Lifetime and 12-month prevalence estimates for mental disorders in northeastern Germany: findings from the Study of Health in Pomerania.

Few epidemiological studies presented 12-month and lifetime prevalence estimates for DSM-IV mental disorders in the adult general population by sex and age up to very old age. From 2007 to 2010, DSM-IV mental disorders were assessed with the DIA-X/M-CIDI among N = 2400 participants (aged 29-89 years) from the Study of Health in Pomerania, an epidemiological study based on a two-stage stratified cluster sample randomly drawn from the adult general population in northeastern Germany. 36.3% of the sample was affected by any 12-month and 54.8% by any lifetime mental disorder. The most frequent diagnostic groups were anxiety (12-month: 14.8%, lifetime: 23.4%), substance use (12-month: 14.5%, lifetime: 25.0%), somatoform (12-month: 12.9%, lifetime: 20.4%) and depressive (12-month: 7.3%, lifetime: 18.6%) disorders. Except for substance use (higher prevalence in men) and bipolar disorders (comparable prevalence in men and women), higher 12-month and lifetime prevalence estimates were found in women vs. men. Moreover, lower 12-month and lifetime prevalence estimates were found in older (aged 60-74 or 75-89 years) vs. younger (aged 29-44 or 45-59 years) age groups. 22.6% (men: 21.1%, women: 23.9%) of those affected by any 12-month disorder met criteria for two and 13.6% (men: 9.6%, women: 16.9%) for three or more 12-month diagnoses. Similarly, 26.4% (men: 25.7%, women: 26.9%) of those affected by any lifetime disorder met criteria for two and 22.7% (men: 19.6%, women: 25.2%) for three or more lifetime diagnoses. Our findings demonstrate the frequency of mental disorders in northeastern Germany and emphasize the need for continued prevention and intervention efforts.

GWAS for executive function and processing speed suggests involvement of the CADM2 gene.

To identify common variants contributing to normal variation in two specific domains of cognitive functioning, we conducted a genome-wide association study (GWAS) of executive functioning and information processing speed in non-demented older adults from the CHARGE (Cohorts for Heart and Aging Research in Genomic Epidemiology) consortium. Neuropsychological testing was available for 5429-32,070 subjects of European ancestry aged 45 years or older, free of dementia and clinical stroke at the time of cognitive testing from 20 cohorts in the discovery phase. We analyzed performance on the Trail Making Test parts A and B, the Letter Digit Substitution Test (LDST), the Digit Symbol Substitution Task (DSST), semantic and phonemic fluency tests, and the Stroop Color and Word Test. Replication was sought in 1311-21860 subjects from 20 independent cohorts. A significant association was observed in the discovery cohorts for the single-nucleotide polymorphism (SNP) rs17518584 (discovery P-value=3.12 × 10(-8)) and in the joint discovery and replication meta-analysis (P-value=3.28 × 10(-9) after adjustment for age, gender and education) in an intron of the gene cell adhesion molecule 2 (CADM2) for performance on the LDST/DSST. Rs17518584 is located about 170 kb upstream of the transcription start site of the major transcript for the CADM2 gene, but is within an intron of a variant transcript that includes an alternative first exon. The variant is associated with expression of CADM2 in the cingulate cortex (P-value=4 × 10(-4)). The protein encoded by CADM2 is involved in glutamate signaling (P-value=7.22 × 10(-15)), gamma-aminobutyric acid (GABA) transport (P-value=1.36 × 10(-11)) and neuron cell-cell adhesion (P-value=1.48 × 10(-13)). Our findings suggest that genetic variation in the CADM2 gene is associated with individual differences in information processing speed.

[Lung Health Data of the Study of Health in Pomerania - a Review of Samples, Methods and First Results]. / Pneumologisch relevante Daten aus der "Study of Health in Pomerania" (SHIP) ­ eine Übersicht zu den Kohorten, Methoden und ersten Ergebnissen.

Investigating reasons for differing life expectancy and prevalence of cardiovascular risk factors between old and new states of the Federal Republic of Germany an epidemiological study in Western Pomerania - the population-based project Study of Health in Pomerania (SHIP) - was planned.Prevalence and incidence of common risk factors, subclinical disorders and clinical diseases have been assessed since 1997 in five-year intervals. The third follow up (SHIP-3) was assessed between 2014 and 2016. In addition, an independent representative population sample was investigated between 2008 - 2012 (SHIP-TREND). Recently, the first follow up of this cohort has been started (SHIP-TREND-1). This paper reports the methodological approaches for detecting pneumological relevant morbidities in this population-based study. It aims to offer insights for potential cooperation with interested research groups.

[Integration of primary and secondary data in the Study of Health in Pomerania and description of clinical outcomes using stroke as an example]. / Die Integration von Primär- und Sekundärdaten in der Study of Health in Pomerania und die Beschreibung von klinischen Endpunkten am Beispiel Schlaganfall.

OBJECTIVE: This study describes (i) the procedure of obtaining patients' consent for secondary data usage, (ii) the complexity of integrating data from multiple sources, and (iii) the correspondence among patients' self-reports, physician reports, routine data, hospital discharge diagnosis, and cause-of-death coding regarding stroke. METHODS: Data from the first follow-up (N=3 186) of the population-based Study of Health in Pomerania (SHIP) were used. These data were combined with secondary data from the Greifswald University Hospital, the association of statutory health insurance physicians Mecklenburg-Western Pomerania, physician reports, and death certificates. RESULTS: Consent for using health-related information from all data sources in question was obtained from more than 90% of the SHIP participants. Follow-up data from at least one source were available for 2 747 (86%) participants. For 92 participants information about the occurrence of stroke was found in at least one data source. In 59 cases the event appeared in only one data source, in 24 cases the event was found in 2 sources, and for 9 participants 3 data sources reported on the event. CONCLUSION: Participants of a population-based cohort are highly willing to give consent for using their health-related information from secondary data sources. Yet, data integration is challenging due to considerable differences in data type, structure and coverage.

[GeKo KidS--Health Literacy in School Children]. / GeKo KidS--Gesundheitskompetenz bei Kindern in der Schule.

The main goal of this study was the evaluation of an intervention programme for the promotion of health literacy in school-aged children (grade 5-6). The project and the programme were highly accepted, the extension of the annual dental health examination was suitable to collect data within evaluation projects in schools. In spite of positive outcomes, a longer supervision phase would be necessary in order to optimise and to implement other programme components fully.

[Comparison of two screening questionnaires for patients with low back pain. Collation of risk factors for chronification]. / Vergleich zweier Screening-Fragebogen für Patienten mit Rückenschmerzen. Erfassung von Risikofaktoren für eine Chronifizierung.

BACKGROUND: Screening for risk factors for chronic low back pain (LBP) (yellow flags) is recommended by clinical guidelines. Various questionnaires to assess yellow flags have been proposed. OBJECTIVES: The aim of this study was to compare the prognostic validity of two screening questionnaires. MATERIAL AND METHODS: This was a prospective observational study with 241 LBP patients from 9 general practitioners, 4 orthopedic surgeons and 2 pain clinics. We compared the Örebro musculoskeletal pain questionnaire (ÖMSPQ) and the Heidelberg short questionnaire (HKF-R10) which were completed by all patients at inclusion before the consultation. Primary outcomes were assessed after 3 months by mail. Clinical endpoints were pain intensity, disability and more than two follow-up consultations. RESULTS: The sensitivity of the HKF-R10 to predict the primary outcome ranged from 81 % to 88 %, while the specificity was much lower (37-47 %). The ÖMSPQ showed an opposite pattern with a low sensitivity ranging from 50 % to 58 % but a higher specificity (77-80 %). In patients initially classified as having chronic LBP (n = 81), using the questionnaires as a diagnostic tool, the sensitivity of both questionnaires increased but specificity decreased. Single items may perform better with regard to primary outcome than the sum scores. CONCLUSION: Both screening questionnaires for chronic LBP have insufficient diagnostic and prognostic validity for routine use in ambulatory care. Further studies are needed to improve diagnostic and prognostic validity and to elaborate criteria for a targeted use of screening questionnaires to guide therapeutic interventions.

[Which route leads from chronic back pain to depression? A path analysis on direct and indirect effects using the cognitive mediators catastrophizing and helplessness/hopelessness in a general population sample]. / Welcher Weg führt von chronischen Rückenschmerzen zur Depressivität? Eine Pfadanalyse zu direkten und indirekten Effekten unter Berücksichtigung kognitiver Mediatoren des Katastrophisierens und der Hilf-/Hoffnungslosigkeit in einer Allgemeinbevölkerungsstichprobe.

BACKGROUND: Chronic pain and depression are highly comorbid; however, the longitudinal link is only partially understood. This study examined direct and indirect effects of chronic back pain on depression using path analysis in a general population sample, focussing on cognitive mediator variables. METHODS: Analyses are based on 413 participants (aged 18-75 years) in a population-based postal survey on back pain who reported chronic back pain at baseline. Follow-up data were collected after 1 year. Depression was measured with the Center for Epidemiologic Studies Depression Scale (CES-D). Fear-avoidance-beliefs (FABQ), catastrophizing and helplessness/hopelessness (KRSS) were considered as cognitive mediators. Data were analyzed using path analysis. RESULTS: Chronic back pain had no direct effect on depression at follow-up when controlling for cognitive mediators. A mediating effect emerged for helplessness/hopelessness but not for catastrophizing or fear-avoidance beliefs. CONCLUSIONS: These results support the cognitive mediation hypothesis which assumes that psychological variables mediate the association between pain and depression. The importance of helplessness/hopelessness is of relevance for the treatment of patients with chronic back pain.

Striking sex differences in magnetic resonance imaging findings in the sacroiliac joints in the population.

BACKGROUND: In patients with axial spondyloarthritis (axSpA), magnetic resonance imaging (MRI) is used to detect bone marrow edema (BME) in sacroiliac joints (SIJ) but SIJ BME are also detected in the population. Not much is known about sex differences in that regard. OBJECTIVE: To explore sex-specific differences associated with the extent of BME in the SIJ suggestive of axSpA in a general population cohort study. METHODS: Taking advantage of 793 recently evaluated MRIs of subjects < 45 years taking part in the SHIP cohort, we used negative-binomial (NB) count data regression to analyze factors associated with the extent of SIJ BME. Predictors were explored by model-based boosting (MBB), a machine learning approach. RESULTS: Estimates of NB regression showed strong effects of sex in interaction with age, BMI, back pain, and particularly HLA-B27. The NB regression model showed incidence rate ratios (IRR) for the main effect of sex (females vs. males): 0.94 [95% CI: 0.63; 1.41], HLA-B27: 4.32 [2.09; 9.8], and for the interaction of sex to HLA-B27: 0.22 [0.06; 0.75]. According to MBB, HLA-B27 positivity, BMI, current smoking, back pain in the last 3 months, the interaction of sex and HLA-B27, and delivery in the last 12 months were of highest importance to explain the extent of SIJ BME. CONCLUSIONS: Different factors were associated with the extent of SIJ BME in females and males. Most importantly, HLA-B27 was relevant only in males but not in females in whom a postpartal state was important. This finding may be relevant for the pathogenesis of axSpA.

[Back pain and social status among the working population: what is the association? Results from a German general population survey]. / Rückenschmerz und Sozialschicht bei Berufstätigen: ergebnisse einer deutschen Bevölkerungsstichprobe.

BACKGROUND: Little empirical evidence is available on differential associations between social status indicators and back pain in Germany. This study therefore systematically evaluated associations between different indicators of social status and back pain. METHODS: In total 4,412 employed adults, aged 18 to 65 years participated in a postal survey in 5 regions of Germany. The point prevalence and 1-year prevalence of back pain were assessed as well as the level of disabling back pain. Educational level, professional category and household income served as measures of social status. Associations between social status and back pain have been assessed cross-sectionally using Poisson regression. RESULTS: Educational level was the best predictor for back pain among the assessed social status indicators. Adults with a low educational level had almost a 4-fold risk of reporting disabling back pain compared to subjects with a high educational level. Associations were highest for disabling back pain and attenuated strongly over the point prevalence towards the 1-year prevalence. DISCUSSION: Back pain cannot generally be regarded as a symptom of a low social status. However, social inequality is of major importance regarding the prediction of severe back problems. A better understanding of mediating factors is essential for the prevention and therapy.

Reference levels for serum thyroid function tests of diagnostic and prognostic significance.

A controversy exists on the value of upper thyrotropin (TSH) reference level. Currently available studies are based on cross-sectional data leaving uncertainty about the prognostic significance of the upper TSH reference level. With the present study we sought to establish reference values for serum thyroid function tests that are of both diagnostic and prognostic significance. We used data from the prospective population-based Study of Health in Pomerania (SHIP) with a 5 year follow-up (6080 person-years). We included data from 1203 subjects (525 women) without prevalent subclinical or manifest thyroid disorders. An event-free reference population was separated comprising 1053 subjects (473 women). When comparing reference values as analyzed from either the whole reference population or the event-free reference population, we observed notable differences in TSH reference intervals. While the lower TSH reference values were similar in both populations, the upper value was 1.95 mIU/l and thus by 7.6% lower in subjects without incident events compared to the whole reference population. Both populations did not substantially differ with respect to serum FT3 and FT4 reference intervals. The upper TSH reference value is lower than recommended when both diagnostic and prognostic significance are considered in the definition of the TSH reference range.

[Pain and pain management for children in Greifswald and East Pomerania: comparison with the results of the German Health Interview and Examination Survey for Children and Adolescents (KiGGS)]. / Schmerzen und Schmerzmanagement bei Kindern in Greifswald und Ostvorpommern: Vergleich mit den Ergebnissen des Kinder- und Jugendgesundheitssurveys (KiGGS).

AIM OF THE STUDY: Pain in children and adolescents in Germany is a common health problem which has a high socioeconomic impact. There have been no studies allowing a reliable estimation of the prevalence of pain in children in the 5 (th) grade (age range 9-13 years) in schools in the region of the city of Greifswald and the administrative district East Pomerania. This population-based cross-sectional study examined the prevalence of pain in children, the treatment of pain and compared these data with the results of the German Health Interview and Examination Survey for Children and Adolescents (KiGGS). METHODS: Data were collected within the extended dental school examination in autumn 2007 including a self-completion questionnaire for the students. Also the parents answered a self-completion questionnaire containing questions on their children's socio-economic status. The pain and sociodemographic questions are compatible with those used in the "German Health Survey for Children and Adolescents" (KiGGS). RESULTS: Students from 19 schools completed a questionnaire on general pain (n=852, proportion of response: 93.2%, mean age: 10 years). Comparing to the KiGGS the overall 3-month prevalence is much higher (95.5%). For boys and girls headache is the pain associated with the most burden ("Hauptschmerz"). 1/4 of the girls (27.9%) and 1/5 (22.4%) of the boys reported their pain with the most burden during the last 3 months with a frequency of at least one time per week. Students with low socio-economic status took medication against pain ("Hauptschmerz") less frequently than students with high socio-economic status. Because of their pain ("Hauptschmerz") students with low socio-economic status visited a doctor less often than students with a mean or high socio-economic status. CONCLUSION: Compared to other epidemiological studies, pain is also a common health problem for children in the city of Greifswald and the administrative district East Pomerania. The data base enables comprehensive conclusions on the health-related state of students in Greifswald/East Pomerania. Further studies should examine additional factors on medication and the degree of doctor?s visits, e. g., parental attitudes towards medication and parental motivation towards the degree of visiting a doctor.

Income is associated with hippocampal/amygdala and education with cingulate cortex grey matter volume.

Income and education are both elements of a person's socioeconomic status, which is predictive of a broad range of life outcomes. The brain's gray matter volume (GMV) is influenced by socioeconomic status and mediators related to an unhealthy life style. We here investigated two independent general population samples comprising 2838 participants (all investigated with the same MRI-scanner) with regard to the association of indicators of the socioeconomic status and gray matter volume. Voxel-based morphometry without prior hypotheses revealed that years of education were positively associated with GMV in the anterior cingulate cortex and net-equivalent income with gray matter volume in the hippocampus/amygdala region. Analyses of possible mediators (alcohol, cigarettes, body mass index (BMI), stress) revealed that the relationship between income and GMV in the hippocampus/amygdala region was partly mediated by self-reported stressors, and the association of years of education with GMV in the anterior cingulate cortex by BMI. These results corrected for whole brain effects (and therefore not restricted to certain brain areas) do now offer possibilities for more detailed hypotheses-driven approaches.

Smoking prevalence in Type 2 diabetes: results of the Study of Health in Pomerania (SHIP) and the German National Health Interview and Examination Survey (GNHIES).

AIMS: Smoking contributes to the development of diabetes and diabetes-related complications. Currently, data on smoking prevalence in subjects with diabetes in Germany are lacking. The aim of our analysis was to determine smoking prevalence in adults with Type 2 diabetes mellitus using data from the two population-based studies in Germany. METHODS: From the Study of Health in Pomerania (SHIP) (n = 4283) and the 1998 German National Health Interview and Examination Survey (GNHIES 98) (n = 6663) subjects aged 20-79 years were investigated. Descriptive statistics on smoking prevalence and behaviours were calculated for Type 2 diabetes mellitus and compared with the general population using weightings reflecting the European adult population. RESULTS: Overall, the prevalence of current smokers was lower among persons with than without Type 2 diabetes mellitus in SHIP (17.3% vs. 38.0%) and in GNHIES 98 (24.7% vs. 32.1%). Only in men, there were more former smokers in Type 2 diabetic patients than in subjects without diabetes in both studies. Among current and former smokers, the number of cigarettes smoked was higher among persons with than without Type 2 diabetes mellitus. For men, this finding was consistent in SHIP and GNHIES 98, while in women, this difference was only observed in GNHIES 98. CONCLUSIONS: The associations between smoking and Type 2 diabetes mellitus are likely to reflect behavioural changes secondary to illness or medical counselling. The high proportion of current smokers among Type 2 diabetic patients, particularly men, should be monitored in repeated surveys following the introduction of disease management programmes.

Physically active life style is associated with increased grey matter brain volume in a medial parieto-frontal network.

To examine the association between the amount of sports activity performed during leisure time and gray matter volume (GMV) of the brain we investigated differences in GMV in a large cohort study of community-dwelling older adults. 967 individuals indicated their average weekly sports activity via a questionnaire, and underwent high resolution T1-weighted structural imaging of the brain. We used voxel based morphometry (CAT 12) in a region of interest approach for (1) comparing participants with higher versus lower sports activity (median split) and (2) calculating a linear regression on GMV and sports activity. We carefully corrected for other factors known to have an impact on GMV (sex, age, total brain volume, education, cigarettes and alcohol consumption, body mass index) and excluded pathology (history of psychiatric or neurological disease; visual inspection of brain scans). Those participants who spend more time performing sports activity per week (median split with > 1 h/week) showed higher GMV in the dorsomedial frontal lobe, the superior parietal lobe, and the precuneus/cuneus area. When splitting participants by their median (55.5 years) into two groups we found a stronger protective effect of sports against age related GMV decline for the older part of the cohort. Overall, a more active lifestyle was associated with increased GMV in areas associated with self-awareness and working memory. These cohort data support data on the protective role of sports activity for the GMV.

Assessing the interplay of childhood adversities with more recent stressful life events and conditions in predicting panic pathology among adults from the general population.

BACKGROUND: Although research suggests that (a) childhood adversities and more recent stressful life events/conditions are risk factors for panic pathology and that (b) early life stress increases vulnerability to later psychopathology, it remains unclear whether childhood adversities amplify the association between more recent stressful life events/conditions and panic pathology. METHODS: Data were derived from a general population sample (Study of Health in Pomerania, SHIP). Lifetime panic pathology was assessed with the Munich Composite International Diagnostic Interview (M-CIDI). Childhood adversities (emotional, physical and sexual abuse; emotional and physical neglect) were assessed with the Childhood Trauma Questionnaire (CTQ). More recent separation/loss events and long-lasting stressful conditions were assessed with the Stralsund Life Event List (SEL). Individuals with lifetime panic pathology (fearful spell, panic attack or panic disorder, N = 286) were compared to controls without any psychopathology (N = 286, matched for sex and age). RESULTS: Conditional logistic regressions revealed that childhood adversities as well as more recent separation/loss events and long-lasting stressful conditions were associated with panic pathology (OR 1.1-2.5). Moreover, more recent separation/loss events - but not long-lasting stressful conditions - interacted statistically with each of the examined childhood adversities except for sexual abuse in predicting panic pathology (OR 1.1-1.3). That is, separation/loss events were associated more strongly with panic pathology among individuals with higher childhood adversities. LIMITATIONS: Data were assessed retrospectively and might be subject to recall biases. CONCLUSIONS: Findings suggest that early childhood adversities amplify the risk of developing panic pathology after experiencing separation or loss events.

Vitamin D and health care costs: Results from two independent population-based cohort studies.

BACKGROUND & AIMS: Vitamin D deficiency is associated with higher morbidity. However, there is few data regarding the effect of vitamin D deficiency on health care costs. This study examined the cross-sectional and longitudinal associations between the serum 25-hydroxy vitamin D concentration (25OHD) and direct health care costs and hospitalization in two independent samples of the general population in North-Eastern Germany. METHODS: We studied 7217 healthy individuals from the 'Study of Health in Pomerania' (SHIP n = 3203) and the 'Study of Health in Pomerania-Trend' (SHIP-Trend n = 4014) who had valid 25OHD measurements and provided data on annual total costs, outpatient costs, hospital stays, and inpatient costs. The associations between 25OHD concentrations (modelled continuously using factional polynomials) and health care costs were examined using a generalized linear model with gamma distribution and a log link. Poisson regression models were used to estimate relative risks of hospitalization. RESULTS: In cross-sectional analysis of SHIP-Trend, non-linear associations between the 25OHD concentration and inpatient costs and hospitalization were detected: participants with 25OHD concentrations of 5, 10 and 15 ng/ml had 226.1%, 51.5% and 14.1%, respectively, higher inpatient costs than those with 25OHD concentrations of 20 ng/ml (overall p-value = 0.001) in multivariable models. CONCLUSIONS: We found a relation between lower 25OHD concentrations and increased inpatient health care costs and hospitalization. Our results thus indicate an influence of vitamin D deficiency on health care costs in the general population.

Isolation and synthesis of acmellonate, a new unsaturated long chain 2-ketol ester from Spilanthes acmella.

Paracress (Spilanthes acmella) is commonly used as a spice, e.g., in Madagascar. To get more information about the taste active compounds, Jambu oleoresin produced from Spilanthes acmella and extracts prepared directly from the plant were fractionated and the fractions were analysed and evaluated by tasting. In addition to the long known tingling compounds (2E,6Z,8E)-deca-2,6,8-trienoic acid N-isobutyl amide (spilanthol) and (2E,6Z,8E)-deca-2,6,8-trienoic acid N-(2-methylbutyl) amide, as a minor constituent also the new 2-ketol ester (7Z,9E)-2-oxo-undeca-7,9-dienyl 3-methylbut-2-enoate (acmellonate) was isolated. The structure of the latter compound was verified by total synthesis of the ketol ester via the reaction of tris(trimethylsilyloxy)ethene and (6Z,8E)-deca-6,8-dienoic acid chloride and subsequent classical esterification. Acmellonate shows a weak tingling and numbing effect on the tongue and contributes only to a small extend to the overall flavour of Jambu.