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

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

Estimation of psycholeptic and psychoanaleptic medicine use in an adult general population sample using the Anatomical Therapeutic Chemical classification.

Little is known about psycholeptic and psychoanaleptic medicine (PM) use in the general population. This study presents prevalence data about PM use. The sample included 4310 individuals aged 20-79 from a general population health examination in a northern German area (participation proportion: 68.8%; Study of Health in Pomerania, SHIP). Medicines taken during the past seven days were assessed from the medicine packages or self-reports and classified according to the Anatomical Therapeutic Chemical (ATC) classification developed by the World Health Organization. In total, 6.3% of the sample reported PM intake, 8.7% of the women and 4.7% of the men. During the past 12 months prior to the health examination, 49.2% of the individuals with PM use consulted a general practitioner but not a neurologist or a psychiatrist. Among the study participants with PM use, 88.8% had one or more mental disorders during lifetime according to a screening questionnaire. It is concluded that considerable proportions of individuals with current PM use exist although lower than may be expected on the basis of the number of individuals with mental disorder in the general population.

A short form of the Fagerström Test for Nicotine Dependence and the Heaviness of Smoking Index in two adult population samples.

Few data exist about the Fagerström Test for Nicotine Dependence (FTND) and the Heaviness of Smoking Index (HSI) from population samples. The goal was to prove to what degree (1) a reduced item solution of the FTND and (2) the HSI represent the FTND. Two randomized adult population samples were used from northern Germany. Sample 1 included 1462 and sample 2 included 1042 current daily cigarette smokers aged 20-64 years with FTND data. The results show that four items of the FTND as well as the HSI represent the FTND. It is concluded that both are valid measures of the urge to smoke and the tobacco-smoke-seeking behavior.

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.

A simulation approach to study planning for large-scale epidemiological surveys.

In study planning for large-scale epidemiological studies with multi-type examinations, important resource questions have to be answered, e.g. study horizons, personnel and other resources and cost estimates are needed. A simulation approach for scheduling that uses relevant parameters to simulate examination times gives simulation distributions that can be utilised to answer planning questions.

Prevalence of risk determinants for metformin-associated lactic acidosis and metformin utilization in the study of health in pomerania.

Risk determinants for the life threatening complication of metformin-associated lactic acidosis are frequently disregarded. Our first aim was to investigate the prevalence of risk determinants in subjects with type 2 diabetes mellitus (DM2) taking metformin compared to subjects with nonmetformin treatment. Our second aim was to estimate the proportion of subjects with alternative drug-treatment, and no risk determinants, which would probably benefit from metformin. The Study of Health in Pomerania is a population-based health survey including 322 DM2 subjects. Risk determinants were assessed by personal interview, ultrasound, and laboratory analysis. Among the subjects with DM2 n=92 (28.6%) were treated with metformin, n=162 (50.3%) with alternative medication, and n=68 (21.1%) with diet. The prevalence of at least one risk determinant was 65% [corrected] for metformin-users. There was no difference in number and type of risk determinants. Heart failure, angina pectoris, and liver disorders presented the most frequent risk determinants. Current risk determinants for metformin-associated lactic acidosis are largely disregarded. Improved selection of patients can result in safe metformin utilization in one quarter of subjects on DM2 related drug treatment. Risk determinants need to be revised. A more practical definition of risk determinants would improve prescription adherence.

[Epidemiology of hypertension in Germany. Selected results of population-representative cross-sectional studies]. / Epidemiologie der arteriellen Hypertonie in Deutschland. Ausgewählte Ergebnisse bevölkerungsrepräsentativer Querschnittstudien.

BACKGROUND AND OBJECTIVES: The mortality rate from cardiovascular disease is higher in northern than southern Germany. To illuminate this further current epidemiological data on arterial hypertension were obtained and compared with previously collected data. METHODS: The results were based on interview and measurement data of 25- to 64 year-old participants in the Study of Health in Pomerania (SHIP-0 1997 - 2001; n = 3,042), and three population-representative surveys in the region of Augsburg, Southern Germany (MONICA S2 1989/90 n = 3,966; MONICA S3 1994/95 n = 3,916; S4 1999-2001 [KORA-2000 n = 3,464]). Hypertension was defined according to the WHO/ISH guidelines as blood pressure levels of > or =140/90 mmHg or antihypertensive medication given the subjects with known hypertension. Antihypertensive medication was classified as recommended by the German Hypertension Society. RESULTS: Currently, 57 % (95 % confidence intervall [CI] 54-59 %) of men and 32 % (CI 30-35) of women in Pomerania had hypertension compared to 36 % (CI 34-38 %) and 23 % (CI 21-25 %) in KORA-2000 with some decreases since MONICA S2 und S3. Although a significantly higher prevalence was found in the north than in the south, the medical care was equally poor in both regions: 44-46 % of men and 29-31 % of women were not aware of their hypertension. Among the hypertensives, only 26-31 % of males and 44-48 % of females were being treated for hypertension, mostly with beta blockers, ACE-inhibitors, calcium antagonists, diuretics and AT(1)-antagonists, at least half being given just one of these drugs. Fewer than half of the treated hypertensives were normotensive, regardless of the antihypertensive drug group that was given. CONCLUSION: As the overall situation regarding the treatment of hypertension remains inadequate, an aggressive approach to applying the evidence-based guidelines is essential. The underlying causes of this unacceptable degree of hypertension control requires further intensive investigation.

[Health Risk drinking and problematic consumption of alcohol in Pomerania: comparative analysis of the Study of Health in Pomerania (SHIP) compared with the Federal German Health and Examination Survey in 1998]. / Riskanter Alkoholkonsum und alkoholbezogene Störungen in Vorpommern: Die Studie "Leben und Gesundheit in Vorpommern" (SHIP) und der Bundesgesundheitssurvey 1998 im Vergleich.

PURPOSE: Epidemiological studies show a "North-South" gradient in drinking patterns in Germany, with the South-Eastern regions consuming more alcohol. Hence, patterns of alcohol consumption as well as at-risk drinking were evaluated in West Pomerania using a representative sample. In addition, the average daily quantities and the proportions of at-risk drinking were compared with representative data for Germany (Federal German Health and Examination Survey 1998 [FGHES]). METHODS: A representative random sample of the Pomeranian population (4,310 persons) was analysed. The response rate was 68.8 %. The amount and frequency of alcohol consumption was surveyed with a standardized questionnaire. Prevalence rates for at- risk drinking (> or = 30 g ethanol per day for men, > or = 20 g ethanol per day for woman), indications of abuse / dependence, and episodes of heavy drinking (number of days with 5 and more drinks consumed per day) are presented. To identify socio-economic correlates of high-risk drinking multiple logistic regression modelling was used. Alcohol consumption was evaluated via a frequency-quantity-measure and by using the "Luebeck Alcohol Dependence and Abuse Screening Test" (LAST). RESULTS: Average daily consumption of pure alcohol was about 11.8 g per day, 18.5 g per day for men and 5.8 g per day for women. The consumed quantities exceeded the levels calculated with the FGHES about 1.5 g, 1.8 g for men and 1.2 g for women. Prevalence of risk drinking and harmful alcohol use in Pomerania is higher than the FGHES as well. At-risk drinking was especially associated with age. In women, belonging to a higher social class at-risk drinking was higher, whereas in men of the lower social class consumption rates were higher. The highest alcohol consumption was observed among middle-aged men and women. CONCLUSIONS: The results suggest that alcohol consumption on a high level as well as high-risk drinking is a common phenomenon in the north-eastern part of Germany. Public health measures are indicated for this region. Such intervention projects should focus on population groups with higher alcohol intake.

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.

[Medical services utilisation: which role does social support play?--Results from the Study of Health in Pomerania (SHIP)]. / Inanspruchnahme medizinischer Leistungen: Welche Rolle spielt die soziale Unterstützung? - Ergebnisse der Study of Health in Pomerania (SHIP).

AIMS: This study examined the role of social support in relation to the use of medical services in a north-eastern German population. METHODS: A representative random sample of the Pomeranian population (4,310 persons) was analysed. The response rate was 68.8 %. Bivariate and multivariate associations between socio-economic variables, need (evaluated and perceived health status), social support and the number of consultations (general practitioners or internists) were assessed. The SF-12 and the MOS social support survey were used as standardised instruments. RESULTS: Social supports showed no main effects on utilisation rates. Individuals living in a partnership showed lower levels of utilisation (median: 4.3 vs. 6.2). The combination of high morbidity and low social support or no partnership results in an increase in medical services utilisation. CONCLUSIONS: Social support treatments that target an appropriate use of the health care system can be a cost-effective measure in chronically ill patients.