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Biomedical subjects

U Helmert

Publications and source records attributed to U Helmert.

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

Morbidity differences by occupational class among men in seven European countries: an application of the Erikson-Goldthorpe social class scheme.

BACKGROUND: This paper describes morbidity differences according to occupational class among men from France, Switzerland, (West) Germany, Great Britain, the Netherlands, Denmark, and Sweden. METHODS: Data were obtained from national health interview surveys or similar surveys between 1986 and 1992. Four morbidity indicators were included. For each country, individual-level data on occupation were recorded according to one standard occupational class scheme: the Erikson-Goldthorpe social class scheme. To describe the pattern of morbidity by occupational class, odds ratios (OR) were calculated for each class using the average of the population as a reference. The size of morbidity differences was summarized by the OR of two broad hierarchical classes. All OR were age-adjusted. RESULTS: For all countries, a lower than average prevalence of morbidity was found for higher and lower administrators and professionals as well as for routine nonmanual workers, whereas a higher than average prevalence was found for skilled and unskilled manual workers and agricultural workers. Self-employed men were in general healthier than the average population. The relative health of farmers differed between countries. The morbidity difference between manual workers and the class of administrators and professionals was approximately equally large in all countries. Consistently larger inequality estimates, with no or slightly overlapping confidence intervals, were only found for Sweden in comparison with Germany. CONCLUSIONS: Thanks to the use of a common social class scheme in each country, a high degree of comparability was achieved. The results suggest that morbidity differences according to occupational class among men are very similar between different European countries.

Adult↗
PubMed1998

Differences in self reported morbidity by educational level: a comparison of 11 western European countries.

STUDY OBJECTIVE: To assess whether there are variations between 11 Western European countries with respect to the size of differences in self reported morbidity between people with high and low educational levels. DESIGN AND METHODS: National representative data on morbidity by educational level were obtained from health interview surveys, level of living surveys or other similar surveys carried out between 1985 and 1993. Four morbidity indicators were included and a considerable effort was made to maximise the comparability of these indicators. A standardised scheme of educational levels was applied to each survey. The study included men and women aged 25 to 69 years. The size of morbidity differences was measured by means of the regression based Relative Index of Inequality. MAIN RESULTS: The size of inequalities in health was found to vary between countries. In general, there was a tendency for inequalities to be relatively large in Sweden, Norway, and Denmark and to be relatively small in Spain, Switzerland, and West Germany. Intermediate positions were observed for Finland, Great Britain, France, and Italy. The position of the Netherlands strongly varied according to sex: relatively large inequalities were found for men whereas relatively small inequalities were found for women. The relative position of some countries, for example, West Germany, varied according to the morbidity indicator. CONCLUSIONS: Because of a number of unresolved problems with the precision and the international comparability of the data, the margins of uncertainty for the inequality estimates are somewhat wide. However, these problems are unlikely to explain the overall pattern. It is remarkable that health inequalities are not necessarily smaller in countries with more egalitarian policies such as the Netherlands and the Scandinavian countries. Possible explanations are discussed.

Adult↗
PubMed1998

[Unemployment as a challenge for general practice].

Tasks for general practitioners in this field are discussed in connection with a two-year follow up of a randomised community sample of 310 unemployed persons in Norway. This study supported both the selective and causative mechanisms for explaining high morbidity among the unemployed. Thus, medicine is faced with both clinical and preventive tasks. Unemployed patients must be cared for by proper somatic and/or psychiatric diagnosing. A sociomedical diagnosis of the main unemployment problem is suggested. Counselling should be an important part of the treatment of unemployed patients. General practitioners may be the only independent counsellors of the many possibilities within the social security system. Secondary prevention may also be necessary to encourage passive unemployed patients to participate in activation programmes offered by the community (education, work opportunity programmes, sports, cultural activities, etc.). Primary prevention should help to avoid unemployment of more than three months' duration. Physicians are encouraged to lobby such measures in their communities.

Forecasting↗
PubMed1997

Poverty and health in West Germany.

The relationship between poverty and several health-related characteristics in West Germany was investigated. Data were derived from the National and Regional Health Surveys conducted in West Germany from 1984 to 1992. 25,544 males and 25,719 females with German nationality aged 25-69 years were examined. Poverty was defined as a household income of 50% less than the mean for West Germany. Multiple logistic regression analysis was used to analyze the relationship between poverty and four health variables: individual health behavior, subjective assessment of health status, cardiovascular disease risk factors, and self-reported prevalence of lifetime chronic diseases. 10.2% of males and 12.8% of females were classified as being below the poverty line. For most but not all health parameters, less favourable results were found for the segment of the population with a household income below the poverty line. The most striking poverty-related differences were observed for lack of regular sport activities, subjective health satisfaction, obesity and myocardial infarction/stroke. Significantly lower prevalence rates for study subjects below the poverty line were observed for hypercholesterolemia in females only. Allergic disorders were the only chronic diseases reported significantly less often in males and females below the poverty line. Poverty has strong effects on individual health status and the prevalence of chronic diseases. Due to the rising unemployment rates in Germany in the last years it is very likely that the strong negative consequences of poverty for health are increasing.

Adult↗
PubMed1997

[Passive smoking in children up to 5 years of age].

Passive smoking is a major health risk in young children. We investigated the percentage of children with mothers and/or fathers who reported regular smoking. Data are the national and regional health surveys of the German Cardiovascular Prevention Study (GCP) conducted from 1984 to 1992 in West Germany. 2538 mothers aged 25-40 years were included. The prevalence of passive smoking in children due to smoking mothers was 33.6% 55.4% of the children up to 5 years lived in households with at least one smoking parent member. In 23.4% of these households both parents were smokers. If only one member of the parents smoked this was in two out of three cases the father. 28.2% of mothers with a child younger than one year were current smokers. This prevalence rate increased with the age of the youngest child up to 35.6% for mothers, whose youngest child was 5 years old. Multiple logistic regression analysis was performed to investigate the association between smoking behaviour and the following variables: mother's age, social class, family status, community size and year of the survey. It was found that lower social class members, unmarried or divorced mothers and inhabitants of large cities reported significantly more often regular current smoking. These results underscore the importance of special intervention programs to reduce smoking in parents with young children.

Child, Preschool↗
PubMed1996

[Cardiovascular risk factors and occupation: results of the health survey of the German Cardiovascular Prevention Study].

It is examined which occupation specific differences exist in the prevalence of cardiovascular disease risk factors in the Federal Republic of Germany (old federal states). The following risk factors for cardiovascular diseases were considered: cigarette smoking, hypertension, hypercholesterolemia, low HDL-cholesterol, obesity, diabetes mellitus, lack of physical activity and Type-A behavior. Data basis are the national and regional health surveys, conducted in the framework of the German Cardiovascular Prevention Study between 1984 and 1991. 17,596 males and 17,403 females, aged 25-69 years, were included in the analysis. Occupations were coded according to the classification of the Germany Federal Statistical Office. With the exception of Type-A behavior it was found for all cardiovascular disease risk factors that higher prevalence rates exist for less qualified occupations. The differences in risk factor prevalence were strongest for obesity and lack of physical activity. Only minor differences were found for hypercholesterolemia. This analysis confirms the results of other studies that health related aspects in the lifestyles of the most qualified occupational groups (professionals, managers, engineers) are characterized by non-smoking, leisure-time physical activity and avoidance of overweight. Up to now, there are no hints that these lifestyles may be adopted from members of less qualified occupations as well.

Adult↗
PubMed1995

International renal-cell cancer study. IV. Occupation.

The relationship between renal-cell cancer (RCC) and occupation was investigated in an international multicenter population-based case-control study. Study centers in Australia, Denmark, Germany, Sweden and the United States interviewed 1732 incident RCC cases and 2309 controls. Significant associations were found with employment in the blast-furnace or the coke-oven industry [relative risk (RR), 1.7; 95% confidence interval (CI), 1.1-2.7], the iron and steel industry (RR, 1.6; 95% CI, 1.2-2.2) and exposure to asbestos (RR, 1.4; 95% CI, 1.1-1.8), cadmium (RR, 2.0; 95% CI, 1.0-3.9), dry-cleaning solvents (RR, 1.4; 95% CI, 1.1-1.7), gasoline (RR, 1.6; 95% CI, 1.2-2.0) and other petroleum products (RR, 1.6; 95% CI, 1.3-2.1). Asbestos, petroleum products and dry-cleaning solvents appear to merit further investigation, in view of the relationship between risk and duration of employment or exposure and after adjustment for confounding. There was a negative association between RCC and education, but it was not consistent across all centers. Overall, the results of our multicenter case-control study suggest that occupation may be more important in the etiology of RCC than indicated by earlier studies.

Aged↗
PubMed1995

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↗
PubMed1994

Social inequalities and health status in western Germany.

STUDY OBJECTIVE: To examine social class gradients for seven self-reported diseases in western Germany. DESIGN: A pooled analysis of three cross-sectional representative health surveys in western Germany and three health surveys in the six intervention regions of the German Cardiovascular Prevention Study. PARTICIPANTS: 44,363 study subjects, of both sexes, with German nationality, aged 25-69 years, were examined in the national and regional health surveys from 1984 to 1991. MEASUREMENT AND MAIN RESULTS: Assessment of disease prevalence was carried out by a standardized self-administered questionnaire. Social class was assessed using a composite index combining educational achievement, occupational status and household income. Cigarette smoking and Pattern A behaviour were based on self-report. Height and weight were measured by physical examination and body mass index was calculated. Statistical analysis were performed using multiple logistical regression. Response rates ranged from 66.0 to 71.4% in the national surveys and from 65.9 to 83.8% in the regional surveys. For both sexes, the prevalence of previous myocardial infarction and the prevalence of stroke, diabetes mellitus and chronic bronchitis was significantly higher in the lower social classes. In males only, the prevalence of intervertebral disc damage and peptic ulcer was significantly higher in the lower social classes. In females only, there was a similar gradient for hyperuricaemia and gout. In both sexes, allergies and hay fever were the only diseases with higher prevalence in the higher social classes. Adjusting these trends for smoking, obesity and Pattern A behaviour resulted in only minor changes in the slopes of the disease-specific social class gradients. CONCLUSION: In western Germany, despite a health system with almost free access for the general population, strong social class inequalities exist for many diseases. These inequalities cannot be explained by social class differences in smoking, obesity or Pattern A behaviour. More research is needed to identify underlying causes for these persistent social inequalities in health status.

Adult↗
PubMed1994

Moderate and vigorous leisure-time physical activity and cardiovascular disease risk factors in West Germany, 1984-1991.

The relationship between leisure-time physical activity (LTPA) and cardiovascular disease (CVD) risk factors was analysed based on data of three cross-sectional National Health Surveys, carried out in West Germany between 1984 and 1991. A total of 7663 males and 7722 females, aged 25-69 years, were examined. A self-administered questionnaire was used to assess LTPA which was defined as the mean duration of time (in minutes) spent during the past week on 14 specified sports during the previous 3 months. The mean time for LTPA per week was 102 minutes for males and 70 minutes for females. No significant differences were observed in LTPA mean duration for the three surveys. Younger age and higher social class were strong predictors for greater LTPA. In multiple linear regression models, after adjustment for age and social class, LTPA was significantly associated with lower systolic and diastolic blood pressure (both sexes), total cholesterol (males only), cigarette smoking (males only) and body mass index (females only), and with higher HDL-cholesterol (both sexes). The data suggest that LTPA plays an important role if aiming at reducing CVD risk factors in the general population.

Adult↗
PubMed1993

[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↗
PubMed1992

Social inequities in cardiovascular disease risk factors in East and West Germany.

Social class related differences in prevalence of cardiovascular disease risk factors in Germany were investigated with special emphasis on comparisons between East and West Germany and on time trends. Databases for West Germany are the first and second National Health Survey (survey 1: N = 4794, survey 2: N = 5315), carried out in the framework of the German Cardiovascular Prevention Study, and for East Germany the first GDR-MONICA project (N = 6125). Different social class indices were applied to evaluate social inequities for hypertension, hypercholesterolemia, cigarette smoking, obesity and predicted cardiovascular disease mortality. As a main result, it was found that very similar patterns in the relation between social class characteristics and cardiovascular disease risk factor prevalence occurred for both parts of Germany. Social class gradients were strongest for obesity and weakest for hypercholesterolemia. Analysis of time trends for the period from 1984 to 1988 (for West Germany only) revealed an increase in social inequalities for hypertension in males and cigarette smoking in females. These findings point to the need to focus more on social disadvantaged segments in the population when community based health promotion and disease prevention programs are brought into action.

Adult↗
PubMed1990

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↗
PubMed1989

Social class and risk factors for coronary heart disease in the Federal Republic of Germany. Results of the baseline survey of the German Cardiovascular Prevention Study (GCP).

The relationship between social class and seven important risk factors for coronary heart disease has been evaluated utilising data from the German Cardiovascular Prevention Study baseline survey. Of German residents aged 25 to 69 years, 16,430 were randomly selected from both the six intervention regions and the Federal Republic of Germany to undergo the screening procedures between 1984 and 1986. Among males the prevalence of cigarette smoking and lack of physical activity was associated with social class. For females, overweight and physical activity demonstrated a strong social gradient. No relationship existed between social class and hypercholesterolaemia. The prevalence of Type A behaviour was significantly higher for the upper social classes. The number of CHD risk factors per study subject increased with decreasing social class. Predicted cardiovascular mortality was clearly higher for the lower social class among males in general and for females younger than 60 years. These findings point to the need for risk factor intervention strategies focusing more on the lower social classes in order to achieve more adequate prevention of coronary heart disease.

Adult↗
PubMed1989

Regular analgesic intake and the risk of end-stage renal failure.

The strength of the association between regular analgesic intake (RAI) and end-stage renal failure (EF) has been insufficiently established until now. A case-control study was conducted to estimate the relative risks (RR) of EF after RAI (defined as consumption of 15 or more analgesic doses per month for a continuous period of at least 1 year) for cumulative drug intake, single-ingredient analgesics, combinations, and specific compounds. The case group included all patients with EF undergoing renal replacement therapy in the area of West Berlin (1984-1986, n = 921). Control subjects, matched to cases by sex, age, and nationality, were selected from a group of patients in outpatient clinics. Matching was possible for 517 cases. The RR of EF after RAI of any analgesic was 2.44 (95% confidence interval: 1.77-3.39) and after RAI of combination drugs 2.65 (95% confidence interval 1.91-3.67). No significant increase was found, however, after RAI of single-ingredient analgesics. The RR after RAI of combination drugs and for the most preferred analgesic ingredients (phenacetin, paracetamol, acetylsalicylic acid, phenazones, caffeine) increased with dose. Furthermore, a dose-time-related RR after RAI of the longest used preparation was found. Thus, the results clearly show an increased RR of EF after RAI related to both dose and exposure time of mixed analgesic compounds, but not for the use of only single-ingredient analgesics.

Adult↗
PubMed1988

[Are females healthier than males? On the health status of females in West Germany].

Women live longer than men - are they healthier than men or do they live better than men? Morbidity data indicate that men and women differ regarding the types of illnesses they undergo. The life-expectancy for females is not the only indicator for a better or healthier life. Women feel more affected by health problems than man (indicators a.o.: complaints, handicaps to daily activities, use of medication). Objective morbidity data are insufficient but indicate significant disease occurrence in women (indicators a.o.: contacts with the physicians, self-reported history of diseases). Based on epidemiological studies the hypotheses of biological protective factors have not been proved or refuted. Women have a lower CVD-risk factor profile than men. Cluster analyses of the first Bremen health survey separated women into four groups related to health behaviour and risk status. The group with the highest risk factor prevalence had also the most social and family stress. For further research about women we have to work on epidemiological data as well as on qualitative and theoretical research on women and health.

Adult↗
PubMed1988

[Social class and risk factors for coronary heart disease--results of the Regional DHP(German Cardiovascular Prevention) Health Surveys].

Prior to the start of the intervention activities in the five study regions of the German Cardiovascular Prevention Study (GCP), health surveys of representative samples of the population (25 to 69 years) were carried out between 1984 and 1986. In all, 11,527 persons participated in the study. Important socio-structural differences existed between the five study regions. An ecological analysis relating social class characteristics to the prevalence of CHD-risk factors did not show any significant findings. However, a pooling of the data of the five study regions resulted in the demonstration, for both sexes, of a significant association of social class with cigarette smoking and overweight. Hypertension and hypercholesterolemia were not related to social class. The proportion of persons with three or more CHD-risk factors was clearly higher in lower social classes. These findings point to the need for risk factor intervention strategies focusing more on the lower social classes in order to achieve more adequate prevention of coronary heart disease.

Adult↗