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Wofford N, Rausch CR, Elkins GR. Aging Adults' Willingness, Preferences, and Access to Self-Hypnosis for Sleep: A Cross-Sectional Survey. Int J Clin Exp Hypn 2024:1-16. [PMID: 38446038 DOI: 10.1080/00207144.2024.2324167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 11/30/2023] [Indexed: 03/07/2024]
Abstract
Sleep disturbance is a public health problem among aging adults (age 45 and older). While aging adults are at an elevated risk for sleep disturbance, many also have high rates of mistrust toward psychological interventions, such as self-hypnosis, which may be beneficial for sleep. The purpose of the study was to assess factors that may impact utilization of self-hypnosis for sleep, including willingness, preferences, and access among informed aging adults. 244 aging adults were recruited. After reading an information sheet on self-hypnosis for sleep, participants completed questionnaires assessing sleep related worry, stress, and perceptions of self-hypnosis for sleep, including willingness, benefits, barriers, preferences, and access. The findings indicated that informed aging adults were willing to engage in self-hypnosis for sleep, regardless of their race or gender. Furthermore, they preferred technological delivery methods (i.e. telehealth or smartphone apps) with flexible scheduling options. However, very few participants endorsed having access to self-hypnosis.
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Affiliation(s)
- Nathan Wofford
- Department of Psychology and Neuroscience, Baylor University, Waco, Texas, USA
| | - Carolyn R Rausch
- Department of Psychology and Neuroscience, Baylor University, Waco, Texas, USA
| | - Gary R Elkins
- Department of Psychology and Neuroscience, Baylor University, Waco, Texas, USA
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2
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Vavassori C, Cipriani E, Colombo GI. Circulating MicroRNAs as Novel Biomarkers in Risk Assessment and Prognosis of Coronary Artery Disease. Eur Cardiol 2022; 17:e06. [PMID: 35321524 PMCID: PMC8924954 DOI: 10.15420/ecr.2021.47] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 01/05/2022] [Indexed: 12/14/2022] Open
Abstract
Coronary artery disease is among the leading causes of death worldwide. Nevertheless, available cardiovascular risk prediction algorithms still miss a significant portion of individuals at-risk. Thus, the search for novel non-invasive biomarkers to refine cardiovascular risk assessment is both an urgent need and an attractive topic, which may lead to a more accurate risk stratification and/or prognostic score definition for coronary artery disease. A new class of such non-invasive biomarkers is represented by extracellular microRNAs (miRNAs) circulating in the blood. MiRNAs are non-coding RNA of 22–25 nucleotides in length that play a significant role in both cardiovascular physiology and pathophysiology. Given their high stability and conservation, resistance to degradative enzymes, and detectability in body fluids, circulating miRNAs are promising emerging biomarkers, and specific expression patterns have already been associated with a wide range of cardiovascular conditions. In this review, an overview of the role of blood miRNAs in risk assessment and prognosis of coronary artery disease is given.
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Affiliation(s)
- Chiara Vavassori
- Unit of Immunology and Functional Genomics, Centro Cardiologico Monzino, IRCCS, Milan, Italy; Cardiovascular Section, Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Eleonora Cipriani
- Unit of Immunology and Functional Genomics, Centro Cardiologico Monzino, IRCCS, Milan, Italy
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Hageman S, Pennells L, Ojeda F, Kaptoge S, Kuulasmaa K, de Vries T, Xu Z, Kee F, Chung R, Wood A, McEvoy JW, Veronesi G, Bolton T, Achenbach S, Aleksandrova K, Amiano P, Sebastian DS, Amouyel P, Andersson J, Bakker SJL, Da Providencia Costa RB, Beulens JWJ, Blaha M, Bobak M, Boer JMA, Bonet C, Bonnet F, Boutron-Ruault MC, Braaten T, Brenner H, Brunner F, Brunner EJ, Brunström M, Buring J, Butterworth AS, Capkova N, Cesana G, Chrysohoou C, Colorado-Yohar S, Cook NR, Cooper C, Dahm CC, Davidson K, Dennison E, Di Castelnuovo A, Donfrancesco C, Dörr M, Doryńska A, Eliasson M, Engström G, Ferrari P, Ferrario M, Ford I, Fu M, Gansevoort RT, Giampaoli S, Gillum RF, Gómez de la Cámara A, Grassi G, Hansson PO, Huculeci R, Hveem K, Iacoviello L, Ikram MK, Jørgensen T, Joseph B, Jousilahti P, Wouter Jukema J, Kaaks R, Katzke V, Kavousi M, Kiechl S, Klotsche J, König W, Kronmal RA, Kubinova R, Kucharska-Newton A, Läll K, Lehmann N, Leistner D, Linneberg A, Pablos DL, Lorenz T, Lu W, Luksiene D, Lyngbakken M, Magnussen C, Malyutina S, Ibañez AM, Masala G, Mathiesen EB, Matsushita K, Meade TW, Melander O, Meyer HE, Moons KGM, Moreno-Iribas C, Muller D, Münzel T, Nikitin Y, Nordestgaard BG, Omland T, Onland C, Overvad K, Packard C, Pająk A, Palmieri L, Panagiotakos D, Panico S, Perez-Cornago A, Peters A, Pietilä A, Pikhart ,H, Psaty BM, Quarti-Trevano F, Garcia JRQ, Riboli E, Ridker PM, Rodriguez B, Rodriguez-Barranco M, Rosengren A, Roussel R, Sacerdote C, Sans S, Sattar N, Schiborn C, Schmidt B, Schöttker B, Schulze M, Schwartz JE, Selmer RM, Shea S, Shipley MJ, Sieri S, Söderberg S, Sofat R, Tamosiunas A, Thorand B, Tillmann T, Tjønneland A, Tong TYN, Trichopoulou A, Tumino R, Tunstall-Pedoe H, Tybjaerg-Hansen A, Tzoulaki J, van der Heijden A, van der Schouw YT, Verschuren WMM, Völzke H, Waldeyer C, Wareham NJ, Weiderpass E, Weidinger F, Wild P, Willeit J, Willeit P, Wilsgaard T, Woodward M, Zeller T, Zhang D, Zhou B, Dendale P, Ference BA, Halle M, Timmis A, Vardas P, Danesh J, Graham I, Salomaa V, Visseren F, De Bacquer D, Blankenberg S, Dorresteijn J, Di Angelantonio E. SCORE2 risk prediction algorithms: new models to estimate 10-year risk of cardiovascular disease in Europe. Eur Heart J 2021; 42:2439-2454. [PMID: 34120177 PMCID: PMC8248998 DOI: 10.1093/eurheartj/ehab309] [Citation(s) in RCA: 406] [Impact Index Per Article: 135.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 03/08/2021] [Accepted: 05/05/2021] [Indexed: 12/14/2022] Open
Abstract
AIMS The aim of this study was to develop, validate, and illustrate an updated prediction model (SCORE2) to estimate 10-year fatal and non-fatal cardiovascular disease (CVD) risk in individuals without previous CVD or diabetes aged 40-69 years in Europe. METHODS AND RESULTS We derived risk prediction models using individual-participant data from 45 cohorts in 13 countries (677 684 individuals, 30 121 CVD events). We used sex-specific and competing risk-adjusted models, including age, smoking status, systolic blood pressure, and total- and HDL-cholesterol. We defined four risk regions in Europe according to country-specific CVD mortality, recalibrating models to each region using expected incidences and risk factor distributions. Region-specific incidence was estimated using CVD mortality and incidence data on 10 776 466 individuals. For external validation, we analysed data from 25 additional cohorts in 15 European countries (1 133 181 individuals, 43 492 CVD events). After applying the derived risk prediction models to external validation cohorts, C-indices ranged from 0.67 (0.65-0.68) to 0.81 (0.76-0.86). Predicted CVD risk varied several-fold across European regions. For example, the estimated 10-year CVD risk for a 50-year-old smoker, with a systolic blood pressure of 140 mmHg, total cholesterol of 5.5 mmol/L, and HDL-cholesterol of 1.3 mmol/L, ranged from 5.9% for men in low-risk countries to 14.0% for men in very high-risk countries, and from 4.2% for women in low-risk countries to 13.7% for women in very high-risk countries. CONCLUSION SCORE2-a new algorithm derived, calibrated, and validated to predict 10-year risk of first-onset CVD in European populations-enhances the identification of individuals at higher risk of developing CVD across Europe.
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Cinza-Sanjurjo S, Micó-Pérez RM, Velilla-Zancada S, Prieto-Díaz MA, Rodríguez-Roca GC, Barquilla García A, Polo García J, Martín Sánchez V, Llisterri Caro JL. [Factors associated with cardiovascular risk and cardiovascular and renal disease in the IBERICAN study: Final results]. Semergen 2020; 46:368-378. [PMID: 32873502 DOI: 10.1016/j.semerg.2020.06.027] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 06/19/2020] [Accepted: 06/27/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To analyse the prevalence in clinical practice of cardiovascular risk factors (CVRF) and cardiovascular disease (CVD), as well as their causal relationship, in the study inclusion visit. MATERIAL AND METHODS Cross-sectional analysis of the study inclusion visit of 8,066 patients of 18 to 85years of age included in the IBERICAN study. By reviewing the medical history, analytics and medical visits, the patient's physician has collected socio-demographic information, personal and family history and prevalence of CVRF and CVD and renal disease. A multivariate analysis was carried out using a logistic regression that included the autonomous region variable as a random effect variable, in order to analyse the impact of certain variables on the development of each CVRF, metabolic syndrome, subclinical organ damage, renal disease, and CVD. RESULTS Dyslipidaemia was 2.4 times more frequent in diabetics, and the risk was increased by 59% in hypertensive patients. Arterial hypertension was twice as frequent in diabetics, and increased 94% in hyperuricaemic patients and 62.1% in dyslipidaemia patients. Diabetes mellitus was 2.5 times higher in dyslipidaemia patients, and 2.2 times higher in hypertensive patients. CVD was four times more frequent in patients with a family history, and the risk in women was increased by 90.8% and by 53.8% in patients with renal disease. CONCLUSIONS The Spanish population seen in Primary Care that were analysed in the IBERICAN study had a high prevalence of CVRF and CVD, which gives it a high CVR. The multivariate analysis performed shows a close causal relationship between the CVRF with each other, and with renal disease and CVD.
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Affiliation(s)
- S Cinza-Sanjurjo
- Centro de Salud de Porto do Son, AS Santiago de Compostela, Porto do Son, A Coruña, España
| | - R M Micó-Pérez
- Centro de Salud de Fontanars dels Alforins, EAP Ontinyent, Fontanars dels Alforins, Valencia, España
| | | | | | - G C Rodríguez-Roca
- Centro de Salud de Puebla de Montalbán, La Puebla de Montalbán, Toledo, España
| | | | - J Polo García
- Centro de Salud Casar de Cáceres, Casar de Cáceres, Cáceres, España
| | - V Martín Sánchez
- Instituto de Biomedicina (IBIOMED), Universidad de León, Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), León, España
| | - J L Llisterri Caro
- Fundación Sociedad Española de Médicos de Atención Primaria, Semergen, Madrid, España
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The role of gender and anxiety in the association between somatic diseases and depression: findings from three combined epidemiological studies in primary care. Epidemiol Psychiatr Sci 2019; 28:321-332. [PMID: 29117876 PMCID: PMC6998911 DOI: 10.1017/s2045796017000567] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
AIMS Although associations between various somatic diseases and depression are well established, findings concerning the role of gender and anxiety disorders for these associations remain fragmented and partly inconsistent. Combining data from three large-scaled epidemiological studies in primary care, we aim to investigate interactions of somatic diseases with gender and anxiety disorders in the association with depression. METHODS Self-reported depression according to the International Classification of Diseases, Tenth Edition (ICD-10) was assessed in n = 83 737 patients from three independent studies [DETECT (Diabetes Cardiovascular Risk Evaluation: Targets and Essential Data for Commitment of Treatment), Depression-2000 and Generalized Anxiety and Depression in Primary Care (GAD-P)] using the Depression Screening Questionnaire (DSQ). Diagnoses of depression, anxiety disorders and somatic diseases were obtained from treating physicians via standardised clinical appraisal forms. RESULTS In logistic regressions, adjusted for gender, age group and study, each somatic disease except for arterial hypertension and endocrine diseases was associated with self-reported depression (odds ratio, OR 1.3-2.6) and each somatic disease was associated with physician-diagnosed depression (OR 1.1-2.4). Most of these associations remained significant after additional adjustment for anxiety disorders and other somatic diseases. The associations with depression increased with a higher number of somatic diseases. Cardiovascular diseases (OR 0.8), diabetes mellitus (OR 0.8) and neurological diseases (OR 0.8) interacted with gender in the association with self-reported depression, while endocrine diseases (OR 0.8) interacted with gender in the association with physician-diagnosed depression. That is, the associations between respective somatic diseases and depression were less pronounced in females v. males. Moreover, cardiovascular diseases (OR 0.7), arterial hypertension (OR 0.8), gastrointestinal diseases (OR 0.7) and neurological diseases (OR 0.6) interacted with anxiety disorders in the association with self-reported depression, and each somatic disease interacted with anxiety disorders in the association with physician-diagnosed depression (OR 0.6-0.8). That is, the associations between respective somatic diseases and depression were less pronounced in patients with v. without anxiety disorders; arterial hypertension was negatively associated with self-reported depression only in patients with anxiety disorders, but not in patients without anxiety disorders. CONCLUSIONS A range of somatic diseases as well as anxiety disorders are linked to depression - and especially patients with co-/multi-morbidity are affected. However, interactions with gender and anxiety disorders are noteworthy and of relevance to potentially improve recognition and treatment of depression by physicians. Somatic diseases are associated more strongly with depression in males v. females as well as in patients without v. with anxiety disorders, primarily because women and patients with anxiety disorders per se are characterised by considerably increased depression prevalence that only marginally changes in the presence of somatic comorbidity.
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Grammer TB, Dressel A, Gergei I, Kleber ME, Laufs U, Scharnagl H, Nixdorff U, Klotsche J, Pieper L, Pittrow D, Silber S, Wittchen HU, März W. Cardiovascular risk algorithms in primary care: Results from the DETECT study. Sci Rep 2019; 9:1101. [PMID: 30705337 PMCID: PMC6355969 DOI: 10.1038/s41598-018-37092-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Accepted: 11/30/2018] [Indexed: 12/11/2022] Open
Abstract
Guidelines for prevention of cardiovascular diseases use risk scores to guide the intensity of treatment. A comparison of these scores in a German population has not been performed. We have evaluated the correlation, discrimination and calibration of ten commonly used risk equations in primary care in 4044 participants of the DETECT (Diabetes and Cardiovascular Risk Evaluation: Targets and Essential Data for Commitment of Treatment) study. The risk equations correlate well with each other. All risk equations have a similar discriminatory power. Absolute risks differ widely, in part due to the components of clinical endpoints predicted: The risk equations produced median risks between 8.4% and 2.0%. With three out of 10 risk scores calculated and observed risks well coincided. At a risk threshold of 10 percent in 10 years, the ACC/AHA atherosclerotic cardiovascular disease (ASCVD) equation has a sensitivity to identify future CVD events of approximately 80%, with the highest specificity (69%) and positive predictive value (17%) among all the equations. Due to the most precise calibration over a wide range of risks, the large age range covered and the combined endpoint including non-fatal and fatal events, the ASCVD equation provides valid risk prediction for primary prevention in Germany.
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Affiliation(s)
- Tanja B Grammer
- University of Heidelberg, Mannheim Medical Faculty, Mannheim Institute of Public Health, Social and Preventive Medicine, Mannheim, Germany. .,University of Heidelberg, Mannheim Medical Faculty, Department of Internal Medicine V (Nephrology, Hypertensiology, Rheumatology, Endocrinology, Diabetology), Mannheim, Germany.
| | - Alexander Dressel
- University of Heidelberg, Mannheim Medical Faculty, Department of Internal Medicine V (Nephrology, Hypertensiology, Rheumatology, Endocrinology, Diabetology), Mannheim, Germany
| | - Ingrid Gergei
- University of Heidelberg, Mannheim Medical Faculty, Department of Internal Medicine V (Nephrology, Hypertensiology, Rheumatology, Endocrinology, Diabetology), Mannheim, Germany
| | - Marcus E Kleber
- University of Heidelberg, Mannheim Medical Faculty, Department of Internal Medicine V (Nephrology, Hypertensiology, Rheumatology, Endocrinology, Diabetology), Mannheim, Germany
| | - Ulrich Laufs
- Clinic and Polyclinic of Cardiology, University Clinic Leipzig, Leipzig, Germany
| | - Hubert Scharnagl
- Medical University of Graz, Clinical Institute of Medical and Chemical Laboratory Diagnostics, Graz, Austria
| | - Uwe Nixdorff
- European Prevention Center, EPC GmbH, Düsseldorf, Germany.
| | - Jens Klotsche
- German Research Center of Rheumatology Berlin, Leibnitz Institute, Berlin, Germany
| | - Lars Pieper
- Charité Universitätsmedizin Berlin, Institute of Social Medicine, Epidemiology and Health Economics, Berlin, Germany
| | - David Pittrow
- Technical University Dresden, Medical Faculty, Institute of Clinical Pharmacology, Dresden, Germany
| | | | - Hans-Ulrich Wittchen
- Technical University Dresden, Institute of Clinical Psychology and Psychotherapy, Dresden, Germany.,Max-Planck- Institute of Psychiatry, Munich, Germany
| | - Winfried März
- University of Heidelberg, Mannheim Medical Faculty, Department of Internal Medicine V (Nephrology, Hypertensiology, Rheumatology, Endocrinology, Diabetology), Mannheim, Germany.,Medical University of Graz, Clinical Institute of Medical and Chemical Laboratory Diagnostics, Graz, Austria.,Synlab Services GmbH, Synlab Academy, Mannheim, Augsburg, Germany
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7
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Kische H, Hoyer J, Pieper L, Venz J, Klotsche J, März W, Koch-Gromus U, Pittrow D, Lehnert H, Silber S, Stalla GK, Zeiher AM, Wittchen HU, Haring R. Testosterone is not associated with traits of optimism or pessimism: Observational evidence from the prospective DETECT study. PLoS One 2018; 13:e0207870. [PMID: 30496216 PMCID: PMC6264867 DOI: 10.1371/journal.pone.0207870] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Accepted: 11/06/2018] [Indexed: 11/18/2022] Open
Abstract
Background Previous experimental research on testosterone (T) and psychological traits is inconclusive. Thus, we performed the first large-scale observational study of the association between T and dispositional optimism / pessimism. Methods We used prospective data from 6,493 primary-care patients (3,840 women) of the DETECT study (Diabetes Cardiovascular Risk-Evaluation: Targets and Essential Data for Commitment of Treatment), including repeated immunoassay-based measurement of serum T and optimism / pessimism assessed by the revised Life-Orientation Test (LOT-R). Cross-sectional and longitudinal associations of baseline T and one-year change in T with optimism and pessimism were investigated using age- and multivariable-adjusted regression models. Results Cross-sectional analyses showed no association of T with optimism or pessimism in both sexes. Longitudinal analyses also showed no association of baseline T with optimism or pessimism at four-year follow-up. Multivariable analyses of total LOT-R score yielded similarly non-significant results (β-coefficient per unit change in T for men: -0.01 (95% CI: -0.24–0.22), women: 0.08 (-0.03–0.20)). Furthermore, change in T was not related to optimism or pessimism at four-year follow-up. Conclusions The present observational study of a large-scale prospective sample showed no association of T with optimism or pessimism. Integrating further experimental and interventional evidence from alternative methodological approaches would strengthen this conclusion and establish stronger evidence about the potential hormonal basis of psychological traits.
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Affiliation(s)
- Hanna Kische
- Behavioral Epidemiology, Institute of Clinical Psychology and Psychotherapy, Technical University of Dresden, Dresden, Germany
| | - Jürgen Hoyer
- Institute of Clinical Psychology and Psychotherapy, Technical University of Dresden, Dresden, Germany
| | - Lars Pieper
- Behavioral Epidemiology, Institute of Clinical Psychology and Psychotherapy, Technical University of Dresden, Dresden, Germany
| | - John Venz
- Behavioral Epidemiology, Institute of Clinical Psychology and Psychotherapy, Technical University of Dresden, Dresden, Germany
| | - Jens Klotsche
- German Rheumatism Research Centre Berlin, Berlin, Germany
| | - Winfried März
- Medical Clinic V, Medical Faculty Mannheim at Heidelberg University, Heidelberg, Germany
| | - Uwe Koch-Gromus
- Department of Medical Psychology, University Medical Center Eppendorf, Hamburg, Germany
| | - David Pittrow
- Institute of Clinical Pharmacology, Medical Faculty, Technical University of Dresden, Dresden, Germany
| | - Hendrik Lehnert
- Department of Medicine I, University of Schleswig-Holstein, Lübeck, Germany
| | | | | | - Andreas M. Zeiher
- Department of Medicine III Cardiology, Goethe University Frankfurt, Frankfurt, Germany
| | - Hans-Ulrich Wittchen
- Institute of Clinical Psychology and Psychotherapy, Technical University of Dresden, Dresden, Germany
| | - Robin Haring
- European University of Applied Sciences, Faculty of Applied Public Health, Rostock, Germany
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- * E-mail:
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8
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Boeckel JN, Palapies L, Klotsche J, Zeller T, von Jeinsen B, Perret MF, Kleinhaus SL, Pieper L, Tzikas S, Leistner D, Bickel C, Stalla GK, Lehnert H, Lindahl B, Wittchen HU, Silber S, Baldus S, Maerz W, Dimmeler S, Blankenberg S, Münzel T, Zeiher AM, Keller T. Adjusted Troponin I for Improved Evaluation of Patients with Chest Pain. Sci Rep 2018; 8:8087. [PMID: 29799020 PMCID: PMC5967336 DOI: 10.1038/s41598-018-26120-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Accepted: 05/03/2018] [Indexed: 11/29/2022] Open
Abstract
The use of cardiac troponins (cTn) is the gold standard for diagnosing myocardial infarction. Independent of myocardial infarction (MI), however, sex, age and kidney function affect cTn levels. Here we developed a method to adjust cTnI levels for age, sex, and renal function, maintaining a unified cut-off value such as the 99th percentile. A total of 4587 individuals enrolled in a prospective longitudinal study were used to develop a model for adjustment of cTn. cTnI levels correlated with age and estimated glomerular filtration rate (eGFR) in males/females with rage = 0.436/0.518 and with reGFR = -0.142/-0.207. For adjustment, these variables served as covariates in a linear regression model with cTnI as dependent variable. This adjustment model was then applied to a real-world cohort of 1789 patients with suspected acute MI (AMI) (N = 407). Adjusting cTnI showed no relevant loss of diagnostic information, as evidenced by comparable areas under the receiver operator characteristic curves, to identify AMI in males and females for adjusted and unadjusted cTnI. In specific patients groups such as in elderly females, adjusting cTnI improved specificity for AMI compared with unadjusted cTnI. Specificity was also improved in patients with renal dysfunction by using the adjusted cTnI values. Thus, the adjustments improved the diagnostic ability of cTnI to identify AMI in elderly patients and in patients with renal dysfunction. Interpretation of cTnI values in complex emergency cases is facilitated by our method, which maintains a single diagnostic cut-off value in all patients.
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Affiliation(s)
- Jes-Niels Boeckel
- Department of Internal Medicine III, Cardiology, University Hospital, Goethe University Frankfurt, Frankfurt, Germany
- German Center for Cardiovascular Disease (DZHK), Berlin, Germany
- Institute of Cardiovascular Regeneration, Centre for Molecular Medicine, Goethe University Frankfurt, Frankfurt, Germany
- Department of Internal Medicine, Cardiology, University Hospital Leipzig, Leipzig, Germany
| | - Lars Palapies
- Department of Internal Medicine III, Cardiology, University Hospital, Goethe University Frankfurt, Frankfurt, Germany
| | - Jens Klotsche
- Clinical Psychology und Psychotherapy, Technical University Dresden, Dresden, Germany
| | - Tanja Zeller
- German Center for Cardiovascular Disease (DZHK), Berlin, Germany
- Clinic for General and Interventional Cardiology, University Heart Centre Hamburg, Hamburg, Germany
| | - Beatrice von Jeinsen
- Department of Internal Medicine III, Cardiology, University Hospital, Goethe University Frankfurt, Frankfurt, Germany
- German Center for Cardiovascular Disease (DZHK), Berlin, Germany
| | - Maya F Perret
- Department of Internal Medicine III, Cardiology, University Hospital, Goethe University Frankfurt, Frankfurt, Germany
| | - Soeren L Kleinhaus
- Institute of Cardiovascular Regeneration, Centre for Molecular Medicine, Goethe University Frankfurt, Frankfurt, Germany
| | - Lars Pieper
- Clinical Psychology und Psychotherapy, Technical University Dresden, Dresden, Germany
| | - Stergios Tzikas
- 3rd Department of Cardiology, Ippokrateio Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
- Department of Medicine II, University Medical Center, Johannes Gutenberg University, Mainz, Germany
| | - David Leistner
- Department of Internal Medicine III, Cardiology, University Hospital, Goethe University Frankfurt, Frankfurt, Germany
- German Center for Cardiovascular Disease (DZHK), Berlin, Germany
| | - Christoph Bickel
- Department of Internal Medicine, Federal Armed Forces Hospital, Koblenz, Germany
| | - Günter K Stalla
- Max Plank Institute for Psychiatry, Neuroendocrinology, Munich, Munich, Germany
| | - Hendrik Lehnert
- Department of Internal Medicine I, University Hospital Schleswig-Holstein, Lübeck, Germany
| | - Bertil Lindahl
- Department of Medical Sciences and Uppsala Clinical Research Center, Uppsala, Sweden
| | - Hans-Ulrich Wittchen
- Clinical Psychology und Psychotherapy, Technical University Dresden, Dresden, Germany
| | - Sigmund Silber
- Praxisklinik, Kardiologische Gemeinschaftspraxis, Munich, Germany
| | - Stephan Baldus
- Clinic for General and Interventional Cardiology, University Heart Centre Hamburg, Hamburg, Germany
- Heart Center, University of Cologne, Cologne, Germany
| | - Winfried Maerz
- Synlab Akademie für ärztliche Fortbildung, Synlab Services GmbH, Mannheim, Germany
| | - Stefanie Dimmeler
- German Center for Cardiovascular Disease (DZHK), Berlin, Germany
- Institute of Cardiovascular Regeneration, Centre for Molecular Medicine, Goethe University Frankfurt, Frankfurt, Germany
| | - Stefan Blankenberg
- German Center for Cardiovascular Disease (DZHK), Berlin, Germany
- Clinic for General and Interventional Cardiology, University Heart Centre Hamburg, Hamburg, Germany
| | - Thomas Münzel
- German Center for Cardiovascular Disease (DZHK), Berlin, Germany
- Department of Medicine II, University Medical Center, Johannes Gutenberg University, Mainz, Germany
| | - Andreas M Zeiher
- Department of Internal Medicine III, Cardiology, University Hospital, Goethe University Frankfurt, Frankfurt, Germany
- German Center for Cardiovascular Disease (DZHK), Berlin, Germany
| | - Till Keller
- Department of Internal Medicine III, Cardiology, University Hospital, Goethe University Frankfurt, Frankfurt, Germany.
- German Center for Cardiovascular Disease (DZHK), Berlin, Germany.
- Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany.
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9
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Kische H, Pieper L, Venz J, Klotsche J, März W, Koch-Gromus U, Pittrow D, Lehnert H, Silber S, Stalla GK, Zeiher AM, Wittchen HU, Haring R. Longitudinal change instead of baseline testosterone predicts depressive symptoms. Psychoneuroendocrinology 2018; 89:7-12. [PMID: 29306775 DOI: 10.1016/j.psyneuen.2017.12.013] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Revised: 12/16/2017] [Accepted: 12/20/2017] [Indexed: 11/24/2022]
Abstract
BACKGROUND The association between total testosterone (T) and depression mostly relies on single sex hormone assessment and remains inconclusive. Thus, we investigated the comparative predictive performance of baseline T and change in T with development of depressive symptoms and incident depressive episodes. METHODS We used data from 6493 primary care patients (2653 men and 3840 women) of the DETECT study (Diabetes Cardiovascular Risk-Evaluation: Targets and Essential Data for Commitment of Treatment), including four-year follow-up, repeated immunoassay-based measurement of serum T and depressive symptoms assessed by the Depression Screening Questionnaire (DSQ). Cross-sectional and longitudinal associations of baseline T and one-year change in T with prevalent and incident depression were investigated using age- and multivariable-adjusted regression models. RESULTS Baseline T showed no association with prevalent or incident depressive symptoms and episodes in both sexes. In men, a positive change in T (higher T at one-year follow-up compared to baseline) was associated with a lower burden of depressive symptoms (β-coefficient per unit change in T: -0.17; 95% CI: -0.31 to -0.04) and lower risk of incident depressive symptoms (odds ratio per unit change in T: 0.84; 95% CI: 0.72-0.98) at four-year follow-up. In women, the association of T change with incident depressive episodes was rendered non-significant after multivariable adjustment. DISCUSSION The present study observed a sex-specific inverse association of T change, but not baseline T, with increased depressive symptom burden in men. Future studies should assess longitudinal changes in sex hormone status as predictor of adverse health outcomes related to low T.
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Affiliation(s)
- Hanna Kische
- Behavioral Epidemiology, Institute of Clinical Psychology and Psychotherapy, Technical University of Dresden, Germany.
| | - Lars Pieper
- Behavioral Epidemiology, Institute of Clinical Psychology and Psychotherapy, Technical University of Dresden, Germany
| | - John Venz
- Behavioral Epidemiology, Institute of Clinical Psychology and Psychotherapy, Technical University of Dresden, Germany
| | | | - Winfried März
- Medical Clinic V, Medical Faculty Mannheim of Heidelberg University, Germany
| | - Uwe Koch-Gromus
- Department of Medical Psychology, University Medical Center Eppendorf, Hamburg, Germany
| | - David Pittrow
- Institute of Clinical Pharmacology, Medical Faculty, Technical University Carl Gustav Carus, Dresden, Germany
| | - Hendrik Lehnert
- Department of Medicine I, University of Schleswig-Holstein, Lübeck, Germany
| | | | - G K Stalla
- Max Planck Institute of Psychiatry, Munich, Germany
| | - Andreas M Zeiher
- Department of Medicine III Cardiology, Goethe-University Frankfurt, Germany
| | - Hans-Ulrich Wittchen
- Institute of Clinical Psychology and Psychotherapy, Technical University of Dresden, Germany
| | - Robin Haring
- European University of Applied Sciences, Faculty of Applied Public Health, Rostock, Germany; School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
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10
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Schöfl C, Petroff D, Tönjes A, Grussendorf M, Droste M, Stalla G, Jaursch-Hancke C, Störmann S, Schopohl J. Incidence of myocardial infarction and stroke in acromegaly patients: results from the German Acromegaly Registry. Pituitary 2017; 20:635-642. [PMID: 28808855 DOI: 10.1007/s11102-017-0827-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE Acromegaly is a rare disease generally brought about by a benign tumour in the pituitary and characterized by growth hormone (GH) and insulin-like growth factor 1 (IGF-1) excess. Increased mortality has been related to cardiovascular events that could be linked to these hormones and patients suffer from high rates of diabetes and hypertension. In this study, we examine if the incidence of myocardial infarction (MI) and stroke differ from that of the general population. METHODS Data from the German Acromegaly Registry in seven specialized endocrine centres were analysed (n = 479, 56% female, 46 years old at diagnosis, 5549 person-years from diagnosis). Standardized incidence ratios (SIR) were calculated as compared to the general population. RESULTS MI and stroke incidences were very close to those of the general population with an SIR (95% CI) of 0.89 (0.47-1.52, p = 0.80) for MI and 1.17 (0.66-1.93, p = 0.61) for stroke. Acromegaly was uncontrolled in 16% of patients with MI or stroke versus 21% in those without (p = 0.56). Prevalence of hypertension at the initial visit was much higher in those with MI or stroke than those without (94 vs. 43%, p < 0.001). No association was seen between radiation therapy and stroke. CONCLUSIONS For acromegaly patients being treated at specialized centres, the incidence of MIs and strokes does not seem to differ from the general population. Certainty regarding such statements requires large, prospective studies however.
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Affiliation(s)
- Christof Schöfl
- Centre of Endocrinology and Metabolism, Obstmarkt 1, 96047, Bamberg, Germany.
| | - David Petroff
- Clinical Trial Centre, University of Leipzig, Leipzig, Germany
| | - Anke Tönjes
- Division of Endocrinology and Nephrology, Medical Department, University of Leipzig, Leipzig, Germany
| | | | | | | | | | - Sylvère Störmann
- Medizinische Klinik IV, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Jochen Schopohl
- Medizinische Klinik IV, Ludwig-Maximilians-University Munich, Munich, Germany
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11
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Control of cardiovascular risk factors and its determinants in the general population- findings from the STAAB cohort study. BMC Cardiovasc Disord 2017; 17:276. [PMID: 29096615 PMCID: PMC5669014 DOI: 10.1186/s12872-017-0708-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Accepted: 10/24/2017] [Indexed: 01/30/2023] Open
Abstract
Background While data from primary care suggest an insufficient control of vascular risk factors, little is known about vascular risk factor control in the general population. We therefore aimed to investigate the adoption of adequate risk factor control and its determinants in the general population free of cardiovascular disease (CVD). Methods Data from the Characteristics and Course of Heart Failure Stages A-B and Determinants of Progression (STAAB) Cohort Study, a population-based study of inhabitants aged 30 to 79 years from the general population of Würzburg (Germany), were used. Proportions of participants without established CVD meeting targets for risk factor control recommended by 2016 ESC guideline were identified. Determinants of the accumulation of insufficiently controlled vascular risk factors (three or more) were assessed. Results Between December 2013 and April 2015, 1379 participants without CVD were included; mean age was 53.1 ± 11.9 years and 52.9% were female; 30.8% were physically inactive, 55.2% overweight, 19.3% current smokers. Hypertension, dyslipidemia, and diabetes mellitus were prevalent in 31.8%, 57.6%, and 3.9%, respectively. Treatment goals were not reached despite medication in 52.7% of hypertensive, in 37.3% of hyperlipidemic and in 44.0% of diabetic subjects. Insufficiently controlled risk was associated with male sex (OR 1.94, 95%CI 1.44–2.61), higher age (OR for 30–39 years vs. 70–79 years 4.01, 95%CI 1.94–8.31) and lower level of education (OR for primary vs. tertiary 2.15, 95%CI 1.48–3.11). Conclusions In the general population, prevalence of vascular risk factors was high. We found insufficient identification and control of vascular risk factors and a considerable potential to improve adherence to cardiovascular guidelines for primary prevention. Further studies are needed to identify and overcome patient- and physician-related barriers impeding successful control of vascular risk factors in the general population. Electronic supplementary material The online version of this article (10.1186/s12872-017-0708-x) contains supplementary material, which is available to authorized users.
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12
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Schmidt N, Schmidt B, Dressel A, Gergei I, Klotsche J, Pieper L, Scharnagl H, Kleber ME, März W, Lehnert H, Pittrow D, Stalla G, Wittchen HU, Grammer TB. Familial hypercholesterolemia in primary care in Germany. Diabetes and cardiovascular risk evaluation: Targets and Essential Data for Commitment of Treatment (DETECT) study. Atherosclerosis 2017; 266:24-30. [DOI: 10.1016/j.atherosclerosis.2017.08.019] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Revised: 08/14/2017] [Accepted: 08/18/2017] [Indexed: 01/31/2023]
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13
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Keller T, Boeckel JN, Groß S, Klotsche J, Palapies L, Leistner D, Pieper L, Stalla GK, Lehnert H, Silber S, Pittrow D, Maerz W, Dörr M, Wittchen HU, Baumeister SE, Völker U, Felix SB, Dimmeler S, Zeiher AM. Improved risk stratification in prevention by use of a panel of selected circulating microRNAs. Sci Rep 2017; 7:4511. [PMID: 28674420 PMCID: PMC5495799 DOI: 10.1038/s41598-017-04040-w] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Accepted: 05/08/2017] [Indexed: 01/08/2023] Open
Abstract
Risk stratification is crucial in prevention. Circulating microRNAs have been proposed as biomarkers in cardiovascular disease. Here a miR panel consisting of miRs related to different cardiovascular pathophysiologies, was evaluated to predict outcome in the context of prevention. MiR-34a, miR-223, miR-378, miR-499 and miR-133 were determined from peripheral blood by qPCR and combined to a risk panel. As derivation cohort, 178 individuals of the DETECT study, and as validation cohort, 129 individuals of the SHIP study were used in a case-control approach. Overall mortality and cardiovascular events were outcome measures. The Framingham Risk Score(FRS) and the SCORE system were applied as risk classification systems. The identified miR panel was significantly associated with mortality given by a hazard ratio(HR) of 3.0 (95% (CI): 1.09–8.43; p = 0.034) and of 2.9 (95% CI: 1.32–6.33; p = 0.008) after adjusting for the FRS in the derivation cohort. In a validation cohort the miR-panel had a HR of 1.31 (95% CI: 1.03–1.66; p = 0.03) and of 1.29 (95% CI: 1.02–1.64; p = 0.03) in a FRS/SCORE adjusted-model. A FRS/SCORE risk model was significantly improved to predict mortality by the miR panel with continuous net reclassification index of 0.42/0.49 (p = 0.014/0.005). The present miR panel of 5 circulating miRs is able to improve risk stratification in prevention with respect to mortality beyond the FRS or SCORE.
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Affiliation(s)
- Till Keller
- Department of Internal Medicine III, Cardiology, University Hospital, Goethe University Frankfurt, Frankfurt, Germany. .,German Centre for Cardiovascular Research (DZHK), Partner site RheinMain, Frankfurt, Germany. .,Department of Cardiology, Kerckhoff Heart and Thorax Centre, Bad Nauheim, Germany.
| | - Jes-Niels Boeckel
- Department of Internal Medicine III, Cardiology, University Hospital, Goethe University Frankfurt, Frankfurt, Germany.,German Centre for Cardiovascular Research (DZHK), Partner site RheinMain, Frankfurt, Germany.,Institute of Cardiovascular Regeneration, Centre for Molecular Medicine, Goethe University Frankfurt, Frankfurt, Germany
| | - Stefan Groß
- German Centre for Cardiovascular Research (DZHK), Partner site RheinMain, Frankfurt, Germany.,German Centre for Cardiovascular Research (DZHK), Partner site Greifswald, Germany
| | - Jens Klotsche
- Institute of Clinical Psychology and Psychotherapy, Technical University Dresden, Dresden, Germany
| | - Lars Palapies
- Department of Internal Medicine III, Cardiology, University Hospital, Goethe University Frankfurt, Frankfurt, Germany
| | - David Leistner
- Department of Internal Medicine III, Cardiology, University Hospital, Goethe University Frankfurt, Frankfurt, Germany.,German Centre for Cardiovascular Research (DZHK), Partner site Berlin, Germany
| | - Lars Pieper
- Institute of Clinical Psychology and Psychotherapy, Technical University Dresden, Dresden, Germany
| | - Günnter K Stalla
- Max Planck Institute of Psychiatry, Endocrinology, Munich, Munich, Germany
| | | | | | - David Pittrow
- Institute of Clinical Pharmacology, Technical University Dresden, Dresden, Germany
| | - Winfried Maerz
- Synlab Akademie für ärztliche Fortbildung, Synlab Services GmbH, Mannheim, Germany
| | - Marcus Dörr
- Department of Internal Medicine B, University Medicine Greifswald, Greifswald, Germany.,German Centre for Cardiovascular Research (DZHK), Partner site Greifswald, Germany
| | - Hans-Ulrich Wittchen
- Institute of Clinical Psychology and Psychotherapy, Technical University Dresden, Dresden, Germany
| | - Sebastian E Baumeister
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany.,Institute of Epidemiology and Preventive Medicine, University of Regensburg, Regensburg, Germany
| | - Uwe Völker
- Interfaculty Institute for Genetics and Functional Genomics, Department of Cardiology, University Medicine Greifswald, Greifswald, Germany.,German Centre for Cardiovascular Research (DZHK), Partner site Greifswald, Germany
| | - Stephan B Felix
- Department of Internal Medicine B, University Medicine Greifswald, Greifswald, Germany.,German Centre for Cardiovascular Research (DZHK), Partner site Greifswald, Germany
| | - Stefanie Dimmeler
- German Centre for Cardiovascular Research (DZHK), Partner site RheinMain, Frankfurt, Germany.,Institute of Cardiovascular Regeneration, Centre for Molecular Medicine, Goethe University Frankfurt, Frankfurt, Germany
| | - Andreas M Zeiher
- Department of Internal Medicine III, Cardiology, University Hospital, Goethe University Frankfurt, Frankfurt, Germany.,German Centre for Cardiovascular Research (DZHK), Partner site RheinMain, Frankfurt, Germany
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14
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15
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Affiliation(s)
- Hans-Michael Steffen
- Klinik für Gastroenterologie und Hepatologie, Universitätsklinikum Köln, Kerpener Str. 62, D-50937, Köln, Deutschland.
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16
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Winter Y, Pieper L, Klotsche J, Riedel O, Wittchen HU. Obesity and Abdominal Fat Markers in Patients with a History of Stroke and Transient Ischemic Attacks. J Stroke Cerebrovasc Dis 2016; 25:1141-1147. [PMID: 26915603 DOI: 10.1016/j.jstrokecerebrovasdis.2015.12.026] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Revised: 11/25/2015] [Accepted: 12/22/2015] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Abdominal obesity is a well-recognized cardiovascular risk factor. Conflicting data concerning its significance with respect to stroke have been discussed in recent years. The objective of this study was to analyze the association between anthropometric parameters and the risk of stroke and transient ischemic attacks (TIAs) in German primary care. METHODS Patient recruitment in this large-scale epidemiological study was performed in 3188 representative primary care offices in Germany. Among 6980 study participants, 1745 patients with a history of stroke or TIA were identified and matched for age and gender with 5235 regional controls. Associations between standard anthropometric measures such as body mass index (BMI), waist-to-hip ratio, waist circumference, waist-to-height ratio, and cerebrovascular risk were investigated using logistic regression analysis with adjustment for age, gender, and vascular risk factors. RESULTS BMI showed no significant associations with the risk of stroke or TIA in any of the applied mathematical models. Markers of abdominal obesity were associated with an increased risk of stroke or TIA in the unadjusted model (waist circumference: odds ratio [OR] 1.15; 95% confidence interval [CI], 1.00-1.32; waist-to-hip ratio: OR 1.21; 95% CI, 1.05-1.38; waist-to-height ratio: OR 1.25; 95% CI, 1.09-1.44, comparisons between top and bottom tertiles). After adjustment for vascular risk factors, all associations were insignificant. CONCLUSIONS Abdominal obesity is a stronger predictor of risk of stroke or TIA than BMI. However, the association between abdominal obesity and the risk of stroke or TIA is not independent of other vascular risk factors. Stroke-related weight changes should be considered in longitudinal studies examining the role of obesity in cerebrovascular disease.
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Affiliation(s)
- Yaroslav Winter
- Department of Neurology, University Medical Center, Johannes Gutenberg University of Mainz, Mainz, Germany.
| | - Lars Pieper
- Department of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany
| | - Jens Klotsche
- Epidemiology Unit, German Rheumatism Research Centre Berlin, A Leibniz Institute, Berlin, Germany
| | - Oliver Riedel
- Department Clinical Epidemiology, Leibniz-Institute of Prevention Research and Epidemiology, Bremen, Germany
| | - Hans-Ulrich Wittchen
- Department of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany
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17
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Manthey J, Gual A, Jakubczyk A, Pieper L, Probst C, Struzzo P, Trapencieris M, Wojnar M, Rehm J. Alcohol use disorders in Europe: A comparison of general population and primary health care prevalence rates. JOURNAL OF SUBSTANCE USE 2016. [DOI: 10.3109/14659891.2015.1063719] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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18
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Kinsman L, Tham R, Symons J, Jones M, Campbell S, Allenby A. Prevention of cardiovascular disease in rural Australian primary care: an exploratory study of the perspectives of clinicians and high-risk men. Aust J Prim Health 2016; 22:510-516. [DOI: 10.1071/py15091] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Accepted: 11/15/2015] [Indexed: 11/23/2022]
Abstract
Rural primary care services have the potential to play a major role in reducing the gap in cardiovascular disease (CVD) outcomes between rural and metropolitan Australians, particularly in men at high risk of CVD. The aim of this study was to explore the self-reported behaviours and satisfaction with their general practice/practitioner of men at high risk of CVD, and attitudes of rural primary care clinicians regarding the role of primary care in CVD prevention. This observational research was addressed through survey questionnaires with rural men at high risk of CVD and semi-structured interviews with rural primary care clinicians. Fourteen rural primary care practices from towns with populations less than 25000 participated. One hundred and fifty-eight high-risk men completed the questionnaire. Their responses demonstrated poorly controlled risk factors despite a willingness to change. Alternatively, rural primary care clinicians (n=20) reported that patients were unlikely to change and that illness-based funding models inhibited cardiovascular preventive activities. Australians living in rural areas have worse CVD outcomes. In addition, there is a disparity in the assumptions of health providers and male patients at high risk of CVD in rural areas. This necessitates innovative rural primary care models that include a blended payment system that incentivises or funds preventive care alongside an emphasis on lifestyle advice, as well as an explicit strategy to influence clinician and patient behaviour to help address the disparity.
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19
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Rehm J, Manthey J, Struzzo P, Gual A, Wojnar M. Who receives treatment for alcohol use disorders in the European Union? A cross-sectional representative study in primary and specialized health care. Eur Psychiatry 2015; 30:885-93. [PMID: 26647862 DOI: 10.1016/j.eurpsy.2015.07.012] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Revised: 07/27/2015] [Accepted: 07/30/2015] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Alcohol use disorders (AUDs) are highly prevalent in Europe, but only a minority of those affected receive treatment. It is therefore important to identify factors that predict treatment in order to reframe strategies aimed at improving treatment rates. METHODS Representative cross-sectional study with patients aged 18-64 from primary health care (PC, six European countries, n=8476, data collection 01/13-01/14) and from specialized health care (SC, eight European countries, n=1762, data collection 01/13-03/14). For descriptive purposes, six groups were distinguished, based on type of DSM-IV AUD and treatment setting. Treatment status (yes/no) for any treatment (model 1), and for SC treatment (model 2) were main outcome measures in logistic regression models. RESULTS AUDs were prevalent in PC (12-month prevalence: 11.8%, 95% confidence interval (CI): 11.2-12.5%), with 17.6% receiving current treatment (95%CI: 15.3-19.9%). There were clear differences between the six groups regarding key variables from all five predictor domains. Prediction of any treatment (model 1) or SC treatment (model 2) was successful with high overall accuracy (both models: 95%), sufficient sensitivity (model 1: 79%/model 2: 76%) and high specificity (both models: 98%). The most predictive single variables were daily drinking level, anxiety, severity of mental distress, and number of inpatient nights during the last 6 months. CONCLUSIONS Variables from four domains were highly predictive in identifying treatment for AUD, with SC treatment groups showing very high levels of social disintegration, drinking, comorbidity and functional losses. Earlier intervention and formal treatment for AUD in PC should be implemented to reduce these high levels of adverse outcomes.
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Affiliation(s)
- J Rehm
- Centre for Addiction and Mental Health, 33, Russell Street, Toronto, ON M5S 2S1, Canada; Addiction Policy, Dalla Lana School of Public Health, University of Toronto, 155, College Street, 6th floor, Toronto, ON M5T 3M7, Canada; Institute of Medical Science, University of Toronto, Faculty of Medicine, Medical Sciences Building, 1, King's College Circle, Room 2374, Toronto, ON M5S 1A8, Canada; Department of Psychiatry, University of Toronto, 250, College Street, 8th floor, Toronto, ON M5T 1R8, Canada; Institute of Clinical Psychology and Psychotherapy & Centre of Clinical Epidemiology and Longitudinal Studies (CELOS), Technische Universität Dresden, Chemnitzer Str. 46, 01187 Dresden, Germany
| | - J Manthey
- Institute of Clinical Psychology and Psychotherapy & Centre of Clinical Epidemiology and Longitudinal Studies (CELOS), Technische Universität Dresden, Chemnitzer Str. 46, 01187 Dresden, Germany.
| | - P Struzzo
- Regional Centre for the Training in Primary Care (Ceformed), Via Galvani 1, 34074 Monfalcone, GO, Italy; University of Trieste, Department of Life Sciences, Via Weiss 2, 34128 Trieste, Italy
| | - A Gual
- Addictions Unit, Psychiatry Department, Neurosciences Institute, Hospital Clinic, Carrer Villarroel 170, 08036 Barcelona, Catalonia, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Carrer Rosselló 149, 08036 Barcelona, Catalonia, Spain; Red de Trastornos Adictivos (RTA-RETICS), Instituto de Salud Carlos III, Villarroel 170, 08036 Barcelona, Catalonia, Spain
| | - M Wojnar
- Department of Psychiatry, Medical University of Warsaw, Nowowiejska 27, 00-665 Warsaw, Poland; Department of Psychiatry, University of Michigan, 4250 Plymouth Rd, Ann Arbor, MI 48109, USA
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Probst C, Manthey J, Martinez A, Rehm J. Alcohol use disorder severity and reported reasons not to seek treatment: a cross-sectional study in European primary care practices. SUBSTANCE ABUSE TREATMENT PREVENTION AND POLICY 2015; 10:32. [PMID: 26264215 PMCID: PMC4534056 DOI: 10.1186/s13011-015-0028-z] [Citation(s) in RCA: 153] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Accepted: 07/24/2015] [Indexed: 12/04/2022]
Abstract
Background Alcohol use disorders are among the mental disorders with the lowest treatment rates. Increasing the treatment rates requires insight on the reasons why patients do not seek treatment. This study examined self-reported reasons for not seeking treatment and their association with alcohol use disorder severity among primary health care patients diagnosed with an alcohol use disorder. Methods Alcohol use disorders, health service utilization, and reasons for not seeking treatment were assessed via interviews on regionally representative samples of primary care patients from 6 European countries (Italy, Germany, Hungary, Latvia, Poland and Spain, total N = 9,098). Additionally, general practitioners had to fill in a questionnaire assessing their patients’ alcohol use and alcohol use disorders. A multinomial logistic regression was performed to investigate the association between reasons for not seeking treatment and alcohol use disorder severity. Results Of 1,008 patients diagnosed with an alcohol use disorder (via general practitioner or patient interview) in the past 12 months, the majority (N = 810) did not receive treatment and 251 of those gave a reason for not seeking treatment. The most frequent reason was ‘lack of problem awareness’ (55.3 % of those who responded), the second most common response was ‘stigma or shame’ (28.6 %), followed by ‘encounter barriers’ (22.8 %) and ‘cope alone’ (20.9 %). The results indicated lower probabilities of reporting ‘denial’ and higher probabilities to report ‘encounter barriers’ as alcohol use disorders severity increases. However, both trends were discontinued for patients with severe alcohol use disorders. Conclusions Particularly at lower levels of alcohol use disorder severity, a lack of problem awareness prevents patients from seeking treatment. Routinely alcohol consumption monitoring in primary care practices could help primary and secondary prevention of alcohol use disorders and increase treatment coverage. Electronic supplementary material The online version of this article (doi:10.1186/s13011-015-0028-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Charlotte Probst
- Social and Epidemiological Research Department, Centre for Addiction and Mental Health, 33 Russell Street, Toronto, ON, M5S 2S1, Canada. .,Institute for Clinical Psychology and Psychotherapy, Technische Universität Dresden, Chemnitzer Str. 46, 01187, Dresden, Germany.
| | - Jakob Manthey
- Institute for Clinical Psychology and Psychotherapy, Technische Universität Dresden, Chemnitzer Str. 46, 01187, Dresden, Germany.
| | - Alicia Martinez
- Department of Addiction, Hospital Clínic, University of Barcelona, Carrer Villarroel 170, 08036, Barcelona, Spain.
| | - Jürgen Rehm
- Social and Epidemiological Research Department, Centre for Addiction and Mental Health, 33 Russell Street, Toronto, ON, M5S 2S1, Canada. .,Institute for Clinical Psychology and Psychotherapy, Technische Universität Dresden, Chemnitzer Str. 46, 01187, Dresden, Germany. .,Addiction Policy, Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, ON, M5T 3M7, Canada. .,Institute of Medical Science, University of Toronto, 1 King's College Circle, Toronto, ON, ON M5S 1A8, Canada. .,Department of Psychiatry, University of Toronto, 250 College Street, Toronto, ON, M5T 1R8, Canada.
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Rehm J, Allamani A, Elekes Z, Jakubczyk A, Manthey J, Probst C, Struzzo P, Della Vedova R, Gual A, Wojnar M. Alcohol dependence and treatment utilization in Europe - a representative cross-sectional study in primary care. BMC FAMILY PRACTICE 2015. [PMID: 26219430 PMCID: PMC4518612 DOI: 10.1186/s12875-015-0308-8] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background Alcohol dependence (AD) in Europe is prevalent and causes considerable health burden. Recognition by general practitioners (GPs) and provision of or referral to treatment may contribute to reduce this burden. This paper studied AD prevalence in varying European primary care settings and examined who received treatment. Methods In a cross-sectional multi-centre study in six European countries, 358 general practitioners assessed 13,003 primary care patients between January 2013 and January 2014, of which 8,476 patients were interviewed, collecting information on socio-demographics, physical and mental problems, and on alcohol use, problems and treatment. AD diagnoses were determined by GPs’ clinical judgement and a standardized interview. A wide definition for AD treatment included individual and group interventions provided by different health professionals. Descriptive as well as inferential statistics were employed. Results AD was prevalent among patients in European primary health care settings (8.7 %, 95 % confidence interval (CI): 8.1-9.3 %). Treatment rates were low (22.3 % of all AD cases, 95 % CI: 19.4-25.2 %). For both prevalence and treatment utilization, considerable country variations were observed. AD was associated with a number of socio-economic disadvantages (e.g. higher unemployment rate) and higher physical (e.g., liver disease, hypertension) and mental comorbidities (e.g., depression, anxiety). Liver problems, mental distress and daily amount of alcohol used were higher among treated versus untreated male patients with AD. Conclusion A minority of people identified as having AD received treatment, showing heavier drinking patterns and a higher level of co-morbidity. Different types of treatment, depending on severity of AD, should be considered. Electronic supplementary material The online version of this article (doi:10.1186/s12875-015-0308-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jürgen Rehm
- Centre for Addiction and Mental Health, 33 Russell Street, Toronto, ON, M5S 2S1, Canada. .,Addiction Policy, Dalla Lana School of Public Health, University of Toronto, 155 College Street, 6th floor, Toronto, ON, M5T 3M7, Canada. .,Institute of Medical Science, University of Toronto, Faculty of Medicine, Medical Sciences Building, 1 King's College Circle, Room 2374, Toronto, ON, M5S 1A8, Canada. .,Department of Psychiatry, University of Toronto, 250 College Street, 8th floor, Toronto, ON, M5T 1R8, Canada. .,Institute of Clinical Psychology and Psychotherapy & Center of Clinical Epidemiology and Longitudinal Studies (CELOS), Technische Universität Dresden, Chemnitzer Str. 46, 01187, Dresden, Germany.
| | - Allaman Allamani
- Agenzia Regionale di Sanità Toscana, Villa la Quiete alle Montalve, Via Pietro Dazzi 1, 50141, Firenze, Italy.
| | - Zsuzsanna Elekes
- Corvinus University of Budapest, Közraktár u. 4-6, H-1093, Budapest, Hungary.
| | - Andrzej Jakubczyk
- Department of Psychiatry, Medical University of Warsaw, Nowowiejska 27, 00-665, Warsaw, Poland.
| | - Jakob Manthey
- Institute of Clinical Psychology and Psychotherapy & Center of Clinical Epidemiology and Longitudinal Studies (CELOS), Technische Universität Dresden, Chemnitzer Str. 46, 01187, Dresden, Germany.
| | - Charlotte Probst
- Institute of Clinical Psychology and Psychotherapy & Center of Clinical Epidemiology and Longitudinal Studies (CELOS), Technische Universität Dresden, Chemnitzer Str. 46, 01187, Dresden, Germany.
| | - Pierluigi Struzzo
- Regional Centre for the Training in Primary Care (Ceformed), Via Galvani 1, 34074, Monfalcone (GO), Italy. .,Department of Life Sciences, University of Trieste, Via Weiss, 2, 34128, Trieste, Italy.
| | - Roberto Della Vedova
- Regional Centre for the Training in Primary Care (Ceformed), Via Galvani 1, 34074, Monfalcone (GO), Italy. .,Center for Study and Research in General Practice (CSeRMEG), Via Praga, 22, 20052, Monza (MI), Italy.
| | - Antoni Gual
- Addictions Unit, Psychiatry Department, Neurosciences Institute, Hospital Clinic, Carrer Villarroel 170, 08036, Barcelona, Catalonia, Spain. .,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Carrer Rosselló 149, 08036, Barcelona, Catalonia, Spain. .,Red de Trastornos Adictivos (RTA - RETICS), Instituto de Salud Carlos III, Villarroel 170, 08036, Barcelona, Catalonia, Spain.
| | - Marcin Wojnar
- Department of Psychiatry, Medical University of Warsaw, Nowowiejska 27, 00-665, Warsaw, Poland. .,Department of Psychiatry, University of Michigan, 4250 Plymouth Rd, Ann Arbor, MI, 48109, USA.
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Leistner SM, Klotsche J, Dimopoulou C, Athanasoulia AP, Roemmler-Zehrer J, Pieper L, Schopohl J, Wittchen HU, Stalla GK, Fulda S, Sievers C. Reduced sleep quality and depression associate with decreased quality of life in patients with pituitary adenomas. Eur J Endocrinol 2015; 172:733-43. [PMID: 25792374 DOI: 10.1530/eje-14-0941] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2014] [Accepted: 03/19/2015] [Indexed: 01/08/2023]
Abstract
OBJECTIVES Several studies reported decreased quality of life (QoL) and sleep as well as increased rates of depression for patients with pituitary adenomas. Our aim was to explore to what extent differences in depression and sleep quality contribute to differences in QoL between patients with pituitary adenomas and controls. DESIGN A cross-sectional case-control study. SETTING Endocrine Outpatient Unit of the Max Planck Institute of Psychiatry, Munich, Department of Internal Medicine, Ludwig-Maximilians-University, Munich, and the Institute of Clinical Psychology and Psychotherapy, Technical University, Dresden. PARTICIPANTS Patients with pituitary adenomas (n=247) and controls (from the DETECT cohort, a large epidemiological study in primary care patients) matched individually by age and gender (n=757). MEASUREMENTS Sleep quality was assessed with the Pittsburgh Sleep Quality Index (PSQI) and QoL was measured by the generic EQ-5D and calculated by the time trade-off- and VAS-method. Depression was categorized as 'no depression', 'subclinical depression', and 'clinical depression' according to the Beck Depressions Inventory for patients and the Depression Screening Questionnaire for control subjects. STATISTICAL ANALYSES General linear and generalized, logistic mixed models as well as proportional odds mixed models were calculated for analyzing differences in baseline characteristics and in different subgroups. RESULTS Patients with pituitary adenomas showed decreased QoL (VAS index: 0.73±0.19) and sleep (PSQI score: 6.75±4.17) as well as increased rates of depression (subclinical or clinical depression: 41.4%) compared with their matched control subjects (VAS index: 0.79±0.18, PSQI score: 5.66±4.31, subclinical or clinical depression: 25.9%). We have shown that a substantial proportion of the reduced QoL (48% respectively 65%) was due to the incidence of depression and reduced sleep quality. CONCLUSIONS These findings emphasize the importance of diagnosing depressive symptoms and sleep disturbances in patients with pituitary disease, with the ultimate goal to improve QoL in patients with pituitary adenomas.
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Affiliation(s)
- Sarah M Leistner
- Department of EndocrinologyMax-Planck-Institute of Psychiatry, Kraepelinstraße 2-10, 80804 Munich, GermanyInstitute of Clinical Psychology and PsychotherapyCenter of Clinical Epidemiology and Longitudinal Studies (CELOS), Technische Universität Dresden, Chemnitzer Straße 46, 01187 Dresden, GermanyMedizinische Klinik InnenstadtLudwig-Maximilians University, Ziemssenstraße 1, 80336 Munich, GermanySleep and Epilepsy CenterNeurocenter of Southern Switzerland, Civic Hospital (EOC) of Lugano, Via Tesserete 46, 6900 Lugano, SwitzerlandA Leibnitz InstituteGerman Rheumatism Research Center, Charitéplatz 1, 10117 Berlin, Germany
| | - Jens Klotsche
- Department of EndocrinologyMax-Planck-Institute of Psychiatry, Kraepelinstraße 2-10, 80804 Munich, GermanyInstitute of Clinical Psychology and PsychotherapyCenter of Clinical Epidemiology and Longitudinal Studies (CELOS), Technische Universität Dresden, Chemnitzer Straße 46, 01187 Dresden, GermanyMedizinische Klinik InnenstadtLudwig-Maximilians University, Ziemssenstraße 1, 80336 Munich, GermanySleep and Epilepsy CenterNeurocenter of Southern Switzerland, Civic Hospital (EOC) of Lugano, Via Tesserete 46, 6900 Lugano, SwitzerlandA Leibnitz InstituteGerman Rheumatism Research Center, Charitéplatz 1, 10117 Berlin, Germany Department of EndocrinologyMax-Planck-Institute of Psychiatry, Kraepelinstraße 2-10, 80804 Munich, GermanyInstitute of Clinical Psychology and PsychotherapyCenter of Clinical Epidemiology and Longitudinal Studies (CELOS), Technische Universität Dresden, Chemnitzer Straße 46, 01187 Dresden, GermanyMedizinische Klinik InnenstadtLudwig-Maximilians University, Ziemssenstraße 1, 80336 Munich, GermanySleep and Epilepsy CenterNeurocenter of Southern Switzerland, Civic Hospital (EOC) of Lugano, Via Tesserete 46, 6900 Lugano, SwitzerlandA Leibnitz InstituteGerman Rheumatism Research Center, Charitéplatz 1, 10117 Berlin, Germany
| | - Christina Dimopoulou
- Department of EndocrinologyMax-Planck-Institute of Psychiatry, Kraepelinstraße 2-10, 80804 Munich, GermanyInstitute of Clinical Psychology and PsychotherapyCenter of Clinical Epidemiology and Longitudinal Studies (CELOS), Technische Universität Dresden, Chemnitzer Straße 46, 01187 Dresden, GermanyMedizinische Klinik InnenstadtLudwig-Maximilians University, Ziemssenstraße 1, 80336 Munich, GermanySleep and Epilepsy CenterNeurocenter of Southern Switzerland, Civic Hospital (EOC) of Lugano, Via Tesserete 46, 6900 Lugano, SwitzerlandA Leibnitz InstituteGerman Rheumatism Research Center, Charitéplatz 1, 10117 Berlin, Germany
| | - Anastasia P Athanasoulia
- Department of EndocrinologyMax-Planck-Institute of Psychiatry, Kraepelinstraße 2-10, 80804 Munich, GermanyInstitute of Clinical Psychology and PsychotherapyCenter of Clinical Epidemiology and Longitudinal Studies (CELOS), Technische Universität Dresden, Chemnitzer Straße 46, 01187 Dresden, GermanyMedizinische Klinik InnenstadtLudwig-Maximilians University, Ziemssenstraße 1, 80336 Munich, GermanySleep and Epilepsy CenterNeurocenter of Southern Switzerland, Civic Hospital (EOC) of Lugano, Via Tesserete 46, 6900 Lugano, SwitzerlandA Leibnitz InstituteGerman Rheumatism Research Center, Charitéplatz 1, 10117 Berlin, Germany
| | - Josefine Roemmler-Zehrer
- Department of EndocrinologyMax-Planck-Institute of Psychiatry, Kraepelinstraße 2-10, 80804 Munich, GermanyInstitute of Clinical Psychology and PsychotherapyCenter of Clinical Epidemiology and Longitudinal Studies (CELOS), Technische Universität Dresden, Chemnitzer Straße 46, 01187 Dresden, GermanyMedizinische Klinik InnenstadtLudwig-Maximilians University, Ziemssenstraße 1, 80336 Munich, GermanySleep and Epilepsy CenterNeurocenter of Southern Switzerland, Civic Hospital (EOC) of Lugano, Via Tesserete 46, 6900 Lugano, SwitzerlandA Leibnitz InstituteGerman Rheumatism Research Center, Charitéplatz 1, 10117 Berlin, Germany
| | - Lars Pieper
- Department of EndocrinologyMax-Planck-Institute of Psychiatry, Kraepelinstraße 2-10, 80804 Munich, GermanyInstitute of Clinical Psychology and PsychotherapyCenter of Clinical Epidemiology and Longitudinal Studies (CELOS), Technische Universität Dresden, Chemnitzer Straße 46, 01187 Dresden, GermanyMedizinische Klinik InnenstadtLudwig-Maximilians University, Ziemssenstraße 1, 80336 Munich, GermanySleep and Epilepsy CenterNeurocenter of Southern Switzerland, Civic Hospital (EOC) of Lugano, Via Tesserete 46, 6900 Lugano, SwitzerlandA Leibnitz InstituteGerman Rheumatism Research Center, Charitéplatz 1, 10117 Berlin, Germany
| | - Jochen Schopohl
- Department of EndocrinologyMax-Planck-Institute of Psychiatry, Kraepelinstraße 2-10, 80804 Munich, GermanyInstitute of Clinical Psychology and PsychotherapyCenter of Clinical Epidemiology and Longitudinal Studies (CELOS), Technische Universität Dresden, Chemnitzer Straße 46, 01187 Dresden, GermanyMedizinische Klinik InnenstadtLudwig-Maximilians University, Ziemssenstraße 1, 80336 Munich, GermanySleep and Epilepsy CenterNeurocenter of Southern Switzerland, Civic Hospital (EOC) of Lugano, Via Tesserete 46, 6900 Lugano, SwitzerlandA Leibnitz InstituteGerman Rheumatism Research Center, Charitéplatz 1, 10117 Berlin, Germany
| | - Hans-Ulrich Wittchen
- Department of EndocrinologyMax-Planck-Institute of Psychiatry, Kraepelinstraße 2-10, 80804 Munich, GermanyInstitute of Clinical Psychology and PsychotherapyCenter of Clinical Epidemiology and Longitudinal Studies (CELOS), Technische Universität Dresden, Chemnitzer Straße 46, 01187 Dresden, GermanyMedizinische Klinik InnenstadtLudwig-Maximilians University, Ziemssenstraße 1, 80336 Munich, GermanySleep and Epilepsy CenterNeurocenter of Southern Switzerland, Civic Hospital (EOC) of Lugano, Via Tesserete 46, 6900 Lugano, SwitzerlandA Leibnitz InstituteGerman Rheumatism Research Center, Charitéplatz 1, 10117 Berlin, Germany
| | - Günter K Stalla
- Department of EndocrinologyMax-Planck-Institute of Psychiatry, Kraepelinstraße 2-10, 80804 Munich, GermanyInstitute of Clinical Psychology and PsychotherapyCenter of Clinical Epidemiology and Longitudinal Studies (CELOS), Technische Universität Dresden, Chemnitzer Straße 46, 01187 Dresden, GermanyMedizinische Klinik InnenstadtLudwig-Maximilians University, Ziemssenstraße 1, 80336 Munich, GermanySleep and Epilepsy CenterNeurocenter of Southern Switzerland, Civic Hospital (EOC) of Lugano, Via Tesserete 46, 6900 Lugano, SwitzerlandA Leibnitz InstituteGerman Rheumatism Research Center, Charitéplatz 1, 10117 Berlin, Germany
| | - Stephany Fulda
- Department of EndocrinologyMax-Planck-Institute of Psychiatry, Kraepelinstraße 2-10, 80804 Munich, GermanyInstitute of Clinical Psychology and PsychotherapyCenter of Clinical Epidemiology and Longitudinal Studies (CELOS), Technische Universität Dresden, Chemnitzer Straße 46, 01187 Dresden, GermanyMedizinische Klinik InnenstadtLudwig-Maximilians University, Ziemssenstraße 1, 80336 Munich, GermanySleep and Epilepsy CenterNeurocenter of Southern Switzerland, Civic Hospital (EOC) of Lugano, Via Tesserete 46, 6900 Lugano, SwitzerlandA Leibnitz InstituteGerman Rheumatism Research Center, Charitéplatz 1, 10117 Berlin, Germany Department of EndocrinologyMax-Planck-Institute of Psychiatry, Kraepelinstraße 2-10, 80804 Munich, GermanyInstitute of Clinical Psychology and PsychotherapyCenter of Clinical Epidemiology and Longitudinal Studies (CELOS), Technische Universität Dresden, Chemnitzer Straße 46, 01187 Dresden, GermanyMedizinische Klinik InnenstadtLudwig-Maximilians University, Ziemssenstraße 1, 80336 Munich, GermanySleep and Epilepsy CenterNeurocenter of Southern Switzerland, Civic Hospital (EOC) of Lugano, Via Tesserete 46, 6900 Lugano, SwitzerlandA Leibnitz InstituteGerman Rheumatism Research Center, Charitéplatz 1, 10117 Berlin, Germany
| | - Caroline Sievers
- Department of EndocrinologyMax-Planck-Institute of Psychiatry, Kraepelinstraße 2-10, 80804 Munich, GermanyInstitute of Clinical Psychology and PsychotherapyCenter of Clinical Epidemiology and Longitudinal Studies (CELOS), Technische Universität Dresden, Chemnitzer Straße 46, 01187 Dresden, GermanyMedizinische Klinik InnenstadtLudwig-Maximilians University, Ziemssenstraße 1, 80336 Munich, GermanySleep and Epilepsy CenterNeurocenter of Southern Switzerland, Civic Hospital (EOC) of Lugano, Via Tesserete 46, 6900 Lugano, SwitzerlandA Leibnitz InstituteGerman Rheumatism Research Center, Charitéplatz 1, 10117 Berlin, Germany
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23
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Rehm J, Allamani A, Della Vedova R, Elekes Z, Jakubczyk A, Landsmane I, Manthey J, Moreno-España J, Pieper L, Probst C, Snikere S, Struzzo P, Voller F, Wittchen HU, Gual A, Wojnar M. General practitioners recognizing alcohol dependence: a large cross-sectional study in 6 European countries. Ann Fam Med 2015; 13:28-32. [PMID: 25583889 PMCID: PMC4291262 DOI: 10.1370/afm.1742] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
PURPOSE Although alcohol dependence causes marked mortality and disease burden in Europe, the treatment rate is low. Primary care could play a key role in reducing alcohol-attributable harm by screening, brief interventions, and initiating or referral to treatment. This study investigates identification of alcohol dependence in European primary care settings. METHODS Assessments from 13,003 general practitioners, and 9,098 interviews (8,476 joint number of interviewed patients with a physician's assessment) were collected in 6 European countries. Alcohol dependence, comorbidities, and health service utilization were assessed by the general practitioner and independently using the Composite International Diagnostic Interview (CIDI) and other structured interviews. Weighted regression analyses were used to compare the impact of influencing variables on both types of diagnoses. RESULTS The rate of patients being identified as alcohol dependent by the CIDI or a general practitioner was about equally high, but there was not a lot of overlap between cases identified. Alcohol-dependent patients identified by a physician were older, had higher rates of physicial comorbidity (liver disease, hypertension), and were socially more marginalized, whereas average consumption of alcohol and mental comorbidity were equally high in both groups. CONCLUSION General practitioners were able to identify alcohol dependence, but the cases they identified differed from cases identified using the CIDI. The role of the CIDI as the reference standard should be reexamined, as older alcohol-dependent patients with severe comorbidities seemed to be missed in this assessment.
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Affiliation(s)
- Jürgen Rehm
- Centre for Addiction and Mental Health, Toronto, Canada (J.R.); Addiction Policy, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada (J.R.); Institute of Medical Science, University of Toronto, Faculty of Medicine, Toronto, Canada (J.R.); Department of Psychiatry, University of Toronto, Toronto, Canada (J.R.); Institute of Clinical Psychology and Psychotherapy & Center of Clinical Epidemiology and Longitudinal Studies (CELOS), Technische Universität Dresden, Dresden, Germany (J.R., J.M., L.P., C.P., H-U.W.); Agenzia Regionale di Sanità Toscana, Villa la Quiete alle Montalve, Firenze, Italy (A.A., F.V.); Regional Centre for the Training in Primary Care (Ceformed), Monfalcone (GO), Italy (R.D.V., P.S.); Center for Study and Research in General Practice (CSeRMEG), Via Praga, 22, 20052 Monza (MI), Italy (R.D.V.); Corvinus University of Budapest, Budapest, Hungary (Z.E.); Department of Psychiatry, Medical University of Warsaw, Warsaw, Poland (A.J., M.W.); Riga Centre of Psychiatry and Addiction Medicine, Riga, Latvia (I.L.); Fundació Clínic per a la Recerca Biomèdica, Barcelona, Spain (J.M-E.); Addictions Unit, Psychiatry Department, Neurosciences Institute, Hospital Clinic, Barcelona, Spain (J.M-E., A.G.); Institute of Sociological Research, Riga, Latvia (S.S.); Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain (A.G.); Red de Trastornos Adictivos (RTA -RETICS), Instituto de Salud Carlos III, Barcelona, Spain (A.G.); Department of Psychiatry, University of Michigan, Ann Arbor, Michigan (M.W.)
| | - Allaman Allamani
- Centre for Addiction and Mental Health, Toronto, Canada (J.R.); Addiction Policy, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada (J.R.); Institute of Medical Science, University of Toronto, Faculty of Medicine, Toronto, Canada (J.R.); Department of Psychiatry, University of Toronto, Toronto, Canada (J.R.); Institute of Clinical Psychology and Psychotherapy & Center of Clinical Epidemiology and Longitudinal Studies (CELOS), Technische Universität Dresden, Dresden, Germany (J.R., J.M., L.P., C.P., H-U.W.); Agenzia Regionale di Sanità Toscana, Villa la Quiete alle Montalve, Firenze, Italy (A.A., F.V.); Regional Centre for the Training in Primary Care (Ceformed), Monfalcone (GO), Italy (R.D.V., P.S.); Center for Study and Research in General Practice (CSeRMEG), Via Praga, 22, 20052 Monza (MI), Italy (R.D.V.); Corvinus University of Budapest, Budapest, Hungary (Z.E.); Department of Psychiatry, Medical University of Warsaw, Warsaw, Poland (A.J., M.W.); Riga Centre of Psychiatry and Addiction Medicine, Riga, Latvia (I.L.); Fundació Clínic per a la Recerca Biomèdica, Barcelona, Spain (J.M-E.); Addictions Unit, Psychiatry Department, Neurosciences Institute, Hospital Clinic, Barcelona, Spain (J.M-E., A.G.); Institute of Sociological Research, Riga, Latvia (S.S.); Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain (A.G.); Red de Trastornos Adictivos (RTA -RETICS), Instituto de Salud Carlos III, Barcelona, Spain (A.G.); Department of Psychiatry, University of Michigan, Ann Arbor, Michigan (M.W.)
| | - Roberto Della Vedova
- Centre for Addiction and Mental Health, Toronto, Canada (J.R.); Addiction Policy, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada (J.R.); Institute of Medical Science, University of Toronto, Faculty of Medicine, Toronto, Canada (J.R.); Department of Psychiatry, University of Toronto, Toronto, Canada (J.R.); Institute of Clinical Psychology and Psychotherapy & Center of Clinical Epidemiology and Longitudinal Studies (CELOS), Technische Universität Dresden, Dresden, Germany (J.R., J.M., L.P., C.P., H-U.W.); Agenzia Regionale di Sanità Toscana, Villa la Quiete alle Montalve, Firenze, Italy (A.A., F.V.); Regional Centre for the Training in Primary Care (Ceformed), Monfalcone (GO), Italy (R.D.V., P.S.); Center for Study and Research in General Practice (CSeRMEG), Via Praga, 22, 20052 Monza (MI), Italy (R.D.V.); Corvinus University of Budapest, Budapest, Hungary (Z.E.); Department of Psychiatry, Medical University of Warsaw, Warsaw, Poland (A.J., M.W.); Riga Centre of Psychiatry and Addiction Medicine, Riga, Latvia (I.L.); Fundació Clínic per a la Recerca Biomèdica, Barcelona, Spain (J.M-E.); Addictions Unit, Psychiatry Department, Neurosciences Institute, Hospital Clinic, Barcelona, Spain (J.M-E., A.G.); Institute of Sociological Research, Riga, Latvia (S.S.); Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain (A.G.); Red de Trastornos Adictivos (RTA -RETICS), Instituto de Salud Carlos III, Barcelona, Spain (A.G.); Department of Psychiatry, University of Michigan, Ann Arbor, Michigan (M.W.)
| | - Zsuzsanna Elekes
- Centre for Addiction and Mental Health, Toronto, Canada (J.R.); Addiction Policy, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada (J.R.); Institute of Medical Science, University of Toronto, Faculty of Medicine, Toronto, Canada (J.R.); Department of Psychiatry, University of Toronto, Toronto, Canada (J.R.); Institute of Clinical Psychology and Psychotherapy & Center of Clinical Epidemiology and Longitudinal Studies (CELOS), Technische Universität Dresden, Dresden, Germany (J.R., J.M., L.P., C.P., H-U.W.); Agenzia Regionale di Sanità Toscana, Villa la Quiete alle Montalve, Firenze, Italy (A.A., F.V.); Regional Centre for the Training in Primary Care (Ceformed), Monfalcone (GO), Italy (R.D.V., P.S.); Center for Study and Research in General Practice (CSeRMEG), Via Praga, 22, 20052 Monza (MI), Italy (R.D.V.); Corvinus University of Budapest, Budapest, Hungary (Z.E.); Department of Psychiatry, Medical University of Warsaw, Warsaw, Poland (A.J., M.W.); Riga Centre of Psychiatry and Addiction Medicine, Riga, Latvia (I.L.); Fundació Clínic per a la Recerca Biomèdica, Barcelona, Spain (J.M-E.); Addictions Unit, Psychiatry Department, Neurosciences Institute, Hospital Clinic, Barcelona, Spain (J.M-E., A.G.); Institute of Sociological Research, Riga, Latvia (S.S.); Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain (A.G.); Red de Trastornos Adictivos (RTA -RETICS), Instituto de Salud Carlos III, Barcelona, Spain (A.G.); Department of Psychiatry, University of Michigan, Ann Arbor, Michigan (M.W.)
| | - Andrzej Jakubczyk
- Centre for Addiction and Mental Health, Toronto, Canada (J.R.); Addiction Policy, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada (J.R.); Institute of Medical Science, University of Toronto, Faculty of Medicine, Toronto, Canada (J.R.); Department of Psychiatry, University of Toronto, Toronto, Canada (J.R.); Institute of Clinical Psychology and Psychotherapy & Center of Clinical Epidemiology and Longitudinal Studies (CELOS), Technische Universität Dresden, Dresden, Germany (J.R., J.M., L.P., C.P., H-U.W.); Agenzia Regionale di Sanità Toscana, Villa la Quiete alle Montalve, Firenze, Italy (A.A., F.V.); Regional Centre for the Training in Primary Care (Ceformed), Monfalcone (GO), Italy (R.D.V., P.S.); Center for Study and Research in General Practice (CSeRMEG), Via Praga, 22, 20052 Monza (MI), Italy (R.D.V.); Corvinus University of Budapest, Budapest, Hungary (Z.E.); Department of Psychiatry, Medical University of Warsaw, Warsaw, Poland (A.J., M.W.); Riga Centre of Psychiatry and Addiction Medicine, Riga, Latvia (I.L.); Fundació Clínic per a la Recerca Biomèdica, Barcelona, Spain (J.M-E.); Addictions Unit, Psychiatry Department, Neurosciences Institute, Hospital Clinic, Barcelona, Spain (J.M-E., A.G.); Institute of Sociological Research, Riga, Latvia (S.S.); Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain (A.G.); Red de Trastornos Adictivos (RTA -RETICS), Instituto de Salud Carlos III, Barcelona, Spain (A.G.); Department of Psychiatry, University of Michigan, Ann Arbor, Michigan (M.W.)
| | - Inga Landsmane
- Centre for Addiction and Mental Health, Toronto, Canada (J.R.); Addiction Policy, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada (J.R.); Institute of Medical Science, University of Toronto, Faculty of Medicine, Toronto, Canada (J.R.); Department of Psychiatry, University of Toronto, Toronto, Canada (J.R.); Institute of Clinical Psychology and Psychotherapy & Center of Clinical Epidemiology and Longitudinal Studies (CELOS), Technische Universität Dresden, Dresden, Germany (J.R., J.M., L.P., C.P., H-U.W.); Agenzia Regionale di Sanità Toscana, Villa la Quiete alle Montalve, Firenze, Italy (A.A., F.V.); Regional Centre for the Training in Primary Care (Ceformed), Monfalcone (GO), Italy (R.D.V., P.S.); Center for Study and Research in General Practice (CSeRMEG), Via Praga, 22, 20052 Monza (MI), Italy (R.D.V.); Corvinus University of Budapest, Budapest, Hungary (Z.E.); Department of Psychiatry, Medical University of Warsaw, Warsaw, Poland (A.J., M.W.); Riga Centre of Psychiatry and Addiction Medicine, Riga, Latvia (I.L.); Fundació Clínic per a la Recerca Biomèdica, Barcelona, Spain (J.M-E.); Addictions Unit, Psychiatry Department, Neurosciences Institute, Hospital Clinic, Barcelona, Spain (J.M-E., A.G.); Institute of Sociological Research, Riga, Latvia (S.S.); Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain (A.G.); Red de Trastornos Adictivos (RTA -RETICS), Instituto de Salud Carlos III, Barcelona, Spain (A.G.); Department of Psychiatry, University of Michigan, Ann Arbor, Michigan (M.W.)
| | - Jakob Manthey
- Centre for Addiction and Mental Health, Toronto, Canada (J.R.); Addiction Policy, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada (J.R.); Institute of Medical Science, University of Toronto, Faculty of Medicine, Toronto, Canada (J.R.); Department of Psychiatry, University of Toronto, Toronto, Canada (J.R.); Institute of Clinical Psychology and Psychotherapy & Center of Clinical Epidemiology and Longitudinal Studies (CELOS), Technische Universität Dresden, Dresden, Germany (J.R., J.M., L.P., C.P., H-U.W.); Agenzia Regionale di Sanità Toscana, Villa la Quiete alle Montalve, Firenze, Italy (A.A., F.V.); Regional Centre for the Training in Primary Care (Ceformed), Monfalcone (GO), Italy (R.D.V., P.S.); Center for Study and Research in General Practice (CSeRMEG), Via Praga, 22, 20052 Monza (MI), Italy (R.D.V.); Corvinus University of Budapest, Budapest, Hungary (Z.E.); Department of Psychiatry, Medical University of Warsaw, Warsaw, Poland (A.J., M.W.); Riga Centre of Psychiatry and Addiction Medicine, Riga, Latvia (I.L.); Fundació Clínic per a la Recerca Biomèdica, Barcelona, Spain (J.M-E.); Addictions Unit, Psychiatry Department, Neurosciences Institute, Hospital Clinic, Barcelona, Spain (J.M-E., A.G.); Institute of Sociological Research, Riga, Latvia (S.S.); Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain (A.G.); Red de Trastornos Adictivos (RTA -RETICS), Instituto de Salud Carlos III, Barcelona, Spain (A.G.); Department of Psychiatry, University of Michigan, Ann Arbor, Michigan (M.W.).
| | - José Moreno-España
- Centre for Addiction and Mental Health, Toronto, Canada (J.R.); Addiction Policy, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada (J.R.); Institute of Medical Science, University of Toronto, Faculty of Medicine, Toronto, Canada (J.R.); Department of Psychiatry, University of Toronto, Toronto, Canada (J.R.); Institute of Clinical Psychology and Psychotherapy & Center of Clinical Epidemiology and Longitudinal Studies (CELOS), Technische Universität Dresden, Dresden, Germany (J.R., J.M., L.P., C.P., H-U.W.); Agenzia Regionale di Sanità Toscana, Villa la Quiete alle Montalve, Firenze, Italy (A.A., F.V.); Regional Centre for the Training in Primary Care (Ceformed), Monfalcone (GO), Italy (R.D.V., P.S.); Center for Study and Research in General Practice (CSeRMEG), Via Praga, 22, 20052 Monza (MI), Italy (R.D.V.); Corvinus University of Budapest, Budapest, Hungary (Z.E.); Department of Psychiatry, Medical University of Warsaw, Warsaw, Poland (A.J., M.W.); Riga Centre of Psychiatry and Addiction Medicine, Riga, Latvia (I.L.); Fundació Clínic per a la Recerca Biomèdica, Barcelona, Spain (J.M-E.); Addictions Unit, Psychiatry Department, Neurosciences Institute, Hospital Clinic, Barcelona, Spain (J.M-E., A.G.); Institute of Sociological Research, Riga, Latvia (S.S.); Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain (A.G.); Red de Trastornos Adictivos (RTA -RETICS), Instituto de Salud Carlos III, Barcelona, Spain (A.G.); Department of Psychiatry, University of Michigan, Ann Arbor, Michigan (M.W.)
| | - Lars Pieper
- Centre for Addiction and Mental Health, Toronto, Canada (J.R.); Addiction Policy, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada (J.R.); Institute of Medical Science, University of Toronto, Faculty of Medicine, Toronto, Canada (J.R.); Department of Psychiatry, University of Toronto, Toronto, Canada (J.R.); Institute of Clinical Psychology and Psychotherapy & Center of Clinical Epidemiology and Longitudinal Studies (CELOS), Technische Universität Dresden, Dresden, Germany (J.R., J.M., L.P., C.P., H-U.W.); Agenzia Regionale di Sanità Toscana, Villa la Quiete alle Montalve, Firenze, Italy (A.A., F.V.); Regional Centre for the Training in Primary Care (Ceformed), Monfalcone (GO), Italy (R.D.V., P.S.); Center for Study and Research in General Practice (CSeRMEG), Via Praga, 22, 20052 Monza (MI), Italy (R.D.V.); Corvinus University of Budapest, Budapest, Hungary (Z.E.); Department of Psychiatry, Medical University of Warsaw, Warsaw, Poland (A.J., M.W.); Riga Centre of Psychiatry and Addiction Medicine, Riga, Latvia (I.L.); Fundació Clínic per a la Recerca Biomèdica, Barcelona, Spain (J.M-E.); Addictions Unit, Psychiatry Department, Neurosciences Institute, Hospital Clinic, Barcelona, Spain (J.M-E., A.G.); Institute of Sociological Research, Riga, Latvia (S.S.); Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain (A.G.); Red de Trastornos Adictivos (RTA -RETICS), Instituto de Salud Carlos III, Barcelona, Spain (A.G.); Department of Psychiatry, University of Michigan, Ann Arbor, Michigan (M.W.)
| | - Charlotte Probst
- Centre for Addiction and Mental Health, Toronto, Canada (J.R.); Addiction Policy, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada (J.R.); Institute of Medical Science, University of Toronto, Faculty of Medicine, Toronto, Canada (J.R.); Department of Psychiatry, University of Toronto, Toronto, Canada (J.R.); Institute of Clinical Psychology and Psychotherapy & Center of Clinical Epidemiology and Longitudinal Studies (CELOS), Technische Universität Dresden, Dresden, Germany (J.R., J.M., L.P., C.P., H-U.W.); Agenzia Regionale di Sanità Toscana, Villa la Quiete alle Montalve, Firenze, Italy (A.A., F.V.); Regional Centre for the Training in Primary Care (Ceformed), Monfalcone (GO), Italy (R.D.V., P.S.); Center for Study and Research in General Practice (CSeRMEG), Via Praga, 22, 20052 Monza (MI), Italy (R.D.V.); Corvinus University of Budapest, Budapest, Hungary (Z.E.); Department of Psychiatry, Medical University of Warsaw, Warsaw, Poland (A.J., M.W.); Riga Centre of Psychiatry and Addiction Medicine, Riga, Latvia (I.L.); Fundació Clínic per a la Recerca Biomèdica, Barcelona, Spain (J.M-E.); Addictions Unit, Psychiatry Department, Neurosciences Institute, Hospital Clinic, Barcelona, Spain (J.M-E., A.G.); Institute of Sociological Research, Riga, Latvia (S.S.); Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain (A.G.); Red de Trastornos Adictivos (RTA -RETICS), Instituto de Salud Carlos III, Barcelona, Spain (A.G.); Department of Psychiatry, University of Michigan, Ann Arbor, Michigan (M.W.)
| | - Sigita Snikere
- Centre for Addiction and Mental Health, Toronto, Canada (J.R.); Addiction Policy, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada (J.R.); Institute of Medical Science, University of Toronto, Faculty of Medicine, Toronto, Canada (J.R.); Department of Psychiatry, University of Toronto, Toronto, Canada (J.R.); Institute of Clinical Psychology and Psychotherapy & Center of Clinical Epidemiology and Longitudinal Studies (CELOS), Technische Universität Dresden, Dresden, Germany (J.R., J.M., L.P., C.P., H-U.W.); Agenzia Regionale di Sanità Toscana, Villa la Quiete alle Montalve, Firenze, Italy (A.A., F.V.); Regional Centre for the Training in Primary Care (Ceformed), Monfalcone (GO), Italy (R.D.V., P.S.); Center for Study and Research in General Practice (CSeRMEG), Via Praga, 22, 20052 Monza (MI), Italy (R.D.V.); Corvinus University of Budapest, Budapest, Hungary (Z.E.); Department of Psychiatry, Medical University of Warsaw, Warsaw, Poland (A.J., M.W.); Riga Centre of Psychiatry and Addiction Medicine, Riga, Latvia (I.L.); Fundació Clínic per a la Recerca Biomèdica, Barcelona, Spain (J.M-E.); Addictions Unit, Psychiatry Department, Neurosciences Institute, Hospital Clinic, Barcelona, Spain (J.M-E., A.G.); Institute of Sociological Research, Riga, Latvia (S.S.); Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain (A.G.); Red de Trastornos Adictivos (RTA -RETICS), Instituto de Salud Carlos III, Barcelona, Spain (A.G.); Department of Psychiatry, University of Michigan, Ann Arbor, Michigan (M.W.)
| | - Pierluigi Struzzo
- Centre for Addiction and Mental Health, Toronto, Canada (J.R.); Addiction Policy, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada (J.R.); Institute of Medical Science, University of Toronto, Faculty of Medicine, Toronto, Canada (J.R.); Department of Psychiatry, University of Toronto, Toronto, Canada (J.R.); Institute of Clinical Psychology and Psychotherapy & Center of Clinical Epidemiology and Longitudinal Studies (CELOS), Technische Universität Dresden, Dresden, Germany (J.R., J.M., L.P., C.P., H-U.W.); Agenzia Regionale di Sanità Toscana, Villa la Quiete alle Montalve, Firenze, Italy (A.A., F.V.); Regional Centre for the Training in Primary Care (Ceformed), Monfalcone (GO), Italy (R.D.V., P.S.); Center for Study and Research in General Practice (CSeRMEG), Via Praga, 22, 20052 Monza (MI), Italy (R.D.V.); Corvinus University of Budapest, Budapest, Hungary (Z.E.); Department of Psychiatry, Medical University of Warsaw, Warsaw, Poland (A.J., M.W.); Riga Centre of Psychiatry and Addiction Medicine, Riga, Latvia (I.L.); Fundació Clínic per a la Recerca Biomèdica, Barcelona, Spain (J.M-E.); Addictions Unit, Psychiatry Department, Neurosciences Institute, Hospital Clinic, Barcelona, Spain (J.M-E., A.G.); Institute of Sociological Research, Riga, Latvia (S.S.); Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain (A.G.); Red de Trastornos Adictivos (RTA -RETICS), Instituto de Salud Carlos III, Barcelona, Spain (A.G.); Department of Psychiatry, University of Michigan, Ann Arbor, Michigan (M.W.)
| | - Fabio Voller
- Centre for Addiction and Mental Health, Toronto, Canada (J.R.); Addiction Policy, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada (J.R.); Institute of Medical Science, University of Toronto, Faculty of Medicine, Toronto, Canada (J.R.); Department of Psychiatry, University of Toronto, Toronto, Canada (J.R.); Institute of Clinical Psychology and Psychotherapy & Center of Clinical Epidemiology and Longitudinal Studies (CELOS), Technische Universität Dresden, Dresden, Germany (J.R., J.M., L.P., C.P., H-U.W.); Agenzia Regionale di Sanità Toscana, Villa la Quiete alle Montalve, Firenze, Italy (A.A., F.V.); Regional Centre for the Training in Primary Care (Ceformed), Monfalcone (GO), Italy (R.D.V., P.S.); Center for Study and Research in General Practice (CSeRMEG), Via Praga, 22, 20052 Monza (MI), Italy (R.D.V.); Corvinus University of Budapest, Budapest, Hungary (Z.E.); Department of Psychiatry, Medical University of Warsaw, Warsaw, Poland (A.J., M.W.); Riga Centre of Psychiatry and Addiction Medicine, Riga, Latvia (I.L.); Fundació Clínic per a la Recerca Biomèdica, Barcelona, Spain (J.M-E.); Addictions Unit, Psychiatry Department, Neurosciences Institute, Hospital Clinic, Barcelona, Spain (J.M-E., A.G.); Institute of Sociological Research, Riga, Latvia (S.S.); Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain (A.G.); Red de Trastornos Adictivos (RTA -RETICS), Instituto de Salud Carlos III, Barcelona, Spain (A.G.); Department of Psychiatry, University of Michigan, Ann Arbor, Michigan (M.W.)
| | - Hans-Ulrich Wittchen
- Centre for Addiction and Mental Health, Toronto, Canada (J.R.); Addiction Policy, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada (J.R.); Institute of Medical Science, University of Toronto, Faculty of Medicine, Toronto, Canada (J.R.); Department of Psychiatry, University of Toronto, Toronto, Canada (J.R.); Institute of Clinical Psychology and Psychotherapy & Center of Clinical Epidemiology and Longitudinal Studies (CELOS), Technische Universität Dresden, Dresden, Germany (J.R., J.M., L.P., C.P., H-U.W.); Agenzia Regionale di Sanità Toscana, Villa la Quiete alle Montalve, Firenze, Italy (A.A., F.V.); Regional Centre for the Training in Primary Care (Ceformed), Monfalcone (GO), Italy (R.D.V., P.S.); Center for Study and Research in General Practice (CSeRMEG), Via Praga, 22, 20052 Monza (MI), Italy (R.D.V.); Corvinus University of Budapest, Budapest, Hungary (Z.E.); Department of Psychiatry, Medical University of Warsaw, Warsaw, Poland (A.J., M.W.); Riga Centre of Psychiatry and Addiction Medicine, Riga, Latvia (I.L.); Fundació Clínic per a la Recerca Biomèdica, Barcelona, Spain (J.M-E.); Addictions Unit, Psychiatry Department, Neurosciences Institute, Hospital Clinic, Barcelona, Spain (J.M-E., A.G.); Institute of Sociological Research, Riga, Latvia (S.S.); Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain (A.G.); Red de Trastornos Adictivos (RTA -RETICS), Instituto de Salud Carlos III, Barcelona, Spain (A.G.); Department of Psychiatry, University of Michigan, Ann Arbor, Michigan (M.W.)
| | - Antoni Gual
- Centre for Addiction and Mental Health, Toronto, Canada (J.R.); Addiction Policy, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada (J.R.); Institute of Medical Science, University of Toronto, Faculty of Medicine, Toronto, Canada (J.R.); Department of Psychiatry, University of Toronto, Toronto, Canada (J.R.); Institute of Clinical Psychology and Psychotherapy & Center of Clinical Epidemiology and Longitudinal Studies (CELOS), Technische Universität Dresden, Dresden, Germany (J.R., J.M., L.P., C.P., H-U.W.); Agenzia Regionale di Sanità Toscana, Villa la Quiete alle Montalve, Firenze, Italy (A.A., F.V.); Regional Centre for the Training in Primary Care (Ceformed), Monfalcone (GO), Italy (R.D.V., P.S.); Center for Study and Research in General Practice (CSeRMEG), Via Praga, 22, 20052 Monza (MI), Italy (R.D.V.); Corvinus University of Budapest, Budapest, Hungary (Z.E.); Department of Psychiatry, Medical University of Warsaw, Warsaw, Poland (A.J., M.W.); Riga Centre of Psychiatry and Addiction Medicine, Riga, Latvia (I.L.); Fundació Clínic per a la Recerca Biomèdica, Barcelona, Spain (J.M-E.); Addictions Unit, Psychiatry Department, Neurosciences Institute, Hospital Clinic, Barcelona, Spain (J.M-E., A.G.); Institute of Sociological Research, Riga, Latvia (S.S.); Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain (A.G.); Red de Trastornos Adictivos (RTA -RETICS), Instituto de Salud Carlos III, Barcelona, Spain (A.G.); Department of Psychiatry, University of Michigan, Ann Arbor, Michigan (M.W.)
| | - Marcin Wojnar
- Centre for Addiction and Mental Health, Toronto, Canada (J.R.); Addiction Policy, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada (J.R.); Institute of Medical Science, University of Toronto, Faculty of Medicine, Toronto, Canada (J.R.); Department of Psychiatry, University of Toronto, Toronto, Canada (J.R.); Institute of Clinical Psychology and Psychotherapy & Center of Clinical Epidemiology and Longitudinal Studies (CELOS), Technische Universität Dresden, Dresden, Germany (J.R., J.M., L.P., C.P., H-U.W.); Agenzia Regionale di Sanità Toscana, Villa la Quiete alle Montalve, Firenze, Italy (A.A., F.V.); Regional Centre for the Training in Primary Care (Ceformed), Monfalcone (GO), Italy (R.D.V., P.S.); Center for Study and Research in General Practice (CSeRMEG), Via Praga, 22, 20052 Monza (MI), Italy (R.D.V.); Corvinus University of Budapest, Budapest, Hungary (Z.E.); Department of Psychiatry, Medical University of Warsaw, Warsaw, Poland (A.J., M.W.); Riga Centre of Psychiatry and Addiction Medicine, Riga, Latvia (I.L.); Fundació Clínic per a la Recerca Biomèdica, Barcelona, Spain (J.M-E.); Addictions Unit, Psychiatry Department, Neurosciences Institute, Hospital Clinic, Barcelona, Spain (J.M-E., A.G.); Institute of Sociological Research, Riga, Latvia (S.S.); Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain (A.G.); Red de Trastornos Adictivos (RTA -RETICS), Instituto de Salud Carlos III, Barcelona, Spain (A.G.); Department of Psychiatry, University of Michigan, Ann Arbor, Michigan (M.W.)
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Predictions get tougher in older individuals: a longitudinal study of optimism, pessimism and depression. Soc Psychiatry Psychiatr Epidemiol 2015; 50:153-63. [PMID: 25201183 DOI: 10.1007/s00127-014-0959-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2013] [Accepted: 08/30/2014] [Indexed: 10/24/2022]
Abstract
PURPOSE To examine whether optimism/pessimism reliably predicts depression and whether such function is stable also in older age. METHOD In a prospective study, we observed a representative sample of n = 4,046 primary care patients over 5 years. The Life Orientation Test (LOT-R, measuring optimism/pessimism) and the Depression-Screening Questionnaire were applied. Medical diagnoses were recorded by the treating physician in a structured medical interview. RESULTS Depression could only be predicted by LOT-R scores in younger-age cohorts. In older adults, test stability and predictive accuracy of optimism/pessimism were markedly reduced, while somatic comorbidity gained importance as a predictor. CONCLUSIONS Predictive value of screening measures for mental disorders may be specific in older age due to lower trait stability and age-specific psychometric limitations as well as age-related changes in relevant predictors.
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Testosterone, sex hormone-binding globulin and the metabolic syndrome in men: an individual participant data meta-analysis of observational studies. PLoS One 2014; 9:e100409. [PMID: 25019163 PMCID: PMC4096400 DOI: 10.1371/journal.pone.0100409] [Citation(s) in RCA: 141] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2013] [Accepted: 05/28/2014] [Indexed: 01/24/2023] Open
Abstract
Background Low total testosterone (TT) and sex hormone-binding globulin (SHBG) concentrations have been associated with the metabolic syndrome (MetS) in men, but the reported strength of association varies considerably. Objectives We aimed to investigate whether associations differ across specific subgroups (according to age and body mass index (BMI)) and individual MetS components. Data sources Two previously published meta-analyses including an updated systematic search in PubMed and EMBASE. Study Eligibility Criteria Cross-sectional or prospective observational studies with data on TT and/or SHBG concentrations in combination with MetS in men. Methods We conducted an individual participant data meta-analysis of 20 observational studies. Mixed effects models were used to assess cross-sectional and prospective associations of TT, SHBG and free testosterone (FT) with MetS and its individual components. Multivariable adjusted odds ratios (ORs) and hazard ratios (HRs) were calculated and effect modification by age and BMI was studied. Results Men with low concentrations of TT, SHBG or FT were more likely to have prevalent MetS (ORs per quartile decrease were 1.69 (95% CI 1.60-1.77), 1.73 (95% CI 1.62-1.85) and 1.46 (95% CI 1.36-1.57) for TT, SHBG and FT, respectively) and incident MetS (HRs per quartile decrease were 1.25 (95% CI 1.16-1.36), 1.44 (95% 1.30-1.60) and 1.14 (95% 1.01-1.28) for TT, SHBG and FT, respectively). Overall, the magnitude of associations was largest in non-overweight men and varied across individual components: stronger associations were observed with hypertriglyceridemia, abdominal obesity and hyperglycaemia and associations were weakest for hypertension. Conclusions Associations of testosterone and SHBG with MetS vary according to BMI and individual MetS components. These findings provide further insights into the pathophysiological mechanisms linking low testosterone and SHBG concentrations to cardiometabolic risk.
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Martos É, Kovács VA, Bakacs M, Kaposvári C, Lugasi A. [Hungarian diet and nutritional status survey -- the OTAP2009 study. I. Nutritional status of the Hungarian population]. Orv Hetil 2013; 153:1023-30. [PMID: 22735373 DOI: 10.1556/oh.2012.29375] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
UNLABELLED Obesity is a leading public health problem, but representative data on measured prevalence among Hungarian adults has been missing since the late eighties. AIM AND METHOD Joining in European Health Interview Survey the aim of the OTAP2009 study was to provide data representative by age and gender on the prevalence of obesity and abdominal obesity among Hungarian adults based on their measured anthropometric data. RESULTS Participation rate was 35% (n = 1165). Data shows that nearly two-thirds of adults are overweight or obese. 26.2% of men and 30.4% of women are obese. Prevalence of morbid obesity is 3.1% and 2.6% in men and women, respectively. Abdominal obesity is more prevalent among women than men (51.0% vs. 33.2%), and rate is increasing parallel with age in both gender. In elderly, 55% of men and almost 80% of women are abdominally obese. CONCLUSIONS Besides interventions of population level for tackling obesity, individual preventive measures are indispensable.
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Affiliation(s)
- Éva Martos
- Országos Élelmezés- és Táplálkozástudományi Intézet Budapest Gyáli út 3/A 1097
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Wehling M. Morbus Diureticus in the Elderly: Epidemic Overuse of a Widely Applied Group of Drugs. J Am Med Dir Assoc 2013; 14:437-42. [DOI: 10.1016/j.jamda.2013.02.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2013] [Revised: 02/04/2013] [Accepted: 02/05/2013] [Indexed: 01/23/2023]
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Leistner DM, Klotsche J, Pieper L, Palm S, Stalla GK, Lehnert H, Silber S, März W, Wittchen HU, Zeiher AM. Prognostic value of NT-pro-BNP and hs-CRP for risk stratification in primary care: results from the population-based DETECT study. Clin Res Cardiol 2013; 102:259-68. [DOI: 10.1007/s00392-012-0530-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2012] [Accepted: 12/03/2012] [Indexed: 01/13/2023]
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Labeit AM, Klotsche J, Pieper L, Pittrow D, Einsle F, Stalla GK, Lehnert H, Silber S, Zeiher AM, März W, Wehling M, Wittchen HU. Changes in the prevalence, treatment and control of hypertension in Germany? A clinical-epidemiological study of 50.000 primary care patients. PLoS One 2012; 7:e52229. [PMID: 23284945 PMCID: PMC3532113 DOI: 10.1371/journal.pone.0052229] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2012] [Accepted: 11/13/2012] [Indexed: 11/23/2022] Open
Abstract
Introduction Medical societies have developed guidelines for the detection, treatment and control of hypertension (HTN). Our analysis assessed the extent to which such guidelines were implemented in Germany in 2003 and 2001. Methods Using standardized clinical diagnostic and treatment appraisal forms, blood pressure levels and patient questionnaires for 55,518 participants from the cross-sectional Targets and Essential Data for Commitment of Treatment (DETECT) study (2003) were analyzed. Physician’s diagnosis of hypertension (HTNdoc) was defined as coding hypertension in the clinical appraisal questionnaire. Alternative definitions used were physician’s diagnosis or the patient’s self-reported diagnosis of hypertension (HTNdoc,pat), physician’s or patient’s self-reported diagnosis or a BP measurement with a systolic BP≥140 mmHg and/or a diastolic BP≥90 (HTNdoc,pat,bp) and diagnosis according to the National Health and Nutrition Examination Survey (HTNNHANES). The results were compared with the similar German HYDRA study to examine whether changes had occurred in diagnosis, treatment and adequate blood pressure control (BP below 140/90 mmHg) since 2001. Factors associated with pharmacotherapy and control were determined. Results The overall prevalence rate for hypertension was 35.5% according to HTNdoc and 56.0% according to NHANES criteria. Among those defined by NHANES criteria, treatment and control rates were 56.0% and 20.3% in 2003, and these rates had improved from 55.3% and 18.0% in 2001. Significant predictors of receiving antihypertensive medication were: increasing age, female sex, obesity, previous myocardial infarction and the prevalence of comorbid conditions such as coronary heart disease (CHD), hyperlipidemia and diabetes mellitus (DM). Significant positive predictors of adequate blood pressure control were CHD and antihypertensive medication. Inadequate control was associated with increasing age, male sex and obesity. Conclusions Rates of treated and controlled hypertension according to NHANES criteria in DETECT remained low between 2001 and 2003, although there was some minor improvement.
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Affiliation(s)
- Alexander Michael Labeit
- Clinical Pharmacology Mannheim, Institute of Experimental and Clinical Pharmacology and Toxicology, Medical Faculty Mannheim of the University of Heidelberg, Heidelberg, Germany.
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Klotsche J, Ferger D, Leistner D, Pieper L, Zeiher AM, Wittchen HU, Rehm J. Binary regression: Total gain in positive and negative predictive values. Biom J 2012; 54:808-23. [DOI: 10.1002/bimj.201100104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2011] [Revised: 08/20/2012] [Accepted: 08/25/2012] [Indexed: 11/09/2022]
Affiliation(s)
| | - Dietmar Ferger
- Department of Mathematics; Technische Universitaet Dresden; Zellescher Weg 12-14; 01069; Dresden; Germany
| | - David Leistner
- Department of Medicine III, Cardiology; Goethe-University Frankfurt; Theodor-Stern-Kai 7; 60596; Frankfurt; Germany
| | | | - Andreas M. Zeiher
- Department of Medicine III, Cardiology; Goethe-University Frankfurt; Theodor-Stern-Kai 7; 60596; Frankfurt; Germany
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Schneider HJ, Klotsche J, Friedrich N, Schipf S, Völzke H, Silber S, März W, Nauck M, Pittrow D, Wehling M, Sievers C, Lehnert H, Stalla GK, Wittchen HU, Wallaschofski H. Risk factors associated with the metabolic syndrome in abdominal obesity. Clin Obes 2012; 2:142-9. [PMID: 25586249 DOI: 10.1111/cob.12002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2012] [Revised: 08/06/2012] [Accepted: 08/12/2012] [Indexed: 11/27/2022]
Abstract
Obesity is associated with the metabolic syndrome. However, not all obese individuals have cardiovascular risk factors (CVRF). It is not clear how many abdominally obese individuals are free of CVRF and what distinguishes them from the group of obese individuals with CVRF. In this study, we aimed to assess the associated factors and prevalence of abdominal obesity without CVRF. In our cross-sectional analysis, we included n = 4244 subjects from the Study of Health in Pomerania (SHIP), a population-based study and n = 6671 subjects from the Diabetes Cardiovascular Risk-Evaluation: Targets and Essential Data for Commitment of Treatment (DETECT) study, a representative primary care study in Germany. We defined abdominal obesity by waist-to-height ratio (WHtR) of 0.5 or greater. We assessed how many subjects with abdominal obesity had CVRF based on the definition of the metabolic syndrome. We analysed which conditions were associated with the absence of CVRF in abdominal obesity. In SHIP and DETECT, 2652 (62.5%) and 5126 (76.8%) subjects had a WHtR ≥ 0.5. Among those with a WHtR ≥ 0.5, 9.0% and 13.8% were free of CVRF and 49.9% and 52.7% had at least two CVRF in SHIP and DETECT, respectively. In both studies, after backward elimination, age, male sex, body mass index and high liver enzymes and unemployment were consistently inversely associated with the absence of CVRF. Among abdominally obese subjects, the prevalence of metabolically healthy subjects is low. Conditions consistently associated with the absence of CVRF in abdominal obesity are younger age, female sex, low BMI, and normal liver enzymes, the latter likely reflecting the absence of steatohepatitis.
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Affiliation(s)
- H J Schneider
- Medizinische Klinik - Innenstadt, Klinikum der Universität, Munich, Germany
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Dechend R, Kaiser E, Derer W, Deeg E, Busjahn A, Schmieder RE, Zeymer U. Guideline adherence in cardiovascular risk assessment and analysis in 15,000 hypertensive German patients in real life: results of the Prospective 3A Registry. J Clin Hypertens (Greenwich) 2012; 14:496-501. [PMID: 22863156 DOI: 10.1111/j.1751-7176.2012.00650.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The benefit obtained from antihypertensive treatment is related more to overall cardiovascular risk reduction than to blood pressure levels. Accurate implementation of cardiovascular diagnostics is a key step toward assessment of cardiovascular risk. In the 3A Registry study, data about patient history, concomitant diseases, diagnostic procedures, and medications were prospectively collected. A total of 14,738 patients recruited by 899 physicians in 2008 and 2009 were analyzed. Assessment of cardiovascular risk factors and subclinical end-organ damage (SOD) showed broad differences in the implementation of European Society of Hypertension/European Society of Cardiology recommendations. Electrocardiograms were available in 59% of patients, cholesterol in 71.4%, and glucose in 69.7%. Almost all patients (99.6%) had creatinine measurements performed and microalbuminuria was measured in 8.5%. Metabolic syndrome (MS) had been evaluated in 59.7%. Implementation of diagnostic guidelines was highest in hypertensive patients with diabetes, followed by patients with known cardiovascular disease and established chronic renal insufficiency. For hypertensive patients without known comorbidities, the authors estimated that up to 29% had missed SOD (detection rate <50%) and 13% missed MS due to incomplete assessment of risk factors. This large registry study shows that assessment for cardiovascular risk factors and SOD is incomplete. Major efforts are required to improve comprehensive hypertension management as recommended by current guidelines.
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Affiliation(s)
- Ralf Dechend
- HELIOS Klinikum Berlin-Buch and Experimental and Clinical Research Center, Charité University Hospital Berlin, Berlin, Germany.
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Leistner DM, Klotsche J, Palm S, Pieper L, Stalla GK, Lehnert H, Silber S, März W, Wittchen HU, Zeiher AM. Prognostic value of reported chest pain for cardiovascular risk stratification in primary care. Eur J Prev Cardiol 2012; 21:727-38. [PMID: 22739685 DOI: 10.1177/2047487312452503] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The prognostic significance of chest pain is well established in patients with coronary artery disease, but still ill defined in primary prevention. Therefore, the aim of our analysis was to assess the prognostic value of different forms of chest pain in a large cohort of primary care subjects under the conditions of contemporary modalities of care in primary prevention, including measurement of serum levels of the biomarker NT-pro-BNP. DESIGN We carried out a post-hoc analysis of the prospective DETECT cohort study. METHODS In a total of 5570 unselected subjects, free of coronary artery disease, within the 55,518 participants of the cross-sectional DETECT study, we assessed chest pain history by a comprehensive questionnaire and measured serum NT-pro-BNP levels. Three types of chest pain, which were any chest pain, exertional chest pain and classical angina, were defined. Major adverse cardiovascular events (MACEs = cardiovascular death, myocardial infarction, coronary revascularization procedures) were assessed during a 5-year follow-up period. RESULTS During follow-up, 109 subjects experienced a MACE. All types of reported chest pain were associated with an approximately three-fold increased risk for the occurrence of incident MACEs, even after adjusting for cardiovascular risk factors. Any form of reported chest pain had a similar predictive value for MACEs as a one-time measurement of NT-pro-BNP. However, adding a single measurement of NT-pro-BNP and the information on chest pain resulted in reclassification of approximately 40% of subjects, when compared with risk prediction based on established cardiovascular risk factors. CONCLUSIONS In primary prevention, self-reported chest pain and a single measurement of NT-pro-BNP substantially improve cardiovascular risk prediction and allow for risk reclassification of approximately 40% of the subjects compared with assessing classical cardiovascular risk factors alone.
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Affiliation(s)
- David M Leistner
- Department of Internal Medicine III, Cardiology, Goethe-University Frankfurt, Germany
| | - Jens Klotsche
- Institute for Clinical Psychology and Psychotherapy, Technische Universität Dresden, Germany
| | - Sylvia Palm
- Department of Internal Medicine III, Cardiology, Goethe-University Frankfurt, Germany
| | - Lars Pieper
- Institute for Clinical Psychology and Psychotherapy, Technische Universität Dresden, Germany
| | | | - Hendrik Lehnert
- Department of Medicine I, University of Schleswig-Holstein, Campus Lübeck, Germany
| | | | - Winfried März
- Synlab Center of Laboratory Diagnostics, Heidelberg, Germany
| | - Hans-Ulrich Wittchen
- Institute for Clinical Psychology and Psychotherapy, Technische Universität Dresden, Germany
| | - Andreas M Zeiher
- Department of Internal Medicine III, Cardiology, Goethe-University Frankfurt, Germany
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Dehnen D, Quellmann T, Herget-Rosenthal S. Current equations estimating glomerular filtration rate in primary care: Comparison and determinants. ACTA ACUST UNITED AC 2012; 46:448-53. [DOI: 10.3109/00365599.2012.695389] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Dorothea Dehnen
- Division of Primary Care, Medical School, University Duisburg-Essen,
Essen, Germany
| | - Thomas Quellmann
- Division of Primary Care, Medical School, University Duisburg-Essen,
Essen, Germany
| | - Stefan Herget-Rosenthal
- Department of Medicine, Rotes Kreuz Krankenhaus,
Bremen, Germany
- Department of Nephrology, University Hospital, University Duisburg-Essen,
Essen, Germany
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Morra L, Zade D, McGlinchey RE, Milberg WP. Normal aging and cognition: the unacknowledged contribution of cerebrovascular risk factors. AGING NEUROPSYCHOLOGY AND COGNITION 2012; 20:271-97. [PMID: 22708889 DOI: 10.1080/13825585.2012.693905] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Despite the widespread assumption that cognitive decline is an inherent part of the normal aging process, research suggests that part of the variance in age-related cognitive decline is attributable to modifiable factors common in geriatric populations such as cerebrovascular risk factors. We completed a literature search using Science Citation Index and evaluated the most cited articles from the last 10 years to determine the extent to which investigations of normal aging and cognition account for the influence of cerebrovascular risk factors. We found that the majority of the most frequently cited literature does not adequately account for the contribution of cerebrovascular risk factors and therefore, it is possible that many conclusions about normal aging and cognition are flawed or incomplete. Further investigation of the role of cerebrovascular risk factors in age-related cognitive decline is imperative to more accurately understand the effect of aging on cognition.
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Affiliation(s)
- L Morra
- Translational Research Center for TBI and Stress Disorders (TRACTS), VA Boston Healthcare System, Boston, MA, USA.
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Reliabilität ärztlicher Morbiditätsangaben zu chronischen Krankheiten. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2012; 55:260-9. [DOI: 10.1007/s00103-011-1414-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Friedrich N, Schneider HJ, Haring R, Nauck M, Völzke H, Kroemer HK, Dörr M, Klotsche J, Jung-Sievers C, Pittrow D, Lehnert H, März W, Pieper L, Wittchen HU, Wallaschofski H, Stalla GK. Improved prediction of all-cause mortality by a combination of serum total testosterone and insulin-like growth factor I in adult men. Steroids 2012; 77:52-8. [PMID: 22037276 DOI: 10.1016/j.steroids.2011.10.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2011] [Revised: 10/11/2011] [Accepted: 10/11/2011] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Lower levels of anabolic hormones in older age are well documented. Several studies suggested that low insulin-like growth factor I (IGF-I) or testosterone levels were related to increased mortality. The aim of the present study was to investigate the combined influence of low IGF-I and low testosterone on all-cause mortality in men. METHODS AND RESULTS From two German prospective cohort studies, the DETECT study and SHIP, 3942 men were available for analyses. During 21,838 person-years of follow-up, 8.4% (n=330) of men died. Cox model analyses with age as timescale and adjusted for potential confounders revealed that men with levels below the 10th percentile of at least one hormone [hazard ratio (HR) 1.38 (95% confidence-interval (CI) 1.06-1.78), p=0.02] and two hormones [HR 2.88 (95% CI 1.32-6.29), p<0.01] showed a higher risk of all-cause mortality compared to men with non-low hormones. The associations became non-significant by using the 20th percentile as cut-off showing that the specificity increased with lower cut-offs for decreased hormone levels. The inclusion of both IGF-I and total testosterone in a mortality prediction model with common risk factors resulted in a significant integrated discrimination improvement of 0.5% (95% CI 0.3-0.7%, p=0.03). CONCLUSIONS Our results prove that multiple anabolic deficiencies have a higher impact on mortality than a single anabolic deficiency and suggest that assessment of more than one anabolic hormone as a biomarker improve the prediction of all-cause mortality.
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Affiliation(s)
- Nele Friedrich
- Institute of Clinical Chemistry and Laboratory Medicine, Ernst Moritz Arndt University, Greifswald, Germany.
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Leistner DM, Klotsche J, Pieper L, Stalla GK, Lehnert H, Silber S, März W, Wittchen HU, Zeiher AM. Circulating Troponin As Measured by a Sensitive Assay for Cardiovascular Risk Assessment in Primary Prevention. Clin Chem 2012; 58:200-8. [DOI: 10.1373/clinchem.2011.174292] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Abstract
BACKGROUND
Measuring circulating cardiac troponin using novel sensitive assays has revealed that even minute elevations are associated with increased mortality in patients with coronary artery disease or even in the general population. Less well defined, however, is the incremental value of measuring circulating cardiac troponin I (cTnI) by a sensitive assay for risk assessment in primary prevention.
METHODS
We measured circulating concentrations of cTnI, N-terminal pro–B-type natriuretic peptide (NT-proBNP), and high-sensitivity C-reactive protein (hsCRP) in 5388 individuals free of known cardiovascular disease recruited into the DETECT study, a prospective longitudinal population-based cohort study. We determined the prognostic implications for incident major adverse cardiovascular events (MACE) during 5 years of follow-up.
RESULTS
Circulating cTnI was detectable in 19% of the subjects. Increased cTnI concentrations were associated with established risk factors for atherosclerosis and demonstrated a graded relationship with all-cause mortality and incident MACE during 5-year follow-up. A single measurement of cTnI significantly improved risk prediction over established risk factors, and also added prognostic information, when adjusted for serum concentrations of NT-proBNP and hsCRP.
CONCLUSIONS
Minute increases in cTnI are associated with increased mortality and incident MACE in a large primary prevention cohort and, thus, identify contributors to cardiovascular risk not fully captured by traditional risk factor assessment.
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Affiliation(s)
- David M Leistner
- Department of Medicine III, Cardiology, Goethe-University Frankfurt, Germany
| | - Jens Klotsche
- Institute for Clinical Psychology and Psychotherapy, Technische Universität Dresden, Germany
| | - Lars Pieper
- Institute for Clinical Psychology and Psychotherapy, Technische Universität Dresden, Germany
| | | | - Hendrik Lehnert
- Department of Medicine I, University of Schleswig-Holstein, Campus Lübeck, Germany
| | | | - Winfried März
- Synlab Centers of Laboratory Diagnostics, Leinfelden Echterdingen and Bad Nauheim, Germany; Mannheim Institute of Public Health, Social and Preventive Medicine, Medical Faculty Mannheim, University of Heidelberg, Germany; and Clinical Institute of Medical and Chemical Laboratory Diagnostics, Graz, Austria
| | - Hans-Ulrich Wittchen
- Institute for Clinical Psychology and Psychotherapy, Technische Universität Dresden, Germany
| | - Andreas M Zeiher
- Department of Medicine III, Cardiology, Goethe-University Frankfurt, Germany
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Schneider HJ, Klotsche J, Wittchen HU, Stalla GK, Schopohl J, Kann PH, Kreitschmann-Andermahr I, Wallaschofski H. Effects of growth hormone replacement within the KIMS survey on estimated cardiovascular risk and predictors of risk reduction in patients with growth hormone deficiency. Clin Endocrinol (Oxf) 2011; 75:825-30. [PMID: 21658091 DOI: 10.1111/j.1365-2265.2011.04137.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE There is growing evidence for an increased cardiovascular (CV) risk in untreated growth hormone deficiency of adults (GHD). We aimed at estimating CV risk with established algorithms before and during GH replacement in GHD and in healthy controls and at identifying predictors of risk reduction. DESIGN A prospective, nested case-control study. PATIENTS We included 344 patients (44·7 ± 14·9 years) from the German Pfizer (formerly Kabi) International Metabolic Database (KIMS) cohort and included a healthy sex- and age-matched control group from a primary care cohort. MEASUREMENTS We calculated Framingham, Prospective Cardiovascular Münster Heart Study (PROCAM) and European Society of Cardiology (ESC) Score algorithms at all time points. In multivariate analyses, we analysed potential predictors of 2-year reduction in CV risk, defined as a higher than median reduction in risk. RESULTS In KIMS, the estimated 10-year risks of CV events or CV mortality calculated with Framingham, PROCAM and ESC Score algorithms at baseline were 4·6%, 6·0% and 2·3%, respectively. These dropped to 2·4%, 4·8% and 0·8%, respectively, after 2 years of GH replacement (all P < 0·001 vs baseline) and returned to baseline levels after four years of GH replacement. In controls, the Framingham risk estimates were lower than in KIMS at baseline. All risk estimates increased during follow-up and were significantly higher than in KIMS after four years (all P < 0·01). In backward-selection models, high total cholesterol, low high-density lipoprotein (HDL) cholesterol and male sex were significant predictors of response in most scores. CONCLUSION Two years of GH replacement decreased CV risk estimates approximately by half. Male sex, high total and low HDL cholesterol levels are potential predictors of good response.
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Baur DM, Klotsche J, Hamnvik OPR, Sievers C, Pieper L, Wittchen HU, Stalla GK, Schmid RM, Kales SN, Mantzoros CS. Type 2 diabetes mellitus and medications for type 2 diabetes mellitus are associated with risk for and mortality from cancer in a German primary care cohort. Metabolism 2011; 60:1363-71. [PMID: 21081242 DOI: 10.1016/j.metabol.2010.09.012] [Citation(s) in RCA: 73] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2010] [Revised: 09/29/2010] [Accepted: 09/30/2010] [Indexed: 12/22/2022]
Abstract
There is growing evidence that patients with type 2 diabetes mellitus have increased cancer risk. We examined the association between diabetes, cancer, and cancer-related mortality and hypothesized that insulin sensitizers lower cancer-related mortality. Participants in the Diabetes Cardiovascular Risk and Evaluation: Targets and Essential Data for Commitment of Treatment study, a nationwide cross-sectional and prospective epidemiological study, were recruited from German primary care practices. In the cross-sectional study, subjects with type 2 diabetes mellitus had a higher prevalence of malignancies (66/1308, 5.1%) compared to nondiabetic subjects (185/6211, 3.0%) (odds ratio, 1.64; 95% confidence interval, 1.12-2.41) before and after adjustment for age, sex, hemoglobin A(1c), smoking status, and body mass index. Patients on metformin had a lower prevalence of malignancies, comparable with that among nondiabetic patients, whereas those on any other oral combination treatment had a 2-fold higher risk for malignancies even after adjusting for possible confounders; inclusion of metformin in these regimens decreased the prevalence of malignancies. In the prospective analyses, diabetic patients in general and diabetic patients treated with insulin (either as monotherapy or in combination with other treatments) had a 2- and 4-fold, respectively, higher mortality rate than nondiabetic patients, even after adjustment for potential confounders (incidence of cancer deaths in patients with type 2 diabetes mellitus [2.6%] vs the incidence of cancer deaths in patients without type 2 diabetes mellitus [1.2%]). Our results suggest that diabetes and medications for diabetes, with the exception of the insulin sensitizer metformin, increase cancer risk and mortality.
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Affiliation(s)
- Dorothee M Baur
- Harvard School of Public Health, Department of Environmental Health, Environmental and Occupational Medicine and Epidemiology, Boston, MA, USA.
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Kardos P, Wittchen HU, Mühlig S, Ritz T, Buhl R, Rabe K, Klotsche J, Riedel O. Controlled and uncontrolled allergic asthma in routine respiratory specialist care - a clinical-epidemiological study in Germany. Curr Med Res Opin 2011; 27:1835-47. [PMID: 21824036 DOI: 10.1185/03007995.2011.606805] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Studies in the last decade showed high rates of poorly treated and poorly controlled asthma in the community. Extending these findings we describe the more recent situation in specialist respiratory care as the most frequent source of treatment provision using comprehensive clinical and patient assessments and exploring predictors for poor control. METHODS This is a German cross-sectional, clinical epidemiological study in a nationally representative stratified treatment prevalence sample of N = 572 outpatients diagnosed with allergic asthma (AA; females 58.2%, aged 47.5 ± 16.3 (16-81 years). Treating physicians completed standardized clinical assessments (lung function, laboratory, clinical findings, severity, illness and treatment history, asthma control [GINA]), supplemented by patients' self-report measures (EQ5-D, AQLQ, ACT) and mental health module (CIDI-SF). RESULTS A total of 65.4% of patients were rated (GINA) as controlled, 30.3% partially controlled, and 4.4% uncontrolled; the patient-rated ACT showed lower rates of control (19.9% controlled, 44.2% partial, 35.8% uncontrolled, kappa: 0.2). Consistent with findings of clinical measures, controlled asthma was highest among patients with pre-treatment stage I severity (83.6%) and decreased by pre-treatment severity (stage IV patients: 29.3%). Poorer control was associated with pre-treatment severity, nocturnal attacks, diminished adherence and comorbid anxiety/depression. Patients received complex multiple drug and non-drug interventions, largely consistent with guidelines. Degree of asthma control was associated with improved and even normalized quality of life findings. CONCLUSION In this representative sample of longterm treated AA patients in specialist respiratory care we find better control rates and better adherence to guidelines as previous studies. Despite remarkable differences in clinician- vs patient-rated control ratings even the initially most severe stage IV patients (12.9% of patients) showed remarkable control rates and close to normal quality of life. Intensified treatment (e.g. omalizumab) was associated with improved control. Poorer control was associated with higher initial severity, diminished adherence, comorbid anxiety/depression and old age. LIMITATION Findings apply to AA patients in respiratory specialist care sector which is likely to treat the more severely affected patients. Thus, findings cannot be generalized to the general population, other treatment settings or asthma types.
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Affiliation(s)
- P Kardos
- Group Practice and Respiratory Department Maingau Hospital Frankfurt/Main, Germany
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Bösner S, Haasenritter J, Hani MA, Keller H, Sönnichsen AC, Karatolios K, Schaefer JR, Baum E, Donner-Banzhoff N. Gender bias revisited: new insights on the differential management of chest pain. BMC FAMILY PRACTICE 2011; 12:45. [PMID: 21645336 PMCID: PMC3125218 DOI: 10.1186/1471-2296-12-45] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/01/2010] [Accepted: 06/06/2011] [Indexed: 11/17/2022]
Abstract
Background Chest pain is a common complaint and reason for consultation in primary care. Few data exist from a primary care setting whether male patients are treated differently than female patients. We examined whether there are gender differences in general physicians' (GPs) initial assessment and subsequent management of patients with chest pain, and how these differences can be explained Methods We conducted a prospective study with 1212 consecutive chest pain patients. The study was conducted in 74 primary care offices in Germany from October 2005 to July 2006. After a follow up period of 6 months, an independent interdisciplinary reference panel reviewed clinical data of every patient and decided about the etiology of chest pain at the time of patient recruitment (delayed type-reference standard). We adjusted gender differences of six process indicators for different models. Results GPs tended to assume that CHD is the cause of chest pain more often in male patients and referred more men for an exercise test (women 4.1%, men 7.3%, p = 0.02) and to the hospital (women 2.9%, men 6.6%, p < 0.01). These differences remained when adjusting for age and cardiac risk factors but ceased to exist after adjusting for the typicality of chest pain. Conclusions While observed gender differences can not be explained by differences in age, CHD prevalence, and underlying risk factors, the less typical symptom presentation in women might be an underlying factor. However this does not seem to result in suboptimal management in women but rather in overuse of services for men. We consider our conclusions rather hypothesis generating and larger studies will be necessary to prove our proposed model.
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Affiliation(s)
- Stefan Bösner
- Department of General Practice/Family Medicine, University of Marburg, 35032 Marburg, Germany.
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Klotsche J, Leistner DM, Pieper L, Pittrow D, Zeiher AM, Wittchen HU. The DETECT adherence score--structure and psychometric exploration of a novel approach to measure adherence to drug and non-drug interventions in primary care. Int J Methods Psychiatr Res 2011; 20:82-92. [PMID: 21618327 PMCID: PMC6878574 DOI: 10.1002/mpr.341] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
There is substantial evidence that patient compliance or rather adherence to medical measures and recommendations for lifestyle changes can pivotally influence the prognosis of the patients or disease progression. However, the scientific evaluation and the statistical analysis of "patient adherence" are extremely difficult due to the fact that the construct of "adherence" is complex and comprised of many layers, and varies greatly in different disease groups. With this paper, we describe the development and structure of this novel assessment tool that takes past and prospective information on different facets of drug and behavioural adherence into account, expected to result in considerably improved prediction of future cardiovascular risk. We suggest a simple scoring scheme and explore the psychometric properties and the higher order factorial structure. In this exploratory study the "Diabetes Cardiovascular Risk Evaluation Targets and Essential Data for Commitment of Treatment" (DETECT) adherence score revealed good psychometric properties in terms of internal consistency and factorial structure, suggesting that its further exploration in terms of external validity is promising. Findings also underline that it is useful and informative to cover within one score both, pharmacologic and non-pharmacologic interventions in primary care. Our combination in this respect is unique, as most studies conducted on this subject so far aimed at assessing solely drug adherence or behavioural adherence.
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Affiliation(s)
- J Klotsche
- Institute of Clinical Psychology and Psychotherapy, Technische Universitaet Dresden, Dresden, Germany
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Friedrich N, Schneider H, Dörr M, Nauck M, Völzke H, Klotsche J, Sievers C, Pittrow D, Böhler S, Lehnert H, Pieper L, Wittchen HU, Wallaschofski H, Stalla GK. All-cause mortality and serum insulin-like growth factor I in primary care patients. Growth Horm IGF Res 2011; 21:102-106. [PMID: 21435927 DOI: 10.1016/j.ghir.2011.02.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2010] [Revised: 12/14/2010] [Accepted: 02/27/2011] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Previous population-based studies provided conflicting results regarding the association of total serum insulin-like growth factor I (IGF-I) and mortality. The aim of the present study was to assess the relation of IGF-I levels with all-cause mortality in a prospective study. DESIGN DETECT (Diabetes Cardiovascular Risk-Evaluation: Targets and Essential Data for Commitment of Treatment) is a large, multistage, and nationally representative study of primary care patients in Germany. The study population included 2463 men and 3603 women. Death rates were recorded by the respective primary care physician. Serum total IGF-I levels were determined by chemiluminescence immunoassays and categorized into three groups (low, moderate, and high) according to the sex- and age-specific 10th and 90th percentiles. RESULTS Adjusted analyses revealed that men with low [hazard ratio (HR) 1.70 (95% confidence interval [CI] 1.05-2.73), p=0.03] and high [HR 1.76 (95% CI 1.09-2.85), p=0.02] IGF-I levels had higher risk of all-cause mortality compared to men with moderate IGF-I levels. The specificity of low IGF-I and high IGF-I levels increased with lower and higher cut-offs, respectively. No such association became apparent in women. CONCLUSIONS The present study revealed a U-shaped relation between IGF-I and all-cause mortality in male primary care patients.
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Affiliation(s)
- N Friedrich
- Institute for Clinical Chemistry and Laboratory Medicine, Ernst Moritz Arndt University of Greifswald, Germany.
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Leistner DM, Klotsche J, Palm S, Pieper L, Stalla GK, Lehnert H, Silber S, März W, Wittchen HU, Zeiher AM. Resting heart rate as a tool for risk stratification in primary care: does it provide incremental prognostic information? Eur J Prev Cardiol 2011; 19:275-84. [PMID: 21450610 DOI: 10.1177/1741826710394304] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Several selected population-based studies have emphasized the significance of resting heart rate as an independent cardiovascular risk factor. However, there are no data available for using resting heart rate as a cardiovascular risk predictor in contemporary primary care. Thus, the aim of our analysis was to examine the clinical value of the measurement of resting heart rate in a large, unselected population-based cohort of primary care subjects under the conditions of contemporary primary prevention. DESIGN Prospective, population-based cohort study. METHODS We examined a subgroup of 5320 unselected primary care subjects free of coronary artery disease from the nationwide, longitudinal Diabetes Cardiovascular Risk Evaluation Targets and Essential Data for Commitment of Treatment (DETECT) cohort study, which was conducted from 2003 to 2008. RESULTS During the follow-up time of 5 years, 258 events were reported. Elevated resting heart rate was not associated with an increased risk for cardiovascular events (HR = 0.75, p = 0.394), cardiovascular mortality (HR = 0.71, p = 0.616) or major cardiovascular events (HR = 0.77, p = 0.376). By cross-sectional analysis, elevated heart rate clustered with markers of the metabolic syndrome, like increased blood pressure (systolic: OR = 5.54, p < 0.0001; diastolic: OR = 3.82, p < 0.0001), elevated fasting plasma glucose levels (OR = 8.84, p < 0.0001), hypertriglyceridaemia (OR = 22.16, p = 0.001), and obesity (body mass index OR = 0.89, p < 0.0001). Assessment of resting heart rate in clinical practice had minimal and non-significant additional prognostic value compared to established cardiovascular risk factors as judged by C statistics (C = 0.001, p = 0.979). CONCLUSION The measurement of resting heart rate in the daily routine of primary care does not provide incremental prognostic information for cardiovascular risk stratification.
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Affiliation(s)
- David M Leistner
- Department of Internal Medicine III, Cardiology, Goethe-University of Frankfurt, Theodor-Stern-Kai 7, Frankfurt/Main, Germany
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Thoenes M, Tebbe U, Rosin L, Paar WD, Bramlage P, Kirch W, Böhm M. Blood pressure management in a cohort of hypertensive patients in Germany treated by cardiologists. Clin Res Cardiol 2011; 100:483-91. [PMID: 21207045 DOI: 10.1007/s00392-010-0271-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2010] [Accepted: 12/17/2010] [Indexed: 01/19/2023]
Abstract
BACKGROUND In Germany, an estimated 20-25 million patients suffer from hypertension. Blood pressure control rates are, however, lower than in many other European countries and the USA. The present analysis reports blood pressure treatment and control rates in Germany in patients with hypertension treated by cardiologists. METHODS The present analysis reports data from a German subgroup analysis of a large, multinational, observational survey i-SEARCH that recruited patients in 2005/2006. It reports blood pressure readings, drug utilization and control rates in cardiology practice. RESULTS A total of 4,982 patients were documented at 417 sites. Mean systolic/diastolic blood pressure (SBP/DBP) was 152 ± 19.5/88.4 ± 11.5 mmHg. SBP was 1.3 mmHg higher in men than in women (p = 0.021). The majority of patients had an SBP between 141 and 160 mmHg and 31.4% of patients had normal SBP. Overall blood pressure control rate was only 11.6% [95% CI 10.7-12.6] in treated patients. It was different in men [10.2%; 95% CI 9.0-11.6] than in women [8.1%; 95% CI 7.1-9.4; p = 0.008] and higher in patients without diabetes [12.7%; 95% CI 11.6-14.0] than in those with diabetes [4.3%; 95% CI 3.4-5.4; p < 0.0001]. One-third of patients received either monotherapy or dual therapy, or three and more drugs, respectively; 42.2% of patients received guideline-recommended dual combination therapy. A combination of beta-blockers + ACE inhibitors was most frequently prescribed (30.8%). CONCLUSIONS Our data indicate a low level of blood pressure control, especially in patients at an increased risk for cardiovascular events, such as those with diabetes or cardiovascular comorbidities. Major efforts are required to improve hypertension management as recommend by current treatment guidelines.
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Affiliation(s)
- Martin Thoenes
- Institute for Clinical Pharmacology, Medical Faculty Carl Gustav Carus, Technical University, Dresden, Germany
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Schneider HJ, Klotsche J, Silber S, Stalla GK, Wittchen HU. Measuring abdominal obesity: effects of height on distribution of cardiometabolic risk factors risk using waist circumference and waist-to-height ratio. Diabetes Care 2011; 34:e7. [PMID: 21193616 DOI: 10.2337/dc10-1794] [Citation(s) in RCA: 96] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Harald J. Schneider
- Medizinische Klinik-Innenstadt, Ludwig-Maximilians University, Munich, Germany
- Institute of Clinical Chemistry and Laboratory Medicine, University of Greifswald, Greifswald, Germany
| | - Jens Klotsche
- Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany
| | | | | | - Hans-Ulrich Wittchen
- Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany
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Longitudinale Assoziationen zwischen depressiven Symptomen und Typ-2-Diabetes sowie deren Auswirkung auf die Mortalität von Hausarztpatienten. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2010; 54:98-107. [DOI: 10.1007/s00103-010-1181-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Friedel H, Delges A, Clouth J, Trautvetter DT. Expenditures of the German statutory health insurance system for patients suffering from acute coronary syndrome and treated with percutaneous coronary intervention. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2010; 11:449-455. [PMID: 19774404 DOI: 10.1007/s10198-009-0181-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2009] [Accepted: 09/01/2009] [Indexed: 05/28/2023]
Abstract
Patients with acute coronary syndrome (ACS) are in need of cost-intensive treatment involving different aspects of the German Health System. Percutaneous coronary intervention (PCI) is the treatment of choice for a large proportion of cases. In the present study, an analysis of the cost impact of ACS with focus on PCI therapy was conducted across-the-board for the German Health System. Results indicated that 85% of all costs arising from treatment of ACS with a trial of PCI are due to in-patient care. Projection of results onto the entire insurant collective of the statutory health system estimated a total of Euro 954,995,603-a proportional 0.7% of all expenditure by statutory health insurance in 2005.
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Affiliation(s)
- Heiko Friedel
- Institut für Prävention und Gesundheitsförderung an der Universität Duisburg-Essen, Max-Fiedler Strasse 6, 45128 Essen, Germany.
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Sievers C, Klotsche J, Pieper L, Schneider HJ, März W, Wittchen HU, Stalla GK, Mantzoros C. Low testosterone levels predict all-cause mortality and cardiovascular events in women: a prospective cohort study in German primary care patients. Eur J Endocrinol 2010; 163:699-708. [PMID: 20685832 DOI: 10.1530/eje-10-0307] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Although associations between testosterone and cardiovascular (CV) morbidity in women have been proposed, no large prospective study has evaluated potential associations between testosterone and mortality in women. The objective was to determine whether baseline testosterone levels in women are associated with future overall or CV morbidity and mortality. DESIGN Prospective cohort study with a 4.5-year follow-up period. METHODS From a representative sample of German primary care practices, 2914 female patients between 18 and 75 years were analyzed for the main outcome measures: CV risk factors, CV diseases, and all-cause mortality. RESULTS At baseline, the study population was aged 57.96±14.37 years with a mean body mass index of 26.71±5.17 kg/m(2). No predictive value of total testosterone for incident CV risk factors or CV diseases was observed in logistic regressions. Patients with total testosterone levels in the lowest quintile Q1, however, had a higher risk to die of any cause or to develop a CV event within the follow-up period compared to patients in the collapsed quintiles Q2-Q5 in crude and adjusted Cox regression models (all-cause mortality: Q2-Q5 versus Q1: crude hazard ratios (HR) 0.49, 95% confidence interval (CI) 0.33-0.74; adjusted HR 0.62, 95% CI 0.42-0.939; CV events: Q2-Q5 versus Q1: crude HR 0.54, 95% CI 0.38-0.77; adjusted HR 0.68, 95% CI 0.48-0.97). Kaplan-Meier curves revealed similar data. CONCLUSIONS Low baseline testosterone in women is associated with increased all-cause mortality and incident CV events independent of traditional risk factors.
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Affiliation(s)
- Caroline Sievers
- Department of Endocrinology, Max Planck Institute of Psychiatry, Kraepelinstrasse 2-10, Munich, Germany.
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