[Hormone replacement therapy--treatment with risk factors].
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Breast Neoplasms↗
Biomedical subjects
E Greiser
Publications and source records attributed to E Greiser.
Study of Health In Pomerania (SHIP): a health examination survey in an east German region: objectives and design.
OBJECTIVES: The reason for the Study of Health in Pomerania (SHIP) is the lack of epidemiological studies with a broad range of health indicators. Furthermore, in Germany there is a need for studies that take into account the particular situation of life after the reunification. One objective of SHIP is to provide prevalence estimates on a broad range of diseases, risk and health factors for a defined region in the former GDR. METHODS: A sample of 7008 women and men aged 20 to 79 years in a north-east region of Germany, 4900 expected participants. The sample was drawn in two steps: First, 32 communities in the region were selected. Second, within the communities a simple random sample was drawn from residence registries, stratified by gender and age. The data collection and instruments include four parts: oral health examination, medical examination, health-related interview, and a health- and risk-factor-related questionnaire. The oral health examination includes the teeth, periodontium, oral mucosa, craniomandibular system, and prosthodontics. The medical examination includes blood pressure measurements, electrocardiography, echocardiography, carotid, thyroid and liver ultrasounds, neurological screening, blood and urine sampling. The computer-aided health-related interview includes cardiovascular symptoms, utilisation of medical services, health-related behaviours, and socioeconomic variables. The self-administered questionnaire comprises housing conditions, social network, work conditions, subjective well-being and individual consequences from the German reunification.
Adult↗
The contribution of cigarette smoking to bladder cancer in women (pooled European data).
BACKGROUND: Using a combined analysis of 11 case-control studies from Europe, we have investigated the relationship between cigarette smoking and bladder cancer in women. METHODS: Available smoking information on 685 female bladder cancer cases and 2416 female controls included duration of smoking habit, number of cigarettes smoked per day, and time since cessation of smoking habit for ex-smokers. RESULTS: There was an increasing risk of bladder cancer with increasing duration of smoking, ranging from approximately a two-fold increased risk for a duration of less than 10 years (odds ratio (OR) = 1.9, 95% confidence interval (CI) 1.1-3.1) to over a four-fold increased risk for a duration of greater than 40 years (OR = 4.1, 95% CI 3.0-5.5). A dose-response relationship was observed between number of cigarettes smoked per day and bladder cancer up to a threshold limit of 15-20 cigarettes per day, OR = 3.8 (95% CI 2.7-5.4), after which no increased risk was observed. An immediate decrease in risk of bladder cancer was observed for those who gave up smoking. This decrease was over 30% in the immediate 1-4 years after cessation, OR = 0.68 (95% CI 0.38-1.2). However, even after 25 years the decrease in risk did not reach the level of the never-smokers, OR = 0.27 (95% CI 0.21-0.35). CONCLUSION: The proportion of bladder cancer cases among women attributable to ever smoking was 0.30, (0.25-0.35) and to current smoking was 0.18 (0.14-0.22). These attributable proportions are less than those observed among men, although they are likely to increase in the future as the smoking-related disease epidemic among women matures.
Adult↗
Cigar, pipe, and cigarette smoking and bladder cancer risk in European men.
OBJECTIVE: Estimating the risk of bladder cancer from cigar and pipe smoking is complicated by a small number of non-cigarette smokers included in most relevant studies. METHODS: We undertook a pooled analysis of the data on men from six published case-control studies from Denmark, France, Germany, and Spain, to assess the association between pipe and cigar smoking and bladder cancer, and to compare it with the risk from cigarette smoking. Complete history of tobacco smoking was ascertained separately for cigarettes, cigars, and pipe. Odds ratios (ORs) were estimated after adjusting for age, study, and employment in high-risk occupations. RESULTS: The pooled data set comprised 2279 cases and 5268 controls, of whom 88 cases and 253 controls smoked only cigars or pipe. The OR for pure cigarette smoking was 3.5 (95% confidence interval [CI] 2.9-4.2), that for pure pipe smoking was 1.9 (95% CI 1.2-3.1) and that for pure cigar smoking was 2.3 (95% CI 1.6-3.5). The increase in the OR of bladder cancer that was observed with duration of smoking was non-significantly lower for cigars than for cigarettes. CONCLUSION: Our results suggest that smoking of cigars and pipe is carcinogenic to the urinary bladder, although the potency might be lower than for cigarettes.
Case-Control Studies↗
Relationship between nonphenacetin-combined analgesics and nephropathy.
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Analgesics, Non-Narcotic↗
Cigarette smoking and bladder cancer in men: a pooled analysis of 11 case-control studies.
The primary risk factor for bladder cancer is cigarette smoking. Using a combined analysis of 11 case-control studies, we have accurately measured the relationship between cigarette smoking and bladder cancer in men. Available smoking information on 2,600 male bladder cancer cases and 5,524 male controls included duration of smoking habit, number of cigarettes smoked per day and time since cessation of smoking habit for ex-smokers. There was a linear increasing risk of bladder cancer with increasing duration of smoking, ranging from an odds ratio (OR) of 1.96 after 20 years of smoking (95% confidence interval [CI] 1.48-2.61) to 5.57 after 60 years (CI 4.18-7.44). A dose relationship was observed between number of cigarettes smoked per day and bladder cancer up to a threshold limit of 15-20 cigarettes per day, OR = 4.50 (CI 3.81-5. 33), after which no increased risk was observed. An immediate decrease in risk of bladder cancer was observed for those who gave up smoking. This decrease was over 30% after 1-4 years, OR = 0.65 (0. 53-0.79), and was over 60% after 25 years of cessation, OR = 0.37 (0. 30-0.45). However, even after 25 years, the decrease in risk did not reach the level of the never-smokers, OR = 0.20. (0.17-0.24). The proportion of bladder cancer cases attributable to ever-smoking was 0.66 (0.61-0.70) for all men and 0.73 (0.66-0.79) for men younger than 60. These estimates are higher than previously calculated.
Adult↗
Coffee consumption and bladder cancer in nonsmokers: a pooled analysis of case-control studies in European countries.
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.
Bias↗
Are acute myocardial infarctions becoming smaller?
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Electrocardiography↗
[Analgesics and laxatives as risk factors for cancer in the efferent urinary tract--results of the Berlin Urothelial Carcinoma Study].
A retrospective case-control study (1990-1995), the Berlin Urothelial Cancer Study (BUS), examined analgesics and laxatives as risks for the induction of urothelial cancer in renal pelvis, ureter and bladder. Especially for renal pelvis cancer could observe substance and dose specific risk of compound analgesics. The analgesic substances Phenacetin, Paracetamol, Acetylsalicylic acid (ASA) and Pyrazolones were assessed. Besides a risk of contact laxatives (chemical or anthranoide ingredients) for urothelial cancer was found, not yet described. The highest risk shows the anthranoide plant Senna. Thus this study confirms the risk of specific analgesic ingredients and found an evidence for a new risk of contact laxatives. As both, analgesics and contact laxatives, are typical OTC--("Over the counter") products, a severe controlling is demanded and for laxatives further studies are needed.
Adult↗
Urothelial cancer at different tumour sites: role of smoking and habitual intake of analgesics and laxatives. Results of the Berlin Urothelial Cancer Study.
BACKGROUND: In Germany about 20000 new cases of urothelial cancer (UC) and about 7500 deaths from bladder cancer alone occur each year. Among the manifold risk factors, little research has been done on the role of smoking and the habitual intake of analgesics and laxatives-practices that are common in parts of the German population. The aim of this study is to define the proportion of risk derived from these preventable habits for the development of UC at its different sites. Subjects and methods. A case-control study in the area of the former West Berlin was performed from 1990 to 1995 including all newly diagnosed incident cases of UC from the eight hospitals of the study area. Study subjects and population-based controls individually matched by age (+/-2 years) and sex were evaluated by a standardized face-to-face interview about the lifelong exposure to cigarette smoking, analgesics, and laxatives. Adjusted risk analysis was carried out for the main exposure variables in relation to the different sites of UC in the bladder, ureter, and renal pelvis. RESULTS: Six hundred and forty-seven cases of UC (571 bladder, 25 ureter, and 51 renal pelvis) and an identical number of controls were included in the analysis (response rate in cases, 84.6%; in controls, 70.2%). Smoking increased the risk of bladder cancer (BC) by an odds ratio (OR) of 3.22 (95% confidence interval (CI) 2.29-4.52), that of ureter (URC) or renal pelvis cancer (RPC) together by OR 6.20 (95% CI 2.04-18.81), and that of RPC alone by OR 5.91 (95% CI 1.47-23.66). Ex-smoking was associated with an increased risk for BC (OR 1.55, 95% CI 1.10-2.19). Intake of more than 1 kg of phenacetin in analgesic mixtures was associated with an OR of 5.28 for RPC (intake of > or = 1 kg paracetamol, OR 3.27; > or = 1 kg pyrazolones, 1.12) and 0.75 for BC (not significant). Laxatives significantly increased the risk of BC (OR 2.14, 95% CI 1.26-3.63) and RPC/URC (OR 9.62, 95% CI 1. 01-91.24) in both sexes. CONCLUSION: Habitual risks from smoking and intake of laxatives significantly contribute to the development of UC, especially of the renal pelvis and ureter cancer. Intake of at least 1 kg of analgesic substances (anilides, pyrazolones) as calculated from this study base is associated with increased but not significant risks for RPC. These data underline that restrictive and educational measurements focusing on common habits would have a strong impact on preventing UC in Germany.
Aged↗
A sex difference in short-term survival after initial acute myocardial infarction. The MONICA-Bremen Acute Myocardial Infarction Register, 1985-1990.
AIMS: To assess the difference between men and women as regards fatality shortly after acute myocardial infarction, and the relationship of patient characteristics. METHODS AND RESULTS: One thousand seven hundred and ten male and 563 female patients, 25-69 years of age and hospitalized with a first acute myocardial infarction occurring from 1985 to 1990, were included in the population-based World Health Organization MONICA-Bremen Acute Myocardial Infarction Register. Patient information, including short-term survival status, was obtained from the medical records of the seven Bremen hospitals with internal medicine departments and municipal death certificate files. The unadjusted 28-day fatality rate after acute myocardial infarction was higher among women than among men (23.1% vs 16.1% respectively: P < 0.001). Adjusting for the older age of women did not eliminate the difference completely (females; 20.9%, males: 16.8%; P = 0.041). Controlling for previous use of inotropic medicine and diuretics, during-the-event receipt of thrombolysis and platelet inhibitors, and age in logistic regression analyses resulted in a similar 28-day mortality risk after acute myocardial infarction for both sexes (female/male odds ratio = 1.13, 95% confidence interval = 0.86 1.50; P = 0.389). CONCLUSIONS: Sex was not an independent predictor of early acute myocardial infarction fatality. Our data suggest that the excess mortality risk in women can be explained by sex differences in age, pre-infarction cardiac impairment, and treatment during the coronary event.
Adult↗
Relations of changes in coronary disease rates and changes in risk factor levels: methodological issues and a practical example.
One of the main hypotheses of the World Health Organization (WHO) MONICA Project is that trends in the major coronary disease risk factors are related to trends in rates of fatal and non-fatal coronary disease events. The units of study are populations rather than individuals. The WHO MONICA Project involves continuous monitoring of all coronary disease events in the populations over a 10-year period and periodic risk factor surveys in random samples of the same populations. Estimation of associations between average annual changes in mortality and risk factor levels is illustrated with the use of data from a subset of MONICA centers. Crude estimates of regression coefficients are compared with estimates obtained by weighting for standard errors in both the outcome and explanatory variables. The results show that the strength of association may be either underestimated or overestimated if these errors are not taken into account.
Adult↗
Coronary heart disease mortality, morbidity, and case fatality in five east and west German cities 1985-1989. Acute Myocardial Infarction Register Teams of Augsburg, Bremen, Chemnitz, Erfurt, and Zwickau.
Cardiovascular mortality (CVD; International Classification of Diseases [ICD] 390-458) is higher in East than in West Germany, but the differences in official coronary heart disease mortality (CHD; ICD 410-414) are not so pronounced. The aim of this study was to validate the official mortality statistics based on the five German AMI registers and to analyze whether these mortality differences are due to differences in the attack rates of acute myocardial infarction (AMI) or to differences in the 28-day case fatality rates. This comparison includes the MONICA study cities of Augsburg and Bremen, both in West Germany, as well as the cities of Chemnitz, Erfurt, and Zwickau in East Germany (former the German Democratic Republic). The rates were calculated on the basis of all MONICA cases of definite AMI or coronary death aged 35 to 64 years occurring in the respective study populations between 1985 and 1989. All study populations except women in Augsburg showed higher coronary death rates compared to the rates based on the official cause of death statistics (ICD 410-414), but this difference was significant only for men in Chemnitz. In men there were no significant differences in the register-based coronary death rates between these urban areas (160/100,000 in Zwickau to 170/100,000 in Chemnitz) nor in the AMI attack rates (327/100,000 in Augsburg to 363/100,000 in Chemnitz), and consequently no significant center differences in the overall 28-day case fatality. However, the prehospital case fatality was significantly higher in Erfurt (34%) than in Bremen (27%). There were no significant differences in the AMI attack rates in women as well (60/100,000 in Chemnitz to 70/100,000 in Bremen and Erfurt), but the overall 28-day case fatality showed a clear gradient from the East (61-71%) to the West German cities (48-56%) and therefore also the register-based coronary death rates (38-50/100,000 and 34-38/100,000, respectively). However, the higher 28-day case fatality in women found in the MONICA registers in East compared to West Germany is not reflected in the CHD mortality statistics because of a stronger underestimation of the official mortality rates and in East than in West Germany, in particular in women. Nevertheless, the total mortality rates and in most cases also the CVD mortality rates were in women significantly higher in the East German compared to the West German cities. The East German official preunification CHD mortality data cannot be used for national and international comparisons. The results of the MONICA AMI registers in East and West Germany indicate, furthermore, the need to improve coronary care in women in the eastern part of the country. Nevertheless, because of the relatively high AMI attack rate in both parts of Germany primary prevention must generally be intensified.
Adult↗
Measuring cardiovascular disease risk factor levels: international comparisons between Bremen-north/west (Germany) and two southeastern New England (USA) cities.
Cardiovascular disease risk factor comparisons were made on study populations from communities in two different countries with similar ongoing intervention programs. Baseline survey data from the intervention and comparison communities of the Pawtucket Heart Health Program in Pawtucket, Rhode Island, and from the intervention Region of Bremen-North/West of the German Cardiovascular Prevention Study were compared with respect to these cardiovascular disease risk factors: smoking, overweight, physical inactivity, hypertension, and hypercholesterolemia. The relationship between these variables and social class was also examined in an attempt to partially explain some of the cross cultural differences in risk factors and predicted CHD and CVD mortality. Results indicated statistically significant differences in amount of cigarettes smoked, exercise frequency, diet, body mass index, total cholesterol, HDL, and blood pressure. These risk factors were generally higher in the German population than in the American population as were the predicted CHD and CVD mortality. For the study populations of both countries, however, the lower the social class, the more prevalent the smoking, excess weight, and lack of physical activity.
Adult↗
[Social inequality in myocardial infarct and stroke in West Germany].
It is examined to which extent social inequalities exist in West-Germany (old federal states) regarding myocardial infarction and stroke in the general population. Databases were the regional and national health surveys which were conducted in the framework of the German Cardiovascular Prevention Study (GCP) from 1984 to 1991. 12.445 males and 13,335 females aged 40-69 years were included in this analysis. The assessment of myocardial infarction and stroke was done by a self administered questionnaire. 648 (5.2%) males and 252 (1.9%) females reported a myocardial infarction. 209 (1.7%) males and 143 (1.1%) females reported a stroke. Social class was measured using an additive index comprising the dimensions income, occupational status and education. For both genders it was found that the prevalence of myocardial infarction and stroke increased significantly with decreasing social class. This association remained significant also under control for age and the cardiovascular disease risk factors cigarette smoking, hypertension, hypercholesterolemia and overweight. The results clearly demonstrate that in West-Germany--as was shown already for many other western industrialized nations--social factors independently from the classical risk factors have a significant effect on the incidence of myocardial infarction and stroke.
Adult↗
Occupational and environmental hazards associated with lung cancer.
In a hospital-based case-control study 194 lung cancer cases, 194 hospital controls, and 194 population controls were interviewed for their smoking, occupational, and residential history by trained interviewers, using a standardized questionnaire. In order to include many different environmental exposures, case ascertainment took place in seven different hospitals with catchment areas ranging from rural to highly industrialized. Lung cancer risk strongly increases with cumulative cigarette dose, reaching an odds ratio (OR) of 16.19 (95% confidence limits (CL): 5.10, 51.33) for male smokers of more than 40 pack-years and an OR of 19.99 (95% CL: 4.98, 80.24) for female smokers of more than 20 pack-years. For the quantification of occupational exposure to known carcinogens of the lung a novel approach was developed which accumulates exposure information obtained by supplemental questionnaires through an automatic procedure. The OR for the highest exposure group in males was 2.7 (95% CL: 1.23, 5.78). Significantly increased risks were observed in the metal industry, particularly in smelter and foundry workers (OR 4.8, 95% CL: 1.15, 20.16) and in turners (OR 2.2, 95% CL: 1.05, 4.75). In the construction industry the risks were particularly high in road construction workers (OR 3.7, 95% CL: 1.06, 13.20) and in unskilled construction workers (OR 2.7, 95% CL: 1.24, 5.76). The risks in these occupational groups increased with duration and with latency. Quantification of air pollution was done on a county basis by time period. An index based on emission data for sulphur dioxide was compared to a semiquantitative index, which included additional information on ambient air pollution. After adjustment for smoking and occupational exposures an OR of 1.01 (95% CL: 0.53, 1.91) for an emission index and of 1.16 (95% CL: 0.64, 2.13) for a semiquantitative index was obtained.
Adult↗
Relationship of social class characteristics and risk factors for coronary heart disease in West Germany.
A cross-sectional analysis of the baseline survey of the German Cardiovascular Prevention Study was carried out to analyse the relationship between four different social class characteristics and major risk factors for coronary heart disease. 4,796 randomly selected German residents aged 25-69 years participated in the health survey between 1984 and 1986. The response rate was 66.2%. No significant association with social class variables was observed for prevalence of hypertension, hypercholesterolaemia or low high density lipoproteins. Multiple logistic regression analysis showed that obesity and lack of physical activity were significantly more prevalent in lower social classes for both sexes, while for cigarette smoking this relationship held for males only. The strongest social class gradient was found for lack of physical activity, adjusted odds ratio 4.75, P less than 0.001, comparing lowest social class by composite index to highest. The number of coronary heart disease risk factors per study subject increased strongly with decreasing social class. Education, measured as years of schooling, showed a stronger association with coronary heart disease risk factors than household income, occupational status, or a three-dimensional composite index of social class. These findings indicate the need to focus on lower social class population groups when carrying out community-based coronary heart disease primary prevention programmes, particularly with regard to smoking, obesity, and lack of physical activity.
Adult↗
Federal Republic of Germany: perspectives in school health.
In the Federal Republic of Germany, responsibilities for health and education are held by the 11 German states. Particularly in the health system, a number of tasks are delegated to private organizations under governmental control. In this review, general characteristics of both the public health and education systems are delineated. An overview of school health programs, including instruction, health services, environment, and school-community relations, and school-based research, also are presented.
Community Participation↗