Random forests for the analysis of matched case-control studies.

BACKGROUND: Conditional logistic regression trees have been proposed as a flexible alternative to the standard method of conditional logistic regression for the analysis of matched case-control studies. While they allow to avoid the strict assumption of linearity and automatically incorporate interactions, conditional logistic regression trees may suffer from a relatively high variability. Further machine learning methods for the analysis of matched case-control studies are missing because conventional machine learning methods cannot handle the matched structure of the data. RESULTS: A random forest method for the analysis of matched case-control studies based on conditional logistic regression trees is proposed, which overcomes the issue of high variability. It provides an accurate estimation of exposure effects while being more flexible in the functional form of covariate effects. The efficacy of the method is illustrated in a simulation study and within an application to real-world data from a matched case-control study on the effect of regular participation in cervical cancer screening on the development of cervical cancer. CONCLUSIONS: The proposed random forest method is a promising add-on to the toolbox for the analysis of matched case-control studies and addresses the need for machine-learning methods in this field. It provides a more flexible approach compared to the standard method of conditional logistic regression, but also compared to conditional logistic regression trees. It allows for non-linearity and the automatic inclusion of interaction effects and is suitable both for exploratory and explanatory analyses.

Incidence trend of type 2 diabetes from 2012 to 2021 in Germany: an analysis of health claims data of 11 million statutorily insured people.

AIMS/HYPOTHESIS: The aim of the study is to describe the time trend of type 2 diabetes incidence in the largest state of Germany, Bavaria, from 2012 to 2021, and to compare the incidence rates during the pandemic period (2020-2021) to the pre-pandemic period (2012-2019). METHODS: This secondary data analysis uses health claims data provided by the Bavarian Association of Statutory Health Insurance Physicians (KVB), covering approximately 11 million insurees, accounting for 85% of the total population of Bavaria, Germany. Newly diagnosed type 2 diabetes cases in adults (≥20 years) coded as E11 (Diabetes mellitus, Type 2) or E14 (Unspecified diabetes mellitus) under ICD-10, German modification (ICD-10-GM) for the study period 2012 to 2021 were included. Annual and quarterly age-standardised incidence rates (ASIR) stratified by sex, age and region were calculated using the European standard population. Sex-specific crude incidence rates (CIR) were calculated using 10-year age groups. Regression analyses adjusted for time trends, seasonal effects, and pandemic effects were used to analyse the incidence trend and to assess the effect of the pandemic. RESULTS: Overall, 745,861 new cases of type 2 diabetes were diagnosed between 2012 and 2021: 50.4% (376,193 cases) in women. The male/female ratio remained stable over the observation period, while the median age at diagnosis decreased from 61 to 58 years in men and from 66 years to 61 years in women. ASIR were consistently higher for men compared with women, with the yearly difference remaining stable over time (2012: 18%; 2021: 20%). An overall decreasing trend in ASIR was observed during the study period, with a strong decrease from 2012 to 2017, followed by a less pronounced decline from 2018 to 2021 for both sexes. For men, ASIR decreased from 1514 per 100,000 person-years in 2012 to 995 per 100,000 person-years in 2021 (4.6% average annual reduction), and for women from 1238 per 100,000 person-years in 2012 to 796 per 100,000 person-years in 2021 (4.8% average annual reduction). This downward trend was also observed for age groups above 50 years. Regression analyses showed no significant change in incidence rates during the pandemic period (2020 and 2021) compared with the pre-pandemic period. CONCLUSIONS/INTERPRETATION: For the first time, a 10-year incidence trend of type 2 diabetes is reported for Germany, showing a strong decline from 2012 to 2017, followed by a less pronounced decline from 2018 to 2021. The incidence trend of type 2 diabetes appears not to have been affected by the first 2 years of the COVID-19 pandemic. Despite an overall increasing prevalence, the incidence is decreasing, potentially resulting from robust screening by family physicians, reducing the median age at diagnosis by 3 to 5 years. However, further investigation is needed to fully identify the reasons for the declining incidence trend. Continued incidence monitoring is necessary to identify the long-term trend and the potential effect of the pandemic on diagnoses of type 2 diabetes.

Global parental acceptance, attitudes, and knowledge regarding human papillomavirus vaccinations for their children: a systematic literature review and meta-analysis.

BACKGROUND: This systematic literature review aims to summarize global research on parental acceptance, attitudes, and knowledge regarding human papillomavirus vaccinations. METHODS: The literature search was conducted in PubMed, Web of Science and Scopus, and included publications from 2006 to 2023. Study quality was assessed using the Newcastle-Ottawa Scale. The Grading of Recommendations Assessment, Development, and Evaluation guidelines were used to assess the strength of evidence for the primary outcome. Meta-analyses were performed using random-effects models to estimate pooled parental acceptance of HPV vaccinations. Studies were stratified by study years, and a subgroup analysis was conducted to estimate vaccine acceptance rates by world regions. Additionally, sensitivity analyses examined the role of parents in accepting HPV vaccinations for children of different sexes. RESULTS: Based on 86 studies, we found that parents generally supported HPV vaccinations for their children, yet HPV vaccine acceptance rates showed high variation (12.0 to 97.5%). The subgroup analysis revealed geographical variations in pooled parental HPV vaccine acceptance rates, with the highest rate observed in Africa (79.6%; 95% CI: 73.5-85.2; I² = 98.3%; p < 0.01) and the lowest in North America (56.7%; 95% CI: 49.3-64.0; I² = 99.4%; p < 0.01). Sensitivity analyses showed that acceptance was higher for daughters than for sons, with mothers more willing to get their daughters vaccinated. The proportion of parents reporting barriers or benefits regarding HPV vaccinations varied widely (0.3-95.8%) between study regions. Across all world regions, fear of adverse effects and concerns about vaccine safety were the main barriers, whereas the desire to protect their children from cancer was a significant predictor of vaccine acceptance. Knowledge levels varied widely (6.5 to 100%) between world regions and according to the questions asked. In most studies, knowledge e.g., that HPV is sexually transmitted, and that HPV vaccination provides protection against cervical cancer, ranged from moderate to high. CONCLUSIONS: The results indicated moderate parental acceptance of HPV vaccines. Public knowledge of HPV infection should be promoted, and special efforts should be made to minimize the existing barriers and increase vaccination accessibility and uptake.

A tree-based modeling approach for matched case-control studies.

Conditional logistic regression (CLR) is the indisputable standard method for the analysis of matched case-control studies. However, CLR is strongly restricted with respect to the inclusion of non-linear effects and interactions of confounding variables. A novel tree-based modeling method is proposed which accounts for this issue and provides a flexible framework allowing for a more complex confounding structure. The proposed machine learning model is fitted within the framework of CLR and, therefore, allows to account for the matched strata in the data. A simulation study demonstrates the efficacy of the method. Furthermore, for illustration the method is applied to a matched case-control study on cervical cancer.

Colposcopy non-attendance following an abnormal cervical cancer screening result: a prospective population-based cohort study.

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 prospective cohort study were analysed. Co-test screen-positive women (atypical squamous cells of undetermined significance or worse [ASC-US+] or high-risk human papillomavirus [hrHPV] positive) aged 30 to 65 years were referred to colposcopy within two screening rounds (3-year interval). Women were surveyed for sociodemographic, HPV-related and other data, and interviewed for non-attendance reasons. Logistic regression was used to examine potential associations with colposcopy attendance. RESULTS: At baseline, 2,627 women were screened (screen-positive = 8.7%), and 2,093 again at follow-up (screen-positive = 5.1%; median 2.7 years later). All screen-positives were referred to colposcopy, however 28.9% did not attend despite active recall. Among co-test positives (ASC-US+ and hrHPV) and only hrHPV positives, 19.6% were non-attendees. Half of only ASC-US+ screenees attended colposcopy. Middle age (adjusted odds ratio [aOR] = 1.55, 95% CI 1.02, 4.96) and hrHPV positive result (aOR = 3.04, 95% CI 1.49, 7.22) were associated with attendance. Non-attendance was associated with having ≥ 3 children (aOR = 0.32, 95% CI 0.10, 0.86). Major reasons for non-attendance were lack of time, barriers such as travel time, need for childcare arrangements and the advice against colposcopy given by the gynaecologist who conducted screening. CONCLUSIONS: Follow-up rates of abnormal screening results needs improvement. A systematic recall system integrating enhanced communication and addressing follow-up barriers may improve screening effectiveness.

Ammonia emissions from agriculture and their contribution to fine particulate matter: A review of implications for human health.

Atmospheric ammonia (NH3) released from agriculture is contributing significantly to acidification and atmospheric NH3 may have on human health is much less readily available. The potential direct impact of NH3 on the health of the general public is under-represented in scientific literature, though there have been several studies which indicate that NH3 has a direct effect on the respiratory health of those who handle livestock. These health impacts can include a reduced lung function, irritation to the throat and eyes, and increased coughing and phlegm expulsion. More recent studies have indicated that agricultural NH3 may directly influence the early on-set of asthma in young children. In addition to the potential direct impact of ammonia, it is also a substantial contributor to the fine particulate matter (PM2.5) fraction (namely the US and Europe); where it accounts for the formation of 30% and 50% of all PM2.5 respectively. PM2.5 has the ability to penetrate deep into the lungs and cause long term illnesses such as Chronic Obstructive Pulmonary Disease (COPD) and lung cancer. Hence, PM2.5 causes economic losses which equate to billions of dollars (US) to the global economy annually. Both premature deaths associated with the health impacts from PM2.5 and economic losses could be mitigated with a reduction in NH3 emissions resulting from agriculture. As agriculture contributes to more than 81% of all global NH3 emissions, it is imperative that food production does not come at a cost to the world's ability to breathe; where reductions in NH3 emissions can be easier to achieve than other associated pollutants.

Knowledge, opinions and expectations of adults concerning personalised genotype-based dietary recommendations: a German survey.

OBJECTIVE: To assess the knowledge, opinions and expectations of persons with and without obesity concerning personalised genotype-based nutrition. DESIGN: Questions about nutrition, weight management and personalised genotype-based dietary recommendations were asked via standardised telephone-based interviews. Sociodemographic and anthropometric data were collected. The data were statistically weighted by age, gender, education, domicile and BMI. SETTING: Germany. PARTICIPANTS: Representative sample of the German population (n 1003) randomly sampled via a scientific Random Digit dial method plus 354 adults with a BMI ≥ 30·0 kg/m2 to enlarge the sample. RESULTS: Data of 1357 participants were analysed (51·1 % female, age: 50·5 ± 18·5 years, 15·9 % adults with a BMI ≥ 30·0 kg/m2). About 42 % or 19 % of the survey participants stated to know the terms personalised dietary recommendation or genotype-based dietary recommendation, respectively. Of those, 15·8 % indicated to have an experience with a personalised or genotype-based dietary recommendation. Almost 70 % of the survey participants believed that a genotype-based dietary recommendation is a reasonable measure for weight management. About 55 % of the survey participants pointed out that a genotype-based dietary recommendation is an effective concept in general. One-third of the survey participants (34·6 %) indicated to conceive the usage of a genotype-based dietary recommendation. CONCLUSION: Most of the survey participants did not know the term personalised or genotype-based dietary recommendation. One-third of the study participants are interested to use a genotype-based dietary recommendation. Therefore, more education of the public is necessary to properly help people making informed and serious decisions and assessing commercially available direct-to-consumer genetic tests.

Effect of legroom proportions and individual factors for sitting with crossed legs: implications on the interior design of automated driving vehicles.

Sitting with crossed legs is a commonly adopted sitting posture in everyday situations. Yet, little is known about suitable design criteria to facilitate such a position inside a vehicle. This study is aimed at determining how much space is necessary for crossing the legs while considering legroom restrictions, anthropometric measures, and individual flexibility. More specifically, 3 D-kinematics of an ankle-on-knee leg-crossing task and the easiness to move ratings of 30 participants were assessed with restrictions of the legroom (2 heights × 3 distances) as well as without restrictions. Functional regression models revealed adaptations to a legroom restriction in the execution of movement, which occurred mainly in the knee joint and increased with more restricted legroom proportions. Therefore, the present study suggests a distance of 120% of the buttock-knee length between the dashboard and the occupant, as it requires only moderate adaptations and does not affect the perceived easiness of move. Practitioner Summary: This research investigated how much space is needed to cross the legs while sitting in a vehicle, finding that the movement execution is affected by legroom proportions, as well as individual anthropometry and flexibility. The study further presents the use of predicted motion traces to determine spatial requirements of movements. Abbreviations: BKL: buttock-knee length; H-point: hip point.

A regularization approach for the detection of differential item functioning in generalized partial credit models.

Most common analysis tools for the detection of differential item functioning (DIF) in item response theory are restricted to the use of single covariates. If several variables have to be considered, the respective method is repeated independently for each variable. We propose a regularization approach based on the lasso principle for the detection of uniform DIF. It is applicable to a broad range of polytomous item response models with the generalized partial credit model as the most general case. A joint model is specified where the possible DIF effects for all items and all covariates are explicitly parameterized. The model is estimated using a penalized likelihood approach that automatically detects DIF effects and provides trait estimates that correct for the detected DIF effects from different covariates simultaneously. The approach is evaluated by means of several simulation studies. An application is presented using data from the children's depression inventory.

Impacts of global warming on confined livestock systems for growing-fattening pigs: simulation of heat stress for 1981 to 2017 in Central Europe.

In the mid-latitudes, pigs and poultry are kept predominantly in confined livestock buildings with a mechanical ventilation system. In the last decades, global warming has already been a challenge which causes hat stress for animals in such systems. Heat stress inside livestock buildings was assessed by a simulation model for the indoor climate, which is driven by meteorological parameters. Besides the meteorological conditions, the thermal environment inside the building depends on the sensible and latent energy release of the animals, the thermal properties of the building and the ventilation system and its control unit. For a site in Austria in the north of the Alpine Ridge, which is representative for confined livestock buildings for growing-fattening pigs in Central Europe, meteorological data between 1981 and 2017 were used for the model calculations of heat stress measures. This business-as-usual simulation over these 37 years resulted in an increase of the mean relative annual heat stress parameters in the range between 0.9 and 6.4% per year since 1981. In order to minimise the negative economic impact as the consequence of this positive trend of heat stress, adaptation measures are needed. The calculations for growing-fattening pigs show that such a simulation model for the indoor climate is an appropriate tool to determine the level of heat stress of livestock inside confined livestock buildings.

Do odour impact criteria of different jurisdictions ensure analogous separation distances for an equivalent level of protection?

Governments are increasingly introducing odour impact criteria (OIC) to determine separation distances between odour sources and residential areas. Previous studies have shown the wide range of OIC available for this purpose, depending on the desired level of protection against odour annoyance. However, it is unclear whether OIC with similar levels of protection can ensure analogous separation distances, which would reasonably be expected. This study presents a comparative analysis of separation distances calculated at two sites for different OIC, but all related to an equivalent level of protection. Here, the equivalent level of protection was defined for urban residential areas (land use), swine odour (hedonic tone) and new facilities (facility type). In this manner, the regulatory criteria currently enforced in Germany, Ireland, and Queensland (Australia) were selected as references for the investigation. The results clearly show that, even for an equivalent level of protection, disparate separation distances can be obtained. Differences in separation distances were found to be greater in prevailing wind directions compared to distances in additional wind directions. Overall, the results demonstrate a risk of poor conclusions in odour assessments. This means that care must be taken when adopting OIC for decision making, principally in those countries that have not yet established specific regulations to manage environmental odours. Concomitantly, the results stress the need for better harmonisation of the concept of the odour impact criterion and components thereof. By using perturbation analysis, it has also been found that the stack exit temperature influences the separation distances in a distinct way, reliant on the criteria used to determine the distances. This finding is of significance for input data collection in future odour modelling studies. Furthermore, approaches used to derive OIC, equivalence between dispersion modelling and field inspections (European standard EN 16841-1), as well as implications of the findings for regulatory practice are summarised and discussed.

Assessing the inter-annual variability of separation distances around odour sources to protect the residents from odour annoyance.

In recent years, there has been a growing concern about potential impacts on public health and wellbeing due to exposure to environmental odour. Separation distances between odour-emitting sources and residential areas can be calculated using dispersion models, as a means of protecting the neighbourhood from odour annoyance. This study investigates the suitability of using one single year of meteorological input data to calculate reliable direction-dependent separation distances. Accordingly, we assessed and quantified the inter-annual variability of separation distances at two sites with different meteorological conditions, one in Brazil and the other in Austria. A 5-year dataset of hourly meteorological observations was used for each site. Two odour impact criteria set in current regulations were selected to explore their effect on the separation distances. The coefficient of variation was used as a statistical measure to characterise the amount of annual variation. Overall, for all scenarios, the separation distances had a low degree of inter-annual variability (mean coefficient of variation values from 8% to 21%). Reasonable agreements from year to year were therefore observed at the two sites under investigation, showing that one year of meteorological data is a good compromise to achieve reliable accuracy. This finding can provide a more cost-effective solution to calculate separation distances in the vicinity of odour sources.

How to transport veterinary drugs in insulated boxes to avoid thermal damage by heating or freezing.

BACKGROUND: The transport of veterinary drugs must comply with the general standards for drug storage. Although many vehicles are equipped with active heating and/or cooling devices assuring recommended storage conditions, simple insulated transport boxes are also often used. In this study, measurements for typical transport boxes were performed under laboratory conditions by the use of a climate chamber for a temperature of -20 °C and 45 °C to investigate the impact of box size, insulation material, liquid vs. dry filling products, filling degree and other parameters on the thermal performance of insulated boxes. Model calculations and instructions are presented to predict the retention time of recommended drug storage temperatures. RESULTS: The measurements and the model calculations showed that the loading of the transport boxes with additional water bottles to increase the heat capacity is appropriate to prolong the retention time of the recommended temperature range of the drugs. Insulated transport boxes are not suitable to store drugs over a period of more than approximately 12 h. For practical use a recipe is presented to measure the thermal properties of a transport box and the related retention time for which the recommended storage temperatures can be assured. CONCLUSIONS: The following principles for drug transportation in vehicles are recommended: (1) Before transfer into boxes, drugs should always be thermally preconditioned (2) Increase the filling degree of the boxes with thermally preconditioned water bottles or re-usable thermal packs will increase the heat capacity. Do not deep-freeze the bottles or packs below 0 °C to avoid drug freezing due to contact. (3) Open the lid of the boxes only to uncase drugs that are immediately needed. (4) The bigger the box and the higher the filling degree, the longer the retention time of the transport box. (5) Wherever possible, place the drug box at a cool site inside the vehicle. (6) The monitoring of the inside temperature of the transport boxes is recommended. By the proper use of such transport boxes the recommended temperatures can be maintained over one working day.

An age-period-cohort analysis of hysterectomy incidence trends in Germany from 2005 to 2019.

Recent studies show declining trends in hysterectomy rates in several countries. The objective of this study was to analyse hysterectomy time trends in Germany over a fifteen-year period using an age-period-cohort approach. Using an ecological study design, inpatient data from Diagnoses Related Group on hysterectomies by subtype performed in Germany from 2005 to 2019 were retrieved from the German Statistical Office. Descriptive time trends and age-period-cohort analyses were then performed. A total of 1,974,836 hysterectomies were performed over the study period. The absolute number of hysterectomies reduced progressively from 155,680 (365 procedures/100,000 women) in 2005 to 101,046 (257 procedures/100,000 women) in 2019. Total and radical hysterectomy decreased by 49.7% and 44.2%, respectively, whilst subtotal hysterectomy increased five-fold. The age-period-cohort analysis revealed highest hysterectomy rates in women aged 45-49 for total and subtotal hysterectomy with 608.63 procedures/100,000 women (95% CI 565.70, 654.82) and 151.30 procedures/100,000 women (95% CI 138.38, 165.44) respectively. Radical hysterectomy peaked later at 65-69 years with a rate of 40.63 procedures/100,000 women (95% CI 38.84, 42.52). The risk of undergoing total or radical hysterectomy decreased over the study period but increased for subtotal hysterectomy. Although, overall hysterectomy rates have declined, subtotal hysterectomy rates have increased; reflecting changes in clinical practice largely influenced by the availability of uterus-sparing options, evolving guidelines and introduction of newer surgical approaches.

Association Between the Postprandial Response to an Oral Glucose Tolerance Test and Anthropometric Changes After an 8-Week Low-Calorie Formula Diet - Results From the Lifestyle Intervention (LION) Study.

SCOPE: Interindividual variations in postprandial metabolism and weight loss outcomes have been reported. The literature suggests links between postprandial metabolism and weight regulation. Therefore, the study aims to evaluate if postprandial glucose metabolism after a glucose load predicts anthropometric outcomes of a weight loss intervention. METHODS AND RESULTS: Anthropometric data from adults with obesity (18-65 years, body mass index [BMI] 30.0-39.9 kg m-2) are collected pre- and post an 8-week formula-based weight loss intervention. An oral glucose tolerance test (OGTT) is performed at baseline, from which postprandial parameters are derived from glucose and insulin concentrations. Linear regression models explored associations between these parameters and anthropometric changes (∆) postintervention. A random forest model is applied to identify predictive parameters for anthropometric outcomes after intervention. Postprandial parameters after an OGTT of 158 participants (63.3% women, age 45 ± 12, BMI 34.9 ± 2.9 kg m-2) reveal nonsignificant associations with changes in anthropometric parameters after weight loss (p > 0.05). Baseline fat-free mass (FFM) and sex are primary predictors for ∆ FFM [kg]. CONCLUSION: Postprandial glucose metabolism after a glucose load does not predict anthropometric outcomes after short-term weight loss via a formula-based low-calorie diet in adults with obesity.

Clusters of longitudinal risk profile trajectories are associated with cardiometabolic diseases: Results from the population-based KORA cohort.

BACKGROUND: Multiple risk factors contribute jointly to the development and progression of cardiometabolic diseases. Therefore, joint longitudinal trajectories of multiple risk factors might represent different degrees of cardiometabolic risk. METHODS: We analyzed population-based data comprising three examinations (Exam 1: 1999-2001, Exam 2: 2006-2008, Exam 3: 2013-2014) of 976 male and 1004 female participants of the KORA cohort (Southern Germany). Participants were followed up for cardiometabolic diseases, including cardiovascular mortality, myocardial infarction and stroke, or a diagnosis of type 2 diabetes, until 2016. Longitudinal multivariate k-means clustering identified sex-specific trajectory clusters based on nine cardiometabolic risk factors (age, systolic and diastolic blood pressure, body-mass-index, waist circumference, Hemoglobin-A1c, total cholesterol, high- and low-density lipoprotein cholesterol). Associations between clusters and cardiometabolic events were assessed by logistic regression models. RESULTS: We identified three trajectory clusters for men and women, respectively. Trajectory clusters reflected a distinct distribution of cardiometabolic risk burden and were associated with prevalent cardiometabolic disease at Exam 3 (men: odds ratio (OR)ClusterII = 2.0, 95% confidence interval: (0.9-4.5); ORClusterIII = 10.5 (4.8-22.9); women: ORClusterII = 1.7 (0.6-4.7); ORClusterIII = 5.8 (2.6-12.9)). Trajectory clusters were furthermore associated with incident cardiometabolic cases after Exam 3 (men: ORClusterII = 3.5 (1.1-15.6); ORClusterIII = 7.5 (2.4-32.7); women: ORClusterII = 5.0 (1.1-34.1); ORClusterIII = 8.0 (2.2-51.7)). Associations remained significant after adjusting for a single time point cardiovascular risk score (Framingham). CONCLUSIONS: On a population-based level, distinct longitudinal risk profiles over a 14-year time period are differentially associated with cardiometabolic events. Our results suggest that longitudinal data may provide additional information beyond single time-point measures. Their inclusion in cardiometabolic risk assessment might improve early identification of individuals at risk.

An audit of 1632 routinely collected cervical cancer screening smears from 398 women in Germany: Results from the TeQaZ Study.

OBJECTIVE: There is evidence in Germany that half of the cervical cancer (CC) cases had undergone screening frequently in the decade preceding their diagnosis, signaling cytology quality issues. This study investigates routine smear assessment accuracy in Germany. METHODS: Within a population-based case-control study in 9 German states, we recruited cases (women with a histologically confirmed diagnosis of CC) and population controls (women with no history of CC or hysterectomy). Two independent expert cytologists audited Pap smears taken within the 10 years preceding CC diagnosis (cases)/study entry (controls). We report the prevalence of positive results, as well as routine assessment's accuracy, as sensitivity, specificity, false-positive and false-negative rates along with 95% confidence intervals (95% CI). We also examined cases' smear history, to investigate possible false-positive recurrence. RESULTS: We audited 1632 smears of 392 women (18.9% cases, 81.1% controls). In the routine assessment, the overall prevalence of positive results was 4.5% (29.0% among cases). According to the expert audit, the overall prevalence of positive results was 7.7% (40.8% among cases). When restricting analyses to the 3 years preceding diagnosis/study entry, this prevalence increased to 11.9% overall (61.4% among cases). The overall sensitivity of the routine assessment was 54.9% (66.8% for cases). CONCLUSION: As cytology remains an important part of CC screening, quality issues must be urgently addressed in Germany. Shifting to objective methods such as primary high-risk HPV screening followed by triaging may help CC elimination in Germany.

Analysis of health claims data on vaccination coverage in older adults in Bavaria, Germany: Influenza, pneumococcus and herpes zoster.

BACKGROUND: Vaccination is essential, especially in older adults whose immune system function declines with age. The COVID-19 pandemic and its associated lockdowns temporarily disrupted routine vaccination services. We aimed to assess vaccination coverage for Influenza, Pneumococcus, and Herpes zoster among older adults in Bavaria over time and investigate potential pandemic effects on these rates. METHODS: Based on health claims data from the Bavarian Association of Statutory Health Insurance Physicians (KVB), we estimated the percentage of adults aged 60 years and older vaccinated following the German Standing Committee on Vaccinations (STIKO) recommendation for Influenza (2012-2021), Pneumococcus (2017-2021) and Herpes zoster (2019-2021), stratified by sex and 10-year age groups. Using time series regression analysis, we estimated the effect of the pandemic period (2020-2021) on quarterly Influenza and Pneumococcal vaccination rates. RESULTS: In the first year of the pandemic (2020), Influenza, Pneumococcus and Herpes zoster coverage in both sexes increased by 9.9, 8.7, and 2.5 percentage points (pp), respectively. In 2021, Influenza coverage decreased by 4.7 pp., while Pneumococcus and Herpes zoster coverage increased by 2.7 and 3.8 pp., respectively. Influenza and Pneumococcal vaccinations showed a seasonal pattern, with vaccinations occurring mainly in the fourth quarter; this pattern was distorted for Pneumococcus during the pandemic. Per the time series regression analysis, Influenza vaccination rates in the fourth quarters of 2020 and 2021 were 7.86 (95 %CI: 5.10-10.62) and 8.87 (95 %CI: 5.80-11.54) pp. higher for males and females, respectively, compared to that of the pre-pandemic period. During the pandemic, the quarterly Pneumococcal vaccination rates increased by 0.68 (95 %CI: 0.19-1.18) pp. in males and 0.80 (95 %CI: 0.30-1.30) pp. in females. CONCLUSION: The heightened increase in vaccination rates observed in 2020 may have resulted from increased vaccination awareness during the pandemic. As the pandemic effect wanes, more efforts are needed to sustain and increase these vaccination rates.

Plasma exogenous creatinine excretion for the assessment of renal function in avian medicine--pharmacokinetic modeling in racing pigeons (Columba livia).

The diagnostic evaluation of the glomerular filtration rate by urinary clearance has significant practical limitations in birds because urine is excreted together with feces. Thus, pharmacokinetic modeling of an exogenous plasma creatinine clearance could be useful for assessing renal creatinine excretion in birds. For this study, creatinine (50 mg/kg) was administered to 2 groups of 15 pigeons (Columba livia) each; in one group by the intravenous (IV) route and in the second by the intramuscular (IM) route. The time series of the plasma creatinine concentrations were analyzed by pharmacokinetic models. Body mass-specific creatinine excretion was determined for IV and IM administration to be between 6.30 and 6.44 mL/min per kg, respectively. Body surface area-specific creatinine clearance, which is related to the metabolic rate, was calculated between 0.506 and 0.523 mL/min per dm2, respectively. The results showed that IV as well as IM administration can be used for assessing renal creatinine excretion in pigeons. For practical reasons, IM administration is recommended, with the use of the Bateman function to calculate creatinine elimination.