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Biomedical subjects

U Keil

Publications and source records attributed to U Keil.

At least 19 recordsLinked to original sources
PubMed2002

[Secondary prevention of coronary heart disease. Results from EuroASPIRE I and II in the region of Münster, Germany].

BACKGROUND: EuroASPIRE (European Action on Secondary Prevention through Intervention to Reduce Events) is a European multicenter study on secondary prevention in patients with coronary heart disease (CHD). The first cross-sectional survey was undertaken in 1995/96 among 3569 patients from nine countries. A second cross-sectional survey (EuroASPIRE II) was conducted in 1999/2000 among 5556 patients from 15 countries to evaluate among others whether coronary prevention had improved since the first. METHODS: The present study was conducted in the region of Münster, Germany, as part of the EuroASPIRE study. Consecutive patients, men and women up to 70 years of age with established CHD, were identified retrospectively. A total of 392 (EuroASPIRE I) and 402 (EuroASPIRE II) patients participated. Information on cardiovascular risk factors, lifestyle and medication were obtained through medical records, interviews and examinations. RESULTS: Both studies demonstrate a high prevalence of risk factors among CHD patients. At the time of the interview more than 60% of the patients in both surveys had two or more risk factors. The comparison of EuroASPIRE I and II reveals a substantial decrease of 20% in the prevalence of hypercholesterolemia, but an increase in the prevalence of hypertension and obesity. ACE-inhibitors, betablockers and lipid lowering drugs, especially statins, were used more frequently in EuroASPIRE II. CONCLUSIONS: We conclude that secondary prevention of CHD in the region of Münster like in the other European study regions is less than optimal and has not substantially improved between 1996 and 2000. Potential reasons are discussed.

Adult↗
PubMed2002

Impact of availability and use of coronary interventions on the prescription of aspirin and lipid lowering treatment after acute coronary syndromes.

BACKGROUND: It has been suggested that patients undergoing acute intervention for coronary syndromes may not receive adequate secondary prevention. OBJECTIVE: To analyse the impact of availability and use of coronary interventions on the prescription of secondary prevention after acute coronary syndromes. DESIGN: Analysis of a prospective multicentre register of patients admitted to hospital for acute coronary syndromes. SETTING: A 1999 pan-European survey in 390 hospitals. PATIENTS: 3092 patients admitted to hospital with acute coronary syndromes (including 777 for ST elevation myocardial infarction within 12 hours of onset). MAIN OUTCOME MEASURES: Rates of prescription of aspirin and lipid lowering agents. RESULTS: Performance of coronary angiography and percutaneous coronary interventions (PCI) during the hospital stay were independent predictors of prescription of aspirin at discharge (odds ratio (OR) 1.29 and 1.89, p = 0.053 and p < 0.0001, respectively). Lipid lowering agents were prescribed more often on discharge in patients admitted to hospitals with catheterisation laboratories than without (for infarction with ST elevation, 45% v 40% (NS); for other acute coronary syndromes, 46% v 36%; p < 0.05). Prescription rates were higher among patients undergoing coronary angiography or PCI than in those treated conservatively (for infarction with ST elevation, 49%, 53%, and 39%, p < 0.05; for other acute coronary syndromes, 50%, 54%, and 34%, p < 0.05). Logistic regression analysis showed that PCI was an independent predictor of prescription of lipid lowering agents at discharge (OR 1.48, p < 0.0002). CONCLUSIONS: Contrary to expectations, invasive procedures for acute coronary syndromes are associated with higher rates of prescription of pharmacological secondary prevention.

Adrenergic beta-Antagonists↗
PubMed2001

Five year changes in waist circumference, body mass index and obesity in Augsburg, Germany.

AIMS: To assess temporal changes in body fat distribution, body mass index and obesity in Augsburg, Germany. METHODS: Waist circumference, weight and height were measured in two independent samples of 4804 and 4792, men and women, aged 25-74 years, in the MONICA Augsburg surveys 1989/90 and 1994/95. Abdominal obesity was defined as waist circumference greater than the 80th gender-specific percentile (men: 103, women: 92 cm) in the 1989/90 population. Obesity was defined as a body mass index (BMI) > or = 30 kg/m2. RESULTS: Age-standardized mean waist circumference increased by more than 1 cm (p-value < 0.00003) in both men and women while BMI increased by 0.3-0.4 kg/m2 (p-value < 0.01). We observed both a shift to higher values in the waist circumference distribution plus--particularly in women older than 45 years --a substantial right shift in the top of the distribution. Moreover, survey participants in 1994/95 who were at the higher end of the BMI distributions were disproportionately more obese than their respective peers in 1989/90. The prevalence of abdominal obesity rose by 3.3% in men and 3.6% in women, while the prevalence of obesity rose by 2% from 17% in men and by 2.5% from 19% in women. CONCLUSIONS: While changes in the Augsburg population may not be as alarming as in other countries, the secular increase in waist circumferences in both men and women occurring over a short time period indicates a need for prevention given the already high absolute weight, BMI and waist circumference levels in the population.

Adult↗
PubMed2001

Inverse association of overweight and breast feeding in 9 to 10-y-old children in Germany.

OBJECTIVE: To evaluate whether breast feeding is associated with prevalent overweight in pre-adolescent children. METHODS: Cross-sectional studies of 9 to 10-y-old children attending fourth grade in 1995/1996 in Dresden (n=1046) and Munich (n=1062), Germany, according to the International Study of Asthma and Allergies in Childhood (ISAAC) Phase II protocol. A comprehensive questionnaire including detailed breast feeding history was filled out by the child's parent. Height and weight were measured in a random subsample of children undergoing spirometry. Overweight was defined as body mass index > or =90th age- and sex-specific percentile of the German reference. RESULTS: While the prevalence of overweight differed substantially between Dresden (girls 9.1%, boys 12.5%) and Munich (17% both), we observed a markedly lower overweight prevalence among breast fed than non-breast fed children in both cities. Controlling for age, sex and city, breast-fed children were substantially less likely to be overweight at 9-10 y (OR 0.55, 95% CI 0.41-0.74). Results were slightly attenuated after adjustment for nationality, socio-economic status, number of siblings, parental smoking (OR 0.66, 95% CI 0.52-0.87). A longer overall duration and duration of exclusive breast feeding was associated significantly with decreasing prevalence of overweight. CONCLUSION: The results highlight the importance and possible preventive potential of early nutrition in the development of overweight in children. Both feeding behaviors acquired by the nursing infant and metabolic effects may contribute to the observed inverse association of breast feeding and overweight in children.

Body Mass Index↗
PubMed2001

Assessing hypertension management in the community: trends of prevalence, detection, treatment, and control of hypertension in the MONICA Project, Augsburg 1984-1995.

OBJECTIVE: To assess trends in prevalence and detection, treatment and control of hypertension in a German population between 1984 and 1995. SETTING AND PARTICIPANTS: Independent random samples of the population were examined in cross-sectional surveys with identical methods in 1984/85 (age range 25 to 64 years, n = 4022 participants), 1989/90 (age range 25 to 74 years, n = 4940) and 1994/95 (age range 25 to 74 years, n = 4856). MAIN OUTCOME MEASURES: Prevalence of hypertension and proportions of hypertensives detected, treated and controlled. Hypertension was defined as blood pressure above 140/90 mm Hg or taking antihypertensive medication. RESULTS: The prevalence of hypertension did not change significantly over the 10 years (25--64 years, age-standardised 1984/85: 37.8% in men and 24.6% in women; 1994/95: 39.3% and 24.8%, respectively). Rates of detection, treatment and control of hypertension did not change much either. Of all hypertensives in 1994/95, 54% were detected in men and 64% in women, the treatment rates were 23% and 32%, and the proportions of those with controlled hypertension (below 140/90 mm Hg with treatment) were as low as 7% and 13%, respectively. Rates were higher in the older age groups, however, control rates never exceeded 20% at any age. CONCLUSIONS: Despite considerable changes in the pharmacological treatment of hypertension there was a disappointing stagnation with regard to the management of this important risk factor in the community. The reasons for this unfavourable trend need clarification and appropriate public health action. Journal of Human Hypertension (2001) 15, 27-36

Adult↗
PubMed2001

Microalbuminuria, central adiposity and hypertension in the non-diabetic urban population of the MONICA Augsburg survey 1994/95.

OBJECTIVE: Microalbuminuria is a renal marker of general vascular endothelial damage and early atherosclerosis with adverse prognostic implications. Microalbuminuria is associated with diabetes, insulin resistance, central adiposity and hypertension. We evaluated the degree of the association of components of the metabolic syndrome with microalbuminuria in a subsample of a non-diabetic study population. DESIGN: Men and women aged 25-74 living in the city of Augsburg, Germany, were interviewed and examined in a standardised manner at a population-based survey conducted in 1994/95. Persons with a history of diabetes or HbA1c level > or = 7% were excluded. OUTCOME: Albumin and creatinine were determined quantitatively in a spot urine and defined as microalbuminuria via an albumin/creatinine ratio between 30 and 299 mg/g. RESULTS: Among 920 men and 879 women, the age- standardised prevalence of microalbuminuria was 8.0% and 7.5%, respectively. While a graded, positive increase in prevalence of microalbuminuria across quintiles of waist-to-hip (WHR) was observed in non-hypertensive men and women, microalbuminuria was uniformly high among hypertensives. Multivariate logistic regression models showed that central adiposity (OR 3.3) or hypertension (OR 4.0) alone significantly increased the odds of microalbuminuria while their joint presence (OR 3.6) did not add to the occurrence of microalbuminuria. While obesity was not associated with microalbuminuria once central adiposity was taken into account, elevated percent body fat remained associated with microalbuminuria. CONCLUSIONS: Signs of early endothelial dysfunction as manifested as microalbuminuria are strongly and independently associated with central adiposity and should be considered in the context of the metabolic or insulin resistance syndrome.

Adult↗
PubMed2000

Assessing the impact of classical risk factors on myocardial infarction by rate advancement periods.

The risk or rate advancement period (RAP) proposed by Brenner et al. (Epidemiology 1993;4:229-36) conveys information on the impact of a risk factor on the age dimension of chronic disease occurrence and may thus facilitate communication of epidemiologic findings. The RAP expresses how much sooner a given risk or rate of disease occurrence is reached among exposed than among unexposed individuals. The purpose of the present analysis was to derive estimates of RAPs for cardiovascular risk factors in relation to incident nonfatal and fatal myocardial infarction in middle-aged men of the Monitoring Trends and Determinants in Cardiovascular Diseases (MONICA) Augsburg cohort, Germany, between 1984 and 1995. RAPs were estimated based on Cox proportional hazards models. After multivariate adjustment, hypertension, smoking, and dyslipidemia were associated with RAPs of 8, 11, and 11 years, respectively, conditional on infarction-free survival to baseline and absence of competing risks. The RAP may be interpreted as that, on average, smokers are expected to advance their risk of myocardial infarction approximately 11 years compared with never/former smokers; for example, 50-year-old smokers are expected to carry the same risk of infarction as 61-year-old nonsmokers. The authors encourage the use and evaluation of the RAP as an effective risk communication tool in actual counseling situations.

Cohort Studies↗
PubMed2000

Exposure to nitrosamines, carbon black, asbestos, and talc and mortality from stomach, lung, and laryngeal cancer in a cohort of rubber workers.

There is sufficient evidence for an excess occurrence of stomach and lung cancer among rubber workers. However, evidence for causal associations with specific exposures is still limited. A cohort of 8,933 male German rubber workers was followed for mortality from January 1, 1981 through December 31, 1991. Work histories were reconstructed using routinely documented cost center codes. For each cost center code, calendar time-and plant-specific levels of exposure to nitrosamines, asbestos, talc (low, medium (m), and high (h)), and carbon black (two levels) were estimated by industrial hygienists. Rate ratios (RR) and 95% confidence intervals (CI) were calculated using Cox proportional hazards models, with the lowest exposure level used as the reference category. Exposure was lagged 10 years to account for latency. Exposure-response relations between exposure to asbestos and lung cancer mortality (RRm = 1.3, 95% CI: 0.9, 1.9; RRh = 2.0, 95% CI: 0.9, 4.1) and between exposure to dust (talc and asbestos combined) and stomach cancer mortality (RRm = 1.8, 95% CI: 0.9, 3.8; RRh = 2.7, 95% CI: 1.0, 7.1) were observed. Exposure to nitrosamines was not associated with mortality from stomach or lung cancer. These results suggest that the increased mortality from lung and stomach cancer among rubber workers is associated with exposure to asbestos and dust, respectively.

Aged↗
PubMed2000

Prevalence and risk factors of RLS in an elderly population: the MEMO study. Memory and Morbidity in Augsburg Elderly.

OBJECTIVE: To evaluate prevalence, sociodemographic characteristics, and risk factors of restless legs syndrome (RLS) in a population-based survey of the elderly, using standard diagnostic criteria. BACKGROUND: Population-based studies of RLS are rare and have not yet used standard definition criteria. METHODS: The Memory and Morbidity in Augsburg Elderly (MEMO) Study is a follow-up project of the World Health Organization Monitoring Trends and Determinants in Cardiovascular Disease (MONICA) Survey-Augsburg, Germany, 1989-1990, evaluating neurologic diseases and their risk factors in a German population 65 to 83 years of age. Two RLS-trained physicians assessed the prevalence of RLS based on the four minimal standard criteria (International Restless Legs Syndrome Study Group, 1995) using standardized questions in face-to-face interviews. They also obtained information on medical history, medications, depression (Center of Epidemiologic Studies Depression Scale), and quality of life (Short Form 36) and performed a standardized neurologic examination for each participant. RESULTS: The study population included 369 participants (173 women and 196 men). The overall prevalence of RLS was 9.8% (n = 36) and higher in women (13.9% versus 6.1%; p = 0.02). In women, the prevalence did not change with age, whereas men showed a nonsignificant inverse trend with increasing age. RLS-positive individuals took more benzodiazepines and estrogen compared with non-RLS cases, but the differences were not statistically significant. Participants with RLS had higher incidence of depression (p = 0.012) and lower self-reported mental health scores (p = 0.029) than did non-RLS cases. CONCLUSIONS: RLS is a frequent syndrome in the elderly with considerable impact on self-perceived mental health, affecting women about twice as often as men.

Aged↗
PubMed2000

Estimation of contribution of changes in coronary care to improving survival, event rates, and coronary heart disease mortality across the WHO MONICA Project populations.

BACKGROUND: The revolution in coronary care in the mid-1980s to mid-1990s corresponded with monitoring of coronary heart disease (CHD) in 31 populations of the WHO MONICA Project. We studied the impact of this revolution on coronary endpoints. METHODS: Case fatality, coronary-event rates, and CHD mortality were monitored in men and women aged 35-64 years in two separate 3-4-year periods. In each period, we recorded percentage use of eight treatments: coronary-artery reperfusion before, thrombolytics during, and beta-blockers, antiplatelet drugs, and angiotensin-converting-enzyme (ACE) inhibitors before and during non-fatal myocardial infarction. Values were averaged to produce treatment scores. We correlated changes across populations, and regressed changes in coronary endpoints on changes in treatment scores. FINDINGS: Treatment changes correlated positively with each other but inversely with change in coronary endpoints. By regression, for the common average treatment change of 20, case fatality fell by 19% (95% CI 12-26) in men and 16% (5-27) in women; coronary-event rates fell by 25% (16-35) and 23% (7-39); and CHD mortality rates fell by 42% (31-53) and 34% (17-50). The regression model explained an estimated 61% and 41% of variance for men and women in trends for case fatality, 52% and 30% for coronary-event rates, and 72% and 56% for CHD mortality. INTERPRETATION: Changes in coronary care and secondary prevention were strongly linked with declining coronary endpoints. Scores and benefits followed a geographical east-to-west gradient. The apparent effects of the treatment might be exaggerated by other changes in economically successful populations, so their specificity needs further assessment.

Adult↗
PubMed2000

Trends in dietary sources of nutrients among middle-aged men in southern Germany. Results of the MONICA Project Augsburg: dietary surveys 1984/1985 and 1994/1995. MONItoring trends and determinants in CArdiovascular disease.

The study analyses 10-year trends (1984/1985-1994/1995) in southern Germany in the food sources of nutrients. In two phases of the MONICA Project in Augsburg, dietary surveys were conducted in subsamples of 45 to 64 year-old men. Responses in 1984/1985 and 1994/1995 were 69.8% and 70.8% with eligible samples of 603 and 607, respectively. Seven-day records were collected and coded with the German food composition database. Percentage contribution of food groups to selected nutrient intakes were calculated. Meat and meat products and eggs decreased in importance as contributors to the intake of energy and several nutrients, whereas fish and fish products, milk and milk products and various food groups of plant origin became more important. In 1984/1985, for instance, meat and meat products delivered 23.4% of energy, 47.5% of protein and 38.1% of fat, whereas in 1994/1995 the respective contributions declined to 21.4%, 44.0% and 34.5%. The new product group of supplements has already become an important contributor to the intake of vitamin C. Both static intakes and changes in intake of certain nutrients can be explained by corresponding fluctuations in patterns of intake of the underlying food sources. Therefore it is recommended that dietary assessments use food source lists derived from the most recent dietary surveys.

Diet↗
PubMed2000

The impact of diabetes mellitus on survival after myocardial infarction: can it be modified by drug treatment? Results of a population-based myocardial infarction register follow-up study.

AIMS/HYPOTHESIS: Mortality of diabetic patients after myocardial infarction remains high despite recent improvement in their management. This study population-based evaluates the impact of cardiovascular drug therapy on mortality within 28 days and during 5-year follow-up in diabetic compared with non-diabetic patients. METHODS: Using the MONICA Augsburg register from 1985 to 1992, 2210 inpatients with incident Q-wave myocardial infarction aged 25-74 years were included, of whom 468 had diabetes. Primary end point was mortality within 28 days and over 5 years. General linear model procedures were used for age-adjustment, controlling for sex, and testing significance; hazard risk ratios were calculated using multivariable Cox proportional hazards model procedures. RESULTS: During the 5-year follow-up, 598 subjects died (396 diabetic, 202 non-diabetic). The mortality rate within 28 days was 12.6% in diabetic patients (women 18.0%, men 9.9%) and 7.3% in non-diabetic patients (p = 0.001). Mortality in diabetic patients over 5 years was increased by 64% (95% confidence interval 1.39-1.95) compared with non-diabetic patients. This was considerably reduced (p < 0.001) in patients treated with thrombolytic drugs (risk ratio: diabetes 0.57, no diabetes 0.65) and with beta blockers (0.62 and 0.64) and antiplatelets (0.76 and 0.74) at hospital discharge. Mortality of diabetic patients treated with these drugs was reduced to that of non-diabetic patients without such treatment (risk ratio 1.01 to 1.27; p > 0.1). CONCLUSION/INTERPRETATION: Diabetic patients after myocardial infarction are at particularly high risk of dying, but benefit clearly from treatment with thrombolytics, beta blockers and antiplatelets. This study does not, however, allow any inferences to be drawn for treatment with angiotensin converting enzyme inhibitors or the impact of left ventricular function.

Adrenergic beta-Antagonists↗
PubMed2000

Coronary artery disease: the role of lipids, hypertension and smoking.

Pioneering epidemiological projects such as the Seven Countries study, and the Framingham Heart study established the classical risk factor concept for coronary heart disease (CAD). These landmark studies showed that a raised serum total cholesterol, high blood pressure (systolic and diastolic) and smoking increase the risk of developing CHD in men and women in a graded fashion. Women develop CHD about 10 years later than men and women's risk is smaller. In the years and decades following these early studies many more prospective cohort studies primarily in the US and Europe have confirmed the early findings. In Germany two occupational and one population based cohort studies have contributed further information on this topic. In addition interactions between the three classical risk factors have been quantified, demonstrating for example that smoking carries a much higher risk for CHD in persons with high cholesterol values. Most cohort studies have confirmed that the relative risks for the classical risk factors are very similar. However, the respective absolute risks can differ tremendously, indicating that many more factors such as socio-economic conditions, nutrition, physical activity and others are of importance for the development of CHD. The scientific community, however, did not accept the consistent findings from the many observational studies as proof of causality. They required evidence that the risk for CHD could be reduced when the respective risk factor(s) was (were) diminished or eliminated. The late 1960s early 1970s thus saw the beginning of the era of randomized controlled trials (RCTs) following the advice of Archibald Cochrane who once wrote "we have to find that point on the distribution curve where therapy does more good than harm". We now know from meta-analyses of RCTs that a 1% reduction in serum cholesterol produces a 2-3% decline in risk for CHD and we can achieve reductions in total cholesterol of 20% or more. Regarding treatment of high blood pressure, meta-analyses of RCTs have shown that a reduction of 1 mmHg in diastolic blood pressure (DBP) produces a 2-3% decline in risk of CHD, and we can achieve reductions in DBP on average of 5-6 mmHg. With regard to smoking cessation, observational studies have shown that within 1-5 years of cessation those who stop smoking have a 50-70% lower risk than current smokers. Thus the findings from observational studies, RCTs and studies on mechanisms have clearly established the importance of the three classical risk factors for CHD. The successful treatment of these risk factors will not only lower the burden of CHD in the population but promises to be the most effective way of improving the health of the whole population.

Coronary Disease↗
PubMed2000

Exposure and allergic sensitization to cockroach allergen in East Germany.

BACKGROUND: Some studies suggest that the prevalence of sensitization to cockroach allergens may be higher in the United States than in Europe, but there are no comparable data from population-based studies. OBJECTIVES: To determine the prevalence of allergic sensitization to German cockroach (GCR) in German schoolchildren and to assess its clinical relevance; and to determine the exposure to the major GCR allergen Bla g 2 in non-selected homes and nurseries. METHODS: The prevalence of allergic sensitization to GCR and other allergens was determined by measurement of specific IgE and skin-prick tests in a cross-sectional study of 2993 children aged 5-11 years in Dresden, Germany. The prevalence of atopic disease was determined by questionnaire, and pulmonary function and bronchial hyperresponsiveness to hypertonic saline were measured. Bla g 2 exposure was determined on floors of 187 kitchens and 47 nurseries by a commercial sandwich ELISA. RESULTS: One hundred and twenty-seven (4.2%) of the children had specific IgE (> 0.7 kU/L) against GCR. Among children with current wheeze, 8.4% were GCR-sensitized. Compared to data from the United States, the prevalence of sensitization to cockroach was similar in children without asthma (3.9%), but less frequent in asthmatic children from Dresden (6.1%). After adjustment for positive reactions to other allergens (SX1 test) no significant impact of GCR sensitization on wheeze or other symptoms and diagnoses was found. Bla g 2 was detected in 29% of the kitchens and 43% of the nurseries. None of these sites had exposure levels above the proposed threshold for causing disease of 80 ng/g dust. CONCLUSION: The data suggest that allergic sensitization to GCR is less frequent in asthmatics from Dresden, Germany than in US cities. The data indicate that GCR sensitization is not an independent risk factor for asthma and other atopic diseases in 5-11-year-olds from this city.

Allergens↗
PubMed2000

Diagnosis and treatment of nicotine dependence with emphasis on nicotine replacement therapy. A status report.

Tobacco use is a global health care problem. Repetitive exposure to nicotine produces neuroadaptation resulting in nicotine dependence. Cigarette smoking is particularly addictive due to the repeated delivery of bolus doses of nicotine to the bloodstream. Although compulsive tobacco use is sustained by nicotine addiction, it is the toxic combustion products in tobacco smoke such as carbon monoxide and oxidant gases that adversely affect the cardiovascular system. Smoking cessation produces significant health benefits and is a very cost-effective intervention. Evidence that nicotine is the addictive component of tobacco provides the rationale for using nicotine replacement therapy to aid cessation. Nicotine replacement therapy doubles successful smoking cessation rates and evidence-based guidelines for the treatment of tobacco addiction recommend routine use of nicotine replacement therapy, particularly in heavily dependent smokers. Success rates of up to 40% can be achieved in specialist clinics. Despite early concerns regarding the safety of nicotine replacement therapy in smokers with heart disease, it is now clear that the health risks of using nicotine replacement therapy to assist such patients to stop, or significantly reduce, smoking far outweigh any treatment-related risks.

Administration, Cutaneous↗
PubMed2000

The ENACT study: a pan-European survey of acute coronary syndromes. European Network for Acute Coronary Treatment.

AIM: The European Network for Acute Coronary Treatment (ENACT) study was designed to collect prospective information across Europe on the relative frequency, diagnosis and management of the whole spectrum of acute coronary syndromes. METHODS: Cardiologists, who were respondents to mailings sent out to 17 European countries with the target of reaching one centre per million inhabitants, completed a prospective patient record, each physician providing information on 10 consecutive patients with a working diagnosis on admission of acute coronary syndrome, and a questionnaire. RESULTS: A total of 390 responses were received (0.91/10(6)population) with data on 3092 patients in 29 countries. The patient population comprised 1431 (46%) with an initial working diagnosis of unstable angina/non-ST-segment elevation myocardial infarction, 1205 (39%) with myocardial infarction and 445 (14%) with suspected acute coronary syndrome. The ratio of unstable angina to myocardial infarction was 1.2:1 and this was similar across Europe. An initial diagnosis of myocardial infarction was more likely to be confirmed than unstable angina or suspected acute coronary syndrome. There were wide variations in the rates of angiography and percutaneous coronary intervention across Europe. Most unstable angina patients received aspirin, nitrates and heparin (unfractionated heparin 44% intravenous, 16% subcutaneous; low-molecular-weight heparin 50%). Overall, 50% of unstable angina patients and 34% of myocardial infarction patients received low-molecular-weight heparin and 6% and 8% respectively received a glycoprotein IIb/IIIa inhibitor, but there were large inter-country differences. There were also national differences in the use of calcium antagonists, angiotensin-converting enzyme inhibitors and beta-blockers. CONCLUSION: The ENACT study provides robust data, for the first time, on the relative frequency of unstable angina and acute myocardial infarction across Europe. It provides insight into differences in management across Europe and a reference benchmark of current treatment.

Acute Disease↗
PubMed2000

A stand-alone windows applications for computing exact person-years, standardized mortality ratios and confidence intervals in epidemiological studies.

We introduce a stand-alone and user-friendly person-years and mortality computation program (PAMCOMP) for calculating exact person-years and standardized mortality and incidence ratios running under Windows 95/98 and NT. The calculation of person-years allows flexible stratification by self-defined and unrestricted categories of age and calendar years. Furthermore, it is possible to lag person-years to account for latency periods. The standardized mortality ratio computation includes calculation of 90%, 95%, and 99% confidence intervals. Import and export filters for standard personal computer file formats are available. The software is free of charge and can be downloaded from: http://medweb.uni-muenster.de/institute/epi/ pamcomp/pamcomp.html

Cohort Studies↗