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  • 1
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    German Medical Science GMS Publishing House; Düsseldorf
    In:  Kongress Medizin und Gesellschaft 2007; 20070917-20070921; Augsburg; DOC07gmds726 /20070906/
    Publication Date: 2007-09-07
    Keywords: ddc: 610
    Language: German
    Type: conferenceObject
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  • 2
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    German Medical Science; Düsseldorf, Köln
    In:  50. Jahrestagung der Deutschen Gesellschaft für Medizinische Informatik, Biometrie und Epidemiologie (gmds), 12. Jahrestagung der Deutschen Arbeitsgemeinschaft für Epidemiologie; 20050912-20050915; Freiburg im Breisgau; DOC05gmds041 /20050908/
    Publication Date: 2005-09-09
    Keywords: ddc: 610
    Language: German
    Type: conferenceObject
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  • 3
    Keywords: BLOOD ; Germany ; human ; CLASSIFICATION ; FOLLOW-UP ; COHORT ; DEATH ; DISEASE ; EPIDEMIOLOGY ; RISK ; PROTEIN ; PROTEINS ; HEART ; PATIENT ; INFECTION ; ASSOCIATION ; antibodies ; antibody ; HUMANS ; meta-analysis ; etiology ; risk factors ; C-REACTIVE PROTEIN ; MYOCARDIAL-INFARCTION ; DIABETES-MELLITUS ; INFECTIONS ; COMPLICATIONS ; STROKE ; SERUM ; ADULT ; PROGRAM ; INCREASE ; CARDIOVASCULAR-DISEASE ; prospective studies ; CORONARY-HEART-DISEASE ; METAANALYSIS ; analysis ; methods ; PARTICIPANTS ; EVENTS ; prospective ; prospective study ; Chlamydophila pneumoniae ; microbiology ; Aged ; Middle Aged ; Antibodies,Bacterial ; cardiovascular disease ; cardiovascular diseases ; Chaperonin 60 ; Chlamydophila Infections ; Coronary Disease ; Diabetes Mellitus ; myocardial infarction ; Proportional Hazards Models ; rehabilitation
    Abstract: BACKGROUND: There have been suggestions of an association between Chlamydia pneumoniae, chlamydial heat shock protein (Ch-hsp) 60 and human heat shock protein (h-hsp) 60 infection sero-status and development of secondary cardiovascular events. Patients with diabetes might be at higher risk since they are prone to infections. The objective of this study was to investigate prospectively the role of Chlamydia pneumoniae (CP), chlamydial heat shock protein (Ch-hsp) 60 and a possible intermediate role of human heat shock protein (h-hsp) 60 sero-status in the development of secondary cardiovascular disease (CVD) events in patients with coronary heart disease (CHD) under special consideration of diabetes mellitus. METHODS: Patients aged 30-70 undergoing an in-patient rehabilitation program after acute manifestation of coronary heart disease (International Classification of Disease, 9th Rev. pos. 410-414) between January 1999 and May 2000 in one of two participating rehabilitation clinics in Germany were included in this analysis. Chlamydia pneumoniae (CP), chlamydial heat shock protein (Ch-hsp) 60 and human heat shock protein (h-hsp) 60 status at baseline were measured by serum immunoglobulin G and A antibodies. Secondary CVD events (myocardial infarction, stroke, and cardiovascular death) were recorded during a mean follow-up period of 33.5 months (response = 87%). RESULTS: Among the 1052 subjects 37.4% and 39.3% were sero-positive to CP IgA and IgG respectively, 22.2% were sero-positive to Ch-hsp 60 IgG and 8.4% were positive to h-hsp 60 IgG at baseline. During follow-up, secondary CVD events occurred among 71 (6.8%) participants. Occurrence of a secondary CVD event was more common among CP (IgA) and CP (IgG) sero-positive than among sero-negative patients (p-values 0.04 and 0.1, respectively). The risk of secondary CVD events was increased among patients with both a positive CP sero-status and diabetes compared to infection negative, non-diabetic patients and in general, sero-positivity added a hazard to diabetes. The interaction term between infection sero-status and diabetes was not statistically significant. We were not able to show an intermediate role of human heat shock protein (h-hsp) 60 sero-status in the development of secondary CVD events in patients with CHD. CONCLUSION: Results from this cohort of 1052 patients with pre-existing CHD cannot exclude a possible moderate increase in risk of secondary CVD events among patients with a positive infection sero-status. However, our study showed no intermediate role of human heat shock protein (h-hsp) 60 sero-status in the development of secondary CVD events in patients with CHD. Larger studies or meta-analysis of multiple studies are needed to address the interaction between infection sero-status and diabetes with adequate power
    Type of Publication: Journal article published
    PubMed ID: 16608530
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  • 4
    Keywords: Germany ; MODEL ; screening ; COHORT ; EPIDEMIOLOGY ; HISTORY ; IMPACT ; HEALTH ; HUMANS ; WOMEN ; MEN ; OBESITY ; smoking ; BODY ; body mass index ; SMOKERS ; MASS INDEX ; ADULT ; ADULTS ; WEIGHT ; body weight ; INTERVAL ; analysis ; methods ; GENDER ; PARTICIPANTS ; OVERWEIGHT ; female ; Male ; cohort analysis ; smoking cessation ; multivariate analysis ; BMI ; RELEVANCE ; Aged ; Middle Aged ; retrospective ; Retrospective Studies ; CESSATION ; statistics & numerical data
    Abstract: OBJECTIVE: To assess the relevance of pre-existing body weight for successful smoking cessation among women and men. METHODS: We carried out a retrospective cohort analysis among 4270 ever smoking participants of a general health screening examination in Germany recruited from July 2000 to June 2002 aged 50 to 74, who provided lifetime histories of both body weight and smoking. RESULTS: In the extended Cox model, the relative cessation rate (RCR) increased significantly with increasing body mass index (BMI) among both genders (test for trend: P 〈 0.01 for women and P 〈 0.0001 for men). In women, this effect was mainly due to a lower cessation rate in low-weight (BMI 〈20) smokers (adjusted RCR = 0.76, 95% confidence interval (CI) 0.62-0.95), whereas in men, the effect was mainly due to a higher cessation rate among overweight and obese smokers (adjusted RCR = 1.26, 95% CI 1.11-1.35, and 1.38, 95% CI 1.17-1.63, respectively) compared to normal-weight smokers. CONCLUSIONS: While in men, overweight and obesity are associated with increased smoking cessation, possibly related to increased health concerns, in women, low weight is associated with decreased smoking cessation, possibly related to increased fear of weight gain
    Type of Publication: Journal article published
    PubMed ID: 16336994
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  • 5
    Keywords: COMBINATION ; Germany ; THERAPY ; PATIENT ; treatment ; TRIAL ; HEALTH ; smoking ; EFFICACY ; RATES ; EXCHANGE ; STRATEGIES ; sensitivity ; 1 ; RANDOMIZED-TRIAL ; PROGRAM ; THERAPIES ; LEVEL ; methods ; REPLACEMENT THERAPY ; smoking cessation ; REPLACEMENT ; COSTS ; CESSATION ; QUIT ; outcome ; GENERAL-PRACTITIONERS ; INTERVENTIONS ; BUPROPION ; REIMBURSEMENT ; 3 ; STRATEGY ; A ; EFFECTIVENESS ACCEPTABILITY CURVES ; NORTRIPTYLINE ; AS ; smoking cessation treatment
    Abstract: Background: Evidence from cost-effective smoking cessation programs is scarce. This study determined the cost-effectiveness of 3 smoking cessation strategies as provided by general practitioners (GPs) in Germany. Methods: In a cluster-randomized smoking cessation trial, rates and intervention costs for 577 smoking patients of 82 GPs were followed up for 12 months. Three smoking cessation treatments were tested: (1) GP training plus GP remuneration for each abstinent patient, (2) GP training plus cost-free nicotine replacement medication and/or bupropion hydrochloride for the patient, and (3) a combination of both strategies. Smoking abstinence at 12 months was the primary outcome used to calculate incremental cost-effectiveness ratios and net monetary benefits. Results: Intervention 1 was not effective compared with treatment as usual (TAU). Interventions 2 and 3 each proved to be cost-effective compared separately with TAU. When applying a 95 percent level of certainty of cost-effectiveness against TAU, (sic)9.80 or (sic)6.96, respectively, had to be paid for each additional 1 percent of patients abstinent at 12 months (maximum willingness to pay). That means that in intervention 2, (sic)92.12 per patient in the program must be invested to gain 1 additional quitter (as opposed to (sic)39.10 paid per patient during the trial). In intervention 2, the cost was (sic)82.82, as opposed to (sic)50.04. Neither of these 2 cost-effective treatments proved to be superior to the other. The cost-effectiveness of both treatments was stable against TAU in sensitivity analyses. (The exchange rate from October 1, 2003, was used; (sic)1 = Dollar 1.17.) Conclusions: Both treatments have a high potential to reduce smoking-related morbidity at a low cost. It is highly recommended that they be implemented as a routine service offered by GPs because in many countries, health insurance plans currently do not fund nicotine replacement therapy
    Type of Publication: Journal article published
    PubMed ID: 19204212
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  • 6
    Keywords: CANCER ; CELLS ; EXPRESSION ; IRRADIATION ; radiotherapy ; CELL ; Germany ; THERAPY ; TOXICITY ; COHORT ; RISK ; SURGERY ; radiation ; PATIENT ; DNA ; INDEX ; QUALITY ; SKIN ; treatment ; BREAST ; breast cancer ; BREAST-CANCER ; LESIONS ; RADIATION-THERAPY ; ASSAY ; WOMEN ; DNA-REPAIR ; REPAIR ; COMET ASSAY ; DAMAGE ; LYMPHOCYTES ; BEAM ; DNA-DAMAGE ; PARAMETERS ; CANCER-PATIENTS ; KINETICS ; body mass index ; DNA repair ; DNA repair capacity ; PERIPHERAL-BLOOD LYMPHOCYTES ; ATAXIA-TELANGIECTASIA ; HETEROZYGOTES ; INTRINSIC RADIOSENSITIVITY ; radiation tolerance,DNA repair capacity,breast neoplasms,body mass index
    Abstract: Background and purpose: Intrinsic and extrinsic factors can affect the occurrence of side effects of radiotherapy. The influence of therapy modalities, personal characteristics and individual DNA repair capacity on the risk of acute skin toxicity was thus evaluated.Materials and methods: In a prospective study of 478 female breast cancer patients receiving adjuvant radiotherapy of the breast after breast-conserving surgery, acute skin toxicity was documented systematically using a modified version of the common toxicity criteria. Prognostic personal and treatment characteristics were identified for the entire cohort. Individual DNA repair capacity was determined in a subgroup of 113 patients with alkaline comet assay using phytohemagglutinin stimulated lymphocytes. Using proportional hazards analysis to account for cumulative biologically effective radiation dose, the hazard for the development of acute skin reactions (moist desquamation) associated with DNA repair capacity was modeled.Results: Of the 478 participants, 84 presented with acute reactions by the end of treatment. Higher body mass index was significantly associated with an increased risk for acute reactions (hazard ratio = 1.09 per 1 kg/m(2)), adjusted for treating hospital and photon beam quality. The comet assay parameters examined, including background DNA damage in non-irradiated cells, DNA damage induced by 5 Gy, and DNA repair capacity, were not significantly associated with risk of acute skin toxicity.Conclusions: Higher BMI is predictive of acute skin toxicity, however, individual repair parameters as determined by the alkaline comet assay are not informative enough. More comprehensive analyses including late effects of radiotherapy and repair kinetics optimized for different radiation-induced DNA lesions are warranted. (C) 2003 Elsevier Ireland Ltd. All rights reserved
    Type of Publication: Journal article published
    PubMed ID: 14643951
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  • 7
    Keywords: BLOOD ; Germany ; MODEL ; DISEASE ; RISK ; HEART ; PATIENT ; kidney ; MARKER ; prognosis ; RENAL-FUNCTION ; RISK-FACTORS ; treatment ; HUMANS ; PLASMA ; STRESS ; etiology ; risk factors ; MARKERS ; RECURRENCE ; LOW-DENSITY-LIPOPROTEIN ; PROGNOSTIC VALUE ; FUTURE ; COMPLICATIONS ; inflammation ; ADULT ; CORONARY-HEART-DISEASE ; INTERVAL ; methods ; EVENTS ; function ; enzymology ; female ; Male ; EVALUATE ; multivariate analysis ; RISK-FACTOR ; A2 ; Aged ; Middle Aged ; Predictive Value of Tests ; PREDICTS ; VARIETIES ; PREDICT ; cardiovascular diseases ; Coronary Disease ; Proportional Hazards Models ; biological markers ; cystatin ; Hemodynamic Processes ; Osmolar Concentration ; Phospholipases A ; physiopathology
    Abstract: OBJECTIVE: We sought to evaluate whether lipoprotein-associated phospholipase A2 (Lp-PLA2), an emerging marker of cardiovascular risk, is associated with prognosis in patients with coronary heart disease (CHD). METHODS AND RESULTS: Plasma concentrations and activity of Lp-PLA2 were determined in 1051 patients aged 30 to 70 years with CHD who were followed for &4 years. A Cox proportional hazards model was used to determine the prognostic value of Lp-PLA2 after adjustment for various covariates, including markers of inflammation, renal function, and hemodynamic stress. In multivariable analyses, Lp-PLA2 mass and activity were strongly associated with cardiovascular events after controlling for traditional risk factors, severity of CHD, statin treatment, cystatin C, and N-terminal proBNP. The hazard ratio (HR) for recurrent events was 2.65 (95% confidence interval [CI], 1.47 to 4.76) for the top tertile of Lp-PLA2 mass compared with the bottom tertile and 2.40 (95% CI, 1.35 to 4.29) for Lp-PLA2 activity. After additional adjustment for low-density lipoprotein (LDL), the HRs were only moderately attenuated (mass: 2.09; 95% CI, 1.10 to 3.96; activity: 1.81; 95% CI, 0.94 to 3.49, respectively), but the latter was no longer statistically significant. CONCLUSIONS: Increased concentrations of Lp-PLA2 predict future cardiovascular events in patients with manifest CHD independent of a variety of potential risk factors including markers of inflammation, renal function, and hemodynamic stress
    Type of Publication: Journal article published
    PubMed ID: 16627803
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  • 8
    Keywords: Germany ; FOLLOW-UP ; COHORT ; cohort studies ; cohort study ; DISEASE ; EPIDEMIOLOGY ; HEART ; PATIENT ; FREQUENCY ; FREQUENCIES ; HUMANS ; DESIGN ; PROSPECTIVE COHORT ; DIET ; DIETARY ; QUESTIONNAIRE ; MULTICENTER ; FOOD ; HOSPITALIZATION ; DIETARY-INTAKE ; ADULT ; PRODUCTS ; INCREASE ; prospective studies ; CORONARY-HEART-DISEASE ; PARTICIPANTS ; prospective ; female ; Male ; RECOMMENDATIONS ; EVALUATE ; Aged ; Middle Aged ; intake ; Coronary Disease ; rehabilitation ; Patient Compliance ; diet therapy ; Diet,Fat-Restricted ; Nutrition Assessment
    Abstract: OBJECTIVE: To evaluate the adherence to nutritional recommendations in inpatient rehabilitation and the long term maintenance of dietary changes among patients with coronary heart disease. DESIGN: Prospective cohort study. SETTING: Two rehabilitation clinics in Germany. PARTICIPANTS: A cohort of 1206 patients undergoing inpatient rehabilitation after an acute manifestation of coronary heart disease. MAIN OUTCOME MEASURES: Self reported dietary intake before, during, and one and three years after rehabilitation measured with a semiquantitative food frequency questionnaire and summarised to a nutritional index, which was used to categorise patients as having a poor, fair, or good diet. RESULTS: During rehabilitation the proportion of patients whose dietary intake was categorised as good increased strongly from 30% to 91%. One and three years after rehabilitation a still increased proportion of 49% and 42%, respectively, in the good category was observed. The strong increase in intake of low fat and wholemeal products that was achieved during rehabilitation was followed after rehabilitation discharge by a backslide to the intake observed before rehabilitation admission. The avoidance of unfavourable food items, such as French fries or eggs, was at least partly maintained during the follow up period. CONCLUSION: During inpatient rehabilitation most patients do have to make major changes in their dietary intake to comply with recommendations. Although some proportion of patients continue to adhere to dietary recommendations in the long run, further research into strategies to improve maintenance of dietary changes is needed to enhance further the long term benefits from cardiac rehabilitation
    Type of Publication: Journal article published
    PubMed ID: 16159977
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  • 9
    Keywords: Germany ; RESPONSES ; TRIAL ; TRIALS ; IDENTIFICATION ; PATTERNS ; CARE ; HEALTH ; CLINICAL-TRIALS ; smoking ; RATES ; STRATEGIES ; DOUBLE-BLIND ; SMOKERS ; RANDOMIZED-TRIAL ; RE ; PATTERN ; MS ; analysis ; ENGLAND ; WAVES ; ABSTINENCE ; BUPROPION ; REIMBURSEMENT ; TRANSDERMAL NICOTINE PATCH
    Abstract: In the statistical analysis of smoking cessation trials, participants with missing outcome data are commonly assumed to be continued smokers. Using algebraic formulas, a numerical example, and a real-life example, we evaluated the implications of nonresponse patterns on results obtained with a "missing = smoking" (MS) analysis compared with results obtained with an "available case" (AC) analysis, which excludes participants with missing outcome data. The algebraic formulas showed that MS and AC analysis provide consistent estimates of relative quit rates (RQR) when response rates in the treatment and control group are equal, regardless of the validity of the underlying assumption of both approaches. However, as shown in our numerical example, RQR estimated with both approaches can differ substantially in case of differential response rates. In the real-life example the proportion abstinent decreased from 16% to 5% in later response waves but did not reach zero. The estimates of the intervention effect from MS analysis and AC analysis converged when high and comparable response rates were achieved in both the treatment and control groups after multiple reminders. We conclude that smoking cessation studies should aim for high and equal response rates in the compared groups to ensure identification of all successful quitters and to be less susceptible to potential bias related to violation of the assumptions underlying the analytic strategies
    Type of Publication: Journal article published
    PubMed ID: 18569764
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  • 10
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