Biomedical subjects

Ulrich John

Publications and source records attributed to Ulrich John.

At least 19 recordsLinked to original sources

PubMed2007

[Improvement of medical care by supporting the intention to change health risk behavior].

A large proportion of disease and death cases could be prevented, if efficacious programs, particularly concerning tobacco smoking, obesity, and alcohol risk drinking, could be applied. Feasible approaches are based, among others, on the Transtheoretical Model of intentional health behavior change. This model allows to develop practical approaches to reduce risk factors of common diseases at the general population level. Evidence about the promotion of the intention to change health risk behaviors revealed successes, e. g., according to smoking cessation. The effects are growing by time. Intervention that is focused at the promotion of change of health risk behaviors can add to the improvement of health care.

Behavior Therapy↗

PubMed2007

The spectrum of thyroid disorders in adult type 1 diabetes mellitus.

BACKGROUND: Thyroid disorders such as goiter, nodules, autoimmune thyroid disease and thyroid dysfunction have rarely been investigated in adult type 1 diabetes mellitus. Our aim was to study the spectrum of thyroid disorders in adult type 1 diabetic subjects and compare them with results obtained from a sample of the general adult population. METHODS: The study population comprised 224 type 1 diabetic and 3481 non-diabetic subjects aged 20-69 years. Thyroid function (TSH, FT3 and FT4) and serum autoantibodies to thyroperoxidase (anti-TPO-Ab) were evaluated from blood samples. Thyroid structure and size were measured by ultrasound. RESULTS: Type 1 diabetic subjects had a higher risk of known thyroid disease [odds ratio (OR) 1.78, 95% confidence interval (CI) 1.11-2.85], a lower risk of goiter (OR 0.73; 95%-CI 0.54-0.99) and nodules (OR 0.54; 95%-CI 0.35-0.85), and a higher risk of anti-TPO-Ab >200 IU/mL (OR 1.94; 95%-CI 1.28-2.95) compared to the reference population. Furthermore, diabetic subjects had lower serum FT3 levels than the non-diabetic references (adjusted mean 5.00 pmol/L; 95%-CI 4.88-5.12 pmol/L versus 5.27 pmol/L; 95%-CI 5.24-5.30 pmol/L). CONCLUSIONS: Adult type 1 diabetes mellitus is associated with a decreased risk of goiter and nodules and an increased risk of thyroid autoimmunity. A diabetes-related low T3 syndrome may contribute to the differences in thyroid function between type 1 diabetic and non-diabetic subjects.

Adult↗

PubMed2007

Prevalence of oral mucosal lesions in a representative population.

OBJECTIVE: The aim of this study was to assess the prevalence and intraoral distribution of oral mucosal lesions in a representative adult population (Study of Health in Pomerania/Germany). METHOD AND MATERIALS: The study sample comprised 6267 randomly selected subjects who were scheduled for examination from 1997 to 2001 (population-based cross-sectional study; response rate: 69%; age range 20 to 81 years). RESULTS: The prevalence of oral mucosal lesions was age dependent (5.56% in 20- to 29-year-olds to 19.55% in 70- to 81-year-olds) with an overall prevalence of 11.83%. The prevalence in men (12.20%) was slightly higher than in women (11.40%). Exophytic neoplasia was the most prevalent alteration (3.00%), followed by leukoplakia simplex (prevalence 2.85%). Premalignant lesions were found in 0.57% of the participants, with lichen ruber mucosae contributing the major part (0.48%). Exophytic neoplasia was most often situated in the buccal mucosa, the hard palate, or the mucosa of the lower lip. CONCLUSION: These data stress the importance of screening for oral mucosal lesions, especially because of a predicted increase in the number of elderly persons in industrialized countries.

Adult↗

PubMed2006

The glu298asp polymorphism in the nitric oxide synthase 3 gene is associated with the risk of ischemic stroke in two large independent case-control studies.

The search for genes involved in the pathogenesis of stroke has been highlighted as a field of needs. We followed the concept, that stroke represents a complex genetic disorder, and analyzed the contribution of 106 informative single nucleotide polymorphisms (SNPs) from 63 candidate genes for cardiovascular diseases for the risk of stroke. We conducted two independent case-control studies in two different German regions and recruited a total of 1,901 hospitalized stroke cases and 1,747 regional population controls. The smaller of both studies was used as the replication study. Multiplex PCR in combination with allele-specific hybridization was used for genotype determination. Descriptive statistics, permutations and multivariable logistic regression were used in the analyses. After permutation testing 5 SNPs, located in the nitric oxide synthase 3, the alpha 2 integrin, the interleukin 13, the selectin P and the chemokine receptor 2 genes, had a significant allele difference between cases and controls in the larger study. For one of these SNPs, the glu298asp polymorphism in the nitric oxide synthase 3 gene, an association with ischemic stroke was replicated in the second study and also in a combined analysis of both studies. This association was independent of age, gender, hypertension, diabetes and hypercholesterolemia in both studies. Using large sample sizes and a replication study approach, we found evidence for a role of a polymorphism in the nitric oxide synthase 3 gene in stroke onset.

Aged↗

PubMed2006

Population impact--definition, calculation and its use in prevention science in the example of tobacco smoking reduction.

INTRODUCTION: Population Impact is a criterion that can enhance prevention practices and provide a solid foundation for integrating policies and programs for prevention. However, to quantify the population impact of programs a statistical measure is needed. The objective of this article is to (a) deduct a formula to quantify population impact (PI), (b) define the formula for population impact of smoking prevention measures and (c) apply this formula on smoking prevention programs. METHODS: Decision analytical approach. RESULTS: The measurement of PI is defined with four parameters: recruitment, retention, efficacy and prevalence. A formula is mathematically deducted and the PI for different smoking prevention programs is calculated. DISCUSSION: The formula supports decision makers in deciding what prevention measure shows a higher impact on the population, gives hints where to improve the measure to increase the impact, whether recruitment, retention or efficacy needs to be improved and makes it easy to do analyses of costs on the population level. CONCLUSIONS: To enhance prevention practice prevention measures need to provide all parameters to calculate the PI, research needs to focus on all parameters influencing the PI and costs of prevention measures need to be provided.

Algorithms↗

PubMed2006

Effects of smoking cessation on health care use: is elevated risk of hospitalization among former smokers attributable to smoking-related morbidity?

BACKGROUND: Although the association between smoking status and health services use is well established, this relation is not well-studied for the comparison of current and former smokers. Some studies showed higher utilization of health services among former smokers compared to continuing smokers. This study investigates the relation between smoking status, time since smoking cessation and hospitalization in a general population sample. We hypothesized that elevated risk of hospitalization among former smokers compared with continuing smokers is related to higher smoking-related morbidity among former smokers. METHODS: Data from a cross-sectional sample of 4310 adults aged 20-79 in Pomerania, Germany was used (response proportion 68.8%). Smoking status, time since smoking cessation (in years), and date of diagnosis of smoking-related diseases were determined from self-reports. We used fractional polynomials to determine the dose-response relation of time since cessation and risk of hospitalization. Confounding was investigated allowing for different sets of confounding variables. RESULTS: We found that the probability of hospitalization was highest among those who quit 1-3 years ago and decreased thereafter. Adjustment for health status and socio-economic variables revealed that this association is attenuated by current diagnosis of smoking-related diseases. CONCLUSION: Short-term excess health care utilization among former smokers might result from smoking-related conditions that may have led to smoking cessation. Findings suggest that smoking cessation has long-term health benefits resulting in lower health care needs.

Adult↗

PubMed2006

Intention to utilize formal help in a sample with alcohol problems: a prospective study.

BACKGROUND: Studies investigating factors of treatment entry have predominantly focussed on persons that have already taken an initial step in the process of help-seeking. With particular emphasis on intention to utilize help, this study aims to detect predictors for alcohol-related help-seeking among a non-help-utilizing sample. METHODS: Using 312 individuals with diverse alcohol problems (dependence, abuse, at-risk drinking), intention to utilize help was assessed in addition to evidence based predictors for utilization of help (e.g. severity of alcohol problem, prior help-seeking). RESULTS: In addition to prior utilization of help (OR=9.76, CI: 4.60-20.74) and adverse consequences from drinking (OR=1.13, CI: 1.02-1.25), intention to utilize help (OR=4.84, CI: 2.04-11.51) was a central predictor for help-seeking. Among individuals who had not obtained prior help, individuals intending to seek help were 8.7 times more likely to utilize help than those not intending to seek help (CI: 1.05-72.2). CONCLUSIONS: In the past, intention to utilize help has been neglected from models investigating treatment entry. This study's findings show that intention is a central factor for utilization of alcohol-specific formal help. Consequently, brief interventions focusing on enhancing motivation are expected to improve early help-seeking among general hospital patients with diverse alcohol problems.

Alcohol Drinking↗

PubMed2006

Tobacco smoking in relation to pain in a national general population survey.

BACKGROUND: We examined whether smoking status including heavy smoking (20 or more cigarettes per day) is related to the number of pain locations and intensity of pain. METHODS: A probability sample of the German national population aged 18 to 79 including 7124 participants (response proportion: 61.4%) was used. All individuals underwent a health examination between 1997 and 1999. Ordinal logistic regression analyses were performed with number of pain locations and pain intensity as dependent variables which had been assessed by questionnaire. RESULTS: Former and current heavy smokers had higher odds for greater numbers of pain locations and for moderate and intense pain than never smokers after adjustment for analgesic medicament use and behavior-related risk factors. Female former heavy smokers had an adjusted odds ratio (OR) of 1.6 (95% confidence interval, CI, 1.2-2.2) and male former heavy smokers had an adjusted OR of 1.4 (CI 1.1-1.8) for higher numbers of pain locations compared to never smoking women and men respectively (female current smokers: OR 1.4, CI 1.0-1.9; male current smokers: OR 1.3, CI 1.1-1.7). CONCLUSION: The findings suggest that former and current heavy smokers are more likely to report more pain locations and more intense pain than never smokers.

Adult↗

PubMed2006

Outcome after coronary artery bypass graft surgery, coronary angioplasty and stenting.

AIMS: We undertook this prospective observational study to investigate the long-term prognosis after balloon angioplasty (PTCA), coronary stenting (CS) and coronary artery bypass grafting (CABG). METHODS AND RESULTS: A total number of 1038 patients with PTCA (n=499), CS (n=294) or CABG (n=245) were followed-up over a mean time of 6.4+/-1.8 years. Forty-two patients (4.0%) were lost to follow-up, leaving a study population of 996 subjects who were available for analyses. The primary and secondary endpoints were mortality and major adverse cardiac events (MACE), respectively. Overall death rate was 19.3%. Age, pulse pressure, smoking, diabetes, serum LDL cholesterol levels and left ventricular ejection fraction rather than the intervention type independently predicted mortality. The incidence rate of MACE was 53.7%. Compared to PTCA patients, CS patients had lower (hazard ratio 0.693; 95% confidence interval 0.514-0.793) and CABG patients the lowest risk of MACE (hazard ratio 0.343; 95% confidence interval 0.261-0.450). Further risk factors for MACE were serum LDL cholesterol levels, three-vessel coronary artery disease and left ventricular ejection fraction of <30%. CONCLUSION: Long-term mortality does not differ among patients who received percutaneous interventions or CABG. Major adverse cardiac events occur more often in patients with previous percutaneous interventions, whereby CS has advantage over PTCA.

Age Distribution↗

PubMed2006

Post-traumatic stress disorder: the role of trauma, pre-existing psychiatric disorders, and gender.

BACKGROUND: The study is aimed at investigating the influence of trauma type, pre-existing psychiatric disorders with an onset before trauma, and gender on post-traumatic stress disorder (PTSD). METHODS: Traumas, PTSD and psychiatric disorders were assessed in a representative sample of 4075 adults aged 18-64 years using the Composite International Diagnostic Interview. Pre-existing DSM-IV diagnoses of anxiety disorders, depressive disorders, somatoform disorders, alcohol abuse and dependence, nicotine dependence, gender, and the type of trauma were analysed with logistic regressions to estimate the influence of these factors on the risk for developing PTSD. RESULTS: The lifetime prevalence of exposure to any trauma did not vary by gender. The conditional probability of PTSD after exposure to trauma was higher in women (11.1% SE = 1.58) than men (2.9% SE = 0.83). Univariate analyses showed that pre-existing anxiety disorders, somatoform disorders and depressive disorders significantly increase the risk of PTSD. Multivariate analyses revealed that specific types of trauma, especially rape and sexual abuse, pre-existing anxiety disorders and somatoform disorders are predictors of an increased risk of PTSD, while gender and depressive disorder were not found to be independent risk factors. CONCLUSION: Women do not have a higher vulnerability for PTSD in general. However, especially sexually motivated violence and pre-existing anxiety disorders are the main reasons for higher prevalences of PTSD in women.

Adolescent↗

PubMed2006

Changes in the "stages of change" as outcome measures of a smoking cessation intervention: a randomized controlled trial.

OBJECTIVE: Employing changes in the "stages of change" as alternative outcome measures of a smoking cessation intervention. METHOD: RCT carried out between 2002 and 2004 in Germany with 485 daily cigarette smokers recruited from a general population survey. The intervention was conceptually based on the transtheoretical model, involving individualized feedback letters generated by computerized expert-system technology. RESULTS: Latent transition analysis was applied to test models for patterns of change, to evaluate stage of change distributions and transitions over time, and to compare the intervention and control group. The patterns of change across three time points could best be described by a model including stability, one-stage regressions, and one-to-four-stage progressions. There were no significant differences between the intervention and control group in the stage of change distributions at each time point or in the amount of stage transitions over time. CONCLUSION: The efficacy of the intervention could not be demonstrated. Reasons may include oversampling of smokers who are interested in health-related topics but do not intend to quit, and power problems due to substantial attrition.

Adult↗

PubMed2006

Tobacco smoking in relation to analgesic drug use in a national adult population sample.

BACKGROUND: Nicotine is known to produce pain-inhibitory effects. Here, we examine whether there is a relation between tobacco smoking and analgesic drug use (ADU). METHODS: A probability sample of the German national population aged 18-79 with 7124 participants (participation rate: 61.4%) was used. All individuals underwent a health examination and ADU was assessed as part of an interview conducted by a study physician. RESULTS: Current and former smokers had higher odds for ADU than never smokers. Current heavy smokers (>20 cigarettes per day) had an odds ratio (OR) of 1.8 (95% confidence interval, CI, 1.4-2.3) for ADU three times per month or less and an OR of 3.1 (CI 2.0-4.8) for ADU once a week to daily, with never smokers as the reference group. Former heavy smokers had an OR of 2.0 (CI 1.3-3.2) for ADU once a week to daily compared to never smokers. CONCLUSION: The findings suggest that current and former smokers, particularly current and former heavy smokers, are more likely to use analgesic drugs than never smokers.

Adolescent↗

PubMed2006

Attitudes towards smoking policies and tobacco control measures in relation to smoking status and smoking behaviour.

BACKGROUND: To examine support for various smoking policies and tobacco control measures among lifetime smokers in a country with weak anti-smoking legislation and an underdeveloped anti-smoking climate. METHODS: Current (n = 624) and former smokers (n = 131) from a general population survey filled in the 30-item Smoking Policy Index (SPI). Structural equation modelling was used to confirm the SPI factorial structure and to test whether smoking status and smoking behaviour variables were related to the six dimensions of the SPI. RESULTS: The dimension with the highest support was penalties for sales to minors. Sanctions against smokers had the lowest support. Current smokers compared with former smokers showed lower support on the taxes/fees, public education, and environmental restrictions dimensions while controlling for gender, age, and social status. Within current smokers, unfavourable smoking behaviours were associated with lower support. CONCLUSION: Even in a country with poor tobacco control conditions, lifetime smokers including smokers with highly unfavourable smoking behaviours strongly support smoking policies and tobacco control measures concerning penalties and advertising/promotion. These measures should be used to promote anti-smoking legislation, and strict law enforcement of these measures is expected to be accepted by all smokers. For measures that are not supported by all lifetime smokers, interventions may be useful to increase acceptability. A limitation of the present study is the absence of never-smokers as a comparison group.

Adult↗

PubMed2006

Measuring activities in tobacco control across the EU. The MATOC.

BACKGROUND: Objectives of this study are (a) to develop a comprehensive and economic tool to estimate tobacco control (TC) activities in single EU member states, (b) to compare TC activities between member states of the EU. This article provides the questionnaire and gives a benchmark of EU member states according to their perceived TC activities. METHODS: An international workshop was specifically initiated to develop the questionnaire "Measuring Activities in Tobacco Control (MATOC)". TC experts from 8 European countries participated and chose 40 items to cover 11 general topics of TC. At the World Conference of Tobacco or Health in Helsinki 2003 participants were asked to fill out the questionnaire. N = 142 participants from EU-member states returned questionnaires. RESULTS: Subjects from the tobacco field in Finland gave the highest TC values to their country, followed by Sweden, Ireland, the UK and the Netherlands. The least active countries in TC were Greece and Germany, behind Austria, Spain, Belgium and Portugal. Italy, France and Denmark constituted the middle field. CONCLUSION: The MATOC provides a profile of TC across European countries and delivers results that are plausible and fit into the existing findings. The data presented here fulfils the purpose to illustrate what is possible with the MATOC and underlines the value of such an approach in delivering information for policy makers and TC advocates how TC is perceived in each country. Yet, further validity testing is necessary, the number of experts per country differs and is partly rather small. Further research with the MATOC should encounter these limitations. The procedure though could serve as model of practice for alcohol and legal drug policy as well.

European Union↗

PubMed2006

Provision of smoking cessation counseling by general practitioners assisted by training and screening procedure.

OBJECTIVE: To examine which counseling behavior among GPs can be achieved after counseling training when organizational support is provided. METHODS: A random sample of 39 general practices was drawn, 34 took part. GPs received a pre-study assessment followed by a training session for smoking counseling. All patients showing up during a period of 1 week were asked about smoking status. Current smokers, aged 18-70 years were eligible (N=551), 81.8% participated. A documentation sheet, filled in by a study nurse transferred smoking-related information about patient to the GP. GPs were advised to fill in a post-counseling assessment for every patient. A post-study assessment with the GPs was conducted. RESULTS: Frequent barriers for smoking counseling were lack of time and the assumption that patients were not motivated to quit. The GP's documented smoking counseling in 96.0%. The patients (87.8%) could be thoroughly counseled. Younger age of the GP, a high number of patients and the contemplation stage quitting smoking were predictors for realizing counseling. 79.3% of the GPs assessed the procedure to be practicable. CONCLUSIONS: Smoking counseling in the general practice is feasible. PRACTICE IMPLICATION: Involving staff in the screening procedure may support counseling activity of the GP.

Adolescent↗

PubMed2006

Negative perceived paternal parenting is associated with dopamine D2 receptor exon 8 and GABA(A) alpha 6 receptor variants: an explorative study.

Twin studies suggest a genetic influence upon perceived parenting. The D(2) dopaminergic receptor is involved in the modulation of social behaviors, and might influence parenting and its perception. A polymorphism (E8) in exon 8 of the D(2) receptor gene (DRD2) has been previously associated with alcoholism-related phenotypes. Similarly, the Pro385Ser variant of GABRA6, the polymorphic gene for GABA(A) receptor alpha6 subunit, has been associated with alcohol- and depression-related traits; and rat pups maintained a more immature GABAR phenotype after brief separation distress. The relationships among DRD2 (E8) and GABRA6 (Pro385Ser) polymorphisms, and perceived parenting were studied here. The association of DRD2 (E8) and GABRA6 (Pro385Ser) genotypes and perceived parental rearing behavior (short-EMBU; questionnaire concerning own memories concerning upbringing) were determined in 207 unrelated adults using multivariate analysis of variance. Temperaments (Temperament and Character Inventory; TCI) were included as covariates. Probands with DRD2 (E8) A/A genotype showed higher scores for father rejection (P = 0.011), parents overprotection (P = 0.021), and father overprotection (P = 0.016) in the total group. An interaction between DRD2 and GABRA6 genotypes on father rejection (P = 0.010) and parents rejection (P = 0.030) was also observed. Further analyses showed that these associations were restricted to the female subgroup only; however, secondary gender-specific analyses were not corrected for multiple testing. Our findings support a role for DRD2 (E8) and GABRA6 (Pro385Ser) in perceived parenting.

Adult↗

PubMed2006

Relation between awareness of circulatory disorders and smoking in a general population health examination.

BACKGROUND: Little is known about proportions of smokers who maintain smoking after they are aware of a circulatory disorder. The goal was to analyze the extent to which the number of circulatory disorders may be related to being a current smoker. METHODS: Cross-sectional survey study with a probability sample of residents in Germany investigated in health examination centers. Questionnaire data of 3,778 ever smoking participants aged 18-79 were used, questions included whether the respondent had ever had hypertension, myocardial infarction, other coronary artery disease, heart failure, stroke, other cerebrovascular disease, peripheral vascular disease, and venous thrombosis. Logistic regression was calculated for circulatory disorders and their number with current smoking as the dependent variable, and odds ratios (OR) are presented adjusted for physician contact, inpatient treatment, smoking cessation counseling, heavy smoking, exercise, overweight and obesity, school education, sex and age. RESULTS: Among ever smokers who had 1 circulatory disorder, 52.1 % were current smokers and among those who reported that they had 3 or more circulatory disorders 28.0 % were current smokers at the time of the interview. The adjusted odds of being a current smoker were lower for individuals who had ever smoked in life and had 2 or more central circulatory disorders, such as myocardial infarction, heart failure or stroke, than for ever smokers without central circulatory disorder (2 or more disorders: adjusted OR 0.6, 95 % confidence interval, CI, 0.4 to 0.8). CONCLUSION: Among those with central circulatory disorders, there is a substantial portion of individuals who smoke despite their disease. The data suggest that only a portion of smokers among the general population seems to be discouraged from smoking by circulatory disorders or its accompanying cognitive or emotional processes.

Adolescent↗

PubMed2006

Stability of remission from alcohol dependence without formal help.

AIMS: To determine the stability of remission from alcohol dependence without formal help. METHODS: In a cohort of untreated remitters, a follow-up after 24 months was conducted. Participants were recruited through media solicitation and via a general population study. At baseline, all participants (n = 144) fulfilled criteria of remission from alcohol dependence for the previous 12 months without prior use of formal help (sustained full remission according to DSM-IV, neither inpatient nor outpatient treatment, no more than two self help group meetings). Personal interviews were conducted using standardized instruments. RESULTS: In the follow-up period, four individuals died; 92.9% of the remaining participants were re-interviewed (n = 130). Of those interviewed 92.3% showed stable remission without formal help, 1.5% were currently alcohol dependent according to DSM-IV, 1.5% were classified alcohol dependent on grounds of collateral information, 1.5% fulfilled one or two criteria of dependence, and 4.6% utilized formal help. CONCLUSIONS: Untreated remission is not a transient phenomenon. Therefore, studying remitters from alcohol dependence without formal help can yield valid information on pathways to recovery.

Alcoholism↗