Care.

BACKGROUND: Hippocampal mean diffusivity (MD) measured by Diffusion-Tensor Imaging is a promising diagnostic marker for Mild Cognitive Impairment (MCI) and dementia. Its performance has yet to be evaluated in primary care patients, who vary systematically from patients visiting specialized care settings. OBJECTIVE: We assessed the diagnostic accuracy of hippocampus diffusivity for detecting MCI and dementia in a sample recruited from primary care, compared to a sample from specialized care. METHOD: One sample was recruited from a primary care intervention trial (DelpHi-MV) (n=70), and the other sample was recruited from our memory clinic (n=70). The samples were matched pairwise for diagnosis, MMSE, age, gender, and education. They included dementia patients, MCI patients and healthy subjects. Mean MD was calculated for the left and right hippocampus, corrected for partial volume effects. Within each sample, left or right hippocampal MD served as predictor for diagnostic group in logistic regressions, which were additionally controlled for white matter lesions. RESULTS: In the primary care sample, hippocampal MD detected dementia with high cross-validated accuracy (left: AUC=.92; right: AUC=.85), but did not classify MCI with an accuracy above chance (left: AUC=.58; right: AUC=.44). In the memory clinic sample, hippocampal MD classified both dementia (left: AUC=.91; right: AUC=.91) and MCI (left: AUC=.86; right: AUC=.83) with high cross-validated accuracy. CONCLUSION: Hippocampal MD supported the identification of dementia but did not contribute to the detection of MCI in the primary care patient population.

Hippocampus and Basal Forebrain Volumetry for Dementia and Mild Cognitive Impairment Diagnosis: Could It Be Useful in Primary Care?

BACKGROUND: Once a patient or a knowledgeable informant has noticed decline in memory or other cognitive functions, initiation of early dementia assessment is recommended. Hippocampus and cholinergic basal forebrain (BF) volumetry supports the detection of prodromal and early stages of Alzheimer's disease (AD) dementia in highly selected patient populations. OBJECTIVE: To compare effect size and diagnostic accuracy of hippocampus and BF volumetry between patients recruited in highly specialized versus primary care and to assess the effect of white matter lesions as a proxy for cerebrovascular comorbidity on diagnostic accuracy. METHODS: We determined hippocampus and BF volumes and white matter lesion load from MRI scans of 71 participants included in a primary care intervention trial (clinicaltrials.gov identifier: NCT01401582) and matched 71 participants stemming from a memory clinic. Samples included healthy controls and people with mild cognitive impairment (MCI), AD dementia, mixed dementia, and non-AD related dementias. RESULTS: Volumetric measures reached similar effect sizes and cross-validated levels of accuracy in the primary care and the memory clinic samples for the discrimination of AD and mixed dementia cases from healthy controls. In the primary care MCI cases, volumetric measures reached only random guessing levels of accuracy. White matter lesions had only a modest effect on effect size and diagnostic accuracy. CONCLUSIONS: Hippocampus and BF volumetry may usefully be employed for the identification of AD and mixed dementia, but the detection of MCI does not benefit from the use of these volumetric markers in a primary care setting.