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OBJECTIVES: Most SARS-CoV-2 seroprevalence studies have focussed on adults and high-risk populations, and little is known about young adults. The objective of the present study was to provide evidence on the SARS-CoV-2 seroprevalence among young adults in Germany and to explore determinants associated with seropositivity in general and, specifically, with previously undetected infections. STUDY DESIGN: This was a population-based SARS-CoV-2 seroprevalence study. METHODS: In November 2020, a population-based study on SARS-CoV-2 seroprevalence in young adults (aged 18-30 years) was conducted in a large German city. Serum samples were obtained to analyse the SARS-CoV-2 antibody status using the Elecsys Anti-SARS-CoV-2 immunoassay. Descriptive statistics and odds ratios (ORs) of seropositivity and of previously undetected infections in relation to different determinants were calculated. RESULTS: Among 2186 participants, SARS-CoV-2 antibodies were detected in 72 individuals, equalling a test performance-adjusted seroprevalence of 3.1% (95% confidence interval [CI]: 2.4-4.0). Based on reported COVID-19 cases to the public health authority, a moderate underascertainment rate of 1.7 was calculated. Seropositivity was higher among individuals who sought COVID-19-related information from social media (OR: 1.83, 95% CI: 1.2-3.1), and undetected COVID-19 infections were more prevalent among men and those not adhering to social distancing. CONCLUSIONS: The results show a substantial underascertainment of SARS-CoV-2 infections among young adults and indicate that seroprevalence is likely to be much higher than the reported COVID-19 prevalence based on confirmed COVID-19 cases in Germany. Preventive efforts should consider the heterogeneity of risk profiles among the young adult population.
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COVID-19 , SARS-CoV-2 , Anticuerpos Antivirales , COVID-19/epidemiología , Humanos , Inmunoglobulina G , Masculino , Estudios Seroepidemiológicos , Adulto JovenRESUMEN
BACKGROUND: Providing frontline support places first responders at a high risk for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. AIMS: This study was aimed to determine the anti-SARS-CoV-2 seroprevalence in a cohort of first responders (i.e. firefighters/paramedics), to detect the underascertainment rate and to assess risk factors associated with seropositivity. METHODS: We conducted a serological survey among 745 first responders in Germany during 27 November and 4 December 2020 to determine the anti-SARS-CoV-2 seroprevalence using Elecsys® Anti-SARS-CoV-2 immunoassay (Roche Diagnostics, Mannheim, Germany). As part of the examination, participants were asked to provide information on coronavirus disease 2019 (COVID-19)-like-symptoms, information on sociodemographic characteristics and workplace risk factors for a SARS-CoV-2 infection and any prior COVID-19 infection. Descriptive statistics and logistic regression analysis were performed and seroprevalence estimates were adjusted for test sensitivity and specificity. RESULTS: The test-adjusted seroprevalence was 4% (95% CI 3.1-6.2) and the underascertainment rate was 2.3. Of those tested SARS-CoV-2 antibody positive, 41% were aware that they had been infected in the past. Seropositivity was elevated among paramedics who worked in the emergency rescue team providing first level of pre-hospital emergency care (6% [95% CI 3.4-8.6]) and those directly exposed to a COVID-19 case (5% [95% CI 3.5-8.1]). Overall, the seroprevalence and the underascertainment rate were higher among first responders than among the general population. CONCLUSIONS: The high seroprevalence and underascertainment rate highlight the need to mitigate potential transmission within and between first responders and patients. Workplace control measures such as increased and regular COVID-19-testing and the prompt vaccination of all personnel are necessary.
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COVID-19 , Socorristas , Anticuerpos Antivirales , COVID-19/epidemiología , Humanos , SARS-CoV-2 , Estudios SeroepidemiológicosRESUMEN
OBJECTIVE: The rapid transformation of labor markets has been accompanied by the belief of rising stress at work. However, empirical evidence on such trends based on reliable survey data is scarce. This study analyzes long-term trends in well-established measures of work stressors across Europe, as well as potential occupational differences. METHODS: We use repeated cross-sectional data of 15 European countries from waves 1995, 2000, 2005, 2010, and 2015 of the European Working Conditions Surveys. We apply three-way multilevel regressions (with employees nested in country-years, which are in turn nested in countries) to analyze trends in work stressors measured according to the demand-control and effort-reward imbalance models. Trends by occupational groups are also assessed. RESULTS: Our findings suggest that work stress generally increased from 1995 to 2015, and that the increase was mostly driven by psychological demands. People working in lower-skilled occupations had generally higher levels of job strain and effort-reward imbalance, as well as they tend to have a steeper increase in job strain than people working in higher-skilled occupations. Most of the change occurred from 1995 to 2005. CONCLUSION: Our results indicate that work stress has been on rise since 1995, specifically for people working in disadvantageous occupations. This directs the attention to the vulnerable position of the least skilled and also to the use of preventive measures to counteract some of the disadvantages experienced by this occupational group.
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Estrés Laboral/epidemiología , Lugar de Trabajo/psicología , Adulto , Europa (Continente)/epidemiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Salud Laboral , Ocupaciones , Encuestas y CuestionariosRESUMEN
An amendment to this paper has been published and can be accessed via the original article.
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BACKGROUND: Many studies have shown that work stressors have a negative impact on health. It is therefore important to gain an understanding of how work stressors can be reduced. Recent studies have shown that employees in countries with high investments into labour market policies less often report exposure to work stressors. Although these studies are indicative of an influence of the political level on work stressors, they are based on cross-sectional cross-country analyses where causal assumptions are problematic. The aim of this study is to extend the existing evidence by longitudinally testing whether changes in labour market policies are related to changes in work stressors. METHODS: We used comparative longitudinal survey data from the European Working Conditions Survey (27 countries; for the years 2005, 2010, 2015). The measurement of work stressors is based on two established work stress models: effort-reward imbalance (ERI) and job demand-control (job strain). To measure labour market policies, we used information on active (ALMP) and passive labour market policies (PLMP). After excluding persons with missing data, 64,659 participants were eligible for the ERI and 67,114 for job strain analyses. Estimation results are provided by three-way multilevel models (individuals, country-years, country), which allow us to estimate longitudinal and cross-country macro-effects. RESULTS: An increase in ALMP leads to a decrease of ERI. The analyses for the subcomponents 'effort' and 'reward' showed that mainly the 'reward' component is positively associated with ALMP. The association between ALMP and 'reward' shows that an increase in ALMP investments is related to an increase in rewards. Yet, no significant longitudinal associations between ALMP and job strain, and between PLMP and the work stressors, were observed. CONCLUSIONS: The study extends the current knowledge with longitudinal information by showing that an increase in ALMP is associated with an increase in rewards and a decrease of ERI. These longitudinal analyses may support a causal interpretation. The findings of this study have important policy implications. Our main result suggests that investments into ALMP can lead to better working conditions.
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Análisis de Datos , Recompensa , Estudios Transversales , Europa (Continente) , Humanos , Satisfacción en el Trabajo , Estudios Longitudinales , Políticas , Estrés Psicológico/epidemiología , Encuestas y CuestionariosRESUMEN
BACKGROUND: Adverse psychosocial working environments characterized by job strain (the combination of high demands and low control at work) are associated with an increased risk of depressive symptoms among employees, but evidence on clinically diagnosed depression is scarce. We examined job strain as a risk factor for clinical depression. METHOD: We identified published cohort studies from a systematic literature search in PubMed and PsycNET and obtained 14 cohort studies with unpublished individual-level data from the Individual-Participant-Data Meta-analysis in Working Populations (IPD-Work) Consortium. Summary estimates of the association were obtained using random-effects models. Individual-level data analyses were based on a pre-published study protocol. RESULTS: We included six published studies with a total of 27 461 individuals and 914 incident cases of clinical depression. From unpublished datasets we included 120 221 individuals and 982 first episodes of hospital-treated clinical depression. Job strain was associated with an increased risk of clinical depression in both published [relative risk (RR) = 1.77, 95% confidence interval (CI) 1.47-2.13] and unpublished datasets (RR = 1.27, 95% CI 1.04-1.55). Further individual participant analyses showed a similar association across sociodemographic subgroups and after excluding individuals with baseline somatic disease. The association was unchanged when excluding individuals with baseline depressive symptoms (RR = 1.25, 95% CI 0.94-1.65), but attenuated on adjustment for a continuous depressive symptoms score (RR = 1.03, 95% CI 0.81-1.32). CONCLUSIONS: Job strain may precipitate clinical depression among employees. Future intervention studies should test whether job strain is a modifiable risk factor for depression.
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Trastorno Depresivo/etiología , Estrés Laboral/complicaciones , HumanosRESUMEN
BACKGROUND AND AIMS: As a modifiable lifestyle factor, diet is hypothesized to play an important role in the progression of atherosclerosis. The aim of this study was to explore associations of comprehensive dietary patterns derived by cluster analysis with degree and progression of coronary artery calcification (CAC) over five years of follow-up. METHODS AND RESULTS: In the population-based Heinz Nixdorf Recall study, 3718 participants (45-75 years; 47.6% men) without coronary heart disease completed a food frequency questionnaire at baseline. Five distinct dietary patterns were identified using cluster analysis: "Health-conscious", "Traditional German/Less alcohol", "Mediterranean-like", "Western" and "Animal fat/Alcohol" (used as reference). CAC was measured using electron-beam computed tomography at baseline and five years later. CAC after five years was predicted based on sex- and age-specific baseline percentiles. After comparing observed and predicted CAC Scores, CAC progression was classified as slow, expected, or rapid. Compared to "Animal fat/Alcohol" diet, a "Mediterranean-like" diet was associated with a relative risk (RR) for a rapid CAC progression in both sexes (men: 0.61; 95%-confidence interval [95%-CI]: 0.41; 0.90; women: 0.59; 95%-CI: 0.45; 0.78). Furthermore, reduced RRs were observed in women with a "Health-conscious" and a "Traditional German/Less alcohol" diet (0.63; 95%-CI: 0.47; 0.84, respectively 0.69; 95%-CI: 0.52; 0.90). No association was observed for a "Western" diet for both sexes. Similar results were revealed for degree of CAC. CONCLUSION: The study results support the hypothesis that a "Mediterranean-like" diet is associated with a lower CAC-progression and lower degree of CAC in men and women.
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Enfermedad de la Arteria Coronaria/epidemiología , Dieta , Conducta Alimentaria , Calcificación Vascular/epidemiología , Anciano , Consumo de Bebidas Alcohólicas , Análisis por Conglomerados , Angiografía por Tomografía Computarizada , Angiografía Coronaria/métodos , Enfermedad de la Arteria Coronaria/diagnóstico por imagen , Enfermedad de la Arteria Coronaria/prevención & control , Dieta/efectos adversos , Encuestas sobre Dietas , Dieta Saludable , Dieta Mediterránea , Dieta Occidental , Grasas de la Dieta , Progresión de la Enfermedad , Femenino , Alemania/epidemiología , Humanos , Modelos Lineales , Masculino , Persona de Mediana Edad , Oportunidad Relativa , Estudios Prospectivos , Factores Protectores , Factores de Riesgo , Índice de Severidad de la Enfermedad , Factores de Tiempo , Calcificación Vascular/diagnóstico por imagen , Calcificación Vascular/prevención & controlRESUMEN
Public health is a population- and system-based approach that is needed to improve the health of societies and to decrease health inequalities. In the face of global challenges, the public health approach is essential. In Germany, the importance of public health is only partly reflected by its institutions and institutional arrangements. This applies equally to research, teaching and training, as well as to the public health service. Furthermore, the public health perspective is not sufficiently considered in cross-sectional topics that are relevant for health.There have been several initiatives to overcome structural deficits which can partly be traced back to historical circumstances. The White Paper presented here should encourage discussions about future policy options in public health. The authors represent public health in practice, research, and teaching in Germany.
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Atención a la Salud/organización & administración , Política de Salud , Accesibilidad a los Servicios de Salud/organización & administración , Modelos Organizacionales , Objetivos Organizacionales , Administración en Salud Pública/métodos , Alemania , Mejoramiento de la CalidadRESUMEN
BACKGROUND: Many patients and healthcare professionals believe that work-related psychosocial stress, such as job strain, can make asthma worse, but this is not corroborated by empirical evidence. We investigated the associations between job strain and the incidence of severe asthma exacerbations in working-age European men and women. METHODS: We analysed individual-level data, collected between 1985 and 2010, from 102 175 working-age men and women in 11 prospective European studies. Job strain (a combination of high demands and low control at work) was self-reported at baseline. Incident severe asthma exacerbations were ascertained from national hospitalization and death registries. Associations between job strain and asthma exacerbations were modelled using Cox regression and the study-specific findings combined using random-effects meta-analyses. RESULTS: During a median follow-up of 10 years, 1 109 individuals experienced a severe asthma exacerbation (430 with asthma as the primary diagnostic code). In the age- and sex-adjusted analyses, job strain was associated with an increased risk of severe asthma exacerbations defined using the primary diagnostic code (hazard ratio, HR: 1.27, 95% confidence interval, CI: 1.00, 1.61). This association attenuated towards the null after adjustment for potential confounders (HR: 1.22, 95% CI: 0.96, 1.55). No association was observed in the analyses with asthma defined using any diagnostic code (HR: 1.01, 95% CI: 0.86, 1.19). CONCLUSIONS: Our findings suggest that job strain is probably not an important risk factor for severe asthma exacerbations leading to hospitalization or death.
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Asma Ocupacional/epidemiología , Asma Ocupacional/etiología , Estrés Psicológico , Progresión de la Enfermedad , Europa (Continente)/epidemiología , Femenino , Humanos , Masculino , Modelos de Riesgos Proporcionales , Riesgo , Índice de Severidad de la Enfermedad , Población BlancaRESUMEN
BACKGROUND: Evidence of an association between job strain and obesity is inconsistent, mostly limited to small-scale studies, and does not distinguish between categories of underweight or obesity subclasses. OBJECTIVES: To examine the association between job strain and body mass index (BMI) in a large adult population. METHODS: We performed a pooled cross-sectional analysis based on individual-level data from 13 European studies resulting in a total of 161 746 participants (49% men, mean age, 43.7 years). Longitudinal analysis with a median follow-up of 4 years was possible for four cohort studies (n = 42 222). RESULTS: A total of 86 429 participants were of normal weight (BMI 18.5-24.9 kg m(-2) ), 2149 were underweight (BMI < 18.5 kg m(-2) ), 56 572 overweight (BMI 25.0-29.9 kg m(-2) ) and 13 523 class I (BMI 30-34.9 kg m(-2) ) and 3073 classes II/III (BMI ≥ 35 kg m(-2) ) obese. In addition, 27 010 (17%) participants reported job strain. In cross-sectional analyses, we found increased odds of job strain amongst underweight [odds ratio 1.12, 95% confidence interval (CI) 1.00-1.25], obese class I (odds ratio 1.07, 95% CI 1.02-1.12) and obese classes II/III participants (odds ratio 1.14, 95% CI 1.01-1.28) as compared with participants of normal weight. In longitudinal analysis, both weight gain and weight loss were related to the onset of job strain during follow-up. CONCLUSIONS: In an analysis of European data, we found both weight gain and weight loss to be associated with the onset of job strain, consistent with a 'U'-shaped cross-sectional association between job strain and BMI. These associations were relatively modest; therefore, it is unlikely that intervention to reduce job strain would be effective in combating obesity at a population level.
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Índice de Masa Corporal , Empleo/psicología , Sobrepeso/epidemiología , Sobrepeso/psicología , Estrés Psicológico/etiología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Estudios de Cohortes , Estudios Transversales , Europa (Continente)/epidemiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Obesidad/epidemiología , Obesidad/psicología , Oportunidad Relativa , Aumento de PesoRESUMEN
The Heinz Nixdorf Recall Study is a population-based study that aims to improve the prediction of cardiovascular events by integrating new imaging and non-imaging modalities in risk assessment. One focus of the study is the evaluation of the quantification of subclinical coronary artery calcifications (coronary artery calcification, CAC) as a prognostic factor in predicting cardiac events. Primary endpoints are myocardial infarction and sudden cardiac death. The study was initiated in the late 1990s and enrolled a total of 4,814 participants aged 45-75 years between December 2000 and August 2003. A 5-year follow-up examination took place between 2006 and 2008. Currently, the 10-year follow-up is under way and is estimated to be finished in July 2013. Extending the original aims of the study, serial CAC measurements will allow the characterization of the natural history of CAC dynamics, the identification of its determinants and an understanding of the impact of CAC progression on the primary endpoints. The Heinz Nixdorf Recall Study will significantly extend our knowledge about new modalities in the prediction of cardiac events.
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Calcinosis/mortalidad , Estudios de Cohortes , Enfermedad de la Arteria Coronaria/mortalidad , Indicadores de Salud , Estado de Salud , Calidad de Vida , Anciano , Causalidad , Femenino , Alemania/epidemiología , Alemania Oriental/epidemiología , Humanos , Masculino , Persona de Mediana Edad , Prevalencia , Factores de Riesgo , Análisis de Supervivencia , Tasa de SupervivenciaRESUMEN
BACKGROUND: Predicting the risk of disability in injured or sick workers is important to adequately assess the need for prevention and rehabilitation. Work-related factors could modify the risk of disability in a sustainable manner, and assessment of these factors might contribute to better risk prediction. AIM: Using the example of psychosocial work factors, empirical studies examining the question whether those exposures predict forthcoming events of disability retirement were to be identified. The review was expected to help quantify disability risks related to specific psychosocial factors at work. METHODS: A systematic review was conducted. 20 studies were found which studied associations between disability retirement and different aspects of the psychosocial work environment in a longitudinal design. RESULTS: Most studies found elevated disability risks in persons exposed to psychosocial factors at work. Important single factors were low control, monotonous work, work stress (job strain, effort-reward imbalance), a lack of social support, problems related to the organization of work and to leadership behaviours. CONCLUSION: There is evidence that psychosocial work factors influence the short- and long-term risk of disability pensioning.
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Evaluación de la Discapacidad , Necesidades y Demandas de Servicios de Salud , Beneficios del Seguro/estadística & datos numéricos , Programas Nacionales de Salud/estadística & datos numéricos , Alemania/epidemiología , Humanos , Salud Laboral , Psicología , Medición de RiesgoRESUMEN
AIMS/HYPOTHESIS: Atherosclerosis and cardiovascular diseases are often present at the time of diagnosis of type 2 diabetes mellitus. Whether subclinical atherosclerosis can be detected in the pre-diabetic (borderline fasting hyperglycemia) state is not clear. This study investigated the association of impaired fasting glucose (IFG) and coronary artery calcification (CAC), a marker of subclinical atherosclerosis, among participants without a history of coronary heart disease or manifest diabetes mellitus. METHODS: Study participants (aged 45-75 years) of the population-based Heinz Nixdorf Recall Study were categorised into those with normal fasting glucose (glucose <6.1 mmol/l) and those with IFG (glucose >or=6.1 to <7.0 mmol/l), excluding participants with a history of CHD or diabetes mellitus. CAC was assessed by electron-beam computed tomography, and risk factors were assessed by extended interviews, anthropometric measurements and laboratory tests. Various CAC cut-off points were used in multiple logistic and ordinal logistic regression models to estimate ORs and 95% CIs. RESULTS: Of the 2,184 participants, more men had IFG than did women (37% vs 22%). Participants with IFG showed a higher prevalence of CAC > 0 (men OR 1.90, 95% CI 1.33-2.70; women 1.63, 1.23-2.15). Risk factor adjustment weakened this association in both sexes (men 1.63, 1.12-1.36; women 1.26, 0.93-1.70). When the age- and sex-specific 75th percentile was used as the cut-off point for CAC, the association further decreased in men (1.10, 0.81-1.50), but became stronger in women (1.41, 1.02-1.94). CONCLUSIONS/INTERPRETATION: These data support the hypothesis that CAC is already present in the pre-diabetic state and that IFG has a modest and independent impact on the atherosclerotic process. Biological sex appears to modify the association between IFG and CAC.
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Aterosclerosis/patología , Glucemia/análisis , Calcinosis/patología , Vasos Coronarios/patología , Diabetes Mellitus Tipo 2/patología , Angiopatías Diabéticas/patología , Estado Prediabético/patología , Anciano , Presión Sanguínea , Índice de Masa Corporal , Colesterol/sangre , Ayuno , Femenino , Humanos , Estilo de Vida , Masculino , Persona de Mediana Edad , Factores de Riesgo , Caracteres SexualesRESUMEN
OBJECTIVES: Traffic-related pollution is associated with cardiovascular disease in general, but previous studies suggested that low socioeconomic status (SES) groups might be more susceptible towards a negative impact. We examined whether the association between long-term exposure to high traffic and early signs of coronary artery disease is modified by SES. METHODS: Individual-level medical and social data from a population-based study were linked with census information on neighbourhood socioeconomic characteristics. Residential exposure to traffic was defined as proximity to major roads using a geographical information system. We studied associations between high traffic and coronary artery calcification (CAC) within strata of SES to examine effect modification. Data stem from an epidemiological study in Germany including 2264 women and 2037 men (45-75 years). RESULTS: High traffic and low SES were both associated with higher amounts of calcification (>or=75th age-specific percentile). More participants with low SES lived close to major roads while stratified analyses did not indicate higher susceptibility in low SES groups. Participants with low SES and simultaneous exposure to high traffic had highest levels of CAC. For example, the prevalence of high calcification was 23.9% in better-educated men with low traffic exposure but 37.7% in lower-educated men with high traffic exposure (women: 22.0% vs 28.1%). CONCLUSIONS: High traffic exposure was associated with coronary calcification in all social groups, but as low SES individuals had higher calcification in general and were also more often exposed to traffic, existing inequalities could be further shaped by traffic exposure.
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Enfermedades Cardiovasculares/etiología , Vehículos a Motor/estadística & datos numéricos , Clase Social , Salud Urbana/estadística & datos numéricos , Emisiones de Vehículos/análisis , Anciano , Calcinosis/epidemiología , Calcinosis/etiología , Enfermedades Cardiovasculares/epidemiología , Estudios Transversales , Exposición a Riesgos Ambientales/efectos adversos , Exposición a Riesgos Ambientales/análisis , Femenino , Alemania/epidemiología , Humanos , Masculino , Persona de Mediana Edad , Áreas de Pobreza , Prevalencia , Características de la Residencia/estadística & datos numéricos , Factores Socioeconómicos , Desempleo/estadística & datos numéricos , Emisiones de Vehículos/toxicidadRESUMEN
BACKGROUND: Long-term exposure to fine-particulate-matter (PM2.5) air pollution may accelerate the development and progression of atherosclerosis. We investigated the associations of long-term residential exposure to traffic and fine particulate matter with the degree of coronary atherosclerosis. METHODS AND RESULTS: We used baseline data on 4494 participants (age 45 to 74 years) from the German Heinz Nixdorf Recall Study, a population-based, prospective cohort study that started in 2000. To assess exposure differences, distances between residences and major roads were calculated, and annual fine particulate matter concentrations, derived from a small-scale dispersion model, were assigned to each address. The main outcome was coronary artery calcification (CAC) assessed by electron-beam computed tomography. We evaluated the association between air pollution and CAC with logistic and linear regression analyses, controlling for individual level risk factors of coronary atherosclerosis. Compared with participants living >200 m away from a major road, participants living within 50, 51 to 100, and 101 to 200 m had odds ratios of 1.63 (95% CI, 1.14 to 2.33), 1.34 (95% CI, 1.00 to 1.79), and 1.08 (95% CI, 0.85 to 1.39), respectively, for a high CAC (CAC above the age- and gender-specific 75th percentile). A reduction in the distance between the residence and a major road by half was associated with a 7.0% (95% CI, 0.1 to 14.4) higher CAC. Fine particulate matter exposure was associated with CAC only in subjects who had not been working full-time for at least 5 years. CONCLUSIONS: Long-term residential exposure to high traffic is associated with the degree of coronary atherosclerosis.
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Enfermedad de la Arteria Coronaria/epidemiología , Exposición a Riesgos Ambientales , Material Particulado/efectos adversos , Características de la Residencia , Anciano , Calcinosis/diagnóstico por imagen , Calcinosis/epidemiología , Calcinosis/etiología , Estudios de Cohortes , Comorbilidad , Enfermedad de la Arteria Coronaria/diagnóstico por imagen , Enfermedad de la Arteria Coronaria/etiología , Femenino , Alemania/epidemiología , Humanos , Industrias , Masculino , Persona de Mediana Edad , Tamaño de la Partícula , Material Particulado/análisis , Estudios Prospectivos , Radiografía , Características de la Residencia/estadística & datos numéricos , Factores de Riesgo , Fumar/epidemiología , Tomografía Computarizada de Emisión , Población Urbana , Emisiones de VehículosRESUMEN
AIMS: To estimate the association between depressive symptoms and Type 2 diabetes, as well as previously undetected diabetes, in a large population-based sample in Germany and to determine associated variables. METHODS: We used baseline data on 4595 participants (age 45-75 years, 50.2% women) from the German Heinz Nixdorf Recall study, a population-based, prospective cohort study which started in 2000. Diabetes mellitus was assessed by self report (physician diagnosis or medication), undiagnosed diabetes based on blood glucose levels. Depressive symptoms were assessed using the Center for Epidemiologic Studies Depression (CES-D) scale short form (cut-off >or= 15 points). We fitted multiple logistic regression models. RESULTS: The prevalence of diagnosed and previously undetected diabetes was 9.3% (95% confidence interval 8.2-11.6) and 7.6% (6.6-8.8) in men and 6.0% (5.1-7.1) and 3.2% (2.5-4.0) in women, respectively. Compared with non-diabetic women, the prevalence of depressive symptoms was not significantly different in diabetic women (age-adjusted odds ratio, 95% confidence interval 1.48; 0.98-2.24) and women with undiagnosed diabetes (0.67; 0.33-1.36). In men, the prevalence of depressive symptoms tended to be lower in diabetic than in non-diabetic subjects (0.62; 0.35-1.09), but the depressive symptoms were significantly less frequent in men with undiagnosed diabetes (0.30; 0.13-0.70). The pattern remained after further adjustment. Significant associations with depressive symptoms were found for co-morbidities and living without a partner in both women and in men, and for body mass index and activity level in women only. CONCLUSIONS: After adjustment for relevant covariates, the association between depressive symptoms and Type 2 diabetes was heterogenous in our population-based study. In subjects with undiagnosed diabetes, however, depressive symptoms were less frequent in men. Co-morbidities and psychosocial conditions are strongly associated with depressive symptoms.
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Depresión/etiología , Diabetes Mellitus Tipo 2/psicología , Anciano , Índice de Masa Corporal , Comorbilidad , Depresión/epidemiología , Diabetes Mellitus Tipo 2/epidemiología , Métodos Epidemiológicos , Femenino , Alemania/epidemiología , Humanos , Estilo de Vida , Masculino , Persona de Mediana Edad , Distribución por SexoRESUMEN
Subclinical systemic inflammation is a hallmark of obesity and insulin resistance. The results obtained from a number of experimental studies suggest that targeting different components of the inflammatory machinery may result in the improvement of the metabolic phenotype. Unsaturated fatty acids exert antiinflammatory activity through several distinct mechanisms. Here, we tested the capacity of ω3 and ω9 fatty acids, directly from their food matrix, to exert antiinflammatory activity through the G protein-coupled receptor (GPR)120 and GPR40 pathways. GPR120 was activated in liver, skeletal muscle, and adipose tissues, reverting inflammation and insulin resistance in obese mice. Part of this action was also mediated by GPR40 on muscle, as a novel mechanism described. Pair-feeding and immunoneutralization experiments reinforced the pivotal role of GPR120 as a mediator in the response to the nutrients. The improvement in insulin sensitivity in the high-fat substituted diets was associated with a marked reduction in tissue inflammation, decreased macrophage infiltration, and increased IL-10 levels. Furthermore, improved glucose homeostasis was accompanied by the reduced expression of hepatic gluconeogenic enzymes and reduced body mass. Thus, our data indicate that GPR120 and GPR40 play a critical role as mediators of the beneficial effects of dietary unsaturated fatty acids in the context of obesity-induced insulin resistance.
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Grasas de la Dieta/farmacología , Resistencia a la Insulina , Obesidad/prevención & control , Ácido Oléico/farmacología , Ácido alfa-Linolénico/farmacología , Tejido Adiposo/efectos de los fármacos , Tejido Adiposo/metabolismo , Animales , Grasas de la Dieta/administración & dosificación , Glucosa/metabolismo , Homeostasis/efectos de los fármacos , Hipoglucemiantes/administración & dosificación , Hipoglucemiantes/farmacología , Immunoblotting , Inflamación/metabolismo , Inflamación/fisiopatología , Inflamación/prevención & control , Insulina/administración & dosificación , Insulina/farmacología , Hígado/efectos de los fármacos , Hígado/metabolismo , Masculino , Ratones Obesos , Músculo Esquelético/efectos de los fármacos , Músculo Esquelético/metabolismo , Obesidad/metabolismo , Obesidad/fisiopatología , Ácido Oléico/administración & dosificación , Interferencia de ARN , Receptores Acoplados a Proteínas G/genética , Receptores Acoplados a Proteínas G/metabolismo , Transducción de Señal/efectos de los fármacos , Aumento de Peso/efectos de los fármacos , Ácido alfa-Linolénico/administración & dosificaciónRESUMEN
In a sample of 552 respondents effects of different scale ranges and respondents' knowledge about AIDS for answering questions about AIDS-risks were examined. Knowledge was assessed with 12 items related to risks for HIV infections and preventive measures. AIDS hazards for different groups (prostitutes, fixers, hospital personnel, homosexuals, and haemophiliacs) had to be rated with five items, one for each group. Response variations were assessed in three parallel questionnaire versions with different ranges of risk assignments. Estimations had to be performed in comparison with the average population. Some groups were consistently rated to be at high risk, others were assigned low risks for becoming infected with the HIV-virus. The analysis of response patterns revealed that the three versions of numeric quantifiers determined the risk ratings only to some extent. The distribution patterns suggest that our subjects had an ordinal risk ordering in mind that might better be expressed in verbal terms. The knowledge about AIDS had no systematic effects on response behavior.
Asunto(s)
Síndrome de Inmunodeficiencia Adquirida/prevención & control , Conocimientos, Actitudes y Práctica en Salud , Síndrome de Inmunodeficiencia Adquirida/transmisión , Adulto , Femenino , Alemania , Educación en Salud , Humanos , Masculino , Riesgo , Estudiantes , Encuestas y CuestionariosRESUMEN
OBJECTIVES: As smoking and unhealthy diet are more prevalent in lower socioeconomic groups, this study aims at exploring whether associations between smoking and fruit and vegetable consumption are confounded by socioeconomic conditions or if smoking is independently associated with consumption. METHODS: Cross-sectional analyses of 4,814 middle-aged participants from the Heinz Nixdorf recall study, a population-based cohort study in Germany. Fruit and vegetable consumption was assessed by a food frequency questionnaire. Education and income were used as indicators for socioeconomic groups. Logistic regression models were run to estimate odds ratios for consumption by smoking status. RESULTS: Smoking is associated with poor consumption of fruits and raw vegetables/salad in both genders, and with poor consumption of boiled vegetables and fruit/vegetable juice in men. Importantly, poor consumption is related to smoking independently of people's socioeconomic conditions. CONCLUSION: The findings imply that smokers in all socioeconomic groups are at higher risk for unhealthy intake of fruits and vegetables. Public health interventions targeted to smokers should include dietary instructions.
Asunto(s)
Dieta/estadística & datos numéricos , Frutas , Fumar/epidemiología , Verduras , Anciano , Estudios de Cohortes , Factores de Confusión Epidemiológicos , Estudios Transversales , Femenino , Alemania , Humanos , Masculino , Persona de Mediana Edad , Factores SocioeconómicosRESUMEN
BACKGROUND: There is evidence that psychosocial factors at work influence the risk of poor health in Western societies, but little is known about the effect of work stress in the former communist countries. The aim of this paper is to compare the association of work stress with self-rated health in Western European and post-communist countries. METHODS: Data from four epidemiological studies were used: the HAPIEE study (Poland, Russia and the Czech Republic), the Hungarian Epidemiological Panel (Hungary), the Heinz Nixdorf Recall study (Germany) and the Whitehall II study (UK). The overall sample consisted of 18 494 male and female workers aged 35-65 years. RESULTS: High effort-reward imbalance at work was associated with poor self-rated health. The adjusted odds ratios for the highest versus lowest quartile of the effort-reward ratio were 3.8 (95% CI 1.9 to 7.7) in Hungary, 3.6 (95% CI 2.3 to 5.7) in the Czech Republic, 2.5 (95% CI 1.5 to 4.1) in the UK, 2.3 (95% CI 1.6 to 3.5) in Germany, 1.5 (95% CI 1.0 to 2.1) in Poland and 1.4 (95% CI 1.1 to 1.8) in Russia. The differences in odds ratios between countries were statistically significant (p<0.05). A similar pattern was observed for the effect of overcommitment on poor health. CONCLUSION: The association of effort-reward imbalance at work and of a high degree of work-related overcommitment with poor self-rated health was seen in all countries, but the size of the effects differed considerably. It does not appear that the effects in Eastern Europe are systematically stronger than in the West.