PubMed Health⌕ Search

Biomedical subjects

Siegfried Geyer

Publications and source records attributed to Siegfried Geyer.

12 recordsLinked to original sources
PubMed2006

Elevated brain natriuretic peptide and reduced exercise capacity in adult patients operated on for tetralogy of fallot is due to biventricular dysfunction as determined by the myocardial performance index.

Although tetralogy of Fallot (TOF) can be repaired surgically, residual lesions that cause abnormal ventricular load can eventually lead to heart failure. Subclinical biventricular dysfunction in these patients may be detected only by using suitably sensitive indexes. The Tei index determined by the pulsed Doppler method enables the measurement of left ventricular (LV) and right ventricular (RV) function. This study was designed to evaluate the biventricular Tei indexes in adults with operated congenital heart disease and to correlate these indexes with cardiopulmonary capacity and neurohormonal activation. Fifty-nine patients with surgically corrected TOF and 52 patients with operated left-to-right-shunt defects were included in the study. Patients with TOF showed significantly greater LV and RV Tei indexes than those with left-to-right-shunt defects (LV Tei index 0.50 +/- 0.09 vs 0.34 +/- 0.05, RV Tei index 0.37 +/- 0.1 vs 0.25 +/- 0.06; p <0.0001). Peak oxygen uptake was significantly reduced in the patients with TOF (25 +/- 6 vs 32 +/- 6 ml x kg(-1) x min(-1), p <0.0001) and was correlated inversely with the LV Tei index (r = -0.61, p <0.0001). N-terminal-pro-brain natriuretic peptide was significantly increased in patients with TOF (150 +/- 141 vs 57 +/- 39 pg/ml, p <0.0001). In conclusion, in asymptomatic or minimally symptomatic patients with TOF, biventricular dysfunction is detected by the Tei index. Further indexes for heart failure in these patients are increased circulating plasma N-terminal-pro-brain natriuretic peptide and impaired peak oxygen uptake. The combined determinations of these 3 variables enable the identification of congenital heart disease with impaired cardiac function before they become clinically symptomatic.

Adult↗
PubMed2006

Incidence and risk distribution of heart failure in adolescents and adults with congenital heart disease after cardiac surgery.

Heart failure (HF) is a major problem in the long-term follow-up of adults with congenital heart disease (CHD) after cardiac surgery. The purpose of this study was to evaluate risk factors for HF in patients with CHD. N-terminal-pro-brain natriuretic peptide and maximal oxygen uptake (VO2max) were measured in 345 consecutive patients with CHD. HF was defined as an elevated N-terminal-pro-brain natriuretic peptide level (> or = 100 pg/ml) and reduced VO2max (< or = 25 ml/kg/min). The HF criteria were met by 89 patients. These patients were significantly older (mean +/- SEM 30.8 +/- 0.9 vs 24.8 +/- 0.5 years), had significantly lower maximal heart rates (149 +/- 3 vs 164 +/- 1 beats/min), and had larger end-diastolic right ventricular diameters (36 +/- 1 vs 27 +/- 1 mm) and right ventricular pressure estimated by Doppler flow velocities of tricuspid valve regurgitation (2.9 +/- 0.1 vs 2.3 +/- 0.03 m/s). Mean fractional shortening of the left ventricle was within the normal range. To estimate risk stratification, odds ratios for HF were determined for the most frequently occurring types of congenital heart defects and surgical procedures. In conclusion, HF in adults with CHD predominately depends on diagnosis, age, the frequency of reoperation, and right ventricular function and may be related to chronotropic incompetence indicated by lower maximal heart rates.

Adolescent↗
PubMed2006

Psychological symptoms in patients after surgery for congenital cardiac disease.

AIMS: We studied a population of patients with surgically corrected congenital cardiac disease to determine whether limitations in activity, impaired cardiac performance, and perception of body image have effects on psychological symptoms. METHODS: We undertook medical examinations, and carried out standardized interviews, in 361 patients aged between 14 and 45 years with surgically corrected congenital cardiac disease. From this data, findings from 343 patients were suitable for analysis. Subjectively reported limitations in activity were classified according to the system proposed by the New York Heart Association, while cardiopulmonary capacity was used as the indicator of cardiac performance. The Brief Symptom Inventory was used for assessing psychological symptoms, such as somatization, obsession-compulsion, interpersonal sensitivity, depression, anxiety, hostility, phobic anxiety, paranoid ideation, and psychoticism. The Body Image Questionnaire was used to depict attitudes towards body image, which is assessed on the two subscales of rejection of the body and vitality. Multivariate regression analyses were conducted separately for females and males, taking into account age and socio-economic position. RESULTS: Impairments of everyday activities had only a few substantial associations with psychological symptoms. No significant effects of cardiac functional capacity as a standardized physiological measure emerged. Psychological symptoms were strongly influenced by perceptions of body image, particularly if they rejected it, this holding particularly for males. There were no gender differences in terms of psychological symptoms. CONCLUSIONS: Limitations of activity, and impaired cardiac performance, have only minor effects on psychological symptoms in patients with surgically corrected congenital cardiac disease. The perception of body image was the strongest predictor, especially if patients rejected their body as a result of disfigurement or perceived deficiency.

Adolescent↗
PubMed2006

[Psychological symptoms and body image in patients after surgery of congenital heart disease].

In the last 20 years the survival rate of patients with congenital heart disease has increased considerably, thus psychological consequences of living with a heart defect have attracted considerable scientific attention. In our study psychological symptoms and the body image of patients with congenital heart disease were compared with the respective scores of general population samples (age: 14 - 45 years). Psychological symptoms were measured by means of the Brief Symptom Inventory (BSI; subscales: somatization, obsessive-compulsive thoughts, interpersonal sensitivity, depression, anxiety, hostility, phobic anxiety, paranoid ideation, psychoticism). Body image was assessed with the FKB-20 body image questionnaire (subscales: rejection of the body, vitality). The patient group consisted of 361 women and men with congenital heart disease. For comparisons with the BSI, a sample of 1165 subjects was available. Comparisons with the FKB-20 were performed with data from a separate survey (N = 1169). After stratification for age and gender, in females only a few differences were found for both instruments. In males higher scores were obtained for "rejection of the body", and lower ones for "vitality". This does not apply to the highest age group (36 - 45 years). For all BSI-subscales except "depression", "phobic anxiety", and "psychoticism" marked differences between patients and controls were found in males and over all age groups. In women group differences emerged on some subscales (obsessive-compulsive thoughts, interpersonal sensitivity, anxiety, hostility, and phobic anxiety), but this does not hold for all age groups. These results do not apply to patients with the severest impairments due to congenital heart disease, because their number in our study was too low.

Adaptation, Psychological↗
PubMed2006

[Do members of self-help groups know more about breast cancer?].

The knowledge of patients about their disease is a precondition for actively participating in decisions on treatment and aftercare. Self-help groups consider themselves as important intermediate agents for conveying disease-related information, but the health-promoting effects of such groups have not yet been studied in much detail. Using a newly developed self-administered questionnaire it was examined whether breast cancer patients involved in self-help groups differ from non-members with respect to their level of knowledge on disease, prevention and after-care. Moreover we considered the influence of age and education on the knowledge on disease. 216 women completed the questionnaire in the presence of an interviewer. Members of self-help groups had a higher level of knowledge than non-members, and this refers to all aspects covered by the questionnaire. Younger women in general had a higher knowledge than older ones, the same holds for higher educational levels. The duration of the disease and the length of membership in self-help groups had no effects on levels of knowledge. Particularly middle-aged women (45 - 59 yrs.) and women with 10 years of schooling profited from a membership. After controlling for education and membership in self-help groups still had a significant impact on knowledge. Since only a minority of patients is willing to be engaged in self-help groups, more effort should be devoted to conveying information in post-treatment care.

Adolescent↗
PubMed2006

Education, income, and occupational class cannot be used interchangeably in social epidemiology. Empirical evidence against a common practice.

STUDY OBJECTIVE: Education, income, and occupational class are often used interchangeably in studies showing social inequalities in health. This procedure implies that all three characteristics measure the same underlying phenomena. This paper questions this practice. The study looked for any independent effects of education, income, and occupational class on four health outcomes: diabetes prevalence, myocardial infarction incidence and mortality, and finally all cause mortality in populations from Sweden and Germany. DESIGN: Sweden: follow up of myocardial infarction mortality and all cause mortality in the entire population, based on census linkage to the Cause of Death Registry. Germany: follow up of myocardial infarction morbidity and all cause mortality in statutory health insurance data, plus analysis of prevalence data on diabetes. Multiple regression analyses were performed to calculate the effects of education, income, and occupational class before and after mutual adjustments. SETTING AND PARTICIPANTS: Sweden (all residents aged 25-64) and Germany (Mettman district, Nordrhein-Westfalen, all insured persons aged 25-64). MAIN RESULTS: Correlations between education, income, and occupational class were low to moderate. Which of these yielded the strongest effects on health depended on type of health outcome in question. For diabetes, education was the strongest predictor and for all cause mortality it was income. Myocardial infarction morbidity and mortality showed a more mixed picture. In mutually adjusted analyses each social dimension had an independent effect on each health outcome in both countries. CONCLUSIONS: Education, income, and occupational class cannot be used interchangeably as indicators of a hypothetical latent social dimension. Although correlated, they measure different phenomena and tap into different causal mechanisms.

Adult↗
PubMed2005

Relation of systemic ventricular function quantified by myocardial performance index (Tei) to cardiopulmonary exercise capacity in adults after Mustard procedure for transposition of the great arteries.

After Mustard repair for transposition of the great arteries, the right ventricle serves as a chronically overloaded systemic ventricle (SV). Thus, during long-term follow-up, dysfunction of the right ventricle with consecutive heart failure (HF) is not unusual. Early signs and symptoms of HF are depressed parameters of right ventricular (RV) function at rest and exercise intolerance. It was hypothesized that the measurement of RV function parameters, N-terminal pro-brain natriuretic peptide (NT-pro-BNP), and peak oxygen uptake (VO2max) during exercise testing were suitable for the early detection of subclinical HF. In 33 asymptomatic adolescents and adults who had undergone Mustard repair, RV function was analyzed by the myocardial performance index (Tei index). NT-pro-BNP and VO2max were also determined. The corresponding data from 52 patients operated on for left-to-right shunt defects without residual lesions served as reference data. In patients who underwent the Mustard procedure, the Tei index and NT-pro-BNP were elevated (mean Tei index of the SV 0.63 +/- 0.17 vs 0.34 +/- 0.05, p <0.002; mean NT-pro-BNP 240 +/- 230 vs 57 +/- 39 pg/ml, p <0.0001), and VO2max was reduced (27 +/- 6 vs 32 +/- 6 ml x kg(-1) x min(-1), p <0.002). A good correlation was found between the Tei index and VO2max (r = -0.83, p <0.0001). In conclusion, RV function is depressed in most patients with Mustard repair. Ventricular dysfunction in such asymptomatic or minimally symptomatic patients can be detected by measurement of the Tei index, NT-pro-BNP, and VO2max. These parameters are simple and reliable screening methods to stratify patients with impaired cardiac dysfunction before they become symptomatic.

Adolescent↗
PubMed2004

Health inequalities in different age groups: the case of type 2-diabetes: a study with health insurance and medication data.

OBJECTIVE: This study investigates social differentials in the prevalence of diabetes type 2 in women and men in a health insurance population. It is considered whether social gradients are present over different age strata. METHODS: Analyses were performed with records obtained from a German statutory health insurance comprising 77,294 women (31.8%) and men (68.2%) of at least 20 years. Occupational status was used as indicator of socio-economic position. Individuals with diabetes were identified using information about antidiabetic medication or by hospital diagnoses according to ICD9. The analyses were performed for the entire insurance population and for different age strata (<40 yrs /40-55 yrs/ >55 yrs). RESULTS: The analyses revealed considerable social differences in diabetes risks. Considering the whole insurance population with the highest socio-economic category as reference group, the odds ratio (OR) for skilled non-manuals was OR = 2.9, for skilled manuals it was OR = 4.7, and OR = 5.6 for unskilled and semi-skilled individuals. After stratifying the insurance population into three age groups the social gradients were reproduced for each stratum, but their magnitudes increased with age. CONCLUSIONS: In the health insurance population considered health inequalities with respect to diabetes are considerable, and they are persisting after stratification into age groups.

Adult↗
PubMed2003

Hospital admissions after transition into unemployment.

OBJECTIVE: It was examined whether the rate of hospital admissions change after transition into unemployment. METHODS: Data from a German statutory health insurance comprising 105,554 individuals (70.9% men, 29.1% women) with documented employment periods were used. Unemployment periods were divided into three intervals: up to eight months, more than eight up to 16, and more than 16 up to 24 months. RESULTS: The overall "risks" of hospital admissions dropped after transition into unemployment. The relative risk (RR) in men and women for unemployment up to eight months was RR = 0.31 (95% CI: 0.28-0.34), for periods of more than eight up to 16 months it was RR = 0.35 (95% CI: 0.32-0.39) and for more than 16 up to 24 months it was RR = 0.27 (95% CI: 0.23-0.33). In contrast, for myocardial infarction they increased with length of unemployment: up to eight months: RR = 1.49 (95% CI: 1.04-2.13), more than eight up to 16 months; RR = 1.82 (95% CI: 1.21-2.74), more than 16 up to 24 months: RR = 3.08 (95% CI: 1.84-5.17). CONCLUSION: For myocardial infarction the findings may reflect increased morbidity, for occupational diseases they may reflect a decrease following ceasing expositions at the workplace. For the remaining diagnostic groups decreasing health care utilisation may apply without morbidity having changed.

Adult↗
PubMed2003

[Educational status and occupational training, occupational status and ischemic heart diseases: a prospective study with data from statutory health insurance in Germany].

OBJECTIVES: To study associations between education, occupational position, and incidence of ischemic heart disease (ICD-9 410-414). METHODS: A cohort of 151,471 male and female members of a German statutory health insurance company aged between 25 and 65 years was investigated. The cohort comprised all members between 1987 and 1996. Information on ischemic heart disease was derived from clinical diagnosis. Education, training, and occupational position according to the British Registrar General defined the indicators of social status. RESULTS: After adjustment for age and length of observation period, education and training as well as occupational position were associated with the incidence of ischemic heart disease in both men and women. Whereas a gradient was observed in men regarding education and training (odds ratios (OR): 3.41-6.02) men with lower occupational position had higher risk estimates as compared to the highest occupational status group (OR: 1.73-3.05). Among women a gradient was observed concerning education and training (OR: 1.75-3.78). With regard to occupational status position female members of the highest group showed the lowest risk as compared to the lower status groups (OR: 1.58-2.19). CONCLUSIONS: Social inequality in ischemic heart disease morbidity was observed among male and female members of a German statutory health insurance. Findings are of importance for health policy and call for preventive action.

Adult↗