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Zeeb H, Pohlabeln H, Preising A, Schulz B, Naczinsky A, Dortmann O, Kolpatzik K. Digital Health Literacy – results of a representative survey among adults in Germany. Eur J Public Health 2021. [DOI: 10.1093/eurpub/ckab164.505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Whereas the concept of health literacy has already found its place in Public Health, this is less the case for digital health literacy (DiHL). To investigate the distribution of digital health literacy in the German adult population, we used a definition encompassing individual, social and technical competencies and resources to search, find, understand, apply and evaluate digital health information. We conducted a representative survey including 8.500 persons aged 18-75 years, based on an online access panel. All participants filled a questionnaire which covered the seven domains of the Digital Health Literacy Instrument (DHLI). Demographic information for participants was available through existing panel data. Optimal cut points to categorize digital health literacy were developed via regression modelling. Data were analysed using descriptive statistics and logistic regression modelling, comparing the two lower categories of DIHL against high/very high DiHL. Results are presented via odds ratios and 95% confidence intervals. Overall, 52.4% of respondents were categorized as having low or moderate DiHL (W: 51.2%; M: 53.7%). There were few differences according to age group and migration status. Those with higher educational attainment also scored higher in terms of DiHL. Operative competencies were generally rated high, whereas the evaluation of reliability of content scored lowest. In the regression analysis, the adjusted odds ratio (OR) for limited DiHL was 2.01 (95%CI 1.51;2.67) among those with poor or very poor self-reported health. Digital health literacy addresses a complex set of competencies and resources. More than half of the adult German population report a limited digital health literacy according to this nationwide survey. Impaired health is associated with low digital health literacy, and many have difficulties assessing the reliability of digital content. This is troublesome as more and more health-related information becomes digitalized.
Key messages
More than half of the German adult population reports limited digital health literacy. Poor health status was found to be associated with low digital health literacy.
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Affiliation(s)
- H Zeeb
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
- Health Sciences Bremen, Bremen, Germany
| | - H Pohlabeln
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
| | - A Preising
- AOK Rheinland Hamburg, Düsseldorf, Germany
| | - B Schulz
- AOK Rheinland Hamburg, Düsseldorf, Germany
| | | | - O Dortmann
- AOK Rheinland Hamburg, Düsseldorf, Germany
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Pischke CR, Helmer SM, Pohlabeln H, Muellmann S, Schneider S, Reintjes R, Schmidt-Pokrzywniak A, Girbig M, Krämer A, Icks A, Walter U, Zeeb H. Effects of a Brief Web-Based "Social Norms"-Intervention on Alcohol, Tobacco and Cannabis Use Among German University Students: Results of a Cluster-Controlled Trial Conducted at Eight Universities. Front Public Health 2021; 9:659875. [PMID: 34055723 PMCID: PMC8160121 DOI: 10.3389/fpubh.2021.659875] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 04/12/2021] [Indexed: 11/13/2022] Open
Abstract
Background and Aim: "Social norms" (SN)-interventions are aimed at changing existing misperceptions regarding peer substance use by providing feedback on actual norms, thereby affecting personal substance use. It is unknown whether SN-intervention effects previously demonstrated in US students can be replicated in German students. The aim of the INSIST-study was to examine the effects of a web-based SN-intervention on substance use. Design: Cluster-controlled trial. Setting: Eight Universities in Germany. Participants and Measurements: Students were recruited at four intervention vs. four delayed intervention control Universities. 4,463 students completed baseline, 1,255 students (59% female) completed both baseline and 5-months follow-up web-based surveys on personal and perceived peer substance use. Intervention participants received feedback contrasting personal and perceived peer use with previously assessed use and perceptions of same-sex, same-university peers. Intervention effects were assessed via multivariable mixed logistic regression models. Findings: Relative to controls, reception of SN-feedback was associated with higher odds for decreased alcohol use (OR: 1.91, 95% CI 1.42-2.56). This effect was most pronounced in students overestimating peer use at baseline and under or accurately estimating it at follow-up (OR: 6.28, 95% CI 2.00-19.8). The OR was 1.33 (95% CI 0.67-2.65) for decreased cannabis use in students at intervention Universities and was statistically significant at 1.70 (95% CI 1.13-2.55) when contrasting unchanged and decreased with increased use. Regarding tobacco use and episodes of drunkenness, no intervention effects were found. Conclusions: This study was the first cluster-controlled trial suggesting beneficial effects of web-based SN-intervention on alcohol and cannabis use in a large sample of German University students. Clinical Trial Registration: The trial registration number of the INSIST-study is DRKS00007635 at the "German Clinical Trials Register."
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Affiliation(s)
- C. R. Pischke
- Institute of Medical Sociology, Centre for Health and Society, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - S. M. Helmer
- Institute of Health and Nursing Science, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - H. Pohlabeln
- Department Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
| | - S. Muellmann
- Department Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
| | - S. Schneider
- Mannheim Institute of Public Health, Social and Preventive Medicine, Ruprecht-Karls-University Heidelberg, Mannheim, Germany
| | - R. Reintjes
- Department of Health Sciences, Hamburg University of Applied Sciences, Hamburg, Germany
| | | | - M. Girbig
- Institute and Policlinic of Occupational and Social Medicine, Technical University Dresden, Dresden, Germany
| | - A. Krämer
- Department of Health Sciences, Bielefeld University, Bielefeld, Germany
| | - A. Icks
- Institute for Health Services Research and Health Economics, Centre for Health and Society, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
- Institute for Health Services Research and Health Economics, German Diabetes Center, Düsseldorf, Germany
| | - U. Walter
- Institute for Epidemiology, Social Medicine and Health Systems Research, Hannover Medical School, Hanover, Germany
| | - H. Zeeb
- Department Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
- Faculty 11 Human and Health Sciences, University of Bremen, Health Sciences, Bremen, Germany
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Cheng L, Pohlabeln H, Ahrens W, Russo P, Veidebaum T, Hadjigeorgiou C, Molnár D, Hunsberger M, De Henauw S, Moreno LA, Hebestreit A. Cross-sectional and longitudinal associations between sleep duration, sleep quality, and bone stiffness in European children and adolescents. Osteoporos Int 2021; 32:853-863. [PMID: 33245373 PMCID: PMC8043938 DOI: 10.1007/s00198-020-05753-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 11/18/2020] [Indexed: 11/25/2022]
Abstract
UNLABELLED In this large perspective cohort among European children and adolescents, we observed that daytime napping was positively associated with bone stiffness, while short or long sleep duration combined with poor sleep quality was associated with less bone stiffness. Our findings are important for obtaining optimal bone stiffness in childhood. INTRODUCTION To examine the cross-sectional and longitudinal associations between sleep duration, sleep quality, and bone stiffness index (SI) in European children and adolescents. METHODS Four thousand eight hundred seventy-one children aged 2-11 years from the IDEFICS study and 861 children aged 6-15 years from the subsequent I.Family study were included. Sleep duration (i.e., nocturnal sleep and daytime napping) and sleep quality (i.e., irregularly bedtime routine, have difficulty falling asleep and trouble getting up in the morning) were reported by self-administrated questionnaires. Nocturnal sleep duration was converted into age-specific z-scores, and total sleep duration was classified into short, adequate, and long based on the National Sleep Recommendation. Calcaneal SI of both feet were measured using quantitative ultrasound. Linear mixed-effects models with country as a random effect were used, with adjustments for sex, age, pubertal status, family socioeconomic status, physical activity, screen time, body mass index, and daylight duration. RESULTS Nocturnal sleep duration z-scores were positively associated with SI percentiles among participants with adequate sleep duration at baseline. Moreover, the positive association between daytime napping and SI percentiles was more pronounced in participants with adequate sleep duration at baseline, while at 4-year follow-up was more pronounced in participants with short sleep duration. In addition, extreme sleep duration at baseline predicted lower SI percentiles after 4 years in participants with poor sleep quality. CONCLUSION The positive associations between nocturnal sleep, daytime napping and SI depended on total sleep duration. Long-term detrimental effect of extreme sleep duration on SI only existed in individuals with poor sleep quality.
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Affiliation(s)
- L Cheng
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Achterstraße 30, 28359, Bremen, Germany
- Faculty of Mathematics and Computer Science, University of Bremen, Bremen, Germany
| | - H Pohlabeln
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Achterstraße 30, 28359, Bremen, Germany
| | - W Ahrens
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Achterstraße 30, 28359, Bremen, Germany
- Faculty of Mathematics and Computer Science, University of Bremen, Bremen, Germany
| | - P Russo
- Institute of Food Sciences, National Research Council, Avellino, Italy
| | - T Veidebaum
- Department of Chronic Diseases, National Institute for Health Development, Tallinn, Estonia
| | - C Hadjigeorgiou
- Research and Education Institute of Child Health, Strovolos, Cyprus
| | - D Molnár
- Department of Pediatrics, Medical School, University of Pécs, Pécs, Hungary
| | - M Hunsberger
- Section for Epidemiology and Social Medicine (EPSO), The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - S De Henauw
- Department of Public Health, Ghent University, 9000, Ghent, Belgium
| | - L A Moreno
- GENUD (Growth, Exercise, Nutrition and Development) Research Group, Instituto Agroalimentario de Aragón (IA2), Instituto de Investigación Sanitaria Aragón (IIS Aragón), Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y Nutrición (CIBERObn), University of Zaragoza, 50009, Zaragoza, Spain
| | - A Hebestreit
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Achterstraße 30, 28359, Bremen, Germany.
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Shams A, Winkler V, Pohlabeln H, Arndt V, Haug U. Effect of Population-Wide Hepatitis B Vaccination in Preventing Liver Cancer Among Children and Young Adults in the United States. J Glob Oncol 2018. [DOI: 10.1200/jgo.18.73700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: Liver cancer is the second most common cause of death from cancer worldwide1. In 2013, 79,2000 new cases of liver cancer and 818,000 deaths occurred globally2,3. Chronic infection with HBV accounts for at least 50% of liver cancer globally4. In the United States (US), liver cancer constitute the ninth leading cause of cancer death. The incidence of the cancer has persistently increased in the recent decades. Universal HBV vaccination was introduced in 1992 in the US. However, incidence trends of liver cancer among US children is poorly researched or relevant studies are not up-to-date5. Aim: This study aims to explore the effect of HBV population-wide vaccination program in reducing liver cancer incidence in the vaccinated children and adolescents in the US. Methods: Liver cancer incidence data were obtained from Cancer Incidence in Five Continents (CI5) databases (volumes I to X) from International Agency for Cancer Research (IARC). Data acquisition and analysis covered available incidence data between 1978-2007 from 9 cancer registries from Surveillance, Epidemiology, and End Results Program (SEER) from the US presented in the CI5 databases. Age-specific incidence rates of liver cancer (based on 5 year age groups ie 5-9 year, 10-14 year and 15-19 years) were calculated using age and sex-disaggregated incidence and population data from the SEER cancer registries. Stata software version 14.0 (StataCorp, USA) was used to calculate age-specific incidence rates, using number of liver cancer incident cases in each age group by the number of population in the respective age group. Age-specific rates were analyzed by period of diagnosis and by birth year. Rate ratios were estimated from age-group-specific Poisson regressions. Results: A total of 140 liver cancer incident cases were registered in the 9 SEER registries between 1978 to 2007 in the US. The incidence rate of liver cancer in children 5 to 9 years of age from 1978-1982 was 0.10 per 100,000 children. The incidence increased to 0.16 for the period from 2003-2007. The same trend is seen for the age group 10-14 and 15-19 years of age. Overall, age-specific incidence rates for liver cancer increased across age groups of 5-9, 10-14 and 15-19 year in the population covered by the 9 SEER registries in the US. However, risk estimates (incidence rate ratios, resulted from age-group-specific Poisson regressions did not show statistical significant effects. Conclusion: While the global response to implement population-wide HBV vaccination program is out of question, efforts to establish processes to evaluate the effect of such programs seems to be incomparably limited. Estimating the effect of HBV vaccination will relatively improve with time as further incidence data become available eg upon publication of data from new volume of CI5 databases.
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Affiliation(s)
- A.Z. Shams
- German Cancer Research Centre (DKFZ), Heidelberg, Germany
| | - V. Winkler
- Heidelberg Institute of Public Health, Heidelberg, Germany
| | - H. Pohlabeln
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
| | - V. Arndt
- German Cancer Research Centre (DKFZ), Heidelberg, Germany
| | - U. Haug
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
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Pohlabeln H, Lemb M. Pulmonary thromboembolism: a retrospective study on the examination of 991 patients by ventilation/perfusion SPECT using Technegas. Nuklearmedizin 2018. [DOI: 10.1055/s-0038-1625760] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
SummaryPurpose: Conventional planar ventilation/perfusion (V/P)- imaging in those patients suspected of suffering from pulmonary thromboembolism (PTE) is of limited diagnostic value. It is the purpose of this retrospective study to determine whether the use of V/P- SPECT using Technegas might reduce the rate of those diagnostic uncertainties and might lead to better results. Methods: 991 patients (660 female, 331 male, age 18-90, mean 60), referred to our laboratory with suspected PTE, were examined as follows: patients inhaled 37 MBq of Technegas in the supine position and a SPECT-acquisition was started. Following SPECT-completion, 185 MBq 99mTc-MAA was injected intravenously. SPECT was then repeated. Coronal and transverse ventilation and perfusion SPECT-slices were reconstructed and compared section by section. 85 patients underwent control scans by the same technique at a mean interval of 22 months after the original scans. Results: As the SPECT images in almost all cases made a clear match/mismatch decision possible, we categorized all patients as embolic (PTE+) if there was at least one mismatching defect, and as non embolic (PTE-) if there were none. Our results were: PTE +: 178 patients (18%), PTE-: 808 patients (81%), uncertain: 5 patients (0.5%), if 34 triple-match defects are included: 39 patients (3.9%). 46 patients, categorized as PΪE+ underwent a control V/P scan after anticoagulant therapy. In 44 of these patients, PTE was confirmed by the controls. In a control group of 39 PTE- patients, control scans were unchanged in 38 cases. From these observations we can calculate a sensitivity of 96% and a specificity of 97%. Conclusion: We conclude that V/P imaging can be improved significantly by V/P SPECT using Technegas.
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Ahrens W, Siani A, Adan R, De Henauw S, Eiben G, Gwozdz W, Hebestreit A, Hunsberger M, Kaprio J, Krogh V, Lissner L, Molnár D, Moreno LA, Page A, Picó C, Reisch L, Smith RM, Tornaritis M, Veidebaum T, Williams G, Pohlabeln H, Pigeot I. Cohort Profile: The transition from childhood to adolescence in European children-how I.Family extends the IDEFICS cohort. Int J Epidemiol 2017; 46:1394-1395j. [PMID: 28040744 PMCID: PMC5837508 DOI: 10.1093/ije/dyw317] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/06/2016] [Indexed: 02/07/2023] Open
Affiliation(s)
- W Ahrens
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
- Institute of Statistics, Bremen University, Bremen, Germany
| | - A Siani
- Institute of Food Sciences, National Research Council, Avellino, Italy
| | - R Adan
- Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - S De Henauw
- Department of Public Health, Ghent University, Ghent, Belgium
| | - G Eiben
- Section for Epidemiology and Social Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - W Gwozdz
- Department of Intercultural Communication and Management, Copenhagen Business School, Copenhagen, Denmark
| | - A Hebestreit
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
| | - M Hunsberger
- Section for Epidemiology and Social Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - J Kaprio
- Department of Public Health, University of Helsinki, Institute for Molecular Medicine (FIMM), Helsinki, Finland
| | - V Krogh
- Epidemiology and Prevention Unit, Fondazione IRCSS Istituto Nazionale dei Tumori, Milan, Italy
| | - L Lissner
- Section for Epidemiology and Social Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - D Molnár
- Department of Paediatrics, University of Pécs, Pécs, Hungary
| | - L A Moreno
- GENUD (Growth, Exercise, Nutrition and Development) Research Group, University of Zaragoza, Zaragoza, Spain
| | - A Page
- Centre for Exercise, Nutrition & Health Sciences, University of Bristol, Bristol, UK
| | - C Picó
- Laboratory of Molecular Biology, Nutrition and Biotechnology (Nutrigenomics), University of the Balearic Islands (UIB) and CIBER Fisiopatología de la Obesidad y Nutrición, Palma de Mallorca, Spain
| | - L Reisch
- Department of Intercultural Communication and Management, Copenhagen Business School, Copenhagen, Denmark
| | - R M Smith
- Minerva Communications UK, Andover, UK
| | - M Tornaritis
- Research and Education Institute of Child Health, Strovolos, Cyprus
| | - T Veidebaum
- National Institute for Health Development, Tallinn, Estonia and
| | - G Williams
- Department of Politics, Philosophy and Religion, Lancaster University, Lancaster, UK
| | - H Pohlabeln
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
| | - I Pigeot
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
- Institute of Statistics, Bremen University, Bremen, Germany
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Schmucker J, Seide S, Wienbergen H, Fiehn E, Stehmeier J, Günther K, Ahrens W, Hambrecht R, Pohlabeln H, Fach A. Socially disadvantaged city districts show a higher incidence of acute ST-elevation myocardial infarctions with elevated cardiovascular risk factors and worse prognosis. BMC Cardiovasc Disord 2017; 17:254. [PMID: 28938873 PMCID: PMC5610462 DOI: 10.1186/s12872-017-0683-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Accepted: 09/11/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The importance of socioeconomic status (SES) for coronary heart disease (CHD)-morbidity is subject of ongoing scientific investigations. This study was to explore the association between SES in different city-districts of Bremen/Germany and incidence, severity, treatment modalities and prognosis for patients with ST-elevation myocardial infarctions (STEMI). METHODS Since 2006 all STEMI-patients from the metropolitan area of Bremen are documented in the Bremen STEMI-registry. Utilizing postal codes of their home address they were assigned to four groups in accordance to the Bremen social deprivation-index (G1: high, G2: intermediate high, G3: intermediate low, G4: low socioeconomic status). RESULTS Three thousand four hundred sixty-two consecutive patients with STEMI admitted between 2006 and 2015 entered analysis. City areas with low SES showed higher adjusted STEMI-incidence-rates (IR-ratio 1.56, G4 vs. G1). This elevation could be observed in both sexes (women IRR 1.63, men IRR 1.54) and was most prominent in inhabitants <50 yrs. of age (women IRR 2.18, men IRR 2.17). Smoking (OR 1.7, 95%CI 1.3-2.4) and obesity (1.6, 95%CI 1.1-2.2) was more prevalent in pts. from low SES city-areas. While treatment-modalities did not differ, low SES was associated with more extensive STEMIs (creatine kinase > 3000 U/l, OR 1.95, 95% CI 1.4-2.8) and severe impairment of LV-function post-STEMI (OR 2.0, 95% CI 1.2-3.4). Long term follow-up revealed that lower SES was associated with higher major adverse cardiac or cerebrovascular event (MACCE)-rates after 5 years: G1 30.8%, G2 35.7%, G3 36.0%, G4 41.1%, p (for trend) = 0.02. This worse prognosis could especially be shown for young STEMI-patients (<50 yrs. of age) 5-yr. mortality-rates(G4 vs. G1) 18.4 vs. 3.1%, p = 0.03 and 5-year-MACCE-rates (G4 vs. G1) 32 vs. 6.3%, p = 0.02. CONCLUSIONS This registry-data confirms the negative association of low socioeconomic status and STEMI-incidence, with higher rates of smoking and obesity, more extensive infarctions and worse prognosis for the socio-economically deprived.
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Affiliation(s)
- J Schmucker
- The Bremer Institut für Herz- und Kreislaufforschung (BIHKF) am Klinikum Links der Weser, Bremen, Germany.
| | - S Seide
- The Bremer Institut für Herz- und Kreislaufforschung (BIHKF) am Klinikum Links der Weser, Bremen, Germany
| | - H Wienbergen
- The Bremer Institut für Herz- und Kreislaufforschung (BIHKF) am Klinikum Links der Weser, Bremen, Germany
| | - E Fiehn
- The Bremer Institut für Herz- und Kreislaufforschung (BIHKF) am Klinikum Links der Weser, Bremen, Germany
| | - J Stehmeier
- The Bremer Institut für Herz- und Kreislaufforschung (BIHKF) am Klinikum Links der Weser, Bremen, Germany
| | - K Günther
- The Leibniz-Institut für Präventionsforschung und Epidemiologie Bremen - BIPS, Bremen, Germany
| | - W Ahrens
- The Leibniz-Institut für Präventionsforschung und Epidemiologie Bremen - BIPS, Bremen, Germany
| | - R Hambrecht
- The Bremer Institut für Herz- und Kreislaufforschung (BIHKF) am Klinikum Links der Weser, Bremen, Germany
| | - H Pohlabeln
- The Leibniz-Institut für Präventionsforschung und Epidemiologie Bremen - BIPS, Bremen, Germany
| | - A Fach
- The Bremer Institut für Herz- und Kreislaufforschung (BIHKF) am Klinikum Links der Weser, Bremen, Germany
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Kovács E, Hunsberger M, Reisch L, Gwozdz W, Eiben G, De Bourdeaudhuij I, Russo P, Veidebaum T, Hadjigeorgiou C, Sieri S, Moreno LA, Pigeot I, Ahrens W, Pohlabeln H, Molnár D. Adherence to combined lifestyle factors and their contribution to obesity in the IDEFICS study. Obes Rev 2015; 16 Suppl 2:138-50. [PMID: 26707023 DOI: 10.1111/obr.12349] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Accepted: 09/25/2015] [Indexed: 12/17/2022]
Abstract
BACKGROUND The Identification and prevention of Dietary- and lifestyle-induced health EFfects In Children and infantS (IDEFICS) study investigated the aetiology of childhood obesity and developed a primary prevention programme. METHODS Pre-intervention adherence to key behaviours related to childhood obesity, namely water/sweetened drink, fruit/vegetable consumption, daily TV time, physical activity, family time and adequate sleep duration, was measured at baseline. Adherence to international recommendations was converted into a composite score ranging from 0 (none) to 6 (adhering to all). Data on adherence were available for 7,444 to 15,084 children aged 2-9.9 years, depending on the behaviour. By means of multi-level logistic regression models adjusted for age, sex and country, we calculated odds ratios (OR) and 95% confidence intervals (CI) to estimate the relationship between adherence to these recommendations and the risk of being overweight/obese. RESULTS Adherence ranged from 15.0% (physical activity) to 51.9% (TV time). As adherence increased, a lower chance of being overweight/obese was observed; adhering to only one key behaviour (score = 1) meant an OR = 0.81 (CI: 0.65-1.01) compared with non-adherence (score = 0), while adhering to more than half of the key behaviours (score ≥ 4) halved the chance for overweight/obesity (OR = 0.54, CI: 0.37-0.80). Adherence to physical activity, TV and sleep recommendations was the main driver reducing the chance of being overweight. Overweight/obese children were more likely not to adhere to at least one of the recommended behaviours (19.8%) than normal-weight/thin children (12.9%) CONCLUSION The selected key behaviours do not contribute equally to a reduced chance of being overweight. Future interventions may benefit most from moving more, reducing TV time and getting adequate sleep.
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Affiliation(s)
- E Kovács
- Department of Paediatrics, Medical Faculty, University of Pécs, Pécs, Hungary.,Institute for Medical Information Processing Biometrics and Epidemiology, German Centre for Vertigo and Balance Disorders, Ludwig Maximilian University, Munich, Germany
| | - M Hunsberger
- Section for Epidemiology and Social Medicine, University of Gothenburg, Gothenburg, Sweden
| | - L Reisch
- Department of Intercultural Communication and Management, Copenhagen Business School, Copenhagen, Denmark
| | - W Gwozdz
- Department of Intercultural Communication and Management, Copenhagen Business School, Copenhagen, Denmark
| | - G Eiben
- Section for Epidemiology and Social Medicine, University of Gothenburg, Gothenburg, Sweden
| | - I De Bourdeaudhuij
- Department of Movement and Sport Sciences, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - P Russo
- Unit of Epidemiology and Population Genetics, Institute of Food Sciences, National Research Council, Avellino, Italy
| | - T Veidebaum
- National Institute for Health Development, Tallinn, Estonia
| | - C Hadjigeorgiou
- Research and Education Institute of Child Health, Strovolos, Cyprus
| | - S Sieri
- Department of Preventive and Predictive Medicine, Nutritional Epidemiology Unit, National Tumor Institute, Milan, Italy
| | - L A Moreno
- GENUD (Growth, Exercise, Nutrition and Development) Research Group, University of Zaragoza, Zaragoza, Spain
| | - I Pigeot
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany.,Institute of Statistics, Faculty of Mathematics and Computer Science, University Bremen, Bremen, Germany
| | - W Ahrens
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany.,Institute of Statistics, Faculty of Mathematics and Computer Science, University Bremen, Bremen, Germany
| | - H Pohlabeln
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
| | - D Molnár
- Department of Paediatrics, Medical Faculty, University of Pécs, Pécs, Hungary
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Nicholls SG, Pohlabeln H, De Bourdeaudhuij I, Chadjigeorgiou C, Gwozdz W, Hebestreit A, Lauria F, Lissner L, Molnár D, Santaliestra-Pasías AM, Veidebaum T, Williams G. Parents' evaluation of the IDEFICS intervention: an analysis focussing on socio-economic factors, child's weight status and intervention exposure. Obes Rev 2015; 16 Suppl 2:103-18. [PMID: 26707020 DOI: 10.1111/obr.12332] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Revised: 09/08/2015] [Accepted: 09/08/2015] [Indexed: 11/28/2022]
Abstract
INTRODUCTION From April 2008 to August 2010 the Identification and prevention of Dietary- and lifestyle-induced health EFfects In Children and infantS (IDEFICS) intervention aimed to encourage healthier diets, higher physical activity levels and lower stress levels among European children and their families. While the intervention was intended to improve children's health, we also wished to assess whether there were unwelcome aspects or negative side-effects. Therefore all parents of children who participated in the IDEFICS intervention were asked for their views on different aspects of the intervention. METHODS A total of 10,016 parents of children who participated in the IDEFICS survey and who were involved in the intervention were invited to complete a questionnaire on positive and negative impacts of the intervention. Responses to each of the statements were coded on a four point Likert-type scale. Demographic data were collected as part of the baseline (T0 ) and first follow-up (T1 ) surveys; intervention exposure data was also collected in the T1 follow-up survey. Anthropometric data was collected in the same surveys, and child's weight status was assessed according to Cole and Lobstein. After initial review of the univariate statistics multilevel logistic regression was conducted to analyse the influence of socio-economic factors, child's weight status and intervention exposure on parental responses. RESULTS In total 4,997 responses were received. Approval rates were high, and few parents reported negative effects. Parents who reported higher levels of exposure to the intervention were more likely to approve of it and were also no more likely to notice negative aspects. Less-educated and lower income parents were more likely to report that the intervention would make a lasting positive difference, but also more likely to report that the intervention had had negative effects. Parents of overweight and obese children were more likely to report negative effects - above all, that 'the intervention had made their child feel as if he/she was "fat" or "overweight." ' CONCLUSION While the results represent a broad endorsement of the IDEFICS intervention, they also suggest the importance of vigilance concerning the psychological effects of obesity interventions on overweight and obese children.
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Affiliation(s)
- S G Nicholls
- School of Epidemiology, Public Health and Preventive Medicine, Faculty of Medicine, University of Ottawa, Ontario, Canada.,Children's Hospital of Eastern Ontario (CHEO) Research Institute, Ottawa, Ontario, Canada
| | - H Pohlabeln
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
| | - I De Bourdeaudhuij
- Department of Movement and Sport Sciences, Faculty of Medicine and Health Sciences, Ghent University, Belgium
| | - C Chadjigeorgiou
- Research and Education Institute of Child Health, Strovolos, Cyprus
| | - W Gwozdz
- Department of Intercultural Communication and Management, Copenhagen Business School, Denmark
| | - A Hebestreit
- Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
| | - F Lauria
- Institute of Food Sciences, National Research Council, Avellino, Italy
| | - L Lissner
- Section for Epidemiology and Social Medicine (EPSO), Institute of Medicine, University of Gothenburg, Sweden
| | - D Molnár
- Department of Paediatrics, University of Pécs, Hungary
| | - A M Santaliestra-Pasías
- GENUD (Growth, Exercise, NUtrition and Development) Research Group, University of Zaragoza, Spain; Red de Salud Materno Infantil y del Desarrollo (RED SAMID), Instituto Carlos III, Madrid, Spain
| | - T Veidebaum
- National Institute for Health Development, Tallinn, Estonia
| | - G Williams
- Department of Politics, Philosophy and Religion, Lancaster University, UK
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Ahrens W, Moreno LA, Mårild S, Molnár D, Siani A, De Henauw S, Böhmann J, Günther K, Hadjigeorgiou C, Iacoviello L, Lissner L, Veidebaum T, Pohlabeln H, Pigeot I. Metabolic syndrome in young children: definitions and results of the IDEFICS study. Int J Obes (Lond) 2015; 38 Suppl 2:S4-14. [PMID: 25376220 DOI: 10.1038/ijo.2014.130] [Citation(s) in RCA: 193] [Impact Index Per Article: 21.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To estimate the prevalence of the metabolic syndrome (MetS) using reference standards obtained in European children and to develop a quantitative MetS score and describe its distribution in children. DESIGN AND METHODS Population-based survey in eight European countries, including 18745 children 2.0 to 10.9 years, recruited during a second survey. Anthropometry (weight, height and waist circumference), blood pressure and serum-fasting triglycerides, HDL cholesterol, glucose and insulin were measured. We applied three widely accepted definitions of the pediatric MetS and we suggest a new definition, to guide pediatricians in decisions about close monitoring or even intervention (values of at least three of the MetS components exceeding the 90th or 95th percentile, respectively). We used a z-score standardisation to calculate a continuous score combining the MetS components. RESULTS Among the various definitions of MetS, the highest prevalence (5.5%) was obtained with our new definition requiring close observation (monitoring level). Our more conservative definition, requiring pediatric intervention gives a prevalence of 1.8%. In general, prevalences were higher in girls than in boys. The prevalence of metabolic syndrome is highest among obese children. All definitions classify a small percentage of thin or normal weight children as being affected. The metabolic syndrome score shows a positive trend with age, particularly regarding the upper percentiles of the score. CONCLUSIONS According to different definitions of pediatric MetS, a non-negligible proportion of mostly prepubertal children are classified as affected. We propose a new definition of MetS that should improve clinical guidance. The continuous score developed may also serve as a useful tool in pediatric obesity research. It has to be noted, however, that the proposed cutoffs are based on a statistical definition that does not yet allow to quantify the risk of subsequent disease.
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Affiliation(s)
- W Ahrens
- 1] Leibniz Institute for Prevention Research and Epidemiology-BIPS, Bremen, Germany [2] Institute of Statistics, Faculty of Mathematics and Computer Science, Bremen University, Bremen, Germany
| | - L A Moreno
- GENUD (Growth, Exercise, Nutrition and Development) Research Group, University of Zaragoza, Zaragoza, Spain
| | - S Mårild
- Department of Paediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - D Molnár
- Department of Paediatrics, Medical Faculty, University of Pécs, Pécs, Hungary
| | - A Siani
- Institute of Food Sciences, Unit of Epidemiology & Population Genetics, National Research Council, Avellino, Italy
| | - S De Henauw
- Department of Public Health, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - J Böhmann
- Paediatric Clinic Delmenhorst, Delmenhorst, Germany
| | - K Günther
- Leibniz Institute for Prevention Research and Epidemiology-BIPS, Bremen, Germany
| | - C Hadjigeorgiou
- Research and Education Institute of Child Health, Strovolos, Cyprus
| | - L Iacoviello
- Department of Epidemiology and Prevention, Unit of Molecular and Nutritional Epidemiology, IRCCS Istituto Neurologico Mediterraneo Neuromed, Pozzilli, Italy
| | - L Lissner
- Department of Public Health and Community Medicine, University of Gothenburg, Gothenburg, Sweden
| | - T Veidebaum
- National Institute for Health Development, Tallinn, Estonia
| | - H Pohlabeln
- Leibniz Institute for Prevention Research and Epidemiology-BIPS, Bremen, Germany
| | - I Pigeot
- 1] Leibniz Institute for Prevention Research and Epidemiology-BIPS, Bremen, Germany [2] Institute of Statistics, Faculty of Mathematics and Computer Science, Bremen University, Bremen, Germany
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Kovacs E, Pohlabeln H, Ahrens W, Molnar D. Differences in adherence to the obesity-related lifestyle intervention targets in the metabolically unhealthy population of the IDEFICS study. Appetite 2015. [DOI: 10.1016/j.appet.2014.12.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Kovács E, Siani A, Konstabel K, Hadjigeorgiou C, de Bourdeaudhuij I, Eiben G, Lissner L, Gwozdz W, Reisch L, Pala V, Moreno LA, Pigeot I, Pohlabeln H, Ahrens W, Molnár D. Adherence to the obesity-related lifestyle intervention targets in the IDEFICS study. Int J Obes (Lond) 2014; 38 Suppl 2:S144-51. [PMID: 25376216 PMCID: PMC4165864 DOI: 10.1038/ijo.2014.145] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND/OBJECTIVES To address behaviours associated with childhood obesity, certain target values are recommended that should be met to improve children's health. In the IDEFICS (Identification and prevention of Dietary- and lifestyle-induced health Effects in Children and infantS) study such lifestyle recommendations were conveyed as six key messages. Here, we investigate the adherence of European children to these messages. METHODS The IDEFICS intervention was based on the intervention mapping approach with the following six targets: increase water consumption (to replace sugar-containing beverages), increase fruit/vegetable consumption, reduce daily screen time, increase daily physical activity, improve the quality of family life and ensure adequate sleep duration. Internationally recommended target values were applied to determine the prevalence of children meeting these targets. RESULTS In a cohort of 18,745 children participating in the IDEFICS baseline survey or newly recruited during follow-up, data on the above lifestyle behaviours were collected for a varying number of 8302 to 17,212 children. Information on all six behaviours was available for 5140 children. Although 52.5% of the cohort was classified in the highest category of water consumption, only 8.8% met the target of an intake of fruits/vegetables five times a day. The prevalence of children adhering to the recommendation regarding total screen time-below 1 h for pre-school children and 2 h for school children-was 51.1%. The recommended amount of at least 60 min of moderate-to-vigorous physical activity per day was fulfilled by 15.2%. Family life of the child measured by various indicators was considered as satisfactory in 22.8%. Nocturnal sleep duration of 11 (10) hours or more in pre-school (school) children was achieved by 37.9%. In general, children in northern countries and younger children showed better adherence to the recommendations. Only 1.1% of the children adhered to at least five of these recommendations. CONCLUSIONS Current adherence of children to lifestyle recommendations to prevent childhood obesity is low where observed differences with respect to country, age and gender call for targeted intervention.
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Affiliation(s)
- E Kovács
- Department of Paediatrics, Medical Faculty, University of Pécs, Pécs, Hungary
| | - A Siani
- Unit of Epidemiology and Population Genetics, Institute of Food Sciences, National Research Council, Avellino, Italy
| | - K Konstabel
- National Institute for Health Development, Tallinn, Estonia
| | - C Hadjigeorgiou
- Research and Education Institute of Child Health, Strovolos, Cyprus
| | - I de Bourdeaudhuij
- Department of Movement and Sports Sciences, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - G Eiben
- Department of Public Health and Community Medicine, University of Gothenburg, Gothenburg, Sweden
| | - L Lissner
- Department of Public Health and Community Medicine, University of Gothenburg, Gothenburg, Sweden
| | - W Gwozdz
- Department of Intercultural Communication and Management, Copenhagen Business School, Frederiksberg, Denmark
| | - L Reisch
- Department of Intercultural Communication and Management, Copenhagen Business School, Frederiksberg, Denmark
| | - V Pala
- Department of Preventive and Predictive Medicine, Epidemiology and Prevention Unit, National Tumor Institute, Milan, Italy
| | - L A Moreno
- GENUD (Growth, Exercise, Nutrition and Development) Research Group, University of Zaragoza, Zaragoza, Spain
| | - I Pigeot
- Leibniz Institute for Prevention Research and Epidemiology—BIPS, Bremen, Germany
- Institute of Statistics, Faculty of Mathematics and Computer Science, University Bremen, Bremen, Germany
| | - H Pohlabeln
- Leibniz Institute for Prevention Research and Epidemiology—BIPS, Bremen, Germany
| | - W Ahrens
- Leibniz Institute for Prevention Research and Epidemiology—BIPS, Bremen, Germany
- Institute of Statistics, Faculty of Mathematics and Computer Science, University Bremen, Bremen, Germany
| | - D Molnár
- Department of Paediatrics, Medical Faculty, University of Pécs, Pécs, Hungary
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Pelz I, Pohlabeln H, Reineke A, Ahrens W. [External quality assurance of the first wave of the German Health Interview and Examination Survey for Adults (DEGS1)]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2013; 56:637-42. [PMID: 23703480 DOI: 10.1007/s00103-013-1685-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The quality management concept for the first wave of the German Health Interview and Examination Survey for Adults (DEGS1) included in addition to conducting internal quality assurance (QS) also the supervision by an external independent institute. After a restricted tendering procedure, the Leibniz Institute for Prevention Research and Epidemiology-BIPS was commissioned to conduct the external quality assurance. The external quality control included the review of the operation manuals, the training of the field staff, the execution of field work (including measurements), and the monitoring of sampling, response and data management. For the realization of the controls in these areas, test criteria were developed to reveal shortcomings early and to give recommendations for the internal quality assurance. This paper briefly describes the concept and the execution of the accompanying external quality assurance with regard to the above mentioned areas. An English full-text version of this article is available at SpringerLink as supplemental.
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Affiliation(s)
- I Pelz
- Leibniz-Institut für Präventionsforschung und Epidemiologie, BIPS GmbH, Achterstr. 30, 28395 Bremen, Deutschland
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Pohlabeln H, Jacobs S, Böhmann J. [A birth cohort study on allergic diseases among toddlers in Northwest Germany]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2012; 55:858-63. [PMID: 22736168 DOI: 10.1007/s00103-012-1489-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
In the late 1990s, a birth cohort study was conducted in the cities of Delmenhorst, Wilhelmshaven and Leer, where more than 3,000 newborn children were recruited in five hospitals. The baseline survey in the clinics was followed by three follow-up surveys 6, 12 and 24 months later. The prime concern of the study was to estimate prevalences and to conduct analyses concerning the association between breastfeeding as well as exposure to pets and the occurrence of allergy symptoms. Children living together with a dog in the same household were at higher risk of disease only if a familial predisposition of allergic diseases was present - without such a familial predisposition a dog in the same household seems to reduce the risk for atopic diseases during the first 2 years of life. A protective effect due to long breastfeeding could be observed in our study in particular in case of a paternal history of allergic diseases, whereas an exclusive maternal history of allergic diseases seems to increase the risk. The concept of the study has proved itself. Contacting mothers in obstetrical departments in hospitals as well as in medical offices of self-employed pediatricians has proven to be very practicable. With comparatively little effort a relatively large cohort was recruited, which allowed us to analyze longitudinal data, adequately taking into account several confounders as well as effect-modifying factors.
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Affiliation(s)
- H Pohlabeln
- BIPS - Institut für Epidemiologie und Präventionsforschung, Achterstr. 30, 28359, Bremen, Deutschland.
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Bauer NH, Schücking BA, Pohlabeln H, zu Sayn-Wittgenstein F. Der Hebammenkreißsaal – Ein klinisches Versorgungskonzept zur Förderung der physiologischen Geburt. Z Geburtshilfe Neonatol 2011. [DOI: 10.1055/s-0031-1293234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
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Peters S, Kromhout H, Olsson A, Wuchmann HE, Bruske I, Consonni D, Landi MT, Caporaso N, Siemiatycki J, Richiardi L, Mirabelli D, Simonato L, Gustavsson P, Plato N, Jockel KH, Ahrens W, Pohlabeln H, Boffetta P, Brennan P, Zaridze D, Cassidy A, Lissowska J, Szeszenia-Dabrowska N, Rudnai P, Fabianova E, Forastiere F, Bencko V, Foretova L, Janout V, Stucker I, Dumitru RS, Benhamou S, Bueno-de-Mesquita B, Kendzia B, Pesch B, Straif K, Bruning T, Vermeulen R. Occupational exposure to organic dust increases lung cancer risk in the general population. Occup Environ Med 2011. [DOI: 10.1136/oemed-2011-100382.151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Macfarlane TV, Macfarlane GJ, Thakker NS, Benhamou S, Bouchardy C, Ahrens W, Pohlabeln H, Lagiou P, Lagiou A, Castellsague X, Agudo A, Slamova A, Plzak J, Merletti F, Richiardi L, Talamini R, Barzan L, Kjaerheim K, Canova C, Simonato L, Conway DI, McKinney PA, Thomson P, Sloan P, Znaor A, Healy CM, McCartan BE, Marron M, Brennan P. Role of medical history and medication use in the aetiology of upper aerodigestive tract cancers in Europe: the ARCAGE study. Ann Oncol 2011; 23:1053-60. [PMID: 21828376 DOI: 10.1093/annonc/mdr335] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND The study aimed to investigate the role of medical history (skin warts, Candida albicans, herpetic lesions, heartburn, regurgitation) and medication use (for heartburn; for regurgitation; aspirin) in the aetiology of upper aerodigestive tract (UADT) cancer. METHODS A multicentre (10 European countries) case-control study [Alcohol-Related CAncers and GEnetic susceptibility (ARCAGE) project]. RESULTS There were 1779 cases of UADT cancer and 1993 controls. History of warts or C. albicans infection was associated with a reduced risk [odds ratio (OR) 0.80, 95% confidence interval (CI) 0.68-0.94 and OR 0.73, 95% CI 0.60-0.89, respectively] but there was no association with herpetic lesions, heartburn, regurgitation or medication for related symptoms. Regurgitation was associated with an increased risk for cancer of the oesophagus (OR 1.47, 95% CI 0.98-2.21). Regular aspirin use was not associated with risk of UADT cancer overall but was associated with a reduced risk for cancer of oesophagus (OR 0.51, 95% CI 0.28-0.96), hypopharynx (OR 0.53, 95% CI 0.28-1.02) and larynx (OR 0.74, 95% CI 0.54-1.01). CONCLUSIONS A history of some infections appears to be a marker for decreased risk of UADT cancer. The role of medical history and medication use varied by UADT subsites with aspirin use associated with a decreased risk of oesophageal cancer and suggestive of a decreased risk of hypopharyngeal and laryngeal cancers.
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Affiliation(s)
- T V Macfarlane
- School of Medicine and Dentistry, University of Aberdeen, Aberdeen, UK.
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Hebestreit A, Pischke C, Gallois KM, Pohlabeln H. Mehr Obst! Weniger Fernsehen! Erste Ergebnisse der deutschen IDEFICS Intervention zur Kooperation zwischen Eltern und Grundschulen/Kindertagestätten. Gesundheitswesen 2011. [DOI: 10.1055/s-0031-1283477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Hense S, De Henauw S, Eiben G, Molnar D, Moreno LA, Barba G, Hadjigeorgiou C, Veidebaum T, Pohlabeln H, Ahrens W. SP6-13 Sleep duration and overweight in European children: is the association modified by geographic region? Br J Soc Med 2011. [DOI: 10.1136/jech.2011.142976p.84] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Foraita R, Pohlabeln H, Ahrens W. Different interaction concepts to detect gene-environment interactions in the context of upper aero-digestive tract cancer. Gesundheitswesen 2011. [DOI: 10.1055/s-0031-1283453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Kendzia B, Gustavsson P, Pohlabeln H, Ahrens W, Jöckel K, Olsson A, Gross I, Brüske I, Wichmann H, Merletti F, Mirabelli D, Boffetta P, Straif K, Brüning T, Pesch B. Cigarette smoking and lung cancer – Risk estimates for the major histological types from a pooled analysis of European case-control studies. Gesundheitswesen 2010. [DOI: 10.1055/s-0030-1266688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Pohlabeln H, Mühlenbruch K, Jacobs S, Böhmann H. Frequency of allergic diseases in 2-year-old children in relationship to parental history of allergy and breastfeeding. J Investig Allergol Clin Immunol 2010; 20:195-200. [PMID: 20635784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023] Open
Abstract
BACKGROUND The association between breastfeeding and the risk of atopic diseases in children is controversial. While some studies support the theory of a decreased risk of asthma and allergic diseases due to breastfeeding, others have failed to confirm such a protective effect, and even suggest increased risk. The aim of this longitudinal study was to investigate the association between breastfeeding and the prevalence of atopic diseases in 2-year-old children. METHODS Data on 1685 children from a birth cohort were collected from questionnaires completed by parents at birth and at 6, 12, and 24 months. By means of logistic regression and considering confounders such as family history and socioeconomic status, we analyzed the association between exclusive breastfeeding and the development of allergic reactions in 2-year-old children. RESULTS Exclusive breastfeeding for >4 months was associated with an increased risk of asthma and atopic dermatitis in children without a parental history of allergic diseases (odds ratio [OR] = 1.62; 95% confidence interval [Cl], 1.02-2.56). Children whose fathers only had a history of allergic disease strongly benefited from exclusive breastfeeding for >4 months (OR = 0.39; 95%-CI: 0.18-0.83) whereas those whose mothers only had such a history had an increased risk of asthma and atopic dermatitis (OR: 2.31; 95%-CI: 1.16-4.60). CONCLUSION In children with a family history of allergy, it seems to be important to distinguish between maternal and paternal predisposition as children whose fathers have a history of atopic disease seem to benefit most from breastfeeding for >4 months.
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Affiliation(s)
- H Pohlabeln
- Bremen Institute for Prevention Research and Social Medicine, Bremen, Germany
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Jahn I, Hebestreit A, Pohlabeln H, Ahrens W. Untersuchung ernährungsbezogener Präventionsangebote in Kitas im Land Bremen – ein Evaluationsprojekt. Gesundheitswesen 2009. [DOI: 10.1055/s-0029-1239067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Marron M, Boffetta P, Ahrens W, Pohlabeln H, Benhamou S, Bouchardy C, Lagiou P, Georgila C, Bencko V, Holcátová I, Merletti F, Richiardi L, Kjaerheim K, Agudo A, Castellsague X, Macfarlane T, Macfarlane G, Talamini R, Barzan L, Canova C, Simonato L, Lowry R, Conway D, McKinney P, Znaor A, Healy C, McCartan B, Møller H, Brennan P, Hashibe M. Alcohol drinking and the risk of upper aero digestive tract cancer: European multicenter case-control study ARCAGE. EJC Suppl 2008. [DOI: 10.1016/s1359-6349(08)71862-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Giersiepen K, Pohlabeln H, Egidi G, Pigeot I. Die ICD-Kodierqualität für Diagnosen in der ambulanten Versorgung. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2007; 50:1028-38. [PMID: 17676417 DOI: 10.1007/s00103-007-0297-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The ICD-coding quality for outpatients' diagnoses by German physicians was analysed in a sample of five million members of the German Statutary Health Insurance System. New federal legislation coming into effect in 2009 for the reimbursement of physicians is based on patients' morbidity risks and thus on the quality of a provider's ICD coding. A sample of physicians' billing data for 2001-2003 containing ICD codes for patients' morbidity and the billed services was linked with outpatients' prescription data for the time period 2002- 2003. As in 2001-2003 information on the certainty of diagnosis was not yet mandatory, only 7.4% of all diagnoses were labelled as either "suspected diagnosis", "excluded diagnosis" or "history of diagnosis", hampering coding validity measurements. Chronic disease persisted in the time window analysed showing only minor successive prevalence decreases after an initial dip of at least 6% in the calendar term following the index term. The immediate decrease following the initial term may be due to initially suspected disease not confirmed until the work up at subsequent visits is completed. The slight downward slope after six months may indicate minor undercoding of chronic diagnoses. Few acute diagnoses persisted for longer than two calendar terms making it unlikely that acute diagnoses were erroneously maintained for repetitive reimbursement. Undercoding of diagnosis was abundant in patients receiving insulin prescriptions, as a diagnosis of diabetes was often missing. Numerous drugs prescribed could not be associated with a corresponding diagnosis coded by physicians. We suggest that before reimbursements to physicians are based on ICD-coded morbidity, a re-analysis of the data should be performed containing information on diagnosis certainty (mandatory since 2004) and the recently updated catalogue on fees for medical procedures provided "Einheitlicher Bewertungsmassstab" (EBM).
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Affiliation(s)
- K Giersiepen
- Bremer Institut für Präventionsforschung und Sozialmedizin, Bremen, Germany.
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Pohlabeln H, Jacobs S, Böhmann J. Exposure to pets and the risk of allergic symptoms during the first 2 years of life. J Investig Allergol Clin Immunol 2007; 17:302-308. [PMID: 17982922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023] Open
Abstract
BACKGROUND Currently, there is a lack of consensus regarding the influence of household pets on the development of allergic diseases in childhood. OBJECTIVE The aim of this birth cohort study was to analyze the relationship between pet ownership at time of birth and the prevalence of atopic diseases approximately 2 years later. METHODS A few days after the delivery of their babies, we asked 3132 mothers of German nationality whether they kept household pets like dogs, cats, or birds. Two years later, we asked whether their children had developed bronchial asthma, eczema, or hay fever. We then used logistic regression models to analyze whether there was an association between the development of allergic reactions among the children and pet ownership at the time of birth. RESULTS In families without a history of atopic disease, the prevalence of asthma and eczema among 2-year-old children was significantly lower in those families that owned a dog at the time the children were born (odds ratio [OR], 0.52; 95% confidence interval [CI], 0.33-0.83). In contrast, in families with a history of atopic disease, early dog exposure was associated with a higher prevalence of asthma and eczema in 2-year-old children (OR, 1.43; 95% CI, 0.95-2.15). Comparable analyses assessing the influence of cats and birds in the home showed no effect on the development of atopic diseases in early childhood. CONCLUSIONS This study confirms the findings of several earlier studies suggesting a negative association between dog ownership and the development of atopic diseases in early childhood, although the effect was only observed in families without a history of atopic disorders.
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Affiliation(s)
- H Pohlabeln
- Bremen Institute for Prevention Research and Social Medicine, Bremen, Germany.
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Pigeot I, Ahrens W, Foraita R, Jahn I, Pohlabeln H. Ausgewählte methodische Probleme evidenzbasierter Prävention. Präv Gesundheitsf 2006. [DOI: 10.1007/s11553-006-0036-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Jahn I, Foraita R, Pohlabeln H. Rauchen, Gewicht, Bewegung, Früherkennung. Zielgruppen für Prävention und Gesundheitsförderung im Land Bremen. Eine geschlechtervergleichende Auswertung der Bremer Umfrage GESUNDHEIT! Gesundheitswesen 2006. [DOI: 10.1055/s-2006-948616] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Bruns-Philipps E, Pohlabeln H, Hoopmann M, Reinke F, Windorfer A. Der öffentliche Gesundheitsdienst als Kooperationspartner in der Prävention. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2005; 48:1153-61. [PMID: 16172786 DOI: 10.1007/s00103-005-1138-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
As resources become scarce there is increasing demand on the public health services to create a system of community-based and jointly used health protection services. Cohort surveys that are currently more and more reduced contribute to both primary and secondary prevention. They enable third parties to implement further prevention projects. In addition, due to continuous quality assessment and standardization process, they yield valid data for developing target-group-specific prevention strategies as well as for evaluating preventive measures. In this respect public health services already fulfil the demand for prevention in the social environment as outlined in the forthcoming Prevention Act. Preventive measures in the field of dental health, atopic diseases and vaccination are presented as examples. The integration of data from continuous cohort surveys into a health reporting system as a basis for developing and evaluating health targets and prevention projects at the state level is demonstrated.
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Pohlabeln H, Jacobs S, Böhmann H. Haustiere und deren Einfluss auf allergische Reaktionen bei Kindern. Gesundheitswesen 2004. [DOI: 10.1055/s-2004-833892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Pohlabeln H, Strube H, Bosche H, Pigeot I. M�hre statt Big Mac, Apfel statt Schokoriegel, Vollkornbrot statt Pizza? Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2004; 47:211-2. [PMID: 15205787 DOI: 10.1007/s00103-004-0802-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Pigeot I, Bosche H, Pohlabeln H. Programme der Prim�rpr�vention von Adipositas und �bergewicht im Kindesalter. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2004; 47:256-65. [PMID: 15205795 DOI: 10.1007/s00103-003-0792-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The prevalence of obesity and overweight in childhood and among adolescents is dramatically increasing worldwide with high impact on their self-esteem and on their health as adults. Therefore, effective programs for primary prevention are urgently required. The focus of these programs should not only be on nutrition but also account for the complete sociocultural environment of the child. This paper will describe some of the more important programs on the one hand and present an exemplary concept for a scientifically observed program for prevention of obesity in preschool children on the other hand. The discussion will be completed by a short overview of programs for secondary prevention. In summary, it can be concluded that no sufficiently evaluated programs for primary prevention of obesity in childhood currently exist in Germany.
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Affiliation(s)
- I Pigeot
- Bremer Institut für Präventionsforschung und Sozialmedizin, Bremen.
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Terschüren C, Hoffmann W, Schill W, Pohlabeln H, Greiser E. S03.5: In home use of pesticides as a risk factor for leukaemia and malignant lymphoma– results of the Northern Germany Leukaemia and Lymphoma Study (NLL). Biom J 2004. [DOI: 10.1002/bimj.200490133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Pohlabeln H, Wild P, Schill W, Ahrens W, Jahn I, Bolm-Audorff U, Jöckel KH. Asbestos fibreyears and lung cancer: a two phase case-control study with expert exposure assessment. Occup Environ Med 2002; 59:410-4. [PMID: 12040118 PMCID: PMC1740301 DOI: 10.1136/oem.59.6.410] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
AIMS To assess the cumulative effect of asbestos on lung cancer risk where the exposure is assessed by an expert rating. METHODS 1678 male cases and controls were enrolled in a population based matched case-control study, focused on occupational risk factors, carried out in West Germany. The exposure to asbestos was computed as lifelong working hours. For a validation subsample of 164 matched pairs from this study the intensity of asbestos exposure was further assessed by a panel of experts in order to obtain an estimate of the cumulative exposure on a time by intensity scale (fibreyears). The information on duration of asbestos exposure in the original study was combined with the fibreyears following the two phase case control study paradigm. RESULTS The number of exposed subjects in the validation subsample was 75 cases and 71 controls. The percentage of subjects with a cumulative exposure < or =1, 1 to < or =10, and >10 fibreyears was 16%, 15%, and 15% for the cases and 18%, 16%, and 9% respectively for the controls. The smoking adjusted odds ratios for the fibreyears based on an unconditional logistic regression were 0.81, 1.02, and 1.60 respectively with increasing exposure categories (not significant). The coefficient (beta) for a log transformed trend was 1.156. Applying the two phase paradigm, these odds ratios became 0.86, 1.33, and 1.94; the latter reached significance and the beta coefficient was 1.178. CONCLUSIONS The two phase paradigm allowed us to obtain a more precise estimate of the effect of asbestos on lung cancer. Results are consistent with a doubling of the lung cancer risk with 25 fibreyears asbestos exposure.
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Affiliation(s)
- H Pohlabeln
- Bremen Institute for Prevention Research and Social Medicine (BIPS), Bremen, Germany.
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Lemb M, Pohlabeln H. Pulmonary thromboembolism: a retrospective study on the examination of 991 patients by ventilation/perfusion SPECT using Technegas. Nuklearmedizin 2001; 40:179-86. [PMID: 11797505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
PURPOSE Conventional planar ventilation/perfusion (V/P)-imaging in those patients suspected of suffering from pulmonary thromboembolism (PTE) is of limited diagnostic value. It is the purpose of this retrospective study to determine whether the use of V/P-SPECT using Technegas might reduce the rate of those diagnostic uncertainties and might lead to better results. METHODS 991 patients (660 female, 331 male, age 18-90, mean 60), referred to our laboratory with suspected PTE, were examined as follows: patients inhaled 37 MBq of Technegas in the supine position and a SPECT-acquisition was started. Following SPECT-completion, 185 MBq 99mTc-MAA was injected intravenously. SPECT was then repeated. Coronal and transverse ventilation and perfusion SPECT-slices were reconstructed and compared section by section. 85 patients underwent control scans by the same technique at a mean interval of 22 months after the original scans. RESULTS As the SPECT images in almost all cases made a clear match/mismatch decision possible, we categorized all patients as embolic (PTE+) if there was at least one mismatching defect, and as non embolic (PTE-) if there were none. Our results were: PTE+: 178 patients (18%), PTE-: 808 patients (81%), uncertain: 5 patients (0.5%), if 34 triple-match defects are included: 39 patients (3.9%). 46 patients, categorized as PTE+ underwent a control V/P scan after anticoagulant therapy. In 44 of these patients, PTE was confirmed by the controls. In a control group of 39 PTE- patients, control scans were unchanged in 38 cases. From these observations we can calculate a sensitivity of 96% and a specificity of 97%. CONCLUSION We conclude that V/P imaging can be improved significantly by V/P SPECT using Technegas.
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Affiliation(s)
- M Lemb
- Röntgeninstitut, Bremerhaven/Germany.
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Shickle D, Carlisle J, Fryers P, Wallace S, Suckling R, Cork M, Bowns I, Beyleveld D, McDonagh A, Sandvik L, Mowinckel P, Abdelnoor M, Erikssen G, Erikssen J, White R, Altmann DR, Nanchahal K, Oliver S, Donovan JL, Peters TJ, Frankel S, Hamdy FC, Neal DE, Whincup PH, Gilg J, Papacosta O, Miller GJ, Alberti KGMM, Cook D, Lawlor DA, Ebrahim S, Smith GD, Lampe F, Morris R, Whincup P, Walker M, Ebrahim S, Shaper A, Brunner E, Shipley M, Hemingway H, Juneja M, Page M, Stansfeld S, Kumari M, Walker B, Andrew R, Seckl J, Papadopoulos A, Checkley S, Marmot M, Wood D, Sheehan J, Reilly M, Twomey H, Collins M, Daly A, Loningsigh S, Dolan E, Smith GD, Ben-Shlomo Y, Perry I, Moher M, Yudkkin P, Wright L, Turner R, Fuller A, Schofield T, Mant D, Feder G, Lilford RJ, Dobbie F, Warren R, Braunholtz D, Boaden R, Nolte E, Scholz R, Shkolnikov V, McKee M, Neilson S, Gilthorpe MS, Wilson RC, Jenkinson C, Coulter A, Bruster S, Richards N, Chandola T, Cromwell DA, Griffiths DA, Campbell MJ, Mollison J, McIntosh E, Grimshaw J, Thomas R, Rovers MM, Straatman H, Zielhuis GA, Hemminki E, Hove SL, Veerus P, Hakama M, Tuimala R, Rahu M, Ukoumunne OC, Gulliford MC, Shepstone L, Spencer N, Araya R, Rojas G, Fritsch RE, Acuna J, Lewis G, Ajdacic-Gross V, Bopp M, Eich D, Rossler W, Gutzwiller F, Corcoran P, Brennan A, Reilly M, Perry IJ, Middleton N, Whitley E, Frankel S, Dorling D, Gunnell D, Stanistreet D, Paine K, Scherf C, Morison L, Walraven G, O'Cathain A, Sampson F, Nicholl J, Munro J, Chapple A, Ziebland S, McPherson A, Herxheimer A, Shepperd S, Miller R, Brindle L, Donovan JL, Peters TJ, Quine S, O'Reilly M, Cahill M, Perry IJ, Maconochie N, Doyle P, Prior S, Ego A, Subtil D, Cosson M, Legoueff F, Houfflin-Debarge V, Querleu D, Rasmussen F, Smith GD, Sterne JAC, Tynelius P, Leon DA, Doyle P, Roman E, Maconochie N, Smith P, Beral V, Macfarlane A, Shoham-Vardi I, Winer N, Weitzman D, Levcovich A, Lahelma E, Kivela K, Roos E, Tuominen T, Dahl E, Diderichsen F, Elstad J, Lissau I, Lundberg O, Rahkonen O, Rasmussen NK, Yngwe MA, Gilmore AB, McKee M, Rose R, Salmond C, Crampton P, Tobias M, Li L, Manor O, Power C, Bruster S, Coulter A, Jenkinson C, Osler M, Prescott E, Gronbak M, Andersen AN, Due P, Engholm G, Drury N, Bruce J, Poobalan AS, Smith WCS, Jeffrey RR, Chambers WA, Mueller JE, Doring A, Stieber J, Thorand B, Lowel H, Chen R, Tunstall-Pedoe H, Redpath A, Macintyre K, Stewart S, Chalmers JWT, Boyd AJ, Finlayson A, Pell JP, McMurray JJV, Capewell S, Chalmers JWT, Macintyre K, Stewart S, Boyd AJ, Finlayson A, Pell JP, Redpath, McMurray JJV, Capewell S, Critchley J, Capewell S, Stefoski-Mikeljevic J, Johnston C, Cartman M, Sainsbury R, Forman D, Haward R, Morris E, Haward R, Forman D, Cartman M, Johnston C, Moebus S, Lehmann N, Goodacre S, Calvert N, Montgomery AA, Fahey T, Ben-Shlomo Y, Harding J, Anderson W, Florin D, Gillam S, Ely M, Nath U, Ben-Shlomo Y, Thomson RG, Morris HR, Wood NW, Lees AJ, Burn DJ, West RR, Fielder HM, Palmer SR, Dunstan F, Fone D, Higgs G, Senior M, Moss N, Campbell R, Pound P, Pope C, Britten N, Pill R, Morgan M, Donovan J, Rottingen JA, Garnett GP, Jagger C, Robine JM, Clarke M, Tobiasz-Adamczyk B, Szafraniec K, Lall R, Campbell MJ, Walter SJ, McGrother C, Donaldson M, Dallosso H, Dineen BP, Bourne RR, Ali SM, Huq DMN, Johnson GJ, Stang A, Jockel KH, Karvonen S, Vikat A, Rimpela M, Borras JM, Schiaffino A, Fernandez E, Borrell C, Garcia M, Salto E, Jefferis B, Power C, Graham H, Manor O, Yudkin P, Hey K, Roberts S, Welch S, Johnstone E, Murphy M, Griffiths S, Jones L, Walton R, Rasul F, Stansfeld SA, Hart CL, Gillis C, Smith GD, Marks D, Lambert H, Thorogood M, Neil H, Humphries S, Wonderling D, Surman G, Newdick H, Johnson A, Pharoah P, Glinianaia SV, Wright C, Rankin J, Basso O, Christensen K, Olsen J, Love A, Cheung WY, Williams J, Jackson S, Maddocks A, Hutchings H, Gissler M, Pakkanen M, Olausson PO, Owen CG, Whincup PH, Odoki K, Gilg JA, Cook DG, Aveyard P, Markham WA, Sherratt E, Bullock A, Macarthur C, Cheng KK, Daniels H, Murphy S, Egger M, Grimsley M, Green G, Read C, Redgrave P, Suokas A, McCulloch A, Zagozdzon P, Zaborski L, Cardano M, Costa G, Demaria M, Gnavi R, Spadea T, Vannoni F, Batty D, Leon DA, Rahi J, Morton S, Leon D, Stavola BDE, Gunnell D, Fouskakis D, Rasmussen F, Tynelius P, Harrison G, Spadea T, Faggiano F, Armaroli P, Maina L, Costa G, Ellison GTH, Travis R, Phillips M, Dedman D, Upton M, McCarthy A, Elwood P, Davies D, Shlomo YB, Smith GD, Berrington A, Cramer DW, Kuper H, Harlow BL, Titus-Ernstoff L, McLeod A, Stockton D, Brown H, Leyland AH, Liratsopulos G, West CR, Williams EMI, Abrams K, Sharp L, Little J, Brockton N, Cotton SC, Haites NE, Cassidy J, Kamali A, Kinsman J, Kintu P, Quigley M, Carpenter L, Kengeya-Kayondo J, Whitworth. JAG, Porter K, Noah N, Rawson H, Crampin A, Smith WCS, Group CMSOBOTMS, Jahn A, Kudzala A, Kitundu H, Lyamuya E, Razum O, Thomas SL, Wheeler JG, Hall AJ, Moore L, Dennehy A, Shemilt I, Belderson P, Brandon M, Harvey I, Moffatt P, Mugford M, Norris N, O'Brien M, Reading R, Robinson J, Schofield G, Shepstone L, Thoburn J, Cliffe S, Leiva A, Tookey P, Hamers F, Nicoll A, Critchley J, Capewell S, Ness AR, Hughes J, Elwood PC, Whitley E, Smith GD, Burr ML, Chase D, Roderick P, Cooper K, Davies R, Raftery J, Martikainen P, Kauppinen TM, Valkonen T, Somerville M, Barton A, Foy C, Basham M, Thomson H, Petticrew M, Morrison D, Chandola T, Biddulph J, McCarthy M, Gallivan S, Utley M, Kinra S, Black ME, Murphy M, Hey K, Jones L, Brzezinski ZJ, Mazur J, Mierzejewska E, Evans JG, Clarke R, Sherliker P, Birks J, Wrieden WL, Connaghan JP, Tunstall-Pedoe H, Silva IDS, Mangtani P, McCormack V, Bhakta D, Sevak L, McMichael AJ, Sauvaget C, Nagano J, Ogilvie D, Raffle AE, Alden B, Brett M, Babb PJ, Quinn M, Banks E, Beral V, Bull D, Reeves G, Leung GM, Lam TH, Thach TQ, Hedley AJ, Roderick P, Davies R, Crabbe D, Patel P, Raftery J, Bhandari P, Pearce R, Thomas MC, Walker M, Lennon LT, Thomson AG, Lampe FC, Shaper AG, Whincup PH, Fallon UB, Ben-Shlomo Y, Laurence KM, Lancashire RJ, Pharoah POD, Nevin NC, Smith GD, Fear NT, Roman E, Ansell P, Bull D, Nilsen TIL, Vatten LJ, Lane JA, Harvey RF, Murray LJ, Harvey IM, Donovan JL, Egger M, Wright CM, Parker L, Lamont D, Craft AW, Hallqvist J, Lundberg M, Diderichsen F, Boniface DR, McNeilly E, Bromen K, Pohlabeln H, Ahrens W, Jahn I, Jockel KH, Darby S, Doll R, Whitley E, Key T, Silcocks P, Linos D, Markaki I, Ntalles K, Riza E, Linos A, Memon A, Darif M, AL-Saleh K, Suresh A, de Vries CS, Bromley SE, Williams TJ, Farmer RDT, Ruiz M, Nieto A, Boshuizen HC, Nagelkerke NJD, Schellekens JFP, Peeters MF, Den Boer JW, Van Vliet JA, Neppelenbroek SE, Spaendonck MAECV, Mazloomzadeh S, Woodman CBJ, Collins S, Winter H, Bailey A, Young LS, Rosenbauer J, Herzig P, Giani G, Olowokure B, Spencer NJ, Hawker JI, Blair I, Smith R, Olowokure B, White J, Rush M, Hawker JI, Ramsay M, Watkins J, Mayor S, Matthews I, Crilly M, Bundred P, Prosser H, Walley T, Walker ZAK, Oakley L, Townsend JL, Donovan C, Smith H, Bell J, Hurst Z, Marshall S, Wild S, Whyman C, Barter M, Wishart K, Macleod C, Marinko K, Malmstrom M, Johansson SE, Sundquist J, Crampton P, Salmond C, Tobias M, Lumley J, Small R, Brown S, Watson L, Gunn J, Hawe P, Shiell A, Langer M, Steiner G, Tiefenthaler M, Adamek S, Ronsmans C, Khlat M, Waterstone M, Bewley S, Wolfe C, Hooper R, Moore L, Campbell R, Whelan A, Winter H, Macarthur C, Bick D, Lancashire R, Knowles H, Henderson C, Belfield C, Gee H, Biggerstaff D, Lilford R, Olsen J, the EuroMap Group, Spencer EA, Davey GK, Appleby PN, Key TJ., Breeze E, Leon D, Clarke R, Fletcher A, Boniface DR, McNeilly E, Lam TH, Ho SY, Hedley AJ, Mak KH, Canoy D, Khaw KT, Thorogood M, Appleby PN, Mann JI, Key TJ, Bobak M, Pikhart H, Martikainen P, Rose R, Marmot M, Rooney CIF, Cook L, Uren Z, Watson MC, Bond CM, Grimshaw JM, Mollison J, Ludbrook A, Poobalan AS, Bruce J, King PM, Krukowksi ZH, Smith WCS, Chambers WA, Seagroatt V, Goldacre M, Purcell B, Majeed A, Mayor S, Watkins J, Matthews I, Morris RW, Whincup PH, Emberson J, Lampe FC, Walker M, Wannamethee G, Shaper AG, Ebrahim S, May M, McCarron P, Frankel S, Smith GD, Yarnell J, Ebrahim S, May M, McCarron P, Shlomo YB, Stansfeld S, Gallacher J, Smith GD, Taylor FC, Rees K, Ebrahim S, Angelini GD, Ascione R, Muller-Nordhorn J, Binting S, Kulig M, Voller H, Willich SN, Group FTPS, Whincup PH, Emberson J, Papacosta O, Walker M, Lennon L, Thomson A, Sturdy PM, Anderson HR, Butland BK, Bland JM, Victor CR, Wilman C, Gupta R, Anderson HR, Mindell J, Joffe M, Nikiforov B, Pattenden S, Armstrong B, Hedley AJ, Wong CM, Thach TQ, Chau P, Lam TH, Anderson HR, Whitley E, Darby S, Deo H, Doll R, Raleigh VS, Logie J, Macrae K, Lawrenson R, Villegas R, Nielson S, O'Halloran DJ, Perry IJ, Gallacher JEJ, Elwood PC, Yarnell JWG, Shlomo YB, Pickering J, Evans JMM, Morris AD, Sedgwick JEC, Pearce AJ, Gulliford MC, Walker M, Thomson A, Whincup P, Lyons RA, Jones S, Richmond P, McCarthy J, Fone D, Lester N, Johansen A, Saunders J, Palmer SR, Barnes I, Banks E, Beral V, Jones GT, Watson KD, Taylor S, Papageorgiou AC, Silman AJ, Symmons DPM, Macfarlane GJ, Pope D, Hunt I, Birrell F, Silman A, Macfarlane G, Thorpe L, Thomas K, Fitter M, Brazier J, Macpherson H, Campbell M, Nicholl J, Morgan A, Roman M, Allison T, Symmons D, Urwin M, Brammah T, Roxby M, Williams G, Primatesta P, Falaschetti E, Poulter NR, Knibb R, Armstrong SJ, Chilvers CED, Logan RFA, Woods KL, Bhavnani V, Clarke A, Dowie J, Kennedy A, Pell I, Goldacre MJ, Kurina L, Seagroatt V, Yeates D, Watson E, Clements A, Yudkin P, Rose P, Bukach C, Mackay J, Lucassen A, Austoker J, Guillemin M, Brown W, Tell GS, Nurk E, Vollset SE, Nygard O, Refsum H, Ueland PM, Villegas R, Nielson S, Creagh D, Hinchion R, Perry IJ, Allen NE, Key TJ, Vatten LJ, Odegard RA, Nilsen ST, Austgulen R, Harding AH, Khaw KT, Wareham NJ, Riza E, Silva IDS, De Stavola B, Bradlow HL, Sepkovic DW, Linos D, Linos A. Society for Social Medicine and the International Epidemiological Association European Group. Abstracts of oral presentations. Br J Soc Med 2001. [DOI: 10.1136/jech.55.suppl_1.a1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Simonato L, Agudo A, Ahrens W, Benhamou E, Benhamou S, Boffetta P, Brennan P, Darby SC, Forastiere F, Fortes C, Gaborieau V, Gerken M, Gonzales CA, Jöckel KH, Kreuzer M, Merletti F, Nyberg F, Pershagen G, Pohlabeln H, Rösch F, Whitley E, Wichmann HE, Zambon P. Lung cancer and cigarette smoking in Europe: an update of risk estimates and an assessment of inter-country heterogeneity. Int J Cancer 2001; 91:876-87. [PMID: 11275995 DOI: 10.1002/1097-0215(200102)9999:9999<::aid-ijc1139>3.0.co;2-7] [Citation(s) in RCA: 119] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Ten case-control studies have been carried out in 6 European countries to investigate the major risk factors for lung cancer. Carcinogenic effect from cigarette smoke was the most relevant interest in our study, which has included 7,609 cases of lung cancer and 10,431 controls, mainly population based. The results indicate elevated odds ratios (ORs; 23.9 among men and 8.7 among women) with attributable risks exceeding 90% for men and close to 60% for women. A large, and statistically significant, variability of the results across countries was detected after adjusting for the most common confounding variables, and after controlling, at least in part, for the instability of the ORs due to the small number of non-smokers in some of the study subsets. This pattern of lung cancer risk associated with cigarettes smoke, across different European regions, reflects inherent characteristics of the studies as well as differences in smoking habits, particularly calendar periods of starting, and it is likely to have been influenced by effect modifiers like indoor radon exposure, occupation, air pollution and dietary habits.
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Affiliation(s)
- L Simonato
- Venetian Tumour Registry, University of Padua, via Gattamelata 64, Padua 35128, Italy.
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Rödelsperger K, Jöckel KH, Pohlabeln H, Römer W, Woitowitz HJ. Asbestos and man-made vitreous fibers as risk factors for diffuse malignant mesothelioma: results from a German hospital-based case-control study. Am J Ind Med 2001; 39:262-75. [PMID: 11241559 DOI: 10.1002/1097-0274(200103)39:3<262::aid-ajim1014>3.0.co;2-r] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND This study examines the role of occupational factors in the development of diffuse malignant mesothelioma with special emphasis on the dose-response relationship for asbestos and on the exposure to man-made vitreous fibers (MMVFs). METHODS One hundred and twenty-five male cases, diagnosed by a panel of pathologists, were personally interviewed concerning their occupational and smoking history. The same number of population controls (matched for sex, age and region of residence) underwent similar interviews by trained interviewers. Odds ratios (OR) were calculated for an expert-based exposure index using conditional logistic regression. RESULTS Exposure to asbestos shows the expected sharp gradient with an OR of about 45 for a cumulative exposure > 1.5 fiber years (arithmetic mean 16 fiber years). A significant OR was calculated even for the lowest exposure category "> 0 - < or = 0.15 fiber years". Although the mean cumulative exposure to MMVF is roughly 10% of the exposure to asbestos, an increased OR is observed in an ever/never evaluation. This observation is heavily hampered by methodical problems. A corresponding case-control study was performed using a lung tissue fiber analysis in addition to interviews. Both interviews and the lung tissue analysis yielded similar OR levels between the reference and the maximum exposure intervals. CONCLUSIONS Despite a possible influence as a result of selection and information bias, our results confirm the previously reported observation of a distinct dose-response relationship even at levels of cumulative exposure below 1 fiber year. Moreover, the study confirms that asbestos is a relevant confounder for MMVF. A causal relationship between exposure to MMVF and mesothelioma could neither be detected nor excluded, as in other studies.
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Affiliation(s)
- K Rödelsperger
- Institute and Outpatient Clinic for Occupational and Social Medicine, University of Giessen, Germany.
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Agudo A, Ahrens W, Benhamou E, Benhamou S, Boffetta P, Darby SC, Forastiere F, Fortes C, Gaborieau V, González CA, Jöckel KH, Kreuzer M, Merletti F, Pohlabeln H, Richiardi L, Whitley E, Wichmann HE, Zambon P, Simonato L. Lung cancer and cigarette smoking in women: a multicenter case-control study in Europe. Int J Cancer 2000; 88:820-7. [PMID: 11072254 DOI: 10.1002/1097-0215(20001201)88:5<820::aid-ijc21>3.0.co;2-j] [Citation(s) in RCA: 58] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
The association between cigarette smoking and lung cancer risk in women was investigated within the framework of a case-control study in 9 centres from 6 European countries. Cases were 1,556 women up to 75 years of age with histologically confirmed primary lung cancer; 2, 450 controls with age distribution similar to cases were selected. The predominant cell type was adenocarcinoma (33.5%), with similar proportions for squamous-cell type (26.4%) and small-cell carcinoma (22.3%). Overall, smoking cigarettes at any time was associated with a 5-fold increase in lung cancer risk (odds ratio 5.21, 95% confidence interval 4.49-6.04); corresponding figures for current smoking habits were 8.94, 7.54-10.6. The association showed a dose-response relationship with duration of the habit and daily and cumulative lifetime smoking. A significant excess risk of 70% was associated with every 10 pack-years smoked. After 10 years of smoking cessation, the relative risk decreased to 20% compared to current smokers. The following characteristics were associated with a higher relative risk: inhalation of smoke, smoking non-filter cigarettes, smoking dark-type cigarettes and starting at young age. The association was observed for all major histological types, being the strongest for small-cell type carcinoma, followed by squamous-cell type and the lowest for adenocarcinoma. The proportion of lung-cancer cases in the population attributable to cigarette smoking ranged from 14% to 85%. We concluded that women share most features of the association between cigarette smoking and lung cancer observed in men.
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Affiliation(s)
- A Agudo
- Catalan Institute of Oncology, L'Hospitalet, Barcelona, Spain.
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Sala M, Cordier S, Chang-Claude J, Donato F, Escolar-Pujolar A, Fernandez F, González CA, Greiser E, Jöckel KH, Lynge E, Mannetje A, Pohlabeln H, Porru S, Serra C, Tzonou A, Vineis P, Wahrendorf J, Boffetta P, Kogevina M. Coffee consumption and bladder cancer in nonsmokers: a pooled analysis of case-control studies in European countries. Cancer Causes Control 2000; 11:925-31. [PMID: 11142527 DOI: 10.1023/a:1026524014954] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Coffee consumption has been associated with an excess bladder cancer risk, but results from epidemiological studies are inconsistent. This association has been long debated, in part due to the potential confounding by smoking. We examined the risk associated with coffee consumption in nonsmokers in a pooled analysis of ten European bladder cancer case-control studies. METHODS The pooled data set comprises 564 cases and 2929 hospital or population controls who had never smoked. They were enrolled in ten studies conducted in Denmark, Germany, Greece, France, Italy and Spain. Information on coffee consumption and occupation was re-coded following standard criteria. Unconditional logistic regression was applied adjusting for age, study center, occupation and gender. RESULTS Seventy-nine percent of the study population reported having drunk coffee, and 2.4% were heavy drinkers, reporting having drunk on average ten or more cups per day. There was no excess risk in ever coffee drinkers (OR = 1.0, 95% CI 0.8-1.3) compared to never drinkers. The risk did not increase monotonically with dose but a statistically significant excess risk was seen for subjects having drunk ten or more cups per day (OR = 1.8, 95% CI 1.0-3.3). This excess was seen in both men and women. There was no evidence of an association of the risk with duration or type of coffee consumption. The pooled results were not dependent on the findings of any specific study, but they depended on the type of controls with an overall excess risk observed only for studies using hospital controls. CONCLUSION Nonsmokers who are heavy coffee drinkers may have a small excess risk of bladder cancer. Although these results cannot be attributed to confounding by smoking, the possibility of bias in control selection cannot be discarded. On the basis of these results, only a very small proportion of cancers of the bladder among nonsmokers could be attributed to coffee drinking.
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Affiliation(s)
- M Sala
- Respiratory and Environmental Health Research Unit, Institut Municipal d'Investigació Mèdica, Barcelona, Spain
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Bromen K, Pohlabeln H, Jahn I, Ahrens W, Jöckel KH. Aggregation of lung cancer in families: results from a population-based case-control study in Germany. Am J Epidemiol 2000; 152:497-505. [PMID: 10997539 DOI: 10.1093/aje/152.6.497] [Citation(s) in RCA: 69] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
The authors investigated familial aggregation of lung cancer by means of a population-based case-control study, conducted in Germany between 1988 and 1993. They compared lung cancer prevalence in first degree relatives of 945 patients and 983 controls, accounting for various potential risk factors using logistic regression and generalized estimating equations. Some 83% of the study participants were male, and about 14% were below age 51 (young age group). Overall, lung cancer in parents or siblings was associated with a 1.67-fold (95% confidence interval (CI): 1.11, 2.52) increase in lung cancer risk. For the young participants, this risk was 4.75 (95% CI: 1.20, 18.77). Having multiple affected relatives (two or more) was related to a threefold risk elevation (odds ratio (OR) = 2.99, 95% CI: 0.32, 27.55). Paternal (OR = 1.64, 95% CI: 0.91, 2.96) but not maternal (OR = 0.91, 95% CI: 0.32, 2.61) lung cancer was associated with an increased risk of the disease. Lung cancer risk from smoking was particularly pronounced in the parents of cases (OR = 12.20, 95% CI: 3.34, 44.62 vs. OR = 7.93, 95% CI: 2.43, 25.91 in parents of controls). No risk elevation was detected for other smoking-related and other cancers in general. Results confirm previous findings and support the etiologic role of a genetic predisposition to lung cancer.
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Affiliation(s)
- K Bromen
- Institute of Medical Informatics, Biometry, and Epidemiology, University of Essen, Germany.
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Pohlabeln H, Boffetta P, Ahrens W, Merletti F, Agudo A, Benhamou E, Benhamou S, Brüske-Hohlfeld I, Ferro G, Fortes C, Kreuzer M, Mendes A, Nyberg F, Pershagen G, Saracci R, Schmid G, Siemiatycki J, Simonato L, Whitley E, Wichmann HE, Winck C, Zambon P, Jöckel KH. Occupational risks for lung cancer among nonsmokers. Epidemiology 2000; 11:532-8. [PMID: 10955405 DOI: 10.1097/00001648-200009000-00008] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
We conducted a case-control study in 12 European study centers to evaluate the role of occupational risk factors among nonsmokers. We obtained detailed occupational histories from 650 nonsmoking cases (509 females/141 males) and 1,542 nonsmoking controls (1,011 females/531 males). On the basis of an a priori definition of occupations and industries that are known (list A) or suspected (list B) to be associated with lung carcinogenesis, we calculated odds ratios (ORs) for these occupations, using unconditional logistic regression models and adjusting for sex, age, and center effects. Among nonsmoking men, an excess relative risk was observed among those who had worked in list-A occupations [OR = 1.52; 95% confidence interval (C) = 0.78-2.97] but not in list-B occupations (OR = 1.05; 95%), CI = 0.60-1.83). Among nonsmoking women, there was an elevation of risk for list-A occupations (OR = 1.50; 95% CI = 0.49-4.53), although this estimate was imprecise, given that less than 1% of cases and controls were exposed. Exposure to list-B occupations was associated with an increase in relative risk (OR = 1.69; 95% CI = 1.09-2.63) in females, but not in males. Women who had been laundry workers or dry cleaners had an OR of 1.83 (95% CI = 0.98-3.40). Our findings confirm that certain occupational exposures are associated with an increased risk for lung cancer among both female and male nonsmokers; however, knowledge on occupational lung carcinogens is biased toward agents to which mainly men are exposed.
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Affiliation(s)
- H Pohlabeln
- Bremen Institute for Prevention Research and Social Medicine, Germany
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Abstract
BACKGROUND The occupational lung cancer risk in manufacturing and repair of shoes was studied by pooling of two major case-control studies from Germany. METHODS Some 4184 incident hospital-based cases of primary lung cancer and 4253 population controls, matched for sex, age, and region of residence were intensively interviewed with respect to their occupational and smoking history. Based on the occupational coding and a free text search, all individuals who had ever worked in shoe manufacturing or repair for at least half a year were identified. Shoemaker-years were calculated as the cumulated duration of working in shoe manufacturing or repair. Odds ratios (OR) and 95% confidence intervals (CI) were calculated via conditional logistic regression. Additional adjustment for smoking and occupational asbestos exposure was used. RESULTS Seventy-six cases and 42 controls who had ever worked in shoe manufacture or repair (OR = 1.89, 95% CI: 1.29-2.78). After adjustment for smoking, this risk was lowered to 1.69 (95% CI: 1.09-2.62). Further adjustment for asbestos exposure only slightly changed the risk estimates upwards. The smoking adjusted OR in males was 1.50 (95% CI: 0.93-2.41) and 2.91 (95% CI: 0.90-9.44) in females. Logistic regression modeling showed a positive dose-effect relationship between duration of exposure in shoe manufacture and repair and lung cancer risk. The odds ratio for 30 years of exposure varied between 1.98 and 2.24 depending on the model specified. CONCLUSIONS The study demonstrates an increased lung cancer risk for shoemakers and workers in shoe manufacturing. The risk seems to double after being 30 years in these occupations.
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Affiliation(s)
- K H Jöckel
- Institute for Medical Informatics, Biometry and Epidemiology, University Clinics of Essen, Essen, Germany.
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Pohlabeln H, Jöckel KH, Brüske-Hohlfeld I, Möhner M, Ahrens W, Bolm-Audorff U, Arhelger R, Römer W, Kreienbrock L, Kreuzer M, Jahn I, Wichmann HE. Lung cancer and exposure to man-made vitreous fibers: results from a pooled case-control study in Germany. Am J Ind Med 2000; 37:469-77. [PMID: 10723041 DOI: 10.1002/(sici)1097-0274(200005)37:5<469::aid-ajim3>3.0.co;2-d] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND To investigate the association between lung cancer and occupational exposure to man-made vitreous fibers (MMVF), a pooled analysis of two case-control studies was conducted in the years 1988-1994. METHODS The case series consisted of 3498 males who were histologically or cytologically verified primary lung cancer cases. 3541 male population controls were drawn at random from the general population and matched to cases by sex, age, and place of residence. To examine the relationship between MMVF and lung cancer we asked all study subjects who worked for at least 6 months as construction and installation workers whether they ever installed or removed insulations and what kind of insulation material they used. RESULTS Some 304 (8.7%) cases and 170 (4.8%) controls reported to have insulated with glass wool or mineral wool mats. Coded as ever/never exposed, the odds ratio was 1.48 (95% CI: 1.17-1.88), adjusted for smoking and asbestos. To be sure to exclude any confounding effect of asbestos, we tried to identify those cases and controls who insulated with glass wool or mineral wool mats only and never reported any asbestos exposure. For this group we calculated an odds ratio of 1.56 (95% CI: 0.92-2.65), after adjustment for smoking. An elevated risk was also estimated on the basis of an expert rating which was done for a subgroup of cases and controls. Ever exposure to MMVF (but not to asbestos) in this subgroup yielded an odds ratio of 1.30 (95% CI: 0.82-2.07). CONCLUSIONS Our study provides some indication for an excess risk of man-made vitreous fibers. This result also persists after adjustment for smoking and asbestos.
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Affiliation(s)
- H Pohlabeln
- Bremen Institute for Prevention Research and Social Medicine, Bremen, Germany.
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48
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Brennan P, Butler J, Agudo A, Benhamou S, Darby S, Fortes C, Jöckel KH, Kreuzer M, Nyberg F, Pohlabeln H, Saracci R, Wichman HE, Boffetta P. Joint effect of diet and environmental tobacco smoke on risk of lung cancer among nonsmokers. J Natl Cancer Inst 2000; 92:426-7. [PMID: 10699073 DOI: 10.1093/jnci/92.5.426] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
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49
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Brüske-Hohlfeld I, Möhner M, Pohlabeln H, Ahrens W, Bolm-Audorff U, Kreienbrock L, Kreuzer M, Jahn I, Wichmann HE, Jöckel KH. Occupational lung cancer risk for men in Germany: results from a pooled case-control study. Am J Epidemiol 2000; 151:384-95. [PMID: 10695597 DOI: 10.1093/oxfordjournals.aje.a010218] [Citation(s) in RCA: 94] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Occupational exposures such as crystalline silica, diesel engine exhaust, polycyclic aromatic hydrocarbons, and man-made mineral fibers are strongly suspected to increase lung cancer risk. Two case-control studies in Germany conducted between 1988 and 1996 were pooled for a joint analysis. A total of 3,498 male cases and 3,541 male population controls, frequency matched for age and region, were included in the study. The lifelong history of all jobs and industries was coded and occupational exposures were evaluated by expert rating. Odds ratios, crude and adjusted for smoking and asbestos exposure, were calculated by conditional logistic regression. Job-related evaluation showed a statistically significant increased odds ratio adjusted for smoking among farmers; forestry workers, fishermen, and livestock workers; miners and quarrymen; chemical processors; cabinet makers and related wood workers; metal producers and processors; bricklayers and carpenters; road construction workers, pipelayers and well diggers; plasterers, insulators, and upholsterers; painters and lacquerers; stationary engine and heavy equipment operators; transport workers and freight handlers; and service workers. With regard to specific occupational exposures, elevated odds ratios (OR) (95% confidence intervals (CI)) for lung cancer risk adjusted for smoking and asbestos exposure were observed for man-made mineral fibers (OR = 1.48, 95% CI 1.17, 1.88); crystalline silica (OR = 1.41, 95% CI 1.22, 1.62); diesel engine exhaust (OR = 1.43, 95% CI 1.23, 1.67); and polycyclic aromatic hydrocarbons (OR = 1.53, 95% CI 1.14, 2.04). The risk of asbestos exposure, adjusted for smoking was also increased (OR = 1.41, 95% CI 1.24, 1.60).
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Affiliation(s)
- I Brüske-Hohlfeld
- GSF-Institute of Epidemiology, National Research Center for Environment and Health, Neuherberg, Germany
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Boffetta P, Nyberg F, Agudo A, Benhamou E, Jockel KH, Kreuzer M, Merletti F, Pershagen G, Pohlabeln H, Simonato L, Wichmann HE, Saracci R. Risk of lung cancer from exposure to environmental tobacco smoke from cigars, cigarillos and pipes. Int J Cancer 2000. [PMID: 10597199 DOI: 10.1002/(sici)1097-0215(19991210)83] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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