Publications by authors named "Edda Weimann"

7 Publications

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Consumers' perspectives on national health insurance in South Africa: using a mobile health approach.

JMIR Mhealth Uhealth 2014 Oct 28;2(4):e49. Epub 2014 Oct 28.

School of Public Health and Family Medicine, Health Sciences Faculty, University of Cape Town, Observatory, Cape Town, South Africa.

Background: Building an equitable health system is a cornerstone of the World Health Organization (WHO) health system building block framework. Public participation in any such reform process facilitates successful implementation. South Africa has embarked on a major reform in health policy that aims at redressing inequity and enabling all citizens to have equal access to efficient and quality health services.

Objective: This research is based on a survey using Mxit as a mobile phone-based social media network. It was intended to encourage comments on the proposed National Health Insurance (NHI) and to raise awareness among South Africans about their rights to free and quality health care.

Methods: Data were gathered by means of a public e-consultation, and following a qualitative approach, were then examined and grouped in a theme analysis. The WHO building blocks were used as the conceptual framework in analysis and discussion of the identified themes.

Results: Major themes are the improvement of service delivery and patient-centered health care, enhanced accessibility of health care providers, and better health service surveillance. Furthermore, health care users demand stronger outcome-based rather than rule-based indicators of the health system's governance. Intersectoral solidarity and collaboration between private and public health care providers are suggested. Respondents also propose a code of ethical values for health care professionals to address corruption in the health care system. It is noteworthy that measures for dealing with corruption or implementing ethical values are neither described in the WHO building blocks nor in the NHI.

Conclusions: The policy makers of the new health system for South Africa should address the lack of trust in the health care system that this study has exposed. Furthermore, the study reveals discrepancies between the everyday lived reality of public health care consumers and the intended health policy reform.
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http://dx.doi.org/10.2196/mhealth.3533DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4259968PMC
October 2014

[Young elite athletes: which health risk they are taking?].

Authors:
Edda Weimann

MMW Fortschr Med 2014 Jul;156(13):37-9

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July 2014

Growth failure in children and adolescents with Crohn's disease.

Turk J Gastroenterol 2009 Mar;20(1):13-9

Kinder- und Jugendklinik der Friedrich-Alexander-Universität Erlangen Klinik für Kinderheilkunde und Jugendmedizin am Sankt Bernward Krankenhaus Hildesheim, Nürnberg, Germany.

Background/aims: A clinical analysis in children, adolescents and young adults with Crohn's disease was performed to investigate if growth failure is caused by an impaired growth hormone secretion in these patients.

Methods: 40 patients with Crohn's disease (26 male, 14 female) with an average age of 16,7 years (median: 17,0 years, range: 4-29) were included in the study. The observation period varied from 8 months to 16,7 years, patient's age ranged from 4 years up to 29 years. To examine growth hormone excretion, urinary growth hormone was measured using an in vitro immunoradiometric assay in three morning urine samples. Renal function was obtained by analysing creatinine and alpha-1-microglobulin in the same samples. Observation period, chronological age, height, growth rate, pubertal stage, localisation, pediatric Crohn disease activity index and corticosteroid treatment as well as IGF-1 levels were determined. We found normal urinary growth hormone levels in Crohn's disease concluding that growth failure in patients with Crohn's disease is not caused by growth hormone deficiency. Evenly corticosteroid therapy did not appear to be the most responsible factor for growth failure in Crohn's disease.

Conclusions: Disease activity indicated by a high pediatric Crohn disease activity index score had an important impact on impaired growth in children and adolescents with Crohn's disease.
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March 2009

Early onset of type I diabetes mellitus, Hashimoto's thyroiditis and celiac disease in a 7-yr-old boy with Down's syndrome.

Pediatr Diabetes 2008 Aug;9(4 Pt 2):423-5

St Bernward Krankenhaus Hildesheim, Klinik für Kinderheilkunde und Jugendmedizin, Treibestr. 9, 31134 Hildesheim, Germany.

Patients with Down's syndrome are at higher risk for developing autoimmune diseases than those of the general population. Autoimmune diseases like Hashimoto's thyroiditis, Graves' disease, diabetes mellitus type I, celiac disease, autoimmune chronic active hepatitis, alopecia, vitiligo and hypoparathyroidism are recognized associations with Down's syndrome. We describe the case of a very young boy with Down's syndrome who was diagnosed with diabetes mellitus type I, Hashimoto's thyroiditis and celiac disease before 8 yr of age. Unspecific symptoms like weight loss, unstable blood sugar with high amplitudes, behavioural problems and dry skin were suspicious for other endocrine disorders or celiac disease in our case. The boy was showing the typical human leukocyte antigen profile for these autoimmune diseases. The prevalence of these autoimmune diseases is higher in Down's syndrome than in general population. Therefore, we advice to follow children with Down's syndrome who develop more than two autoimmune diseases very carefully.
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http://dx.doi.org/10.1111/j.1399-5448.2008.00355.xDOI Listing
August 2008

Respiratory syncytial virus infection in 406 hospitalized premature infants: results from a prospective German multicentre database.

Eur J Pediatr 2007 Dec 16;166(12):1273-83. Epub 2007 Feb 16.

Department of Pediatric Hematology and Oncology, Children's Hospital Medical Center, University of Bonn, Adenauerallee 119, 53113 Bonn, Germany.

Premature birth, chronic lung disease of prematurity (CLD), congenital heart disease and immunodeficiency predispose to a higher morbidity and mortality in respiratory syncytial virus (RSV) infection. This study describes the preterms hospitalised with RSV infection from the prospective German DSM RSV Paed database. The DMS RSV Paed database was designed for the prospective multicentre documentation and analysis of clinically relevant aspects of the management of inpatients with RSV infection. This study covers six consecutive RSV seasons (1999-2005); the surveillance took place in 14 paediatric hospitals in Germany. Of the 1,568 prospectively documented RSV infections, 26% (n=406) were observed in preterms [vs. 1,162 children born at term (74%)] and 3% (n=50) had CLD, of which 49 had received treatment in the last 6 months ('CLDplus'). A significantly higher proportion in the preterm group had congenital heart disease, nosocomial infection, and neuromuscular impairment. There were significantly more children older than 24 months in the preterm group. The attributable mortality was 0.2% (n=2) in children born at term vs. 1.2% (n=5) in the preterm group (p=0.015) [preterm plus CLD 8.0% (n=4 of 50); McIntosh grade 1, 8.6% (n=3 of 35) and McIntosh Grade 4, 15% (n=3 of 20)]. Eight patients were categorized as 'palivizumab failures'. In the multivariate analysis, premature birth, CLD(plus), and nosocomial infection were significantly and independently associated with the combined outcome 'complicated course of disease'. In conclusion, this is the first prospective multicentre study from Germany that confirms the increased risk for severe RSV disease in preterms, in particular in those with CLD treated in the last 6 months before the onset of the infection. From the perspective of our results, the statements of the German Society of Paediatric Infectious Diseases considering the use of passive immunisation (2003) seem reasonable.
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http://dx.doi.org/10.1007/s00431-007-0426-yDOI Listing
December 2007

[Changes in carbohydrate metabolism and insulin resistance in patients with Prader-Willi Syndrome (PWS) under growth hormone therapy].

Wien Med Wochenschr 2007 Feb;157(3-4):82-8

Pädiatrisches Zentrum, St. Bernward Krankenhaus Hildesheim, Hildesheim, Germany.

Background: Life expectance and life quality have markedly changed in PWS patients within the last 10-15 years. A strict diet, improved physical activity and an additive growth hormone treatment have led to these changes. Growth hormone therapy decreases body fat and improves final height. But growth hormone also antagonizes insulin and therefore increases the diabetic potential. The purpose of our study was to investigate incidence and multiple dependencies of development of impaired carbohydrate metabolism in patients with PWS under growth hormone therapy and to determine suitable parameters for the work-up.

Patients And Methods: 34 patients with genetically approved PWS have been treated with growth hormone for at least 0.5 years. The mean duration of growth hormone treatment was 2.15 years (0.5-4.51). At the start of growth hormone treatment patients were 1.33 to 16.47 years old. The clinical picture and the nutritional situation of children with PWS change age-dependent and can be divided up into three phases. The patients were duty subdivided into three age-groups at the beginning of growth hormone treatment. Group 1: 15 PWS patients, mean age 2.62 years (1.33-3.78). Group 2: 10 PWS patients, mean age 5.54 years (4.08-7.61). Group 3: 9 PWS patients, mean age 11.35 years (8.89-16.47). Data were collected within 0.3-0.38 years before start of treatment and every 6 months throughout the treatment period. Anthropometrical data, fat mass by bioelectric impedance analysis (BIA), fasting insulin, HbA1c, C-peptide, blood fats and the blood sugar profile in oral glucose tolerance tests (OGT/1.75 g glucose/kg body mass) were obtained. Growth hormone therapy was started with an average dose of 0.031 mg/kg body mass in all groups. Insulin resistance was based on Homeostasis Model Assessment-Test (HOMA).

Result: No IR or pathological OGT were detected when growth hormone therapy started before the 4th year of life. When therapy started between the 4th and 8th year, PWS patients with normal weight did not develop an IR under GH therapy. 6% developed a glucose tolerance (IGT) disorder and 4% developed an increased fasting glucose (IFG). 5 of 9 PWS patients older than 8 years at therapystart showed a transient disorder of glucose metabolism: 11% of the results obtained in these patients presented an IR with no pathological OGT, 13% showed an IR with IGT, 7% showed an IR with IFG, and 2% showed an IR with transient diabetes. For 4% the IFG persisted with no IR, for 4% the IGT persisted with no IR. These patients differed from younger ones by an increased average BMI, an increase fat body ratio and an increase fasting insulin as well as an already reached puberty. No difference was found in C-peptide, HbA1c or GH dose/kg/body mass.

Conclusion: Transient glucose metabolism disorders with no development of manifest insulin resistance are shown by PWS patients with normal weight starting from 4th year under GH therapy. Changes in the glucose metabolism with and with no development of IR appear after start of puberty and weight increase. Changes persisted partially for 18 months. GH therapy was not interrupted for any patient, whereby physical training and dietetic measurements were increased for all patients. HOMA-index and OGT shall be used in parallel to monitor glucose metabolism as both show independently distinctive features. HbA1c and C-peptide are not suitable parameters for monitoring carbohydrate metabolism in PWS patients under GH treatment.
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http://dx.doi.org/10.1007/s10354-007-0382-1DOI Listing
February 2007

Gender-related differences in elite gymnasts: the female athlete triad.

Authors:
Edda Weimann

J Appl Physiol (1985) 2002 May;92(5):2146-52

Medical Centre for Child Heath, Clinic for Pediatric Endocrinology and Metabolism, Johann Wolfgang Goethe University, D-60590 Frankfurt, Germany.

High-intensity training can alter the normal pattern of pubertal development in elite gymnasts. We investigated sex hormones, the ob gene product leptin, body composition, nutrition, and eating habits in female and male elite gymnasts from national cadres to elucidate gender-related differences. Serum leptin levels were decreased, particularly in pubertal girls, and did not show the normal developmental pattern. After leptin levels were transformed into standard deviation scores, mainly pubertal female gymnasts had significantly lower values than normal controls of the same gender, pubertal stage, and body mass index. The percentage of body fat was reduced compared with a normal age-matched population in both genders but to a higher degree in female gymnasts. When leptin standard deviation scores were based on percent body fat instead of body mass index, mean values were still significantly decreased compared with those of normal controls: -1.05 in girls (P < 0.001) and -0.60 in boys (P = 0.025). In both genders, total energy consumption and nutritional intake were insufficient, although to a lesser extent in male gymnasts. Pubertal development is influenced to a different degree in female and male elite gymnasts. In contrast to their male counterparts, high-intensity training takes place during the sensitive phase of pubertal maturation in female gymnasts. Whereas the girls displayed low estrogen levels, hypoleptinemia, reduced body fat mass, insufficient caloric intake, and retarded menarche, the pubertal development of male gymnasts remained almost unaltered.
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http://dx.doi.org/10.1152/japplphysiol.00572.2001DOI Listing
May 2002