Sektionsbericht 2004-2006 · 3 Sektion Epidemiologie und Biostatistik Unit of Epidemiology and Biostatistics 2004-2006 Prof. Dr. Heiko Becher

Hygiene-InstitutAbteilung Tropenhygiene und öffentliches GesundheitswesenInstitute of HygieneDepartment of Tropical Hygiene and Public Health

Sektion Epidemiologie und BiostatistikUnit of Epidemiology and Biostatistics

Leiter der Sektion und stv. Abteilungsleiter: Prof. Dr. Heiko Becher

Sektionsbericht 2004-2006

UniversitätsKlinikum Heidelberg

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Sektion Epidemiologie und Biostatistik

Unit of Epidemiology and Biostatistics

2004-2006

Prof. Dr. Heiko Becher

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Inhaltsverzeichnis – Contents

Einleitung ● Introduction ...................................................................................... 3 1. Forschung ● Research .................................................................................... 3 1.1. Deskriptive Epidemiologie ● Descriptive epidemiology ...................................... 3 1.2. Infektionsepidemiologie ● Infectious disease epidemiology................................ 3 1.3. Krebsepidemiologie ● Cancer epidemiology..................................................... 3 1.4. Sozialepidemiologie ● Social epidemiology...................................................... 3 1.5. Biostatistik ● Biostatistics............................................................................. 3 1.6. Sonstige Projekte ● Other projects ................................................................ 3 2. Lehre ● Teaching............................................................................................ 3 2.1. HeiCuMed.................................................................................................. 3 2.2. Graduiertenkolleg 793 ● PhD program 793 ................................................... 3 2.3. MSc International Health.............................................................................. 3 2.4. Vorlesungen ● Lectures ............................................................................... 3 2.5. Graduiertenschule Public Health ● Graduate School Public Health....................... 3 3. Weitere Aktivitäten ● Further activities ......................................................... 3 3.1. Positionen innerhalb und außerhalb der Universität ● Positions within and

outside the university................................................................................. 3 3.2. Universitäre Partnerschaften ● University Partnerships ..................................... 3 3.3. Tätigkeiten als Editor oder Reviewer ● Reviewing and editorial tasks .................. 3 3.4. Tagungen und Workshops ● Meetings and workshops....................................... 3 3.5. Der Verein „Freunde von Nouna e.V.“ ● The Union „Friends of Nouna e.V.“.......... 3 4. Mitarbeiter, Kooperationen, Drittmittel ● Staff, Collaborators, Funding ......... 3 4.1. Mitarbeiter ● Staff....................................................................................... 3 4.2. Frühere Mitarbeiter ● Previous staff members ................................................. 3 4.3. Klinikinterne Kooperationspartner ● Internal collaborators ................................ 3 4.4. Externe Kooperationspartner ● External collaborators ...................................... 3 4.5. Drittmittel ● Grants..................................................................................... 3 5. Ausblick ● Perspectives.................................................................................. 3 6. Publikationen, Hochschulschriften ● Publications and Theses........................ 3 6.1. Publikationen ● Publications ......................................................................... 3 6.2. Hochschulschriften ● Academic theses ........................................................... 3

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Vorwort ● Preface

Mit dem vorliegenden Dreijahresbericht wer-den die Aktivitäten der Sektion Epidemiologie und Biostatistik der Jahre 2004 bis 2006 beschrieben.

Die Sektion hat im Berichtszeitraum eine

Reihe von Veränderungen erfahren. Am 1.10. 2004 nahm Herr Prof. Oliver Razum einen Ruf auf die C4-Professur für Epidemiologie an der Universität Bielefeld an. Sein Nachfolger wurde Herr Dr. Thomas Jänisch, dem auch die stellvertretende Sektionsleitung über-tragen wurde. Seine Aktivitäten, bei denen er von einer Doktorandin unterstützt wird, liegen auf dem Bereich der Malaria und des Dengue-Fiebers, so dass der Bereich der Infektionsepidemiologie gestärkt wurde. Weiterhin haben die ersten Doktoranden des Graduiertenkollegs 793 die Sektion nach erfolgreicher Promotion verlassen, und wurden ersetzt durch neue Doktoranden. Als weiterer Postdoc wurde im Rahmen des SFB 544 Herr Dr. Heribert Ramroth eingestellt, der als Doktorand im DKFZ Erfahrungen in der Krebsepidemiologie mitbringt, und hier im Rahmen eines SFB-Projektes zusammen mit einem weiteren Doktoranden epidemiologische Projekte bearbeitet.

Aus Anlass der Erstellung dieses Berichts möchte ich mich herzlich bei allen Kooperationspartnern für die angenehme Zusammenarbeit danken. Besonders hervorheben möchte ich die Kollegen am „Centre de Recherche en Santé de Nouna“ (CRSN) in Nouna, Burkina Faso. Mein Dank gilt auch allen Mitarbeiterinnen und Mitarbeitern der Abteilung Tropenhygiene und öffentliches Gesundheitswesen, und ganz besonders allen Mitgliedern meiner Sektion, für die vertrauensvolle und konstruktive Unterstützung.

In this triennial report the activities of the Unit of Epidemiology and Biostatistics during the years 2004 to 2006 are presented.

The unit underwent a number of changes during that time. On October 1st, 2004, Prof. Oliver Razum left the unit and accepted a position as Professor for Epidemiology at the University of Bielefeld. His successor is Dr. Thomas Jänisch who became deputy head of the unit. His activities, in which he is supported by a PhD student, are focused on malaria and dengue fever, so that the infectious disease epidemiology groups are strengthened. Furthermore, the first PhD students within the PhD program of epidemiology defended their theses successfully, left the unit and were replaced by new PhD students. Another new Postdoc is Dr. Heribert Ramroth, who was PhD student at the DKFZ, thus having experience in cancer epidemiology. Here, he works on a project within the SFB-project together with a PhD student.

I would like to take this opportunity to thank all colleagues for the pleasant and successful collaboration, in particular the colleagues at the “Centre de Recherche en Santé de Nouna” (CRSN) in Nouna, Burkina Faso. I am also grateful to all colleagues at the department of Tropical Hygiene and Public Health, and in particular to all members of the Unit for their continuing and constructive support.

Heidelberg, Februar 2007

Prof. Dr. Heiko Becher

Leiter der Sektion und stv. Abteilungsleiter

Head of Unit and Deputy Director

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Einleitung ● Introduction Epidemiologie hat in Deutschland eine vergleichsweise kurze Geschichte. In den achtziger Jahren des letzten Jahrhunderts existierten nur wenige Lehrstühle, und deren Zahl erhöhte sich im Vergleich zu anderen Fächern auch nur moderat bis zur heutigen Zeit. In Heidelberg begann der Aufschwung der Epidemiologie im Deutschen Krebsforschungszentrum mit der Neubesetzung der Abteilungsleitung im Jahr 1986 und Umbenennung der ehemaligen Abteilung medizinische Dokumentation und Statistik in die Abteilung Epidemiologie. Weitere Gründungen epidemiologischer Abteilungen im DKFZ und im Deutschen Zentrum für Alternsforschung brachten einen weiteren Aufschwung des Faches in Heidelberg mit sich.

An der Universität Heidelberg wurde eine entsprechende Abteilung nicht eingerichtet, und es fanden nur einige epidemiologische Aktivitäten innerhalb verschiedener klinischer Abteilungen oder in Instituten statt. Eng verbunden mit der Epidemiologie ist die Biostatistik. Die Biostatistik ist in Heidelberg seit langer Zeit mit der Abteilung „medizinische Biometrie“ sehr gut vertreten, allerdings mit deutlichem Schwerpunkt auf Klinische Studien und weniger auf biostatistische Methodenforschung in der Epidemiologie.

Im Jahr 1998 wurde an der medizinischen Fakultät der Universität Heidelberg eine Professur für Epidemiologie und Biostatistik ausgeschrieben, die am Hygiene-Institut in der Abteilung Tropenhygiene und öffentliches Gesundheitswesen angesiedelt wurde. Die Besetzung dieser Professur war verbunden mit der stellvertretenden Abteilungsleitung dieser relativ großen Abteilung mit ca. 60 Mitarbeitern. Der damit verbundenen informellen Gründung einer „Unit of Epidemiology und Biostatistics“ folgte im Jahr 2003 die formale Schaffung der Sektion Epidemiologie und Biostatistik.

Meilensteine in der Entstehung und Entwicklung der Sektion waren die Projektleitung von zwei Teilprojekten des SFB 544 „Kontrolle tropischer Infektionskrankheiten“, welcher sich derzeit in seiner dritten Förderphase

Epidemiology has a relatively short tradition in Germany. A few such research departments existed in the eighties of the last century. Since then the number has increased only modestly compared to that in other fields. In Heidelberg the growth of the field began in 1986 with the appointment of a new professor in epidemiology to head a new Department of Epidemiology (formerly medical documentation and statistics) at the German Cancer Research Center (DKFZ). The establishment of further departments of epidemiology were installed at the DKFZ and at the German Center for Research on Ageing which led to a significant development of the field in Heidelberg.

At the medical faculty of the University of Heidelberg there was still no department of Epidemiology. There were nevertheless some epidemiological activities which took place within different clinical departments or other institutes. Closely linked to Epidemiology is the field of Biostatistics. This subject is well represented at Heidelberg University by the reputable Department of Medical Biometry, however, it has its focus on clinical trials and not on methods in epidemiology.

In 1988 a new position for a professor of Epidemiology and Biostatistics was created at the Medical Faculty of the University of Heidelberg, assigned to the Department of Tropical Hygiene and Public Health at the Institute of Hygiene with the additional responsibility of being deputy head of this relatively large department with about 60 members. A working group Epidemiology and Biostatistics was established which became an official unit (section) under the statutes of the faculty in 2003.

Milestones in the development of the unit are two projects within the collaborative research grant SFB 544 “Control of Tropical Infectious Diseases” which is currently in its third funding phase, and the PhD Program (Graduiertenkolleg 793) for epidemiology “Epidemiology of communicable and chronic, non-communicable diseases and their interrelationships”, which is funded from 2002 to 2011, and of which the head of

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befindet, und die Gründung und Förderung durch die DFG des Graduiertenkollegs 793 „Epidemiologie übertragbarer und chronischer, nicht übertragbarer Erkrankungen und deren Wechselbeziehungen“, welches eine Laufzeit von 2002-2011 hat, und dessen Sprecher der Sektionsleiter ist.

Die Forschungsthemen innerhalb der Sektion sind vielfältig. Sie beinhalten infektionsepidemiologische Studien im Bereich Malaria und TBC, Studien zur Epidemiologie chronischer Krankheiten – insbesondere Krebsepidemiologie - , sozialepidemiologische Studien zu Migranten, Studien im Bereich der deskriptiven Epidemiologie und Gesundheitsberichterstattung in Afrika, biostatistische Forschungsprojekte und andere. Einen breiten Raum nimmt auch die methodische Beratung an Forschungsprojekten anderer Mitarbeiter des Instituts oder des SFB 544 ein. Diese Vielfalt erklärt sich aus verschiedenen Gründen. Epidemiologische Studien sind in der Regel Langzeitprojekte, bei denen sich sinnvolle Folgeprojekte aus der Thematik heraus ergeben. Beispielsweise ist die Fall-Kontroll-Studie zum Larynxkarzinom, die bereits 1996 zusammen mit der HNO-Universitätsklinik in Heidelberg begonnen wurde, bis zum heutigen Tag ein aktuelles Projekt, bei dem zahlreiche Erkenntnisse und entsprechende Publikationen entstanden sind und noch entstehen werden. Der Wechsel des Sektionsleiters von dem Deutschen Krebsforschungszentrum an die Abteilung Tropenhygiene und öffentliches Gesundheitswesen am Hygieneinstitut, brachte die oben genannten neue Themenfelder mit sich, die heute einen breiten Raum einnehmen und auch in der Zukunft einnehmen werden.

Im Bereich der Lehre ist die Sektion vielfältig tätig. Die Organisation der Epidemiologie im Querschnittsbereich Epidemiologie, medizinische Biometrie und medizinische Informatik, ein Pflichtbereich nach der neuen Approbationsordnung, obliegt dem Sektionsleiter. Eine Reihe von Mitarbeitern der Sektion, sowie Kollegen aus dem DKFZ, sind hier an der Lehre beteiligt. Die epidemiologischen Teile der Masterprogramme und anderer Kurse an der Abteilung werden von der Sektion

this unit is the speaker.

There are a number of different areas of research in the unit. These include studies in infectious disease epidemiology, with focus on malaria and tuberculosis, studies of chronic diseases – in particular cancer – studies in social epidemiology in migrants, descriptive studies with focus on Africa, biostatistical research projects and others.

An important area is the methodological support of studies performed by other members of the department or of the SFB. This large variety of topics is easily explained. Epidemiological studies are usually long-term studies, and often new projects directly develop from these. For example, the case-control study on laryngeal cancer which started in collaboration with the Department of Otolaryngology at Heidelberg University Clinics in 1996, is an ongoing project up to the present day, in which results are still produced and corresponding publications have been emerged and more are expected in the future. The new head of section who moved from the German Cancer Research Center (DKFZ) to the Department of Tropical Hygiene and Public Health brought with him the new fields of research which are a focus today and will remain a focus in the unit.

Teaching also plays a major role in the unit. The epidemiological part of the “Querschnittsbereich” Epidemiology, Medical Biometry and Medical Informatics which is compulsory according to the new “Approbationsordnung” for medical students is organized by the unit head. A number of members of the unit as well as colleagues from the DKFZ are involved in teaching. The epidemiological parts of the master courses and other courses within the department are covered by the unit.

Furthermore the teaching courses of the PhD program (“Graduiertenkolleg 793”) are organized. This is outlined in chapter 2.2 of the report. Chapter 3 informs on all other academic activities within and outside the faculty.

Most parts of this report are given in German and English, indicated by the print color. The description of scientific projects, however, is given in English only.

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bestritten. Das Lehrprogramm für das Graduiertenkolleg wird ebenfalls organisiert. Dies ist in dem Bericht weiter aufgeführt, sowie auch weitere wissenschaftliche Aktivitäten innerhalb und außerhalb der Fakultät.

Der Bericht ist größtenteils in Deutsch und Englisch verfasst. Aus Platzgründen sind die Beschreibungen der wissenschaftlichen Projekte nur auf Englisch enthalten.

Abb. 1: Campus „Im Neuenheimer Feld“ mit Hygiene-Institut Fig. 1: New University Campus „Im Neuenheimer Feld“ with Institute of Hygiene

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1. Forschung ● Research In diesem Kapitel werden die wesentlichen Forschungsprojekte des Berichtszeitraums kurz beschrieben, wobei ebenfalls ein Ausblick auf laufende und geplante Projekte eingeschlossen ist. Für jedes Projekt bzw. jeden Themenbereich sind die beteiligten Mitarbeiter und externen Kooperationspartner genannt. Der bzw. die Projektleiter ist bzw. sind unterstrichen (falls zutreffend).

Publikationen aus den jeweiligen Projekten sind mit der Nummer angegeben, die sich auf die Publikationsliste am Ende des Berichts bezieht.

Die meisten Ergebnisse wurden auf nationalen und internationalen Kongressen präsentiert. Auf eine Auflistung wird verzichtet.

In this chapter the main ongoing and past research activities of the last three years are briefly described. This includes completed and ongoing projects as well as projects in preparation. For each project or topic the names of the internal working group and of the external collaborators are given. The project leader(s) is (are) underlined (if applicable).

Publications are listed for each project with the number that refers to the list of publications at the end of the report.

Most results have been presented at national and international conferences. A listing of all presentations is not given.

Abb. 2: Karte und Impressionen aus Nouna, Burkina Faso Fig. 2: Map and impressions of Nouna, Burkina Faso

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1.1. Deskriptive Epidemiologie ● Descriptive epidemiology

Die deskriptive Epidemiologie liefert die Basis für eine Gesundheitsbericht-erstattung, die die Grundlage für analytische Studien einerseits, und für Maßnahmen im Bereich der Public Health andererseits darstellt.

In Entwicklungsländern besteht hier ein großer Nachholbedarf. In unserer Sektion wird, insbesondere in Kooperation mit dem „Centre de Recherche en Santé de Nouna“ (CRSN) in Nouna, Burkina Faso, für eine Verbesserung der Berichterstattung zu Basisparametern in der Epidemiologie gearbeitet. Wir untersuchen räumliche und zeitliche Muster der Mortalität, sowie demographische und andere Faktoren für Kindersterblichkeit.

Basis dieser Untersuchungen ist jeweils ein so genanntes „Demographic Surveillance System (DSS)“, welches in Nouna seit 1993 existiert, und in dem eine Population von gegenwärtig über 60000 Personen unter konstanter demografischer Surveillance ist.

Descriptive Epidemiology is the basis for health reports, which in turn are the basis for analytic studies and for public health activities.

In developing countries there is a large deficit in this field. In our unit we work on an improvement of estimating basic epidemiological parameters in close cooperation with the „Centre de Recherche en Santé de Nouna“ (CRSN) in Nouna, Burkina Faso. We investigate spatial and temporal patterns of mortality, as well as demographic and other risk factors for childhood mortality.

Basis of all these investigations is a so-called „Demographic Surveillance System (DSS)“, which exists in Nouna since 1993, and in which a populaton of currently more than 60000 persons is under constant demographic surveillance.

Mortalitätsmuster in Abhängigkeit von Geburts- und Todestag in Burkina Faso Patterns of mortality by season of birth and death in Burkina Faso Project team: Heiko Becher, Gael Hammer, Gisela Kynast-Wolf, Robert Ndugwa, Heribert Ramroth, Gabriele Stieglbauer

Collaborators within the department: Olaf Müller

External collaborators: Bocar Kouyaté, Adjima Gbangou, Mamadou Sanon, Ali Sié, Nouna, Burkina Faso

Funding: DFG (SFB 544) Mortality in developing countries has multiple causes. Some of these causes are linked to climatic conditions that differ over the year. We analysed longitudinal data from a population of ~35 000 individuals in Burkina Faso. During the observation period 1993–2001, a total number of 4098 deaths were recorded. The effect of season on mortality was investigated separately by age group as (i) date of death and (ii) date of birth.

Overall mortality was found to be consistently higher during the dry season (November to May). The pattern was seen in all age groups except in infants where a peak was seen around the end of the rainy season. In infants we found a strong association between high mortality and being born during the time period September to February. No effect was seen for the other age groups.

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Fig. 3 Crude death rates by month of death (adjusted for sex and age), rural Burkina Faso, 1993–2001

The association between high infant mortality and being born at around the end of the rainy season is probably explained by most of the malaria deaths in areas of high transmission intensity occurring in the second half of infancy.

Publication: [31] Risikofaktoren für Kinder- und Säuglingssterblichkeit in Burkina Faso Risk factors of infant and child mortality in Burkina Faso Project team: Heiko Becher, Gael Hammer, Gisela Kynast-Wolf, Robert Ndugwa, Heribert Ramroth, Gabriele Stieglbauer

Collaborators within the department: Albrecht Jahn, Olaf Müller


Funding: DFG (SFB 544)

The aim of this study was to quantify the effect of risk factors for childhood mortality in a typical rural setting in sub-Saharan Africa. We performed a survival analysis of births within the DSS population in Nouna. All children born alive in the period 1 January 1993 to 31 December 1999 in the study area (n = 10 122) followed-up until 31 December 1999 were included. All-cause childhood mortality was used as outcome variable.

Within the observation time, 1340 deaths were recorded. In a Cox regression model a simultaneous estimation of hazard rate ratios showed death of the mother and being a twin as the strongest risk factors for mortality. For both, the risk was most pronounced in infancy. Further factors

associated with mortality include age of the mother, birth spacing, season of birth, village, ethnic group, and distance to the nearest health centre. Finally, there was an overall decrease in childhood mortality over the years 1993-99.

The study supports the multi-causation of childhood deaths in rural West Africa during the 1990s and supports the overall trend, as observed in other studies, of decreasing childhood mortality in these populations. The observed correlation between the factors highlights the need for multivariate analysis to disentangle the separate effects. These findings illustrate the need for more comprehensive improvement of prenatal and postnatal care in rural sub-Saharan Africa.

Publication: [2]

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Vergleich von Daten eines “Demographic and Health Surveys” und eines „Demographic Surveillance System“ Comparison of data from a Demographic and Health Survey and from a Demographic Surveillance System Project team: Heiko Becher, Gael Hammer, Gisela Kynast-Wolf, Robert Ndugwa, Heribert Ramroth, Gabriele Stieglbauer



Funding: DFG (SFB 544) In a comparative analysis, the effect of risk factors for childhood mortality in Burkina Faso, sub-Saharan Africa, were computed from Demographic and Health Survey (DHS) and from the Nouna DSS, two very different sources. While most analyses so far determined levels of risk factors, this analysis focuses on the effects of those risk factors.

Mortality levels are often calculated by strata of risk factor levels separately for each factor. In this publication, their effect was modeled jointly by survival analysis, using all-cause childhood mortality as outcome variable. All live births in rural Burkina Faso in the period of 1994–1998 recorded by the DHS survey Burkina Faso 1998–1999 (5018 births) and the DSS in

Nouna, western Burkina Faso (6196 births) were included.

A simultaneous estimation of hazard rate ratios by a Cox regression model yielded similar estimates for the DHS and DSS data, in line with previous findings based on the Nouna DSS alone. Despite the different nature of survey (DHS) and longitudinal (DSS) data, these findings demonstrate that, despite some limitations, results derived from DHS surveys are broadly comparable to DSS data. Both are valuable tools for assessing the importance of risk factors for childhood mortality in sub-Saharan Africa, and they could be combined for better predictions.

Publication: [29] Analyse von Zwillingsgeburten in Burkina Faso Analysis of twin births in rural Burkina Faso Project team: Heiko Becher, Gael Hammer, Gisela Kynast-Wolf, Gabriele Stieglbauer



Funding: DFG (SFB 544) We used the Nouna DSS to investigate the birth of twins in rural Burkina Faso with respect to prevalence, mortality, and provision of obstetric care. Health service data were derived from a document review in health facilities in the Nouna District for the years 1994-2001. The district hospital provides obstetric care for the entire district with its 252,000

population (1998). All births in the period from January 1, 1993 to December 31, 1998 (9457 recorded deliveries with 9,610 live births) were included and followed up until April 30, 2002. The main outcome measures were the prevalence of twin delivery as well as age- and sex-specific mortality risks.

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Mortality of twins is high, with one out of three dying before reaching the age of five years--2.5 times the mortality risk of singletons. Among twins, mortality is particularly high in the neonatal period (RR 5.16; CI: 3.6-7.5) and in twins born to mothers above the age of 35 (RR 5.12; CI: 3.5-7.6). The overall population-based prevalence of twin delivery is 1.6% (CI: 1.4-1.9) versus a hospital-based prevalence of 2.8% (CI: 2.2-3.1). Despite this moderate trend towards hospital-

based obstetric care, most twins (90.5%) are still delivered outside a hospital setting.

The high neonatal mortality in twins points to the need for special care in pregnancy, child birth, and postpartum. Maternity services fail to adequately cover the vast majority of multiple pregnancies and deliveries.

Publication: [30] Räumliche Muster der Kindersterblichkeit Spatial Clustering of childhood mortality Project team: Heiko Becher, Gael Hammer, Gisela Kynast-Wolf, Robert Ndugwa, Heribert Ramroth, Gabriele Stieglbauer


External collaborators: Bocar Kouyaté, Adjima Gbangou, Mamadou Sanon, Ali Sié, Nouna, Burkina Faso; Osman A. Sankoh, Ghana

Funding: DFG (SFB 544) In an earlier analysis of the data from the DSS in Nouna, Burkina Faso, an extremely high childhood mortality was found in a particular village. Spatial scan statistics was the method used for the analysis. In an ongoing analysis, we investigate whether this clustering persists after a new well has been built to improve water supply in the village. Preliminary results show that the childhood mortality has slightly decreased in the years 2000 to 2003, however, the mortality is still significantly higher than in the neighboring villages.

Fig. 4: Clustering of childhood mortality in the Nouna DSS region

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1.2. Infektionsepidemiologie ● Infectious disease epidemiology

Infektionskrankheiten waren das ursprüngliche Feld der Epidemiologie. Als klassisches Beispiel hierfür wird häufig die Arbeit von John Snow herangezogen, der Mitte des 19. Jahrhunderts Übertragungsweise von Cholera entdeckte und effektive Interventionen vor der Entdeckung des Vibrio cholerae entwickelte.

Auch heute ist die Infektionsepidemiologie ein wichtiger Bereich, insbesondere im Zusammenhang mit Forschung in Entwicklungsländern. In dieser Sektion werden derzeit Studien zu Infektionskrankheiten mit Schwerpunkt auf Malaria und Tuberkulose durchgeführt.

Epidemiology developed from research on infectious diseases. As a classical example the work of John Snow is often cited who discovered the mode of transmission of cholera in the 19th century and developed an effective intervention before the agent Vibrio cholerae was discovered.

Infectious disease epidemiology is still an important field, in particular in collaborative research in developing countries. In this Unit we currently perform studies in this field with emphasis on Malaria and tuberculosis.

Verteilung von Todesursachen bei Kindern in einem Malaria-endemiegebiet in Burkina Faso Pattern of cause-specific childhood mortality in a malaria endemic area of Burkina Faso Project team: Heiko Becher, Gael Hammer, Gisela Kynast-Wolf, Robert Ndugwa, Heribert Ramroth, Gabriele Stieglbauer



Funding: DFG (SFB 544) Reliable mortality data are a prerequisite for planning health interventions, yet such data are often not available in developing countries, particularly in sub-Saharan Africa (SSA). Demographic surveillance systems (DSS) implementing the verbal autopsy (VA) method are the only possibility to observe cause-specific mortality of a population on a longitudinal basis in many countries.

This paper reports all-cause and cause-specific mortality rates in children under the age of five years from 1999 until 2003 in a malaria holoendemic area of north-western Burkina Faso. The DSS of the Nouna Health Research Centre, in which VA data were analyzed, covers a rural population of about 30,000 (41 villages)

and an urban population of about 25,000 (Nouna town).

A total of 1,544 deaths were analyzed. All cause mortality rates of children under five years were higher in the rural than the urban area (34 vs. 24 per 1,000 person-years) and in the rainy than the dry season (35 vs 29 per 1,000 person years). Malaria was the most frequent diagnosis (42%) with peak mortality rates in infants aged 6–11 months.

Malaria is the most important cause of death in this remote area of SSA, even considering the low specificity of malaria diagnosis in young children. Strengthening the existing malaria control tools is of prime importance to reduce the high childhood mortality in the endemic areas of SSA.

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Publication: [28] Malaria Inzidenz und Mortalität in Ländern mit unterschiedlicher Transmissionsintensität Malaria Incidence and Mortality in countries with different transmission intensity Project team: Heiko Becher, Heribert Ramroth, Robert Ndugwa, Gisela Kynast-Wolf, Gabriele Stieglbauer


External collaborators: Bocar Kouyaté, Mamadou Sanon, Ali Sié, Nouna, Burkina Faso; Brian Greenwood, London; Mamadou Jasseh, Farafenni, The Gambia Funding: DFG (SFB 544) The aim of this ongoing project is to investigate and compare the burden of malaria in a holoendemic area (Nouna/Burkina Faso) and in a mesoendemic area (Farafenni/The Gambia) based on a meta-analysis of data from several clinical trials in combination with DSS follow-up data.

In a first step of the project, in a literature review studies which provide data on malaria morbidity and mortality in both countries were identified and relevant data were reviewed. A combined age-standardized estimate on malaria mortality from Burkina Faso studies was

obtained with a value of 15.2 per 1000 person-years (95% CI 13.4-17.1). In a first publication, we added this to a global estimate of malaria mortality in Sub-saharan Africa which was published recently and which was somewhat lower with a value of 11.36 per 1000 person-years (95% CI 9.8-12.92). In further analyses we give a summary estimate for malaria mortality in Burkina Faso and in the Gambia and found a higher value in the first. Additional analyses are ongoing in which we incorporate malaria incidence information into the mortality estimates.

Publication: [36] Saisonale Muster der Malariamortalität Saisonal patterns in malaria mortality Project team: Heiko Becher, Gisela Kynast-Wolf, Heribert Ramroth, Robert Ndugwa, Michael Preuss, Gabriele Stieglbauer


External collaborators: Bocar Kouyaté, Mamadou Sanon, Ali Sié, Nouna, Burkina Faso; Gael Hammer, Mainz; Göran Kauermann, Pavel Khomski, Bielefeld


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Previous studies from Burkina Faso and The Gambia have shown that overall mortality differs by season, possibly reflecting the effect of different malaria transmission rates. We evaluated seasonal patterns of malaria and all-cause mortality. Data from the aforementioned Nouna Demographic Surveillance System were analyzed for the period 1999 to 2003. Cause of death was ascertained by verbal autopsy. Age-specific death rates by month of death were calculated by age group. Under five and infant mortality was 31.9 (95% Confidence Interval 30.4-33.5) and 60.6 (56.2-65.3) by 1000, respectively. For malaria the corresponding rates were 13.3 (12.3-14.3) and 23.4 (20.7-26.4). Both, infants and under five children had a significantly higher mortality in the main malaria transmission period August-October. In

infants, the relative rate (RR) in the month with highest risk was 1.72 (1.4-2.1) in August for all causes and 2.44 (1.8-3.3) also in August for malaria. The corresponding results for children under five were 1.49 (1.3-1.7) in November for all causes and 1.98 (1.6-2.4) in August for malaria. For other causes of death the highest risk was 1.65 (1.2-2.1) in November for both groups. In contrast, older people had highest rates in April (hot dry season) with RR 1.37 (1.0-1.8) for other causes and highest rates also in April with RR 1.50 (0.9-2.3) for malaria. The results showed that the increased mortality towards the end of the rainy season in children can to a large extent be attributed to malaria.

Publikationen: [31] , [46] Molekulare Epidemiologie von Malaria-Parasiten Molecular epidemiology of malaria parasites Project team: Thomas Jänisch, Robert Ndugwa

External Collaborators: David Sullivan, Sunil Sazawal, Dani Fallin, Don Burke, Johns Hopkins Bloomberg School of Public Health

Funding: Johns Hopkins Malaria Research Institute Pilot Grant Why do some children become severely ill with Falciparum Malaria and others proceed to (naturally acquired) semi-immunity without severe illness?

A number of studies with the objective to throw light on the dynamics of natural acquired immunity in African children have been done. So far they lacked a sufficient sample size and the biotechnology tools

Fig. 5: Malaria mortality by month, children under five, 1999-2003, observed rates (x), model fit (red) and moving average (black)

1999 2000 2001 2002 2003

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that have recently become available for the molecular epidemiology of malaria parasites.

In a holoendemic area for Plasmodium falciparum on Pemba Island, Tanzania,

550 children aged 3-15 months at enrolment were followed over time for a period of 6 months each. Blood samples (only finger prick) were taken every 14 days for malaria blood smear, differential

count (including hemoglobin) and genetic fingerprinting. By use of a microsatellite marker system, genetic fingerprinting of individual parasites “moving” through time and space will be attempted and subsequently be linked with clinical malaria episodes.

The hypothesis of this study is that the parasite genetic variability over time is an important individual exposure and thus a predictor of subsequent illness and/or immunity.

Modellierung der Malaria Modeling of malaria Project team: Heiko Becher, Thomas Jänisch, Kerstin Rosenberger

External Collaborators: Martin Eichner, Markus Schwehm, Klaus Dietz, Tübingen

Funding: Core Funding and “Bonusmittel” Mathematical simulation models of Epidemics have a long tradition – especially in the field of malaria epidemiology, where the first mathematical models were developed by Ronald Ross and W. MacDonald. At present the field of malaria epidemiology is characterized by a large amount of data which is partly contradicting. Competing hypotheses about the relationship between exposure (number of infective mosquito bites per time unit) and response (disease, number of parallel sub clinical infections, level of immunity) do exist.

The aim of our modeling project is to clarify the relationship between exposure

and response in malaria epidemiology and to help focus the questions which field-based research projects will have to target in a next step. Thus, modeling as a tool is mainly helpful for the reduction of complexity and for testing the coherence of competing hypothesis.

One special focus of our modeling exercises is the “concert” of mechanisms conferring (semi)immunity in the field of malaria research. With the help of stochastic units built into a larger deterministic computative model we want to test hypotheses about cross-immunity between malaria genotypes and the composition of relevant immune mechanisms in malaria.

Fig. 6: Apparent correlation between transmission intensity (EIR) and Multiplicity of Infection (MOI) in an ecological study

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Fig.7: Multiple Genotypes in a sample from Tanzania, Microsatellite PCR run with two colors

Genetische Epidemiologie von Malaria-Parasiten Genetic epidemiology of malaria parasites Project team: Heiko Becher, Thomas Jänisch, NN (Doktorand)

External Collaborators: Lars Beckmann, DKFZ Heidelberg

Funding: DFG - GK 793 Malaria transmission can be reduced by interventions like for example impregnated bed nets - or by climate itself, as it is the case during the dry season in the Sahelian zone of Africa. “Unstable malaria transmission” dynamics merit special attention because of the fact that morbidity in humans is low during the dry season – however, as soon as the wet season starts, morbidity and mortality rises. Long-lasting sub clinical P. falciparum malaria infections over lasting the dry season could be documented. The parasitic and genetic ‘reservoir’ for the rise in disease at the beginning of the wet season may be stored as sub clinical infections that hibernate in humans during the dry season. Within this study we want to concentrate on markers of parasite population biology and genetic variability and investigate whether it can be documented that these markers change between dry and wet seasons –

and whether parasite subtypes (or genotypes) found in diseased persons

compared to asymptomatic parasite-positive persons cluster within the ‘genetic space’.

Diagnostik von Malaria mit PCR oder Mikroskopie – eine Vergleichsstudie Diagnosis of malaria by PCR or microscopy-a comparative study Project team: Heiko Becher, Gabriele Stieglbauer

External Collaborators: Michael Lanzer, Department of Parasitology, Heidelberg and colleagues, Centre de Recherche en Santé de Nouna, Burkina Faso


21

This study was performed within the department of Parasitology headed by Prof. Lanzer. The biostatistician analysis was performed in this unit.

A malaria survey of the entire population of a village in Western Burkina Faso (n=1,561) was conducted to assess malaria endemicity. The study population was examined for symptoms characteristic of malaria including fever, anaemia, splenomegaly and parasites present in thick blood films. In the overall study population, the prevalence of Plasmodium spp. infection by microscopic examination of thick blood films was 79.0% (1,233/1,561). In a subcohort with 201

individuals, PCR techniques found a prevalence rate for all Plasmodium spp. of 92.0% (185/201), while microscopy found one of 80.6% (162/201). A combination of both methods gives a rate of 95.5% (192/201). Though univariate logistic analyses of elevated body temperature, anaemia, splenomegaly and age showed them all to be predictors of or risk factors for an infection, only elevated body temperature and age were predictors in multivariate logistic analysis. However, the symptom of splenomegaly did show a highly significant association with infection by multiple species of Plasmodium.

Publication: [42] Effekt von imprägnierten Bettnetzen im Säuglingsalter Effects of insecticide-treated bednets during early infancy Project team: Heiko Becher, Gabriele Stieglbauer

Collaborations within the department: Olaf Müller

External Collaborators: Corneille Traoré, Bocar Kouyaté, Yazoumé Yé, Claudia Frey, Boubacar Coulibaly

Funding: DFG, SFB 544 This study was performed under the supervision of PD Dr. Olaf Müller and analyued in this unit. Insecticide-impregnated bednets and curtains have been shown by many studies to be effective against malaria. However, because of possible interactions with immunity development, treated bednets may cause no effect at all or even an increase in malaria morbidity and mortality in areas of high transmission. To clarify this issue, we did a randomized controlled trial to assess the long-term effects of bednet protection during early infancy.

A total of 3387 neonates from 41 villages in rural Burkina Faso were individually randomized to receive either bednet protection from birth (group A) or from age 6 months (group B). Primary outcomes were all-cause mortality in all study children and incidence of falciparum

malaria in a representative subsample of the study population.

After a mean follow-up of 27 months, there were 129 deaths in group A and 128 deaths in group B rate ratio (RR) 1.0 (95% confidence interval (CI): 0.78-1.27)). Falciparum malaria incidence was lower in group A than in group B, during early (0-5 months) and late infancy (6-12 months) (RR 3.1, 95% CI: 2.0-4.9; RR 1.3, 95% CI: 1.1-1.6) and rates of moderate to severe anaemia were significantly lower during late infancy (11.5% vs 23.3%, P = 0.008), but there were no differences between groups in these parameters in children older than 12 months. The findings from this study provide additional evidence for the efficacy of insecticide-treated nets in young children living in areas of intense malaria transmission.

Publication: [35]

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Transmissionsdynamik der Lungen-Tuberkulose Transmission dynamics of lung tuberculosis Project team: Heiko Becher, Valerie Louis

Collaborations within the department: Thomas Junghanss, Judit Barniol

External Collaborators: Walter Haas, RKI; Elke Göhring-Zwacka, Caroline Dreweck, Stuttgart; Sabine Rüsch-Gerdes, Stefan Niemann, Borstel

Funding body: DFG The incidence of Tuberculosis in Western Europe had declined since the 19th Century but immigration of people from high prevalence countries in the last decades had led to an increase of strains resistant to standard treatment. To effectively tackle this public health problem, knowledge on transmission dynamics is needed. The study was initiated to measure the dynamics of transmission between low and high prevalence populations in Baden-

Württemberg (BW) in relation to social interactions over time and to evaluate the use of genetic fingerprints as a tool for better characterisation of transmission dynamics.

We conducted a prospective study involving confirmed cases of pulmonary tuberculosis and their contact persons as identified through Public health authorities (ÖGD) in BW from 01.01.2003 to 31.12.2005. Data are obtained from routine data collected within the framework of the revised law for protection from infectious diseases, through structured questionnaires addressing social interactions among the indigenous population and migrants and

from molecular typing (DNA fingerprints).

Eligible study participants were all newly diagnosed pulmonary tuberculosis cases diagnosed in a period Jan 1st, 2003- Dec. 31st 2005 occurring with last place of residence in the state of Baden-Württemberg, Germany. According to the

“Infektionsschutzgesetz” there was a mandatory reporting of all cases to the

Robert-Koch-Institute Berlin. A total of 1293 incident cases occurred in the study area over the study period. For 592

cases a molecular genetic typing has been performed, this is a sampling fraction of 45.8 %. Preliminary analysis show that 19% of all infections in Germans are acquired from a migrant. Further analysis is ongoing.

Publication: [5] , J Barniol, C Kyobutungi, S Rüsch-Gerdes, S Niemann, E Göhring-Zwacka, H Becher, W Haas, T Junghanss. A molecular epidemiological study on Migration and Transmission of pulmonary tuberculosis in Baden-Württemberg (Abstract). Meeting of the German Society for Epidemiology, Greifswald, 2006

0

2

4

6

8

10

12

14

16

1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005

DeutschlandBaden-Württemberg

Fig. 8: Tuberculosis Incidence in Baden-Württemberg and Germany

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Virusprävalenz in einer ländlichen Bevölkerung in Burkina Faso Seroprevalence of viruses in a rural population in Burkina Faso Project team: Heiko Becher, Gisela Kynast-Wolf

External Collaborators: Ellen Collenberg, Helmut Fickenscher, Hans-Georg Kräusslich, Denis M. Tebit, Department of Virology; Jean Ganamé, Bocar Kouyaté, CRSN, Nouna; Thierry Ouedraogo, Lassana Sangare, University of Ouagadougou

Funding body: DFG (SFB 544) A seroprevalence study was carried out by the department of virology (Prof. Kräusslich) of six different human pathogenic viruses, namely human immunodeficiency virus (HIV), hepatitis B virus (HBV), hepatitis C virus (HCV), human T-cell leukemia virus (HTLV), human herpesvirus type 8 (HHV-8), and dengue virus among pregnant women and blood donors from rural (Nouna) and urban (Ouagadougou) Burkina Faso, West Africa. A total of 683 samples from blood donors (n=191) and pregnant women (n=492) were collected from both sites and screened for the different virus infection markers resulting in the following prevalence values for Nouna or

Ouagadougou, respectively: HIV 3.6/4.6, anti- HBV core (anti-HBc) 69.6/76.4, HBV surface antigen (HBsAg)14.3/17.3, HCV 2.2/1.5, HTLV 1.4/0.5, HHV-8 11.5/13.5, dengue virus 26.3/36.5. Individuals aged _25 years were more likely to be infected with HIV than those below 24 years (P< 0.05). Infection with HIV increased the likelihood of co-infection with other viruses, such as HHV-8, HBV and HTLV. Co-infection studies involving five viruses (HBV-HBsAg, HHV-8, HIV, HCV, and HTLV) showed that 4.8% (33/683) of the studied population were dually infected, with HBsAgþ HHV-8 (13/33), HBsAgþHIV (8/33) and HIVþHHV-8 (8/33) being the most common co-infections.

Publication: [26]

Abb. 9: Dorf im Distrikt Kossi, Burkina Faso Fig. 9: Village in district Kossi, Burkina Faso

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1.3. Krebsepidemiologie ● Cancer epidemiology Krebsepidemiologie hat sich seit dem Nachweis des Zusammenhangs zwischen Rauchen und Lungenkrebs in den fünfziger Jahren des 20. Jahrhunderts rasant entwickelt. Studien fanden in der überwiegenden Mehrzahl in Industrie-ländern statt, in denen Krebs eine der Haupttodesursachen ist. In letzter Zeit werden auch zunehmend krebsepide-miologische Studien in Entwicklungs-ländern durchgeführt, bedingt durch eine insgesamt steigende Lebenserwartung und einer damit verbundenen ansteigenden Krebsinzidenz. In dieser Sektion werden eine Reihe von Studien aus dem Bereich der Krebsepidemiologie durchgeführt, die zum Teil als Lang-zeitprojekte ihren Ursprung in der früheren Position des Sektionsleiters am Deutschen Krebsforschungszentrum haben.

Cancer epidemiology developed very rapidly since the 1950s when the link between smoking and lung cancer was discovered. Studies were mainly performed in western countries, where cancer is one of the major causes of death. Studies in developing countries, however, are becoming more and more common, mainly because of the overall increasing life expectancy and a related increasing cancer incidence. In this Unit we perform a number of cancer studies, which in part originated as long term projects from the former position of the unit head at the German Cancer Research Center.

Rauchen und Lungenkrebs in Afrika Smoking and lung cancer in Africa Project team: Volker Winkler, Heiko Becher

External collaborators: Bocar Kouyaté, Adjima Gbangou, Nouna, Burkina Faso;

Funding: GKR 793, SFB 544 and core funding In general data on smoking prevalence is scarce for African countries, but there are several studies for different countries available that show an alarming trend: Male smoking prevalence in African varies from about 20% up to over 65% depending on age and country.

Traditionally, smokers are mostly males. The proportion of women smokers is very low, but is already rising in a few African countries. According to the WHO, in 1999, Africa smoked 4% of World cigarette consumption and the UN's Food and Agricultural Organisation (FAO) state cigarette smoking in Africa is growing by a record 3.5% a year. Tobacco is the major cause of cancer and an important risk factor for several other chronic diseases. Due to the epidemiological transition in

developing countries (increasing life expectancy) there is an increasing relevance of chronic diseases to the total burden of diseases.

We developed a method to estimate the number of lung cancer cases caused by smoking in Africa using lung cancer mortality data from industrialized countries only in combination with smoking prevalence data in Africa. The results showed, that on one hand the previous estimates by other studies may be too high but on the other hand up to lung cancer 50000 deaths per year occur in Africa, most of them caused by smoking.

Publication: [43]

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Darmstadt

Heilbronn

Heidelberg

Mannheim

Ludwigshf.

Darmstadt

Heilbronn

Heidelberg

Mannheim

Ludwigshf.

Note: The diploma thesis of Volker Winkler ("Schätzung der tabakassoziierten Lungenkrebsfälle in afrikanischen Entwicklungsländern") emerging from this project has won the GMDS- Förderpreis 2005 Passivrauchen und Krebs Passive smoking and cancer Project team: Heiko Becher

External collaborators: M. Pötschke-Langer, DKFZ Heidelberg, U. Keil, J. Wellmann, Universität Münster

Funding: DKFZ Passive smoking is classified into group 1 (This agent is carcinogenic to humans) by the International Agency for Research on Cancer. In collaboration with the DKFZ and the University of Münster we performed an assessment of the hazard in Germany. Major results are: Passive smoking is responsible for

• more than 260 deaths per year of lung cancer

• more than 2140 individuals per year who die of coronary heart disease

• more than 770 deaths per year caused by stroke

• more than 50 deaths per year from chronic-obstructive lung disease

• the development of a large number of non-fatal cases of these diseases

• in summary, more than 3300 deaths within nonsmokers per year occur in Germany caused by passive smoking, this number is larger than all deaths from illegal drugs, asbestos, BSE and SARS combined.

• passive smoking may lead to sudden infant death. 60 infants die per year in Germany because the mother is a smoker

Publication: [3] , [25] Berufliche und andere Risikofaktoren für Kehlkopfkrebs Occupational and other risk factors for laryngeal cancer Project team: Heiko Becher, Heribert Ramroth

External collaborators: Andreas Dietz, Leipzig; Wolfgang Ahrens, Bremen; Angela Risch, Peter Schmezer, Odilia Popanda, DKFZ Heidelberg

Funding: BMBF The Rhein-Neckar-Larynx Study is a population-based case-control study 1:3 frequency matched by age and sex on laryngeal cancer in South-West Germany with 257 cases, histologically confirmed and diagnosed between 1.5.1998 and 31.12.2000 and 769 population controls. Information about occupational exposures, lifestyle factors and socio demographic background were obtained with face-to-face interviews

using a detailed standardized questionnaire.

As expected, highest risks on laryngeal cancer were found for smoking and alcohol consumption (Ramroth et al. 2004). For occupational exposures we found higher risks for polycyclic aromatic hydrocarbons (Becher et

al 2005), cement dust (Dietz et al. 2004) and wood dust (Ramroth et al. submitted), but no association for asbestos. We did not find a risk modifying

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effect of genetic polymorphisms in enzymes involved in ethanol and tobacco carcinogen metabolism (Risch et al. 2002), but our results suggest that a reduced capacity of somatic cells to synthesize poly(ADP-ribose) (Rajaee-

Behbahani et al. 2002) might be associated with an increased risk for laryngeal cancer. Further analyses related to alcohol, and active and passive smo-king have additionally been performed.

Publications: [7] , [14] , [21] , [38] , [55] , [56] Brustkrebsüberlebensraten in verschiedenen ethnischen Gruppen Breast cancer survival in different ethnic groups Project team: Heiko Becher, Malabika Sarker

External Collaborators: Ismail Jatoi, Bethesda, USA

Funding: Bonusmittel There is a known difference in survival in breast cancer survival between races in the US for which several factors such as social, lifestyle and genetic factors may be relevant.

In this retrospective study we considered women entitled to free treatment in the US department of defense health care system. Within this group, we investigated the temporal trend of absolute survival of 13,793 of White and African American (AA) aged 20-59 years and diagnosed

between 1980 and 1999 with breast cancer. There is a 3% overall improvement in survival in whites which can be explained by an earlier detection, and a two percent decrease in AA with a

distinct pattern by age group. In the 40-49 year age group, the survival in white increases from 84.5% in the year 1980-1984 to 87.4 % in the year 1995-1999, in AA we estimate a decrease from 79.7% to 78.5%. When accounting for stage at diagnosis a slight reduction in survival in whites and a strong reduction in AA indicates a significant interaction between race and calendar period. The gap in survival which strongly

increased with calendar period cannot be explained by unequal access to health care. Possible explanations include a lower participation of early detection programs for breast cancer in AA and an increasing prevalence of obesity over time which is more pronounced in AA than in whites.

Publications: [57]

Fig. 10: Comparison of 5 years absolute survival rate among different age groups diagnosed with Stage 2 breast cancer

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Fig. 10: Cimicifuga racemosa (Traubensilberkerze)

Brustkrebsüberlebensraten nach Behandlung mit Phytoestrogenen Breast cancer survival after treatment with phytoestrogens Project team: Heiko Becher

External Collaborators: Tracy Slanger, DKFZ; H. Heinecke v. Zepelin, U. Stammwitz, Salzgitter; K. Kostev, D. Schröder-Bernhardi, Frankfurt In this retrospective pharmaco-epidemiological cohort study the unit provided methodological support. The objective was to investigate the influence of an isopropanolic Cimicifuga racemosa extract (iCR) on recurrence-free survival after breast cancer, including estrogen-dependent tumors. It is based on breast cancer patients treated at general, gynecological, and internal facilities linked to a medical database in Germany. The main endpoint was disease-free survival following a diagnosis of breast cancer. The impact of treatment with iCR following diagnosis was analyzed by Cox proportional hazards models, controlling for age and other confounders.

Of 18,861 patients selected from the IMS Disease Analyser Mediplus database, a

total of 1,102 had received an iCR therapy. Results showed that iCR was not associated with an increase in the risk of

recurrence but associated with prolonged disease-free survival. The primary Cox regression model controlling for age, Tamoxifen use and other confounders demonstrated a protractive effect of iCR on the rate of recurrence (hazard ratio 0.83, 95% confidence interval 0.69-0.99). This effect remained consistent throughout all variations of the statistical model, including subgroup analyses. Sensitivity analyses showed good internal and external validity of the database.

It was concluded that an increase in the risk of breast cancer recurrence for women having had iCR treatment,

compared to women not treated with iCR is unlikely.

Publication: [51]

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1.4. Sozialepidemiologie ● Social epidemiology In der Sozialepidemiologie geht es primär um die Identifizierung von Determinanten von Gesundheitsrisiken (Stress, Risikoverhalten, soziale Isolation usw.) und um die quantitative Erfassung ihrer Auswirkungen auf Wohlbefinden, Lebensqualität, Krankheit und Mortalität. Wir ordnen eine Reihe von Studien in diese Kategorie ein, die sich mit der Gesundheit von Minderheiten, benachteiligten Bevölkerungsgruppen, oder Migranten befassen.

In Social Epidemiology we deal with identification of social and behavioral determinants of health risks (stress, risk behavior, social isolation etc.) and with the quantitative assessment of these determinants on wellbeing, quality of life, morbidity and mortality. We group a number of studies into that category, which deal with the health of minorities, disadvantaged population groups or migrants.

Mortalität von Migranten aus der ehemaligen Sowietunion Mortality of migrants from the Former Soviet Union Dieses Projekt, das in eine Reihe von Teilprojekte untergliedert ist, kann auch in die Kategorie der Migrantenstudien eingeordnet werden. Wir untersuchen hier verschiedene Aspekte der Gesundheit von Migranten aus der früheren Sowjetunion / Russ. Föderation.

This is a project that also falls in the category of migrant studies. We investigate the health of migrants from the former Soviet union / Russian Federation in different aspects. The project can be subdivided into several sub-projects as given below.

Mortalität von Spätaussiedlern in Deutschland – die AMOR-Studie Mortality of ethnic German immigrants from the former Soviet Union in Germany – The AMOR study Project team: Heiko Becher, Catherine Kyobutungi, Ulrich Ronellenfitsch, Jördis J. Ott, Volker Winkler

External collaborators: Judit Laki, Budapest; Ari Paltiel, Jerusalem; Oliver Razum, Bielefeld; Christa Stegmaier, Saarbrücken

Funding: DFG (GRK 793) Since the breakdown of the communist regimes in Eastern Europe in the late 1980s, almost 2.9 million Ethnic Germans, so-called Spätaussiedler, and their descendants migrated from Eastern European countries to Germany. Factors potentially influencing the health of the Aussiedler in Germany are:

• The high mortality in Eastern Europe and especially in the countries of the Former Soviet Union (FSU).

• Their presumed socio-economical disadvantage compared to native Germans

• The high mortality from external causes especially suicide among males in the FSU.

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Fig. 11: Age-standardised CVD mortality rates per 100.000 and 95% confidence intervals for men in the cohort (●) and in the general German population (■).

Thus, it can be expected that their health status is worse compared to the entire German population, confirmed by a higher mortality, especially for the aforementioned causes. This hypothesis was tested within a large epidemiological study, the first of its kind on the health of this population group. We established a cohort of 34,393 out of 218,356 eligible

Aussiedler who settled in North Rhine Westphalia (NRW) from the FSU between 1990 and 2001 and accomplished first follow-up until 31.12.2002. Overall, 1805 deaths were observed with 2004,2 expected, yielding an SMR of 0.90 (95% CI: 0.85-0.95). Thus, the overall mortality was significantly lower than expected.

We observed 104 deaths from external causes (23 females and 81 males) with an SMR of 1.60 and 1.04, respectively, which

is a significant increase in males. In a further analysis, number of residential changes after migration was analyzed to be a predictor for suicide and other external cause mortality. We found that the risk to die from external causes increases with number of residential changes which could be caused by social disintegration. Regression analysis also

shows that time to death from suicide is 2.5 times shorter than death from other causes.

With regard to cardiovascular diseases 731 cohort members had died of CVD. The cause-specific SMR was 0.79 (95%CI 0.71-0.88) in males and 0.86 (95%CI 0.78-0.95) in females. In contrast to our hypothesis, CVD mortality among Aussiedler was lower than in Germany’s general population.

Males have comparable overall cancer mortality to

the German population while females have lower mortality. The respective SMR are 0.98 (95% CI: 0.88-1.11) and 0.77 (95% CI: 0.67-0.87). However, the SMR for all cancers does not reflect differences in SMR for different cancer sites as shown. The SMR for lung cancer in males and for stomach cancer are greater than one. In contrast, SMR for cancers of the reproductive system is less than one and significantly for cancers of prostate and breast (females).

Publications: [18] , [33] , [32] , [41] , [45] , [54] , [58] Krebsinzidenz und -mortalität von Spätaussiedlern im Saarland (AMOR-Saar) Cancer incidence and mortality of German immigrants in the Saarland (AMOR-Saar) Project team: Heiko Becher, Volker Winkler

External collaborators: Christa Stegmaier, Saarbrücken

Funding: DFG (GRK 793)

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In this ongoing PhD project Spätaussiedler who immigrated in the 1990ies from the former Soviet Union to the Saarland will be examined regarding the cancer mortality and cancer incidence.

The cohort consists of approx. 20,000 migrants, who settled in the Saarland. Cases of cancer are identified in collaboration with the Saarland cancer registry. Information about death and cause of death of all cancer cases is

available at the cancer register by alignment of the “Melderegister” and public health authorities. The vital status of all members of the cohort is assessed from the registration offices in order to determine the total mortality. With an average Follow-Up time of eight years, approx. 160,000 person-years are expected.

Zeitmuster der Mortalität von Migranten aus der ehemaligen Sowjetunion nach Israel The Time Pattern of Mortality of Migrants from the former Soviet Union to Israel Project team: Heiko Becher, Jördis J. Ott

External collaborators: Ari Paltiel, Jerusalem

Funding: DFG (GRK 793) This ongoing project investigates the time patterns of sex, age and cause-specific mortality of the immigrants from the former USSR to Israel over the years 1990 to 2003, in comparison to mortality conditions in Israel. The study will attempt to disaggregate the overall pattern of mortality and its changes over time by regarding it as an expression of three sets of factors which characterize migration: 1. Factors relating to the short-term stresses which the migration experience entails 2. Factors relating to health status and behavior in the country of origin 3. Factors relating to health conditions and medical practice in the country of destination. It is hypothesized that the impact of these factors will vary by age and sex, and that the paradox of the “healthy migrant” which is seen in cross-sectional data, will be modified when the data is disaggregated by age and sex and investigated longitudinally.

The study is based on a longitudinal dataset which was constructed by the Central Bureau of Statistics in Jerusalem from the administrative data files which describe the demographic and educational characteristics of all immigrants to Israel. These files were matched with death records and emigration records, resulting in a complete follow up for this migration stream, including over 6o thousand deaths which were coded by underlying cause of death according to international standards. Since by the late 1990s the migrants form the former USSR had become such a large portion of the population of Israel, for comparative purposes the dataset includes mortality data for the complement of this group: all Israelis who are not migrants from the former USSR. Thus this dataset offers a unique opportunity to investigate patterns which in most other cases are obscured by small sample size and incomplete follow-up.

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Mortalität von Migranten aus der ehemaligen Sowjetunion nach Deutschland und Israel – eine Vergleichsstudie Mortality of migrants from the former Soviet Union to Germany and Israel – a comparative study Project team: Heiko Becher, Jördis J. Ott

External collaborators: Ari Paltiel, Jerusalem

Funding: DFG (GRK 793) This is an ongoing PhD project which started in 2005. After 1990 about one million jews migrated from the former Sowjet Union to Israel (15% of the total Israel population). The health status of these is determined by: (i) persisting impact on health status of the country of origin (ii) assimilation stress and eventually deteriorating socio-economic position in the host country.

Two hypothesis will be investigated: (1) migrants from the Russian federation do have a worse health status than the population of destination (measured as cause-specific mortality). (2) their cause-specific mortality shows different patterns than the native population.

The study is based on data from the aforementioned AMOR-cohort with an extended follow-up until the end of 2005 and on the cohort of immigrants to Israel. Data on population and causes of death are centrally available at the Central Bureau of Statistics in Jerusalem. By means of a historical cohort design age and cause-specific mortality rates will be compared. The direct comparison of the results from Israel and Germany emphasizes different health risks. Disease groups with a higher risk among the migrants will be identified and perspectives for targeted prevention programs in the framework of Public Health will be provided.

Genetische und Lebensstilfaktoren für Herz-Kreislauf-mortalität von Spätaussiedlern Genetic and lifestyle factors for cardiovascular disease mortality in German resettlers Project team: Heiko Becher , NN

External collaborators: H.-Erich Wichmann, R. Holle, GSF, Neuherberg

Funding: DFG (Antragsphase) Previous studies on migrants from the former Soviet Union showed a surprisingly low mortality of cardiovascular diseases, which is not only lower than in the country of origin, but also lower than in Germany, the country of destination. Since these studies were register based and did not contain individual information on risk factors, we plan a study in collaboration with the GSF in the framework of the CORA activities in Augsburg / Bavaria.

The number of migrants which had their first place of residence in Augsburg is estimated between 10.000 and 20000 individuals. It is planned to obtain information from population registries and to collect individual information with a self-administered questionnaire. Blood samples will be collected from a sub sample to investigate genetic polymorphisms which may play a role in the etiology of cardiovascular disease.

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1.5. Biostatistik ● Biostatistics Die Analyse epidemiologischer Studien erfordert ein weit gefächertes biostatistisches Handwerkszeug. Viele der heute angewendeten Methoden wurden erst in der jüngsten Vergangenheit entwickelt, da die für die Berechnungen notwendige Computerkapazität früher noch nicht vorhanden war. Darüber hinaus ergeben sich nicht selten neue methodische Probleme, für die ein angemessenes Instrumentarium entwickelt werden muss. Die hier beschriebenen Projekte sind Beispiele dafür. Die Sektion leistet zudem allgemeine biostatistische Beratung für Projekte außerhalb der Abteilung, oft im Rahmen des SFB 544.

For the analysis of epidemiological studies a wide range of biostatistical methods is needed. Many of the methods currently

used have been developed only recently since the increasing computer power triggered the research on computer intensive methods. In addition, quite often it occurs during the course of a study that the analysis requires methods which

are not yet available. The projects described in this part of the report are examples of that kind. In addition to the projects described here, the unit acts as a biostatistical consultant for projects outside the department, often within the SFB 544.

Spline regression für eine Modellierung der Mortalität abhängig von Alter und Saison der Geburt Using spline regression to model age- and season-of-birth effects on mortality Project team: Heiko Becher, Gabriele Stieglbauer

External Collaborator: Göran Kauermann, Pavel Khomski, Universität Bielefeld

Funding: DFG (SFB 544) Several previous studies have identified risk factors for childhood mortality in high risk areas, such as Sub-Saharan Africa. Among these are lifestyle factors related for example to nutrition or sanitation. Others are related to social class, ethnicity and poverty in general. Few studies have investigated a dependence of these factors by age and season of birth which was the focus in this study.

We performed a survival analysis of 9121 children born between 1998 and 2001 in a rural area of western Burkina Faso. The whole population is under demographic surveillance since 1993. All cause mortality was used as the endpoint.

Follow-up information data until the age of five was available. Recently developed spline regression methods were adopted for analysis.

Ethnic group, religion, age of mother, twin status, sex, and distance to next health center were used as covariables all of which having a clear effect on survival in standard Cox regression analysis. Ethnicity is more related to death at early age, as well as age of mother. The effect of the risk factors considered also appear to be related with season of birth. With penalized spline regression, a more detailed risk pattern analysis is obtained.

Publication: [44]

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Konfidenzbänder für eine parametrische Modellierung von Saisoneffekten auf die Mortalität Confidence bands for a parametric modelling of season on mortality Project team: Heiko Becher, Michael Preuß, Gisela Kynast-Wolf

Funding: DFG (GRK 793) A common problem in epidemiology is the modeling of mortality rates r which is often done with Poisson regression models of the form log(r│X=x,Z=z)=α+βx+γ’z, where x is the variable of primary interest, and z is a vector of further covariables.

The mortality of certain diseases may depend of season. Earlier studies have shown that this is the case for malaria. Here, a parametric modeling with a sine function may be appropriate. The rate can then be expressed in the form log(r│X=x,Z=z)=α+β sin((x-k)/365*2Π)

+γ’z, where x denotes the day (xЄ{1,…,365}), β the amplitude and k the phase. If both parameters are to be estimated, we are outside the class of generalized linear models. For a fixed k, however, standard software, like PROC GENMOD in SAS can be used.

We developed a procedure to obtain a Maximum-Likelihood-Schätzer for (k, β) and the

corresponding confidence band. The goodness of fit for a given

parameter combination (k*, β*) is obtained by a suitable offset term in the regression model. A macro in SAS allows the calculation of an confidence ellipsoid for the ML-estimate of (k, β). This is then used for a confidence band.

The procedure is illustrated with data from the DSS in Nouna, Burkina Faso. Data from more than 10000 births in the period 1993-2003 are available. We show that the procedure allows a simple an precise description of the mortality by season.

Publication: Konfidenzbänder für eine parametrische Modellierung von Saisoneffekten auf die Mortalität (Abstract). 53.Biometrisches Kolloquium, Bielefeld. 2007.

Fig. 12: Seasonal effect on infant mortality with correct (red) and naive (blue) confidence band, Nouna DSS, Burkina Faso

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1.6. Sonstige Projekte ● Other projects Migration und Diabetes Migration and Diabetes Project team: Heiko Becher, Jördis J. Ott

Collaborators within the department: Thomas Junghanss, Universität Heidelberg

External Collaborators: Oliver Razum, Universität Bielefeld; Manuel Carballo, International Centre for Migration and Health, Geneva, partners from 10 collaborating centers worldwide

Funding: ICMH This project is in its planning phase and a grant application is being developed. The aim of the project is to enhance global understanding about the dynamics of diabetes in the context of migration and strengthen the prevention and management capacity of migrants (especially those living with diabetes), their families, healthcare services and health-related personnel. In order to achieve the aim of the project the specific objectives are to: • identify and characterize the profile of

migrants diagnosed with diabetes • assess and describe their interaction

with the health care system

• assess and describe their beliefs/perceptions of diabetes and its management

• identify and characterize the profile of non-migrants diagnosed with diabetes

• assess and describe their interaction with the health care system


• identify and characterize the profile of migrants not-diagnosed with diabetes


• assess and describe how healthcare personnel perceive migrants with diabetes

Epidemiologische Studien zum Schlaganfall Studies on Stroke epidemiology Project team: Heiko Becher, Catherine Kyobutungi, Gabriele Stieglbauer

External Collaborators: Armin Grau, Florian Buggle, Frederic Palm, Abteilung Neurologie, städt. Kliniken Ludwigshafen

Funding: DFG (GKR 793), Core Funding In collaboration with the Department of Neurology, Städt. Kliniken Ludwigshafen we collaborate in a project to build up a population based stroke registry. This cooperation results from previous collaborative projects on stroke

epidemiology. In these studies, acute infections, chronic inflammation of dental diseases, and temperature changes were investigated as risk factors for stroke. An grant application to the DFG is in preparation.

Publications: [8] , [10] , [23] , Palm F, MD; Bode B, MD; Buggle F, MD; Becher H, MD, PhD; Armin J. Grau, MD, PhD. The Ludwigshafen Stroke Study (LuSSt). First data from a population-based stroke registry (Abstract). Conference of the European Neurological Society, Rhodes, 2007

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Krankenversicherung im ländlichen Burkina Faso Community Health insurance in rural Africa Project team: Heiko Becher, Gisela Kynast-Wolf

Collaborators within the department : Rainer Sauerborn, Manuela di Allegri

Funding: DFG (SFB 544) This is a collaboration within project D2 of the SFB in which this unit provided statistical support. One of the topics was to identify factors associated with decision to enrol in a community health insurance (CHI) scheme. a population-based case–control study among 15 communities offered insurance in 2004 in rural Burkina Faso was conducted. For inclusion in the study, we selected all 154 enrolled (cases) and a random sample of 393 non-enrolled (controls) households.

Multivariate analysis revealed that enrolment in CHI was associated with Bwaba ethnicity, higher education, higher

socioeconomic status, a negative perception of the adequacy of traditional care, a higher proportion of children living within the household, greater distance from the health facility, and a lower level of socioeconomic inequality within the community, but not with household health status or previous household health service utilization.

The provides evidence that the decision to enrol in CHI is shaped by a combination of household head, household, and community factors. Policies aimed at enhancing enrolment ought to act at all three levels.

Publication: [27] , [48] Immunhämatologische Referenzwerte und Evaluation einer vereinfachten durchfluss-zytometrischen Zwei-Plattform-Methode zur Bestimmung von Lymphozytensubpopulationen in Nouna, Burkina Faso Immunohematological reference ranges and evaluation of a simplified dual platform flow cytometric method for measurement of lymphocyte subsets in Nouna, Burkina Faso Project team: Gisela Kynast-Wolf

External Collaborators: Thomas Böhler et al.

Funding: DFG (SFB544) In the context of a program for prevention of mother-to-child transmission of HIV in Nouna, Burkina Faso, site- and gender-specific immunohematological reference ranges (leukocyte and lymphocyte counts, peripheral blood lymphocyte subsets, and T cell maturation phenotypes) were established in 186 healthy adults (89 female, 97 male; age range 18 to 78 years) using both single-platform and dual-platform flow cytometry (FCM). Male

blood donors had significantly lower CD4+ T cell counts than females (mean

difference: -140 cells per µl, 95% confidence interval [CI]: -43 to -238 cells per µl; p<0.005), whereas NK cell counts were significantly higher (mean difference: 163 cells per µl, 95% CI: 83 to 242 cells per µl; p<0.0001). No significant age-associated changes in absolute numbers of lymphocyte subpopulations were observed. In addition, a simplified dual-platform FCM method was evaluated that allows determination of all major

lymphocyte subsets (CD4+ and CD8+ T- cells, B-cells and NK-cells) in a single test

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tube. Single-platform and dual-platform FCM methods were compared for 177 individuals. Analysis of comparative measurements revealed that the simplified dual-platform FCM method systematically underestimates the proportion of NK-cells, overestimates the

percentage of CD3+ and CD8+ lymphocytes, and yields proportions of B-

cells and CD4+ T-cells comparable with single-platform FCM. Bland-Altman

analysis showed a low bias with an acceptable precision for percent values of

CD4+ T cells (bias±precision –1±6.5%)

and CD8+ T cells (–3±6%). Absolute cell numbers of all lymphocyte subpopulations, however, were systematically biased towards lower values obtained by the simplified dual-platform FCM method.

Publication: [47] , [52] Studie über Gesichtsschmerz in der älteren Bevölkerung Study on joint (TMJ) and facial pain in the elderly Project team: Heiko Becher, N.N.

External Collaborators: Prof. Dr. Rammelsberg, Dr. Hassel and PD Dr. Schmitter, Mund-Zahn-Kiefer-Klinik, Universitätsklinikum Heidelberg

Funding: BMBF (Antragsphase) This is a project within the call „Förderung von Forschungsverbünden zur Gesundheit im Alter“ in the programme „Gesundheitsforschung: Forschung für den Menschen“ of the German Ministry of Research and Technology.

We will assess the prevalence of temporomandibular disorders in the elderly and its association with gender- and age-related (tooth loss etc.) issues as well as psychosocial aspects. In this context pain-relevant assessment instruments will be adapted and validated for the elder age groups. Mechanisms of temporomandibular pain and related disorders will be examined by testing

pain-related sensitization, pain-related brain plasticity and co-morbidity with mental disorders. In addition, a multidisciplinary treatment approach will be evaluated. This project has several objectives of which one is within the field of epidemiology :

Assessment of the prevalence of TMD in an age group of 75+ that has so far not yet been tested; Assessment of risk factors for TMD; Pain perception in TMD subjects with pain.

The unit is co-applicant and will be responsible for the epidemiological part of the project.

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2. Lehre ● Teaching In diesem Kapitel werden die Lehraktivitäten von Mitgliedern der Sektion beschrieben. Praktisch alle Mitarbeiter der Sektion sind an der Lehre beteiligt. Die wesentlichen Bereiche der Lehre sind für

(i) Medizinstudenten an der Universität Heidelberg (s. 2.1),

(ii) Studenten im Masterkurs „ Master of Science in International Health“ (früher “Master of Community Health and Health Management in Developing Countries”) (s. 2.2) und

(iii) Doktoranden im Bereich der Doktorandenausbildung des Graduiertenkollegs 793 (s. 2.3).

Darüber hinaus sind Mitarbeiter der Abteilung an weiteren Kursen beteiligt. Ab 2007 bietet die Sektion wird zusätzlich das Modul Epidemiologie im Masterkurs „Biometrie“ des Instituts für med. Biometrie und med. Informatik angeboten. Für 2008 ist geplant, den dreiwöchigen Kurs „European Course in Tropical Epidemiology“ in Heidelberg anzubieten. Weiterhin findet eine Beteiligung an der Lehre im Fach Epidemiologie an anderen Universitäten statt (s. Abschnitt 2.4).

In this chapter the teaching activities of members of the unit are described. Almost all members of the unit contribute to lectures or courses. Major areas of teaching are

(i) undergraduate teaching for medical students of Heidelberg University (section 2.1)

(ii) Postgraduate Students in the Master Course “Master of Science in International Health” (formerly “Master of Community Health and Health Management in Developing Countries”) (section 2.2)

(iii) Training for doctoral students within the PhD program “Graduiertenkolleg 793”

In addition, members of the unit contribute to further courses. From 2007 onwards the unit organizes the module Epidemiology within the Master course “Biometry”, organized by the institute of Medical Biometry and Medical Informatics at the faculty. For 2008 we plan to organize the three-week course „European Course in Tropical Epidemiology“ in Heidelberg. Furthermore there are contributions to teaching in epidemiology at other universities (section 2.4).

2.1. HeiCuMed Mit der neuen Approbationsordnung ist die Epidemiologie als Teil des Querschnittsbereichs „Epidemiologie, medizinische Biometrie und medizinische Informatik“ Teil im Pflichtcurriculum des Medizinstudiums. Die Durchführung und Organisation der Lehre im Bereich der Epidemiologie obliegt dem Sektionsleiter.

Folgende Mitglieder der Sektion waren im Berichtszeitraum an der Lehre beteiligt:

The new ”Approbationsordnung” includes Epidemiology as part of the topic „Epidemiology, medical Biometry and medical Informatics“ as a compulsory subject within the medical curriculum. The unit head is responsible for organisation and the teaching of the part Epidemiology. The following members of the unit contributed to the teaching within the reporting period:

Prof. Dr. rer. nat. Heiko Becher (verantwortlich) Dr. med. Thomas Jänisch PD Dr. med. Olaf Müller

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Zusätzlich trugen auch folgende Kollegen aus den epidemiologischen Abteilungen des Deutschen Krebsforschungszentrums zu der Lehre bei:

In addition, the following colleagues from the departments of epidemiology at the German Cancer Research Center contributed to teaching:

Prof. Dr. sc.hum. Nikolaus Becker Prof. Dr. sc.hum. Jenny Chang-Claude Dr. rer. nat. Alexanda Nieters Dr. rer. nat. Karen Steindorf PD Dr. med. Til Stürmer Prof. Dr. med. Dietrich Rothenbacher Dr. Sabine Rohrmann Dr. med. Tilla Ruf PD Dr. med. Volker Arndt Dr. Justo Lorenzo, PhD

Die Lehrmaterialien wurden gemeinsam entwickelt und stehen den Studenten im Internet passwortgeschützt zur Verfügung

Alle Lehrveranstaltungen wurden durch die Studenten evaluiert. Obgleich das Fach a priori oft eher als trocken und weniger relevant im Vergleich zu der klinischen Ausbildung angesehen wird, waren die Bewertungen bisher erfreulich. Eine Reihe von Studenten haben sich in der Vergangenheit entschieden, ihre Doktorarbeit in diesem Bereich anzufertigen. Im folgenden sind einige Ergebnisse des kürzlich fertig gestellten Evaluationsberichts für das Studienjahr 2005/2006 angegeben. Dabei wurde folgender Evaluationsbogen verwendet und die Fragen mit Schulnoten bewertet:

Teaching material was jointly developed and is available to medical students in the internet (password-protected).

Each teaching units are evaluated by the students. Although the field is a priori rated as rather theoretical and less relevant for clinical education, the rating was surprisingly positive so far. A number of students have chosen in the past an epidemiological project for their MD thesis. In the following some results from the recent evaluation report for the academic year 2005/2006 are given. The following evaluation sheet was used. Rating follows German school marks (1: very good – 6: unsatisfactory)

HeiCuMed Evaluationsbogen HeiCuMed Evaluation Sheet 1. Die Veranstaltungen waren gut organisiert 2. Die DozentInnen wirkten gut vorbereitet 3. Die Veranstaltungen waren interessant 4. Die DozentInnen zeigten Engagement in ihrer Lehrtätigkeit und versuchten

Begeisterung zu vermitteln 5. Die DozentInnen konnten Kompliziertes verständlich machen 6. Die DozentInnen unterstützten die Mitbeteiligung der Studierenden 7. Es fanden ausreichend Diskussionen statt 8. Die Diskussionen in den Veranstaltungen waren produktiv 9. Ich habe Sinnvolles und Wichtiges gelernt 10. Ich empfand die Lernatmosphäre als angenehm 11. Die Teilnahme an den Veranstaltungen lohnt sich 12. Das Fach ist relevant für das Studium 13. Das Fach ist relevant für den Beruf 14. Die Stoffmenge war für mich 1 – zu gering, 3 – genau richtig, 5 – zu hoch

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Die schlechtesten Bewertungen erfolgte für die Fragen 11. und 13 (s. Abb.13). Die Bedeutung des Faches für den zukünftig praktisch tätigen Arzt ist offensichtlich schwierig zu vermitteln. Es ist allerdings auch wenig verwunderlich, dass die Studenten den klinischen Fächern eine größere Bedeutung beimessen.

The worst evaluation was for questions 11 and 13 (see fig. 13). It appears difficult to show the relevance of the field for the future general practitioner. It is, however, not surprising that students rate clinical subjects higher.

Abb. 13: Fragenspezifische Bewertung Epidemiologie; aus: HeiCuMed Evaluationsbericht für das Studienjahr 2005/2006 Fig. 13: Evaluation Epidemiology; from: HeiCuMed evaluation report 2005/2006

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Im Vergleich zu den anderen theoretischen Fächern im Block 4 schneidet das Fach gut ab (s. Tab.1). Ob dies mehr an dem Fach oder an den Dozenten liegt, muss offen bleiben.

In comparison to other theoretical fields in Block 4 epidemiology is rated positively (see tab.1). It must remain open whether this is due to the performance of the lecturers or due to the subject itself.

Tab. 1: Gesamtnoten Block 4 (nach Schulnoten) Overall marks Block 4 (1: very good - 6: unsatisfactory)

Fach Subject Durchschnittsnote Average mark

N

Rechtsmedizin 1,61 119

Genetik 1,67 43

Pädiatrie 2,09 179

Medizinische Informatik 2,58 112

Epidemiologie 2,90 112

Gynäkologie 3,08 96

Umweltmedizin 3,11 89

Medizinische Biometrie 3,41 112

Arbeitsmedizin 3,48 130

Sozialmedizin 3,61 117

Geschichte, Theorie, Ethik in der Medizin 3,84 97

(aus/from: HeiCuMed Evaluationsbericht für das Studienjahr 2005/2006)

In Abb. 14. ist das Ablaufschema von HeiCuMed beschrieben. Die Epidemiologie wird in Block IV gelehrt. Der Unterricht findet in Gruppen von ca. 35 Studenten statt.

Fig. 14 shows the scheme of HeiCuMed. Epidemiology is taught in module IV. Teaching is done in small groups with an average number of about 35 students.

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Abb. 14: Ablaufschema HeiCuMed, medizinische Fakultät Heidelberg Fig. 14: Teaching Scheme HeiCuMed, Medical Faculty, Heidelberg

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2.2. Graduiertenkolleg 793 ● PhD program 793 Das Graduiertenkolleg (GRK) 793 „Epidemiologie übertragbarer und chronischer, nicht übertragbarer Erkrankungen und deren Wechselbeziehungen“ ist das derzeit einzige Doktorandenprogramm für das Fach Epidemiologie in Deutschland. Es hat eine Laufzeit von 1.4.2002 – 30.3.2011 und wird von der DFG gefördert. Die Sektion Epidemiologie stellt den Sprecher des GRK und zwei weitere Projektleiter. Die Sekretärin der Sektion, Elke Braun-van der Hoeven, nimmt gleichermaßen die Verwaltungsaufgaben im Rahmen des GRK wahr. Im Laufe des Berichtszeitraums haben 23 Doktoranden, davon 15 Stipendiaten und 8 assoziierte Doktoranden ihre Promotion erfolgreich abgeschlossen.

Weitere Information zu dem Programm sind zu finden auf der Homepage

http://grk.dermis.net

The PhD program „Graduiertenkolleg 793: Epidemiology of communicable and chronic, non-communicable diseases and their interrelationships” is currently the only PhD program for epidemiology in Germany. It runs since April 1st, 2002 and will end on March 31, 2011. The speaker and two more projects leaders are members of this unit. The administration of the program is organized by Ms Elke Braun-van der Hoeven who is also the secretary of the unit. During the period of this report 23 PhDs (15 fellows and 8 associate members of the program) have successfully defended their thesis.

Further information on the program is given on the website

http://grk.dermis.net

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2.3. MSc International Health Die Sektion ist an der Lehre in dem seit 1993 laufenden Master-Studiengang der Abteilung maßgeblich beteiligt. Der MSc in International Health ist einer der wenigen englischsprachigen Postgraduiertenkurse in Deutschland. Vor kurzem wurde eine Umstrukturierung in ein modulares System gemäß angelsächsischer Vorbilder durchgeführt und erfolgreich abgeschlossen. Der MScIH in Heidelberg ist akkreditiert mit dem Europäischen Netwerk TropEd (www.TropEd.org).

Im Kernkurs werden während des Blocks ‚Quantitative Methoden’ epidemiologische und biostatistische Grundbegriffe sowie das Programmpaket EPIINFO praxisnah gelehrt (Dozenten: Jänisch, Becher, Ramroth, Stieglbauer) . In einer Vielzahl von ‚advanced modules’ (http://www.klinikum.uni-heidelberg.de/ Short-Courses-tropEd.7083.0.html) können die Teilnehmer dann ihre Kenntnisse vertiefen, bevor sie den Abschluss „Master of Science in International Health“ erhalten. Themen der Vorlesungen sind in Abschnitt 2.4.4. angegeben.

The unit is strongly involved in the Master-Course which is offered by the department since 1993. The MSc in International Health is of the few postgraduate courses in Germany taught in English. Recently, a new structure into a modular system was successfully implemented according to successful models in Great Britain or North America. The MScIH in Heidelberg is accredited with the European network TropEd (www.TropEd.org).

Within the basic modules “quantitative methods” epidemiological and biostatistical basics are taught, and the software package EPIINFO for health professionals is introduced. In a number of advanced modules (http://www.klinikum.uni-heidelberg.de/ Short-Courses-tropEd.7083.0.html) the participants are given the possibility to broaden their knowledge and to specialize in certain fields before they obtain the degree „Master of Science in International Health“. Titles of lectures are given in section 2.4.4.

2.4. Vorlesungen ● Lectures 2.4.1. Vorlesungen im Rahmen des Heidelberger Curriculums Medizin (HeiCuMed) Lectures for Heidelberger Curriculums Medizin (HeiCuMed) Querschnittsbereich „Epidemiologie, medizinische Biometrie und medizinische Informatik“

Organisation: Becher (Epidemiologie), Pritsch (med. Biometrie), Wetter (med. Informatik) (siehe Kap 2.1) 2.4.2 Allgemeine Vorlesungen ● General lectures Regelmäßig jedes Semester ● Each term Kolloquium Medizinische Biometrie, Informatik und Epidemiologie Becher, Victor, Wahrendorf, Wellek, Wetter,Edler mondays 16:00-18:00 Ringvorlesung Epidemiology Becher, Chang-Claude, Becker tuesdays 16:00-18:00

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2.4.3 Vorlesungen im Graduiertenkolleg 793 Lectures within the PhD program

Regelmäßig jedes Semester ● Each term

• Doktoranden-Kolloquium tuesdays 16:00-18:00 (fortnightly) Organisation: Becher, Brenner, Chang-Claude, Diepgen, Wahrendorf,

• Journal Club

Spezielle Vorlesungen (ganztägig) ● special courses (full day)

Wintersemester 2003/2004

Rate Estimation and Survival Analysis with Register Data Becher /Hammer

Fr. 06.02.04

Rate Estimation and Survival Analysis with Register Data Becher /Hammer

Fr. 13.02.04

Sommersemester 2004 Advanced methods to analyse continuous covariables Becher

Fr. 14.05.2004

Simulation methods in Epidemiology Hammer

Fr. 18.06.2004

Wintersemester 2004/2005 Interaction in Case Control Studies Becher

Mo 29.11.04

Tuberkulose Becher

Mo 14.02.05

Sommersemester 2005 ( second round GRK 793 starting) Basics of Biostatistics Becher, Ramroth

04.-06.07.2005

Wintersemester 2005/2006 Introduction into the Statistical Software Package SAS Bruckner, Ramroth

10.-11.10.2005

Basics of demography I + II Paltiel

9.12.2005 / 13.01.2006

Methods in Biostatistics II Becher, Steindorf

20.01.2006 / 27.01.2006

Sommersemester 2006 Modelling in Cohort studies – Poisson and Cox regression Becher

19.05.2006

Wintersemester 2006/2007 Dose-Response Analysis Becher

01.12.2006

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2.4.4 Vorlesungen im Masterkurs „ Master of Science in International Health “ Lectures within the master course „ Master of Science in International Health“ Masterkurs 2003/2004, 2004/ 2005, 2005/2006 2006/2007 ‘Quantitative Methods’ Introduction and advanced methods in Epidemiology Razum (2003/2004), Jänisch (2004/ 2005, 2005/2006 2006/2007)

Introduction into the epidemiological software EPI INFO Becher, Stieglbauer, Hammer, Ramroth

Tab. 2: Modul 4 & Modul 5 in November/December 2006: “Research Foundations in International Health”

Monday 20 Tuesday 21 Wednesday 22 Thursday 23 Friday 24 Introduction to biostatistics (2): The Normal distribution, sampling variation, standard errors, and confidence intervals Kopp-Schneider

Introduction Outbreak investigation example Jänisch

Introduction to biostatistics (3): Principles of statistical testing Kopp-Schneider

Introduction to biostatistics (4): Significance tests confidence intervals for quantitative variables Kopp-Schneider

Diagnostic testing II & Screening Jänisch

Epi-Info tutorial: introduction Becher Ramroth Stieglbauer

Epi-Info tutorial: Descriptive statistics Becher Ramroth Stieglbauer

Measures of disease occurrence Jänisch

Diagnostic testing I Jänisch

Epidemiology tutorial Jänisch

Monday 27 Tuesday 28 Wednesday 29 Thursday 30 Friday 1 Introduction to biostatistics (5): Significance tests and confidence intervals for qualitative variables (chi-squared tests) Kopp-Schneider

Observational study designs Measures of association, part II Jänisch

Introduction to biostatistics (6): Sampling and sample size calculations Kopp-Schneider

Introduction to biostatistics (7): Correlation and regression Kopp-Schneider

Stratification, Age adjustment & SMR Jänisch

Observational study designs Measures of association, part I Jänisch

Epi Tutorial Jänisch

Epi-Info tutorial: Chi-squared and t-tests Becher Ramroth Stieglbauer

Bias & Confounding Jänisch

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Monday 4 Tuesday 5 Wednesday 6 Thursday 7 Friday 8 Design of survey instruments

Reliability and validity in survey based studies

Group work and presentations of survey results

Introduction to biostatistics (8): regression methods Kopp-Schneider

Ethical principles for research in International Health Mueller

Survey data entry Kroeger

Prep of data presentation, validity testing… Kroeger

Ctd. Kroeger

Epi Info tutorial: regression Becher Ramroth Stieglbauer

Monday 11 Tuesday 12 Wednesday 13 Thursday 14 Friday 15 Review session: Epidemiology Jänisch

Review session: biostatistics

Exam mod 4-5

2.4.5 weitere Vorlesungen ● further lectures • various guest lectureships within the Master course “Master of Epidemiology”, Mainz

University Becher

• yearly guest lectureship at the Department of Toxicology, University of Tübingen (Epidemiologie für Toxikologen) Becher

• from 2007 onwards: module “Epidemiology” in the Master Course “Medical Biometry/Biostatistics” Becher and colleagues

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2.5. Graduiertenschule Public Health ● Graduate School Public Health

Im Rahmen der Excellenzinitiative der DFG beteiligt sich die Universität Heidelberg mit zahlreichen Excellenzclustern, Graduiertenschulen und einem Zukunftskonzept. Mit Ausschreibung im Jahr 2006 und nach universitätsinterner Auswahl wurde unter Koordination von Prof. Rainer Sauerborn eine Projektskizze „Heidelberg School of International Public Health“ eingereicht. Dieser wurde positiv bewertet, und die Antragsteller wurden aufgefordert, einen Vollantrag einzureichen.

Die Epidemiologie nimmt in diesem Antrag eine zentrale Stellung ein, auch bedingt durch die starke Präsenz dieses Faches in Heidelberg, die sich in der Existenz des Graduiertenkollegs 793 ausdrückt. Zum Zeitpunkt der Erstellung dieses Berichts wird dieser Vollantrag ausgearbeitet.

Heiko Becher ist als Projektleiter beteiligt. Er ist zudem Mitglied des Redaktionsteams zur Erstellung dieses Antrags. Die Entscheidung zur Einrichtung dieser Graduiertenschule wird im Oktober 2007 fallen.

Internet: http://www.hyg.uni-heidelberg.de/GRIPH/

Within the framework of the excellence initiative the University of Heidelberg submitted several applications to so-called clusters of excellence, graduate schools, and a concept for the future. After a general call by the German Research Foundation in 2006 and an internal evaluation within the University a draft project application “Heidelberg School of International Public Health” with Prof. Rainer Sauerborn as coordinator was submitted. After positive evaluation the applicants were invited to submit a full proposal.

Epidemiology plays a major role in this application, due to the strong presence of the field in Heidelberg, and due to the “Graduiertenkolleg 793”. As of now, the full application is in progress with deadline April 2007.

Heiko Becher is project leader and member of the proposal writing committee. The final decision on the application is due October 2007.

Internet: http://www.hyg.uni-heidelberg.de/GRIPH/

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3. Weitere Aktivitäten ● Further activities 3.1. Positionen innerhalb und außerhalb der Universität ●

Positions within and outside the university Heiko Becher • Mitglied des Promotionsausschusses

(Dr. med.) der medizinischen Fakultät Heidelberg

• Associate Editor, Biometrical Journal (seit 2004)

• Vorsitzender (2005-2007), Deutsche Gesellschaft für Epidemiologie (DGEpi)

• Mitglied des wissenschaftlichen Beirats des GSF – Forschungszentrums für Umwelt und Gesundheit in der Helmholz-Gemeinschaft (2005-2007)

• Mitglied der Kommission Infektionsepidemiologie des RKI (2003-2005)

• Council member, International Biometric Society (2002-2005)

• Sprecher des Graduiertenkollegs 793 (2002-2011)

• Koordinator des Moduls “Epidemiologie” des Heidelberger Curriculums Medizin (HeiCuMed) (seit 2004)

• Member of the doctoral committee (Dr. med.), Medical Faculty, Heidelberg

• Associate Editor, Biometrical Journal (since 2004)

• President (2005-2007), German Society for Epidemiology (DGEpi)

• Member of the scientific council of the GSF – Forschungszentrum für Umwelt und Gesundheit in der Helmholz-Gemeinschaft (2005-2007)

• Member of the commission “Infectious Disease Epidemiology” of the Robert Koch Institute (RKI) (2003-2005)

• Council member, International Biometric Society (2002-2005)

• Speaker of the PhD program Graduiertenkolleg 793 (2002-2011)

• Coordinator of the module “Epidemiology” of the Heidelberg Curriculum Medicinale (HeiCuMed) (since 2004)

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3.2. Universitäre Partnerschaften ● University Partnerships

Thomas Jänisch Koordinator der Hochschulpartnerschaft zwischen der Universität Heidelberg und der School of Public Health and Social Sciences (SPHSS) am Muhimbili College of Health Sciences (MUCHS) in Daressalam, Tanzania.

Diese Partnerschaft wird vom Deutschen Akademischen Auslandsdienst gefördert und bietet eine Plattform für den langfristigen personellen Austausch im der Postgraduiertenlehre und die Beantragung weiterer Forschungsprojekte.

Coordinator of the university partnership between Heidelberg University and School of Public Health and Social Sciences (SPHSS), Muhimbili College of Health Sciences (MUCHS) in Daressalam, Tanzania.

This partnership is supported by the German academic exchange Service and provides a platform for a long-lasting exchange in postgraduate teaching and for joint research projects.

Abb. 15: Schneesturm während des Partnerschafts- Koordinationstreffen in Heidelberg, Dezember 2005 Fig. 15: Snowstorm during the partnership-meeting in Heidelberg, December 2005

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3.3. Tätigkeiten als Editor oder Reviewer ● Reviewing and editorial tasks

Heiko Becher

• Associate Editor

Biometrical Journal (since 2003)

• Examiner

External examiner of PhD theses at the Swiss Tropical Institute, Basel, Switzerland

• Reviewer

For funding agencies: DFG Deutsche Krebshilfe

Wellcome Trust For journals: American Journal of Epidemiology

American Journal of Tropical Medicine and Hygiene BMC Women's Health BMC Public Health Environmental Health Perspectives European Journal of Epidemiology International Journal of Cancer International Journal of Epidemiology Human Biology Statistics in Medicine Tropical Medicine and International Health Journal of Epidemiology and Community Health

• Editorials Im Rahmen der Kooperation mit dem CRSN in Nouna/Burkina Faso und anlässlich dessen 5. Geburtstages haben der Leiter des CRSN und der Sektionsleiter eine Monographie herausgegeben ( [20] ), in der die Historie und die wissenschaftlichen Ergebnisse präsentiert sind.

The 5th anniversary of the CRSN and the long-lasting cooperation with the Department of Tropical Hygiene and Public

Health gave rise to a monograph in which the history of the cooperation and the scientific achievements are described.

Abb. 16: Umschlag Buch „Health Research in Developing Countries”, Springer 2005 [20] Fig. 16: Cover of „Health Research in Developing Countries”, Springer 2005 [20]

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3.4. Tagungen und Workshops ● Meetings and workshops 16.–19.3.2004 IBS / DAE Tagung in Heidelberg

Gemeinsame Tagung der Deutschen Region der Internationalen Biometrischen Gesellschaft (50. Kolloquium) und der Deutschen Arbeitsgemeinschaft für Epidemiologie, (11. Jahrestagung).

Joint conference of the German Region of the International Biometrical Society (50th colloquium) and the German Epidemiological Association (11th. meeting).

Tagungspräsident (Vorsitzender): Heiko Becher 19.-20.3.2006 SFB 544/GRK 793 Symposium Epidemiologic and clinical research on tropical diseases in Africa

Organised by: SFB 544 "Control of Tropical Infectious Diseases" (Speaker: Prof. Dr. Hans-Georg Kräusslich) and GRK 793 "Epidemiology of communicable and chronic non-communicable diseases and their interrelationships" (Speaker: Prof. Dr. Heiko Becher)

Organisation: Barbara Kappes (Heidelberg), Olaf Müller (Heidelberg)

Since 2001, the unit gives courses on methodological topics at our partner institute in Nouna, Burkina Faso. During the period of this report, the following courses took place:

11.1.–17.1.2004 Course in Nouna, Burkina Faso Title:“Biostatistical Methods in Epidemiology and Introduction to the SAS Statistical Analysis System“

Organisation and lecturer: Gaël Hammer 26.2.–14.3.2006 Course in Nouna, Burkina Faso Title: “Biostatistical Methods in Epidemiology & Applications in Epi Info Software” Objectives of the course:

• To introduce a statistical routine program (STAR) written in Heidelberg by Gisela Kynast-Wolf and Gabriele Stieglbauer to calculate population size and mortality rates (crude, age-specific and age standardized rates). The program is menu driven, thus no specific SAS knowledge is required. The program works on the DSS-database (updated checked DSS-data in ACCESS format transformed into SAS table format).

• To give an introduction into the “Analysis”-Module of the Software EpiInfo (Version 3.3.2), to provide an analysis tool which is capable to calculate the above mentioned rates.

• To give an introduction into the “Make View”- and the “Enter Data”-Module of EpiInfo. “Make View” is the tool to create questionnaires (i.e. forms). “Enter Data” is the tool to enter data into the tables which lay behind these forms.

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Abb. 17: Biostatistik-Kurs in Nouna, 2006 Fig. 17: Biostatistics Course, Nouna, 2006

• To provide statistical background to Nouna staff on Regression methods, logistic regression methods and how they are implemented in Epinfo software.

Organisation and lecturers: Heribert Ramroth und Robert Ndugwa

1.3.–8.3.2007 Course in Nouna, Burkina Faso

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Abb. 18:Broschüre Brunnenprojekt Fig. 18: brochure, well project

3.5. Der Verein „Freunde von Nouna e.V.“ ● The Union „Friends of Nouna e.V.“

Angeregt durch Forschungstätigkeiten in wissenschaftlicher Kooperation mit dem Centre de Recherche en Santé de Nouna (CRSN) in Nouna (Burkina Faso) im Rahmen des SFB „Kontrolle tropischer Infektionskrankheiten“ (siehe Kap. 1) entstand die Idee, über Ursachenforschung hinaus Hilfsprojekte in dieser Region über einen gemeinnützigen Verein zu initiieren und zu fördern. So wurde 2001 der Verein „Freunde von Nouna e.V.“ von Mitgliedern der Abteilung gegründet. Vorsitzender war zunächst Prof. Becher, seit 2004 ist es Dr. Ronellenfitsch; Schatzmeisterin ist Frau Gabriele Stieglbauer.

Vereinsziele sind die Förderung von Projekten des Bildungswesens, der landwirtschaftlichen und dörflichen Entwicklung und des Gesundheitswesens im Rahmen der Hilfe zur Selbsthilfe in der Provinz Kossi im Nordwesten des Landes, sowie die Förderung und Entwicklung des kulturellen Austausches der Länder Burkina Faso und Deutschland im Rahmen des Völkerverständigungsgedankens.

Als erstes großes Projekt wurde ein Brunnenbauprojekt in dem kleinen Dorf Cissé, welches eine extrem hohe Kindersterblichkeit aufwies, in Angriff genommen und Dank großzügiger Hilfe von Sponsoren bis Ende 2004 realisiert.

Weitere kleinere Entwicklungshilfeprojekte folgten: finanzielle Unterstützung örtlicher Initiativen zur Durchführung eines Hühner- und Schweinezuchtprojektes, Ausstattung von fünf ländlichen Gesundheitszentren mit Solaranlagen zur Betreibung von Kühlschränken und elektrischer Beleuchtung und die finanzielle Unterstützung des Aufbaus einer Schule für jugendliche und erwachsene Analphabeten. Aktuell ist ein weiteres Solarprojekt in konkreter Planungs- und Durchführungsphase.

The idea to initiate a non-profit association giving humanitarian aid beyond causal research was developed following research activities at the „Centre de Recherche en Santé de Nouna (CRSN)“ in Nouna/Burkina Faso in the context of

the SFB 544 „Control of tropical infectious diseases“ (see chapter 1). The union „Friends of Nouna“ was founded in 2001 by members of the department. Prof. Becher was chairman until 2004, from 2004 till today this position is held by Dr. Ronellenfitsch; Ms. Stieglbauer is the treasurer of the union.

The aims of the organisation are the promotion of projects in the fields of training, agricultural development and health in the province

Kossi, situated in the north west of Burkina Faso as well as the promotion and development of cultural exchange between Burkina Faso and Germany within the idea of international understanding.

The first major project was building a well in the small village of Cissé. In this village, an extremely high child mortality was observed, and the drinking water supply was particularly poor. Thanks to the generous help of sponsors the well was finished by the end of 2004.

Further smaller developing aid projects followed: financial support of local initiatives of pig and chicken breeding, installation of solar panels for refrigerators and lighting in five rural health centres and financial support for a school for adolescent and adult illiterates. Most recently another solar project is planned and implemented.

www.freunde-von-nouna.de

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4. Mitarbeiter, Kooperationspartner, Drittmittel ● Staff, Collaborators, Funding 4.1. Mitarbeiter ● Staff Zum 31.12.2006 gehörten der Sektion 15 Mitarbeiter und vier assoziierte Mitarbeiter an. Neben dem Leiter der Sektion haben derzeit zwei Wissenschaftler eine halbe Stelle aus Landesmitteln. Alle anderen Mitarbeiter werden aus Drittmitteln finanziert. Das Sekretariat der Sektion wird von Frau Elke Braun-van der Hoeven geleitet, die zugleich die administrative Leitung des Graduiertenkollegs 793 hat.

As of December 31st, 2006, the unit had 15 full and four associate members. The salaries of the head of unit and two scientists (50% each) are covered by core budget. All other members have contracts based on soft money. The unit office is managed by Ms. Elke Braun-van der Hoeven who also has the administrative responsibility for the PhD program (Graduiertenkolleg).

Tab. 3: Liste der Mitarbeiter, 31.12.2006 ● Staff list as of 31.12.2006

Name, Vorname, Akad. Grad Name, first name, degree

Position Finanzierung / Funding

Becher Heiko Prof. Dr. rer. nat

Head of Unit Landesmittel

Braun-van der Hoeven, Elke Project+office management

Drittmittel DFG (GRK 793)

Gaszkowski, Roger cand. Med. Inf.

Student Drittmittel (EU)

Jänisch, Thomas Dr. med.

Postdoc Landesmittel (50%)

Kynast-Wolf, Gisela MSc

Dipl. Statistician Drittmittel DFG (SFB 544)

Louis, Valerie Ph. D.

Postdoc Drittmittel DFG (TB-Studie)

Ndugwa, Robert P. MSc

Doctoral student Drittmittel DFG (SFB 544)

Ott, Jördis J. MA

Doctoral student Drittmittel DFG (GRK 793)

Preuß, Michael cand. med. Inf.

Diploma student Drittmittel (Bonusmittel)

Ramroth, Heribert Dr. sc. hum.

Postdoc Drittmittel DFG (SFB 544)

Rosenberger, Kerstin Dipl. med. Inf

Doctoral student Landesmittel (50%)

Sankoh, Osman Dr. rer. nat.

Scientist (Mitarbeiter ohne Vergütung; derzeit Accra/Ghana)

Stieglbauer, Gabriele Medical Documentalist Drittmittel DFG (SFB 544)

Winkler, Volker Dipl. Biol.

Doctoral student Drittmittel DFG (GRK 793)

Wolf, Robert Student / Zivi Drittmittel (Grundausstattung SFB 544)

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Assoziierte Mitarbeiter:

Barniol, Judit, MSc, doctoral student Müller, Olaf, PD Dr. med., MPH Sarker, Malabika, Dr. med., MBBS MPH Schilling, Marcellus, EDV/Computer Administration

4.2. Frühere Mitarbeiter ● Previous staff members

Albrecht, Romy, studentische Hilfskraft Dannenberg, Sandra, Verw. Ang. Gmyrek, Alexander, studentische Hilfskraft Hammer, Gael, Dr. P.H. Krabbe, Dagmar, Dipl. Soz.wiss. Kyobutungi, Catherine, Dr. sc. hum. Laki, Judit, Dipl. med. (Budapest) Razum, Oliver, Prof. Dr. med. Ronellenfitsch, Ulrich, Dr. med.

4.3. Klinikinterne Kooperationspartner ● Internal

collaborators Mitglieder der Abteilung Tropenhygiene und öffentliches Gesundheitswesen Direktor: Prof. Rainer Sauerborn Projektleiter des SFB 544 Sprecher: Prof. Hans-Georg Kräusslich, Abteilung Virologie Prof. Thomas L. Diepgen, Abteilung klinische Sozialmedizin Prof. Christoph Dörfer, Mund-Zahn-Kiefer-Klinik, Universitätsklinikum Heidelberg Prof. Walter Haefeli, Abteilung Klinische Pharmakologie und Pharmakoepidemiologie Prof. Armin Grau, Neurologische Universitätsklinik / Klinikum Ludwigshafen Dr. Alexander Hassel, Mund-Zahn-Kiefer-Klinik, Universitätsklinikum Heidelberg Prof. Peter Rammelsberg, Mund-Zahn-Kiefer-Klinik, Universitätsklinikum Heidelberg PD Dr. Marc Schmitter, Mund-Zahn-Kiefer-Klinik, Universitätsklinikum Heidelberg Prof. Norbert Victor, Abteilung medizinische Biometrie, Universitätsklinikum Heidelberg Projektleiter in GRIPH (planned Graduate School “International Public Health”) Sprecher der Initiative: Prof. Rainer Sauerborn

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4.4. Externe Kooperationspartner ● External collaborators Prof. Wolfgang Ahrens, BIPS, Bremen Dr. Lars Beckmann, DKFZ Heidelberg Dr. Olaf Berke, Guelph University, Canada Prof. Maria Blettner, Universität Mainz Prof. Hermann Brenner, DKFZ Heidelberg Dr. Florian Buggle, Klinikum Ludwigshafen Dr. Don Burke, Johns Hopkins Bloomberg

School of Public Health Dr. Manuel Carballo, ICHM, WHO, Genf,

Schweiz Prof. Jenny Chang-Claude, DKFZ

Heidelberg Dr. Boubacar Coulibaly, CRSN, Nouna,

Burkina Faso Prof. Andreas Dietz, Universität Leipzig Prof. Klaus Dietz, Universität Tübingen PD Dr. Martin Eichner, Universität

Tübingen Dr. Dani Fallin, Johns Hopkins Bloomberg

School of Public Health Dr. Regina Fertmann, Universität

Hamburg PD Dr. Dieter Flesch-Janys, Universität

Hamburg Dr. Jean Ganamé, CRSN, Nouna, Burkina

Faso Adjima Gbangou, MSc, CRSN, Nouna,

Burkina Faso Dr. Elke Göhring-Zwacka,

Landesgesundheitsamt Stuttgart Prof. Brian Greenwood, LSTMH, London,

England PD Dr. Walter Haas, RKI, Berlin Dr. Gael Hammer, Universität Mainz Prof. Rolf Holle, GSF, Neuherberg Mamadou Jasseh, MSc, MRC Farafenni,

The Gambia Dr. Ismail Jatoi, Bethesda, Maryland, USA Prof. Göran Kauermann, Universität

Bielefeld Prof. Ulrich Keil, Universität Münster Pavel Khomski, MSc, Universität Bielefeld Karel Kostev, IMS Health, Frankfurt Dr. Bocar Kouyaté, CRSN, Nouna, Burkina

Faso

Dr. Catherine Kyobutungi, APHRC, Nairobi, Kenya

PD Dr. Jakob Linseisen, DKFZ Heidelberg Ari Paltiel, MSc, Central Bureau of

Statistics, Jerusalem, Israel Dr. Martina Pötschke-Langer, DKFZ

Heidelberg PD Dr. Odilia Popanda, DKFZ Heidelberg Prof. Oliver Razum, Universität Bielefeld PD Dr. Angela Risch, DKFZ Heidelberg Prof. Marcella Rietschel, ZI Mannheim Prof. Dietrich Rothenbacher, DKFZ

Heidelberg Mamadou Sanon, MSc, CRSN, Nouna,

Burkina Faso Dr. Sunil Sazawal, Johns Hopkins

Bloomberg School of Public Health Dr. Osman Sankoh, INDEPTH, Accra,

Ghana Dr. Peter Schmezer, DKFZ Heidelberg Detlev Schröder-Bernhardi, IMS Health,

Frankfurt Dr. Markus Schwehm, Universität

Tübingen Dr. Ali Sié, CRSN, Nouna, Burkina Faso Dr. Tracy Slanger, DKFZ Heidelberg Dipl. biol. Ute Stammwitz, Schaper &

Brümmer AG, Salzgitter Dipl. med.Inf. Christa Stegmaier,

Krebsregister Saarland, Saarbrücken PD Dr. Til Stürmer, Harvard University Dr. David Sullivan, Johns Hopkins

Bloomberg School of Public Health Dr. Corneille Traoré, CRSN, Nouna,

Burkina Faso Prof. Stig Wall, Umea University, Umea,

Schweden Prof. Jürgen Wahrendorf, DKFZ Dr. Jürgen Wellmann, Universität Münster Prof. H.-Erich Wichmann, GSF,

Neuherberg Dr. Yazoume Yé, APHRC, Nairobi, Kenya Dr. Henneike v. Zepelin, Schaper &

Brümmer AG, Salzgitter

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4.5. Drittmittel ● Grants Mit Ausnahme des Leiters der Sektion und zwei halben Wissenschaftlerstellen werden alle Mitarbeiter der Sektion durch Drittmittel finanziert. Die beiden größten Projekte sind das Graduiertenkolleg, durch das Doktoranden, Diplomanden und die Administration finanziert werden, sowie der Sonderforschungsbereich 544, in dem H. Becher Projektleiter für zwei Teilprojekte ist. In der folgenden Tabelle sind die Gesamtfördersummen der letzten drei Jahre angegeben.

With the exception of the Unit leader and one full (two half) position for a scientist, all members of the unit are currently financed by soft money. The two largest grants are the “Graduiertenkolleg 793” financing the doctoral students, diploma students as well as the program coordination, and the SFB 544 where H. Becher is principal investigator of two projects. The following table lists the total soft money funding within the last three years.

Tab. 4: Drittmittel 2004-2006 ● Grants

Jahr Bezeichnung Geldgeber

Funding agency

Bewilligung

(in €)

2004 Graduiertenkolleg 793 (GRK 793) DFG 313.202,--

Mongoleikooperation innerhalb des GRK

793

DFG 9.710,--

Sonderforschungsbereich 544 (SFB 544) DFG 138.000,--

MuT-Studie DFG 63.000,--



793

DFG 18.000,--


MuT-Studie DFG 60.000,--



793

DFG 18.000,--


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5. Ausblick ● Perspectives Die Sektion Epidemiologie und Biostatistik hat sich seit ihrer Gründung zu einer wissenschaftlich produktiven und finanziell selbständigen Einheit entwickelt. Seit 2004 sind insgesamt 59 Publikationen entstanden, davon viele in führenden Fachzeitschriften. Der Sektionsleiter ist verantwortlich für die Lehre im Fach Epidemiologie in HeiCuMed, einem Pflichtfach nach der neuen Approbationsordnung.

Die Sektion hatte am 31.12.2006 neun-zehn Mitarbeiter, wobei vier assoziierte Mitglieder eingeschlossen sind. Neben dem Leiter der Sektion werden zwei halbe Wissenschaftlerstellen aus Haushalts-mitteln finanziert, alle anderen über Drittmittel, zumeist aus DFG-Projekten.

Die Zusammenarbeit mit anderen Abteilungen innerhalb des Klinikums und mit Forschungsinstituten innerhalb und außerhalb von Heidelberg ist ausgezeichnet. Hierzu trägt insbesondere das Graduiertenkolleg 793 mit H. Becher als Sprecher und der Sonderforschungsbereich 544 bei, an denen die Mitglieder der Sektion maßgeblich beteiligt sind.

Das Graduiertenkolleg 793 ist ein wesentliches Standbein der Sektion. Mit einer bereits bewilligten Laufzeit bis zum Jahr 2011 ist die Ausbildung von Doktoranden in epidemiologischen Forschungsprojekten mittelfristig gesichert. Besonders hervorzuheben ist die deutsch-israelische Kooperation in der Sektion mit der ausschließlich hier

Since its foundation the unit of Epidemiology and Biostatistics has developed into a scientifically productive and financially independent group. Since the year 2004, 59 papers were published or submitted, many of them in leading journals of the field. The unit head is responsible for epidemiology teaching for the medical students in Heidelberg, which is a compulsory subject according to the new approbation rules.

As of December 31st, 2006, the unit has nineteen members, including four associate colleagues. The salary of the unit head and of two positions (50% each) for scientists is based on core funding, all others are on soft money, mostly from DFG funded projects.

The collaboration with other departments within the University hospital and research institutes in Heidelberg is excellent. The PhD program (Graduiertenkolleg 793) with H. Becher as speaker and the special research grant (Sonderforschungsbereich 544), in which members of the unit play a major role, greatly contribute to that.

The “Graduiertenkolleg 793” is a major backbone for the Unit. The funding is secured until the year 2011, therefore we are fortunate to have a relative long lasting security for doctoral training in the

Abb. 20: Auf der DGEpi Tagung, Greifswald, 2006

Fig. 20: During the DGEpi conference, Greifswald, 2006

Abb. 19: Mitglieder der Sektion Fig. 19: Members of the unit

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angesiedelten Migrantenstudie.

Es ist zu erwarten, dass sich die Zusammenarbeit mit anderen Abteilungen innerhalb des Klinikums in Zukunft verstärken wird. Dies liegt darin begründet, dass zum einen in den Kliniken zunehmend klinisch-epidemiologische Fragestellungen zu bearbeiten sind, für die eine kompetente epidemiologische Beratung erforderlich ist, zum anderen dass der Sektionsleiter der einzige Professor für Epidemiologie im Universitätsklinikum ist. In umfang-reicheren Projekten führt dies zu einer Zusammenarbeit mit gemeinsamer Antragstellung auf Förderung. Falls – wie derzeit mit ein wenig Optimismus zu erwarten – die Graduiertenschule „International Public Health“ eingerichtet wird, ist auch die Zukunft der Epidemiologie an der Universität Heidelberg optimistisch zu beurteilen.

field of epidemiology. The German-Israel cooperation within the unit on the studies of migrants is completely embedded into this PhD program and should be particularly mentioned.

We expect an even closer collaboration with other departments of the University clinic in the future. This is due to the increasing number of research questions in clinical epidemiology needing competent advice and to the fact that the unit head is the only professor for epidemiology within the university clinic. In larger projects this has led and will lead to close collaborations with joint project application and funding. We can be optimistic at that stage that the planned Graduate School “International Public Health” will be implemented. If so, one can also be optimistic regarding the future development of epidemiology at Heidelberg University.

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6. Publikationen, Hochschulschriften ● Publications and Theses

6.1. Publikationen ● Publications

Die folgende Liste der Publikationen bezieht sich auf den Zeitraum seit 2004. Artikel von gegenwärtigen oder früheren Mitgliedern der Sektion, die während der Beschäftigungszeit entstanden, sind aufgenommen. Eingereichte Publika-tionen sind ebenfalls aufgeführt.

The following list of publications cover the period since 2004. Included are papers from present or former members of the unit which developed or appeared during the time of employment at the unit. Papers currently under review are also listed.

2004 [1] Becher H: General Principles of data analysis: Continuous covariables in

epidemiological studies; in Ahrens W, Pigeot I (eds): Handbook of epidemiology. Springer Verlag Heidelberg, 2004, pp 595-624.

[2] Becher H, Müller O, Jahn A, Gbangou A, Kynast-Wolf G, Kouyate B: Risk factors of

infant and child mortality in rural Burkina Faso. Bull World Health Organ 2004;82:265-273.

[3] Becher H: Epidemiologie des Lungenkarzinoms; in Haustein K-O (ed): Rauchen und

Krebs - Frau und Rauchen - Probleme der medikamentösen Raucherentwöhnung. Organon-Verlag B. Conventz, Weinheim, 2004, pp 9-21.

[4] Berke O, Becher H: Ein Fallbeispiel zur geografischen Risikoanalyse mittles der

räumlichen relativen Risikofunktion: Eine Expositionskarte für die Echinokokkose in Niedersachsen. Informatik, Biometrie und Epidemiologie in Medizin und Biologie 2004;35:195-206.

[5] Bischof U, Becher H, Dreweck C, Haas W, Richter E, Niemann S, Junghanss T:

Prospective molecular epidemiological study on transmission of pulmonary tuberculosis and migration. Meth Inform Med 2004;43:475-478.

[6] Bonu S, Rani M, Razum O: Global public health mandates in a diverse world: the polio

eradication initiative and the expanded programme on immunization in sub-Saharan Africa and south Asia. Health Policy 2004;70:327-345.

[7] Dietz A, Ramroth H, Urban T, Ahrens W, Becher H: Exposure to cement dust, related

occupational groups and laryngeal cancer risk: Results of a population based case-control study. International Journal of Cancer 2004;108:907-911.

[8] Dörfer C, Becher H, Ziegler C, Kaiser C, Lutz R, Jorss D, Lichy C, Buggle F, Bultmann

S, Preusch M, Grau A: The association of gingivitis and periodontitis with ischemic stroke. J Clin Periodontol 2004;31:396-401.

[9] Frentzel-Beyme R, Salzer-Kuntschick N, Becher H, Kotz R, Salzer M: Factors affecting

then incident juvenile bon tumors in an Austrian Case-Control study. Journal of Cancer Detection and Prevention 2004;28:159-169.

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[10] Grau A, Becher H, Ziegler C, Lichy C, Buggle F, Kaiser C, Dörfer C, Lutz R, Bültmann S, Preusch M: Periodontitis as a Risk Factor for Ischemic Stroke. Stroke 2004;35:496-501.

[11] Khechinashvili G, Andall-Brereton G, Razum O: Cigarette smoking among school

teachers in Tobago. West Indian Med J 2004;53:260-262. [12] Müller O, Razum O, Traore C, Kouyate B: Community effectiveness of chloroquine and

traditional remedies in the treatment of young children with falciparum malaria in rural Burkina Faso. Malaria Journal 2004;3:36.

[13] Nayar K, Kyobutungi C, Razum O: Self-help: What future role in health care for low

and middle-income countries? Int J Equity Health 2004;3:1. [14] Ramroth H, Dietz A, Becher H: Interaction effects and population attributable risks for

smoking and alcohol on laryngeal cancer and its subsites: a case-control study from Germany. Meth Inform Med 2004;43:499-504.

[15] Razum O, Zeeb H: Suicide mortality among Turks in Germany. Nervenarzt

2004;75:1092-1098. [16] Razum O, Mittal O, Priya R, Nayar K, Sathyamala C: Language use in public health.

Lancet 2004;363:2190-2191. [17] Ronellenfitsch U, Razum O: Deteriorating health satisfaction among immigrants from

Eastern Europe to Germany. Int J Equity Health 2004;3:4. [18] Ronellenfitsch U, Kyobutungi C, Becher H, Razum O: Large-scale, population-based

epidemiological studies with record linkage can be done in Germany. Eur J Epidemiol 2004;19:1073-1074.

[19] Zeeb H, Razum O: Breast Cancer among Turkish women in Germany - epidemiology

and research agenda. Zentralbl Gynakol 2004;126:77-80. 2005 [20] Becher H, Kouyate B (eds.): Health Research in Developing Countries. A collaboration

between Burkina Faso and Germany. Springer Verlag Heidelberg, 2005. 303 pages. [21] Becher H, Ramroth H, Ahrens W, Risch A, Schmezer P, Dietz A: Occupation, exposure

to polycyclic aromatic hydrocarbons and laryngeal cancer risk. Int J Cancer 2005;116:451-457.

[22] Chingang L, Bischof U, Andall-Brereton G, Razum O: "Have a Pap smear!" - doctors,

their clients, and opportunistic cervical cancer screening. Int J STD AIDS 2005;16:233-236.

[23] Kyobutungi C, Grau A, Stieglbauer G, Becher H: Absolute temperature, temperature

changes and stroke risk: A case-crossover study. Eur J Epidemiol 2005;20:693-698. [24] Ramroth H, Specht-Leible N, Brenner H: Hospitalisations before and after nursing

home admission: a retrospective cohort study from Germany. Age Ageing 2005;34:291-294.

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2006 [25] Becher H, Bertram H, Ehrmann K, Heidrich J, Heuschmann P, Keil U, Kraywinkel K,

Pötschke-Langer M, Schaller KSA, Schulze A, Thielmann H, Vennemann M, Wellmann J: Passivrauchen - ein unterschätztes Gesundheitsrisiko, Rote Reihe Tabakprävention und Tabakkontrolle Band 5. Deutsches Krebsforschungszentrum 2006.

[26] Collenberg E, Ouedraogo T, Ganame J, Fickenscher H, Kynast-Wolf G, Becher H,

Kouyate B, Kräusslich H, Sangare L, Tebit D: Seroprevalence of six different viruses among pregnant women and blood donors in rural and urban Burkina Faso: A comparative analysis. Journal of Medical Virology 2006;78:683-692.

[27] De Allegri M, Kouyate B, Becher H, Gbangou A, Pokhrel S, Sanon M, Sauerborn R:

Understanding enrolment in community health insurance in Sub-Saharan Africa: population-based case-control study in rural Burkina Faso. Bull WHO 2006;84:852-858.

[28] Hammer GP, Some F, Müller O, Kynast-Wolf G, Kouyate B, Becher H: Pattern of cause-

specific childhood mortality in a malaria endemic area of Burkina Faso. Malaria Journal 2006;Jun 8;5(1)47.

[29] Hammer GP, Kouyate B, Becher H: Risk factors for childhood mortality in sub-Saharan

Africa. A comparison of data from a national survey and information from a demographic surveillance system. Acta Tropica 2006;98:212-218.

[30] Jahn A, Kynast-Wolf G, Kouyate B, Becher H: Multiple pregnancy in rural Burkina Faso:

frequency, survival, and use of health services. Acta Obstet Gynecol Scand 2006;85:26-32.

[31] Kynast-Wolf G, Hammer GP, Kouyate B, Becher H: Season of death and birth predict

patterns of mortality in Burkina Faso. International Journal of Epidemiology 2006;35:427-435.

[32] Kyobutungi C, Ronellenfitsch U, Razum O, Becher H: Mortality from cancer among

ethnic German immigrants from the Former Soviet Union, in Germany. Eur J Cancer 2006;42:2577-84.

[33] Kyobutungi C, Ronellenfitsch U, Razum O, Becher H: Mortality from external causes

among ethnic German immigrants from former Soviet Union countries, in Germany. European Journal of Public Health 2006;16:376-382.

[34] Müller O, Becher H: Malnutrition and childhood mortality in developing countries

(letter). Lancet 2006;367(9527):1978. [35] Müller O, Traore C, Kouyate B, Becher H, Ye Y, Frey C, Coulibaly B: Effects of

insecticide-treated bednets during early infancy in an African area of intense malaria transmission: a randomized controlled trial. Bull WHO 2006;84:120-126.

[36] Ndugwa R, Müller O, Kouyate B, Ramroth H, Becher H: Improving malaria mortality

estimates for rural Africa by adding further studies (letter) Re: Rowe AK, Rowe SY, Snow RW et al. The burden of malaria mortality among African children in the year 2000. Int J Epidemiol 2006;35:691-704. published online Dez. 14, 2006.

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[37] Ramroth H, Specht-Leible N, König H-H, Brenner H: Medical Care for Older Adults. National Perspectives in International Context; in Wahl H, Brenner H, Mollenkopf H, Rothenbacher D, Rott C (eds): The Many Faces of Health, Competence and Well-Being in Old Age: Integrating Epidemiological, Psychological and Social Perspectives. Springer Verlag Heidelberg, 2006, pp 175-188.

[38] Ramroth H, Dietz A, Becher H: Rauchen und Alkohol sind Hauptrisikofaktoren für

Kehlkopfkrebs. Ergebnisse einer deutschen Fall-Kontroll-Studie im europäischen Vergleich. Deutsches Ärzteblatt 2006;103:A 1078-1083.

[39] Ramroth H, Specht-Leible N, König H-H, Mohrmann M, Brenner H: Inanspruchnahme

stationärer Krankenhausleistungen durch Pflegeheimbewohner. Deutsches Ärzteblatt 2006;103:A-2710-2713.

[40] Ramroth H, Specht-Leible N, König HH, Brenner H: Hospitalizations during the last

months of life of nursing home residents: a retrospective cohort study from Germany. BMC Health Serv Res 2006;6:70.

[41] Ronellenfitsch U, Kyobutungi C, Becher H, Razum O: All-cause and Cardiovascular

mortality among ethnic German immigrants from the Former Soviet Union: A cohort study. BMC Public Health 2006;Jan 26;6:16.

[42] Stich A, Oster N, Abdel-Aziz I, Stieglbauer G, Coulibaly B, Wickert H, McLean J,

Kouyate B, Becher H, Lanzer M: Malaria in a holoendemic area of Burkina Faso: A cross-sectional study. Parasitology Research 2006;98:596-599.

[43] Winkler V, Gbangou A, Kouyate B, Becher H: A simple method to estimate tobacco-

related lung cancer deaths in sub-Saharan Africa. Meth Inf Med 2006;45:397-403. 2007 and submitted [44] Becher H, Khomski P, Sanon M, Kauermann G. Using spline regression to model age-

and season-of-birth-dependent effects of childhood mortality risk factors in rural Burkina Faso (submitted). 2007.

[45] Becher H, Razum O, Kyobutungi C, Laki J, Ott JJ, Ronellenfitsch U, Winkler V.

Mortalität von Aussiedlern aus der ehemaligen Sowjetunion: Ergebnisse einer Kohortenstudie (submitted). 2007.

[46] Becher H, Kynast-Wolf G, Sie A, Ndugwa R, Ramroth H, Kouyate B, Müller O. Pattern

of all-cause and cause-specific mortality in a malaria endemic area of West Africa: 1999 until 2003 (submitted). 2007.

[47] Böhler T, von Au M, Klose N, Müller K, Coulibaly B, Nauwelaers F, Spengler HP,

Kynast-Wolf G, Kräusslich H. Evaluation of a single-tube dual-platform flow cytometric method for measurement of lymphocyte subsets in Nouna, Burkina Faso (submitted). 2007.

[48] De Allegri M, Pokhrel S, Becher H, Dong J, Mansmann U, Kynast-Wolf G, Kouyate B,

Gbangou A, Bridges J, Sauerborn R. Step-wedge cluster-randomised community-based trials An application to the study of the impact of community health insurance (submitted). 2007.

[49] Fertmann R, Becher H, Berger J, Schümann M. Cancer mortality in a residential area

with soil contamination of arsenic, PCDD/F and heavy metals (submitted). 2007.

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[50] Garenne M, Müller O, Becher H, Baltussen A, Ye Y, Diallo D, Konate M, Nebie I, Gbangou A, Kouyate B: Sex specific responses to zinc supplementation in Nouna, Burkina Faso. J Ped Gastroent Nutr (in press) 2007.

[51] Henneicke-von Zepelin H-H, Meden H, Kostev K, Schröder-Bernhardi D, Stammwitz U,

Becher H: The safety of isopropanolic black cohosh extract on the risk of breast cancer recurrence. International Journal of Clinical Pharmacology and Therapeutics (in press) 2007.

[52] Klose N, Coulibaly B, Tebit DM, Nauwelaers F, Spengler HP, Kynast-Wolf G, Kouyate B,

Kräusslich H, Böhler T. Immunohematological reference values for healthy adults in Burkina Faso (submitted). 2007.

[53] Kouyate B, Some F, Jahn A, Coulibaly B, Erikson J, Sauerborn R, Gustafson L,

Tompson G, Becher H, Müller O. Effects of a community intervention on malaria in rural Burkina Faso: randomized controlled trial (submitted). 2007.

[54] Ott JJ, Laki J, Winkler V, Becher H. External cause mortality and residential change:

findings from a cohort of migrants (submitted). 2007. [55] Ramroth H, Dietz A, Ahrens W, Becher H. Occupational wood dust exposure and the

risk of laryngeal cancer in a population based case-control study in Germany (submitted). 2007.

[56] Ramroth H, Dietz A, Becher H. Environmental tobacco smoke and the risk of laryngeal

cancer. A population based case-control study in Germany (submitted). 2007. [57] Sarker M, Jatoi I, Becher H: Racial differences in Breast cancer Survival in woman

under age 60. Breast Cancer Research and Treatment (in press) 2007. [58] Winkler V, Ott JJ, Becher H. Time interval between residential change and suicide or

other causes of death in migrants (submitted). 2007. [59] Ye Y, Traore C, Meissner P, Coulibaly B, Becher H, Müller O: Ability of mothers to

diagnose fever and anaemia in young children of a West African malaria endemic region. Annals of Tropical Medicine and Parasitology (in press) 2007.

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6.2. Hochschulschriften ● Academic theses Abgeschlossene oder gegenwärtig betreute Dissertationen oder Diplom/Master-Arbeiten Supervised dissertations and diploma/master theses completed or under supervision Winkler, Volker Schätzung der tabakassoziierten Lungenkrebsfälle in afrikanischen Entwicklungsländern Diplomarbeit (Dipl. Biol.) Note: 1.0 Betreuer / Supervisor: Heiko Becher Jahr / Year: 2004 ausgezeichnet mit dem GMDS-Förderpreis 2005 für herausragende Abschlussarbeiten auf den Gebieten Medizinische Informatik, Medizinische Biometrie und Epidemiologie

Urban, Tobias Eine epidemiologische Validierungsstudie im Rahmen einer Fall-Kontroll-Studie zu Risiken des Larynxkarzinoms durch Zement und polyzyklische aromatische Kohlenwasserstoffe Dissertation (Dr. med) Note: cum laude Betreuer / Supervisor: Heiko Becher Jahr / Year: 2004

Parajuli, Jagadish Evaluation of Health Management System (HMIS) in North West Province (Cameroon) Master-Thesis (MCH) Note: 1.3 Betreuer / Supervisor: Heiko Becher Jahr / Year: 2004

Muhjazi, Ghada Barriers to participation in cervical cancer screening in Trinidad & Tobago Master-Thesis (MCH) Note: 2 Betreuer / Supervisor: Oliver Razum Jahr / Year: 2004

Iza, Karina Barriers towards seeking medical care after diagnosis of severe dysplasia or cervical carcinoma in women in Trinidad & Tobago Master-Thesis (MCH) Note: 1.7 Betreuer / Supervisor: Oliver Razum Jahr / Year: 2004

Sarker, Malabika HIV related knowledge, Risk perception and Demand forecasting for VCT/PMTCT in women living in Rural Burkina Faso Dissertation (Dr. sc.hum.) Note: Magna cum laude Betreuer / Supervisor: Heiko Becher Jahr / Year: 2005

Kyobutungi, Catherine Mortality from cancers and external causes of death among Aussiedler in Germany 1990-2002 – an epidemiological cohort study Dissertation (Dr. sc.hum.)

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Note: Magna cum laude Betreuer / Supervisor: Heiko Becher, Oliver Razum Jahr / Year: 2005

Nadew, Mesrak Assessment of maternal death audit and indicators of obstetric services in Tanga, Tanzania Master-Thesis (MCH) Note: 2.3 Betreuer / Supervisor: Thomas Jänisch Jahr / Year: 2005

Ronellenfitsch, Ulrich Cardiovascular mortality among ethnic German immigrants from the Former Soviet Union to Germany: a retrospective cohort study Dissertation (Dr. med) Note: Magna cum laude Betreuer / Supervisor: Oliver Razum, Heiko Becher Jahr / Year: 2005

Tsenang, Mositi Otsetswe Adolescents and Community Perceptions on Factors Influencing Early Marriages of Adolescent Females in Kumi District, Uganda. Master-Thesis (MCH) Note: 2.3 Betreuer / Supervisor: Heiko Becher Jahr / Year: 2005

Krabbe, Dagmar Qualität und Verfügbarkeit demographischer Daten als Voraussetzung für eine effektive und effiziente Gesundheitsvorsorge in Entwicklungsländern am Beispiel Burkina Faso Diplomarbeit (Dipl. Soz.Wiss.) Note: 1.0 Betreuer / Supervisor: Heiko Becher, Olaf Müller Jahr / Year: 2006

Barniol, Judit Transmission dynamics of tuberculosis in Germany (Provisional title) Dissertation (Dr. sc.hum.) Betreuer / Supervisor: Heiko Becher, Thomas Junghanss Jahr / Year: 2007 (expected)

Kynast-Wolf, Gisela Mortality patterns in a malaria endemic area of Burkina Faso, West Africa (Provisional title) Dissertation (Dr. sc.hum.) Betreuer / Supervisor: Heiko Becher Jahr / Year: 2007 (expected)

Preuss, Michael Diplomarbeit (Dipl. Inf.med.) Konstruktion von Konfidenzbändern für saisonale Modellierung der Mortalität. Theorie und Anwendung an einer Population in Burkina Faso (Provisional title) Betreuer / Supervisor: Heiko Becher Jahr / Year: 2007 (expected)

Ndugwa, Robert Malaria Incidence and Mortality in countries with different transmission intensity (Provisional title) Dissertation (Dr. sc.hum.) Betreuer / Supervisor: Heiko Becher Jahr / Year: 2008 (expected)

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Ott, Jördis Assessment of mortality trends among Russian migrants in Israel and Germany (Provisional title) Dissertation (Dr. sc.hum.) Betreuer / Supervisor: Heiko Becher Jahr / Year: 2008 (expected)

Paltiel, Ari Time pattern of migrant mortality in Israel and cause of death structure (Provisional title) Dissertation (Dr. sc.hum.) Betreuer / Supervisor: Heiko Becher Jahr / Year: 2008 (expected)

Winkler, Volker Cancer incidence and Mortality of German immigrants in the Saarland (Provisional title) Dissertation (Dr. sc.hum.) Betreuer / Supervisor: Heiko Becher Jahr / Year: 2008 (expected) Gegenwärtig betreute Habilitationen ● Habilitations currently under supervision Jänisch, Thomas, Dr. med. Habilitation in Epidemiology 2009

Ramroth, Heribert, Dr. sc. hum. Habilitation in Epidemiology 2009

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Kontakt:

Prof. Dr. Heiko Becher Sektion Epidemiologie und Biostatistik Universitätsklinikum Heidelberg Im Neuenheimer Feld 324 69120 Heidelberg +49-6221-565031 [email protected] http://www.klinikum.uni-heidelberg.de/epistat Impressum:

Redaktion: Prof. Heiko Becher, Elke Braun-van der Hoeven, Gabriele Stieglbauer Redaktionsschluss: 1. März 2007 Fotos: Prof. Heiko Becher und Mitarbeiter, Medienzentrum Umschlag: Medienzentrum Universitätsklinikum Heidelberg Druck: City Druck, Heidelberg Die Sektion Epidemiologie und Biostatistik bedankt sich bei Schaper & Brümmer GmbH & Co. KG und bei IMS HEALTH GmbH für die großzügige Unterstützung!

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Sektion Epidemiologie und BiostatistikUniversitätsklinikum HeidelbergIm Neuenheimer Feld 324, 69120 Heidelberghttp://www.klinikum.uni-heidelberg.de/epistat

Hygiene-Institut

Documents

Sektionsbericht 2004-2006 · 3 Sektion Epidemiologie und Biostatistik Unit of Epidemiology and Biostatistics 2004-2006 Prof. Dr. Heiko Becher