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  • 1
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    German Medical Science GMS Publishing House; Düsseldorf
    In:  Mainz//2011; 56. Jahrestagung der Deutschen Gesellschaft für Medizinische Informatik, Biometrie und Epidemiologie (gmds), 6. Jahrestagung der Deutschen Gesellschaft für Epidemiologie (DGEpi); 20110926-20110929; Mainz; DOC11gmds168 /20110920/
    Publication Date: 2011-09-20
    Keywords: neighbourhood SES ; cardiovascular risk factors ; ddc: 610
    Language: English
    Type: conferenceObject
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  • 2
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    German Medical Science GMS Publishing House; Düsseldorf
    In:  Jahrestagung der Gesellschaft für Medizinische Ausbildung - GMA; 20091008-20091010; Freiburg im Breisgau; DOC09gmaT5V106 /20090902/
    Publication Date: 2009-09-02
    Keywords: ddc: 610
    Language: German
    Type: conferenceObject
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  • 3
    Keywords: POPULATION ; HEALTH ; RISK FACTOR ; BLOOD-PRESSURE ; DISORDERS ; hyperthyroidism ; HYPOTHYROIDISM ; ARTERIAL STIFFNESS ; SUBCLINICAL THYROID-DYSFUNCTION ; ENDOTHELIUM-DEPENDENT VASODILATATION
    Abstract: Background: Recent data from a population-based study in children and adolescents suggest that serum thyrotropin (TSH) levels are associated with arterial blood pressure and hypertension. These results are in agreement with some but not all population-based studies in adults. Discrepancies in results might be explained by drug intake, different iodine supplies, and sizes of populations investigated. In addition, it is not clear whether an association between TSH and hypertension exists longitudinally or only cross-sectionally. Thus, our aim was to investigate cross-sectional and longitudinal associations between thyroid function and arterial blood pressure in a large consortium of cohort studies in adults. Methods: Data from five population-based studies were pooled resulting in 17,023 individuals being available for cross-sectional and 10,048 individuals for longitudinal analyses. Associations of baseline TSH with baseline blood pressure or hypertension were analyzed by multivariable median or logistic regression models. Multivariable median or Poisson regression models were used to investigate associations of baseline TSH with five-year change in arterial blood pressure or incident hypertension. Results: There was a cross-sectional positive association of TSH with arterial blood pressure (p〈0.001) and hypertension (odds ratio [OR]=1.76 [confidence interval (CI) 1.24-2.50], p=0.002). Likewise, hypothyroidism was associated with systolic (beta=1.1 [CI 0.1-2.1], p=0.040) and diastolic blood pressure (beta=1.4 [CI 0.7-2.0], p〈0.001). TSH, however, was not consistently associated with a five-year change in blood pressure or incident hypertension. Conclusions: High serum TSH levels were associated with current hypertension and blood pressure but not with a five-year change in blood pressure and incident hypertension. This argues for only a short-term effect of thyroid hormone levels on arterial blood pressure or a spurious association that needs further evaluation in population-based studies.
    Type of Publication: Journal article published
    PubMed ID: 23427935
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  • 4
    Keywords: RISK-FACTORS ; CARDIOVASCULAR-DISEASE ; INSULIN SENSITIVITY ; GENERAL-POPULATION ; OBESE WOMEN ; THYROID-STIMULATING HORMONE ; REFERENCE RANGE ; SUBCLINICAL HYPOTHYROIDISM ; EUTHYROID SUBJECTS ; TSH LEVEL
    Abstract: Background: Population-based studies investigating the sex-specific association between thyrotropin (TSH) levels and serum lipid concentrations are scarce. We examined the association between TSH and total cholesterol, low-density lipoprotein (LDL) cholesterol, high-density lipoprotein (HDL) cholesterol, and triglycerides in men and women from the general population. Furthermore, the association with TSH outside and within the reference range and lipid levels was studied. Methods: Individual data of 13,571 men and women without lipid medication of four population-based studies conducted in Western European adults were pooled for cross-sectional analyses. The association between TSH levels and lipid concentrations were analyzed by calculating sex-specific multivariable median regression models. Results: In the pooled population, serum TSH levels were significantly positively associated with triglyceride values in men and with total cholesterol, LDL cholesterol, and triglyceride values in women. In the pooled male population, low serum TSH levels (〈3.0 mIU/L) were significantly associated with lower total cholesterol, while high serum TSH levels (〉= 3.0 mIU/L) were associated with higher triglyceride values. In the pooled female population, low serum TSH levels were significantly associated with lower total cholesterol, LDL cholesterol, and HDL cholesterol. High TSH levels were associated with higher total cholesterol and LDL cholesterol in the pooled female population. In both sexes, serum TSH levels within the reference range (0.3-3.0 mIU/L) were significantly positively associated with triglyceride concentrations. Conclusions: Increasing levels of TSH were associated with a less favorable lipid profile in both men and women from the general population. In both sexes, TSH levels within the reference range were significantly positively associated with triglyceride concentrations.
    Type of Publication: Journal article published
    PubMed ID: 24102572
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  • 5
    Abstract: OBJECTIVE: To study the association between socioeconomic status (SES) and annual relative change in anthropometric markers in the general German adult population. METHODS: Longitudinal data of 56,556 participants aged 18-83 years from seven population-based German cohort studies (CARLA, SHIP, KORA, DEGS, EPIC-Heidelberg, EPIC-Potsdam, PopGen) were analyzed by meta-analysis using a random-effects model. The indicators of SES were education and household income. RESULTS: On average, all participants gained weight and increased their waist circumference over the study's follow-up period. Men and women in the low education group had a 0.1 percentage points greater annual increase in weight (95% CI men: 0.06-0.20; and women: 0.06-0.12) and waist circumference (95% CI men: 0.01-0.45; and women: 0.05-0.22) than participants in the high education group. Women with low income had a 0.1 percentage points higher annual increase in weight (95% CI 0.00-0.15) and waist circumference (95% CI 0.00-0.14) than women with high income. No association was found for men between income and obesity markers. CONCLUSIONS: Participants with lower SES (education and for women also income) gained more weight and waist circumference than those with higher SES. These results underline the necessity to evaluate the risk of weight gain based on SES to develop more effective preventive measures.
    Type of Publication: Journal article published
    PubMed ID: 26833586
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  • 6
    Abstract: BACKGROUND: Disagreement exists on the association between changes in blood pressure and cognitive impairment. We aimed to examine whether 4-year changes in systolic and diastolic blood pressure (SBP and DBP) are associated with cognitive status in a representative sample of older men and women. METHODS: Analysis of longitudinal data from 854 participants of a population-based German sample (aged 60-87 years) was performed with standard cognitive screening and blood pressure measurements. Effects of changes in SBP and DBP (10 mmHg and 5 mmHg respectively as unit of regression effect measure) on cognitive status were evaluated using non-parametric and linear regression modeling. RESULTS: No clear associations were seen between changes in SBP or in DBP and cognitive scores. Small effects were found after stratification for sex and hypertension awareness. Specifically, larger decreases in SBP were associated with higher cognitive scores in those men aware of their hypertension (10 mmHg decrease in SBP, beta = -0.26, 95% CI: -0.51 to -0.02) and men with controlled hypertension (10 mmHg decrease in SBP, beta = -0.44, 95% CI: -0.92 to -0.03). Additionally larger increases in DBP were associated with higher cognitive scores in men with controlled hypertension (5 mmHg increase in DBP, beta = 0.67, 95% CI: 0.19-1.15). For women aware of their hypertension, larger decreases in DBP were associated with higher cognitive scores (5 mmHg decrease in DBP, beta = -0.26; 95%CI: -0.51 to -0.01). CONCLUSIONS: Changes in blood pressure were only weakly associated with cognitive status. Specifically, decreases in SBP were associated with higher cognitive scores in men aware of their hypertension and especially those that were medically controlled.
    Type of Publication: Journal article published
    PubMed ID: 26918011
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  • 7
    Abstract: BACKGROUND: Precise blood pressure (BP) measurements are central for the diagnosis of hypertension in clinical and epidemiological studies. The purpose of this study was to quantify the variability in BP associated with arm side, body position, and successive measurements in the setting of a population-based observational study. Additionally, we aimed to evaluate the influence of different measurement conditions on prevalence of hypertension. METHODS: The sample included 967 men and 812 women aged 45 to 83 years at baseline. BP was measured according to a standardized protocol with oscillometric devices including three sitting measurements at left arm, one simultaneous supine measurement at both arms, and four supine measurements at the arm with the higher BP. Hypertension was defined as systolic BP (SBP) 〉/=140 mmHg and/or diastolic BP (DBP) 〉/=90 mmHg. Variability in SBP and DBP were analysed with sex-stratified linear covariance pattern models. RESULTS: We found that overall, no mean BP differences were measured according to arm-side, but substantial higher DBP and for men also higher SBP was observed in sitting than in supine position and there was a clear BP decline by consecutive measurement. Accordingly, the prevalence of hypertension depends strongly on the number and scheme of BP measurements taken to calculate the index values. CONCLUSIONS: Thus, BP measurements should only be compared between studies applying equal measurement conditions and index calculation. Moreover, the first BP measurement should not be used to define hypertension since it overestimates BP. The mean of second and third measurement offers the advantage of better reproducibility over single measurements.
    Type of Publication: Journal article published
    PubMed ID: 28100183
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  • 8
    Abstract: AIMS: To determine the interaction between HRV and inflammation and their association with cardiovascular/all-cause mortality in the general population. METHODS AND RESULTS: Subjects of the CARLA study (n = 1671; 778 women, 893 men, 45-83 years of age) were observed for an average follow-up period of 8.8 years (226 deaths, 70 cardiovascular deaths). Heart rate variability parameters were calculated from 5-min segments of 20-min resting electrocardiograms. High-sensitivity C-reactive protein (hsCRP), interleukin-6 (IL-6), and soluble tumour necrosis factor-alpha receptor type 1 (sTNF-R1) were measured as inflammation parameters. The HRV parameters determined included the standard deviation of normal-to-normal intervals (SDNN), the root-mean-square of successive normal-interval differences (RMSSD), the low- and high-frequency (HF) power, the ratio of both, and non-linear parameters [Poincare plot (SD1, SD2, SD1/SD2), short-term detrended fluctuation analysis]. We estimated hazard ratios by using covariate-adjusted Cox regression for cardiovascular and all-cause mortality incorporating an interaction term of HRV/inflammation parameters. Relative excess risk due to interactions (RERIs) were computed. We found an interaction effect of sTNF-R1 with SDNN (RERI: 0.5; 99% confidence interval (CI): 0.1-1.0), and a weaker effect with RMSSD (RERI: 0.4; 99% CI: 0.0-0.9) and HF (RERI: 0.4; 99% CI: 0.0-0.9) with respect to cardiovascular mortality on an additive scale after covariate adjustment. Neither IL-6 nor hsCRP showed a significant interaction with the HRV parameters. CONCLUSION: A change in TNF-alpha levels or the autonomic nervous system influences the mortality risk through both entities simultaneously. Thus, TNF-alpha and HRV need to be considered when predicating mortality.
    Type of Publication: Journal article published
    PubMed ID: 27221352
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  • 9
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    German Medical Science GMS Publishing House; Düsseldorf
    In:  GMS Zeitschrift für Medizinische Ausbildung; VOL: 29; DOC59 /20120808/
    Publication Date: 2012-08-08
    Description: Introduction: The Internet represents a central communication medium for patients and physicians. Some national information is available regarding the design of physicians' homepages and patient requirements regarding homepages of physicians in private practice. To date, no data are available for homepages of medical faculties and their users' needs.Methods: In 2008 the homepages of the 36 German medical faculties were analyzed according to a catalogue of 128 criteria assigned to five domains which had been developed from the literature. Structure, content and extent were compared. Results: The homepages covered the criteria to a very different extent. The best homepage reached 80%, the worst only 26% of the achievable points. The mean was slightly above 50% . Faculties addressed mainly applicants and students as their target groups, less frequently lecturers and alumni.Conclusion: This study shows differences in quality and quantity of the "teaching section" on websites of medical faculties. The results allow faculties to use the criteria to adjust their websites with regard to addressing the relevant target groups of students, applicants, lecturers and alumni comprehensively.
    Description: Einleitung: Für Ärzte und Patienten stellt das Internet ein zentrales Informationsmedium im Gesundheitswesen dar. Es liegen national einige Informationen zur Gestaltung einer Arzthomepage und zu Patientenwünschen an den Internetauftritt eines niedergelassenen Arztes vor. Für Internetauftritte medizinischer Fakultäten und die Bedürfnisse ihrer Zielgruppen gibt es bislang keine Daten.Methoden: In 2008 wurden die Internetauftritte der 36 Medizinischen Fakultäten anhand von über 100 aus der Literatur entwickelten Kriterien erfasst, die fünf Bereichen zugeordnet wurden. Aufbau, Inhalt und Umfang wurden miteinander verglichen. Ergebnisse: Die Internetauftritte deckten die Kriterien in sehr unterschiedlichem Umfang ab. Der beste Auftritt erreichte 80%, der schlechteste lediglich 26% der erreichbaren Punkte, im Mittel wurde gut die Hälfte der Kriterien erfüllt. Die Fakultäten bedienten vor allem Studienbewerber und Studierende als Zielgruppen, weniger die Lehrenden und Alumni. Schlussfolgerung: Die vorliegende Studie zeigt Qualitäts - und Quantitätsunterschiede der Lehrbereiche der Internetauftritte medizinischer Fakultäten. Die Ergebnisse bieten den Fakultäten anhand der Kriterien die Möglichkeit, ihre Internetauftritte zu überarbeiten, um den relevanten Zielgruppen der Studierenden, Studieninteressierten, Lehrenden und Absolventen eine umfassende Informationsplattform zu bieten.
    Keywords: internet ; websites ; medical faculties ; medical education ; students ; Internet ; Homepage ; Medizinische Fakultät ; Medizinstudium ; Studierende ; ddc: 610
    Language: German
    Type: article
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  • 10
    Keywords: RISK ; HEART ; NECROSIS-FACTOR-ALPHA ; MARKERS ; TNF-ALPHA ; INJURY ; cross-sectional analysis ; CREATININE ; CHRONIC KIDNEY-DISEASE ; EQUATION
    Abstract: BACKGROUND: There is evidence that chronic inflammation is associated with the progression/development of chronic renal failure; however, relations in subjects with preserved renal function remain insufficiently understood. OBJECTIVE: To examine the association of inflammation with the development of renal failure in a cohort of the elderly general population. METHODS: After excluding subjects with reduced estimated glomerular filtration rate (eGFR〈60 mL/min/1.73 m2) and missing data, the cohort incorporated 785 men and 659 women (aged 45-83 years). Follow-up was performed four years after baseline. Covariate adjusted linear and logistic regression models were used to assess the association of plasma/serum concentrations of soluble tumour necrosis factor receptor 1 (sTNF-R1), C-reactive protein (CRP), and interleukin 6 (IL-6) with change in eGFR/creatinine. The areas under the curve (AUCs) from receiver operating characteristics (ROCs) were estimated. RESULTS: In adjusted models sTNF-R1 was distinctively associated with a decline in eGFR in men (0.6 mL/min/1.73 m2 per 100 pg/mL sTNF-R1; 95% CI: 0.4-0.8), but not in women. A similar association could not be found for CRP or IL-6. Estimates of sTNF-R1 in the cross-sectional analyses were similar between sexes, while CRP and IL-6 were not relevantly associated with eGFR/creatinine. CONCLUSION: In the elderly male general population with preserved renal function sTNF-R1 predicts the development of renal failure.
    Type of Publication: Journal article published
    PubMed ID: 25259714
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