Raffaella Matteucci Gothe - Academia.edu (original) (raw)

Papers by Raffaella Matteucci Gothe

Research paper thumbnail of Mercury Exposure Data from Gold Miners in Indonesia, Mongolia, Philippines, Tanzania and Zimbabwe

ISEE Conference Abstracts

Background and aims: In many developing countries, gold mining is performed using mercury. Mercur... more Background and aims: In many developing countries, gold mining is performed using mercury. Mercury is used to extract gold from ore. Mercury exposure leads to negative health effects. The aim of th...

Research paper thumbnail of Update: Trends in the treatment of intracranial aneurysms in Austria 1999–2013 – A population-based study using administrative data

Objective: The structure of the public health system in Austria allows for an analysis of trends ... more Objective: The structure of the public health system in Austria allows for an analysis of trends in population-based data regarding incidence, treatment modality and outcome for intracranial aneurysms (IAs) with minimal inclusion bias. Method: All IAs treated between 1999 and 2013 were identified[for full text, please go to the a.m. URL]

Research paper thumbnail of Energy metabolism measured by 31P magnetic resonance spectroscopy in the healthy human brain

Journal of Neuroradiology, 2021

BACKGROUND AND PURPOSE Phosphorous magnetic resonance spectroscopy (31P-MRS) allows a non-invasiv... more BACKGROUND AND PURPOSE Phosphorous magnetic resonance spectroscopy (31P-MRS) allows a non-invasive analysis of phosphorus-containing compounds in vivo. The present study investigated the influence of brain region, hemisphere, age, sex and brain volume on 31P-MRS metabolites in healthy adults. MATERIALS AND METHODS Supratentorial brain 31P-MRS spectra of 125 prospectively recruited healthy volunteers (64 female, 61 male) aged 20 to 85 years (mean: 49.4 ± 16.9 years) were examined with a 3D-31P-MRS sequence at 3T, and the compounds phosphocreatine (PCr), inorganic phosphate (Pi) and adenosine triphosphate (ATP) were measured. From this data, the metabolite ratios PCr/ATP, Pi/ATP and PCr/Pi were calculated for different brain regions. In addition, volumes of grey matter, white matter and cerebrospinal fluid were determined. RESULTS For all metabolite ratios significant regional differences and in several regions sex differences were found. In some brain regions and for some metabolites hemispheric differences were detected. In addition, changes with ageing were found, which differed between women and men. CONCLUSIONS The present results indicate that 31P-MRS metabolism varies throughout the brain, with age and between sexes, and therefore have important practical implications for the design and the interpretation of future 31P-MRS studies under physiological conditions and in patients with various cerebral diseases.

Research paper thumbnail of Onset features and time to diagnosis in Friedreich’s Ataxia

Orphanet Journal of Rare Diseases, 2020

Background In rare disorders diagnosis may be delayed due to limited awareness and unspecific pre... more Background In rare disorders diagnosis may be delayed due to limited awareness and unspecific presenting symptoms. Herein, we address the issue of diagnostic delay in Friedreich’s Ataxia (FRDA), a genetic disorder usually caused by homozygous GAA-repeat expansions. Methods Six hundred eleven genetically confirmed FRDA patients were recruited within a multicentric natural history study conducted by the EFACTS (European FRDA Consortium for Translational Studies, ClinicalTrials.gov-Identifier NCT02069509). Age at first symptoms as well as age at first suspicion of FRDA by a physician were collected retrospectively at the baseline visit. Results In 554 of cases (90.7%), disease presented with gait or coordination disturbances. In the others (n = 57, 9.3%), non-neurological features such as scoliosis or cardiomyopathy predated ataxia. Before the discovery of the causal mutation in 1996, median time to diagnosis was 4(IQR = 2–9) years and it improved significantly after the introduction o...

Research paper thumbnail of Linkage von klinischen Primärdaten und Krankenkassenabrechnungsdaten in der Evaluation der Schlaganfallversorgung – SeDaStro: Erfahrungen aus dem Tiroler StrokeCard-Programm

Das Gesundheitswesen, 2020

Zusammenfassung Hintergrund Und Zielsetzung Datenlinkage-Verfahren sind von erheblicher Bedeutung... more Zusammenfassung Hintergrund Und Zielsetzung Datenlinkage-Verfahren sind von erheblicher Bedeutung für die Evaluation von Therapieregimes chronischer Erkrankungen, bei denen Patient/inn/en zwischen verschiedenen Versorgungssektoren navigieren. Ein umfassendes Bild langfristiger Effekte und der Kosten-Effektivität der Behandlung kann nur gezeichnet werden, wenn Daten verschiedener Provenienz miteinander verknüpft werden. Methodische Probleme und Herausforderungen Am Beispiel der post-akuten Versorgung des Schlaganfalls veranschaulicht die vorliegende Studie, wie per exaktem deterministischem Datenlinkage klinische Patient/inn/endaten (Primärdaten) mit Routineabrechnungsdaten (Sekundärdaten) der Tiroler Gebietskrankenkasse (TGKK) verknüpft werden können. Die von Datenlinkage-Projekten bekannten Herausforderungen traten auch beim StrokeCard-Projekt der Medizinischen Universität Innsbruck auf, insgesamt jedoch begünstigten die Spezifika des österreichischen Gesundheitssystems (ein Großte...

Research paper thumbnail of Recurrence of genitals warts in pre-HPV vaccine era after laser treatment

Archives of Gynecology and Obstetrics, 2019

Purpose Human papillomavirus (HPV) can cause condylomata acuminata, also known as genital warts. ... more Purpose Human papillomavirus (HPV) can cause condylomata acuminata, also known as genital warts. Our aim was to evaluate the long-term recurrence of genital warts after primary carbon dioxide laser treatment before the introduction of the vaccination against HPV. Methods Recurrence rate and localization of genital warts were analysed in a retrospective study in 1798 women presenting with a new diagnosis of genital warts from 1992 to 2009 at a University hospital and had received laser treatment. Additionally, data on topography, pregnancy status, and cervical smear were available for women treated from 2003 to 2009 (n = 825, data subset 1) and systematic follow-up data for women treated in 2006 and 2007 (n = 242, data subset 2). Results Median time from laser treatment to first recurrence was 14.6 weeks (data subset 2). The site most affected was the vulva (90.7%) followed by the perineum/perianal region (59.3%) and the vagina (47.3%). Abnormal Pap smear was observed in 22.6%. Systematic follow-up with a median follow-up time of 3.1 years revealed at least one recurrence in 68 (28.1%) of 242 women. Women with multifocal genital warts had a 2.9 times increased risk for recurrence compared to women with unifocal lesions (p = 0.01). Conclusions Nearly 30% of women presenting with genital warts experienced at least one recurrence after treatment with carbon dioxide laser. Multifocal lesions are the strongest indicator of recurrence. These data provide an important insight to recurrence rates of genital warts before HPV vaccination and underline the significance of a long-term follow-up and HPV vaccination.

Research paper thumbnail of Assessing Type and Impact of Biases Potentially Occurring when Analyzing Real World Evidence: The Case of Second Line Treatment for Ovarian Cancer

Value in Health, 2018

s213 time-dependent covariate to account for immortal time bias, the corresponding crude and adju... more s213 time-dependent covariate to account for immortal time bias, the corresponding crude and adjusted HR increased to 1.665 (95%CI 1.459-1.901) and 1.683 (95%CI 1.407-2.014). Applying a causal (counterfactual) analysis using IPCW and replication yielded a HR of 1.067 (95%CI 1.020-1.115), which matched the results of a published randomized clinical trial. ConClusions: When using routine RWE data, DAGs can guide the identification of potential biases and variables that need to be controlled for. In our analysis, potential biases were substantial with different directions. Only the application of the target trial and replication approach in combination with a causal analysis matched data from clinical trials.

Research paper thumbnail of Comparative Effectiveness Analysis Using Real World Evidence (RWE) and Applying a Causal Marginal Structural Model: the Case of Second-Line Treatment in Patients with Ovarian Cancer

Value in Health, 2018

ObjectiveS: VATS-S is a newly introduced surgical technique in the treatment of stage I NSCLC. Ho... more ObjectiveS: VATS-S is a newly introduced surgical technique in the treatment of stage I NSCLC. However, owing to small sample sizes of relevant clinical studies, there is no conclusive evidence of the relative benefit between the outcomes of VATS-S and VATS-L in Chinese patients. This meta-analysis offers the first robust comparative assessment of the safety and clinical outcomes of VATS-S versus VATS-L in Chinese patients with NSCLC-I. MethOdS: A thorough search of major electronic databases was conducted to identify surgical studies on Chinese patients with NSCLC-I till September 2017. Random-effects meta-analysis was used to estimate risk ratios (RRs, 95% CI) and mean differences (MD, 95% CI) for dichotomous and continuous variables, respectively. The main outcomes and measures were operating room time (ORT), intraoperative blood loss (BL), number of lymph nodes resected (LNRN), total volume of chest tube drainage postoperatively (TVCTD), chest tube duration (CTD), length of stay (LOS), post-operative complications (POC), overall cancer recurrence rate (ORR), local cancer recurrence rate (LRR) and distal cancer recurrence rate (DRR). ReSultS: 7 studies, with 762 NSCLC-I patients (229 VATS-S, 533 VATS-L), were included. Patient characteristic baselines were matched between 2 groups, including age (p= 0.22), gender (p= 0.67) and comorbidity rate (p= 0.37). The average follow-up time was 10.2 to 27 months. VATS-S group was associated with a reduction in TVCTD by 224.42 ml (MD:-224.42, 95%CI (-345.06,-103.79), p= 0.0003); a reduction of CTD by 0.73 days (-1.42,-0.03; p= 0.04); and a reduction of LOS by 0.58 days (-1.04,-0.11; p= 0.02). There was no significant difference between the groups in BL, LNRN, POC, ORT, ORR, LRR, and DRR. cOncluSiOnS: VATS-S is a less invasive surgical technique which is associated with less chest tube drainage volume, shorter chest tube duration, and shorter length of stay compared to VATS-L in the treatment of Chinese patients with stage I NSCLC.

Research paper thumbnail of Mediator Effect of Balance Problems on Association Between Grip Strength and Falls in Older Adults: Results From the KORA-Age Study

Gerontology and Geriatric Medicine, 2018

Barbara Thorand and Christa Meisinger contributed equally.

Research paper thumbnail of Mortality of Critically Ill Children Requiring Continuous Renal Replacement Therapy: Effect of Fluid Overload, Underlying Disease, and Timing of Initiation*

Pediatric Critical Care Medicine, 2018

Objective: To identify risk factors associated with mortality in critically ill children requirin... more Objective: To identify risk factors associated with mortality in critically ill children requiring continuous renal replacement therapy. Design: Retrospective observational study based on a prospective registry. Setting: Tertiary and quaternary referral 30-bed PICU. Patients: Critically ill children undergoing continuous renal replacement therapy were included in the study. Interventions: Continuous renal replacement therapy. Measurements and Main Results: Overall mortality was 36% (n = 58) among the 161 patients treated with continuous renal replacement therapy during the study period and was significantly higher in patients on extracorporeal membrane oxygenation (47.5%, 28 of 59) than in patients not requiring extracorporeal membrane oxygenation (28.4%, 29 of 102; p = 0.022). According to the admission diagnosis, we found the highest mortality in patients with onco-hematologic disease (77.8%) and the lowest in patients with renal disease (5.6%). Based on multivariate logistic regr...

Research paper thumbnail of A bias-adjusted evidence synthesis of RCT and observational data: the case of total hip replacement

Research paper thumbnail of Gender differences in the association between grip strength and mortality in older adults: results from the KORA-age study

BMC Geriatrics, 2016

Background: Reduced muscular strength in the old age is strongly related to activity impairment a... more Background: Reduced muscular strength in the old age is strongly related to activity impairment and mortality. However, studies evaluating the gender-specific association between muscularity and mortality among older adults are lacking. Thus, the objective of the present study was to examine gender differences in the association between muscular strength and mortality in a prospective population-based cohort study. Methods: Data used in this study derived from the Cooperative Health Research in the Region of Augsburg (KORA)-Age Study. The present analysis includes 1,066 individuals (mean age 76 ± 11 SD years) followed up over 3 years. Handgrip strength was measured using the Jamar Dynamometer. A Cox proportional hazard model was used to determine adjusted hazard ratios of mortality with 95% confidence intervals (95% CI) for handgrip strength. Potential confounders (i.e. age, nutritional status, number of prescribed drugs, diseases and level of physical activity) were pre-selected according to evidence-based information. Results: During the follow-up period, 56 men (11%) and 39 women (7%) died. Age-adjusted mortality rates per 1,000 person years (95% CI) were 77 (59-106), 24 (13-41) and 14 (7-30) for men and 57 (39-81), 14 (7-27) and 1 (0-19) for women for the first, second and third sex-specific tertile of muscular strength, respectively. Low handgrip strength was significantly associated with all-cause mortality among older men and women from the general population after controlling for significant confounders. Hazard ratios (95% CI) comparing the first and second tertile to the third tertle were 3.33 (1.53-7.22) and 1.42 (0.61-3.28), respectively. Respective hazard ratios (95% CI) for mortality were higher in women than in men ((5.23 (0.67-40.91) and 2.17 (0.27-17.68) versus 2.36 (0.97-5.75) and 0. 97 (0.36-2.57)). Conclusions: Grip strength is inversely associated with mortality risk in older adults, and this association is independent of age, nutritional status, number of prescribed drugs, number of chronic diseases and level of physical activity. The association between muscular strength and all-cause mortality tended to be stronger in women. It seems to be particularly important for the weakest to enhance their levels of muscular strength in order to reduce the risk of dying early.

Research paper thumbnail of Remote ischemic preconditioning in the prevention of ischemic brain damage during intracranial aneurysm treatment (RIPAT): study protocol for a randomized controlled trial

Trials, Jan 29, 2015

The treatment of intracranial aneurysms may be associated with cerebral ischemia. We hypothesize ... more The treatment of intracranial aneurysms may be associated with cerebral ischemia. We hypothesize that pre-interventional remote ischemic preconditioning (RIPC) reduces ischemic cerebral tissue damage in patients undergoing elective intracranial aneurysm treatment. This study is a single-center, prospective, randomized, double-blind explorative trial. Patients with an unruptured intracranial aneurysm admitted to Innsbruck Medical University Hospital for coiling or clipping will be consecutively randomized to either the intervention group (= RIPC by inflating an upper extremity blood-pressure cuff for 3 x 5 min to 200 mmHg) or the control group after induction of anesthesia. Participants will be randomized 1:1 to either the preconditioning group or the sham group using a random allocation sequence and block randomization. The precalculated sample size is n = 24 per group. The primary endpoint is the area-under-the-curve concentration of serum biomarkers (S100B, NSE, GFAP, MMP9, MBP, a...

Research paper thumbnail of Abstract 1063: Economic Evaluation of the Fractional Flow Reserve vs. Angiography for Multivessel Evaluation (FAME) Study

Research paper thumbnail of Diagnosis and prediction of the occurrence of acute mountain sickness measuring oxygen saturation—independent of absolute altitude?

Sleep and Breathing, 2015

Commercialization of trekking tourism enables untrained persons to participate in trekking tours.... more Commercialization of trekking tourism enables untrained persons to participate in trekking tours. Because hypoxia is one of the main purported triggers for acute mountain sickness (AMS), pulse oximetry, which measures arterial oxygen saturation (SPO2), is discussed to be a possible and useful tool for the diagnosis of AMS. The purpose of this study was to evaluate possible associations between SPO2 values and the occurrence of AMS. In 204 trekkers, SPO2 values (pulse oximetry) were measured and the Lake Louise Self-assessment Score (LLS) was administered over the first 7 days of their trekking tours. During treks at altitudes of 2500-5500 m in Nepal, India, Africa, and South America, 100 participants suffered from mild AMS, 3 participants suffered from severe AMS, and 9 participants reported both mild and severe AMS. The lowest mean SPO2 was 85.5 (95 % confidence interval (CI), 83.9-86.1 %) on day 5. SPO2 and LLS exhibited a weak to moderate negative correlation for all days of the study (ρ ranging from -0.142 to -0.370). Calculation of time-shifted associations of 24 and 48 h resulted in the disappearance of most associations. Susceptibility to headaches (odds ratio (OR) 2.9-7.2) and a history of AMS (OR 2.2-3.1) were determined to be potential risk factors for the development of AMS. Since there is no strong altitude-independent association between AMS and SPO2 during the first week of high-altitude adaptation, the implementation of pulse oximetry during trekking in order to detect and predict AMS remains questionable.

Research paper thumbnail of Human Biomonitoring Data from Mercury Exposed Miners in Six Artisanal Small-Scale Gold Mining Areas in Asia and Africa

Minerals, 2011

Objectives: In artisanal small-scale gold mining (ASGM) areas in many developing countries, mercu... more Objectives: In artisanal small-scale gold mining (ASGM) areas in many developing countries, mercury (Hg) is used to extract gold from ore. Data of 1250 participants from Indonesia, Mongolia, Philippines, Tanzania, and Zimbabwe were combined to analyze the relation between exposure in ASGM areas and body burden. Methods: Four groups were selected relating to their intensity of contact with mercury: (i) a non-exposed control group; (ii) a low exposed group with participants only living in mining areas, but not working as miners; (iii) a medium exposed group, miners living in exposed areas and working with mercury without smelting amalgam; and (iv) a high

Research paper thumbnail of Short-Term Effects of Bright Light Therapy in Adults with Chronic Nonspecific Back Pain: A Randomized Controlled Trial

Pain Medicine, 2014

Objective. The present trial evaluated incorporation of bright light therapy in the treatment of ... more Objective. The present trial evaluated incorporation of bright light therapy in the treatment of chronic nonspecific back pain (CNBP). Design. A prospective, randomized, controlled, multicenter, open design with three parallel trial arms was used.

Research paper thumbnail of PMD10 Impact Analyses of Fractional Flow Reserve-Guided Percutaneous Coronary Intervention in Patients with Multivessel Disease in France and Belgium

Research paper thumbnail of PMD40 Cost Effectiveness of Fractional Flow reserve Measurement in Multivessel Coronary Artery Disease in Belgium and France

Value in Health, 2011

medical therapies were randomized to receive either the EXPRESS or a trabeculectomy. Clinical out... more medical therapies were randomized to receive either the EXPRESS or a trabeculectomy. Clinical outcomes included intraocular pressure (IOP), use of IOP lowering medications and post-operative eye surgeries. The study follow-up was 5 years. The economic perspective was the one of the French society. EXPRESS cost was not included. Patients were considered a success if they had an IOP less than or equal to the success thresholds of 15 or 18 mmHg, without IOP lowering medications, and without having undergone further glaucoma surgery. Time to failure was analyzed using a log rank test. Costs were discounted at a 3% rate. RESULTS: 78 patients were analyzed, 39 in each arm. EXPRESS eyes had better IOP control at 1 (12.0 vs 13.9 mmHg; Pϭ0.02), 2 (11.9 vs 13.8 mmHg; Pϭ0.01) and 3 years (12.0 vs 13.5 mmHg; Pϭ0.04). The five-year failure rate was 41% for EXPRESS versus 69% for trabeculectomy (Pϭ0.005) using an 18 mmHg IOP target and 46% versus 77% (Pϭ0.001) for 15 mmHg. At year 5, 41.0% of the EXPRESS patients had an IOP lowering drug prescription versus 53.9% for the trabeculectomy patients. EXPRESS patients received 0.85 IOP lowering medications versus 1.10 in the trabeculectomy group. EXPRESS patients required less needling (2 versus 5) and had fewer cataract surgeries (5 versus 8). Without discounting, drug savings with EXPRESS equaled €277.00, €331.02 as a total. With a 3% discounting, the figures became €260.00 and €342.97, respectively. CONCLUSIONS: At 5 years after surgery, EXPRESS demonstrated that it better controls IOP than trabeculectomy, resulting in post-operative savings.

Research paper thumbnail of PCN63 Meta-Analytic, Trial-Level Approach to Validation of Progression-Free Survival as a Surrogate Endpoint in Advanced Breast Cancer

Value in Health, 2007

SD = 0.15). CONCLUSION: Results obtained thus far suggest that the HRQL of CLL patients in remiss... more SD = 0.15). CONCLUSION: Results obtained thus far suggest that the HRQL of CLL patients in remission is high. Patients utilize the additional categories provided with a 5-level instrument. However, in this case the labelled levels still attracted the greatest percentage of answers, which may be a function of the design of the questionnaire.

Research paper thumbnail of Mercury Exposure Data from Gold Miners in Indonesia, Mongolia, Philippines, Tanzania and Zimbabwe

ISEE Conference Abstracts

Background and aims: In many developing countries, gold mining is performed using mercury. Mercur... more Background and aims: In many developing countries, gold mining is performed using mercury. Mercury is used to extract gold from ore. Mercury exposure leads to negative health effects. The aim of th...

Research paper thumbnail of Update: Trends in the treatment of intracranial aneurysms in Austria 1999–2013 – A population-based study using administrative data

Objective: The structure of the public health system in Austria allows for an analysis of trends ... more Objective: The structure of the public health system in Austria allows for an analysis of trends in population-based data regarding incidence, treatment modality and outcome for intracranial aneurysms (IAs) with minimal inclusion bias. Method: All IAs treated between 1999 and 2013 were identified[for full text, please go to the a.m. URL]

Research paper thumbnail of Energy metabolism measured by 31P magnetic resonance spectroscopy in the healthy human brain

Journal of Neuroradiology, 2021

BACKGROUND AND PURPOSE Phosphorous magnetic resonance spectroscopy (31P-MRS) allows a non-invasiv... more BACKGROUND AND PURPOSE Phosphorous magnetic resonance spectroscopy (31P-MRS) allows a non-invasive analysis of phosphorus-containing compounds in vivo. The present study investigated the influence of brain region, hemisphere, age, sex and brain volume on 31P-MRS metabolites in healthy adults. MATERIALS AND METHODS Supratentorial brain 31P-MRS spectra of 125 prospectively recruited healthy volunteers (64 female, 61 male) aged 20 to 85 years (mean: 49.4 ± 16.9 years) were examined with a 3D-31P-MRS sequence at 3T, and the compounds phosphocreatine (PCr), inorganic phosphate (Pi) and adenosine triphosphate (ATP) were measured. From this data, the metabolite ratios PCr/ATP, Pi/ATP and PCr/Pi were calculated for different brain regions. In addition, volumes of grey matter, white matter and cerebrospinal fluid were determined. RESULTS For all metabolite ratios significant regional differences and in several regions sex differences were found. In some brain regions and for some metabolites hemispheric differences were detected. In addition, changes with ageing were found, which differed between women and men. CONCLUSIONS The present results indicate that 31P-MRS metabolism varies throughout the brain, with age and between sexes, and therefore have important practical implications for the design and the interpretation of future 31P-MRS studies under physiological conditions and in patients with various cerebral diseases.

Research paper thumbnail of Onset features and time to diagnosis in Friedreich’s Ataxia

Orphanet Journal of Rare Diseases, 2020

Background In rare disorders diagnosis may be delayed due to limited awareness and unspecific pre... more Background In rare disorders diagnosis may be delayed due to limited awareness and unspecific presenting symptoms. Herein, we address the issue of diagnostic delay in Friedreich’s Ataxia (FRDA), a genetic disorder usually caused by homozygous GAA-repeat expansions. Methods Six hundred eleven genetically confirmed FRDA patients were recruited within a multicentric natural history study conducted by the EFACTS (European FRDA Consortium for Translational Studies, ClinicalTrials.gov-Identifier NCT02069509). Age at first symptoms as well as age at first suspicion of FRDA by a physician were collected retrospectively at the baseline visit. Results In 554 of cases (90.7%), disease presented with gait or coordination disturbances. In the others (n = 57, 9.3%), non-neurological features such as scoliosis or cardiomyopathy predated ataxia. Before the discovery of the causal mutation in 1996, median time to diagnosis was 4(IQR = 2–9) years and it improved significantly after the introduction o...

Research paper thumbnail of Linkage von klinischen Primärdaten und Krankenkassenabrechnungsdaten in der Evaluation der Schlaganfallversorgung – SeDaStro: Erfahrungen aus dem Tiroler StrokeCard-Programm

Das Gesundheitswesen, 2020

Zusammenfassung Hintergrund Und Zielsetzung Datenlinkage-Verfahren sind von erheblicher Bedeutung... more Zusammenfassung Hintergrund Und Zielsetzung Datenlinkage-Verfahren sind von erheblicher Bedeutung für die Evaluation von Therapieregimes chronischer Erkrankungen, bei denen Patient/inn/en zwischen verschiedenen Versorgungssektoren navigieren. Ein umfassendes Bild langfristiger Effekte und der Kosten-Effektivität der Behandlung kann nur gezeichnet werden, wenn Daten verschiedener Provenienz miteinander verknüpft werden. Methodische Probleme und Herausforderungen Am Beispiel der post-akuten Versorgung des Schlaganfalls veranschaulicht die vorliegende Studie, wie per exaktem deterministischem Datenlinkage klinische Patient/inn/endaten (Primärdaten) mit Routineabrechnungsdaten (Sekundärdaten) der Tiroler Gebietskrankenkasse (TGKK) verknüpft werden können. Die von Datenlinkage-Projekten bekannten Herausforderungen traten auch beim StrokeCard-Projekt der Medizinischen Universität Innsbruck auf, insgesamt jedoch begünstigten die Spezifika des österreichischen Gesundheitssystems (ein Großte...

Research paper thumbnail of Recurrence of genitals warts in pre-HPV vaccine era after laser treatment

Archives of Gynecology and Obstetrics, 2019

Purpose Human papillomavirus (HPV) can cause condylomata acuminata, also known as genital warts. ... more Purpose Human papillomavirus (HPV) can cause condylomata acuminata, also known as genital warts. Our aim was to evaluate the long-term recurrence of genital warts after primary carbon dioxide laser treatment before the introduction of the vaccination against HPV. Methods Recurrence rate and localization of genital warts were analysed in a retrospective study in 1798 women presenting with a new diagnosis of genital warts from 1992 to 2009 at a University hospital and had received laser treatment. Additionally, data on topography, pregnancy status, and cervical smear were available for women treated from 2003 to 2009 (n = 825, data subset 1) and systematic follow-up data for women treated in 2006 and 2007 (n = 242, data subset 2). Results Median time from laser treatment to first recurrence was 14.6 weeks (data subset 2). The site most affected was the vulva (90.7%) followed by the perineum/perianal region (59.3%) and the vagina (47.3%). Abnormal Pap smear was observed in 22.6%. Systematic follow-up with a median follow-up time of 3.1 years revealed at least one recurrence in 68 (28.1%) of 242 women. Women with multifocal genital warts had a 2.9 times increased risk for recurrence compared to women with unifocal lesions (p = 0.01). Conclusions Nearly 30% of women presenting with genital warts experienced at least one recurrence after treatment with carbon dioxide laser. Multifocal lesions are the strongest indicator of recurrence. These data provide an important insight to recurrence rates of genital warts before HPV vaccination and underline the significance of a long-term follow-up and HPV vaccination.

Research paper thumbnail of Assessing Type and Impact of Biases Potentially Occurring when Analyzing Real World Evidence: The Case of Second Line Treatment for Ovarian Cancer

Value in Health, 2018

s213 time-dependent covariate to account for immortal time bias, the corresponding crude and adju... more s213 time-dependent covariate to account for immortal time bias, the corresponding crude and adjusted HR increased to 1.665 (95%CI 1.459-1.901) and 1.683 (95%CI 1.407-2.014). Applying a causal (counterfactual) analysis using IPCW and replication yielded a HR of 1.067 (95%CI 1.020-1.115), which matched the results of a published randomized clinical trial. ConClusions: When using routine RWE data, DAGs can guide the identification of potential biases and variables that need to be controlled for. In our analysis, potential biases were substantial with different directions. Only the application of the target trial and replication approach in combination with a causal analysis matched data from clinical trials.

Research paper thumbnail of Comparative Effectiveness Analysis Using Real World Evidence (RWE) and Applying a Causal Marginal Structural Model: the Case of Second-Line Treatment in Patients with Ovarian Cancer

Value in Health, 2018

ObjectiveS: VATS-S is a newly introduced surgical technique in the treatment of stage I NSCLC. Ho... more ObjectiveS: VATS-S is a newly introduced surgical technique in the treatment of stage I NSCLC. However, owing to small sample sizes of relevant clinical studies, there is no conclusive evidence of the relative benefit between the outcomes of VATS-S and VATS-L in Chinese patients. This meta-analysis offers the first robust comparative assessment of the safety and clinical outcomes of VATS-S versus VATS-L in Chinese patients with NSCLC-I. MethOdS: A thorough search of major electronic databases was conducted to identify surgical studies on Chinese patients with NSCLC-I till September 2017. Random-effects meta-analysis was used to estimate risk ratios (RRs, 95% CI) and mean differences (MD, 95% CI) for dichotomous and continuous variables, respectively. The main outcomes and measures were operating room time (ORT), intraoperative blood loss (BL), number of lymph nodes resected (LNRN), total volume of chest tube drainage postoperatively (TVCTD), chest tube duration (CTD), length of stay (LOS), post-operative complications (POC), overall cancer recurrence rate (ORR), local cancer recurrence rate (LRR) and distal cancer recurrence rate (DRR). ReSultS: 7 studies, with 762 NSCLC-I patients (229 VATS-S, 533 VATS-L), were included. Patient characteristic baselines were matched between 2 groups, including age (p= 0.22), gender (p= 0.67) and comorbidity rate (p= 0.37). The average follow-up time was 10.2 to 27 months. VATS-S group was associated with a reduction in TVCTD by 224.42 ml (MD:-224.42, 95%CI (-345.06,-103.79), p= 0.0003); a reduction of CTD by 0.73 days (-1.42,-0.03; p= 0.04); and a reduction of LOS by 0.58 days (-1.04,-0.11; p= 0.02). There was no significant difference between the groups in BL, LNRN, POC, ORT, ORR, LRR, and DRR. cOncluSiOnS: VATS-S is a less invasive surgical technique which is associated with less chest tube drainage volume, shorter chest tube duration, and shorter length of stay compared to VATS-L in the treatment of Chinese patients with stage I NSCLC.

Research paper thumbnail of Mediator Effect of Balance Problems on Association Between Grip Strength and Falls in Older Adults: Results From the KORA-Age Study

Gerontology and Geriatric Medicine, 2018

Barbara Thorand and Christa Meisinger contributed equally.

Research paper thumbnail of Mortality of Critically Ill Children Requiring Continuous Renal Replacement Therapy: Effect of Fluid Overload, Underlying Disease, and Timing of Initiation*

Pediatric Critical Care Medicine, 2018

Objective: To identify risk factors associated with mortality in critically ill children requirin... more Objective: To identify risk factors associated with mortality in critically ill children requiring continuous renal replacement therapy. Design: Retrospective observational study based on a prospective registry. Setting: Tertiary and quaternary referral 30-bed PICU. Patients: Critically ill children undergoing continuous renal replacement therapy were included in the study. Interventions: Continuous renal replacement therapy. Measurements and Main Results: Overall mortality was 36% (n = 58) among the 161 patients treated with continuous renal replacement therapy during the study period and was significantly higher in patients on extracorporeal membrane oxygenation (47.5%, 28 of 59) than in patients not requiring extracorporeal membrane oxygenation (28.4%, 29 of 102; p = 0.022). According to the admission diagnosis, we found the highest mortality in patients with onco-hematologic disease (77.8%) and the lowest in patients with renal disease (5.6%). Based on multivariate logistic regr...

Research paper thumbnail of A bias-adjusted evidence synthesis of RCT and observational data: the case of total hip replacement

Research paper thumbnail of Gender differences in the association between grip strength and mortality in older adults: results from the KORA-age study

BMC Geriatrics, 2016

Background: Reduced muscular strength in the old age is strongly related to activity impairment a... more Background: Reduced muscular strength in the old age is strongly related to activity impairment and mortality. However, studies evaluating the gender-specific association between muscularity and mortality among older adults are lacking. Thus, the objective of the present study was to examine gender differences in the association between muscular strength and mortality in a prospective population-based cohort study. Methods: Data used in this study derived from the Cooperative Health Research in the Region of Augsburg (KORA)-Age Study. The present analysis includes 1,066 individuals (mean age 76 ± 11 SD years) followed up over 3 years. Handgrip strength was measured using the Jamar Dynamometer. A Cox proportional hazard model was used to determine adjusted hazard ratios of mortality with 95% confidence intervals (95% CI) for handgrip strength. Potential confounders (i.e. age, nutritional status, number of prescribed drugs, diseases and level of physical activity) were pre-selected according to evidence-based information. Results: During the follow-up period, 56 men (11%) and 39 women (7%) died. Age-adjusted mortality rates per 1,000 person years (95% CI) were 77 (59-106), 24 (13-41) and 14 (7-30) for men and 57 (39-81), 14 (7-27) and 1 (0-19) for women for the first, second and third sex-specific tertile of muscular strength, respectively. Low handgrip strength was significantly associated with all-cause mortality among older men and women from the general population after controlling for significant confounders. Hazard ratios (95% CI) comparing the first and second tertile to the third tertle were 3.33 (1.53-7.22) and 1.42 (0.61-3.28), respectively. Respective hazard ratios (95% CI) for mortality were higher in women than in men ((5.23 (0.67-40.91) and 2.17 (0.27-17.68) versus 2.36 (0.97-5.75) and 0. 97 (0.36-2.57)). Conclusions: Grip strength is inversely associated with mortality risk in older adults, and this association is independent of age, nutritional status, number of prescribed drugs, number of chronic diseases and level of physical activity. The association between muscular strength and all-cause mortality tended to be stronger in women. It seems to be particularly important for the weakest to enhance their levels of muscular strength in order to reduce the risk of dying early.

Research paper thumbnail of Remote ischemic preconditioning in the prevention of ischemic brain damage during intracranial aneurysm treatment (RIPAT): study protocol for a randomized controlled trial

Trials, Jan 29, 2015

The treatment of intracranial aneurysms may be associated with cerebral ischemia. We hypothesize ... more The treatment of intracranial aneurysms may be associated with cerebral ischemia. We hypothesize that pre-interventional remote ischemic preconditioning (RIPC) reduces ischemic cerebral tissue damage in patients undergoing elective intracranial aneurysm treatment. This study is a single-center, prospective, randomized, double-blind explorative trial. Patients with an unruptured intracranial aneurysm admitted to Innsbruck Medical University Hospital for coiling or clipping will be consecutively randomized to either the intervention group (= RIPC by inflating an upper extremity blood-pressure cuff for 3 x 5 min to 200 mmHg) or the control group after induction of anesthesia. Participants will be randomized 1:1 to either the preconditioning group or the sham group using a random allocation sequence and block randomization. The precalculated sample size is n = 24 per group. The primary endpoint is the area-under-the-curve concentration of serum biomarkers (S100B, NSE, GFAP, MMP9, MBP, a...

Research paper thumbnail of Abstract 1063: Economic Evaluation of the Fractional Flow Reserve vs. Angiography for Multivessel Evaluation (FAME) Study

Research paper thumbnail of Diagnosis and prediction of the occurrence of acute mountain sickness measuring oxygen saturation—independent of absolute altitude?

Sleep and Breathing, 2015

Commercialization of trekking tourism enables untrained persons to participate in trekking tours.... more Commercialization of trekking tourism enables untrained persons to participate in trekking tours. Because hypoxia is one of the main purported triggers for acute mountain sickness (AMS), pulse oximetry, which measures arterial oxygen saturation (SPO2), is discussed to be a possible and useful tool for the diagnosis of AMS. The purpose of this study was to evaluate possible associations between SPO2 values and the occurrence of AMS. In 204 trekkers, SPO2 values (pulse oximetry) were measured and the Lake Louise Self-assessment Score (LLS) was administered over the first 7 days of their trekking tours. During treks at altitudes of 2500-5500 m in Nepal, India, Africa, and South America, 100 participants suffered from mild AMS, 3 participants suffered from severe AMS, and 9 participants reported both mild and severe AMS. The lowest mean SPO2 was 85.5 (95 % confidence interval (CI), 83.9-86.1 %) on day 5. SPO2 and LLS exhibited a weak to moderate negative correlation for all days of the study (ρ ranging from -0.142 to -0.370). Calculation of time-shifted associations of 24 and 48 h resulted in the disappearance of most associations. Susceptibility to headaches (odds ratio (OR) 2.9-7.2) and a history of AMS (OR 2.2-3.1) were determined to be potential risk factors for the development of AMS. Since there is no strong altitude-independent association between AMS and SPO2 during the first week of high-altitude adaptation, the implementation of pulse oximetry during trekking in order to detect and predict AMS remains questionable.

Research paper thumbnail of Human Biomonitoring Data from Mercury Exposed Miners in Six Artisanal Small-Scale Gold Mining Areas in Asia and Africa

Minerals, 2011

Objectives: In artisanal small-scale gold mining (ASGM) areas in many developing countries, mercu... more Objectives: In artisanal small-scale gold mining (ASGM) areas in many developing countries, mercury (Hg) is used to extract gold from ore. Data of 1250 participants from Indonesia, Mongolia, Philippines, Tanzania, and Zimbabwe were combined to analyze the relation between exposure in ASGM areas and body burden. Methods: Four groups were selected relating to their intensity of contact with mercury: (i) a non-exposed control group; (ii) a low exposed group with participants only living in mining areas, but not working as miners; (iii) a medium exposed group, miners living in exposed areas and working with mercury without smelting amalgam; and (iv) a high

Research paper thumbnail of Short-Term Effects of Bright Light Therapy in Adults with Chronic Nonspecific Back Pain: A Randomized Controlled Trial

Pain Medicine, 2014

Objective. The present trial evaluated incorporation of bright light therapy in the treatment of ... more Objective. The present trial evaluated incorporation of bright light therapy in the treatment of chronic nonspecific back pain (CNBP). Design. A prospective, randomized, controlled, multicenter, open design with three parallel trial arms was used.

Research paper thumbnail of PMD10 Impact Analyses of Fractional Flow Reserve-Guided Percutaneous Coronary Intervention in Patients with Multivessel Disease in France and Belgium

Research paper thumbnail of PMD40 Cost Effectiveness of Fractional Flow reserve Measurement in Multivessel Coronary Artery Disease in Belgium and France

Value in Health, 2011

medical therapies were randomized to receive either the EXPRESS or a trabeculectomy. Clinical out... more medical therapies were randomized to receive either the EXPRESS or a trabeculectomy. Clinical outcomes included intraocular pressure (IOP), use of IOP lowering medications and post-operative eye surgeries. The study follow-up was 5 years. The economic perspective was the one of the French society. EXPRESS cost was not included. Patients were considered a success if they had an IOP less than or equal to the success thresholds of 15 or 18 mmHg, without IOP lowering medications, and without having undergone further glaucoma surgery. Time to failure was analyzed using a log rank test. Costs were discounted at a 3% rate. RESULTS: 78 patients were analyzed, 39 in each arm. EXPRESS eyes had better IOP control at 1 (12.0 vs 13.9 mmHg; Pϭ0.02), 2 (11.9 vs 13.8 mmHg; Pϭ0.01) and 3 years (12.0 vs 13.5 mmHg; Pϭ0.04). The five-year failure rate was 41% for EXPRESS versus 69% for trabeculectomy (Pϭ0.005) using an 18 mmHg IOP target and 46% versus 77% (Pϭ0.001) for 15 mmHg. At year 5, 41.0% of the EXPRESS patients had an IOP lowering drug prescription versus 53.9% for the trabeculectomy patients. EXPRESS patients received 0.85 IOP lowering medications versus 1.10 in the trabeculectomy group. EXPRESS patients required less needling (2 versus 5) and had fewer cataract surgeries (5 versus 8). Without discounting, drug savings with EXPRESS equaled €277.00, €331.02 as a total. With a 3% discounting, the figures became €260.00 and €342.97, respectively. CONCLUSIONS: At 5 years after surgery, EXPRESS demonstrated that it better controls IOP than trabeculectomy, resulting in post-operative savings.

Research paper thumbnail of PCN63 Meta-Analytic, Trial-Level Approach to Validation of Progression-Free Survival as a Surrogate Endpoint in Advanced Breast Cancer

Value in Health, 2007

SD = 0.15). CONCLUSION: Results obtained thus far suggest that the HRQL of CLL patients in remiss... more SD = 0.15). CONCLUSION: Results obtained thus far suggest that the HRQL of CLL patients in remission is high. Patients utilize the additional categories provided with a 5-level instrument. However, in this case the labelled levels still attracted the greatest percentage of answers, which may be a function of the design of the questionnaire.