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Biomedical subjects

A Pfahlberg

Publications and source records attributed to A Pfahlberg.

At least 37 records · Page 2Linked to original sources
PubMed2002

Fcgamma receptor IIa, IIIa, and IIIb polymorphisms in German patients with systemic lupus erythematosus: association with clinical symptoms.

BACKGROUND: Receptors for IgG play an important part in immune complex clearance. Several studies have identified polymorphisms of receptors for the Fc fragment of IgG (FcgammaR) as genetic factors influencing susceptibility to disease or disease course of systemic lupus erythematosus (SLE). OBJECTIVE: To examine these possibilities by evaluating a panel of clinical parameters in a cohort of 140 German patients with SLE for correlations with the FcgammaRIIa, IIIa, and IIIb polymorphisms in an explorative study. METHODS: 140 German patients with SLE according to American College of Rheumatology (ACR) criteria and 187 German controls were genotyped for the FcgammaRIIa, IIIa, and IIIb polymorphisms. Associations between FcgammaR genotypes, combined genotypes and clinical as well as laboratory features were analysed. RESULTS: No significant skewing of any of the three FcgammaR polymorphisms was seen in the German SLE cohort studied. Various clinical and serological parameters were found more frequently and at younger age in homozygous patients with the genotypes IIA-R/R131 or IIIA-F/F158 than in patients with IIA-H/H131 or IIIA-V/V158. These effects were even more pronounced in patients with the low binding combined phenotypes of the FcgammaRIIa, IIIa (double negative phenotypes) and FcgammaRIIa, IIIa, and IIIb (triple negative phenotypes). In patients with the double negative IIA and IIIA genotypes significantly higher frequencies of nephritis (63% v 33%) and proteinuria according to ACR criteria (58% v 11%), anaemia (84% v 55%), and anticardiolipin antibodies (63% v 22%) were found than in patients with the double positive genotypes. Patients with the IIA-R/R131 genotype and the double negative homozygous genotype had an earlier incidence of clinical symptoms, haematological and immunological abnormalities. Accordingly, SLE is diagnosed earlier in these patients, the difference reaching statistical significance only in the double negative v the double positive genotype (26.3 v 39.5 years) and the IIIA-F/F158 genotype v the rest (26.7 v 32.0 years). Most relevant is the fact that a higher median disease activity (ECLAM score) was demonstrated, both in the IIA-R/R131 homozygous (3.3 v 2.7) and the double negative (3.4 v 2.3) patients, reaching statistical significance in the first group. CONCLUSION: The results of this explorative study support the view that the FcgammaRIIa/IIIa and IIIb polymorphisms constitute factors influencing clinical manifestations and the disease course of SLE but do not represent genetic risk factors for the occurrence of SLE. Higher frequencies of clinical symptoms, haematological and immunological abnormalities as well as an earlier onset of clinical symptoms, haematological and immunological markers of active disease were found in patients with the IIA-R/R131 genotype and the double negative and triple negative genotypes.

Adolescent↗
PubMed2002

Respiratory symptoms and diseases among workers in the soft tissue producing industry.

AIMS: To correlate the prevalence of respiratory tract symptoms and diseases with dust and fibre exposure in the soft tissue industry in Germany. METHODS: Ambient monitoring was performed for inhalable, respirable dust and fibres in seven soft tissue producing factories. In 441 workers (72 controls, 90 moderate, 279 high exposure) a standardised questionnaire on respiratory symptoms, diseases, occupational history, and smoking habits was used. Crude differences in the prevalence of respiratory symptoms and diseases were assessed. Logistic regression analysis was used to determine the relation between the respiratory symptoms/diseases and the cumulative dust and fibre exposure, respectively, while adjusting for age, gender, smoking habits, and factory. The effects of exposure intensity and duration were differentiated by categorising dust/fibre concentrations and years of exposure separately and setting up logistic regression models. RESULTS: The mean concentrations for inhalable, respirable, and fibrous dusts were 10.3 mg/m(3), 0.22 mg/m(3), and 415,000 fibres/m(3). Adjusted odds ratios (OR) with relation to cumulative dust exposure intensity were significantly raised for blocked nose (18.2), mucosal irritation (6.5), dry nose (8.9), cough (3.5), phlegm (7.5), exercise induced dyspnoea (2.6), hoarseness (11.3), and sneezing attacks (7.9) (ORs for highest exposure categories). Cumulative dust or fibre exposure had no significant effects on the prevalence of respiratory diseases. For all symptoms with significantly raised ORs, combined effects of intensity and duration of exposure were found. CONCLUSIONS: Because of the high prevalence of respiratory symptoms a reduction of dust exposures is recommended. Chronic exposure effects could not be found in this study, however, a healthy worker effect has to be considered.

Adult↗
PubMed2001

Another look at seasonal variation in patch test results. A multifactorial analysis of surveillance data of the IVDK. Information Network of Departments of Dermatology.

There is conflicting evidence concerning seasonal variability of patch test results and no evidence concerning the influence of season on weak-positive, possibly false-positive, irritant reactions, which was analysed in the present study. Data collected in the German Information Network of Departments of Dermatology (IVDK) 1992 to 1997 were combined with external environmental data on temperature and absolute humidity in Germany, and bivariate as well as logistic regression analyses performed concerning the association between reactivity to selected allergens and air temperature and absolute humidity on the respective days of patch testing. Between 39,239 and 41,629 patients had been tested with the 4 allergens considered here. Only formaldehyde exhibited a distinct increase in questionable or irritant as well as weak-positive reactions associated with dry, cold weather. Methylchloroisothiazolinone/methylisothiazolinone and lanolin alcohol showed only a weak, and epoxy resin no, association with climatic conditions. The results indicate that weak-positive reactions, at least to formaldehyde as a prototype of an allergen which is at the same time a marginal irritant, may sometimes be irritant rather than allergic. Patients showing these should be re-tested to improve the poor reproducibilty observed with this allergen.

Climate↗
PubMed2001

Timing of excessive ultraviolet radiation and melanoma: epidemiology does not support the existence of a critical period of high susceptibility to solar ultraviolet radiation- induced melanoma.

BACKGROUND: The existence of a 'critical period' early in life characterized by a high susceptibility to melanoma initiation due to excessive ultraviolet (UV) radiation has been suggested by various authors based on epidemiological findings from migration studies and some case-control studies. However, the evidence so far is controversial as several epidemiological investigations failed to corroborate these results. Objective To compare the increase in melanoma risk due to excessive UV radiation between different periods in life. METHODS: In a multicentre case-control study we recruited 603 melanoma cases and 627 population controls in seven European countries. We obtained data on the history of sunburns during 'childhood' (</= 15 years) and 'adulthood' (> 15 years), respectively, in standardized personal interviews. We employed logistic regression analyses to estimate the impact of the exposure factors under study, while simultaneously controlling for the effect of a variety of confounding variables. RESULTS: We found a very similar upward gradient of melanoma risk in exposure categories related to the frequency of sunburns during both periods in life. More than five sunburns doubled the melanoma risk, irrespective of their timing in life. CONCLUSIONS: Our data do not provide supporting evidence for the existence of a 'critical period'. The hazardous impact of sunburns seems to persist lifelong and thus activities concerned with melanoma prevention should be directed to the entire population rather than being focused only on younger age groups.

Adolescent↗
PubMed2001

[Preventing skin damage in beauticians].

The incidence of occupational dermatitis of the hands is particularly high in the hairdressing trade. To elucidate the role of various risk factors, and to ultimately improve primary prevention of occupational hand dermatitis, a prospective cohort study was conducted between 1992 and 1997, including 2352 hairdressing trainees. Already six weeks after the start of training (median) 35.4% had--usually mild--irritant skin changes, mainly involving the interdigital web spaces. These were associated with subsequent, possibly more severe, hand dermatitis. Reduced exposure to wet work, i.e., improved skin protection with gloves, often led to the resolution of dermatitis of the hands. In conclusion, early irritant skin damage is a sentinel event that heralds possibly disabling occupational skin disease and should prompt adequate preventive measures.

Beauty Culture↗
PubMed2001

Association between occupation and contact allergy to the fragrance mix: a multifactorial analysis of national surveillance data.

OBJECTIVES: To assess the role of potential (occupational) risk factors for fragrance contact allergy (FCA). Most studies assessing the range of contact sensitisation in various clinical populations found the fragrance mix, a good screening tool for the detection of FCA in general, to be one of the leading allergens. The role of occupational exposure to fragrances is, however, yet unclear. METHODS: Firstly, crude analyses of the prevalence of FCA in various occupational fields including all 57,779 patients patch tested in the participating centres of the Information Network of Departments of Dermatology (IVDK) between January 1992 and December 1998. Secondly, a multifactorial Poisson regression analysis of these patients, including several potential risk factors. RESULTS: (a) The proportion of patients with FCA varied greatly between different occupational groups from 2.5% to 17.4%, (b) the highest occupational risk of FCA was associated with work as a masseur or physiotherapist, metal furnace operator, potter or glass maker etc, or geriatric nurse, (c) non-occupational factors that influenced risk of FCA included atopy, female sex, several sites, in particular the axillae, and increasing age. CONCLUSIONS: Occupations with a high risk of FCA were identified as targets of preventive action--that is, the substitution of scented products with fragrance free materials with which to work (skin disinfectants, cleaning solutions, personal care products) wherever possible.

Adult↗
PubMed2001

Atopic signs and symptoms: assessing the 'atopy score' concept.

BACKGROUND: Score concepts have been suggested for the standardised diagnosis of atopic dermatitis, incorporating various anamnestic and clinical minor criteria of atopy, including the 'Erlangen Score', developed in the hospital-based setting of a dermatitis clinic. OBJECTIVE: To evaluate the properties of this score in the context of a population-based epidemiological study. METHODS: The association between relevant atopic criteria and previous or current flexural eczema was evaluated in 2,352 hairdressing apprentices. RESULTS: The association was not as strong as in the patient-based studies, comparing the respective odds ratios. Accordingly, the discriminating power of the Erlangen Score was poor, resulting in low sensitivity (55.7%) and specificity (73.8%) for, e.g., 8 points as cutpoint. CONCLUSION: While the score appears useful to summarise minor criteria, the individual relevance of its point values should not be overestimated in view of a low positive predictive value in a population (compared to a clinical) setting.

Adolescent↗
PubMed2001

The application of methods to quantify attributable risk in medical practice.

Several epidemiological parameters have been introduced for quantifying the population impact of a certain exposure on morbidity on a population level, termed 'attributable risk' (AR). Of these definitions, the AR as suggested by Levin in 1953 or some algebraic transformations of it are most commonly used. A structured literature search, based on the Medline database, identified 334 original epidemiological studies dealing with this AR published between 1966 and 1996 (mostly case-control studies). A considerable increase in the number of published studies incorporating some quantification of the exposure impact on the population level in terms of the AR was observed in the last decade. However, in 64.5% of these studies no exact definition of the AR used was given. Adjustment procedures necessary in multifactorial situations were performed by only 37.5%, confidence intervals for the AR were given by only 19.3% of authors. Thus, although the increasing popularity of this important epidemiological measure is encouraging, its correct application and comprehensive reporting in medical practice should be promoted further.

Algorithms↗
PubMed2000

[Ultraviolet exposure in childhood and in adulthood: which life period modifies the risk of melanoma more substantially?].

The paper is devoted to the analysis of the relationship between the frequency of sunburns in childhood and adulthood, respectively, and the occurrence of malignant melanoma of the skin. The analysis is based on case-control data of 603 melanoma cases and 627 population controls from 11 participating centers in seven European countries. The results confirm the increase in melanoma risk for an increasing number of sunburns during childhood and adulthood in the same magnitude of risk elevation. The maximum OR for the highest exposure category of more than five sunburns was during the childhood 2.0 (95%-CI: 1.2-3.5) and during the adulthood 2.1 (95%-CI: 1.4-3.3), respectively. The analysis of the joint effects of sunburns during child- and adulthood on melanoma development corroborated these findings. In this joint analysis an OR of 2.1 (95%-CI: 1.3-3.5) quantifies the melanoma risk of those with three or more sunburns during child- and adulthood, respectively, compared to those without any sunburns during these periods. The study does therefore provide no supporting evidence for the presence of "critical period" during childhood in which a higher melanoma risk due to sunburns has been suggested by other studies.

Adolescent↗
PubMed2000

Is there a relationship between influenza vaccinations and risk of melanoma? A population-based case-control study.

The aim of the present case-control study was to ascertain whether, in adults, yearly repeated anti-influenza vaccinations (AIV) enhance protection against cutaneous melanoma (CM), as do repeated febrile infections. Ninety-nine new cases of histologically confirmed CM and 104 healthy controls (matched to cases for sex, age, and skin colour) selected from the general population were examined in order to ascertain their skin type, the number of nevi on both arms, and the intensity of freckles on the face and the arms; in these subjects, a structured questionnaire was used to obtain information on age, sex, education, social class, exposure and susceptibility to sunlight, history of febrile infectious diseases, and vaccinations. The odds ratio (OR) and the 95% confidence interval (CI) were estimated by commonly used methods and by fitting models of logistic regression. The risk of CM was reduced in subjects with a history of febrile (temperature above 38.5 degrees C) infections in the 5 years prior to CM surgery (cases) or interview (controls), but was increased in those with voluntary exposure to sunlight in tropical countries. By holding the above factors constant at logistic regression analysis, it was found that a history of repeated AIV (3-5 times in the last 5 years) halved the risk (OR: 0.43; CI: 0.19-1.00; p < 0.05). With the variable 'nevi on arms' included, the protective influence of repeated AIVs was observed in a similar magnitude. The inverse relationship found between melanoma and influenza vaccinations is unlikely to have depended on a bias, even if based on replies in a questionnaire, because neither the interviewers nor the interviewers were informed in advance of the working hypothesis.

Adult↗
PubMed2000

Current clinical diagnosis in Creutzfeldt-Jakob disease: identification of uncommon variants.

According to the recently established molecular basis for phenotypic heterogeneity of sporadic Creutzfeldt-Jakob disease (CJD), six different phenotypes are characterized by the size of the protease-resistant fragment of the pathological prion protein (types 1 and 2) and homozygosity or heterozygosity for methionine or valine at codon 129 of the prion protein gene (designated by MM1, MM2, MV1, MV2, W1, and W2). In the present investigation, we analyzed the value of commonly used clinical tests (electroencephalogram [EEG], detection of 14-3-3 protein in cerebrospinal fluid [CSF], and hyperintensity of the basal ganglia in magnetic resonance imaging) for the clinical diagnosis in each CJD phenotype. The detection of periodic sharp and slow wave complexes in the EEG is reliable in the clinical diagnosis of MM1 and MV1 patients only. The CSF analysis for 14-3-3 protein showed high sensitivity in all analyzed subgroups with the exception of MV2 patients. Valine-homozygous patients had a negative EEG, but most had detectable levels of neuronal proteins in the CSF. The sensitivity of the magnetic resonance imaging was 70%, irrespective of the subgroup, but was particularly reliable in the clinical diagnosis of MV2 patients. The widening spectrum of diagnostic techniques in CJD is not only useful in the increased accuracy of the clinical diagnosis but should also lead to the identification of more atypical cases of sporadic CJD.

14-3-3 Proteins↗
PubMed1999

The effect of stress on the onset and progression of Creutzfeldt-Jakob disease: results of a German pilot case-control study.

The association between Creutzfeldt-Jakob disease (CJD) and stressful life events was examined in a pilot case-control study in Germany. The study sample consisted of 37 CJD cases and 37 controls, both groups were frequency-matched for age and sex. In standardised interviews of close relatives of the cases and the controls, all stressful life events were assessed and subsequently grouped into one of the following three subgroups: psychosocial stress events, medical operations with hospitalisation, and other serious medical examinations. A significantly higher proportion of CJD cases experienced stressful life events during the last six months before disease onset than controls (65% vs. 32%, p = 0.01), yielding an odds ratio (OR) of 3.85 (95% confidence interval (CI): 1.33-11.30). We found the clearest distinction between cases and controls for the subgroup of medical operations where an OR of 6.97 (95% CI: 0.76-329.20) was observed. Further data indicated that stressful events seem to influence not only the onset of CJD but also the progression of the disease. Although based on a rather small study sample, this pilot case-control investigation suggests evidence that stressful life events in the last six months before disease onset may influence CJD occurrence and may modify the course of disease. This 'stress hypothesis', which is in line with findings from other epidemiological and experimental studies in CJD, is thus a promising direction for future CJD research as it could enlighten the pathophysiological mechanisms and point towards strategies for the prevention and therapy of CJD.

Age Distribution↗
PubMed1999

The association between size of test chamber and patch test reaction: a statistical reanalysis.

A recent study by Brasch and co-workers reported on the association between size of test chamber and patch test reaction. The investigators interpreted their data on 495 patients as having conclusively shown that standard preparations of fragrance mix, wool wax alcohols, Kathon CG and formaldehyde led to more positive test reactions when large Finn Chambers were used for patch testing. We have scrutinized the statistical aspects of this study and conclude that the authors should have adopted a statistical approach suitable to analyse dependent samples. After explaining the correct methodological way of dealing with quadratic contingency tables formed by 2 dependent samples, we reanalyze the data accordingly and compare the results to those of the original paper. Based on this reanalysis, the conclusions are more complex: the reaction pattern for the fragrance mix and wool wax alcohols is significantly different between small and large test chambers; however, this discrepancy arises primarily from changing weak positive reactions with small chambers to strong positive reactions with large chambers. For formaldehyde, no relationship between chamber size and patch test reaction was found in the data, while for Kathon CG, statistical evidence is borderline that more positive test reactions are yielded by large test chambers than by small ones.

Adult↗
PubMed1999

Hand dermatitis in a prospectively-followed cohort of hairdressing apprentices: final results of the POSH study. Prevention of occupational skin disease in hairdressers.

The incidence of hand dermatitis is high in the hairdressing trade; the individual disease burden is substantial, as are the costs of treatment, workers compensation and retraining programs. To evaluate the risk of developing occupational irritant hand dermatitis associated with several potential risk factors, namely constitution (atopy) and occupational exposure, an observational prospective population-based cohort study set in vocational training schools in northwest Germany, recruiting 2352 hairdressing apprentices, was performed. Unprotected wet work of more than 2 h per day is the major significant risk factor; low ambient absolute humidity is equally associated with a significantly increased risk. Compared to the youngest age group, risk diminishes with increasing age. Constitutional risk factors are difficult to evaluate because of selective dropout of atopic participants. For primary prevention, a population approach, improving working conditions and skin protection for all exposed, appears to be the most beneficial.

Adolescent↗
PubMed1999

Risk of hand dermatitis among hairdressers versus office workers.

OBJECTIVES: The risk of irritant skin damage associated with hairdressing was estimated with the individual occupational exposure and other relevant factors having been taken into consideration. METHODS: A cohort of 2352 hairdressing and 111 office apprentices was prospectively followed for the duration of their vocational training (3 years), 3 examinations having been made and 3 years of recruitment having been used [1992 (hairdressers only), 1993, 1994] in 15 vocational training schools in northwest Germany. The information of the final follow-up examination was used for the analysis. RESULTS: A multifactorial analysis taking several (constitutional) risk factors, which were unevenly distributed between the 2 groups, into account revealed a significantly increased risk for hairdressers when compared with office workers (odds ratio approximately 4.0) with a marked decline in the most recently recruited (1994) apprentice group. Other significant factors increasing the dermatitis risk were (i) low ambient absolute humidity, (ii) young age, and (iii) a certain higher range of "atopy score". If the individual profile of occupational exposure among hairdressers was also considered, unprotected wet work of more than 2 hours per day was found to be a significant risk factor. CONCLUSIONS: Good skin protection, as operationalized in the present study, can diminish, but not eliminate, the risk of occupational irritant hand dermatitis among hairdressers.

Adolescent↗
PubMed1999

Infections and melanoma risk: results of a multicentre EORTC case-control study. European Organization for Research and Treatment of Cancer.

Immune function plays a prominent role in the defence against cutaneous malignant melanoma and the increased risk of melanoma development during immunosuppression. Since the immune system is challenged beyond its routine activity by an infection, the effect of previous infectious diseases on the risk of melanoma may also be crucial. In a European Organization for Research and Treatment of Cancer (EORTC) case-control study performed in six European countries and Israel, we compared the history of severe infections in 603 melanoma patients with that in 627 population controls. We calculated adjusted odds ratios (ORs) to estimate the effect of infectious diseases on melanoma risk. The ORs for melanoma risk were below 1 for nearly all types of infections (except two) if body temperature was not taken into consideration, and for all infections with a body temperature above 38.5 degrees C. In the latter category significantly lowered ORs were found for pulmonary tuberculosis (0.16; 95% confidence interval [CI] 0.01-0.98), Staphylococcus aureus infections (0.54; 95% CI 0.31-0.94), sepsis (0.23; 95% CI 0.06-0.70), influenza and related infections (0.65; 95% CI 0.48-0.86) and pneumonia (0.45; 95% CI 0.27-0.73). Analysis of the cumulative influence revealed a consistent pattern of results pointing to a reduction in melanoma risk with increasing numbers of recorded infections and fever height. This apparent dose-response relationship suggests a causal association. Speculations on the underlying mechanism include a Shwartzman-like phenomenon when melanoma formation precedes the infection and/or an infection-related Th1-cell activation preventing the establishment of the tumour.

Adult↗