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Biomedical subjects

J Stieber

Publications and source records attributed to J Stieber.

At least 37 records · Page 2Linked to original sources
PubMed1998

[Use of vitamins and minerals all food supplements from the MONICA cross-sectional study of 1994/95 from the Augsburg study region].

The intake of vitamin and mineral supplements was examined in a southern German population. Analyses are based on data from the 3rd survey of the MONICA Project Augsburg which took place from 1994 to 1995. The study population were 4,856 persons aged 25 to 74 years of a representative sample (net response 74.9%). During a standardized interview, participants were asked about their intake of vitamin or mineral supplments in the previous week (information available from 4,854 persons). To evaluate this information, a database on vitamin and mineral contents of about 500 supplements was established. The prevalence of supplement users is significantly higher among women than among men: more than a quarter of women (27.5%) versus nearly a fifth of men (18.1%). With increasing age women take supplements more frequently, especially minerals. Male supplement usage increases up to the age group 35-44 years and then remains constant. Vitamin C (women 12.8%, men 9.4%), magnesium (women 12.4%, men 8.7%), vitamin E (women 9.8%, men 7.8%), and calcium (women 10.7%, men 4.9%) are the vitamins and minerals supplemented most often. Among supplement users, 46.5% of women and 52.1% of men reported taking vitamin C. The median daily intake of vitamins--except biotin and niacin in men and folic acid and biotin in women--is at least 100% of the recommendations of the German Society for Nutrition for both men and women. All of the median intake values for minerals were less or equal than 100% of the recommendations.

Adult↗
PubMed1998

Classical risk factors and their impact on incident non-fatal and fatal myocardial infarction and all-cause mortality in southern Germany. Results from the MONICA Augsburg cohort study 1984-1992. Monitoring Trends and Determinants in Cardiovascular Diseases.

BACKGROUND: The MONICA (Monitoring Trends and Determinants in Cardiovascular Diseases) project in Augsburg provides the first population-based cohort study in Germany to quantify the associations of the risk factors hypertension, hypercholesterolaemia and smoking with incident non-fatal and fatal myocardial infarction and all-cause mortality, and to assess their impact at the population level. METHODS: The cohort comprises 1074 men and 1013 women aged 45-64 years; they were followed over 8 years from 1984-1992. In the men, there were 61 non-fatal and fatal myocardial infarctions and 92 all-cause mortality events over this period; in the women the number of deaths from all causes was 45. Incidence rates, hazard rate ratios, population attributable fractions and rate advancement periods were calculated. RESULTS: Adjusting for confounders, the myocardial infarction hazard rate ratios for men with hypertension, or a total cholesterol/HDL-cholesterol ratio > or =5.5, or smoking > or =20 cigarettes/day, were 2.0 (95% CI 1.2-3.5), 2.9 (95%, CI 1.7-5.0), and 2.7 (95% confidence interval (CI) 1 4-5.0), respectively. The risk factor combination total cholesterol/HDL cholesterol ratio > or = 5.5 and cigarette smoking was particularly hazardous. The three risk factors contributed 65% of the burden of myocardial infarction in the population. The rate advancement period for myocardial infarction associated with hypertension, total cholesterol/HDL cholesterol ratio > or =5.5 or smoking > or =20 cigarettes/day was 8.3, 12.4 and 11.5 years, respectively. In women, these risk factors were similarly predictive of all-cause mortality. Comparing the cohort data from Augsburg with those of two occupational cohorts from Germany reveals higher absolute myocardial infarction risks in the Augsburg population; however, the relative risk estimates in the Augsburg and the two occupational cohorts were very similar. CONCLUSION: Our results confirm the important contribution of the classical risk factors to the risk of myocardial infarction and all-cause mortality in Germany. The results pertaining to the concept of rate advancement periods particularly demonstrate the great potential for prevention.

Cause of Death↗
PubMed1997

The relation of alcohol intake to coronary heart disease and all-cause mortality in a beer-drinking population.

Epidemiologic studies indicate that light to moderate alcohol consumption from beer, wine, or spirits is associated with a reduction in all-cause mortality, owing primarily to a reduced risk of coronary heart disease (CHD). To find out whether this protective effect of small to moderate amounts of alcohol could be confirmed in Germany, where much of the alcohol consumed is taken in the form of beer, we studied the relation between alcohol and CHD and total mortality in a population of southern Germany. We conducted a prospective cohort study from 1984 to 1992 among 1,071 men and 1,013 women, age 45-64 years at baseline, from the Augsburg region. Eighty-seven per cent of men and 56% of women reported drinking alcohol at baseline. Among drinkers, men had an average alcohol intake of 42 gm per day, of which 33 gm per day came from beer. Women who drank had an average alcohol intake of 16 gm per day and derived about half of it from beer and the other half from wine. During the 8 years of follow-up, 96 deaths (all causes) and 62 incident CHD events (nonfatal and fatal) occurred in men, and 45 deaths (all causes) occurred in women. Adjusting for a number of potential confounders, in men the adjusted hazard rate ratio (HRR) of CHD events for drinkers as compared with nondrinkers was 0.51 [95% confidence interval (CI) = 0.27-0.95]; this protective effect starts with the 0.1-19.9 gm per day alcohol category and does not change much with higher intake. In men, the adjusted total mortality HRR for drinkers as compared with nondrinkers was 0.59 (95% CI = 0.36-0.97). The total mortality HRRs for the different alcohol groups compared with nondrinkers show a U-shaped curve, with the lowest HRR of 0.46 (95% CI = 0.20-0.80) for the 20-39.9 gm per day alcohol group and an HRR of 1.04 (95% CI = 0.54-2.00) for the > or = 80 gm per day alcohol group. In women, the total mortality HRR for those drinking up to 19.9 gm per day as compared with nondrinkers was 0.46 (95% CI = 0.22-0.96).

Age Distribution↗
PubMed1997

The angiotensinogen T235 variant and the use of antihypertensive drugs in a population-based cohort.

Variants of the angiotensinogen gene may increase the risk of developing arterial hypertension, but their effect on the use of antihypertensive medication in the general population remains unclear. Thus, we determined T174M and M235T allele status and angiotensinogen plasma levels in a cross-sectional sample of 634 middle-aged subjects (48.4% men) from the Monitoring Trends and Determinants in Cardiovascular Disease (MONICA) Augsburg cohort study. We found no association between T174M allele status and angiotensinogen levels, blood pressure, or use of antihypertensive drugs. In contrast, multivariate analysis revealed that individuals who carried at least one copy of the T235 allele (n = 418) had higher systolic and diastolic pressures (P = .007) and .008, respectively) and were more likely to use an antihypertensive drug (1.6-fold risk, P = .04) than homozygotes for the M235 allele (n = 216). The likelihood of taking two or more antihypertensive medications was 2.1-fold higher in carriers of the T235 allele (P = .02). Overall, 22.5% of all antihypertensive drugs taken appeared to be attributable to the excess risk associated with this allele. These associations were replicated in two previous surveys carried out on the same individuals over 10 years. Furthermore, the T235 allele was related to higher angiotensinogen plasma levels [15.5 +/- 0.31 versus 16.5 +/- 0.15 (nmol/L)/L in homozygotes for the M235 and T235 alleles, respectively; P < .01], which were also related to systolic pressure (P = .03) and more intensive antihypertensive medication (P = .03). We conclude that the angiotensinogen T235 allele accounts for a substantial proportion of antihypertensive drug use in this middle-aged, population-based group of white subjects.

Aged↗
PubMed1997

[Nonparticipation as a factor influencing the value of follow-up studies. Results of a telephone 5-year follow-up interview of 55-74-year-old participants of the Augsburg 1989/90 MONICA Survey].

In prospective cohort studies losses to follow-up are the major source of bias. This article describes the results of the investigation whether there are systematic differences in socio-economic and health-related factors between participants in a follow up study and those who are lost to follow-up. Subjects included were 1,030 men and 957 women aged 55-74 who participated in the second MONICA Survey Augsburg, F.R.G., 1989/90 (MONICA = Monitoring of trends and determinants of cardiovascular disease). They were reexamined in 1994-95. In 1994/95 910 men and 912 women of the baseline study were still alive, 1305 persons (663 men, 642 women) took part in the follow up by telephone. Altogether 120 men and 45 women had died since 1989/90. 144 persons were not eligible for the study (15 moved away, 5 severely ill persons, 124 without telephone). 373 persons were classified as eligible non-responders. The response rate was 77.8% concerning 1678 eligible persons (men 79.1%, women 76.4%). Non-response has led to an underrepresentation of the lower social class (workers, less than 10 years of education; household income less than 1500 DM) and of persons living alone (single, divorced, widowed; single-person households). In females, non-responders were overrepresented by "never employed persons" (odds ratio 3.02; 1.89-4.85). We found that the odds of being non-responder for single, divorced or widowed men was 3.40 (95 %-CI: 2.20-5.23) compared to married men. Men "without chronic diseases" at the baseline study compared with ill men had an odds for non-response of 1.54 (95%-CI: 1.00-2.37); the odds was 1.38 (95%-CI: 1.02-1.85) among women who had described their health status as "not so good/bad" in comparison with women with good self reported health. The reported distortions by non-response could be important in analyses of social conditions of morbidity and mortality. The underrepresentation of men without chronic diseases and women with bad self-assessment of their health is relevant for the estimates of morbidity as health outcome. Both aspects have to be taken into account in the interpretation of the results.

Aged↗
PubMed1996

Cardiovascular risk factors, ECG abnormalities and quality of life in subjects with atrial fibrillation.

In Central European regions epidemiologic findings for atrial fibrillation (AF) in a randomly selected population are not available. Therefore, information obtained by a standardized examination procedure including resting 12 lead ECG of 4003 participants (2014 men, 1989 women), aged 25 to 64 years, of the MONICA-Augsburg Survey 1984/85 were analysed. Reexamination of 3753 subjects took place three years later (Follow-up Study 1987/88). Persons with AF in the baseline survey (n = 13) were compared with an age-and sex-matched control group (n = 156) without AF, chosen from the same population sample, with regard to cardiovascular risk factors, associated disease and disturbances in the subjects' general well-being. In 1984/85 thirteen cases with AF (6 males, 7 females) were observed, giving an age-standardized prevalence of AF in males of 0.22% and in females of 0.34%. The age of men with AF ranged between 50 and 63 years and of women between 61 and 64 years. No significant differences were observed in persons with AF compared to the control group in risk factor levels and alcohol consumption; however, significant differences could be seen concerning disturbances in quality of life like self-reported health status (p < 0.001), sleep disturbances (p < 0.05), antihypertensive medication (p < 0.001). AF cases were found to have further ECG abnormalities significantly more often (left anterior hemiblock: p < 0.05; ventricular premature beats: p < 0.05). In all subjects with AF in the initial examination 1984/85 AF was found three years later (chronic AF). Overall 13 new cases (7 men, 6 women) were identified in the 1987/88 follow-up. The prevalence of AF in a South German population is comparable with AF prevalences reported from studies in other populations (e.g.) Framingham 1950, Reykjavik 1967/70). Associated ECG abnormalities were found more frequently in subjects with AF. Cases with AF have considerable disturbances in their general well-being.

Adult↗
PubMed1996

Blood pressure measurements in epidemiological surveys--time to change?

Blood pressure recordings in epidemiological surveys are usually obtained by non-ambulatory, multiple one-occasion, manual sphygmomanometric measurements by trained observers in study participants subjected to standardized examination conditions. High validity and reliability of blood pressure measurements ensure the comparability of study results obtained in different places and at different times, and have a major impact on the detection of correlates and determinants of blood pressure and hypertension. A blood pressure measurement quality assessment was performed within the multi-center collaborative WHO-MONICA Project investigating results of 47 surveys from various geographic regions of the world. In an overall summary assessment, six out of these 47 surveys were found to have had major measurement problems which prohibited their further inclusion in collaborative analyses. Most of the problems were associated with observer-related factors. Therefore, it was contended that automatic blood pressure measurement devices might be able to reduce and abolish most of these "nuisance" factors. In 1995, we had the opportunity to simultaneously study two independent random samples of men and women, aged 45 to 64 years, from the city of Augsburg in Southern Germany. One sample was examined by 16 observers with a random zero sphygmomanometer (MONICA Augsburg), the other sample (J.A.P. Study) was examined by two observers with an invasively validated, automatic oscillometric device (boso Oscillomat). In both surveys, blood pressure was measured three times under similarly standardized conditions. comparing the blood pressure results of the two surveys, the intra-individual measurement variation tended to be slightly higher with the Oscillomat than the random zero, and the population mean blood pressures and hypertension prevalences were found to be significantly lower with the Oscillomat. We conclude that manual measurements of blood pressure by sphygmomanometer should not be indiscriminately replaced externally validated automatic devices. The imponderabilities of automatic devices with varying technical principles have to be assessed in epidemiological settings weighed against recognized disadvantages of sphygmomanometry before any recommendations can be given as to changing the present epidemiological practice.

Bias↗
PubMed1993

[The effect of education and professional position on changes in cigarette smoking and alcohol consumption: results of the MONIKA Augsberg cohort study].

This study examined the influence of educational achievement and occupational position on changes in risk behavior. Study population were 3753 men and women aged 25-64 years who were sampled by the first MONICA Augsburg Survey (Monitoring trends and determinants in cardiovascular disease). The subjects were sampled in 1984-85, were followed up for three years, and were reexamined in 1987-88. The baseline findings showed for both men and women a statistically significant inverse association between current cigarette smoking and educational level. During the follow-up period the differences between highest and lowest educational levels increased significantly among men. In 1987-88 only 21% of the best educated men were smokers compared to 38% of those with the lowest educational level. Men with low educational levels also drank more alcohol than better educated men, whereas among women those with lowest educational level drank less alcohol than the better educated. Statistically independent of education and age it was found that male civil servants and farmers had the lowest proportion of smokers in cross-sectional as well as longitudinal analyses. Among women, smoking was and remained most prevalent in simple white-collar occupations. In general, the findings indicate that the type of occupation and the actual working conditions have effects on life-style related risk factors which are in part independent of a social gradient. The results also suggest that the tendency to change unhealthy behavior is less pronounced in "high risk" groups.

Adult↗
PubMed1993

Five-year changes in population blood pressure and hypertension prevalence. Results from the MONICA Augsburg surveys 1984/85 and 1989/90.

Two cardiovascular risk factor surveys were carried out in 1984/85 and 1989/90 in the Augsburg study region of the international World Health Organization (WHO) Monitoring Trends and Determinants of Cardiovascular Disease (MONICA) project. Independent random samples of the 25- to 64-year-old population were examined at each survey. Five-year changes in blood pressure (BP) and hypertension parameters were monitored in a population not targeted by any formal intervention program. Response rates in both surveys ranged close to 80%. Evaluation of selected quality indicators confirmed comparability of the two surveys in terms of BP measurement quality. Small but consistent decreases in mean systolic and diastolic BP were observed, particularly for women 35 years and older, whereas BP changes in men were less pronounced and inconsistent. Likewise, downward shifts of the 10th, 50th, and 90th percentiles of systolic and diastolic BP occurred in women and their slopes of BP rise with age decreased while such changes were less clear in men. The age-standardized prevalence of men and women with hypertensive BP (HBP; > or = 160/95 mm Hg) decreased slightly. This contrasted with rises in the prevalence of actual hypertension (those with HBP plus those taking antihypertensive drugs) for 45- to 64-year-old men, which originated from changes in hypertension management involving a more frequent drug treatment of borderline-hypertensive men (140 to 159/90 to 94 mm Hg) in 1989/90. There were notable overall increases in the awareness, treatment, and control of men and women with hypertension.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1993

Trends in alcohol intake in a southern German population from 1984-1985 to 1989-1990: results of the MONICA Project Augsburg.

This study was undertaken to measure trends in alcohol intake from 1984-85 to 1989-90 in a southern German population. In the surveys of the MONICA Augsburg Project conducted in 1984-85 (Survey 1) and 1989-90 (Survey 2) data on alcohol intake (in grams/day) were gathered from two independent representative samples (Survey 1: 4,016; Survey 2: 3,960) of men and women, aged 25 to 64 years. A validated recall method was applied. Self-reported mean alcohol intake was high in Survey 1 (36 g/day in men; 11 g/day in women), but decreased from Survey 1 to Survey 2 in both men and women (32 g/day in men; 9 g/day in women). The decrease is reflected also in the median and 95th percentile values of alcohol intake and in an increase of the proportion of self-reported nondrinkers from Survey 1 to Survey 2. Alcohol intake in the MONICA Augsburg population is rather high in comparison to other countries, but a trend to lower intakes was observed from 1984-85 to 1989-90.

Adult↗
PubMed1992

The association of antihypertensive treatment patterns and adverse lipid effects in population-based studies.

We investigated the relationship between antihypertensive drug treatment of hypertensives and their mean serum lipid concentrations in population based studies in Germany. Data from three surveys (Luebeck Blood Pressure Study (LBS) of 1984, MONICA Augsburg Survey I of 1984/85, MONICA Augsburg Survey II of 1989/90), obtained on random samples of the population aged 25-64 years, were used for cross-sectional analyses. Moreover, prospective analyses were carried out on participants of the MONICA Augsburg cohort study of 1987/88 (3-year-follow-up of the MONICA Survey I). Blood pressure, non-fasting serum total cholesterol and HDL-cholesterol, and body height and weight were measured under strictly standardized conditions. Interview data were available on medical history including medication use, and on smoking and alcohol consumption. In cross-sectional and prospective analyses treated male and female hypertensives in each population had significantly lower crude mean HDL-C concentrations than untreated hypertensives, borderliners, or normotensives. Differences in mean HDL-C between untreated and treated hypertensives were attenuated but still significant after control of confounders and ranged from 1.8 to 6.1 mg/dl (i.e. in relative terms, -3.4 to -12.9%) in men and from 3.6 to 9.4 mg/dl (-5.7 to -14.9%) in women. By contrast, crude and multivariate associations of antihypertensive treatment with non-HDL-C (total minus HDL-C) levels were inconsistent and not significant. The inverse association of drug therapy with HDL-C was confirmed by prospective analyses in the MONICA cohort study supporting a causal relationship. Treatment patterns in a community (prevalence of prescribed drug classes) correlated with the magnitude and significance of HDL-C effects.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1991

[Drug interactions in the prescriptions of patients before and after a heart infarct: results of the MONICA Augsburg heart infarct registry].

The prescriptions of 603 patients who had survived acute myocardial infarction (AMI) for at least one year and were registered from 1 Oct 84 to 31 Dec 86 in the Coronary Event Register of the MONICA project Augsburg were analyzed for the presence of drug-drug interactions with the aid of a computerized drug information system (SMA). Prior to AMI, 59% of patients were treated (average of 2 active substance per patient), 100% were treated on release from hospital (4.5 active substances), and 96% one year after AMI (5.8 active substances). Potential drug-drug interactions were found in 18% of patients before AMI, 65% on discharge from hospital, and 66% one year after AMI. While the potential frequency and severity of interactions are minor on average, prescriptions frequently contain several interactions. Calculations show that at least 5-6% of all prescriptions after AMI will produce interactions, so that drug safety for this high-risk patient group can be enhanced by a drug information system. Beta-blockers are the substance group most frequently involved in potential interactions in AMI patients.

Adult↗
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

Smoking habits and attitude to smoking in the study population of the MONICA Project Augsburg.

Data concerning smoking habits were derived from the first MONICA-Augsburg survey 1984/85 based on a random two stage cluster sample of the 25-64 year old population of the city of Augsburg and the two surrounding rural districts (n = 5312). Data were gathered by a standardized interview. Response was 79%. Overall, about 36% of men and 18% of women are regular cigarette smokers (i.e. smoking more than one cigarette per day). In both sexes smoking decreases with increasing age. In men 43% of the 25-34 year old participants are regular smokers and 29% in the age group 55-64. In women 29% of the youngest age group but only 9% aged 55-64 are current regular smokers. In male regular cigarette smokers the mean amount of cigarettes consumed per day is 21, in women 14 cigarettes. The mean amount of nicotine and tar consumed per day is 17 mg and 277 mg in men, 10 mg and 159 mg in women. On the average men start smoking at the age of 18 and women at the age of 21. In both sexes the percentage of regular smokers, who are willing to change their smoking habits, is very high. In each age and sex group about 60% of all regular smokers affirmed their willingness to quit smoking in the future. It is hoped, that this willingness of the population to change their smoking behavior will be supported by suitable education and intervention programs.

Adult↗
PubMed1988

Social relations and smoking behavior: results from the first MONICA Survey Augsburg.

This study examines the relationship between various aspects of social relations and the prevalence of smoking, using data from the first MONICA Survey, Augsburg, FRG, 1984/85. Study population of the survey was a two-stage cluster sample of 5312 men and women aged 25 to 64. The response was 79.4%. The measurement of social relations included a modified form of the Syme/Berkman social network scale, as used in the Alameda County Study. Analyses were carried out separately for the total four-level social network index in relation to smoking, and for specific components of that index (marital status, contacts with friends and relatives, activities in informal groups). The results showed for both men and women, that there was a significant association between the social network index and the prevalence of smoking: the more social ties and contacts, the lower the percentage of smokers. The results from multiple logistic regression analyses indicated an effect of social relations on smoking, that is at least partly independent of age, gender and educational level. In general, the findings may contribute to a better understanding of 'risk groups', and the possible pathways leading from social relations to health and disease.

Adult↗
PubMed1988

The cardiovascular risk factor profile in the study area Augsburg. Results from the first MONICA survey 1984/85.

The main objective of the first survey was the investigation of the prevalence and distribution of hypertension, hypercholesterolemia and cigarette smoking in the study area. The data-collection phase lasted from October 1984 to May 1985. A two-stage cluster sample of 5312 persons of German nationality was drawn from a population of 282,279 inhabitants, aged 25-64. The data were gathered through interview, physical examination and self-administered questionnaire. A response of 79% was achieved. Sixteen percent of men and 10% of women had high blood pressure (BP) values (greater than or equal to 160/95 mmHg). Only 16% of male and 34% of female hypertensives had controlled BP values. The prevalence of hypercholesterolemia (greater than or equal to 6.72 mmol/L = greater than or equal to 260 mg/dl) was 26% in men and 22% in women. Forty percent of men and 22% of women reported they were current cigarette smokers. Among participants, aged 25-44, cigarette smoking was the most prevalent risk factor in men and women. Thirty-seven percent of men and 52% of women, aged 25-64, had none of the three major risk factors.

Adult↗