Aktueller Stand und zukünftige Entwicklung der prä- und postnatalen Vorsorge- bzw. Screeninguntersuchungen – Evidenz tut Not

Hebebrand, Julian; Hamelmann, Eckard; Hartmann, A.; Holtmann, Martin; Jöckel, Karl Heinz; Kremer, U.; Legenbauer, Tanja; Lücke, Thomas; Radkowski, K.; Reinehr, T; Wand, K.; Mühlig, Yvonne; Föcker, Manuel

doi:10.1055/s-0042-118187

Cited by 2 publications

(4 citation statements)

References 25 publications

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“…We, therefore, included and investigated the Arg/NO pathway in the NIKI Study in pediatric patients with AD, BA and AD + BA. In a sub-cohort of the NIKI Study [45][46][47], we measured several metabolites of the Arg/NO pathway in plasma and urine samples in order to evaluate potential associations of this pathway with atopic diseases. Children with ADHD only served as a control group for patients with atopic diseases, as the NIKI study included ADHD (see below).…”

Section: Resultsmentioning

confidence: 99%

Characterization of the L-Arginine/Nitric Oxide Pathway and Oxidative Stress in Pediatric Patients with Atopic Diseases

Hanusch

Sinningen

Brinkmann

et al. 2022

IJMS

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Introduction: L-Arginine (Arg) is a semi-essential amino acid. Constitutive and inducible nitric oxide synthase (NOS) isoforms convert Arg to nitric oxide (NO), a potent vaso- and bronchodilator with multiple biological functions. Atopic dermatitis (AD) and bronchial asthma (BA) are atopic diseases affecting many children globally. Several studies analyzed NO in airways, yet the systemic synthesis of NO in AD and BA in children with BA, AD or both is elusive. Methods: In a multicenter study, blood and urine were obtained from 130 of 302 participating children for the measurement of metabolites of the Arg/NO pathway (BA 31.5%; AD 5.4%; AD + BA 36.1%; attention deficit hyperactivity disorder (ADHD) 12.3%). In plasma and urine amino acids Arg and homoarginine (hArg), both substrates of NOS, asymmetric dimethylarginine (ADMA) and symmetric dimethylarginine (SDMA), both inhibitors of NOS, dimethylamine (DMA), and nitrite and nitrate, were measured by gas chromatography–mass spectrometry. Malondialdehyde (MDA) was measured in plasma and urine samples to evaluate possible effects of oxidative stress. Results: There were no differences in the Arg/NO pathway between the groups of children with different atopic diseases. In comparison to children with ADHD, children with AD, BA or AD and BA had higher plasma nitrite (p < 0.001) and nitrate (p < 0.001) concentrations, suggesting higher systemic NO synthesis in AD and BA. Urinary excretion of DMA was also higher (p = 0.028) in AD and BA compared to patients with ADHD, suggesting elevated ADMA metabolization. Discussion/Conclusion: The Arg/NO pathway is activated in atopic diseases independent of severity. Systemic NO synthesis is increased in children with an atopic disease. Plasma and urinary MDA levels did not differ between the groups, suggesting no effect of oxidative stress on the Arg/NO pathway in atopic diseases.

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Section: Resultsmentioning

confidence: 99%

Characterization of the L-Arginine/Nitric Oxide Pathway and Oxidative Stress in Pediatric Patients with Atopic Diseases

Hanusch

Sinningen

Brinkmann

et al. 2022

IJMS

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“…Results from long-term studies are particularly important in this context in order to be able to show the effects into adulthood, for example concerning diseases that often only manifest in middle to old age. In most studies, however, the follow-up periods in this context are too short [ 16 , 46 ]. Another difficulty is the comparability of findings between different countries, as the services offered differ considerably and, if the related outcomes are assessed, different measures are often used [ 47 , 48 ].…”

Section: Discussionmentioning

confidence: 99%

“…However, the costs for the U10, U11 and J2 examinations are not yet reimbursed by all health insurance funds and are not part of the standard care in Germany. One reason for this is that their effectiveness has not yet been adequately evaluated [ 3 , 16 ]. For this reason, the present results, which partially confirm the effectiveness of the examinations, represent an important contribution to the creation of an evidence base for these screening measures in children and adolescents.…”

Section: Discussionmentioning

confidence: 99%

“…For this reason, it will also be investigated whether the generated results apply to all subgroups irrespective of education and income among other things. However, there is limited evidence for the effectiveness of screening examinations for children and adolescents [ 16 ]. Thus, this analysis is intended to contribute to the creation of an evidence base for screening programmes in children and adolescents.…”

Section: Introductionmentioning

confidence: 99%

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The effectiveness of additional screening examinations for children and adolescents in Germany: a longitudinal retrospective cohort study

Krüger

Lapstich

Reber³

et al. 2023

BMC Pediatr

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Background Continuous medical care is particularly important in childhood and adolescence. Since there are gaps in regular care in Germany, various health insurance providers offer to cover additional examinations (e.g., U10, U11, J2) to ensure ongoing paediatrician visits. However, the question arises as to whether these examinations are effective. Thus, the main objective of this study is to determine whether participation in the U10, U11 or J2 examinations leads to more frequent and earlier diagnosis and treatment of age-specific diseases. Methods The analyses are based on administrative claims data from a statutory health insurance fund. For each examination, an intervention group (IG) is formed and matched with a corresponding control group (CG). Descriptive analyses include proportion with diagnosis and treatment, average age of diagnosis and treatment initiation. Hypothesis testing is performed using methods appropriate to each. In addition, subgroup analyses and binominal logistic regression models are conducted. Results More diagnoses are detected in IG, irrespective of subgroups. Additionally, diagnoses are made slightly earlier on average in IG. In the total samples, more therapies are initiated in IG, and slightly earlier. Considering only diagnosed cases, more therapies are initiated in CG but continue to be started earlier in IG. Regression models show that participation in the examinations has the highest predictive power for detecting a diagnosis. The presence of a chronic disease and sex - male at the U10 and U11 and female at the J2 - are also significantly associated. The models further show that nationality, unemployment of parents and region also have a significant influence in some cases, whereas school-leaving qualification, vocational qualification and income of parents do not. Considering the initiation of treatment in overall samples, the models show similar results, but here the presence of a chronic illness has the highest predictive power. Conclusion The results indicate that participation in the examinations leads to significantly more diagnoses and, in the overall samples, significantly more treatments. In addition, diagnoses were made somewhat earlier and therapies were initiated somewhat earlier. In the future, it would be useful to investigate the U10, U11 and J2 examinations over a longer time horizon to determine whether the statistically significant difference found is also clinically relevant, i.e., earlier diagnosis and initiation of therapy lead to prevention of manifestation or progression of the diagnosed diseases and to avoidance of secondary diseases. Trial registration German Clinical Trials Register (DRKS), DRKS-ID: DRKS00015280. Prospectively registered on 18 March 2019.

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Aktueller Stand und zukünftige Entwicklung der prä- und postnatalen Vorsorge- bzw. Screeninguntersuchungen – Evidenz tut Not

Cited by 2 publications

References 25 publications

Characterization of the L-Arginine/Nitric Oxide Pathway and Oxidative Stress in Pediatric Patients with Atopic Diseases

Characterization of the L-Arginine/Nitric Oxide Pathway and Oxidative Stress in Pediatric Patients with Atopic Diseases

The effectiveness of additional screening examinations for children and adolescents in Germany: a longitudinal retrospective cohort study

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