[Health risk railroad noise - prognosis of potential health risks subsequent to night-time exposure to railroad noise in the German part of the Transversal Rotterdam Genova]. / Krankheitsfaktor Schienenlärm - Prognose der möglichen Krankheitsfolgen durch nächtlichen Schienenlärm im Bereich der Transversale Rotterdam-Genua im Bereich der Bundesrepublik Deutschland.

Based on risk coefficients for cardiovascular and psychiatric disease derived from a case-control study in the vicinity of a major German airport, statistics on persons exposed to night-time railroad noise in the vicinity of the Rotterdam-Genova Transversal, and on health expenditure calculations by the Federal Statistical Office of Germany a prognosis on effects of railroad noise was performed. It resulted for 1 10-year period in nearly 75 000 excess cases of diseases, nearly 30 000 excess deaths and health expenditures of 3.8 billion euros.

[Social and economic consequences of night-time aircraft noise in the vicinity of Frankfurt/Main airport]. / Soziale und ökonomische folgen nächtlichen fluglärms im umfeld des flughafens Frankfurt/Main.

A prospective calculation of disease-related social and economic costs due to night-time aircraft noise in the vicinity of Frankfurt/Main airport was performed for the calendar years 2012-2021. It was based on risk estimates for a variety of diagnostic entities (cardiovascular disease, depression, psychosis, diabetes mellitus, dementia and Alzheimer's disease, all cancers except malignancies of the respiratory system) from a previous case-control study on more than 1 million persons enrolled in compulsory sickness funds in the vicinity of the Cologne-Bonn airport, on disease-related cost estimates performed by the German Federal Statistical Office for the calender years 2002-2008, and calculations of the population exposed to night-time aircraft noise in the vicinity of Frankfurt/Main airport (2005 aircraft routes and flight frequencies). Total estimated costs came to more than 1.5 billion € with an excess of 23 400 cases of diseases treated in hospitals and of 3 400 subsequent deaths.

Spontaneous tumors and common diseases in two colonies of Syrian hamsters. I. Incidence and sites.

Syrian hamsters from two colonies [Eppley colony (EC); Hannover colony (HC)] were examined for spontaneous neoplastic and noneoplastic diseases. Significant differences were found in tumor incidence (30%, EC' 42%, HC), occurrence of malignant neoplasms (15%, EC; 32%, HC), appearance of multiple primary tumors in different organs (42%, EC; 30%, HC), average survival rates of tumor-bearing animals, organ distribution and histologic types, and average survival rates of all animals. The frequencies of nonneoplastic diseases also varied between the two colonies. The findings indicated a need for precise histologic evaluation to generate information for comparative purposes regarding the use of hamsters in experimental pathology and carcinogenesis studies.

German investigations on morbidity and mortality of workers exposed to vinyl chloride.

Two studies on mortality and morbidity of workers exposed to vinyl chloride monomer (VCM) which have been carried out on behalf of the Ministry of Labour, Health and Social Affairs on Northrhine-Westphalia are reported.

Coronary heart disease mortality, morbidity, and case fatality in five east and west German cities 1985-1989. Acute Myocardial Infarction Register Teams of Augsburg, Bremen, Chemnitz, Erfurt, and Zwickau.

Cardiovascular mortality (CVD; International Classification of Diseases [ICD] 390-458) is higher in East than in West Germany, but the differences in official coronary heart disease mortality (CHD; ICD 410-414) are not so pronounced. The aim of this study was to validate the official mortality statistics based on the five German AMI registers and to analyze whether these mortality differences are due to differences in the attack rates of acute myocardial infarction (AMI) or to differences in the 28-day case fatality rates. This comparison includes the MONICA study cities of Augsburg and Bremen, both in West Germany, as well as the cities of Chemnitz, Erfurt, and Zwickau in East Germany (former the German Democratic Republic). The rates were calculated on the basis of all MONICA cases of definite AMI or coronary death aged 35 to 64 years occurring in the respective study populations between 1985 and 1989. All study populations except women in Augsburg showed higher coronary death rates compared to the rates based on the official cause of death statistics (ICD 410-414), but this difference was significant only for men in Chemnitz. In men there were no significant differences in the register-based coronary death rates between these urban areas (160/100,000 in Zwickau to 170/100,000 in Chemnitz) nor in the AMI attack rates (327/100,000 in Augsburg to 363/100,000 in Chemnitz), and consequently no significant center differences in the overall 28-day case fatality. However, the prehospital case fatality was significantly higher in Erfurt (34%) than in Bremen (27%). There were no significant differences in the AMI attack rates in women as well (60/100,000 in Chemnitz to 70/100,000 in Bremen and Erfurt), but the overall 28-day case fatality showed a clear gradient from the East (61-71%) to the West German cities (48-56%) and therefore also the register-based coronary death rates (38-50/100,000 and 34-38/100,000, respectively). However, the higher 28-day case fatality in women found in the MONICA registers in East compared to West Germany is not reflected in the CHD mortality statistics because of a stronger underestimation of the official mortality rates and in East than in West Germany, in particular in women. Nevertheless, the total mortality rates and in most cases also the CVD mortality rates were in women significantly higher in the East German compared to the West German cities. The East German official preunification CHD mortality data cannot be used for national and international comparisons. The results of the MONICA AMI registers in East and West Germany indicate, furthermore, the need to improve coronary care in women in the eastern part of the country. Nevertheless, because of the relatively high AMI attack rate in both parts of Germany primary prevention must generally be intensified.

Cardiovascular disease risk factors, CHD morbidity and mortality in the Federal Republic of Germany.

Analyses of data from the first National Health Examination Survey undertaken from 1984-1986 within the framework of the German Cardiovascular Prevention Study, show the following risk factor prevalences in 25-69 year-old men and women: overweight (BMI males: greater than 25, females greater than 24) or obese (BMI greater than 30): men 65.0%, women 57.6%; total serum cholesterol (less than 5.17 mmol/dl): men 73.7%, women 74.0%; normal blood pressure (according to JNC definitions): men 45.0%, women 59.1%; hypertension according to WHO criteria: men 26.0%, women 21.1%; controlled hypertensives (WHO criteria): men 19.9%, women 33.9%; current smoking: men 40.8%, women 26.1%. For most of the cardiovascular risk factors there is a clear negative association between prevalence and length of school education. Three myocardial infarction (MI) registries (WHO MONICA Project) are operating in the Federal Republic of Germany. Incidence and case-fatality data are within comparable ranges. Coronary heart disease (CHD) mortality has been relatively stable in both sexes from 1970 to 1986 with a minor peak in 1976 and a slight downward trend since then. A study of the reliability of coding procedures in West German state statistical offices revealed major disagreements so that trends derived from national mortality data as aggregate data of the federal states might be spurious. An ecological correlation of regional smoking prevalences (1978) and regional CHD mortality rates (1977-9) showed significant coefficients in men, but not in women.

Occupational and environmental hazards associated with lung cancer.

In a hospital-based case-control study 194 lung cancer cases, 194 hospital controls, and 194 population controls were interviewed for their smoking, occupational, and residential history by trained interviewers, using a standardized questionnaire. In order to include many different environmental exposures, case ascertainment took place in seven different hospitals with catchment areas ranging from rural to highly industrialized. Lung cancer risk strongly increases with cumulative cigarette dose, reaching an odds ratio (OR) of 16.19 (95% confidence limits (CL): 5.10, 51.33) for male smokers of more than 40 pack-years and an OR of 19.99 (95% CL: 4.98, 80.24) for female smokers of more than 20 pack-years. For the quantification of occupational exposure to known carcinogens of the lung a novel approach was developed which accumulates exposure information obtained by supplemental questionnaires through an automatic procedure. The OR for the highest exposure group in males was 2.7 (95% CL: 1.23, 5.78). Significantly increased risks were observed in the metal industry, particularly in smelter and foundry workers (OR 4.8, 95% CL: 1.15, 20.16) and in turners (OR 2.2, 95% CL: 1.05, 4.75). In the construction industry the risks were particularly high in road construction workers (OR 3.7, 95% CL: 1.06, 13.20) and in unskilled construction workers (OR 2.7, 95% CL: 1.24, 5.76). The risks in these occupational groups increased with duration and with latency. Quantification of air pollution was done on a county basis by time period. An index based on emission data for sulphur dioxide was compared to a semiquantitative index, which included additional information on ambient air pollution. After adjustment for smoking and occupational exposures an OR of 1.01 (95% CL: 0.53, 1.91) for an emission index and of 1.16 (95% CL: 0.64, 2.13) for a semiquantitative index was obtained.

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.

Social gradient of CVD risk in Germany before/after unification.

A social gradient of cardiovascular risk has been found in several European countries, including the former East and West Germany. Have any changes have occurred in Germany, particularly in the east, since the wall came down? We analyzed the results of three compatible, population-based, interview-and-examination health surveys that were performed in both parts of Germany between 1984 and 1992. Total years of education was the social indicator. Systolic/diastolic blood pressure, body mass index, prevalence of hypertension, obesity, and cigarette smoking showed a social gradient in favor of higher social class groups; the social gradient for total cholesterol and hyper-cholesterolemia in men was less clear. Despite a much higher risk-factor profile in the east, neither a difference between the social gradients of the former East and West Germany nor a clear trend after the wall came down were found. In both areas, the social gradient clearly increased only for women smokers. Overall, we found very little evidence to support the idea that the ferocity of socioeconomic changes in the east had already led to a higher gradient of cardiovascular risk in 1991/1992 relative to that in the western part of the German population.

Variation in coronary risk factor levels of men and women between the German-speaking MONICA centres.

The aim of this analysis was to compare levels of risk factors for coronary heart disease (CHD) in men and women aged 25-64 years between German-speaking MONICA collaborating centres, the German Democratic Republic (GDR), Augsburg - the Federal Republic of Germany (FRG)(Au), Bremen - FRG (Br), Heidelberg - FRG (He), and Vaud/Fribourg - Switzerland (CH, with a German-speaking minority). Prevalence of cigarette smoking in men showed little variation in four centres (34 to 40%) and was higher in BR men (49%), while it varied from 17% (GDR) to 33% (BR) in women. Mean total serum cholesterol values (mmol/L) were highest in GDR and CH men (both 6.2) and GDR women (6.1), and lowest in both He men (5.7) and He women (5.6). The proportion with cholesterol values greater than or equal to 6.7 mmol/L was largest in CH men (34%) and smallest in FRG (He) women (17%), while lowering the cut-off point from 6.7 to 6.5 mmol/L raised the prevalence of hypercholesterolaemia in all centres by 5 to 10%. Mean values (mmHg) of blood pressure (BP) were highest in both GDR men (140/88) and women (138/86), as was the prevalence of hypertensive BP values. In all centres, women aged 25-34 had BP values approximately 12/5 mmHg lower than age-matched men, but BP values similar to men at age 55-64, which indicates that age-parallel increase in BP was steeper in women than men.(ABSTRACT TRUNCATED AT 250 WORDS)

[Social class and risk factors for coronary heart disease--results of the Regional DHP(German Cardiovascular Prevention) Health Surveys]. / Soziale Schicht und Risikofaktoren für koronare Herzkrankheiten--Resultate der regionalen DHP-Gesundheitssurveys.

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.

[Are females healthier than males? On the health status of females in West Germany]. / Sind Frauen gesünder als Männer? Zur gesundheitlichen Lage der Frauen in der Bundersrepublik Deutschland.

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.

[Social inequality in myocardial infarct and stroke in West Germany]. / Soziale Ungleichheit bei Herzinfarkt und Schlaganfall in West-Deutschland.

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.

[Analgesics and laxatives as risk factors for cancer in the efferent urinary tract--results of the Berlin Urothelial Carcinoma Study]. / Analgetika und Laxantien als Risikofaktoren für Krebs der ableitenden Harnwege--Ergebnisse der Berliner Urothelkarzinom-Studie (BUS).

A retrospective case-control study (1990-1995), the Berlin Urothelial Cancer Study (BUS), examined analgesics and laxatives as risks for the induction of urothelial cancer in renal pelvis, ureter and bladder. Especially for renal pelvis cancer could observe substance and dose specific risk of compound analgesics. The analgesic substances Phenacetin, Paracetamol, Acetylsalicylic acid (ASA) and Pyrazolones were assessed. Besides a risk of contact laxatives (chemical or anthranoide ingredients) for urothelial cancer was found, not yet described. The highest risk shows the anthranoide plant Senna. Thus this study confirms the risk of specific analgesic ingredients and found an evidence for a new risk of contact laxatives. As both, analgesics and contact laxatives, are typical OTC--("Over the counter") products, a severe controlling is demanded and for laxatives further studies are needed.

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.

Study of Health In Pomerania (SHIP): a health examination survey in an east German region: objectives and design.

OBJECTIVES: The reason for the Study of Health in Pomerania (SHIP) is the lack of epidemiological studies with a broad range of health indicators. Furthermore, in Germany there is a need for studies that take into account the particular situation of life after the reunification. One objective of SHIP is to provide prevalence estimates on a broad range of diseases, risk and health factors for a defined region in the former GDR. METHODS: A sample of 7008 women and men aged 20 to 79 years in a north-east region of Germany, 4900 expected participants. The sample was drawn in two steps: First, 32 communities in the region were selected. Second, within the communities a simple random sample was drawn from residence registries, stratified by gender and age. The data collection and instruments include four parts: oral health examination, medical examination, health-related interview, and a health- and risk-factor-related questionnaire. The oral health examination includes the teeth, periodontium, oral mucosa, craniomandibular system, and prosthodontics. The medical examination includes blood pressure measurements, electrocardiography, echocardiography, carotid, thyroid and liver ultrasounds, neurological screening, blood and urine sampling. The computer-aided health-related interview includes cardiovascular symptoms, utilisation of medical services, health-related behaviours, and socioeconomic variables. The self-administered questionnaire comprises housing conditions, social network, work conditions, subjective well-being and individual consequences from the German reunification.

Federal Republic of Germany: perspectives in school health.

In the Federal Republic of Germany, responsibilities for health and education are held by the 11 German states. Particularly in the health system, a number of tasks are delegated to private organizations under governmental control. In this review, general characteristics of both the public health and education systems are delineated. An overview of school health programs, including instruction, health services, environment, and school-community relations, and school-based research, also are presented.

Population-based research on occupational and environmental factors for leukemia and non-Hodgkin's lymphoma: the Northern Germany Leukemia and Lymphoma Study (NLL).

BACKGROUND: The Northern Germany Leukemia and Lymphoma Study (NLL) is a population-based study designed to provide a quantitative basis for investigations into occupational and environmental risk factors for leukemia and lymphoma. METHODS: All incident cases of leukemia and lymphoma diagnosed between 1/1/1986 and 12/31/1998 in six counties in Northern Germany were actively ascertained. Controls were selected from population registries. Use of pesticides, sources of food supply, time spent at home and work, medical and family history were assessed via face-to-face interview. This self-reported information was used in conjunction with direct environmental measurements of pesticides in household dust and electromagnetic fields (EMFs). In addition, geographical information system (GIS) data were used to derive estimates of environmental exposure to pesticides, EMFs associated with transmission lines, and ionizing radiation from routine nuclear power reactor operations. Occupational exposure assessment was based on lifetime work history. For each job, information on branch of industry, company, job description, and duration of employment were ascertained. RESULTS: Fourteen hundred thirty cases and 3041 controls were recruited. Lifetime residential and workplace histories totaled 49,628 addresses. Occupational exposure to pesticides was reported by 15% of the male participants (women: 16%). Four percent of the men (women: 8%) were occupationally exposed to ionizing radiation for >or=1 year over their lifetime. Sixty four percent of the participants had lived in the vicinity (20 km) of a nuclear power plant in operation. CONCLUSIONS: The NLL illustrates the successful application of innovative methods to simultaneously assess occupational and environmental risk factors for leukemia and lymphoma including radiological hazards, pesticides, and EMFs.

[Coding of cause of death for mortality statistics--a comparison with results of coding by various statistical offices of West Germany and West Berlin]. / Verschlüsselung von Todesursachen für Mortalitätsstatistiken--Vergleich von Signierergebnissen in verschiedenen statistischen Amtern der Bundesrepublik Deutschland und West-Berlins.

1.136 death certificates representing all 1985 Bremen cardiovascular deaths and a 50%-sample of non-cardiovascular deaths in the age group 25-69 years were analyzed for reliability of nosologists' coding according to ICD-coding rules (9th revision). The 1.136 photocopied death certificates were used to assess intra-observer-variation in Bremen and to determine inter-observer-variation among 7 nosologists from 6 different State Statistical Offices and the Federal Statistical Office. Intra-observer-agreement in Bremen was found to be similar to the results presented in a comparable US-study: Bremen: 92.1%; Curb et al. 1983: 94.8%-96.1%; 3-digit-ICD-Code. Inter-observer-agreement was found to be much lower in Germany than in two US-studies: 3 coders agreeing on 3-digit-ICD-Code: Bremen: 67.7% (average, 3 coders out of 7); Curb et al.: 90.2% (3 coders); 3 coders agreeing on 4-digit-ICD-Code: Bremen: 61.5%; NCHS 1980: 90.3%. Agreement-rates were also much lower in Germany than in the USA (Curb et al.) when particular disease groups were analysed: Ischaemic heart disease (ICD 410-414): Bremen: 82.7% (average); USA: 97.2%; cerebrovascular disease (ICD 430-438): Bremen 65.6% (average); USA: 93.2%; neoplasms (ICD 140-239): Bremen: 94.0% (average); USA: 97.8%. We conclude that training, individual characteristics of nosologists, and other factors may cause important artifacts when comparing German mortality statistics on a regional level or during different time intervals.

A sex difference in short-term survival after initial acute myocardial infarction. The MONICA-Bremen Acute Myocardial Infarction Register, 1985-1990.

AIMS: To assess the difference between men and women as regards fatality shortly after acute myocardial infarction, and the relationship of patient characteristics. METHODS AND RESULTS: One thousand seven hundred and ten male and 563 female patients, 25-69 years of age and hospitalized with a first acute myocardial infarction occurring from 1985 to 1990, were included in the population-based World Health Organization MONICA-Bremen Acute Myocardial Infarction Register. Patient information, including short-term survival status, was obtained from the medical records of the seven Bremen hospitals with internal medicine departments and municipal death certificate files. The unadjusted 28-day fatality rate after acute myocardial infarction was higher among women than among men (23.1% vs 16.1% respectively: P < 0.001). Adjusting for the older age of women did not eliminate the difference completely (females; 20.9%, males: 16.8%; P = 0.041). Controlling for previous use of inotropic medicine and diuretics, during-the-event receipt of thrombolysis and platelet inhibitors, and age in logistic regression analyses resulted in a similar 28-day mortality risk after acute myocardial infarction for both sexes (female/male odds ratio = 1.13, 95% confidence interval = 0.86 1.50; P = 0.389). CONCLUSIONS: Sex was not an independent predictor of early acute myocardial infarction fatality. Our data suggest that the excess mortality risk in women can be explained by sex differences in age, pre-infarction cardiac impairment, and treatment during the coronary event.