Ultraflexible vesicles, Transfersomes, have an extremely low pore penetration resistance and transport therapeutic amounts of insulin across the intact mammalian skin.

New vehicles for the non-invasive delivery of agents are introduced. These carriers can transport pharmacological agents, including large polypeptides, through the permeability barriers, such as the intact skin. This capability depends on the self-regulating carrier deformability which exceeds that of the related but not optimized lipid aggregates by several orders of magnitude. Conventional lipid suspensions, such as standard liposomes or mixed lipid micelles, do not mediate a systemic biological effect upon epicutaneous applications. In contrast to this, the properly devised adaptable carriers, when administered on the intact skin, transport therapeutic amounts of biogenic molecules into the body. This process can be nearly as efficient as an injection needle, as seen from the results of experiments in mice and humans with the insulin-carrying vesicles. The carrier-mediated transcutaneous insulin delivery is unlikely to involve shunts, lesions or other types of skin damage. Rather than this, insulin is inferred to be transported into the body between the intact skin cells with a bio-efficiency of at least 50% of the s.c. dose action.

Alcohol consumption as a risk factor for high blood pressure. Munich Blood Pressure Study.

The Munich Blood Pressure Study (MBS), a 1980-81 cross-sectional study (with follow-up) of a random sample of 3198 Munich citizens aged 30-69 years (response rate 69%), revealed hypertensive blood pressure (BP) values in 17.7% of men and 10.7% of women (WHO criteria). One of the main goals of the MBS was to search for social, behavioral, and environmental risk factors for hypertension. The relationship between BP and five possible risk factors--alcohol consumption (g/day), cigarette smoking, oral contraceptive use, years of education, obesity (BMI)--has been examined. The major emphasis of this report is the relationship of alcohol consumption to BP. Multiple linear and logistic regression analyses were run controlling for both age and sex. All second- and third-order interactions between the independent variables were tested during a backward-stepping procedure. Alcohol consumption appeared as a significant main effect in many of the analyses. The coefficient of the alcohol variable ranged from 0.02 to 0.06 for men and women in the separate linear regression analyses for systolic and diastolic BP. Thus, for example, according to the model, the daily consumption of 1 liter of beer (40 g alcohol) may cause an increase in diastolic BP in women of 2.4 mm Hg.

The angiotensinogen T235 variant and the use of antihypertensive drugs in a population-based cohort.

Variants of the angiotensinogen gene may increase the risk of developing arterial hypertension, but their effect on the use of antihypertensive medication in the general population remains unclear. Thus, we determined T174M and M235T allele status and angiotensinogen plasma levels in a cross-sectional sample of 634 middle-aged subjects (48.4% men) from the Monitoring Trends and Determinants in Cardiovascular Disease (MONICA) Augsburg cohort study. We found no association between T174M allele status and angiotensinogen levels, blood pressure, or use of antihypertensive drugs. In contrast, multivariate analysis revealed that individuals who carried at least one copy of the T235 allele (n = 418) had higher systolic and diastolic pressures (P = .007) and .008, respectively) and were more likely to use an antihypertensive drug (1.6-fold risk, P = .04) than homozygotes for the M235 allele (n = 216). The likelihood of taking two or more antihypertensive medications was 2.1-fold higher in carriers of the T235 allele (P = .02). Overall, 22.5% of all antihypertensive drugs taken appeared to be attributable to the excess risk associated with this allele. These associations were replicated in two previous surveys carried out on the same individuals over 10 years. Furthermore, the T235 allele was related to higher angiotensinogen plasma levels [15.5 +/- 0.31 versus 16.5 +/- 0.15 (nmol/L)/L in homozygotes for the M235 and T235 alleles, respectively; P < .01], which were also related to systolic pressure (P = .03) and more intensive antihypertensive medication (P = .03). We conclude that the angiotensinogen T235 allele accounts for a substantial proportion of antihypertensive drug use in this middle-aged, population-based group of white subjects.

Mutations in the S4 domain of a pacemaker channel alter its voltage dependence.

In an attempt to study the functional role of the positively charged amino acids present in the S4 segment of hyperpolarization-activated cyclic nucleotide-gated cation (HCN) channels, we have introduced single and sequential amino acid replacements throughout this domain in the mouse type 2 HCN channel (mHCN2). Sequential neutralization of the first three positively charged amino acids resulted in cumulative shifts of the midpoint voltage activation constant towards more hyperpolarizing potentials. The contribution of each amino acid substitution was approximately -20 mV. Amino acid replacements to neutralize either the first (K291Q) or fourth (R300Q) positively charged amino acid resulted in the same shift (about 20 mV) towards more hyperpolarized potentials. Replacing the first positively charged amino acid with the negatively charged glutamic acid (K291E) produced a shift of approximately -50 mV in the same direction. None of the above amino acid substitutions had any measurable effect on the time course of channel activation. This suggests that the S4 domain of HCN channels critically controls the voltage dependence of channel opening but is not involved in regulating activation kinetics. No channel activity was detected in mutants with neutralization of the last six positively charged amino acids from the S4 domain, suggesting that these amino acids cannot be altered without impairing channel function.

Five-year changes in population blood pressure and hypertension prevalence. Results from the MONICA Augsburg surveys 1984/85 and 1989/90.

Two cardiovascular risk factor surveys were carried out in 1984/85 and 1989/90 in the Augsburg study region of the international World Health Organization (WHO) Monitoring Trends and Determinants of Cardiovascular Disease (MONICA) project. Independent random samples of the 25- to 64-year-old population were examined at each survey. Five-year changes in blood pressure (BP) and hypertension parameters were monitored in a population not targeted by any formal intervention program. Response rates in both surveys ranged close to 80%. Evaluation of selected quality indicators confirmed comparability of the two surveys in terms of BP measurement quality. Small but consistent decreases in mean systolic and diastolic BP were observed, particularly for women 35 years and older, whereas BP changes in men were less pronounced and inconsistent. Likewise, downward shifts of the 10th, 50th, and 90th percentiles of systolic and diastolic BP occurred in women and their slopes of BP rise with age decreased while such changes were less clear in men. The age-standardized prevalence of men and women with hypertensive BP (HBP; > or = 160/95 mm Hg) decreased slightly. This contrasted with rises in the prevalence of actual hypertension (those with HBP plus those taking antihypertensive drugs) for 45- to 64-year-old men, which originated from changes in hypertension management involving a more frequent drug treatment of borderline-hypertensive men (140 to 159/90 to 94 mm Hg) in 1989/90. There were notable overall increases in the awareness, treatment, and control of men and women with hypertension.(ABSTRACT TRUNCATED AT 250 WORDS)

The association of antihypertensive treatment patterns and adverse lipid effects in population-based studies.

We investigated the relationship between antihypertensive drug treatment of hypertensives and their mean serum lipid concentrations in population based studies in Germany. Data from three surveys (Luebeck Blood Pressure Study (LBS) of 1984, MONICA Augsburg Survey I of 1984/85, MONICA Augsburg Survey II of 1989/90), obtained on random samples of the population aged 25-64 years, were used for cross-sectional analyses. Moreover, prospective analyses were carried out on participants of the MONICA Augsburg cohort study of 1987/88 (3-year-follow-up of the MONICA Survey I). Blood pressure, non-fasting serum total cholesterol and HDL-cholesterol, and body height and weight were measured under strictly standardized conditions. Interview data were available on medical history including medication use, and on smoking and alcohol consumption. In cross-sectional and prospective analyses treated male and female hypertensives in each population had significantly lower crude mean HDL-C concentrations than untreated hypertensives, borderliners, or normotensives. Differences in mean HDL-C between untreated and treated hypertensives were attenuated but still significant after control of confounders and ranged from 1.8 to 6.1 mg/dl (i.e. in relative terms, -3.4 to -12.9%) in men and from 3.6 to 9.4 mg/dl (-5.7 to -14.9%) in women. By contrast, crude and multivariate associations of antihypertensive treatment with non-HDL-C (total minus HDL-C) levels were inconsistent and not significant. The inverse association of drug therapy with HDL-C was confirmed by prospective analyses in the MONICA cohort study supporting a causal relationship. Treatment patterns in a community (prevalence of prescribed drug classes) correlated with the magnitude and significance of HDL-C effects.(ABSTRACT TRUNCATED AT 250 WORDS)

Population trends in antihypertensive drug use: results from the MONICA Augsburg Project 1984 to 1995.

Trends in antihypertensive drug use were assessed among 25- to 64-year-old participants of three independent surveys of the MONICA Augsburg region in 1984/85, 1989/90, and in 1994/95. Despite constant prevalences of hypertension, the percentage of hypertensives taking medication increased over the study period. The latter was mainly due to significant rises in antihypertensive monotherapy. By contrast, the use of combination treatments with two or more agents remained constant; however, although combinations composed of only two drugs were taken more often in 1995, those with three or more agents and fixed-dose preparations decreased substantially. Beta-blockers were most frequently, and with a rising tendency, taken as antihypertensive monotherapy. Newer drug classes like calcium channel blockers and ACE-inhibitors were introduced as monotherapy more hesitantly. Diuretics persisted as the basis of antihypertensive combination therapy. The use of combination therapies containing obsolete drugs, like reserpine, declined significantly with corresponding increases in drug combinations of, in particular, calcium channel blockers or ACE-inhibitors. We conclude that monotherapies account for most of the rising antihypertensive treatment rates and probably reflect intensified therapy of borderline hypertensives. The trends in antihypertensive drug classes and treatment regimens reflect a less rapid adoption of novel therapeutic concepts but a fairly close adherence to national and international guidelines.

Factors associated with measured differences between fourth and fifth phase diastolic blood pressure.

Data from the Munich Blood Pressure Study I were used to investigate the distributions of fourth (D4) and fifth (D5) phase diastolic blood pressures in a population and to identify factors related to their difference. Muffling (in contrast to change of amplitude) of sounds was taken as the criterion for fourth phase Korotkoff sounds. D4 could not be detected (ie D4 = D5) in 33.7% of the 1032 men and in 42.1% of the 1163 women. The difference D4-D5 (mean +/- SEM) was 3.1 +/- 0.1 mmHg for male and 2.4 +/- 0.1 mmHg for female participants. Only 28.0% of D4-D5 differences were greater than 4 mmHg in men and 20.2% in women. D4-D5 varied considerably between the three measurements of each examination both related to participants and observers. Participant characteristics associated with greater D4-D5 were higher SBP, higher D4, and lower D5. Smoking was more common in men with greater D4-D5. Inter-observer variability was very strong. Non-detection of D4 ranged from 78.8% to 10.2% between observers. To assess the relative importance of participant and observer influence on the magnitude of D4-D5, we fitted a polychotomous logistic regression model. In this model, participant characteristics had only a weak effect on measured D4-D5. This was outweighted by potential observer effects several-fold stronger than the strongest participant effect. We conclude that for reliability reasons D5 should be given preference over D4 when measuring diastolic blood pressure in adults, whether for clinical or for epidemiological purposes.

Oral contraceptive use and blood pressure in a German metropolitan population.

The relationship between blood pressure (BP) and oral contraceptive (OC) use in women has been examined with the data from the Munich Blood Pressure Study (MBS), a cross-sectional study with follow-up of a random sample of 3198 Munich citizens aged 30-69 (response rate 69.3%). Multiple linear and logistic regression analyses were run with BP as the dependent variable and age, OC use, obesity, alcohol consumption, and smoking habit as the independent variables. All second and third order interactions between the independent variables were tested during a backward stepping procedure. OC use appeared as a significant main effect in most of the analyses. The coefficient of the OC variable was about 3 in the linear regression analyses for both systolic BP and diastolic BP, indicating an increase of about 3 mmHg in the systolic and diastolic BP of the OC users. An analysis of the change in BP after one year in relation to change in OC user status has also been made. It was observed that women ceasing to use OC had a clear decrease in BP while those starting to use OC had on average an increase in BP.

PIP: A random sample of 3198 persons aged 30-69, as part of the Munich Blood Pressure Study, revealed that oral contraceptive use raises blood pressure. Data were collected from December 1980 to May 1981, and from January to March 1982, on the same subjects. Each participant was interviewed about risk factors for about 30 minutes in a sitting position, and his pressure measured 3 times afterward with the Hawksley Random Zero sphygmomanometer. There were 113 women using pills, 32 different brands. Multiple linear and logistic regression analyses were run with blood pressure as the dependent variable, and age, pill use, obesity, alcohol consumption, and smoking habit as the independent variables. Pill use appeared as a significant main effect in most of the analyses. Based on the coefficient of the pill variable in the linear regression, an increase of about 3 mm Hg in both systolic and diastolic pressures was demonstrated. It was observed that women stopping oral contraception had a clear decrease of 7.2 mm Hg systolic, and 2.8 mm Hg diastolic pressure, and those beginning oral contraception appeared to have an increase in pressure, if the results were adjusted for regression toward the mean. Even a slight increase of 3 or 4 mm Hg in blood pressure, when added to other risk factors such as obesity, smoking, and age, may increase the overall risk for cardiovascular disease considerably.

Assessing hypertension management in the community: trends of prevalence, detection, treatment, and control of hypertension in the MONICA Project, Augsburg 1984-1995.

OBJECTIVE: To assess trends in prevalence and detection, treatment and control of hypertension in a German population between 1984 and 1995. SETTING AND PARTICIPANTS: Independent random samples of the population were examined in cross-sectional surveys with identical methods in 1984/85 (age range 25 to 64 years, n = 4022 participants), 1989/90 (age range 25 to 74 years, n = 4940) and 1994/95 (age range 25 to 74 years, n = 4856). MAIN OUTCOME MEASURES: Prevalence of hypertension and proportions of hypertensives detected, treated and controlled. Hypertension was defined as blood pressure above 140/90 mm Hg or taking antihypertensive medication. RESULTS: The prevalence of hypertension did not change significantly over the 10 years (25--64 years, age-standardised 1984/85: 37.8% in men and 24.6% in women; 1994/95: 39.3% and 24.8%, respectively). Rates of detection, treatment and control of hypertension did not change much either. Of all hypertensives in 1994/95, 54% were detected in men and 64% in women, the treatment rates were 23% and 32%, and the proportions of those with controlled hypertension (below 140/90 mm Hg with treatment) were as low as 7% and 13%, respectively. Rates were higher in the older age groups, however, control rates never exceeded 20% at any age. CONCLUSIONS: Despite considerable changes in the pharmacological treatment of hypertension there was a disappointing stagnation with regard to the management of this important risk factor in the community. The reasons for this unfavourable trend need clarification and appropriate public health action. Journal of Human Hypertension (2001) 15, 27-36

Microalbuminuria, central adiposity and hypertension in the non-diabetic urban population of the MONICA Augsburg survey 1994/95.

OBJECTIVE: Microalbuminuria is a renal marker of general vascular endothelial damage and early atherosclerosis with adverse prognostic implications. Microalbuminuria is associated with diabetes, insulin resistance, central adiposity and hypertension. We evaluated the degree of the association of components of the metabolic syndrome with microalbuminuria in a subsample of a non-diabetic study population. DESIGN: Men and women aged 25-74 living in the city of Augsburg, Germany, were interviewed and examined in a standardised manner at a population-based survey conducted in 1994/95. Persons with a history of diabetes or HbA1c level > or = 7% were excluded. OUTCOME: Albumin and creatinine were determined quantitatively in a spot urine and defined as microalbuminuria via an albumin/creatinine ratio between 30 and 299 mg/g. RESULTS: Among 920 men and 879 women, the age- standardised prevalence of microalbuminuria was 8.0% and 7.5%, respectively. While a graded, positive increase in prevalence of microalbuminuria across quintiles of waist-to-hip (WHR) was observed in non-hypertensive men and women, microalbuminuria was uniformly high among hypertensives. Multivariate logistic regression models showed that central adiposity (OR 3.3) or hypertension (OR 4.0) alone significantly increased the odds of microalbuminuria while their joint presence (OR 3.6) did not add to the occurrence of microalbuminuria. While obesity was not associated with microalbuminuria once central adiposity was taken into account, elevated percent body fat remained associated with microalbuminuria. CONCLUSIONS: Signs of early endothelial dysfunction as manifested as microalbuminuria are strongly and independently associated with central adiposity and should be considered in the context of the metabolic or insulin resistance syndrome.

Do siblings of myocardial infarction patients have a specific management of hypertension?

The aim of this study was to determine whether the management of hypertension differs between siblings of myocardial infarction patients and the general population. Siblings aged 35 to 74 years, unaffected by myocardial infarction, were drawn from the Augsburg Family Heart Study, conducted in 1996-1997 in southern Germany (n = 524). The reference group consisted of participants of the third MONICA population-based survey conducted in 1994-1995 in the same area, who were aged 35 to 74 years and also unaffected by myocardial infarction (n = 3802). Prevalence, awareness, treatment and control of hypertension (defined by blood pressure > or = 140/90 mm Hg or use of antihypertensive medication) were compared between the two groups. The result was that the prevalence of hypertension was higher in the siblings (men: age-adjusted OR = 1.31, 95% CI: 0.99-1.75; women: age-adjusted OR = 1.83, 95% CI: 1.39-2.41). Male hypertensive siblings were more often aware and treated for hypertension than male hypertensives of the reference group whereas the level of awareness and treatment was comparable between female hypertensives of the two groups. In both genders, no difference in the degree of control was shown between hypertensives of the two groups. In conclusion the siblings and their physicians should pay more attention to the family history of myocardial infarction in order to improve the management of hypertension in this high risk group.

Activation of the Autonomic Nervous System and Blood Coagulation in Association with an Air Pollution Episode.

Air pollution has been associated with increases in hospital admissions for cardiovascular diseases. This article aims to identify subgroups of individuals who exhibit early biological responses consistent with the health effects of ambient air pollution. Resting heart rates have been recorded in a cohort of 2681 men and women aged 25-64 yr who participated in the MONICA Augsburg survey during the winter 1984/1985 and in a reexamination during the winter 1987/1988. Increases in heart rate of 1.8 beats per minute (bpm) (95% confidence interval: 0.7 to 2.8 bpm) were observed during the air pollution episode compared to nonepisode days, adjusted for potential cardiovascular risk factors and meteorological parameters. Among persons whose plasma viscosity was above the 90th percentile, heart rates increased 5.1 bpm (95% confidence interval: 2.1 to 8.2 bpm) during the air pollution episode. Persons with normal values of plasma viscosity only had an increase of 1.4 bpm (95% confidence interval: 0.3 to 2.5 bpm) during the air pollution episode. Subjects with increased plasma viscosity showed a more pronounced acceleration in heart rate at rest, pointing toward a modification of the autonomic control of the heart during an air pollution episode.

Comparative floral development of Mir-grown and ethylene-treated, earth-grown Super Dwarf wheat.

To study plant growth in microgravity, we grew Super Dwarf wheat (Triticum aestivum L.) in the Svet growth chamber onboard the orbiting Russian space station, Mir, and in identical ground control units at the Institute of BioMedical Problems in Moscow, Russia. Seedling emergence was 56% and 73% in the two root-module compartments on Mir and 75% and 90% on earth. Growth was vigorous (produced ca. 1 kg dry mass), and individual plants produced 5 to 8 tillers on Mir compared with 3 to 5 on earth-grown controls. Upon harvest in space and return to earth, however, all inflorescences of the flight-grown plants were sterile. To ascertain if Super Dwarf wheat responded to the 1.1 to 1.7 micromoles mol-1 atmospheric levels of ethylene measured on the Mir prior to and during flowering, plants on earth were exposed to 0, 1, 3, 10, and 20 micromoles mol-1 of ethylene gas and 1200 micromoles mol-1 CO2 from 7 d after emergence to maturity. As in our Mir wheat, plant height, awn length, and the flag leaf were significantly shorter in the ethylene-exposed plants than in controls; inflorescences also exhibited 100% sterility. Scanning-electron-microscopic (SEM) examination of florets from Mir-grown and ethylene-treated, earth-grown plants showed that development ceased prior to anthesis, and the anthers did not dehisce. Laser scanning confocal microscopic (LSCM) examination of pollen grains from Mir and ethylene-treated plants on earth exhibited zero, one, and occasionally two, but rarely three nuclei; pollen produced in the absence of ethylene was always trinucleate, the normal condition. The scarcity of trinucleate pollen, abrupt cessation of floret development prior to anthesis, and excess tillering in wheat plants on Mir and in ethylene-containing atmospheres on earth build a strong case for the ethylene on Mir as the agent for the induced male sterility and other symptoms, rather than microgravity.

Trends in alcohol intake in a southern German population from 1984-1985 to 1989-1990: results of the MONICA Project Augsburg.

This study was undertaken to measure trends in alcohol intake from 1984-85 to 1989-90 in a southern German population. In the surveys of the MONICA Augsburg Project conducted in 1984-85 (Survey 1) and 1989-90 (Survey 2) data on alcohol intake (in grams/day) were gathered from two independent representative samples (Survey 1: 4,016; Survey 2: 3,960) of men and women, aged 25 to 64 years. A validated recall method was applied. Self-reported mean alcohol intake was high in Survey 1 (36 g/day in men; 11 g/day in women), but decreased from Survey 1 to Survey 2 in both men and women (32 g/day in men; 9 g/day in women). The decrease is reflected also in the median and 95th percentile values of alcohol intake and in an increase of the proportion of self-reported nondrinkers from Survey 1 to Survey 2. Alcohol intake in the MONICA Augsburg population is rather high in comparison to other countries, but a trend to lower intakes was observed from 1984-85 to 1989-90.

Induced abnormality in Mir- and Earth grown Super Dwarf wheat.

Super-dwarf wheat grown on the Mir space station using the Svet "Greenhouse" exhibited morphological, metabolic and reproductive abnormalities compared with Earth-grown wheat. Of prominent importance were the abnormalities associated with reproductive ontogeny and the total absence of seed formation on Mir. Changes in the apical meristem associated with transition from the vegetative phase to floral initiation and development of the reproductive spike were all typical of 'Super-Dwarf' wheat up to the point of anthesis. Observation of ruptured anthers from the Mir-grown plants revealed what appeared to be normally developed pollen. These pollen gains, however, contained only one nuclei, while normal viable pollen is tri-nucleate. A potentially important difference in the flight experiment, compared with ground reference studies, was the presence of a high level of atmospheric ethylene (1,200 ppb). Ground studies conducted by exposing 'Super-Dwarf' wheat to ethylene just prior to anthesis resulted in manifestation of the same abnormalities observed in the space flight samples.

Variation in coronary risk factor levels of men and women between the German-speaking MONICA centres.

The aim of this analysis was to compare levels of risk factors for coronary heart disease (CHD) in men and women aged 25-64 years between German-speaking MONICA collaborating centres, the German Democratic Republic (GDR), Augsburg - the Federal Republic of Germany (FRG)(Au), Bremen - FRG (Br), Heidelberg - FRG (He), and Vaud/Fribourg - Switzerland (CH, with a German-speaking minority). Prevalence of cigarette smoking in men showed little variation in four centres (34 to 40%) and was higher in BR men (49%), while it varied from 17% (GDR) to 33% (BR) in women. Mean total serum cholesterol values (mmol/L) were highest in GDR and CH men (both 6.2) and GDR women (6.1), and lowest in both He men (5.7) and He women (5.6). The proportion with cholesterol values greater than or equal to 6.7 mmol/L was largest in CH men (34%) and smallest in FRG (He) women (17%), while lowering the cut-off point from 6.7 to 6.5 mmol/L raised the prevalence of hypercholesterolaemia in all centres by 5 to 10%. Mean values (mmHg) of blood pressure (BP) were highest in both GDR men (140/88) and women (138/86), as was the prevalence of hypertensive BP values. In all centres, women aged 25-34 had BP values approximately 12/5 mmHg lower than age-matched men, but BP values similar to men at age 55-64, which indicates that age-parallel increase in BP was steeper in women than men.(ABSTRACT TRUNCATED AT 250 WORDS)

[The effect of education and professional position on changes in cigarette smoking and alcohol consumption: results of the MONIKA Augsberg cohort study]. / Der Einfluss von Ausbildung und beruflicher Position auf Veränderungen im Zigarettenrauchen und Alkoholkonsum: Ergebnisse der MONICA Augsberg Kohortenstudie.

This study examined the influence of educational achievement and occupational position on changes in risk behavior. Study population were 3753 men and women aged 25-64 years who were sampled by the first MONICA Augsburg Survey (Monitoring trends and determinants in cardiovascular disease). The subjects were sampled in 1984-85, were followed up for three years, and were reexamined in 1987-88. The baseline findings showed for both men and women a statistically significant inverse association between current cigarette smoking and educational level. During the follow-up period the differences between highest and lowest educational levels increased significantly among men. In 1987-88 only 21% of the best educated men were smokers compared to 38% of those with the lowest educational level. Men with low educational levels also drank more alcohol than better educated men, whereas among women those with lowest educational level drank less alcohol than the better educated. Statistically independent of education and age it was found that male civil servants and farmers had the lowest proportion of smokers in cross-sectional as well as longitudinal analyses. Among women, smoking was and remained most prevalent in simple white-collar occupations. In general, the findings indicate that the type of occupation and the actual working conditions have effects on life-style related risk factors which are in part independent of a social gradient. The results also suggest that the tendency to change unhealthy behavior is less pronounced in "high risk" groups.

Social relations and smoking behavior: results from the first MONICA Survey Augsburg.

This study examines the relationship between various aspects of social relations and the prevalence of smoking, using data from the first MONICA Survey, Augsburg, FRG, 1984/85. Study population of the survey was a two-stage cluster sample of 5312 men and women aged 25 to 64. The response was 79.4%. The measurement of social relations included a modified form of the Syme/Berkman social network scale, as used in the Alameda County Study. Analyses were carried out separately for the total four-level social network index in relation to smoking, and for specific components of that index (marital status, contacts with friends and relatives, activities in informal groups). The results showed for both men and women, that there was a significant association between the social network index and the prevalence of smoking: the more social ties and contacts, the lower the percentage of smokers. The results from multiple logistic regression analyses indicated an effect of social relations on smoking, that is at least partly independent of age, gender and educational level. In general, the findings may contribute to a better understanding of 'risk groups', and the possible pathways leading from social relations to health and disease.

Cardiovascular risk factors, ECG abnormalities and quality of life in subjects with atrial fibrillation.

In Central European regions epidemiologic findings for atrial fibrillation (AF) in a randomly selected population are not available. Therefore, information obtained by a standardized examination procedure including resting 12 lead ECG of 4003 participants (2014 men, 1989 women), aged 25 to 64 years, of the MONICA-Augsburg Survey 1984/85 were analysed. Reexamination of 3753 subjects took place three years later (Follow-up Study 1987/88). Persons with AF in the baseline survey (n = 13) were compared with an age-and sex-matched control group (n = 156) without AF, chosen from the same population sample, with regard to cardiovascular risk factors, associated disease and disturbances in the subjects' general well-being. In 1984/85 thirteen cases with AF (6 males, 7 females) were observed, giving an age-standardized prevalence of AF in males of 0.22% and in females of 0.34%. The age of men with AF ranged between 50 and 63 years and of women between 61 and 64 years. No significant differences were observed in persons with AF compared to the control group in risk factor levels and alcohol consumption; however, significant differences could be seen concerning disturbances in quality of life like self-reported health status (p < 0.001), sleep disturbances (p < 0.05), antihypertensive medication (p < 0.001). AF cases were found to have further ECG abnormalities significantly more often (left anterior hemiblock: p < 0.05; ventricular premature beats: p < 0.05). In all subjects with AF in the initial examination 1984/85 AF was found three years later (chronic AF). Overall 13 new cases (7 men, 6 women) were identified in the 1987/88 follow-up. The prevalence of AF in a South German population is comparable with AF prevalences reported from studies in other populations (e.g.) Framingham 1950, Reykjavik 1967/70). Associated ECG abnormalities were found more frequently in subjects with AF. Cases with AF have considerable disturbances in their general well-being.