Are there associations between hip geometry and bone quality? An analysis on 3074 adults from a general population.

INTRODUCTION: Patients with reduced bone mineral density and altered hip geometry are susceptible for hip pathologies. Knowledge on associations between bone properties and hip geometric parameters might facilitate identification of patients at risk for hip pathologies. The aim of the present study was to identify associations of bone properties assessed by quantitative ultrasound (QUS) at the heel and hip geometric parameters like center-edge angle (CE), neck-shaft angle (NSA) and alpha angle. MATERIALS AND METHODS: Hip geometric parameters (CE, NSA and alpha angle) of 3074 participants from the population-based Study of Health in Pomerania were assessed on magnetic resonance imaging. QUS was performed on both calcanei providing broadband ultrasound attenuation (BUA), speed of sound (SOS) and stiffness-index. Based on the stiffness-index the individual osteoporotic fracture risk (low, moderate or high) was determined. Associations between QUS-based and hip geometric parameters were calculated in linear regression models adjusted for age, sex, body height and weight. Interactions of QUS markers with age and sex on hip geometric parameters were tested. RESULTS: Significant inverse associations between BUA (ß = - 0.068), SOS (ß = - 0.024) as well as stiffness-index (ß = - 0.056) and CE were present, while fracture risk was positively associated with CE (ß for high = 1.28 and moderate = 2.54 vs. low fracture risk). Interactions between BUA and sex as well as between SOS and age were detected in the models for CE. Furthermore, there was an inverse relation between fracture risk and NSA that was restricted to the moderate risk (ß for moderate vs. low fracture risk = - 0.60). There were no significant associations between QUS parameters and alpha angle. CONCLUSIONS: In the general population, several associations between QUS-based bone properties or fracture risk and hip geometry are present. Less dysplastic hips had a lower stiffness-index and a higher fracture risk, whereas more valgus hips had a lower fracture risk.

Regional and temporal differences in the associations between cardiovascular disease and its classic risk factors: an analysis of 49 cohorts from 11 European countries.

AIMS: The regional and temporal differences in the associations between cardiovascular disease (CVD) and its classic risk factors are unknown. The current study examined these associations in different European regions over a 30-year period. METHODS AND RESULTS: The study sample comprised 553 818 individuals from 49 cohorts in 11 European countries (baseline: 1982-2012) who were followed up for a maximum of 10 years. Risk factors [sex, smoking, diabetes, non-HDL cholesterol, systolic blood pressure (BP), and body mass index (BMI)] and CVD events (coronary heart disease or stroke) were harmonized across cohorts. Risk factor-outcome associations were analysed using multivariable-adjusted Cox regression models, and differences in associations were assessed using meta-regression. The differences in the risk factor-CVD associations between central Europe, northern Europe, southern Europe, and the UK were generally small. Men had a slightly higher hazard ratio (HR) in southern Europe (P = 0.043 for overall difference), and those with diabetes had a slightly lower HR in central Europe (P = 0.022 for overall difference) compared with the other regions. Of the six CVD risk factors, minor HR decreases per decade were observed for non-HDL cholesterol [7% per mmol/L; 95% confidence interval (CI), 3-10%] and systolic BP (4% per 20 mmHg; 95% CI, 1-8%), while a minor HR increase per decade was observed for BMI (7% per 10 kg/m2; 95% CI, 1-13%). CONCLUSION: The results demonstrate that all classic CVD risk factors are still relevant in Europe, irrespective of regional area. Preventive strategies should focus on risk factors with the greatest population attributable risk.

All classic cardiovascular disease (CVD) risk factors are still relevant in Europe, irrespective of regional area. The differences in the associations of CVD risk factors with overt CVD between regions of Europe are generally small. Minor temporal hazard decreases were observed for non-HDL cholesterol and systolic blood pressure, while a minor hazard increase was observed for body mass index.

Reference values and influencing factors of the glenohumeral subluxation index: a study on 3004 participants.

BACKGROUND: The primary objective of this study was to examine the glenohumeral subluxation index (GHSI) in a large general population cohort and to define reference values. Glenohumeral subluxation is important in the development and prediction of pathological states of the shoulder joint and in total shoulder arthroplasty. Therefore, another objective was to examine the influence of age, sex, body mass index, and body height and weight on GHSI. METHODS: GHSI according to Walch was measured on bilateral magnetic resonance imaging of 3004 participants of the Study of Health in Pomerania (SHIP, aged 21-90 years). SHIP drew a sample of the adult general population of Pomerania (Northeastern Germany). Reference values for GHSI were assessed by quantile regression models. Associations of sex, age, and anthropometric markers with the GHSI were calculated by linear regression models. RESULTS: A reference range between 42% and 55% for men with a mean of 49% ± 4% was defined, while the upper reference limit for women was 1% higher (mean, 50% ± 4%). Age was inversely associated with the GHSI in males (P < 0.001), while no significant association in females was observed (P = .625). Body weight and body mass index were positively associated (P < .001) without effect modification by sex. Heavy mechanical oscillations on the upper extremity showed no significant association with GHSI (P = .268). CONCLUSION: The reference values for GHSI were expanded to a range of 42%-57% on magnetic resonance imaging. Several associations between GHSI and anthropometric properties are present. According to these associations, adjusted formulas are provided to enable individual, patient-specific diagnostics and therapy. Nevertheless, the clinical picture cannot be neglected.

Monitoring and management of chronic kidney disease in ambulatory care - analysis of clinical and claims data from a population-based study.

BACKGROUND: Although chronic kidney disease (CKD) is highly prevalent in the general population, little research has been conducted on CKD management in ambulatory care. Objective was to assess management and quality of care by evaluating CKD coding in ambulatory care, patient diagnosis awareness, frequency of monitoring and whether appropriate patients are referred to nephrology. METHODS: Clinical data from the population-based cohort Study of Health in Pomerania (SHIP-START) were matched with claims data of the Association of Statutory Health Insurance Physicians. Quality of care was evaluated according international and German recommendations. RESULTS: Data from 1778 participants (56% female, mean age 59 years) were analysed. 10% had eGFR < 60 ml/min/1.73m2 (mean age 74 years), 15% had albuminuria. 21% had CKD as defined by KDIGO. 20% of these were coded and 7% self-reported having CKD. Coding increased with GFR stage (G3a 20%, G3b 61%, G4 75%, G5 100%). Serum creatinine and urinary dip stick testing were billed in the majority of all participants regardless of renal function. Testing frequency partially surpassed recommendations. Nephrology consultation was billed in few cases with stage G3b-G4. CONCLUSION: CKD coding increased with stage and was performed reliably in stages ≥ G4, while CKD awareness was low. Adherence to monitoring and referral criteria varied, depending on the applicability of monitoring criteria. For assessing quality of care, consent on monitoring, patient education, referral criteria and coordination of care needs to be established, accounting for patient related factors, including age and comorbidity. TRIAL REGISTRATION: This study was prospectively registered as DRKS00009812 in the German Clinical Trials Register (DRKS).

The effects of incidental findings from whole-body MRI on the frequency of biopsies and detected malignancies or benign conditions in a general population cohort study.

Magnetic resonance imaging (MRI) yields numerous tumor-related incidental findings (IFs) which may trigger diagnostics such as biopsies. To clarify these effects, we studied how whole-body MRI IF disclosure in a population-based cohort affected biopsy frequency and the detection of malignancies. Laboratory disclosures were also assessed. Data from 6753 participants in the Study of Health in Pomerania (SHIP) examined between 2008 and 2012 were utilized. All underwent laboratory examinations and 3371 (49.9%) a whole-body MRI. Electronic biopsy reports from 2002 to 2017 were linked to participants and assigned to outcome categories. Biopsy frequency 2 years pre- and post-SHIP was investigated using generalized estimating equations with a negative-binomial distribution. Overall 8208 IFs (laboratory findings outside reference limits: 6839; MRI: 1369) were disclosed to 4707 participants; 2271 biopsy reports belonged to 1200 participants (17.8%). Of these, 938 biopsies occurred pre-SHIP; 1333 post-SHIP (event rate/100 observation years = 6.9 [95% CI 6.5; 7.4]; 9.9 [9.3; 10.4]). Age, cancer history, recent hospitalization, female sex, and IF disclosure were associated with higher biopsy rates. Nonmalignant biopsy results increased more in participants with disclosures (post-/pre-SHIP rate ratio 1.39 [95% CI 1.22; 1.58]) than without (1.09 [95% CI 0.85; 1.38]). Malignant biopsy results were more frequent post-SHIP (rate ratio 1.74 [95% CI 1.27; 2.42]). Biopsies increased after participation in a population-based cohort study with MRI and laboratory IF disclosure. Most biopsies resulted in no findings and few malignancies were diagnosed, indicating potential overtesting and overdiagnosis. A more restrictive policy regarding IF disclosure from research findings is required.

Recall accuracy of notifications about incidental findings from an MRI examination: results from a population-based study.

BACKGROUND: Self-reports of medical findings are indispensable in clinical practice and research but subject to recall bias. We analysed the recall accuracy of notifications about incidental findings (IFs) from a whole-body MRI examination and assessed determinants of recall error. METHODS: Data from 3746 participants of a postal follow-up survey conducted on average 2.47 years after examination in the population-based Study of Health in Pomerania were analysed. Among those, 2185 (58.3%) underwent whole-body MRI at baseline, and findings of potential clinical relevance were disclosed in standardised postal letters. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were calculated to determine the accuracy of self-reports. Poisson regression analysis was conducted to analyse predictors for false-positive and false-negative recall. RESULTS: An IF was disclosed to 622 (28.5%) individuals; 81.5% had tumour relevance. The overall sensitivity and PPV of participants' self-reports were 80% and 60%, respectively. PPvs were higher among women, better educated and married participants and among those with good verbal memory. Among MRI participants, lower educational level was associated with a higher risk of false-positive recall (risk ratio (RR) 1.44, 95% CI 1.01 to 2.03), while increasing age was associated with a higher risk of false-negative recall (RR 1.64, 95% CI 1.33 to 2.01). CONCLUSIONS: Most participants correctly recalled disclosed IFs. However, the probability of an event in case of a positive recall is barely above 50%. Therefore, relying on subjects' recall of disclosed IFs will lead to a relevant proportion of errors. Clinicians and researchers should be aware of this problem and of participants' characteristics which may moderate the probability of correct decisions based on recalled findings.

Associations between shift work and risk of colorectal cancer in two German cohort studies.

The association between shift work and the risk of colorectal cancer (CRC) is still unclear. Therefore, we studied the associations between exposure to shift or night work and incident CRC in two German population-based cohort studies, the Heinz Nixdorf Recall Study (HNR) and the Study of Health in Pomerania (SHIP). Including up to 6,903 participants, we analyzed the cohorts pooled and individually. We estimated incidence rate ratios (IRRs) with adjusted log-linear Poisson regression models with the natural logarithm of person-years as offset and performed subgroup analyses by sex and tumor localization in HNR. The pooled analysis revealed no increased risks for men working in night shifts (IRR: 1.03, 95% CI: 0.62; 1.71). In male HNR participants, we found an increased risk estimate for cancer of the distal colon in shift workers (IRR: 1.60, 95% CI: 0.53; 4.87) and in shift workers who did not perform night work (IRR: 3.93, 95% CI: 0.98; 15.70), but not in night workers. In SHIP, we observed elevated CRC risk estimates for rotating shift work including night work (IRR: 1.45, 95% CI: 0.72; 2.92) and for long-term exposure (IRR: 1.79, 95% CI: 0.81; 3.92) for men. In conclusion, night-shift work was not associated with CRC, although an increased risk was suggested for rotating shift work including nights in SHIP. The heterogeneity of shift-work jobs and schedules and associated lifestyle factors should be taken into account to disentangle a possible relationship between shift work and the risk for CRC in future investigations.

[Effect of ambulatory geriatric rehabilitation on polypharmacy and potentially inappropriate medication-an observational study]. / Effekt der ambulanten geriatrischen Komplexbehandlung auf Polypharmazie und potenziell inadäquate Arzneimittel ­ eine Beobachtungsstudie.

BACKGROUND: Ambulatory geriatric rehabilitation (AGR) is a prevention program for multimorbid patients with the contractual agreement to prevent the need for care and hospital admissions and to promote self-sufficiency. It provides an opportunity to reduce the prevalence of polypharmacy and to discontinue potentially inadequate medication (PIM). AIM: The study investigated the effect of AGR on the number of drugs and PIM. MATERIAL AND METHODS: The observational longitudinal study was based on claims data from the statutory health insurance AOK Nordost. A comparison of the prescribed drugs with the PRISCUS list was performed. The study investigated the effect of AGR on the number of drugs prescribed and PIM in the period of two quarterly periods before and two quarterly periods after AGR. The numbers of prescribed statins, opioids, antidementia drugs, proton pump inhibitors and antidepressants were assessed and grouped into further prescriptions, new prescriptions and discontinued drug prescriptions. RESULTS: Out of 699 participants 682 (73% women, mean age 79 years, SD ± 5 years) were analyzed. The number of substances and PIM remained at the same levels after AGR. Psycholeptic, antiphlogistic and psychoanaleptic drugs were the most frequently prescribed PIM. The majority of statins, opioids, antidementia drugs, proton pump inhibitors and antidepressants were prescribed further. Antidementia drugs were the medication with the most newly started prescriptions. CONCLUSION: The AGR has no influence on the number of prescribed drugs and PIM. A structured drug review and a conversation with the general practitioner should be strengthened to improve drug safety and reduce polypharmacy as well as undertreatment.

Prevalence of benign osseous lesions of the spine and association with spinal pain in the general population in whole body MRI.

BACKGROUND: Benign osseous lesions of the spine are common but precise population prevalence estimates are lacking. Our study aimed to provide the first population-based prevalence estimates and examine association with back and neck pain. MATERIALS AND METHODS: We used data from the population-based Study of Health in Pomerania (SHIP). Whole-body MRI examinations (1.5 Tesla: T1, T2, and TIRM weightings) were available from 3,259 participants. Readings of the spinal MRI images were conducted according to a standardized protocol by a single reader (JS). The intra-rater reliability was greater than Kappa values of 0.98. Pain measures included the seven-day prevalence of spine pain and neck pain, and average spine pain intensity due to spine pain during the past three months. RESULTS: We found 1,200 (36.8%) participants with at least one osseous lesion (2,080 lesions in total). Osseous lesions were less common in men than in women (35.5% vs 38.9%; P = .06). The prevalence of osseous lesions was highest at L2 in both sexes. The prevalence of osseous lesions increased with age. Up to eight osseous lesions were observed in a single subject. Hemangioma (28%), and lipoma (13%) occurred most often. Sclerosis (1.7%), aneurysmal bone cysts (0.7%), and blastoma (0.3%) were rare. Different osseous lesions occurred more often in combination with each other. The association with back or neck pain was mostly negligible. CONCLUSION: Osseous lesions are common in the general population but of no clinical relevance for spinal pain. The prevalence of osseous lesions varied strongly across different regions of the spine and was also associated with age and gender. Our population-based data offer new insights and assist in judging the relevance of osseous lesions observed on MRIs of patients.

Prospective associations of androgens and sex hormone-binding globulin with 12-month, lifetime and incident anxiety and depressive disorders in men and women from the general population.

BACKGROUND: Findings on associations of androgens and sex hormone-binding globulin (SHBG) with anxiety and depressive disorders in the general population remain inconclusive. METHODS: We used data of n = 993 men and n = 980 women from the Study of Health in Pomerania (SHIP, a prospective-longitudinal general population study from northeastern Germany). Immunoassay-measured serum concentrations of total testosterone, androstenedione and SHBG were assessed when participants were aged 20-80. 12-month, lifetime and incident DSM-IV anxiety and depressive disorders were assessed with the DIA-X/M-CIDI at 10-year follow-up, when participants were aged 29-89. Logistic regressions were adjusted for age, smoking, alcohol consumption, physical activity, waist circumference, hypertension and oral contraceptive use (women only) at baseline and follow-up interval. RESULTS: In men and women, androgens and SHBG were not associated significantly with incident anxiety and depressive disorders. In men, higher total testosterone predicted any 12-month (OR = 1.46) and lifetime (OR = 1.34) anxiety disorder, lifetime social phobia (OR = 2.15), and 12-month (OR = 1.48) and lifetime (OR = 1.39) specific phobia, but neither 12-month nor lifetime depression. Moreover, androstenedione in men interacted with age in predicting lifetime anxiety disorders (OR = 0.98): Higher androstenedione more strongly predicted lifetime anxiety in younger vs. older men. These findings, however, did not survive correction for multiple testing. In women, androgens and SHBG were not associated significantly with 12-month and lifetime anxiety and depressive disorders. LIMITATIONS: The follow-up period was relatively long and other factors might have affected the examined associations. CONCLUSIONS: Higher serum total testosterone in men and androstenedione in younger men may relate to an increased risk of anxiety disorders.

[Prevalence of Cardiovascular Risk Factors at The Population Level: A Comparison of Ambulatory Physician-Coded Claims Data With Clinical Data From A Population-Based Study]. / Untersuchung der Prävalenz kardiologischer Risikofaktoren in der Allgemeinbevölkerung: Ein Vergleich ambulanter ärztlicher Abrechnungsdaten mit Daten einer populationsbasierten Studie.

OBJECTIVE: The study assesses the validity of ICD-10 coded cardiovascular risk factors in claims data using gold-standard measurements from a population-based study for arterial hypertension, diabetes, dyslipidemia, smoking and obesity as a reference. METHODS: Data of 1941 participants (46 % male, mean age 58±13 years) of the Study of Health in Pomerania (SHIP) were linked to electronic medical records from the regional association of statutory health insurance physicians from 2008 to 2012 used for billing purposes. Clinical data from SHIP was used as a gold standard to assess the agreement with claims data for ICD-10 codes I10.- (arterial hypertension), E10.- to E14.- (diabetes mellitus), E78.- (dyslipidemia), F17.- (smoking) and E65.- to E68.- (obesity). RESULTS: A higher agreement between ICD-coded and clinical diagnosis was found for diabetes (sensitivity (sens) 84%, specificity (spec) 95%, positive predictive value (ppv) 80%) and hypertension (sens 72%, spec 93%, ppv 97%) and a low level of agreement for smoking (sens 18%, spec 99%, ppv 89%), obesity (sens 22%, spec 99%, ppv 99%) and dyslipidemia (sens 40%, spec 60%, ppv 70%). Depending on the investigated cardiovascular risk factor, medication, documented additional cardiovascular co-morbidities, age, sex and clinical severity were associated with the ICD-coded cardiovascular risk factor. CONCLUSION: The quality of ICD-coding in ambulatory care is highly variable for different cardiovascular risk factors and outcomes. Diagnoses were generally undercoded, but those relevant for billing were coded more frequently. Our results can be used to quantify errors in population-based estimates of prevalence based on claims data for the investigated cardiovascular risk factors.

What Are the Reference Values and Associated Factors for Center-edge Angle and Alpha Angle? A Population-based Study.

BACKGROUND: The available evidence regarding normal ranges for the center-edge angle and the alpha angle derives from a few small studies, and associated factors such as sex and anthropometric factors have not been well evaluated. Knowing more about normal values for these parameters is critical, because this can inform decisions about when to perform elective hip preservation surgery. Population-level studies would provide considerable clarity on these issues, but to our knowledge, no such studies are available. QUESTIONS/PURPOSES: The purposes of this study were (1) to use MRI in patients of a population-based study to establish normal values for the alpha and center-edge angles in the normal adult hip; and (2) to determine whether age, sex, or anthropometric variables were associated with differences in these values. METHODS: We used MRI images (1.5 T) of 3226 participants of the Study of Health in Pomerania (SHIP). SHIP is a population-based study that started with 4308 participants in 1997. Participants were recruited randomly from official inhabitant data files as a stratified cluster sample of the population from a defined region in northeastern Germany. To ensure a representative epidemiologic cohort, stratification variables were sex, age, and city of residence. Between 2008 and 2012, 1094 of these participants underwent whole-body MRI with pelvic sequences in the second followup. In parallel, the next cohort, SHIP-Trend, started with the same protocol in which 2132 participants underwent MRI examination. Reference values were calculated by quantile regressions for the 2.5 and 97.5 percentiles. Associations with the demographic features sex, age, weight, height, body mass index (BMI), and waist circumference were analyzed by bivariate linear regression models. RESULTS: The mean center-edge angle was 31° (± 7°) with a corresponding calculated normal range of 17° to 45°. The mean alpha angle was 55° (± 8°) with a corresponding calculated normal range between 39° and 71°. Men (30° ± 7°) had a lower center-edge angle than women (32° ± 8°) (p < 0.001, ß = 1.4°; 95% confidence interval [CI], 0.9°-1.9°) and a higher alpha angle (57° ± 8° versus 52° ± 7°, p < 0.001, ß = 5.7°; 95% CI, 5.2°-6.3°). Moreover, a higher center-edge angle for the left side was found (33° ± 8° versus 30° ± 8°, p < 0.001, ß =3.2°; 95% CI, 3.0°-3.4°). In addition to sex, we found that age, height, waist circumference, and BMI affected both center-edge angle and alpha angle. Weight was associated with the alpha angle as well. Because of these associations, age- and sex-adjusted reference values with belonging formulas were calculated. CONCLUSIONS: The range of normal center-edge and alpha angles is quite wide. Therefore, only markedly abnormal angles may be associated with pathology. Moreover, center-edge angle and alpha angle are associated with age, sex, and anthropometric factors, which have to be taken into account for better interpretation. CLINICAL RELEVANCE: The association of abnormal radiographic values with true clinical hip pathology is tenuous at best. Assuming that a patient with an abnormal radiograph requires treatment is unwise. The clinical picture has to be substantial for therapeutic decisions.

[Cancer screening in the elderly: Explorative mixed methods study]. / Krebsfrüherkennungsuntersuchungen im hohen Alter: Explorative "Mixed-methods"-Studie.

BACKGROUND: The benefits of cancer screening in the elderly are uncertain. While the risk of cancer increases with age the participation in cancer screening decreases. AIM: The study investigated the attitudes of older adults towards cancer screening as well as their motives for or against participation. MATERIAL AND METHODS: This population-based explorative mixed methods study was based on a survey of residents aged 69-89 years from the district of Western Pomerania-Greifswald (northeast Germany). Criteria for exclusion were cognitive deficits and/or cancer. Attitudes towards different statements regarding cancer screening were assessed by a questionnaire using 5-point Likert scales. Semi-structured interviews were used to explore the motivations. RESULTS: Out of 630 contacted residents, 120 (19%) with an average age of 77 years (SD ± 6 years) participated in the face-to-face survey. The majority were in favor of lifelong cancer screening, 14% stated other health problems to be more important than cancer screening and 7% assumed that they would not live long enough to benefit from screening. Motives for participation in cancer screening were habit, regularity, sense of obligation, fear and belief in benefits. Motives for discontinuing screening included a lack of interest, no assumed necessity and fear. Disadvantages were not feared. CONCLUSION: Elderly people show great trust in cancer screening. They overestimated the benefits of cancer screening and their risk to die of cancer. The elderly should be better informed about the benefits and risks of cancer screening. Shared decision-making should be based on life expectancy and personal preferences.

Prevalence trends in lifestyle-related risk factors.

BACKGROUND: The regional prevalence of risk factors can vary over time. The Study of Health in Pomerania (SHIP) addresses prevalence trends for common risk factors in a region in northeast Germany. METHODS: A longitudinal study was carried out from 1997 to 2001 (SHIP-0, with 4308 subjects), and a second, independent random sample of the population in the same region was studied from 2008 to 2012 (SHIP-Trend, with 4420 subjects). All data were standardized with post-stratification weighting derived from the adult population of the state of Mecklenburg-West Pomerania. RESULTS: SHIP reveals a marked decline of mean alcohol consumption in the adult population, from 5.57 g/day (95% confidence interval, 5.51-5.63) to 3.12 g/day (95% CI 3.09-3.15). The percentage of active smokers among men declined from 38.6% (95% CI 36.0-41.2) to 34.3% (95% CI 32.1-36.6). Simultaneously, however, there was a rightward shift of the BMI distribution, with a marked increase in the prevalence of obesity, from 24.7% to 32.0%. There was a corresponding increase in the prevalence of diabetes, from 9.1% to 13.8%. Compared to eleven years ago, the amount of exercise taken during free time has risen among the elderly, but fallen among young women. CONCLUSION: Tobacco and alcohol consumption have declined over the past decade, although this study may have overestimated these trends through a combination of selection bias and reporting bias. Meanwhile, the northeast German population now has a worse metabolic risk profile, as indicated by the increased prevalence of obesity and diabetes. Society as a whole must take measures to combat this trend.

[The lifetime prevalence of mental disorders in north-eastern Germany. What is the influence of earlier mental morbidity on survey participation and prevalence estimates? Results from the SHIP-study]. / Die Lebenszeitprävalenz psychischer Störungen in Vorpommern. Welchen Einfluss haben frühere psychische Auffälligkeiten auf die Survey-Teilnahme und Prävalenzschätzungen? Ergebnisse der SHIP-Studie.

OBJECTIVE: This work addresses the life-time-prevalence of mental disorders in the adult general population in a German region (Vorpommern). We address effects of attrition on prevalence estimates. METHODS: Analyses are based on a general population cohort study (29 - 89 years, Study of Health in Pomerania, N = 2400), using the M-CIDI to obtain life-time diagnoses of mental disorders according to ICD-10. Statistical weights were used to assess the effects of selective non-response on prevalence estimates related to baseline physical and psychological morbidity and sociodemographic variables, measured 10 years before. RESULTS: In total 44.6 % of the male and 55.2 % of the female participants fulfilled criteria for at least one ICD mental disorder including specific phobias and tobacco dependence. Physical but not psychological baseline morbidity showed relevant associations to participation in the psychological examination ten years later. Weighted and unweighted prevalence estimates for mental disorders were very similar. CONCLUSION: Our results illustrate the high burden due to mental disorders. Most prevalence estimates seem robust to prior mental comorbidities.

Psoriasis is associated with increased intima-media thickness--the Study of Health in Pomerania (SHIP).

BACKGROUND: Psoriasis has been associated with cardiovascular diseases, but its relationship to markers of subclinical atherosclerosis has not been fully elucidated. The aim of the study is to analyze the association of psoriasis with common carotid artery intima-media thickness (CCA-IMT) and plaque prevalence of the carotid arteries. METHODS: Data of 1987 men and women aged 25-88 years from the population-based Study of Health in Pomerania (SHIP) in north-eastern Germany were used. Cross-sectional associations of psoriasis with IMT and carotid plaque prevalence were analyzed using linear and logistic regression models adjusted for relevant confounders (age, sex, smoking, alcohol consumption, waist circumference, physical activity, systolic blood pressure, anti-hypertensive medication, acetylsalicylic acid, HbA(1c), total/HDL cholesterol ratio, lipid-lowering medication). RESULTS: Psoriasis was associated with mean CCA-IMT, but not with carotid plaque prevalence. Comparisons between subjects with and without psoriasis showed an adjusted mean difference of the CCA-IMT of 0.016 mm (95% confidence interval [CI]: 0.004 mm-0.028 mm, p < 0.01) and an odds ratio for plaque prevalence of 1.12 (95% CI: 0.85-1.47) after adjusting for confounders. CONCLUSION: Our findings suggest that psoriasis is associated with increased carotid mean IMT and might therefore contribute to the atherosclerotic process and subsequent cardiovascular events.

[A brief instrument for the assessment of childhood abuse and neglect: the childhood trauma screener (CTS)]. / Ein Screeninginstrument für Missbrauch und Vernachlässigung in der Kindheit: der Childhood Trauma Screener (CTS).

OBJECTIVE: There is a lack of a psychometrically sound screening questionnaire that assesses important dimensions of traumatic experiences during childhood and adolescence in a time-efficient way. Based on the German version of the "Childhood Trauma Questionnaire" (CTQ, 28 items) we developed a five-item self-report childhood trauma screener (CTS) that covers sexual, emotional and physical abuse and emotional and physical neglect. METHOD: The data set of the SHIP-LEGEND study (n = 1668) was used to extract five items of the CTQ that optimally covered the five dimensions and showed a high correlation with the total score. In two validation samples (clinical sample [n = 211] and subjects from the BiDirect study [n = 288]) the psychometric properties of the CTS were evaluated. RESULTS: The correlations between the five CTS Items and the corresponding dimensions from the CTQ were r = 0.55 to 0.87 (p < 0.0001) within the clinical sample. Furthermore, we found high correlations (r = 0.88; p < 0.0001) with the total CTQ score. The internal consistency was 0.757 (Cronbachs α). CONCLUSION: The CTS is a reliable, valid and economic screener for the retrospective assessment of adverse childhood experiences especially in large epidemiological studies.

Assessing a risk tailored intervention to prevent disabling low back pain--protocol of a cluster randomized controlled trial.

BACKGROUND: Although most patients with low back pain (LBP) recover within a few weeks a significant proportion has recurrent episodes or will develop chronic low back pain. Several mainly psychosocial risk factors for developing chronic LBP have been identified. However, effects of preventive interventions aiming at behavioural risk factors and unfavourable cognitions have yielded inconsistent results. Risk tailored interventions may provide a cost efficient and effective means to take systematic account of the individual risk factors but evidence is lacking. METHODS/DESIGN: This study will be a cluster-randomised controlled trial comparing screening and a subsequent risk tailored intervention for patients with low back pain to prevent chronic low back pain compared to treatment as usual in primary care. A total of 600 patients from 20 practices in each study arm will be recruited in Berlin and Goettingen. The intervention comprises the following elements: Patients will be assigned to one of four risk groups based on a screening questionnaire. Subsequently they receive an educational intervention including information and counselling tailored to the risk group. A telephone/email consulting service for back pain related problems are offered independent of risk group assignment. The primary outcomes will be functional capacity and sick leave. DISCUSSION: This trial will evaluate the effectiveness of screening for risk factors for chronic low back pain followed by a risk tailored intervention to prevent chronic low back pain. This trial will contribute new evidence regarding the flexible use of individual physical and psychosocial risk factors in general practice. TRIAL REGISTRATION: ISRCTN 68205910.