[Implementation of the principle of supported employment in Germany : Position paper of a task force of the DGPPN]. / Umsetzung der Prinzipien des Supported Employment in Deutschland : Positionspapier einer Task-Force der DGPPN.

The effects of mental diseases on the employment and working situation can be substantial. They are one of the main reasons for inability to work and reduced earning capacity. Against this background the question arises about suitable occupational reintegration measures for people with severe mental illnesses. In recent years, the principle of supported employment has been internationally shown to be increasingly more successful. In this context mentally ill people are primarily placed at a position of the first employment market and supported on-site by a job coach. This concept is inclusive, individual and evidence based. Despite proven effectiveness, it has so far been insufficiently implemented in German-speaking regions. In the future it will be a matter of considering the individual needs for assistance of mentally ill people more intensively than previously and to respond with functional and in a best-case scenario, multiprofessional and flexible offers.

How much does it hurt to be lonely? Mental and physical differences between older men and women in the KORA-Age Study.

OBJECTIVE: Loneliness has a deep impact on quality of life in older people. Findings on sex-specific differences on the experience of loneliness remain sparse. This study compared the intensity of and factors associated with loneliness between men and women. METHODS: Analyses are based on the 2008/2009 data of the KORA-Age Study, comprising 4127 participants in the age range of 64-94 years. An age-stratified random subsample of 1079 subjects participated in a face-to-face interview. Loneliness was measured by using a short German version of the UCLA-Loneliness-Scale (12 items, Likert scaled, ranging from 0 to 36 points). Multiple logistic regression analysis was conducted to analyze the associations of socio-demographic, physical, and psychological factors with loneliness. RESULTS: The mean level of loneliness did not significantly differ between men (17.0 ± 4.5) and women (17.5 ± 5.1). However, among the oldest old (≥85 years), loneliness was higher in women (p value = 0.047). Depression, low satisfaction with life, and low resilience were associated significantly with loneliness, which was more pronounced in men. Living alone was not associated with loneliness, whereas lower social network was associated with a three time higher risk for feeling lonely in both men and women. CONCLUSIONS: The extent of loneliness was equally distributed between men and women, although women were more disadvantaged regarding living arrangements as well as physical and mental health. However, loneliness was stronger associated with adverse mental health conditions in men. These findings should be considered when developing intervention strategies to reduce loneliness.

Alcohol-induced metabolomic differences in humans.

Alcohol consumption is one of the world's major risk factors for disease development. But underlying mechanisms by which moderate-to-heavy alcohol intake causes damage are poorly understood and biomarkers are sub-optimal. Here, we investigated metabolite concentration differences in relation to alcohol intake in 2090 individuals of the KORA F4 and replicated results in 261 KORA F3 and up to 629 females of the TwinsUK adult bioresource. Using logistic regression analysis adjusted for age, body mass index, smoking, high-density lipoproteins and triglycerides, we identified 40/18 significant metabolites in males/females with P-values <3.8E-04 (Bonferroni corrected) that differed in concentrations between moderate-to-heavy drinkers (MHD) and light drinkers (LD) in the KORA F4 study. We further identified specific profiles of the 10/5 metabolites in males/females that clearly separated LD from MHD in the KORA F4 cohort. For those metabolites, the respective area under the receiver operating characteristic curves were 0.812/0.679, respectively, thus providing moderate-to-high sensitivity and specificity for the discrimination of LD to MHD. A number of alcohol-related metabolites could be replicated in the KORA F3 and TwinsUK studies. Our data suggests that metabolomic profiles based on diacylphosphatidylcholines, lysophosphatidylcholines, ether lipids and sphingolipids form a new class of biomarkers for excess alcohol intake and have potential for future epidemiological and clinical studies.

[Vitamin D and multiple sclerosis : the role for risk of disease and treatment]. / Vitamin D und Multiple Sklerose : Der Stellenwert für das Erkrankungsrisiko und die Behandlung.

In addition to its important role in bone metabolism and calcium homeostasis an increasing number of beneficial effects are being attributed to vitamin D. Because of its suggested immunomodulatory capacity vitamin D deficiency or disturbance in the vitamin D metabolism might be a risk factor for the development of autoimmune diseases, such as multiple sclerosis; but supplementation with vitamin D might also be a therapeutic option. Substantial epidemiologic evidence indicates an association between vitamin D levels and risk of multiple sclerosis, suggesting vitamin D to be one of the long searched environmental factors for the development of this most common chronic inflammatory disease of the central nervous system. Less consistent are the available data for modification of the disease course in already established multiple sclerosis.This review highlights possible interactions between vitamin D and multiple sclerosis and focuses on its putative involvement in the pathogenesis and its possible role for treatment of multiple sclerosis. In particular the as yet insufficiently investigated therapeutic aspect is currently being addressed in several high quality clinical trials.

[Association between the social status of city districts and health risks: multilevel analyses concerning the regional distribution of overweight, hypertension and self-rated health in Augsburg, Germany]. / Zusammenhang zwischen dem sozialen status eines stadtgebietes und den gesundheitlichen risiken seiner bewohner: ergebnisse einer mehrebenenanalyse zu übergewicht, hypertonie und gesundheitszustand am beispiel Augsburg.

INTRODUCTION: In empirical studies it has repeatedly been shown that the socioeconomic status (SES) of a region could infl uence the health status of its inhabitants, even if measures of individual SES are controlled for. This research has just started in Germany, but most studies focus on large geographical areas such as rural districts. Taking the example of districts in the city of Augsburg, the analyses focus on the question if these associations can also be found in a small-scale regional comparison. METHODS: We included 1 888 participants of the KORA S4 Survey aged 25-74 years. The city districts were grouped according to the unemployment rate (low, medium, high). The dependent variables were self-rated health and 3 risk factors (obesity, high waist-hip ratio, hypertension). Additional individual variables included are age, sex, educational level and unemployment. The analyses were based on multilevel logistic regressions. RESULTS: After adjustment for individual level variables (age, sex, education, unemployment), the analyses show a signifi cantly increased risk of 'high waist-hip ratio' in the regions with the highest unemployment rate (OR 1.53; 95 % conf. interval 1.03-2.26). A similar association was found for obesity. No signifi cant association was observed between unemployment rate on the one hand and hypertension and self-rated health on the other. CONCLUSION: Some health risks seem to be especially high in city districts characterised by a high unemployment rate. It can be concluded that interventions aimed at reducing these risks should focus on districts with high unemployment rates. Further studies are needed for an understanding of the causes behind the social and regional inequalities shown here.

Serum potassium is associated with prediabetes and newly diagnosed diabetes in hypertensive adults from the general population: the KORA F4-study.

AIMS/HYPOTHESIS: Evidence suggests that low serum potassium concentrations or hypokalaemia induced by the intake of diuretics are associated with incident diabetes and increased risk for diabetes in persons with hypertension. We examined a possible association between serum potassium and prediabetes (defined as isolated impaired fasting glucose [i-IFG], isolated impaired glucose tolerance [i-IGT] or combined IFG/IGT), as well as known and newly diagnosed diabetes (NDD), in 32- to 81-year-old men and women with and without hypertension. METHODS: This cross-sectional analysis was based on 2,948 participants in the Cooperative Health Research in the Region of Augsburg (KORA) F4 study conducted in 2006-2008 in southern Germany. Serum concentrations of potassium were measured by indirect potentiometry. RESULTS: In the total sample there was no association between serum potassium concentrations and prediabetes. In hypertensive persons however serum potassium levels in the first and second quartile compared with the highest quartile were independently significantly associated with prediabetes after multivariable adjustment (OR for prediabetes, 2.02 [95% CI 1.27, 3.21] for quartile 2 and 2.00 [95% CI 1.27, 3.15] for quartile 1), while in persons without hypertension no association was found. In multinomial logistic regression analysis these findings could be confirmed. In hypertensive participants after multivariable adjustment the associations were statistically significant for i-IGT and NDD (i-IGT OR 1.23; NDD OR 1.41). However, in non-hypertensive persons, all associations between serum potassium levels and each of the categories of impaired glucose regulation were non-significant. CONCLUSIONS/INTERPRETATION: Serum potassium levels were independently associated with prediabetes and NDD in hypertensive adults from the general population.

Geographic variations in the frequency of thyroid disorders and thyroid peroxidase antibodies in persons without former thyroid disease within Germany.

OBJECTIVE: To investigate regional variations in the frequency of undiagnosed thyroid disorders among 25- to 88-year-old men and women in two communities in the northeast and the south of Germany. In addition, autoantibodies to thyroperoxidase (TPO-Abs) and urinary iodine excretion were determined. METHODS: Two population-based surveys of men and women using a common standardized protocol, the Study of Health in Pomerania (SHIP) in the northeast of Germany (2505 participants) and the Kooperative Gesundheitsforschung in der Region Augsburg (KORA) in the south of Germany (2316 participants), were compared with regard to the frequency of undiagnosed thyroid disorders. RESULTS: Compared with the northeast of Germany, urinary iodine excretion and serum thyroid-stimulating hormone (TSH) levels were significantly higher in the south. The median urinary iodine concentration was 110 µg/l (64; 169 µg/l) in SHIP and 151 µg/l (97; 214 µg/l) in KORA, and the median TSH value was 0.81 mIU/l (0.56; 1.15 mIU/l) in SHIP and 1.22 mIU/l (0.84; 1.80 mIU/l) in KORA. The frequency of elevated TSH (TSH ≥ 2.12 mIU/l) was 4.3% in SHIP and 14.1% in KORA (P<0.001); the corresponding values for suppressed TSH (<0.25 mIU/l) were 3.5 and 1.7% (P<0.001). The proportion of ultrasonographic findings was 55.5% in SHIP and 68.0% in KORA. The frequency of serum TPO-Abs did not differ significantly between northeast and south Germany. CONCLUSIONS: There were considerable regional disparities in the frequency of thyroid disorders within Germany. These differences can be explained not only by different regional histories of natural iodine deficiency but also by current differences in the iodine supply under an identical nationwide iodine fortification program.

Screening for primary aldosteronism in hypertensive subjects: results from two German epidemiological studies.

OBJECTIVE: The prevalence of primary aldosteronism in unselected hypertensive patients is currently unknown. We investigated the frequency of positive screening results for primary aldosteronism based on the aldosterone-to-renin ratio (ARR) in hypertensive subjects aged 30-79 years from two German epidemiological studies. We further examined the frequency of positive screening results in subjects with resistant hypertension or stage III hypertension and assessed possible disparities between untreated and treated hypertensive subjects. METHODS: Data were obtained from the first follow-ups of the population-based study of health in Pomerania (SHIP; n=1392) and the cooperative health research in the region of Augsburg (KORA; n=1052). Study-specific reference ranges for plasma aldosterone concentration (PAC), plasma renin concentration (PRC) and the ARR were applied. Confirmation tests for primary aldosteronism were not performed in these epidemiological studies.Three definitions for a positive screening for primary aldosteronism were applied: A) increased ARR; B) increased ARR and decreased PRC; and C) increased ARR and increased PAC and decreased PRC. RESULTS: The frequency of positive screening results was 7.0, 3.8 and 0.2% according to definitions A-C respectively. In the subgroups of subjects with resistant hypertension (11.9, 5.5 and 0.9%) or stage III hypertension (18.3, 14.0 and 1.1%), these frequencies were markedly higher than those in the general hypertensive population. There was no difference in the frequency of positive screening results between the treated and untreated hypertensive subjects. CONCLUSIONS: A maximum of 7.0% of the hypertensive population in Germany shows a positive screening result for primary aldosteronism. Thus, primary aldosteronism may be less frequent than previously expected based on data from referred hypertensive patients.

[Relevance of 'subjective social status' for health risks and health status - results from the KORA-F4-study]. / Einfluss des subjektiven Sozialstatus auf gesundheitliche Risiken und Gesundheitszustand - Ergebnisse der KORA-F4-Studie.

OBJECTIVES: In public health research, social status is usually assessed by objective indicators such as educational level and income. Recent studies have shown the importance of including 'subjective social status (SSS)'. The aim of this study is to analyse the influence of SSS on health for the first time in Germany, and to find out if there is an effect over and above the objective indicators of social status. METHODS: The KORA F4 study took place in 2006-2008 in the region of Augsburg, Southern Germany, with a study population of 3 080 men and women aged 32-81 years. SSS was assessed by a single question with 6 possible responses. For the analyses, 3 SSS categories were differentiated: low, middle and high. The following dependent variables were included: self-rated health (SRH), hypertension (uncontrolled), diabetes, metabolic syndrome, hay fever, no participation in medical cancer prevention, obesity (assessed by body mass index and waist-hip-ratio), smoking, physical inactivity. Logistic regression models were used to estimate the influence of SSS (e. g. adjusted for educational level and income). RESULTS: About 25% of the participants group themselves into the lowest SSS-category. Without adjustment for educational level and income, SSS is negatively associated with SRH, hypertension, diabetes, metabolic syndrome, obesity, no participation in medical cancer prevention, smoking and physical inactivity; as expected the association with hay fever is positive. After adjustment for educational level and income, not all of these associations remain significant. Some of the adjusted odds ratios (OR) for SSS differ considerably when stratified by gender, for example concerning the variable 'physical inactivity': The comparison of 'SSS low' vs. 'SSS high' shows for men OR 2.35 (95% confidence interval (CI) 1.57-3.50) and for women OR 3.58 (95% CI 2.34-5.47). CONCLUSION: The results from this study strongly suggest that SSS is an important indicator of social status (to date largely disregarded in public health research). Thus, SSS should be applied in addition to other indicators of social status such as educational level and income. The associations with SSS depend on the health indicator studied. Also, sometimes there are large differences when stratified by gender. Further research is needed to fully understand the determinants of SSS and its impact on health.

Age at menarche is associated with prediabetes and diabetes in women (aged 32-81 years) from the general population: the KORA F4 Study.

AIMS/HYPOTHESIS: The aim of this study was to examine the association between age at menarche and prediabetes as well as diabetes, considering confounding factors and the possible mediating role of adult obesity. METHODS: This cross-sectional study analysed data on 1,503 women aged 32-81 years from the German population-based KORA (Cooperative Health Research in the Region of Augsburg, South Germany) F4 Study (2006-2008). Data were collected by standardised interviews, physical examinations, and whole blood and serum measurements, including administration of an OGTT in non-diabetic participants. RESULTS: Of the 1,503 women, 226 showed a prediabetic state (impaired fasting glucose and/or impaired glucose tolerance) and 140 persons had diabetes (45 participants with previously undiagnosed diabetes and 95 with known diabetes). In Poisson regression analysis, age at menarche was significantly inversely associated with prediabetes or diabetes after adjustment for year of birth (RR 0.88; 95% CI 0.82, 0.94, p < 0.0001 per additional year of menarche) and after additional adjustment for a number of confounding factors (RR 0.88; 95% CI 0.83, 0.94, p = 0.0001). Further adjustment for current BMI slightly attenuated the association with prediabetes or diabetes (RR 0.89; 95% CI 0.83, 0.95, p = 0.0009), but the association remained clearly significant. CONCLUSIONS/INTERPRETATION: Age at menarche seems to be inversely associated with prediabetes and diabetes independent of confounding factors including current BMI. Women at risk for diabetes might be identified by a history of young age at menarche.

Dietary patterns, subclinical inflammation, incident coronary heart disease and mortality in middle-aged men from the MONICA/KORA Augsburg cohort study.

BACKGROUND/OBJECTIVES: We aimed to identify dietary patterns associated with inflammatory markers and to examine their impact on the incidence of coronary heart disease (CHD) and all-cause mortality, as subclinical inflammation is a risk factor for these outcomes. SUBJECTS/METHODS: The study population comprised 981 middle-aged men participating in the first or third 'MONItoring of Trends and Determinants in CArdiovascular Diseases' (MONICA) Augsburg surveys who completed 7-day dietary records. Subjects were followed up until 2002 for CHD and until 2007 for mortality. Dietary patterns were derived using reduced rank regression (RRR) with C-reactive protein, interleukin (IL)-6 and IL-18 as responses. Alternatively, partial least squares and principal components regression were used. RESULTS: A high score of the RRR-derived pattern was characterised by high intakes of meat, soft drinks and beer and low intakes of vegetables, fresh fruit, chocolates, cake, pastries, wholemeal bread, cereals, muesli, curd, condensed milk, cream, butter, nuts, sweet bread spread and tea. This score was associated with a higher risk for CHD (hazard ratio=1.33, 95% confidence interval: 1.06-1.67, P=0.013) and mortality (hazard ratio=1.34, 1.17-1.53, P<0.001) after multivariable adjustment. However, for CHD and CHD mortality the significant association disappeared after further adjustment for smoking status; for all-cause mortality it was attenuated but remained significant (hazard ratio=1.16, 1.00-1.33, P=0.046). Patterns derived from the other methods resembled the RRR pattern showing similar results regarding disease outcomes. CONCLUSIONS: Participants exhibiting higher dietary pattern scores had higher levels of inflammatory markers and higher risk for CHD and all-cause mortality, however, smoking was an important confounder, especially for CHD outcomes.

Implications of prevalent and incident diabetes mellitus on left ventricular geometry and function in the ageing heart: the MONICA/KORA Augsburg cohort study.

BACKGROUND AND AIM: It is unclear to what extent diabetes modulates the ageing-related adaptations of cardiac geometry and function. METHODS AND RESULTS: We examined 1005 adults, aged 25-74 years, from a population-based survey at baseline in 1994/5 and at follow-up in 2004/5. We compared persistently non-diabetic individuals (ND; no diabetes at baseline and at follow-up, n=833) with incident (ID; non-diabetic at baseline and diabetic at follow-up, n=36) and with prevalent diabetics (PD; diabetes at baseline and follow-up examination, n=21). Left ventricular (LV) geometry and function were evaluated by echocardiography. Statistical analyses were performed with multivariate linear regression models. Over ten years the PD group displayed a significantly stronger relative increase of LV mass (+9.34% vs. +23.7%) that was mediated by a more pronounced increase of LV end-diastolic diameter (+0% vs. +6.95%) compared to the ND group. In parallel, LA diameter increased (+4.50% vs. +12.7%), whereas ejection fraction decreased (+3.02% vs. -4.92%) more significantly in the PD group. Moreover, at the follow-up examination the PD and ID groups showed a significantly worse diastolic function, indicated by a higher E/EM ratio compared with the ND group (11.6 and 11.8 vs. 9.79, respectively). CONCLUSIONS: Long-standing diabetes was associated with an acceleration of age-related changes of left ventricular geometry accumulating in an eccentric remodelling of the left ventricle. Likewise, echocardiographic measures of systolic and diastolic ventricular function deteriorated more rapidly in individuals with diabetes.

[Multimorbidity and successful aging: the population-based KORA-Age study]. / Multimorbidität und erfolgreiches Altern: Ein Blick auf die Bevölkerung im Rahmen der KORA-Age-Studie.

BACKGROUND: The objective of the KORA-Age research consortium is to assess the determinants and consequences of multimorbidity in the elderly and to look into reasons for successful aging in the general public. PATIENTS AND METHODS: In the KORA-Age cohort study 9,197 persons were included who where born in the year 1943 or before and participants of previous KORA cohort studies conducted between 1984 and 2001 (KORA: Cooperative Health Research in the Region of Augsburg). The randomized intervention study KORINNA (Coronary infarct follow-up treatment in the elderly) tested a nurse-based case management program with 338 patients with myocardial infarct and included an evaluation in health economics. RESULTS: A total of 2,734 deaths were registered, 4,565 participants submitted a postal health status questionnaire and 4,127 participants were interviewed by telephone (response 76.2% and 68.9% respectively). A gender and age-stratified random sample of the cohort consisting of 1,079 persons took part in a physical examination (response 53.8%). CONCLUSION: The KORA-Age consortium was able to collect data in a large population-based sample and is contributing to the understanding of multimorbidity and successful aging.

Genes and lifestyle factors in obesity: results from 12,462 subjects from MONICA/KORA.

BACKGROUND: Data from meta-analyses of genome-wide association studies provided evidence for an association of polymorphisms with body mass index (BMI), and gene expression results indicated a role of these variants in the hypothalamus. It was consecutively hypothesized that these associations might be evoked by a modulation of nutritional intake or energy expenditure. OBJECTIVE: It was our aim to investigate the association of these genetic factors with BMI in a large homogenous population-based sample to explore the association of these polymorphisms with lifestyle factors related to nutritional intake or energy expenditure, and whether such lifestyle factors could be mediators of the detected single-nucleotide polymorphism (SNP)-association with BMI. It was a further aim to compare the proportion of BMI explained by genetic factors with the one explained by lifestyle factors. DESIGN: The association of seven polymorphisms in or near the genes NEGR1, TMEM18, MTCH2, FTO, MC4R, SH2B1 and KCTD15 was analyzed in 12,462 subjects from the population-based MONICA/KORA Augsburg study. Information on lifestyle factors was based on standardized questionnaires. For statistical analysis, regression-based models were used. RESULTS: The minor allele of polymorphism rs6548238 C>T (TMEM18) was associated with lower BMI (-0.418 kg m(-2), P=1.22 × 10(-8)), and of polymorphisms rs9935401 G>A (FTO) and rs7498665 A>G (SH2B1) with increased BMI (0.290 kg m(-2), P=2.85 × 10(-7) and 0.145 kg m(-2), P=9.83 × 10(-3)). The other polymorphisms were not significantly associated. Lifestyle factors were correlated with BMI and explained 0.037% of the BMI variance as compared with 0.006% of explained variance by the associated genetic factors. The genetic variants associated with BMI were not significantly associated with lifestyle factors and there was no evidence of lifestyle factors mediating the SNP-BMI association. CONCLUSIONS: Our data first confirm the findings for TMEM18 with BMI in a single study on adults and also confirm the findings for FTO and SH2B1. There was no evidence for a direct SNP-lifestyle association.

Reference intervals for aldosterone, renin, and the aldosterone-to-renin ratio in the population-based Study of Health in Pomerania (SHIP-1).

The renin-angiotensin-aldosterone system plays a key role in the regulation of human blood pressure. The aldosterone-to-renin ratio (ARR) is widely accepted for screening the primary hyperaldosteronism (PAL). Various cutoffs for positive PAL screening have been defined in patient cohorts from endocrinological referral centers and primary care. However, the distribution of the ARR in the general population is largely unknown. We aim to provide reference ranges for plasma aldosterone concentration (PAC), plasma renin concentration (PRC), and the ARR for the general population of north-east Germany. A cohort of 3 300 subjects participated in the first follow-up of the longitudinal, population-based Study of Health in Pomerania (SHIP). PAC and PRC were measured by radioimmunometric procedures. The reference interval was defined as the central 95% range between the 2.5(th) and 97.5(th) percentiles. A reference population comprising 1,347 healthy subjects was selected. Sex and age-specific (25-54 and 55-74 years) reference ranges are presented. The upper reference limit for the ARR was 14.2 and 20.3 in younger, and 22.4 and 25.5 in older men and women, respectively. Time of blood sampling had no influence on the ARR, while beta blockers, and agents acting on the renin-angiotensin system were associated with higher and lower ARR, respectively. Our upper reference limit for the ARR is clearly lower than previously reported values from studies of hypertensive patients in primary care or hypertension referral centers. We confirm that PAC and PRC are associated with various factors, including sex, age, intake of estrogen, and various antihypertensive medications.

[The BSD Health Study: a pilot study to examine the comparability of Bavarian blood donors with the Bavarian general population by a comparison with KORA S4]. / Die BSD Gesundheitsstudie: eine Pilotstudie zur Untersuchung der Vergleichbarkeit bayerischer Blutspender mit der Allgemein-bevölkerung Bayerns durch einen Vergleich mit KORA S4.

AIM: The aim of this pilot study was to compare the health status of Bavarian blood donors to the general population in Bavaria (Southern Germany). METHODS: Blood donors in Bavaria were evaluated with respect to socio-demographic characteristics, smoking status and selected diseases. The subset of blood donors from rural areas and aged 35-74 years (n=1 187), was compared to participants in the population-based survey KORA S4 living in rural areas near Augsburg (n=1 870). The comparison was based on logistic regression models adjusted for age and sex. RESULTS: Bavarian blood donors lived significantly more often in communities with less than 20 000 inhabitants (OR=4.73, KI: 3.69-6.13). They were more often born in Germany (OR=2.71, KI: 2.12-3.50) and had less university degrees (OR=0.60, KI: 0.44-0.81). Never smoking is more common in blood donors (OR=1.53, 95% KI: (1.30; 1.80)). The prevalence of asthma, myocardial infarction (HI) and cancer (men only) is significantly lower in blood donors compared to the general population both living in rural areas (OR (Asthma)=0.32, 95% KI: (0.20; 0.52); OR (HI)=0.17, 95% KI: (0.08; 0.34)). The initially significantly lower number of cancer cases in male blood donors disappeared after adjustment for smoking status and community size. No difference was detected for type 2 diabetes. CONCLUSION: With the exception of type 2 dia-betes, the prevalence of the investigated diseases was lower in blood donors than in the general population. Differences can probably be explained by lifestyle factors as there might be a selection of healthier and more health-conscious blood donors. In the literature, a reduced risk of MI is discussed to be related to the frequency of blood donation. However, these questions need further research.

Beta-blocker use and risk of fractures in men and women from the general population: the MONICA/KORA Augsburg cohort study.

UNLABELLED: Use of beta-blockers is associated with a reduced risk of fractures in middle-aged and older subjects from the general population. INTRODUCTION: The present prospective population-based study investigated the association between use of beta-blockers and incidence of any fracture. METHODS: The study was based on 1,793 persons 55 to 74 years of age who participated in one of the three MONICA Augsburg surveys between 1984 and 1995. Subjects were without any fracture at baseline. Incident fractures were assessed using a health questionnaire. Hazard ratios (HRs) were estimated from Cox proportional hazard models. RESULTS: During a mean follow-up of 10.7 years, there occurred 263 incident fractures. beta-blocker users were older, were significantly more likely to be obese, to drink no alcohol, to have hypertension or diabetes, to use thiazides and statins, and to be physically inactive. The use of beta-blockers was associated with a lower risk of any fracture (HR 0.57; 95% CI = 0.36-0.90) after adjustment for age, sex and survey. Further adjustment for body mass index and education years only slightly attenuated the relationship (HR 0.60; 95% CI = 0.38-0.95) and additional adjustment for a variety of further risk factors did not attenuate the association (HR 0.60; 95% CI = 0.37-0.96). CONCLUSION: Use of beta-blockers was associated with a reduced risk of fractures in middle-aged and older subjects from the general population.

Swimming pool attendance and hay fever rates later in life.

BACKGROUND: Exposure to chlorination by-products through swimming pool attendance showed adverse health effects on children. The aim of our study was to assess whether pool attendance in childhood would be related to higher rates of allergic diseases in adulthood, with special regard to hay fever. METHODS: 2606 adults aged 35-74 years provided retrospectively collected information on swimming pool attendance and medical history, including data on atopic diseases. Information was assessed by a combination of a personal interview and a self-administered questionnaire. Logistic regression models were applied to study associations between hay fever and swimming pool attendance, adjusted for potentially relevant confounders, such as age, gender, region, education and smoking. RESULTS: Higher rates of hay fever could be seen when frequently exposed at school age (aOR: 1.74, 95% CI: 1.09-2.77), frequently exposed during the past 12 months (aOR: 1.32, 95% CI: 0.92-1.89) and ever exposed (aOR: 1.65, 95% CI: 0.98-2.78). Strongest associations were found for the youngest subjects and were dose-related to the extent of current and school-age pool attendance. CONCLUSIONS: Impaired integrity of the lung epithelial by exposure to chlorination by-products might facilitate a closer contact to allergens and therefore could result in higher rates of hay fever.