Biomedical subjects

A Assmann

Publications and source records attributed to A Assmann.

At least 19 recordsLinked to original sources

PubMed2002

[Trends of OC use 1980-1999 in a German cohort of women].

INTRODUCTION: There is no doubt, oral contraceptives are a safe, reversible and commonly used method of contraception. Ever use is about 80 % in developed countries and current use of OCs about 40 %. Almost all information about prevalence of OC use came from cross-sectional studies and did not distinguish between high- and low-dose OCs. This paper deals with the prevalence of OC use as it was observed during lifetime of a large cohort of German women by calendar year and estrogen content. METHODS: The prevalence of OC use between 1980 to 1999 was analysed on occasion of an interim analysis of the German cohort study on women's health. This analysis is based on more than 10 000 women with about 390 000 women-years of observation. RESULTS: The proportion of women under the age of 50, that ever used OCs, increased steeply from 1980, i. e. from 62 % (1980) to about 90 % from 1996 onward. The proportion of current users in a given calendar year rose from 44 % (1980) to 49 % (1991-95) and dropped after the "pill crisis 1995". The percentage of current users who used high-estrogen-dose OCs dropped from 32 % (1980) to 5 % (1999). In contrast, the percentage of users of low-dose OCs of the 2nd generation steeply increased as was the percentage of users of the 3rd generation pills, however the latter dropped after 1995. CONCLUSION: The high acceptance of oral contraceptives despite many "pill crises" underlines the continuously high appreciation of their efficacy on the one hand, but underscores also the high responsibility of physicians and industry concerning surveillance or reduction of discussed side effects.

Adolescent↗

PubMed2002

[Reliability of the Menopause Rating Scale (MRS): Investigation in the German population].

The Menopause Rating Scale (MRS) is a well accepted instrument to measure the severity of menopausal symptoms. As yet, however, investigations had not specifically been directed towards short-term test-retest reliability of the scale. The MRS was twice applied in a random sample of 45-65 years aged women of the German Cohort Study of Women's Health with a distance between the measurements of 14 days. The response rate in the sample was 70 %. The correlation coefficient (Pearson) of the sum-score of the two measurements was r = 0.82. The high repeatability of the test results confirms our clinical experience and emphasizes excellent practical applicability. The MRS can be recommended for the clinical practice as a reliable scale both for the measurement and long-term surveillance of menopausal complaint dynamics.

Aged↗

PubMed2001

[Reasons for the change in HRT therapy from the perspective of women. Results of the German Cohort Study on Women's Health].

Acceptance and reasons for changing the HRT play an important role against the background of the efficiency of the therapy and increasing life expectancy. Women in developed, industrialized countries live about one-third of their lives in the peri- and postmenopausal phases.--The frequency of switching and the reasons were examined in an interim analysis of the German cohort study on women's health. This historical analysis was based on over 10,000 women (i.e. about 300,000 man-years of observation), of whom 2,002 women (aged 40-65) were constant users of HRT.--The prevalence of use and the frequency of switching to other HRT preparations were somewhat higher in women above 60 as compared to those aged 40-59. The duration of use had no impact on the prevalence of use or the frequency of switching or cessation. Neither education nor the past use of oral contraceptives showed a clear association with the frequency of switching. The most frequent reasons for switching or cessation were adverse events, i.e. reasons independent of age. Women aged from 40 to 49 more frequently reported weight gains, menstrual disturbances, headaches, and impaired well-being than did older women. A recurrence of menstruation was more frequently reported by women over 60 as the reason for switching or discontinuing HRT.--The knowledge of the reasons for women switching or discontinuing HRT underlines the importance of close collaboration between women and their gynaecologists, as well as that of intensified research for optimal products.

Adult↗

PubMed2001

[Frequency and reasons for switching/stopping use of oral contraceptives. Results of the German Cohort Study on Women Health].

Frequency and reasons for switching/stopping use of oral contraceptives. Results of the German Cohort Study on Women Health. Use of oral contraceptives is the safest and most commonly used method of contraception. The frequency of use underscores the importance of research on benefits, risks, and acceptability of long-term use. - An interim analysis of the German Cohort Study on Women's Health (aged 15-65 years) was performed to analyse frequency and reason of switching or stop of OC-use. We got for this analysis over 10 000 women with almost 100 000 years of observation from first to last (or current) OC use. - The prevalence of ever use of OCs was 85.5 % in our cohort. Switching or stop of OC use was observed in 93 % of the women. The frequency of switching increased with age and duration of use. Social parameter such as education, employment status, and living in the old or the new Federal States were not materially associated with the frequency of switching or stopping OC use. Satisfaction with general health, psychic stability, and sexual life was slightly associated with the frequency of switching: The better satisfaction the lower frequency of switching, but the sequence of cause and consequence is unclear. The most frequent categories of reasons for switching were observed side effects and personal reasons. Desire to get pregnant was the number one single reason, followed by headache/migraine, and bleeding problems. The frequency of more than 50 single reasons is listed. - The frequency and the knowledge of reason for switching or stopping OC use underlines the need for a good collaboration between physician and treated woman. However, also research on long-term compliance is required and the development of OCs with even less side effects.

Adolescent↗

PubMed2000

[The Bavarian Thromboembolic Risk Cohort Study (BATER). Study protocol, state of the investigation and first results].

OBJECTIVE: Familiar venous thromboembolic disease (VTE) is known to be related with factor V Leiden mutation (FVL), but also with other genetic markers. It is the objective to investigate of the BATER-study in a representative Bavarian cohort, and to assess whether they could predict VTE events. This paper shortly describes the study protocol, gives an overview of planned sub-studies, and provides first results of the historic cohort analysis. PATIENTS AND METHODS: The baseline survey of the cohort study of Bavarian women aged 18-49 years (random sample from the population) was performed in two samples in 1996 and 1997. It was planned to estimate a prevalence and predictive value of potential markers of VTE in a historic--prospective as well as concurrent approach with annual follow-up of the cohort. This representative cohort should build a basis for nested case-control studies and serve as a reference group for other analytical epidemiological studies in young women. 1685 women were ascertained (response rate 61%), underwent an inquiry, and provided blood samples for a blood bank; for this paper, complete data are available from 1650 women. Laboratory parameters were measured to determine APC resistance, FVL-mutation, antithrombin-, protein C and S deficiency, and were correlated to the results of a detailed, life-time history of thrombembolic events. RESULTS: The prevalence of FVL mutation in the sample was 5.7% (95% confidence interval 4.6-6.6%). Other genetic VTE risk markers were observed to be less frequent than 1%. The positive predictive value (pPV) of FVL mutation for a VTE event is about 7%, but for a positive family history of VTE (first grade relatives) 3% only. CONCLUSIONS: VTE events are rare in the German population of young women, even in cases of FVL mutation. A positive family history is rarely associated with the occurrence of VTE in women under 50 years of age, and the predictive value of FVL mutation is low. Therefore, a screening for FVL mutation is not justified unless there is suspicion of a high VTE risk for other reasons.

Adolescent↗

PubMed2000

Cerebriform nodular amelanotic metastases of malignant melanoma: a challenge in differential diagnosis of a rare variant.

High variability of the clinical appearance of malignant melanoma (MM) and its metastases render the differential diagnosis of solid amelanotic tumours difficult. We report a 71-year-old woman with several unusual cutaneous tumours of cerebriform morphology, suggesting skin metastases from occult internal cancer. Histopathological findings and thorough investigations, however, revealed a late-stage metastatic MM. We discuss the differential diagnosis of skin metastases of various origin and underline the difficulties for early detection of MM.

Aged↗

PubMed2000

One-electron reduction of selenomethionine oxide.

Experimental evidence is provided that selenomethionine oxide (MetSeO) is more readily reducible than its sulfur analogue, methionine sulfoxide (MetSO). Pulse radiolysis experiments reveal an efficient reaction of MetSeO with one-electron reductants, such as e(aq)-, (k = 1.2x10(10) M(-1) s(-1)), CO2*- (k = 5.9x10(8) M(-1) s(-1)) and (CH3)2 C*OH (k = 3.5x10(7) M(-1) s(-1)), forming an intermediate selenium-nitrogen coupled zwitterionic radical with the positive charge at an intramolecularly formed Se(three-electron bond)N 2sigma/1sigma* three-electron bond, which is characterized by an optical absorption with lambda(max) at 375 nm, and a half-life of about 70 micros. The same transient is generated upon HO* radical-induced one-electron oxidation of selenomethionine (MetSe). This radical thus constitutes the redox intermediate between the two oxidation states, MetSeO and MetSe. Time-resolved optical data further indicate sulfur-selenium interactions between the Se(three-electron bond)N transient and GSH. The Se(three-electron bond)N transient appears to play a key role in the reduction of selenomethionine oxide by glutathione.

Chemical Phenomena↗

PubMed2000

Sex differences in 'climacteric symptoms' with increasing age? A hypothesis-generating analysis of cross-sectional population surveys.

Are the established clinical symptoms of the female climacteric really specific for women? We were interested to compare the prevalence of these symptoms across age and sex. In the absence of longitudinal (cohort) studies, we tried to find cross-sectional, population-based studies with a broad age span to find a preliminary answer. We obtained six surveys that contained information for at least some of the symptoms. We re-analyzed these databases, which included over 8000 males and 8000 females, in a pooled fashion. Sixteen symptoms of predominantly somatic, psychological and urogenital origin were identified and the age-dependent increase of the relative frequencies was compared between genders. A general tendency for women to report more symptoms was confirmed; however, no significant differences were found between genders regarding the time trend of these symptoms. The analyses suggest that males experience a similar symptomatology in the same age span as women. One may thus be tempted to conclude that aging males experience similar phenomena to women during their menopausal transition. This should be confirmed in a specifically designed study.

Journal Article↗

PubMed2000

Learning artificial grammars: no evidence for the acquisition of rules.

Two experiments investigated whether there is evidence for acquisition of rules in implicit artificial grammar learning (AGL). Two different methods were used in meeting this goal, multiple regression analysis and analysis of receiver-operating characteristics (ROCs). By means of multiple regression analysis, several types of knowledge were identified that were used in judgments of grammaticality, for example, about single letters and about larger stimulus fragments. There was no evidence for the contribution of rule knowledge. The ROCs were in accord with a similarity-based account of AGL and thus did not support the notion that rule knowledge is acquired in AGL either. Simulations with a connectionist model corroborated the conclusion that the results were in accord with a similarity-based, associative account.

Adult↗

PubMed1999

Oral progestogen-only contraceptives and cardiovascular risk: results from the Transnational Study on Oral Contraceptives and the Health of Young Women.

BACKGROUND: The risk of cardiovascular disease associated with progestogen-only pills has rarely been studied so far. METHODS: In the Transnational case-control study we were looking for a potential cardiovascular disease risk with oral progestogen-only pills in women aged 16-44 years. A total of 1058 cases of myocardial infarction, thromboembolic cerebrovascular accident or venous thromboembolism, and 3808 controls unaffected by these diseases, were enrolled. The group of women who had either used oral progestogen-only pills or no oral contraceptives included 394 cardiovascular disease cases (123 cases of myocardial infarction, 90 cases of thromboembolic cerebrovascular accident and 181 cases of venous thromboembolism) and 2366 controls. RESULTS: The adjusted (matched) odds ratio (OR) for all cardiovascular diseases combined for women using progestogen-only pills compared with non-users of oral contraceptives was 0.84 (95% confidence interval (CI), 0.45-1.58). The adjusted ORs for myocardial infarction, thromboembolic cerebrovascular accidents and venous thromboembolism for users of progestogen-only pills were 0.94 (95% CI, 0.31-2.91), 1.60 (95% CI, 0.24-0.72) and 0.68 (95% CI, 0.28-1.66), respectively. Hence, there was no significant increase in cardiovascular disease risk associated with progestogen-only pill use. The association between cardiovascular disease and established risk factors (smoking and hypertension) was confirmed. CONCLUSION: Although limited by the small number of exposed cases, our data suggest that there is no convincing evidence for an increased risk of cardiovascular disease associated with progestogen-only pill use.

Adolescent↗

PubMed1998

Reduction of methionine selenoxide to selenomethionine by glutathione.

Selenomethionine, an amino acid occurring in proteins in place of methionine, reacts efficiently with oxidants, e.g., peroxynitrite, a biological oxidant generated in inflammatory states, to produce the oxidation product, methionine selenoxide. The present work describes the rapid and efficient reduction of the selenoxide to selenomethionine by glutathione in a stoichiometric reaction utilizing two equivalents of thiol. This nonenzymatic reaction establishes a defense line against peroxynitrite or other oxidants by selenomethionine residues in proteins, maintained by the ubiquitous thiol, glutathione.

Glutathione↗

PubMed1998

Normalized activated protein C ratio itself not associated with increased risk of venous thromboembolism.

Recently, discussions focused on the question whether acquired activated (APC) resistance is a clue to the observed association between venous thromboembolism (VTE) risk and oral contraceptive (OC) use, especially with the so-called third-generation OC. The objective of our study was to check the validity of acquired APC resistance regarding VTE risk in a case-control study. Sixty-seven women with confirmed VTE diagnosis (n = 67) were consecutively ascertained in primary health care settings, interviewed and blood samples taken (at the earliest 6 months after VTE). Cases were age-matched to 290 population controls. Acquired APC resistance was measured as normalized APC ratio (APCRN). The effect of APC on tissue factor initiated thrombin generation was measured in plasma using alpha 2-macroglobulin attached thrombin activity as an endpoint. Higher risk (odds) ratio with 95% CI) of VTE for carriers of heterozygote Factor V Leiden mutation was confirmed [OR = 2.72 (CI:1.51-4.92)]. However, there is no association between VTE and the level of APCRN OR 0.65 (CI:0.35-1.22). We conclude that acquired APC resistance, measured with a tissue factor initiated test, is unlikely to have a direct association to the clinical outcome of venous thromboembolism.

Adolescent↗

PubMed1998

Resistance to activated protein C in women using oral contraceptives.

Resistance to activated protein C (APC resistance) is an important and common risk factor for deep vein thrombosis. The majority of patients with APC resistance carry a mutation on the factor V gene at nucleotide position 1691 (G/A), called factor V Leiden mutation. Besides the factor V Leiden mutation several acquired risk factors like lupus anticoagulant, elevated levels of acute phase proteins (increased plasma levels of factor VIII and fibrinogen), pregnancy, or the use of oral contraceptives are known to induce APC resistance in plasma. We studied the effect of oral contraceptives (OC) on hemostasis variables known to be risk factors for venous thromboembolism, especially looking for acquired APC resistance and the plasmatic factors of the protein C system. We studied 821 women, who were randomly selected and enrolled in the BATER- cohort study (Bavarian Thromboembolic Risk Study), which was carried out in Bavaria (Germany) from 1996 to 1997. Current use of any OC type compared with noncurrent use showed a significantly impaired response to APC. There was no difference in APC response among women currently using OCs of different generations. Coagulation factor VIII was the only factor of the protein C pathway that was not altered under OC use. All other plasmatic factors of the protein C system changed in the expected range as described before. On the other hand, coagulation factor VIII was the only factor of the protein C system which negatively correlated with the APC response in the assays applied. Thus, APC resistance is significantly lower in OC users than in nonusers but cannot be attributed to increased factor VIII levels. Whether a decreased response to APC in OC users is of clinical relevance has to be proven in further studies.

Activated Protein C Resistance↗

PubMed1996

Interim review of the Transnational Case-control Study of Oral Contraceptives and Health: approved protocol revisions through September 1995.

UNLABELLED: The protocol of the Transnational Study on Oral Contraceptives has been published at the outset of the study in order to ensure the correct performance of the study and to ensure the study's scientific integrity. Potential revisions and additions to this protocol had been announced in the prior publication. This article focuses on those points of protocol which have been resolved as practical experience was gathered as well as additional modifications required by practical and scientific considerations. The major alterations are based on exposure prevalences in controls and on power calculations. The low (1.8%) exposure to gestodene among German controls led to the discontinuation of the German component and to the accelerated accession in additional countries. THE CASE: control ratio was altered to 3:1 for purposes of economy based on power calculations. Numerous minor points, most addressed in the prior protocol, have been resolved. It is found that these modifications of the study protocol do not impair the study's conduct, its scientific integrity, nor its capability of providing answers to the study question.

Journal Article↗

PubMed1996

Could preferential prescribing and referral behaviour of physicians explain the elevated thrombosis risk found to be associated with third generation oral contraceptives?

BACKGROUND: Recently published case-control studies on third versus second generation oral contraceptives showed a slightly increased risk for venous thromboembolism (VTE) and led to a discussion about biases or confounders external to the study such as, preferential prescribing of third generation pills to women at higher risk and differential diagnostic behaviour. METHODS: An interview survey with 102 physicians was performed in 2 weeks of December 1995 in Germany and 1209 of their patients were included in a retrospective cohort analysis of drug utilization and risk markers. RESULTS: German physicians previously preferred to prescribe third generation pills whenever an increased risk was perceived, i.e. risk for VTE and for arterial thrombosis (risk factors, personal or family history of cardiovascular diseases). Almost all predefined risk scenarios were associated with an increased attention to non-specific venous symptoms and patients were more frequently sent for intensive diagnostic search for venous thromboses. The behaviour was not directly dependent on the type of OC; however the third generation pills were indirectly associated with higher risk in the pill-taking women. The physicians' view was confirmed by the analysis of the cohorts of patients: preferential prescribing was also found in this data set, although it was not as impressive as in the physicians responses. CONCLUSION: The possibility cannot be excluded that preferential prescribing and differential diagnostic behaviour alone could have explained the roughly two-fold increased odds ratios from case-control studies recently published, had this information been available among the study variables.

Journal Article↗

PubMed1990

Variation in coronary risk factor levels of men and women between the German-speaking MONICA centres.

The aim of this analysis was to compare levels of risk factors for coronary heart disease (CHD) in men and women aged 25-64 years between German-speaking MONICA collaborating centres, the German Democratic Republic (GDR), Augsburg - the Federal Republic of Germany (FRG)(Au), Bremen - FRG (Br), Heidelberg - FRG (He), and Vaud/Fribourg - Switzerland (CH, with a German-speaking minority). Prevalence of cigarette smoking in men showed little variation in four centres (34 to 40%) and was higher in BR men (49%), while it varied from 17% (GDR) to 33% (BR) in women. Mean total serum cholesterol values (mmol/L) were highest in GDR and CH men (both 6.2) and GDR women (6.1), and lowest in both He men (5.7) and He women (5.6). The proportion with cholesterol values greater than or equal to 6.7 mmol/L was largest in CH men (34%) and smallest in FRG (He) women (17%), while lowering the cut-off point from 6.7 to 6.5 mmol/L raised the prevalence of hypercholesterolaemia in all centres by 5 to 10%. Mean values (mmHg) of blood pressure (BP) were highest in both GDR men (140/88) and women (138/86), as was the prevalence of hypertensive BP values. In all centres, women aged 25-34 had BP values approximately 12/5 mmHg lower than age-matched men, but BP values similar to men at age 55-64, which indicates that age-parallel increase in BP was steeper in women than men.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1988

Risk factors in the population of the GDR-MONICA Study (1983/84).

The GDR-MONICA project comprises 25 administratively defined areas with a population of nearly two million people aged 25-64. Data from the first random sample survey are reported here. The survey gathered information regarding risk factors, dietary behaviour, physical activity and psychosocial factors from 11,281 persons aged 25-64. The average risk factor levels were high in the population: The mean casual blood pressure was 140/88 mmHg and 138/86 mmHg for men and women respectively. In both sexes the mean total cholesterol level exceeded 6.1 mmol/L, and the mean body mass index (BMI) was just over 26.0. The study population consumed, on average, excessive amounts of energy, fat, alcohol, and sodium, and too few carbohydrates. Preliminary conclusions regarding unfavourable trends in risk factor levels have been drawn by comparing the present data with other recent reliable epidemiological studies.

Adult↗

PubMed1983

[Behavior of staphylococci of the nasal cavity in subjects exposed to hyperbaric oxygen].

A careful qualitative and quantitative study revealed a significant decrease in bacterial, and especially staphylococcal, cultures from nasal swabs 24 hr after exposure to oxygen at 2.5 atm for 30', followed by a gradual return to initial values after a further four days. It is felt that this picture was ascribable to the influence of hyperbaric O2 on the microorganisms and their metabolism, and on the body's defence mechanisms.

Humans↗