Search PubMed⌕ Search

Biomedical subjects

H Brenner

Publications and source records attributed to H Brenner.

At least 37 records · Page 2Linked to original sources
PubMed2001

Socio-demographic factors, health behavior and late-stage diagnosis of breast cancer in Germany: a population-based study.

Late-stage diagnosis of breast cancer is associated with poor survival. Identification of individuals at high risk of late-stage diagnosis could be an effective step to reduce breast cancer mortality. We examined the association of socio-demographic factors and health behavior with breast cancer stage in a population-based sample of 380 female breast cancer patients in Saarland, Germany. Overall, 182 women (47.9%) were diagnosed with late-stage (regional or distant) breast cancer. After control for potential confounding by multivariate logistic regression, an increased risk of late-stage diagnosis was observed for older age (OR = 1.8; 95% CI 1.0-3.2), foreign nationality (OR = 3.9; 95% CI 0.7-20.8), living in large households (OR = 1.7; 95% CI 1.0-2.9), non-participation in general health check-up (OR = 1.5; 95% CI 0.9-2.4) and low interest in health care (OR = 1.6; 95% CI 1.0-2.7). The proportion of late-stage cancer was clearly decreased when tumors were detected by screening (OR = 0.4; 95% CI 0.2-0.8). Certain socio-demographic factors and characteristics of health behavior seem to represent independent risk indicators of late-stage diagnosis.

Adult↗
PubMed2001

Helicobacter pylori colonization and diarrhoeal illness: results of a population-based cross-sectional study in adults.

It has been suggested that Helicobacter pylori colonization may protect against diarrhoeagenic gastrointestinal infections. The aim of this analysis was to investigate the association between H. pylori infection and the frequency of diarrhoeal episodes among adults. Helicobacter pylori infection status was determined by 13C-urea breath test. Overall, 784 adults (mean age: 48.7 +/- 17.7; range 18-85 years) who participated in two epidemiological studies were included in the analysis. Overall H. pylori prevalence was 25.5%. Episodes of diarrhoea within prior 3 months were less often reported for H. pylori infected subjects compared with H. pylori negative subjects (40.2 vs. 51.6%, p = 0.016). Compared to H. pylori negative subjects the odds ratio (OR) for the occurrence of diarrhoea within the prior 3 months was 0.63 (95% CI: 0.45-0.87) for H. pylori infected subjects. After adjustment for covariates the OR was 0.67 (95% CI: 0.47-0.95). These results support the hypothesis that colonization with H. pylori may protect from gastrointestinal infections that cause diarrhoea.

Adult↗
PubMed2001

Characteristics of differences in Helicobacter pylori serology and 13C-urea breath-testing in an asymptomatic sample of blood donors.

Numerous tests, both invasive and non-invasive, are available for the diagnosis of Helicobacter pylori infection. The aim of this study was to evaluate the extent and determinants of differences in serology and 13C-urea breath test (13C-UBT) in diagnosing H. pylori. Four-hundred-and-seventy-four asymptomatic blood donors aged 40 to 68 years (mean age 55.8 years) and of German nationality were recruited between October 1996 and November 1997. H. pylori infection was measured with 13C-UBT and with a commercial IgG-ELISA test (Medac; Hamburg, Germany). A standardized questionnaire was applied to identify factors which could explain discrepant results of 13C-UBT and serology. Prevalence of infection was similar according to both tests (33.1% for 13C-UBT and 30.8% for serology). From the 146 subjects with a positive serology, 121 (82.7%) had a positive 13C-UBT. Previous treatment of H. pylori infection was the strongest predictor of a negative 13C-UBT given positive IgG serology (odds ratio (OR)= 12.87, 95% CI=4.10-40.36). Coffee consumption of more than 3 cups/day was also associated with an increased odds of a negative 13C-UBT given positive serology (OR = 3.12, 95% CI=1.16-8.43). No significant determinants of positive 13C-UBT given negative serology could be identified. These findings suggest a delayed fall in serum antibodies following eradication of the infection to be a major source of differences in H. pylori diagnosis using non invasive 13C-UBT and serology.

Antibodies, Bacterial↗
PubMed2001

Non-insulin dependent diabetes mellitus (NIDDM) and patterns of osteoarthritis. The Ulm osteoarthritis study.

OBJECTIVES: Despite recent advances regarding the role of diabetes with respect to cartilage metabolism, epidemiologic data to quantify the role of diabetes in the development of osteoarthritis (OA) are sparse. METHODS: OA patterns were studied in 809 patients with knee or hip joint replacement due to OA. NIDDM was defined by a history of physician diagnosed diabetes or use of antihyperglycemics. RESULTS: Patients with NIDDM had more often bilateral OA (adjusted odds ratio (OR)=2.2; 95% confidence interval (CI): 0.8-6.4). No association between NIDDM and generalized OA (adjusted OR= 1.0; 95%CI: 0.5-1.9) was observed. CONCLUSIONS: Our results are consistent with the hypothesis that NIDDM might be a potentially important systemic risk factor for knee and hip OA, but chance cannot be ruled out as an alternative explanation.

Aged↗
PubMed2001

Hysterectomy and patterns of osteoarthritis. The Ulm Osteoarthritis Study.

OBJECTIVE: To determine the association between hysterectomy (HE) and patterns of osteoarthritis (OA) METHODS: We performed a large cross-sectional study including 504 female patients admitted for arthroplasty of knee or hip joint. Patients with OA were categorized as having bilateral or generalized OA (GOA) according to the presence of radiographic OA in the contralateral or different finger joints. Odds ratios (OR) and their 95% confidence intervals (CI) for the association between HE and OA patterns were estimated adjusting for potential confounders. RESULTS: Hysterectomy (HE) was reported by 24.9 percent of the patients. Bilateral OA was present in 86.2 percent and GOA was present in 33.3 percent of the patients. HE was not associated with bilateral OA (adjusted OR=0.9; 95% CI: 0.5-1.8) but with a lower prevalence of GOA (adjusted OR=0.6; CI: 0.3-0.99). CONCLUSION: In contrast to earlier studies our results suggest that HE might be a marker for a reduced risk for a generalized pattern of OA.

Age Distribution↗
PubMed2001

Alcohol intake and high density lipoprotein-cholesterol: comparison of food frequency questionnaire and diet record in a general population sample.

BACKGROUND: Moderate alcohol consumption is known to affect several cardiovascular risk factors, including high density lipoprotein-cholesterol (HDL-C). Accurate measurement of alcohol intake in epidemiological studies is crucial for valid estimation of alcohol-related effects. METHODS: We compared two widely used alcohol-intake assessment methods, a food frequency questionnaire (FFQ) and a 7-day diet record (DR) regarding the association between alcohol intake and HDL-C in the general population. RESULTS: In a representative sample (842 men, 1103 women) of the population of former West Germany (VERA study), 75.6% of the participants reported drinking alcoholic beverages in the FFQ, whereas the percentage was 84.9% according to the DR. The median daily alcohol intake of consumers was 10.3 and 12.1 g, as assessed by the FFQ and the DR, respectively. There was moderate agreement between reported consumption levels ranked by quintiles according to FFQ and DR (kappa = 0.49). With both approaches alcohol intake showed a strong positive association with HDL-C in linear regression models. The estimated increases in HDL-C (mg dL(-1)) per gram alcohol per day from the FFQ and DR were 0.15 [95% confidence interval (CI): 0.12-0.18] and 0.14 (95% CI: 0.11-0.17), respectively. When participants with different classification of the amount of alcohol consumed by FFQ and DR were excluded from the analysis, the association between alcohol intake and HDL-C was more pronounced. DISCUSSION: Our analyses suggest that both FFQ and DR lead to similar results regarding the alcohol-HDL-C association in the general population, despite major differences in the recorded prevalence of drinking and amount of alcohol consumed. Both methods may tend to under-estimate the true alcohol-HDL-C association.

Adult↗
PubMed2001

Degree of matching and gain in power and efficiency in case-control studies.

Frequency matching can be used to increase the precision and power of case-control studies. Unmatched and frequency-matched designs are only two distinct possibilities of control selection in a continuum regarding the frequency of the matching factor in controls. We assessed the power and efficiency of case-control studies under a variety of assumptions regarding the prevalence and the effects of the matching factor and the exposure of interest as well as their association in the population. For each set of parameters, we simulated 10,000 case-control studies varying the degree of matching, that is, the proportion of the matching factor in selected controls over a wide range including the proportion in cases (matched design) and the population (unmatched design) as two special options. Traditional frequency matching increased the precision and power in most scenarios, but most of the gain was often achieved by incomplete (less than perfect) matching. Even greater gains were sometimes observed by increasing the prevalence of the matching factor in controls above the one in cases. In the scenarios assessed, perfect matching was neither necessary nor the optimum degree of matching in many circumstances. It might be worthwhile to evaluate the optimum degree of matching for specific settings in the design of case-control studies.

Case-Control Studies↗
PubMed2001

Alcohol as a gastric disinfectant? The complex relationship between alcohol consumption and current Helicobacter pylori infection.

Alcoholic beverages have antimicrobial effects against Helicobacter pylori in vitro. To elucidate the relation between alcohol consumption and current infection with H. pylori in vivo, we carried out a pooled analysis of three recent studies from Southern Germany, comprising 1410 adults age 15 to 69. Detailed information on consumption of various alcoholic beverages was collected through standardized questionnaires. Helicobacter pylori infection was measured by 15C-urea breath test. Overall, prevalence of current H. pylori infection was lower among subjects who consumed alcohol (34.9%) than among nondrinkers (38.0%). The adjusted odds ratio was 0.79, with a 95% confidence interval of 0.58-1.08. Furthermore, alcohol consumption showed a strong inverse relation to the result of the 13C-urea breath test, a semiquantitative measure of the bacterial load, among infected subjects. The inverse association between alcohol consumption and H. pylori infection was not monotonic, however. Odds of infection were lowest at moderate levels of alcohol consumption and increased at higher levels of alcohol consumption, regardless of the type of alcoholic beverages consumed. These results support the hypothesis that moderate alcohol consumption may favor suppression and eventual elimination of H. pylori infection. At higher levels of alcohol consumption, the antimicrobial effects of alcoholic beverages may be opposed by adverse systemic effects of drinking, such as adverse effects on the immune defense.

Adolescent↗
PubMed2001

Coronary heart disease risk reduction in a predominantly beer-drinking population.

Moderate alcohol consumption protects against coronary heart disease, but there is ongoing debate about whether the effects and the underlying mechanisms differ by type of alcoholic beverage. In our case-control study from Germany, we assessed and compared the effect of alcohol consumption from various sources on risk of coronary heart disease and its underlying mechanisms. The sample included 312 patients with clinically stable, angiographically confirmed coronary heart disease and 479 healthy controls. After control for potential confounding factors, the odds ratio for coronary heart disease was 0.55 (95% confidence interval = 0.37--0.83) for drinkers compared with nondrinkers. Risk reduction was particularly strong among the majority of study participants who reported drinking predominantly or exclusively beer. Alcohol consumption from various sources was consistently associated with a more favorable profile of lipids and hemostatic factors. Nevertheless, a strong inverse association persisted between beer drinking and coronary heart disease even after control for these "intermediate variables." Our results support suggestions that the protective effect of moderate alcohol consumption against coronary heart disease is mediated in part by beneficial effects of ethanol on lipids and hemostatic factors. Additional mechanisms may account for the strong protective effect of moderate beer consumption.

Adult↗
PubMed2001

Helicobacter pylori infection and serum ferritin: A population-based study among 1806 adults in Germany.

OBJECTIVE: Helicobacter pylori may possibly affect the iron metabolism by occult bleeding, impaired absorption of non-hem iron, and by scavenging hem iron or ferritin, as some studies have suggested. The aim of this study was to analyze the association between H. pylori infection and serum ferritin, a marker of the body iron stores. In this analysis, we paid particular attention to the role of dietary iron intake and CagA, an established virulence factor of the agent. METHODS: The analysis is based on a cross-sectional national health and nutrition survey among healthy people in Germany conducted in 1987/1988. The examination included a detailed questionnaire on medical history and lifestyle factors, a 7-day food record, and blood samples. Infection with H. pylori was measured serologically by ELISA and Westernblot. RESULTS: In total, 39.2% of 1806 persons aged 18 to 89 yr included in the study were H. pylori positive, of whom 57.6% had an infection with a CagA-positive H. pylori strain. Age- and sex-adjusted geometric mean of ferritin was 54.5 microg/dl among H. pylori-infected compared with 63.8 microg/dl among uninfected persons. A multiple linear regression model with log-transformed serum ferritin concentration as dependent variable and H. pylori infection and several potential confounding factors as independent variable was fitted. In this model, H. pylori infection was associated with a 17.0% decrease of the serum ferritin concentration (95% CI = 9.8-23.6). The association between H. pylori infection and serum ferritin levels did not vary by gender, age, and iron intake, and it was similar for CagA-positive and CagA-negative H. pylori infections. CONCLUSIONS: The decreased serum ferritin concentration among subjects infected with H. pylori might be induced by the uptake of ferritin in the stomach by H. pylori. Possible health implications of H. pylori-induced low ferritin levels warrant further investigation.

Adolescent↗
PubMed2001

Demonstration of the healthy worker survivor effect in a cohort of workers in the construction industry.

OBJECTIVES: To assess the potential of a healthy worker survivor effect due to differential occupational mobility in a cohort of construction workers. METHODS: A cohort of 10 809 male employees in the German construction industry aged 15-64 years was followed up for occupational mobility, early retirement due to permanent disability, and total mortality from 1986 to 1994. Using the Cox's proportional hazards model of relative rates (RRs) with 95% confidence intervals (95% CIs) of occupational mobility, early retirement and total mortality were estimated according to medical diagnoses at baseline after adjustment for various covariates. RESULTS: During follow up, 2472 subjects changed employment, 359 employees were granted a disability pension for health reasons and 188 subjects died. A wide range of chronic diseases was associated with increased rates of early retirement and total mortality but not occupational mobility. However, a healthy worker survivor effect was identified related to disorders of the back and spine (ninth revision of the international classification of diseases, ICD-9, code 720-4), a common predictor of both occupational mobility (RR 1.17, 95% CI 1.04 to 1.32) and early retirement (RR 1.50, 95% CI 1.20 to 1.88). In total, there were about as many events of occupational changes (n = 41) as events of early retirement due to permanent disability (n = 39) significantly attributable to disorders of the back and spine. Differential occupational mobility preceded differential early retirement due to permanent disability by more than one decade. CONCLUSIONS: These findings show the need to consider a healthy worker survivor effect due to occupational mobility in occupational epidemiological research. Furthermore these results underline the necessity of further health promotion targeting work related conditions in the construction industry.

Adolescent↗
PubMed2001

Current infection with Helicobacter pylori, but not seropositivity to Chlamydia pneumoniae or cytomegalovirus, is associated with an atherogenic, modified lipid profile.

Infectious agents may be involved in atherothrombogenesis. The potential pathogenic pathway, however, remains unclear. We investigated the association between various infectious agents and lipoproteins known to have an atherogenic effect. We recruited 470 healthy blood donors and 238 patients with angiographically proven coronary heart disease (CHD), aged 40 to 68 years. Seropositivity to Chlamydia pneumoniae (CP), chlamydial lipopolysaccharide, and cytomegalovirus (CMV) was determined; infection with Helicobacter pylori (HP) was assessed by using the [(13)C]urea breath test. In all subjects, total cholesterol, high density lipoprotein (HDL) cholesterol, lipoprotein(a), and various apolipoproteins (apos) were determined. In unadjusted analysis, mean HDL cholesterol concentration was significantly decreased in HP-positive healthy subjects (1.36 vs 1.44 mmol/L, P=0.006) compared with HP-negative subjects. The HDL cholesterol to total cholesterol ratio was significantly decreased in HP-positive (0.259 vs 0.276, P=0.01) and CP-seropositive (0.266 vs 0.280, P=0.04) healthy subjects compared with (sero)negatives. Mean apoAI levels were significantly lower in HP-positive healthy subjects (1.46 vs 1.51 g/L, P=0.03) and in CMV-positive healthy subjects (1.47 vs 1.52 g/L, P=0.01) compared with (sero)negative subjects. After multivariable adjustment by means of linear regression analysis, only the association between HP infection and decreased HDL cholesterol (P=0.002), decreased HDL cholesterol to total cholesterol ratio (P:=0.005), decreased apoAI (P=0.02), and increased apoB (P=0.02) persisted and remained significant. There was no independent association between other lipoproteins and serological markers of CP or CMV infection. Current infection with HP, but not seropositivity to CP or CMV, was associated with an atherogenic, modified lipid profile. These lipid alterations could explain, at least in part, the reported weak association between chronic HP infection and atherosclerotic diseases.

Adult↗
PubMed2001

Plasma fibrin D-dimer levels and risk of stable coronary artery disease: results of a large case-control study.

Increased levels of fibrin D-dimer are indicative of a hypercoagulable state, as found in acute coronary syndromes. Few well-controlled studies have assessed D-dimers in patients with stable coronary artery disease (CAD). We measured levels of D-dimers (in ng/mL by enzyme-linked immunosorbent assay) in 312 patients with angiographically proved CAD and stable angina pectoris and in 477 age- and sex-matched healthy blood donors. Demographic characteristics were assessed by a standardized questionnaire, and a complete lipid profile was performed for all subjects. In addition, a variety of other markers of hemostasis and inflammation were measured. The distribution of D-dimer levels was skewed to the right, and plasma median levels were higher in cases than in controls (median: 11.2 vs 2.8 ng/mL; P<0.001). In controls, correlations of D-dimer were found with fibrinogen, plasma viscosity, and interleukin-6. In logistic regression analysis, the age- and sex-adjusted odds ratio (OR) for the presence of CAD was 2.6 (95% confidence interval [CI], 1.9 to 3.5) when the highest quartile of the D-dimer distribution was compared with the combined lower 3 quartiles. The OR did not change appreciably after controlling for nonlipid risk factors (OR, 2.7; 95% CI, 1.9 to 3.9) and remained significant after further adjustment for other hemostatic parameters (OR, 2.4; 95% CI, 1.7 to 3.3) and markers of inflammation (OR, 2.1; 95% CI, 1.5 to 2.9). Plasma D-dimer levels are strongly and independently associated with the presence of CAD in patients with stable angina pectoris. These results support the concept of a contribution of intravascular fibrin to atherothrombogenesis.

Adult↗
PubMed2001

More up-to-date monitoring of long-term survival rates by cancer registries: an empirical example.

A few years ago, a new method of survival analysis, denoted period analysis, has been developed to derive more up-to-date estimates of long-term survival rates of cancer patients, but this method has rarely been applied so far. Using empirical examples from the Saarland Cancer Registry, we illustrate how seriously traditional long-term survival estimates may lag behind survival expectations of newly diagnosed cancer patients in the case of recent improvement in prognosis, and to what extent this problem may be reduced by period analysis of survival. We conclude that period analysis should be more widely used for deriving more up-to-date long-term survival estimates.

Aged↗
PubMed2000

Assessing the impact of classical risk factors on myocardial infarction by rate advancement periods.

The risk or rate advancement period (RAP) proposed by Brenner et al. (Epidemiology 1993;4:229-36) conveys information on the impact of a risk factor on the age dimension of chronic disease occurrence and may thus facilitate communication of epidemiologic findings. The RAP expresses how much sooner a given risk or rate of disease occurrence is reached among exposed than among unexposed individuals. The purpose of the present analysis was to derive estimates of RAPs for cardiovascular risk factors in relation to incident nonfatal and fatal myocardial infarction in middle-aged men of the Monitoring Trends and Determinants in Cardiovascular Diseases (MONICA) Augsburg cohort, Germany, between 1984 and 1995. RAPs were estimated based on Cox proportional hazards models. After multivariate adjustment, hypertension, smoking, and dyslipidemia were associated with RAPs of 8, 11, and 11 years, respectively, conditional on infarction-free survival to baseline and absence of competing risks. The RAP may be interpreted as that, on average, smokers are expected to advance their risk of myocardial infarction approximately 11 years compared with never/former smokers; for example, 50-year-old smokers are expected to carry the same risk of infarction as 61-year-old nonsmokers. The authors encourage the use and evaluation of the RAP as an effective risk communication tool in actual counseling situations.

Cohort Studies↗
PubMed2000

Inverse relationship between gastric colonization of Helicobacter pylori and diarrheal illnesses in children: results of a population-based cross-sectional study.

It has been suggested that carriage of Helicobacter pylori may protect against infections by exogenous intestinal pathogens. An analysis was done of all children who were screened for school fitness during 1996-1998 in Ulm, Germany, to compare rates of diarrheal illnesses in H. pylori-positive and H. pylori-negative children. Of 2477 5-8-year-old children studied, 304 (12.3%) were H. pylori-positive by carbon 13-labeled urea breath test. For H. pylori-positive children, diarrhea within the prior 3 months was less often reported than for H. pylori-negative children (54.3% vs. 76.1%; P<.001, adjusted for nationality). Compared with H. pylori-negative children, the odds ratio (OR) for the occurrence of diarrhea within the prior 3 months was 0.37 (95% confidence interval [CI], 0.28-0.49) for H. pylori-positive children; after adjustment for covariates, the OR was 0.56 (95% CI, 0.42-0.76). These data support the hypothesis that H. pylori colonization may protect against diarrheagenic gastrointestinal infections.

Child↗
PubMed2000

Obesity, overweight and patterns of osteoarthritis: the Ulm Osteoarthritis Study.

The objective of this study was to assess the association between obesity and osteoarthritis (OA) of the knee, hip, and hand. OA patterns were studied in 809 patients with knee or hip joint replacement due to OA. Patients with OA were categorized as having bilateral or generalized OA according to the presence of radiographic OA in the contralateral joint or different finger joints, and as normal weight, overweight, or obese according to their body mass index (BMI). Odds ratios (OR) and 95% confidence intervals (CI) for relative weight and OA patterns were estimated with multivariable logistic regression. Eighty-five percent of participants had bilateral OA, 26% had generalized OA, and 31% were obese. Obesity (BMI >/= 30 kg/m(2); OR = 8.1; 95% CI: 2.4-28) and overweight (BMI >/= 25 kg/m(2); OR = 5.9; 95% CI: 2.0-18) were strongly associated with bilateral knee OA. No association between obesity and bilateral hip OA (OR = 0.7; 95% CI: 0.3-1.7) nor generalized OA (OR = 1.1; 95% CI: 0.6-2.1) was observed. Obesity seems to be a mechanical rather than a systemic risk factor for OA with the knee joint being especially susceptible.

Aged↗