Post-COVID syndrome and work ability 9-12 months after a SARS-CoV-2 infection among over 9000 employees from the general population.

Objectives: Evidence on the work-related societal impact of long-term health-related consequences following SARS-CoV-2 is emerging. We characterize the modified work ability index (mWAI) of employees 6 to 12 months after an acute infection compared to pre-infection. Methods: Analyses were based on a population-based, multi-center cross-sectional study including employees aged 18-65 years with positive SARS-CoV-2 polymerase chain reaction (tested between October 2020-April 2021 in defined geographic regions in Germany). Prevalences and results of adjusted logistic regression analyses were given. Results: In 9752 employees (mean age 45.6 years, 58% females, response 24%), n = 1217 (13.1%) participants were regarded as having low mWAI compared to pre-infection. Outpatient medical treatment, inpatient treatment, and admission to intensive care during infection were associated with mWAI <15th percentile (P15, each odds ratio [OR] >3.0). Post-COVID symptom clusters most strongly linked to mWAI

Pre- and early postpartum psychosocial stress trajectories in mothers and child body mass index at 3 years: a birth cohort study.

BACKGROUND: Child overweight remains a prevalent public health concern, but the impact of maternal psychosocial stress and related constructs, the timing, and possible trajectories on child body mass index (BMI) is controversial. We aimed to investigate the association of maternal stress, depression and anxiety symptoms, and maternal hair cortisol concentrations (HCC) at delivery, 6, and 12 months postpartum with child BMI and age- and sex-standardized BMI (BMI-SDS) at age 3 years. METHODS: Data were derived from the Ulm SPATZ Health Study with a baseline examination between 04/2012 and 05/2013 at the University Medical Centre Ulm, Germany, the only maternity clinic in Ulm, with a good representation of the source population. Adjusted regression analyses based on BMI/BMI-SDS (dependent) and trajectories of stress, depression, and anxiety (independent variables) were investigated in 596 mothers and children. Multiple imputation of missing covariates was performed. RESULTS: Various trajectories in independent variables were identified, trajectories of maternal anxiety symptom differed between child sexes. We did not find an association between trajectories of maternal chronic stress, depression symptoms, or HCC and child BMI/BMI-SDS. However, trajectories of low-increasing maternal anxiety symptoms were linked to higher child BMI compared to a low-stable trajectory group (b = 0.58 kg/m2, 95% Confidence Interval: 0.11; 1.04) in girls. CONCLUSIONS: Trajectories of maternal anxiety symptoms were associated with the child's BMI/BMI-SDS in girls at age 3 years. However, further large scale studies should include variables to determine the causal pathway and enlighten sex-specific differences.

Trajectories of child mental health, physical activity and screen-time during the COVID-19 pandemic considering different family situations: results from a longitudinal birth cohort.

BACKGROUND: Many authors have described a significant mental health burden on children and adolescents during the COVID-19 pandemic, possibly moderated by social disparities. This analysis explores whether pre-pandemic family circumstances might be related to different aspects of child health during the pandemic. METHODS: We analyzed trajectories of health-related outcomes in children aged 5 to 9 years (T7 to T11) using the Ulm SPATZ Health study, a population based birth cohort study (baseline 04/2012-05/2013) conducted in the South of Germany. Outcomes were children's mental health, quality of life, and lifestyle, such as screen time and physical activity. We conducted descriptive statistics of maternal and child characteristics before and throughout the pandemic. We defined three different groups of pre-pandemic family situations and used adjusted mixed models to estimate differences in means associated with the time during the pandemic vs. before the pandemic in (a) all children and in (b) children belonging to specific pre-pandemic family situations. RESULTS: We analyzed data from n = 588 children from whom at least one questionnaire was completed between T7 and T11. When not considering the pre-pandemic family situation, adjusted mixed models showed statistically significant lower mean scores of health-related quality of life among girls during vs. before the COVID-19 pandemic (difference in means (b): - 3.9 (95% confidence interval (CI): - 6.4, - 1.4). There were no substantial differences in mental health, screen time, or physical activity in boys or girls. When considering pre-pandemic family situations, boys with mothers having symptoms of depression or anxiety showed a substantial loss of health-related quality of life on the subscale of friends (b: - 10.5 (95% CI: - 19.7, - 1.4)). Among girls in this group, 60% of the 15 assessed outcomes were negatively associated with a remarkable loss in health-related quality of life (e.g., KINDL-physical well-being difference in means: - 12.2 (95% CI: - 18.9, - 5.4)). Furthermore, a substantial increase in screen time was found (+ 2.9 h (95% CI: 0.3, 5.6)). CONCLUSION: Our results suggest that the health (and behavior) of primary school-aged children is possibly impacted by the COVID-19 pandemic, with adverse consequences differing by gender and very likely by the pre-pandemic family situation. Especially in girls having a mother with depression or anxiety symptoms, the adverse consequences of the pandemic on mental health seem to be aggregated. Boys showed fewer adverse trajectories, and it needs to be further assessed which factors exactly are behind the (socio-economic) factors, such as maternal working habits and limited living space, when analyzing the effect of the pandemic on children's health.

Trajectory and determinants of agreement between parental and physicians' reports of childhood atopic dermatitis.

BACKGROUND: Parent self-administered reports are commonly used in studies on childhood atopic dermatitis (AD) but data on its validity are sparse. We aimed to examine the agreement between parent- and physician-reported measures of childhood AD throughout early life and identify the determinants. METHODS: In this prospective cohort study, we used data of 449 infants and their mothers recruited in the Ulm SPATZ Health Study in Germany. Longitudinal data of parental and children's caring physicians' reports were used to assess the point and cumulative agreement of parent- and physician-reported AD diagnoses, AD onset age, and trend of agreement at child ages between 1 and 6 years overall and by child and parent demographics and health conditions. A Generalized Estimating Equation model was fitted to identify factors associated with the sensitivity of parent reports. RESULTS: The point agreement between parent- and physician-reported AD was substantial at the age of 1 (kappa = 0.63, 95% CI: 0.51-0.75) but declined with age and became fair after the age of 3 (kappa < 0.40). The cumulative agreement remained moderate at the age of 6 (kappa = 0.51, 95% CI: 0.43-0.60). Parents had a bias towards delayed reporting of the AD onset age. The AD severity was the only strong determinant for the agreement of AD diagnoses and largely explained the variance of the sensitivity of parent reports. CONCLUSION: The disagreement between parent- and physician-reported AD increases with child age, likely due to the change of AD severity. Using parent-reported data might miss a substantial portion of mild childhood AD cases.

Lifestyle changes, mental health, and health-related quality of life in children aged 6-7 years before and during the COVID-19 pandemic in South Germany.

BACKGROUND: The measures against the COVID-19 pandemic are challenging for children and parents, and detrimental effects on child health are suggested especially from lock-down measures and school closings. METHODS: We conducted a cross-sectional analysis using a population based longitudinal (birth-) cohort study (SPATZ study) conducted in the South of Germany. Data included all 6 or 7 year old children for whom a questionnaire was completed during first grade of school. Consequently, we were able to analyze children being in first grade before the first lockdown in Germany (≤ 15th March 2020), as well as children being in first grade during the pandemic (> 15th March 2020). We conducted descriptive statistics and estimated the associations between the two time periods, before and during the pandemic, and various outcomes of child health using multivariable adjusted linear or logistic regression modeling. The analysis was stratified by gender. RESULTS: Results among n = 362 children aged six or seven years showed substantially lower mean scores of health-related quality of life (difference in means: - 5.5, 95% confidence interval (CI) - 9.0, - 2.0), and higher mean scores in total emotional and behavioral difficulties (difference in means: 2.0, 95% CI 0.2, 3.8) in girls during vs. before the COVID-19 pandemic using multivariable linear regression modeling. In addition, weekly screen-time was increased in boys by 3.5 h (95% CI 0.6, 6.4). We did not find substantial differences in sleep quality, physical activity, and time spent with books, neither in boys nor in girls, however, the limited sample size has to be considered. CONCLUSION: Child health (and behavior) of first grade school children is possibly impacted by the COVID-19 pandemic with adverse consequences possibly differing by gender.

[Determinants of Cognitive Development in Preschoolers - Results of the Mann-Zeichen Test]. / Determinanten der kognitiven Entwicklung bei Kindern ­ Ergebnisse des Mann-Zeichen-Tests aus der Vorschuluntersuchung.

OBJECTIVES: To study the determinants and factors influencing the development of cognition and perception using the Mann-Zeichen Test in preschool children. METHODS: Data were obtained from the Ulm Birth Cohort Study (UBCS) including newborns and their mothers recruited in Ulm between 2000-2001. Data were collected using self-administered parental questionnaires following delivery (baseline examination) and at 2, 3, 4, and 6 years of children's age. Cognitive development was tested using drawings of n=298 children at a school entrance examination (mean age=5.8 years, SD=0.4). Bi- und multivariable linear regression analyses were conducted. RESULTS: In boys, we observed statistically significant positive associations between high paternal education and the children's cognitive development (regression coefficient b, p-value: 6.65, p=0.018). There was a trend towards negative association between institutional care during the first 3 years of life (b=- 0.18/months of institutional care, p=0.074), as well as allergic diseases (b=- 6.02, p=0.075) and cognitive development. More than 30 min. spent on watching television (TV) or video at children's age of 4 years was significantly associated with reduced cognitive abilities at 6 years of age (b=- 9.37, p=0.005). In girls, there was a trend towards negative association between maternal education (b=- 4.43, p=0.091) and a positive association between allergic diseases and the cognitive development (b=6.42, p=0.075). Mutually adjusted, the effects were attenuated in boys and girls. However, a negative association between paternal education and time spent watching TV with children's cognitive ability was observed. CONCLUSION: The study shows modifiable factors associated with the cognitive abilities at age 6 years, especially early TV consumption in boys.

Association of maternal uric acid and cystatin C serum concentrations with maternal and neonatal cardiovascular risk markers and neonatal body composition: The Ulm SPATZ Health Study.

PURPOSE: In utero exposure to cardiometabolic risk factors may determine health related outcomes at birth and in later life. The aim of this analysis was to describe the relationship of maternal serum uric acid (SUA) and cystatin C with maternal and neonatal cardiometabolic risk markers and with birth weight and risk of small-for-gestational age (SGA) as well as large-for gestational age (LGA). MATERIAL AND METHODS: In the Ulm SPATZ Health Study, 934 singleton newborns and their mothers were recruited during their hospital stay in the University Medical Center Ulm between 04/2012 and 05/2013 (overall response 49%). The association between SUA and cystatin C (both in quartiles and as continuous measures) with risk for SGA as well as with LGA was quantified by means of multivariable logistic regression. RESULTS: Overall, n = 885 mother-newborn pairs were included in the final analysis. Most of the mothers were of German nationality (85%) and were between 26 and 35 years of age at delivery (69%). Maternal SUA was associated with maternal age, body mass index, alcohol consumption and history of hypertension as well as with many other maternal and neonate cardiovascular risk markers. Cystatin C was associated with parity. No clear association of SUA with SGA and LGA was observed in fully adjusted models. However, cystatin C was negatively associated with SGA with an odds ratio (OR) of 0.35 (95% CI: 0.16-0.77; p for trend 0.04) comparing the top quartile vs. the bottom quartile and was positively associated with LGA with an OR of 5.92 (95% CI: 2.27-15.44; p for trend <0.0001) after adjustment for covariates. CONCLUSIONS: We found a positive association of cystatin C with birth weight and a clearly increased risk for LGA with maternal increased cystatin C values in a population with fairly normal renal function.

Time trends in dyspepsia and association with H. pylori and work-related stress-An observational study in white collar employees in 1996 and 2015.

PURPOSE: We aimed to describe time trends in functional dyspepsia and the association of dyspepsia-related factors, Helicobacter pylori (H. pylori) and work-related stress with functional dyspepsia in white collar employees in 1996 and 2015. MATERIALS AND METHODS: Repeat cross-sectional study conducted in 1996 (n = 190, response rate = 76.1) and 2015 (n = 195, response rate = 40.2) within a health insurance company in South-West Germany. Dyspeptic symptoms measured according to the Rome III criteria, effort-reward imbalance and further work- or dyspepsia-related factors were assessed by self-administered questionnaire. H. pylori infection as possible factor for dyspeptic symptoms was measured by a 13C-urea breath test or an antigen stool test. Kruskal-Wallis tests and multivariable logistic regression models were calculated comparing the upper tertile of dyspeptic symptom scale to the middle and lower tertile. RESULTS: Mean dyspepsia symptom scores and work-related stress did not differ comparing 1996 and 2015. In bivariate analyses, dyspeptic symptom scores were consistently correlated with sex, age, and using antacids. Further dyspepsia-related factors were smoking and non-leading occupational position in 1996 and non-steroidal anti-inflammatory drugs as well as high effort-reward imbalance in 2015. High intrinsic effort was positively associated with high dyspepsia symptom scores in both studies. Following multivariable adjustment, we observed a consistent association between high intrinsic effort at work and dyspeptic symptoms, although the association was only marginally statistically significant in 1996. Furthermore, a strong association of somatization, only measured in 2015, with dyspeptic symptoms was shown. CONCLUSIONS: Dyspepsia-related factors may have changed throughout the last decades. Nevertheless, although occupational situations might differ, the intrinsic effort is still strongly associated with dyspeptic symptoms.

Screen Time, Physical Activity and Self-Esteem in Children: The Ulm Birth Cohort Study.

Screen time is a central activity of children’s daily life and jeopardizes mental health. However, results appear inconclusive and are often based on small cross-sectional studies. We aimed to investigate the temporal sequence of the association between screen time and self-esteem taking into account further indirect effects through family or friendship relationship. In our population-based birth cohort study (baseline November 2000⁻November 2001, Ulm, Germany), these relationships were explored in n = 519 11- and 13-year-old children and their parents who both provided information on children’s screen time: time spent watching television or videos (TV), time spent on computers, video game consoles, mobile devices, or cell phones; so called “other screen time”, and children’s self-esteem (KINDL-R). Time watching TV (self-reported) at age 11 was negatively associated with girls’ self-esteem at the same age but positively with an increase of self-esteem between age 11 and 13. However, the latter association was restricted to low to moderate TV viewers. In boys, a higher increase of other screen time between age 11 and age 13 was associated with lower self-reported self-esteem at age 13. Additionally, friendship relationship mediated the association between watching TV and self-esteem in girls. For parental reports similar associations were observed. These findings indicate that time sequence and potential mediators need further investigation in cohort studies with multiple assessments of screen time and self-esteem.

Changes in children's sleep domains between 2 and 3 years of age: the Ulm SPATZ Health Study.

OBJECTIVE: There is growing interest in the link between sleep habits and child health but reference values specific to toddlers as well as longitudinal data on sleep are scarce. We aimed to describe parent-reported child sleep habits and their intra-individual changes in two- to three-year-olds using data from a regional birth cohort study. METHODS: In the Ulm SPATZ Health Study, a birth cohort study conducted at Ulm, Southern Germany, with baseline examination from April 2012 to May 2013, the German version of the Children's Sleep Habits Questionnaire (CSHQ-DE) was used longitudinally at follow-ups at two and three years (N = 615 children). Descriptive statistics including intra-individual differences between three- and two-year scores were reported, the latter using the sign test. RESULTS: The sample-averaged total and subscale CSHQ scores differed only slightly between two and three years (max. Cohen's d = 0.39). Intra-individual comparisons of the CSHQ subscales or single items revealed congruent but also opposing changes in items belonging to the same subscale. Whereas items on bedtime resistance generally improved, sleep duration shortened with older age. With regard to sleep anxiety, we found worsening in the item 'Afraid of sleeping in the dark' in about one-fifth of our children whereas other items on this CSHQ subscale showed an opposing trend with age. A similar opposing trend was detected within the subscale on night wakings. CONCLUSION: Our data provide initial descriptive information on sleep habits in toddlers. The high intra-individual changes, partly in opposing directions which may be masked by aggregation, indicate a need for age- and item-specific analyses.

Maternal prenatal stress and child atopic dermatitis up to age 2 years: The Ulm SPATZ health study.

BACKGROUND: Evidence linking maternal psychosocial stress during pregnancy to subsequent child atopic dermatitis (AD) is growing, but the definition of AD is diverse and results are inconsistent. We aimed to analyze the relationship between stress and AD using alternative measurements of stress and AD. METHODS: In the Ulm SPATZ Health Study, chronic stress and symptoms of anxiety and depression were assessed by standardized self-reported questionnaires in 934 mothers of singletons following delivery in Ulm, Germany, from 04/2012-05/2013. Maternal hair cortisol concentrations (HCCs, n = 626) at childbirth and the cumulative incidences of parent-reported child AD symptoms, parent-, and pediatrician-reported AD diagnoses were assessed until age 2 years (n = 787). Overall, 205 dermatologic examinations were performed in 167 children showing AD symptoms. Crude and adjusted risk ratios (RR, aRR) with 95% confidence intervals were estimated. RESULTS: Maternal stress and anxiety were associated with child AD symptoms by trend (RR and aRR: 1.5 (1.0,2.3) for the highest vs. the lowest quarter of chronic stress; aRR: 1.4 (1.0,2.0) for possible anxiety symptoms vs. no symptoms). No relationship was found between stress or related constructs and AD diagnoses nor could we show consistent associations between maternal HCC and child AD. However, a higher RR of child AD was evident in families not yet affected by AD in siblings given maternal depressive symptoms, examined in the crude model. CONCLUSIONS: Stress measurements or related constructs are linked to AD symptoms, but association with AD diagnoses is limited. The reason for this divergence still needs further research.

Differential Regulation of Myeloid-Derived Suppressor Cells by Candida Species.

Myeloid-derived suppressor cells (MDSCs) are innate immune cells characterized by their ability to suppress T-cell responses. Recently, we demonstrated that the human-pathogenic fungi Candida albicans and Aspergillus fumigatus induced a distinct subset of neutrophilic MDSCs. To dissect Candida-mediated MDSC induction in more depth, we studied the relative efficacy of different pathogenic non-albicans Candida species to induce and functionally modulate neutrophilic MDSCs, including C. glabrata, C. parapsilosis, C. dubliniensis, and C. krusei. Our data demonstrate that the extent of MDSC generation is largely dependent on the Candida species with MDSCs induced by C. krusei and C. glabrata showing a higher suppressive activity compared to MDSCs induced by C. albicans. In summary, these studies show that fungal MDSC induction is differentially regulated at the species level and differentially affects effector T-cell responses.

The Association of Hair Cortisol with Self-Reported Chronic Psychosocial Stress and Symptoms of Anxiety and Depression in Women Shortly after Delivery.

BACKGROUND: Psychosocial stress during pregnancy including anxiety and depression is known to have adverse health effects on newborns. However, measuring these psychological constructs is complex with psychological, endocrinological, and physiological systems being affected. Hair cortisol concentrations (HCC), assumed to reflect long-term endocrine consequences of stress exposure, represent a promising instrument for epidemiological research. However, the association between HCC and questionnaire-based instruments is unclear. METHODS: In the Ulm SPATZ Health Study, mothers were recruited shortly after delivery in the University Medical Centre Ulm, Germany between April 2012 and May 2013. HCC of 768 participants were determined in scalp-near 3 cm maternal hair segments, assumed to reflect cortisol exposure over the last trimester of pregnancy. Chronic stress, anxiety, and depressive symptomatology were self-reported in questionnaire-based instruments. Spearman correlation coefficients between HCC and these instruments as well as means of HCC in highly and low stressed subgroups were calculated. RESULTS: HCC were not correlated with self-reported chronic stress, anxiety, or depressive symptomatology. Furthermore, the investigation of sub-populations did not reveal substantial differences of HCC across highly and low stressed women. CONCLUSIONS: HCC were not found to correlate with self-reports of chronic stress, anxiety, or depressive symptomatology. Among other things, these findings could reflect problems with questionnaire-based assessments obtained shortly after delivery such as recall bias and/or suggest that associations between cortisol secretion and psychosocial stress are difficult to detect due to, e.g. a strong physiological increase of cortisol in the last trimester.

Determinants of maternal hair cortisol concentrations at delivery reflecting the last trimester of pregnancy.

Hair cortisol concentrations (HCC) are emerging as a promising marker of chronic psychosocial stress. However, limited information on relevant correlates of this biomarker in late pregnancy is available. In the Ulm SPATZ Health Study mothers were recruited between 04/2012 and 05/2013 shortly after delivery in the University Medical Center Ulm, Germany. Cortisol concentrations of N=768 participants were determined by HPLC-MS/MS in the scalp-near 3cm of maternal hair reflecting stress exposure over the preceding three months. Sociodemographic characteristics, pregnancy-related variables and comorbidities were assessed. We conducted bivariate and multiple linear regression analyses using log transformed HCC. In bivariate analyses, significantly higher cortisol concentrations were found in obese compared to normal weight (b=0.32, p<0.001) and smoking as opposed to non-smoking mothers (b=0.34, p=0.002). Conversely, primary C-section was associated with lower HCC compared to spontaneous delivery. Besides, a strong impact of season of delivery with significantly higher HCC in summer and autumn as opposed to winter (both bs=0.58, p<0.001) was found. Further determinants of HCC were maternal education, number of persons in the household, premature delivery and hair characteristics. In a mutually adjusted model, all but education, multiple jobholding, hair characteristics and premature delivery remained statistically significant. Maternal hair cortisol in the last trimester of pregnancy is determined by many factors. Delivery mode, body mass index and season of delivery should be considered when investigating the association between HCC and further outcomes in mothers shortly after delivery.

Age-specific influence of wheezing phenotypes on pre-adolescent and adolescent health-related quality of life.

INTRODUCTION: Asthma is associated with diminished health-related quality of life (HRQoL). Particularly in adolescence, asthma may be under-diagnosed and undertreated or poorly managed. Therefore, we aimed to determine the association between childhood wheezing phenotypes rather than asthma and adolescent HRQoL in children aged 10-17 yr. METHODS: We analyzed the data from two prospective population-based cohort studies (n = 604 and n = 1804) conducted in southern Germany with baseline assessments in 2000 and 2006 and follow-ups at frequent intervals. Parent-reported wheeze was categorized into never, early transient, persistent, and late-onset wheeze. We assessed child-reported HRQoL in seven scales using the validated KINDL-R. Multivariate linear regression models were computed. RESULTS: Participants with late-onset wheeze had significantly lower values in all HRQoL scales, but physical well-being compared to never wheezers. Early transient wheeze was negatively associated with three HRQoL scales only (family, school, and total). These effects were confined to the oldest age group (≥13.5 yr) in one study. Persistent wheeze was not associated with HRQoL. CONCLUSIONS: In teenagers, late-onset wheezers seem to be particularly vulnerable for impairments in psychosocial aspects of health-related quality of life. They may therefore require particular attention with regard to education about asthma management and potentially family-based psychosocial intervention.

Infant atopic eczema and subsequent attention-deficit/hyperactivity disorder--a prospective birth cohort study.

BACKGROUND: Comorbidity between childhood atopic eczema (AE) and attention-deficit/hyperactivity disorder (ADHD) has been observed, but temporal relationships remain unclear. METHODS: We analyzed data of a population-based, prospective birth cohort study among 770 children included at baseline in 2000/2001 with follow-up up to age 11. Information on age at diagnosis of AE, rhinoconjunctivitis, and ADHD was obtained by questionnaires administered to parents and for AE also to caring physicians. Adjusted relative risks (aRR) with 95% confidence intervals (95% CI) were modeled with a modified Poisson regression. RESULTS: Early AE up to age 4 yr was reported for 14.8% of the children by the parents and for 26.0% by the physicians with only fair agreement between these reports (kappa = 0.36). Based on parental reports, the association of early AE with early ADHD was strong (aRR: 5.17, 95% CI: 2.18; 12.28), but absent for late ADHD [aRR: 0.50 (0.13; 2.02)]. The association of late AE with late ADHD [aRR: 3.03 (0.75; 12.29)] was not statistically significant. This pattern was independent of the presence of rhinoconjunctivitis. CONCLUSIONS: The observed comorbidity between AE and ADHD may indicate vulnerability to develop ADHD symptoms in response to AE symptoms or through a common underlying mechanism. This vulnerability seems to decrease with time since AE onset and may be greater in early life. These temporal relationships should be considered in future research investigating mechanisms linking both diseases and in clinical efforts to screen for and prevent ADHD symptoms in children with AE.

Short-term goal attainment of in-patient rehabilitation in Germany and long-term risk of early retirement in patients with musculoskeletal diseases: results from a prospective 5-year follow-up study.

PURPOSE: Occupational consequences of musculoskeletal disorders (MSDs) are consistently found in epidemiological studies. The aim of this study was to evaluate the prognostic value of various short-term rehabilitation outcome parameters on early retirement in Germany. METHOD: In a prospective multi-centre cohort study of self-rated patient status, physician chosen therapy goals and attainment were measured by means of standardized questionnaires at the beginning and end of medical rehabilitation. Information with regard to disability was collected by self-report over a 5-year follow-up period. RESULTS: We included 1268 MSD patients aged 45-57 who underwent a 3-week, multidisciplinary, in-patient rehabilitation programme in 10 rehabilitation centres in Southern Germany between January and December 2001. During follow-up (mean duration: 3.9 years) 117 (9%) patients received a disability pension. After adjustment for sex, age and patient outcomes, risk for early retirement was significantly increased for patients with only partial success with respect for the therapy goals pain reduction (HR 1.95), improvement in spine motility (HR 1.6) and improvement of muscle strength (HR 2.3). Patients who did not have the therapy goal were at the same risk as patients with full goal achievement. CONCLUSIONS: Clinicians' rating of short-term therapy outcome might be of prognostic relevance of MSD patients' long-term employment status.

The impact of social status inconsistency on cardiovascular risk factors, myocardial infarction and stroke in the EPIC-Heidelberg cohort.

BACKGROUND: Social inequalities in cardiovascular diseases are well documented. Yet, the relation of social status inconsistency (having different ranks in two or more status indicators like education, occupational position or income) and medical conditions of heart or vessels is not clear. Status inconsistency (SI) is assumed to be stressful, and the association of psychosocial distress and health is well known. Therefore, we aimed to analyze the relationship between cardiovascular diseases (CVD) and status inconsistency. Another target was to assess the influence of behaviour related risk factors on this association. METHODS: 8960 men and 6070 women, aged 45-65 years, from the EPIC-Heidelberg cohort (European Prospective Investigation into Cancer and Nutrition) were included. Socio-economic status was assessed by education/vocational training and occupational position at recruitment. During a median follow-up of 8.7 years, information on CVD was collected. RESULTS: Compared to status consistent subjects, men who were in a higher occupational position than could be expected given their educational attainment had a nearly two-fold increased incidence of CVD (Odds Ratio (OR) = 1.8, 95% Confidence Interval (CI) = 1.5; 2.4, adjusted for age). Smoking behaviour and BMI differed significantly between those who had adequate occupational positions and those who did not. Yet, these lifestyle factors, as opposed to age, did not contribute to the observed differences in CVD. No association of cardiovascular diseases and status inconsistency was found for women or in cases where education exceeded occupational position. CONCLUSIONS: Status inconsistent men (occupational position > education) had a higher risk of cardiovascular diseases than status consistent men. However, harmful behaviour did not explain this relationship.

The impact of education on risk factors and the occurrence of multimorbidity in the EPIC-Heidelberg cohort.

BACKGROUND: In aging populations, the prevalence of multimorbidity is high, and the role of socioeconomic status and its correlates is not well described. Thus, we investigated the association between educational attainment and multimorbidity in a prospective cohort study, taking also into account intermediate factors that could explain such associations. METHODS: We included 13,781 participants of the Heidelberg cohort of the European Prospective Investigation into Cancer and Nutrition (EPIC), who were 50-75 years at the end of follow-up. Information on diet and lifestyle was collected at recruitment (1994-1998). During a median follow-up of 8.7 years, information on chronic conditions and death were collected. RESULTS: Overall, the prevalence of multimorbidity (>= 2 concurrent chronic diseases) was 67.3%. Compared to the highest educational category, the lowest was statistically significantly associated with increased odds of multimorbidity in men (OR = 1.43; 95% CI 1.28-1.61) and women (OR = 1.33; 95% CI 1.18-1.57). After adjustment, the positive associations were attenuated (men: OR = 1.28; 95% CI 1.12-1.46; women: OR = 1.16; 95% CI 0.99-1.36). Increasing BMI was more strongly than smoking status an intermediate factor in the association between education and multimorbidity. CONCLUSION: In this German population, the prevalence of multimorbidity is high and is significantly associated with educational level. Increasing BMI is the most important predictor of this association. However, even the fully adjusted model, i.e. considering also other known risk factors for chronic diseases, could not entirely explain socio-economic inequalities in multimorbidity. Educational level should be considered in the development and implementation of prevention strategies of multimorbidity.