BACKGROUND:Several epidemiological studies have investigated the association between occupation and brain tumour risk, but results have been inconclusive. We investigated the association between six occupational categories defined a priori: chemical, metal, agricultural, construction, electrical/electronic and transport, and the risk of glioma, meningioma and acoustic neuroma. METHODS:In a population-based case-control study involving a total of 844 cases and 1688 controls conducted from 2000 to 2003, detailed information on life-long job histories was collected during personal interviews and used to create job calendars for each participant. Job title, job activity, job number, and the starting and ending dates of the activity were recorded for all activities with duration of at least 1 year. Reported occupational activities were coded according to the International Standard Classification of Occupations 1988 (ISCO 88). For the analyses we focused on six a priori defined occupational sectors, namely chemical, metal, agricultural, construction, electrical/electronic and transport. Multiple conditional logistic regression analysis was used to estimate odds ratios and their 95% confidence intervals. RESULTS:Most of the observed odds ratios were close to 1.0 for ever having worked in the six occupational sectors and risk of glioma, meningioma and acoustic neuroma. Sub-group analyses according to duration of employment resulted in two elevated odds ratios with confidence intervals excluding unity. CONCLUSIONS:We did not observe an increased risk of glioma or meningioma for occupations in the agricultural, construction, transport, chemical, electrical/electronic and metal sectors. The number of 'significant' odds ratios is consistent with an overall 'null-effect'.

The only known risk factor for sporadic acoustic neuroma is high-dose ionising radiation. Environmental exposures, such as radiofrequency electromagnetic fields and noise are under discussion, as well as an association with allergic diseases.We performed a population-based case-control study in Germany investigating these risk factors in 97 cases with acoustic neuroma, aged 30 to 69 years, and in 194 matched controls.Odds ratios (ORs) and 95% confidence intervals (Cls) were calculated in multiple logistic regression models.Increased risks were found for exposure to persistent noise (OR = 2.31; 95% CI 1.15-4.66), and for hay fever (OR = 2.20; 95% CI 1.09-4.45), but not for ionising radiation (OR = 0.91; 95 % CI 0.51-1.61) or regular mobile phone use (OR = 0.67; 95% CI 0.38-1.19).The study confirms results of recently published studies, although the pathogenetic mechanisms are still unknown. (c) 2007 Elsevier Ltd. All rights reserved.

Hintergrund: Häufigkeiten und Ursachen angeborener Fehlbildungen sind in mehr als der Hälfte der Fälle unbekannt und somit Inhalt wissenschaftlicher Forschungsprojekte. Ziele: Die Aufgaben der Geburtenregister liegen einerseits in der Ermittlung populationsbezogener Fehlbildungsprävalenzen und gegebenenfalls zeitlicher/räumlicher Trends als auch in der Ursachenforschung zur Entstehung angeborener Malformationen. Weitere Zielsetzungen sind die Ermittlung von Ansatzpunkten für Präventionsmaßnahmen sowie deren Überprüfung und die Wirkungsweise als Instrument der Qualitätskontrolle. Methode: Seit der Etablierung (1990) des Geburtenregisters Mainzer Modell wurden bis 2004, 51.345 Neugeborene und Feten innerhalb der ersten Lebenswoche standardisiert untersucht. Bei allen induzierten Aborten, Totgeburten und Spontanaborten wurden die Befunde des pathologischen Instituts herangezogen. Die Erhebung der anamnestischen Daten erfolgt etwa sechs Wochen vor dem Geburtstermin. Risikofaktoren werden in Fall-Kontroll-Analysen der Geburtenkohorte ermittelt. Als Maßzahl dient das Odds Ratio (OR) mit 95-%-Konfidenzintervall. Ergebnisse: Große Fehlbildungen wurden populationsbezogen bei 6,7% aller Kinder diagnostiziert. Die am häufigsten betroffenen Organkategorien sind Skelettsystem (2,2%), kardiovaskuläres System (1,1%) und internes Urogenitalsystem (1,5%). Als mögliche Ursachen sind künstliche Befruchtung (ICSI-Methode OR 2,7, 1,8–3,9), mütterliches Alter OR 1,1, 1,01–1,2, Medikamente (β2-Sympathomimetika OR 1,9, 1,1–3,0), etc. zu diskutieren. Die pränatale sonographische Erkennungsrate wurde ermittelt und im Rahmen einer europäischen Zusammenarbeit bewertet. Schlussfolgerung: Das Geburtenregister Mainzer Modell ermittelt populationsbezogene epidemiologische Daten zur perinatalen Gesundheit. Ein Follow-up der Patienten dieser Geburtenkohorte ist geplant.

Hintergrund: Folsäure und ihre gesundheitsprotektiven Wirkungen, insbesondere bei Schwangeren zur Prävention von Neuralrohrdefekten (NRD), sind unumstritten u. wissenschaftlich belegt. In anderen Ländern, wie z.B. den USA, wurde durch eine Anreicherung von Mehl die gesundheitspolitische Konsequenz gezogen. Ziele: Der Bekanntheitsgrad und das Wissen über Folsäure in der Allgemeinbevölkerung sollte für Rheinland-Pfalz überprüft werden. Der Anteil der werdenden Mütter, die über den positiven Effekt der perikonzeptionellen Folsäureprophylaxe informiert sind und sie durchführen, sollte ermittelt werden. Methode: In einer Stichprobe wurden 5.366 Mütter neugeborener Kinder in Rheinland-Pfalz (23% aller Geburten des Studienzeitraumes 2003/2004) zum Kenntnisstand über Folsäure und deren Substitution befragt, 2.346 (44%) Fragebögen wurden ausgewertet. Ende 2005 wurde in Rheinland-Pfalz eine repräsentative Telefonumfrage mit 1.076 deutschsprachigen Einwohnern zum Wissen über Folsäure durchgeführt. Die deskriptive Analyse erfolgte mittels SPSS. Ergebnisse: 2/3 der Schwangeren kannten den Sinn einer perikonzeptionellen Folsäuresubstitution, jedoch nur jede elfte Mutter hat zum richtigen Zeitpunkt in ausreichender Dosis eine Prophylaxe durchgeführt. Der Anteil der Kinder mit NRD liegt seit mehr als 10 Jahren unverändert bei ca. 2 Kindern pro 1.000 Geburten. Der Bekanntheitsgrad der Folsäure lag bei den Teilnehmern der Telefonumfrage bei ca. 60%, wobei Frauen (w:56% vs. m:44%) und höhere soziale Schichten (40% vs. 71%) besser informiert waren, ein Stadt-Land-Unterschied nicht erkennbar war und jüngere Teilnehmer (16–19 Jahre; 31%) gegenüber älteren (30–39J.; 70%) schlechter abschnitten. Schlussfolgerung: Trotz des Wissens einer Mehrheit der Bevölkerung über Folsäure und deren Nutzen ist von einer Unterversorgung – insbesondere von Schwangeren – auszugehen. Eine Verminderung des Auftretens von Neuralrohrdefekten ist nicht festzustellen. Deutschland kann als „Folsäure-Entwicklungsland“ bezeichnet werden. Die bisherige Aufklärung ist als unzureichend anzusehen. Eine Anreicherung von Grundnahrungsmitteln muss diskutiert werden.

The widespread use of cellular telephones has generated concern about possible adverse health effects, particularly brain tumors. In this population-based case-control study carried out in three regions of Germany, all incident cases of glioma and meningioma among patients aged 30-69 years were ascertained during 2000-2003. Controls matched on age, gender, and region were randomly drawn from population registries. In total, 366 glioma cases, 381 meningioma cases, and 1,494 controls were interviewed. Overall use of a cellular phone was not associated with brain tumor risk; the respective odds ratios were 0.98 (95% confidence interval (CI): 0.74, 1.29) for glioma and 0.84 (95% CI: 0.62, 1.13) for meningioma. Among persons who had used cellular phones for 10 or more years, increased risk was found for glioma (odds ratio = 2.20, 95% CI: 0.94, 5.11) but not for meningioma (odds ratio = 1.09, 95% CI: 0.35, 3.37). No excess of temporal glioma (p = 0.41) or meningioma (p = 0.43) was observed in cellular phone users as compared with nonusers. Cordless phone use was not related to either glioma risk or meningioma risk. In conclusion, no overall increased risk of glioma or meningioma was observed among these cellular phone users; however, for long-term cellular phone users, results need to be confirmed before firm conclusions can be drawn.

Biometrical JournalVolume 46, Issue S1 p. 7-7 Oral Sessions Abstracts S03.4: Associations between childhood cancer and major malformations: Analysis of 36.874 newborns of the birth registry Mainz Model Gabriela Stolz, Gabriela StolzSearch for more papers by this authorA. Wiesel, A. WieselSearch for more papers by this authorK. Schlaefer, K. SchlaeferSearch for more papers by this authorM. Dittrich, M. DittrichSearch for more papers by this authorC. Spix, C. SpixSearch for more papers by this authorJ. Wahrendorf, J. WahrendorfSearch for more papers by this authorA. Queisser-Luft, A. Queisser-Luft queisser@kinder.klinik.uni-mainz.de Universitätskinderklinik, Mainzer ModellSearch for more papers by this author Gabriela Stolz, Gabriela StolzSearch for more papers by this authorA. Wiesel, A. WieselSearch for more papers by this authorK. Schlaefer, K. SchlaeferSearch for more papers by this authorM. Dittrich, M. DittrichSearch for more papers by this authorC. Spix, C. SpixSearch for more papers by this authorJ. Wahrendorf, J. WahrendorfSearch for more papers by this authorA. Queisser-Luft, A. Queisser-Luft queisser@kinder.klinik.uni-mainz.de Universitätskinderklinik, Mainzer ModellSearch for more papers by this author First published: 17 March 2004 https://doi.org/10.1002/bimj.200490275AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume46, IssueS1Supplement: Abstracts of the Joint Meeting of the IBS-DR and the DAEMarch 2004Pages 7-7 RelatedInformation

UNLABELLED:Malformations of the internal urogenital system are common. The birth registry "Mainz Model" reflects population-based prevalence of renal malformations, calculates sensitivity rates of the prenatal ultrasonographic findings and demonstrates rates of surgery needed.METHOD AND MATERIAL:During the study period (1990-2001) all newborns of the area of Mainz were examined according to a standardized procedure including ultrasonography of the kidneys. Pathology reports were reviewed for stillbirth, abortions (> 15.SSW) and induced abortions. Beside these clinical findings, since 1996 (after implementation of a special ultrasonographic malformation screening according to the german maternity guidelines) the results of prenatal as well as postnatal ultrasonographic examinations of the kidney were recorded. All children with pathologic diagnoses of the kidneys were retrospectively analysed. Data about the follow up and surgery if needed, were collected.RESULTS:During the study period from 1990-2001 34.450 newborns were examined. 407 of the neonates (1.2%) had a malformation of the kidney. During the study period from 1996-2001 13.162 neonates were examined. 194 neonates (1.5%) had pathologic and 225 neonates (2.07%) had controllable findings. The most common diagnoses were supernumerary kidney, hydronephroses und megaureter. 22 neonates (12.8%) underwent surgery. The sensitivity of the prenatal ultrasonography was 36% and the specificity was 99%.CONCLUSION:Both, the prenatal as well as the postnatal ultrasonographic screening of the kidneys are ingenious examinations. The prenatal examination detects life threatening malformations of the kidneys. The postnatal examination completes early diagnosis of renal defects by uncovering the malformations, which have been missed prenatally. The prevalence of malformations of the kidney is comparable to the one of hip dislocation. We therefore conclude, that ultrasonographic screening of the kidneys is needed.

Prevalence rates of birth defects in the Federal Republic of Germany are informative to assess the general background risk of having a child with a birth defect. They provide basic figures to determine temporal and regional prevalence trends, to evaluate and initiate preventive measures and to initiate research projects. To avoid observer, definition and collection bias, active monitoring systems are required. Data collected in the active monitoring system of the Mainz Birth Defects Registry are presented. From 1990–1998, 30940 livebirths, stillbirths and abortions underwent standardized physical and sonographic examinations. Anamnestic data were collected from prenatal care records, maternity files and hospital records. Major malformations were diagnosed in 2144 (6.9%) and mild errors of morphogenesis in 11104 (35.8%) of all infants. Risk factors associated with the occurrence of major malformations were identified by comparing anamnestic data from infants with and without major malformations. Using multivariate regression models, statistically significant associations were established for 9 risk factors. Causally related risk factors were parents or siblings with malformations, parental consanguinity, more than 3 minor errors of morphogenesis in the proband, maternal diabetes mellitus and ingestion of antiallergic drugs in the first trimester of pregnancy. Conjunctional risk factors were polyhydramnios, oligohydramnios and gestational age <32 weeks at birth. Using these risk factors, populations at risk for the occurrence of major malformation can be identified.

Zusammenfassung Epidemiologische Daten eines klinischen Neugeborenenscreenings sind die Grundlage, zeitliche und regionale Trends von Fehlbildungsprävalenzen zu erfassen, Risikofaktoren und damit Ansatzpunkte für Präventionsmaßnahmen zu ermitteln, Präventionsmaßnahmen zu veranlassen bzw. zu überprüfen sowie Forschungsprojekte zu initiieren. Zur Erfassung valider Daten und zur Vermeidung von Beobachter-, Definitions- und Selektionsverzerrungen sollten aktive Erfassungssysteme verwendet werden. 34.211 Lebendgeborene, Totgeborene und Aborte der populationsbezogenen Geburtenkohorte des aktiven Mainzer Geburtenregisters wurden nach einem standardisierten Schema klinisch und sonographisch untersucht und anamnestische Daten erhoben. Prävalenzen großer und kleiner Fehlbildungen wurden erfasst und frühzeitig therapeutische Maßnahmen eingeleitet. Dies ermöglicht eine optimale, problemangepasste Therapie sowie eine Beratung und Begleitung der betroffenen Familien. Prävalenz-Odds-Ratios wurden berechnet, um Risikofaktoren für angeborene Fehlbildungen zu ermitteln. Dies erlaubt die Identifikation eines Risikokollektivs, bei dem das Vorliegen großer Fehlbildungen ausgeschlossen werden sollte. Die für Screeninguntersuchungen geforderten Voraussetzungen – Existenz therapeutischer Maßnahmen, Verschlechterung der Prognose bei Ausbleiben einer Behandlung und Gesundheitsgewinn bei Durchführung einer Therapie – erfüllt ein strukturiertes klinisch-morphologisches Neugeborenenscreening zur Fehlbildungserfassung vollständig.

Epidemiological data of clinical screening examinations in newborns represent the basis to determine temporal and regional prevalence trends for malformations, to evaluate and initiate preventive measures, and to initiate research projects. Active monitoring systems should be required to avoid collection, observer and definition bias. 34,211 livebirths, stillbirths and abortions of the population based Mainz birth registry underwent standardized physical and sonographic examinations and anamnestic data were collected. Prevalence rates of major malformations and mild errors of morphogenesis were calculated and early treatment was initiated. This enables optimal care of these infants and adequate counseling of their families. In addition, prevalence odds ratios were established to determine risk factors for congenital malformations, allowing the identification of populations at risk for birth defects where major malformations should be ruled out. The important criteria for screening programs - the existence of preventive or therapeutic interventions, aggravation of the prognosis due to the lack of adequate measures, and health benefit from therapy - are completely fulfilled by clinical screening examinations in newborns.

AIM:To investigate the risk of congenital malformations for newborn of obese women (BMI > or = 30) compared with women of average prepregnancy weight.METHODS:We performed a prospective, population-based case-control study of 20,248 newborn born in the city of Mainz. A total of 1,451 infants (cases) with and 8,088 without congenital malformations (controls) were analysed. The relative risks of associations between obesity and malformations were calculated as odds ratios (OR) with 95% confidence intervals (CI).RESULTS:The prevalence of malformations in children of obese mothers is 11.1% and thus approximately 4% higher than those of the total study population. There is a significant odds ratio for major malformations (OR 1.3; KI 1.0-1.7). Statistically significant associations were calculated for malformations of the internal urogenital system (OR 1.7; 1.1-2.8), the eyes (OR 5.0; 1.3-20.0) and for orofacial clefts (OR 1.7; 1.1-2.8). Among the specific malformations the highest associations occurred for encephalocele (OR 7.3; 1.1-50.6), common truncus arteriosus (OR 6.3; 1.6-24.8) and Potter sequence (OR 6.3; 1.6-24.8). Adjustment for confounding factors (e.g. maternal diabetes mellitus and age) did not change the odds ratios.CONCLUSIONS:Our data demonstrate that newborn of obese mothers are at an increased risk for malformations. An adequate prenatal examination of these pregnancies should include ultrasound screening by specially trained ultrasonographers in tertiary units (DEGUM II/DEGUM III) and serum alpha-fetoprotein measurements. Public health campaigns for prevention are advised.

Antenatal ultrasound screening for birth defects is increasingly becoming a routine procedure of prenatal care. Prenatal detection of malformations and subsequent adjustment of obstetric management are essential for secondary prevention. It is unknown whether ultrasound screening is effective in all pregnant women, or should only be performed in high risk populations. From 1990-1994, 20,248 livebirths, stillbirths and abortions underwent physical and sonographic examinations and anamnestic data were collected. To identify the high risk group, case control analyses of births with one of the 23 selected major malformations (controls) were performed with respect to anamnestic risk factors. All women had at least three routine ultrasound scans. The selected malformations were diagnosed in 298 children; 95 (30.3 per cent) were diagnosed antenatally. Detection rates were: CNS (68.6 per cent), gastro-intestinal tract (42.3 per cent), urinary system (24.1) per cent), heart (5.9 per cent). Complications during pregnancy were calculated as indicators of congenital anomalies: premature labour (< 28 week) OR 4.7 (3.8-5.9), placental insufficiency OR 1.9 (1.1-2.7) and vaginal bleeding OR 1.5 (1.2-1.8), etc. Antenatal routine ultrasound screening is not effective risk populations. Anamnestic risk factors risk factors during pregnancy may be essential indicators for identifying high risk populations. We propose screening of the described high risk pregnancies (about 22 per cent of all pregnancies) to be performed by specially trained and highly experienced ultrasonographers to increase sensitivity rates and benefit cost effectiveness.

Maternal medication during the first trimester of pregnancy has been discussed as a risk factor for development of birth defects. The correlation between maternal drug use and major malformations was investigated in a population-based case-control study in Mainz. Over a period of 5 years (1990-1994), 20,248 livebirths, stillbirths, and abortions underwent physical and sonographic examination, and anamnestic data were collected. A total of 1,472 births with congenital anomalies (cases) and 9,682 births without major and minor malformations (controls) were analyzed. We distinguished between 30 different drug categories, which were divided into medication taken continuously (before and during pregnancy; CM) and acute medication (drugs given within the first 3 months of gravidity; AM). Statistically highly-significant results [CM: Odds Ratios (OR) 1.2, Confidence Intervals (CI) 1.1-1.4, P = 0.008; AM: OR 1.2, CI 1.1-1.3, P = 0.008] were established for maternal drug use in correlation to birth defects. For the majority of combinations between drugs and specific malformations no teratogenic risks were found. However, statistically significant associations were recorded for antiallergics and heart anomalies (CM, AM) as well as musculoskeletal anomalies (AM); for bronchodilators and heart anomalies (CM, AM); for antiepileptics and anomalies of the internal urogenital system (CM), as well as cleft palate/cleft lips (AM); for thyroid hormones and anomalies of the nervous system (CM, AM), as well as anomalies of the external urogenital system (CM, AM); for insulin and anomalies of the musculoskeletal system (CM); for digitalis and anomalies of the musculoskeletal system (AM).

Background: There are no recent data on the occurrance of Neural Tube Defects in Germany. Such data, however, are mandatory for the evaluation of the efficacy of the recommendations for periconceptional folic acid supplementation. Methods: Two sources were used to assess the prevalence and incidence of Neural Tube Defects: data from a perinatal quality assessment programme, in which Neural Tube Defects in life births are reported (prevalence estimates) and the "Mainzer Modell" with systematic registration of malformations in spontaneous or induced abortions after week 16, stillbirths and live-births (prevalence and incidence). Results: The perinatal programme data show an about 50% decline in the prevalence of Neural Tube Defects since 1984. In 1992 the prevalence was 4.4/10 000 livebirths, which is likely to be an underestimate. Comparison with the "Mainzer Modell" data suggests, that only 45 to 75% of the cases are registered in the perinatal programme. The true prevalence of Neural Tube Defects is likely to be in the range of 6 to 10/10000 livebirths. The Neural Tube Defects incidence estimates from the "Mainzer Modell" gave a figure of 11.1/10000 pregnancies with a 95% CI of 4.6-17.7. Conclusions: 1) The incidence and prevalence of Neural Tube Defects in Germany in the lower range if compared to other European countries. 2) The decline of the Neural Tube Defects prevalence is likely to result from induced abortions after prenatal diagnosis of Neural Tube Defects. 3) The presently available prevalence figures are insufficient to monitor the efficacy of periconceptional folic acid supplementation. 4) Valid incidence estimates with much narrower confidence intervals are mandatory; these require further monitor stations ("Mainzer Modell" type) and acitive surveillance for Neural Tube Defects in pregnancies.