A tribute to Theodor M. Fliedner.
Explore the source record for details and available documents.
Germany↗
Biomedical subjects
T M Fliedner
Publications and source records attributed to T M Fliedner.
Elevated liver enzyme activity in construction workers: prevalence and impact on early retirement and all-cause mortality.
BACKGROUND: Gamma-glutamyl transferase (GGT), alanine transaminase (ALT), and aspartate transaminase (AST) are widely used as markers of hepatobiliary disorders in occupational health surveillance. Little is known, however, about the prevalence and occupational and non-occupational determinants of elevated levels of these enzymes in specific occupational groups or about the prognostic value of elevated levels with respect to long-term outcomes such as all-cause mortality and vocational disability. METHODS: A cohort study was conducted among 8,043 male construction workers aged 25-64 years who had undergone occupational health examinations in 6 centers in southern Germany from 1986 to 1988 and had been followed until 1994. The prevalence of elevated levels of GGT, ALT, and AST, depending on the sociodemographic and medical characteristics determined at the baseline examination and the risk of vocational disability and all-cause mortality in relation to elevated liver enzyme activity at baseline were assessed. Covariates considered in multivariate analysis included age, nationality, occupation, body mass index (BMI), smoking, and alcohol consumption. RESULTS: The baseline prevalence of elevated activity levels of GGT (>28 U/1 at 25 degrees C), ALT (>22 U/1), and AST (>18 U/1) was 32%, 22%, and 12%, respectively. Factors most strongly related to elevated serum activity levels for all three enzymes were self-reported alcohol consumption, diabetes, and hypertension. BMI was strongly associated with elevations in GGT and ALT but not in AST. Elevated levels of AST and GGT were strongly related to early retirement and all-cause mortality. Men with AST levels exceeding 18 U/1 had a 2-fold risk of early retirement and a 3 times higher risk of all-cause mortality as compared with men with lower AST levels. No significant association was observed between ALT and either of the long-term outcomes. CONCLUSIONS: Our findings suggest that screening for elevated GGT and AST levels, which are a common finding among construction workers, may be a powerful tool for the identification of individuals at increased risk of early retirement and preterm mortality and may be helpful in targeting of prevention efforts.
Adult↗
A pragmatic implementation of medical temporal reasoning for clinical medicine.
In most development tools for knowledge-based systems object-property-value-triples are the basic ontological representation. We have extended this approach for temporal reasoning by replacing the values with time-objects. A time-object is a combination of a value with a time-point or a time-interval. By preserving the object-property-value-triples basic artificial intelligence techniques can be applied without modifications in the temporal case. The greater complexity of temporal inferences is compensated by a blackboard control architecture enabling small knowledge-sources. The control of the strategic reasoning is in accordance with the select and test model. A prototype of a knowledge-based advisor for the acute radiation syndrome has been implemented and partially evaluated. Due to the affected proliferative tissues it is a strongly time-oriented medical domain.
Acute Disease↗
Providing dermatological photographs using the multimedia extension of the international computer database for radiation accident case histories.
The World Health Organisation (WHO) Radiation Emergency Medical Preparedness (REMPAN) centres have built up the International Computer Database for Radiation Accident Case Histories (ICDREC) to document the medical treatment of acute radiation syndrome (ARS) patients. Images play an increasing role as complementary information beside text and numerical data in medicine. In particular, retrieval and display of digitised skin photographs serve to improve patient care, medical education and scientific analysis concerning the cutaneous radiation syndrome (CRS). The ICDREC has been built up as a client/server system. Particular focus has been set on using commercial off-the-shelf software components. All the medical data including the multimedia data are stored in a relational database system. The database can be accessed by inexpensive personal computers in the physician's workplace. Retrieval of one photograph via local area network (LAN) requires approximately 3 s. Authorised institutions can access the database via the Internet. The current state of the ICDREC multimedia component is illustrated with the skin lesion treatment of a Chernobyl patient. An example is given on how the workflow in a dermatology department is supported by the ICDREC.
Databases, Factual↗
Early retirement due to permanent disability in relation to smoking in workers of the construction industry.
Little is known about the relation of cigarette smoking and early retirement due to permanent disability. We conducted a cohort study among 4796 construction workers aged 40 to 59 who underwent occupational health examinations in 1986-1988 in occupational health centers located in the southern region of Germany. They were followed up with respect to working status until July 1994. The effect of smoking on early retirement due to permanent disability was assessed using the Cox proportional hazard model. Overall, smoking prevalence at baseline was 52%. The relative rate (RR) for permanent disability was 1.3 (95% CI 1.0-1.8) for all current smokers, compared with never-smokers. A positive dose-response relationship between smoking and the rate of early retirement due to permanent disability was found after adjustment for covariates. RR ranged from 1.3 in persons who reported smoking 1-19 cigarettes a day to 1.6 in persons who reported smoking > or = 30 cigarettes a day (P value for trend = 0.02). These findings underline the need for comprehensive efforts at the workplace to reduce smoking and its negative consequences for the individual, as well as to limit the associated social burden for society.
Adult↗
A multimedia database for dermatology.
The World Health Organisation (WHO) Radiation Emergency Medical Preparedness (REMPAN) centres have built up the International Computer Database for Radiation Accident Case Histories (ICDREC) to document the treatment of acute radiation syndrome (ARS) patients. Radiation induced skin lesions may cause severe late effects in radiation accident patients. Dermatological multimedia documentation is included into the ICDREC. In particular, retrieval and display of digitised skin photographs and medical reports serves to improve patient care, medical education, and scientific analysis concerning the cutaneous radiation syndrome (CRS). The database has been built up as a client/server system. A particular focus has been set on using commercial off-the-shelf software components. The medical data including the multimedia data are stored in a relational database system. The database can be accessed by inexpensive personal computers in the dermatologist's workplace. Authorised institutions can access the database via the Internet. Retrieval of one skin photograph via local area network (LAN) requires approximately 3 seconds. The current state of the application is illustrated with the skin lesion treatment of a Chernobyl patient. An example is given on how to access the ICDREC from a dermatologist's desktop personal computer. The discussion focuses on the advantages of storing the textual and pictorial data in one central database to be accessed from different care centres and how the results can be generalised for medical multimedia information systems.
Dermatology↗
Disorders of the back and spine in construction workers. Prevalence and prognostic value for disability.
STUDY DESIGN: A cohort study on back-related morbidity and its impact on early retirement resulting from disability among employees in the construction industry. OBJECTIVE: To describe the prevalence of back-related morbidity according to different measures in various occupational groups and to assess the prognostic value of these measures for early retirement resulting from disability. METHODS: The results of occupational health examinations conducted in 1986-1988 among 4,958 employees of the German construction industry aged 40-64 years were analyzed. Active follow-up evaluation was carried out between October 1992 and July 1994 to ascertain employment status. RESULTS: Compared with that of white-collar employees, no excess risk for self-reported back pain or sciatica was seen for any of the manual professions. In contrast, the age-adjusted prevalence of clinical findings of the spine was elevated among all employees in manual professions, and the prevalence of a recorded diagnosis related to disorders of the back and spine (ICD-9 position 720-724) was elevated among bricklayers compared with white-collar employees. The relative risk of being granted a disability pension in the follow-up period was 1.6 (95% Confidence Interval [Cl], 1.3-2.1) for persons reporting back pain or sciatica, 1.8 (95% Cl, 1.4-2.2) for persons with an abnormal clinical finding of the spine, and 1.5 (95% Cl, 1.2-1.8) for persons with a recorded medical diagnosis related to disorders of the back or spine (ICD-9 720-724). CONCLUSION: Patterns of morbidity varied according to the evaluated morbidity measure. All three measures qualified as significant predictors of disability and helped to identify high-risk occupations and high-risk employees.
Back Pain↗
Changes in the repair capacity of blood cells as a biomarker for chronic low-dose exposure to ionizing radiation.
The purpose of this study was to examine whether changes in the repair capacity of blood cells could be used as a valuable biomarker for radiation exposure. To characterize the repair kinetics in nonirradiated and irradiated cells we first performed in vitro split dose experiments. DNA damage and DNA repair capacity were analysed using the comet assay. Our results showed that the first in vitro irradiation affects the repair system of the cells, resulting in a decreased repair capacity after the second irradiation. Furthermore, the second irradiation results in a large amount of DNA damage in the blood cells. To test whether the analysis of the DNA repair capacity after in vitro irradiation is also a valuable method for in vivo studies of donors exposed to radiation, we analysed the repair capacity of blood cells of two exposed groups: patients subjected to a radioiodine therapy and chronically irradiated volunteers from the Chernobyl region. Both groups also showed a significantly impaired repair capacity indicating a stress on the hematopoietic system. In addition, in the group of the Ukrainians DNA damage after in vitro irradiation was significantly higher than in a control group. These results lead to the presumption that the repair capacity and the DNA damage after in vitro irradiation might be a very useful biological marker for radiation exposure in population monitoring.
Adolescent↗
Criteria for the selection of radiation accident victims for stem cell transplantation.
The management of acute radiation syndrome in persons inadvertently exposed to total-body irradiation greatly benefits from the experience gained in previous clinical management situations. Within the framework of exposure to high doses, one of the most critical issues is the question of whether hematopoietic stem cell transplantation is indicated. A valid answer can be given with appropriate accuracy based on a thorough analysis and evaluation of all accessible case histories. Based on the clinical evaluation of patients severely affected with acute radiation syndrome, the following recommendations may be issued. There is limited indication for stem cell transplantation when there is accompanying severe radiation damage to organ systems other than the hematopoietic system. The optimum duration of pancytopenia can be estimated using the biomathematical model introduced in this article.
Acute Disease↗
Body weight, pre-existing disease, and all-cause mortality in a cohort of male employees in the German construction industry.
The impact of body weight on all-cause mortality is subject to ongoing debate. We assessed the relation between body mass index (BMI) and all-cause mortality in a cohort of 8043 male employees in the German construction industry who underwent detailed occupational health examinations at ages 25-64 and who were followed for all cause mortality over an average period of 4.5 years. Overall, there was a negative, graded relation between BMI and all-cause mortality, which persisted after controlling for multiple covariates including age and cigarette smoking, and after excluding the initial two years of follow-up. There was a strong positive cross-sectional relationship between BMI and a medical diagnosis of diabetes, hypertension, and ischemic heart disease at the baseline examination. While BMI showed a strong negative relation with all-cause mortality among men with such diseases, the association was much weaker and non-monotonic for mean free of these diseases. Our results underline the importance of preexisting diseases for the prognostic value of body weight.
Adult↗
The association between alcohol consumption and all-cause mortality in a cohort of male employees in the German construction industry.
BACKGROUND: Many epidemiological studies have shown a J- or U-shaped association between alcohol consumption and total mortality. It has been argued that the higher mortality among abstainers than among moderate drinkers might result from misreporting of alcohol consumption, confounding or inclusion of a high proportion of ex-drinkers or individuals with pre-existing diseases among abstainers. METHODS: These concerns were addressed in a cohort study among 8043 construction workers aged 25-64 years who underwent occupational health examinations at six centres in South West Germany during 1986 to 1988. Abstainers were compared with alcohol users with respect to biological markers of alcohol consumption, prevalence of pre-existing diseases and other covariates. Study participants were followed for all-cause mortality until 1994. RESULTS: There was a clear monotonic dose-response relationship of biological markers with self-reported alcohol consumption. Prevalence of pre-existing diseases was highest among heavy drinkers, while no major differences were observed between abstainers and men who consumed 1-49 g of alcohol per day. Overall, 172 men died during the follow-up period. There was a strong U-shaped relationship between alcohol consumption and total mortality. Mortality was 2.8 times higher (95% confidence interval [CI]: 1.5-5.4) among non-drinkers than among men who consumed 1-49 g of alcohol per day after control for potential confounders in multivariable analyses. Strongly increased mortality was also found among heavy drinkers. Exclusion of non-drinkers with pre-existing diseases did not change the U-shaped association. CONCLUSIONS: We found a strong U-shaped association between alcohol consumption and all-cause mortality which is unlikely to be explained by misreporting, confounding or pre-existing disease.
Adult↗
Chronic respiratory disease morbidity in construction workers: patterns and prognostic significance for permanent disability and overall mortality.
The aim of this study was to determine chronic respiratory disease morbidity in construction workers, and to assess the prognostic value of various morbidity measures on permanent disability and on all-cause mortality. Subjects in this analysis were male employees in the German construction industry, aged 40-64 yrs, who were examined by the occupational health service between August 1986 and December 1988. Prevalence of respiratory disorders as characterized by: 1) pathological findings on lung auscultation; 2) reduced forced expiratory volume in one second (FEV1); and 3) a medical diagnosis of chronic respiratory disease (International Classification of Diseases 9th revision (ICD-9) 490496) was assessed among occupational groups of construction workers, and compared with prevalence among white-collar employees. Active follow-up was conducted between October 1992 and July 1994 to ascertain working and life status (completeness: 92 and 96%, respectively). The prognostic value of the morbidity measures on permanent disability and on all-cause mortality was assessed using the Cox proportional hazards model. In the entire cohort, crude prevalence was 7.6% for pathological findings on lung auscultation, 8.8% for a reduced FEV1 (<70% of predicted value), and 6.1% for a recorded diagnosis of chronic respiratory disease. There was strong variation of prevalence with age, smoking status and, less clearly, occupation. The relative risk for permanent disability varied between 1.9 and 3.2, and for mortality between 2.0 and 2.9, respectively, when men with the various measures of bronchopulmonary disorders were compared with other men. The morbidity measures utilized allow the identification of employees at higher risk of disability and death, and this may facilitate targeting of specific prevention and rehabilitation measures.
Adult↗
Visual Health Information Profile (VHIP). A quantitative approach for analysing the health status of a population.
A new approach for illustrating and analysing the health status of a given population is presented. The concept takes the multi-dimensional nature of health into account. It is based on a clearly out-lined indicator hierarchy, a decile reference system and a computerised information system. The instrument displays the health status of a population and allows comparisons to be made of various health aspects for a given population at different times and allows comparisons to be made of different populations during given time periods. It is possible to represent quantitative and qualitative aspects of health, to monitor the impact of interventions, and to assess the extent to which objectives in the health field have been achieved. Therefore, it can serve as an instrument for communication between policy makers and scientists to manage and to co-ordinate programs that aim at an improvement of the health status and to assist in the priority setting process. The method was applied to several countries using the World Health Organisation's (WHO) "Health For All Global Indicator Database" as the main data source. Country and region specific health status patterns could be generated showing the practicability of the approach. Using a computerised information system, a high degree of transparency and flexibility with respect to the input data and the choices of measurables was achieved.
Computer Graphics↗
The critique of DALYs: a counter-reply.
The DALY Review Group of the WHO Advisory Committee on Health Research (ACHR) believes that, unless they are constructed purely as an intellectual exercise, indicators should have a function--ultimately to guide decision-making about resource allocation. Disability-adjusted life years (DALYs) obscure too much and in its present stage of development the DALY approach does not solve the problem of prioritization and of resource allocation and may yet turn out to have been a side-track.
Persons with Disabilities↗
Internet access to a medical case repository for teaching and analysis.
The acute radiation syndrome is a rare disease. Teaching its treatment and the achievement of scientific progress require a sufficient number of accessible case histories. An information system for standardized recording of acute radiation syndrome case histories has been established in the framework of the World Health Organization Radiation Medical Emergency Preparedness and Assistance Network Centers. The information system has been realized in client/server architecture. The centers are able to access the database by easy to use graphical user interfaces via the Internet. Focusing on optimization of network traffic and flexible information retrieval the hypertext transfer protocol has not been applied. At the moment the system is tested on the campus of the University of Ulm before it will be installed at the other centers.
Acute Disease↗
Surface antigen expression on CD34+ cord blood cells: comparative analysis by flow cytometry and limiting dilution (LD) RT-PCR of chymopapain-treated or untreated cells.
Expression of antigens coexpressed on cord blood (CB) CD34+ cells was evaluated by flow cytometry analysis and reverse transcriptase polymerase chain reaction (RT-PCR). Antigen expression was also comparatively analyzed by flow cytometry and limiting dilution (LD) RT-PCR to investigate effects of chymopapain on epitopes of several cell surface markers: LD RT-PCR allows detection of the expression of antigens degraded by chymopapain which are not identified by flow cytometry. Monoclonal antibodies (MoAbs) that recognize chymopapain resistant epitopes on several coexpressed cell surface markers were identified: these included MoAbs directed against CD11a, CD13, CD18, CD38, CD45RO, CD51, HLA-DR, Thy-1, c-kit, flt-3 (STK-1), and mdr-1. Interestingly, chymopapain treatment caused enhanced staining with MoAbs against HLA-DR, Thy-1, flt-3, mdr-1, and CD51. The frequency (LD RT-PCR) of CD18, CD38, Thy-1, and c-kit RT-PCR signals on pure sorted CD34+ CD18-, CD34+ CD38-, CD34+ Thy-1-, and CD34+ c-kit- cells, respectively, was similar in corresponding subsets treated or not with chymopapain. In contrast, the frequency of CD33 RT-PCR signals on sorted CD34+ CD33- cells was higher in chymopapain-treated samples than in untreated samples and thus confirmed at the transcriptional level that the epitope recognized by anti-CD33 is chymopapain sensitive. Our findings extend data on the phenotypic profile of CB CD34+ cells and show that several key cell surface markers of hematopoietic progenitor cells are chymopapain resistant. In addition, the results of the present study demonstrate that the RT-PCR can be applied to the analysis of multiple RNA species in small numbers of hematopoietic progenitor cells and show that LD RT-PCR allows the identification and frequency determination of rare cells which are undetectable by flow cytometry.
Antibodies, Monoclonal↗
Smoking patterns and mortality attributable to smoking in a cohort of 3528 construction workers.
This study describes the smoking patterns of 3528 construction workers as reported at occupational health examinations, in four occupational health centres located in the South of Germany, conducted between August 1986 and December 1988. Subjects were aged 20 to 59 years and were working as plumbers, carpenters, painters or varnishers, plasterers, bricklayers, unskilled workers or white collar employees. Overall smoking prevalence was 53.5%. It was considerably higher than in a representative population sample of the same age groups. Active follow up was carried out to ascertain vital status between October 1992 and July 1994. The effect of smoking on all cause mortality was assessed using the cox proportional hazard model. The relative risk of current smoking was 2.5 (95% CI 1.4-4.4) after adjustment for age, profession, self reported alcohol consumption, body mass index, nationality, and company size. 60% of the deaths among smokers and 34% of deaths in the whole cohort were attributable to smoking. These findings underline the need for comprehensive efforts to reduce smoking and its negative consequences in the occupational group.
Adult↗
Stem cell responses after radiation exposure: A key to the evaluation and prediction of its effects.
A biomathematical model of granulocytopoiesis is described and used to analyze the blood granulocyte changes seen in the blood of dogs and humans after continuous and after acute external radiation exposure. This allows to relate the cell change pattern seen to the extent of stem cell damage in the hematopoietic bone marrow distributed as semi-autonomous units throughout the skeletal bones. The model is described briefly and consists of 8 cellular and 2 regulatory compartments and is described by 37 differential equations. With the help of this model, it can be shown that the chronic radiation exposure of dogs at a rate of between 0.003 and 0.12 Gy per day results in a system failure with subsequent death of the animal, if the stem cell pool decreases below 2.5% of its normal content. In human beings exposed to a single radiation exposure (as seen in radiation accidents) the simulation of the granulocyte pattern results in the finding that a reduction of the stem cell pool to 5-10% of normal is compatible with the assumption of its "reversible" damage (to be treated by conventional replacement therapy including cytokines), whereas the reduction of blood granulocytes to levels of less than 200-300 per mm3 on day 5-6 after exposure indicates that no stem cells remain from which a spontaneous regeneration could occur and hence would require a substitution therapy by stem cell transplantation. In order to test the approach, the same model was used to correlate the changing granulocyte pattern seen after autologous blood stem cell transfusion in patients treated with a supralethal radiochemo conditioning regimen. The results indicate a proportionality of progenitor cells in the transfusate with the calculated stem cell number of the modeling exercise. It is proposed to use the pattern of granulocyte changes in the blood as a principal indicator to predict the outcome of a radiation exposure and to select appropriate therapeutic strategies.
Animals↗