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

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

Prospective Study of Serum 25-hydroxy Vitamin D and Tooth Loss.

Vitamin D deficiency and oral diseases (periodontitis, caries, and tooth loss) are highly prevalent in Germany. Previous studies suggested that vitamin D might be a modifiable and protective factor for periodontitis, caries, and tooth loss. However, prospective studies investigating such associations are limited. We explored the association between the concentration of serum 25-hydroxy vitamin D (25OHD) and incidence of tooth loss, progression of clinical attachment loss (CAL) ≥ 3 mm, and progression of restorative and caries status in a population-based longitudinal study. We analyzed data from 1,904 participants from the Study of Health in Pomerania with a five-year follow-up. Generalized estimating equation models were applied to evaluate tooth-specific associations between serum 25OHD and incidence of tooth loss, progression of CAL ≥ 3 mm, and progression of restorative and caries status. Age, sex, education, smoking status, alcohol drinking, waist circumference, dental visit frequency, reasons of dental visit, vitamin D or calcium supplements, and season of blood draw were considered as confounders. Serum 25OHD was inversely associated with incidence of tooth loss. A significant dose-response relationship (p = .0022) was observed across the quintiles of serum 25OHD. After adjusting for multiple confounders, each 10-µg/L increase of serum 25OHD was associated with a 13% decreased risk of tooth loss (risk ratio: 0.87; 95% confidence interval: 0.79, 0.96). The association was attenuated for changes of CAL ≥ 3 mm when adjusting for multiple confounders. No significant association was found between serum 25OHD and caries progression. Vitamin D might be a protective factor for tooth loss. The effect might partially be mediated by its effect on periodontitis.

Use of complementary medicinal therapies in West Pomerania: a population-based study.

OBJECTIVES: Prior studies suggested a high prevalence of complementary and alternative medicine (CAM) in Germany. The objectives of this study were (1) to describe in more detail the utilization of CAM, (2) to compare characteristics between CAM users and non-users, and (3) to delineate information on source of prescription and insurance coverage of 14 specific CAM therapies. METHODS: We extracted information derived from a computer-aided personal interview on the use of CAM, medical history, behavioral, and sociodemographic characteristics, all of which were generated by the Study of Health in Pomerania (formerly part of East Germany), a cross-sectional population-based survey. We analyzed data from 4291 individuals aged 20-79 years. RESULTS: Use of any CAM within the previous year was reported by 6.0% of the population. The modality used most widely among CAM users was active and passive exercise therapy (including various massage therapies). CAM users, when compared to non-users, were more likely to be female, experienced more years of education, were more physically active, less often overweight, reported a lower self-rated physical health status, and were more likely to visit an outpatient facility during the last year. There were higher proportions of several chronic diseases in CAM users than non-users. The results of this survey suggest that CAM therapies were most often utilized to alleviate pain. Most CAM therapies were prescribed by a physician. Reimbursement schemes were complex and differed according to therapy. CONCLUSIONS: The low estimate of CAM use might be explained by specific characteristics of the study region, including changes after the German reunification. CAM users and non-users differ with respect to several behavioral, sociodemographic and medical characteristics.

Gynaecological health care utilization and use of sex hormones--the study of Health in Pomerania.

BACKGROUND: In Germany, there is a lack of population-based data related to the use of gynaecological health care services. The objectives of our analyses utilizing a population-based cross-sectional survey conducted in one geographically defined area [Study of Health in Pomerania (SHIP)] are to assess the prevalences of: (i) attendance of gynaecological outpatient facilities and of (cervical) cancer screening; (ii) gynaecological and breast surgery; (iii) use of oral contraceptives (OC) and menopausal hormone therapy (MHT). METHODS: We analysed socio-demographic factors, reproductive history, gynaecological service utilization, and use of sex hormones in 2186 women aged 20-79 years. We used standard statistics and sex- and age group-specific weighting factors to reflect characteristics of the population of Western Pomerania. RESULTS: Approximately 43% of women reported surgical procedures. Participation in cancer screening at least once was reported by 78% of women (lifetime prevalence). Two-thirds of women stated ever use of OC, 28% (aged >40 years) ever use of MHT. CONCLUSIONS: Women in Western Pomerania reported a high life-time use of both OC and MHT. The use of cervical cancer screening exceeded the national average. Women had an almost 50% risk of undergoing gynaecological, breast or obstetric surgery. The high use of MHT and surgical procedures calls for efforts regarding continuing medical education and health care policy actions.