Biomedical subjects

Ulrich John

Publications and source records attributed to Ulrich John.

125 records · Page 7Linked to original sources

PubMed2002

The importance of a positive family history of alcoholism, parental rejection and emotional warmth, behavioral problems and peer substance use for alcohol problems in teenagers: a path analysis.

OBJECTIVE: The purpose of this study was to test a hypothetical model of alcohol problems in German adolescents. Among 180 offspring, family history of alcoholism, parenting styles, behavioral and emotional problems, peer-group characteristics, feelings of self-esteem, behavioral problems and psychiatric comorbidity of the parents were examined. METHOD: Data were generated from the Study of Health in Pomerania (SHIP), in which families were randomly selected if 12-18 year old biological offspring were members of the household; a smaller group of subjects was selected from local outpatient treatment centers. Members of 133 families, including 180 (50.6% male) offspring who were appropriate for the current analyses, received personal semistructured diagnostic interviews and several self-rating questionnaires. Analyses compared offspring with alcohol problems (AP; n = 40) and with no alcohol problems (NAP; n = 140), and used structural equation modeling to test a hypothetical model. RESULTS: The comparisons revealed that the AP group had significantly more behavioral problems (e.g., aggression/delinquency), more perceived parental rejection and less emotional warmth, a higher amount of alcohol consumption, were more likely to associate with substance-using peers and more often received a diagnosis of conduct disorder or antisocial personality disorder. Whereas the family history of alcoholism did not differ significantly between groups, parents of offspring with an alcohol use disorder had significantly more additional diagnoses on DSM-IV Axis I. The evaluation of the model supported the importance of aggression/delinquency and association with substance-using peers for alcohol problems in people. An additional diagnosis in the parents was directly and indirectly (through aggression/delinquency) related to alcohol problems of the adolescents. CONCLUSIONS: The data indicate that alcohol problems in the offspring are associated with several domains of influence in their environment. Prospective studies measuring both biological and environmental factors using sufficient sample sizes will be needed for optimal understanding of the development of alcohol problems in youth.

Adolescent↗

PubMedDate not supplied

An intervention to support postpartum women to quit smoking or remain smoke-free.

Effectiveness studies among pregnant and postpartum women indicate that pregnancy and the postpartum period provide a window of opportunity to promote smoking cessation and smoke-free families. Yet, there is a lack of information about interventions that are portable to routine care. The goal of this article is to describe the structure, basic strategies, and the application of a smoking cessation and relapse prevention intervention for postpartum women in the general population. By using the stages of change concept and motivational interviewing, a classification of current and former smokers is given, and basic strategies and techniques are described to counsel women postpartum with regard to smoking.

Counseling↗

PubMedDate not supplied

[Antonovsky's sense of coherence scale and presentation of a psychiatric diagnosis].

Despite a wide reception of Antonovsky's salutogenetic model, only recently representative data measuring sense of coherence with the Sense of Coherence Scale (SOC) have been collected for Germany. Meanwhile, norms have been published for the long (SOC-29) and the short-form (SOC-13) of the scale. Also an alternative short-form (SOC-9L) has been developed. Basis of this investigation are data from 4002 subjects (70.2 % response rate) from a representative sample in the City of Lübeck and the surrounding communities. In addition to a comprehensive battery of psychometric instruments, the Munich-Composite International Diagnostic Interview (M-CIDI) was used to derive DSM-IV diagnostic criteria. In this study, test statistical parameters for SOC-items stemming from a representative survey are reported. Internal consistencies (Cronbach's alpha) for the three forms are: SOC-29 = 0.91, SOC-13 = 0.86 und SOC-9L = 0.85. Critical differences with an alpha of 5 % are ascertained at: SOC-29 = 17.73, SOC-13 = 11.55 und SOC-9L = 8.61. Arithmetic means (and standard deviations) of the three scales for the whole sample are: SOC-29 = 155 (23), SOC-13 = 70 (11), SOC-9L = 51 (8). Also descriptive values, respecting age and gender for the three forms of the SOC are referred. Additionally all three SOC forms for the whole sample are contrasted with SOC scores of subjects who a) never fulfilled criteria for a psychiatric disorder in their lifetime, b) fulfilled criteria for a psychiatric disorder once in their lifetime, and c) fulfilled criteria for a psychiatric disorder in the last 12 months. Subjects who never fulfilled criteria showed highest scores, those who did so within the last 12 months showed lowest scores. The other two group scored in between.

Adolescent↗

PubMedDate not supplied

Predictors of increased body mass index following cessation of smoking.

The objective of this study was to explore nicotine withdrawal symptoms as predictors of increased body mass index (BMI) after an attempt to quit or reduce tobacco smoking. The authors used a survey study, with a probability sample of 4,075 18-64-year-old residents. The participation rate was 70.2%, which included 1,545 current daily smokers. Follow-ups were carried out for current smokers after thirty and 36 months. The authors found that smokers who experienced increased appetite or weight gain (IAW) as a nicotine withdrawal symptom had a higher BMI than smokers without IAW. They concluded that IAW after quitting might be a specific determinant of the BMI increase following smoking cessation in a subgroup of smokers.

Adolescent↗

PubMedDate not supplied

Screening for alcohol use disorders and at-risk drinking in the general population: psychometric performance of three questionnaires.

Most screening questionnaires are developed in clinical settings and there are few data on their performance in the general population. This study provides data on the area under the receiver-operating characteristic (ROC) curve, sensitivity, specificity, and internal consistency of the Alcohol Use Disorders Identification Test (AUDIT), the consumption questions of the AUDIT (AUDIT-C) and the Lübeck Alcohol Dependence and Abuse Screening Test (LAST) among current drinkers (n = 3551) of a general population sample in northern Germany. Alcohol dependence and misuse according to DSM-IV and at-risk drinking served as gold standards to assess sensitivity and specificity and were assessed with the Munich-Composite Diagnostic Interview (M-CIDI). AUDIT and LAST showed insufficient sensitivity for at-risk drinking and alcohol misuse using standard cut-off scores, but satisfactory detection rates for alcohol dependence. The AUDIT-C showed low specificity in all criterion groups with standard cut-off. Adjusted cut-points are recommended. Among a subsample of individuals with previous general hospital admission in the last year, all questionnaires showed higher internal consistency suggesting lower reliability in non-clinical samples. In logistic regression analyses, having had a hospital admission increased the sensitivity in detecting any criterion group of the LAST, and the number of recent general practice visits increased the sensitivity of the AUDIT in detecting alcohol misuse. Women showed lower scores and larger areas under the ROC curves. It is concluded that setting specific instruments (e.g. primary care or general population) or adjusted cut-offs should be used.

Adult↗

PubMedDate not supplied

The readiness to change questionnaire in subjects with hazardous alcohol consumption, alcohol misuse and dependence in a general population survey.

AIMS: To investigate properties and aspects of validity of the Readiness to Change Questionnaire (RCQ) when applied to hazardous drinking, alcohol-abusing or alcohol-dependent subjects sampled from the general population. METHODS: In a representative survey conducted in the general population of a region in northern Germany, participants were randomly selected from resident registration office files, contacted and interviewed personally (n = 4.075). A total of 302 subjects who showed hazardous drinking behaviour (n = 202) or met diagnostic criteria of alcohol misuse (n = 46) or alcohol dependence (n = 54) were assessed and diagnosed using the Munich Composite International Diagnostic Interview (M-CIDI) according to DSM-IV diagnostic criteria. The battery of self-report questionnaires comprised, among others, the RCQ, and two methods of allocation were used, the quick method and the refined method of allocation. According to the method of allocation used, the stages are: precontemplation (PC), contemplation (C), preparation (P) and action (A); P may only be assigned using the refined method. RESULTS: The RCQ, a brief instrument to assess stages of change in individuals sampled from the general population, gave internal consistencies of: PC = 0.68, C = 0.79, A = 0.83. Allocation to stages of change according to the quick method resulted in 67% of subjects being allocated to PC, 24% to C and 8% to A and according to the refined method in 58% to PC, 15% to C, 4% to P, 4% to A, with 19% not being classified because of non-theory-consistent scale profiles. CONCLUSIONS: Classification did not differ substantially according to the method of allocation. A three-factor solution, as reported in the literature, could not be replicated. Allocation to stages of change with the RCQ reflected predictions made from the Transtheoretical Model of behaviour change.

Adult↗

PubMedDate not supplied

Alcohol-attributable mortality in a high per capita consumption country -- Germany.

AIMS: Little is known about age and gender distributions in alcohol-attributable mortality (AAM). The aim of this paper is to describe age and gender in AAM in a high per capita consumption country. METHODS: The AAM was determined using national mortality statistics and data on the prevalence of alcohol risk drinking from Germany. According to this approach, alcohol-attributable fractions (AF) of causes of death are estimated. RESULTS: In males, as well as females, more than 70% of the AAM cases are due to alcohol consumption as well as smoking. The mortality rates are highest in the age range 35-64 years with 25% of the total mortality in males, and 13% in females. The median age at death in AAM exclusively based on alcohol is 15 years below the median age at death in the male and 24 years below that in the female population. CONCLUSIONS: Early intervention should be stressed.

Adult↗

PubMedDate not supplied

Estimation of tobacco- or alcohol-attributable disease rates in national hospital care: an approach based on routine in-patient disease register data and systematic diagnosis of alcohol use disorders.

AIMS: The goal of this paper was to estimate and compare the numbers and rates of tobacco- or alcohol-attributable disease (TAAD) in in-patient-treated cases in a high tobacco smoking and alcohol consumption country, based on different estimates. METHODS: Two samples, three TAAD estimates, and tobacco- or alcohol-attributable fractions were used. Sample 1 included all disease cases aged 25-64 years and treated more than 24 h as in-patients during the year 1997 (n = 7 344 079) in the hospitals in Germany. Sample 2 included all in-patients aged 25-64 years (n = 1136) consecutively admitted to one general hospital. The first estimate of the TAAD was the routine main diagnosis based on the treating physician's report to the in-patient disease register (IDR) in sample 1. The second estimate included up to three routine treatment diagnoses in sample 2, and the third estimate a diagnosis of alcohol dependence or misuse according to DSM-III-R or ICD-10, as well as harmful or hazardous alcohol consumption, in sample 2. The tobacco- and alcohol-attributable fractions were calculated based on the method for the estimation of tobacco- and alcohol-attributable mortality, originally provided for the Centers for Disease Control in the USA. RESULTS: When the three estimates were combined, a total of 37.8% of all in-patient treatment cases had at least one diagnosis that was attributable in part or fully to tobacco smoking, alcohol dependence, alcohol misuse, or harmful or hazardous alcohol drinking. When the tobacco- and the alcohol-attributable fractions were considered, of all treatment cases, 10.5% could be revealed as attributable to smoking or alcohol consumption according to the one main diagnosis based on the IDR. When all three estimates were combined, the rate was 30.2%. This corresponded to 32.2% of the national in-patient hospital care costs. CONCLUSIONS: The TAAD rate is underestimated when using one routine diagnosis alone. Additional alcohol misuse or dependence diagnoses are needed, which may be obtained with a reasonable level of resources in a sample of hospitals. TAAD rates may be used for the planning and practice of brief intervention and as an outcome measure for population-based intervention.

Adult↗

PubMedDate not supplied

Strength of the relationship between tobacco smoking, nicotine dependence and the severity of alcohol dependence syndrome criteria in a population-based sample.

AIMS: Little is known about the relationship between current and past smoking behaviour and the severity of alcohol dependence. The purpose was to explore the strength of this relationship. METHODS: A random population sample of 18 to 64 year-olds from northern Germany was used (n = 4075; participation rate: 70%). It included 761 cigarette smokers fulfilling at least one alcohol-dependence criterion. The severity of alcohol dependence according to the alcohol-dependence syndrome criteria frequency (ASF) was estimated by a standardized questionnaire based on diagnostic instruments of the alcohol dependence syndrome and which included five response categories, from 'never' to 'daily'. Nicotine dependence was diagnosed according to the Diagnostic and Statistical Manual of mental disorders (DSM-IV) with the Composite International Diagnostic Interview (CIDI). As a second measure, the Fagerström Test of Nicotine Dependence (FTND) was used. RESULTS: The number of cigarettes and years of daily smoking, nicotine dependence, and the number of nicotine dependence symptoms each showed a relationship with the ASF. Effect size (w) were 0.17-0.21 for chi-squared (chi(2)) tests. In a general linear regression model with the ASF as the dependent variable (R(2) = 0.17), number of years of daily smoking, age at onset of smoking, number of attempts to reduce or quit, the number of nicotine-dependence symptoms according to DSM-IV and the FTND sum score were retained as independent variables. CONCLUSIONS: Long-term smoking, a large number of nicotine-dependence symptoms according to DSM and a strong urge to smoke according to the FTND are related with a high ASF.

Adolescent↗

PubMedDate not supplied

Menopause and determinants of quality of life in women at midlife and beyond: the study of health in pomerania (SHIP).

OBJECTIVE: Determinants of quality of life (QoL) in pre- and postmenopausal women including nonhormonal modulators of QoL in adult women are not well understood; there is an ongoing controversy about the impact of menopause on health-related QoL. We investigated the extent to which diverse mental and physical symptoms are associated with (a) menopausal status; (b) sociodemographic, psychosocial, and lifestyle factors; and (c) menopausal hormone therapy (MHT) in adult women after the German reunification in a region of the former German Democratic Republic. DESIGN: The Study of Health in Pomerania is a cross-sectional, population-based survey. Computer-based structured interviews and self-administered questionnaires were used to capture QoL (Zerssen Symptom List) and sociodemographic parameters, psychosocial, and lifestyle indicators (age, socioeconomic status, abuse, social support, nutrition, body mass index, self-rated health, chronic diseases, and use of MHT) in 1,119 pre- and postmenopausal women with an intact uterus. RESULTS: Analyses suggest that menopausal status was not associated with QoL. MHT was associated with physical, mental, and gastrointestinal symptoms. Age was a significant predictor for cardiopulmonary symptoms and sensory impairment. The relationship between age and both physical and mental complaints was inverse as was the relationship between age and both mood and gastrointestinal symptoms. Age, socioeconomic status, physical and sexual abuse, perceived social support, nutrition, body mass index, self-rated health, chronic diseases, and MHT modulated QoL. CONCLUSIONS: Our findings do not support the hypothesis that QoL is reduced after menopause. Differences between pre- and postmenopausal women can be explained by sociodemographic, psychosocial, and lifestyle factors.

Affect↗

PubMedDate not supplied

Somatoform pain disorder in the general population.

BACKGROUND: Chronic pain disorder is assumed to represent a frequent and disabling condition. However, data on the prevalence of somatoform pain symptoms and somatoform pain disorder in the community are limited to date. METHODS: German versions of the Composite International Diagnostic Interview were administered to a representative national sample of 4,075 people. Somatoform pain disorder was diagnosed by standardized diagnostic algorithm based on the DSM-III-R criteria (absence of adequate physical findings). One subgroup was identified as also meeting the DSM-IV criterion B for 'significant distress or psychosocial impairment due to the somatoform pain'. RESULTS: A lifetime prevalence rate of somatoform pain disorder according to DSM-III-R of 33.7% and a 6-month rate of 17.3% was found. When applying the DSM-IV B criterion, the prevalence rate dropped to 12.3 and 5.4%, respectively. In both groups more than 95% of the probands had contacted their doctor because of the pain. In 25% of the probands the pain was positively assigned to psychological factors. A female:male ratio of 2:1 was found. CONCLUSIONS: Somatoform pain disorder (DSM-III-R) is a frequent condition. However, only about one third of these subjects is severely distressed or impaired by the pain. A clear operationalized concept of the DSM-IV criterion C 'psychological factors are judged to have an important role in the onset, severity, exacerbation or maintenance of the pain' should be provided in the further development of the diagnosis 'pain disorder' in order to make this diagnosis suitable for general population surveys.

Adolescent↗

PubMedDate not supplied

Specific somatoform disorder in the general population.

The authors assessed the validity of the recently proposed diagnosis for specific somatoform disorder in the general population. German versions of the DSM-IV adapted Composite International Diagnostic Interview were administered to a representative sample of 4075 individuals. Multivariate analyses were used to compare impairment, life satisfaction, and use of health care. A total of 803 of 4075 subjects (19.7%) with undifferentiated somatization disorder were identified, which included 51 subjects (1.3%) who met criteria for specific somatoform disorder. Subjects with specific somatoform disorder were more impaired, had lower life satisfaction, and had higher use of health care than subjects with undifferentiated somatization disorder only. The proposed diagnosis of specific somatoform disorder demonstrated a high validity independent of comorbid depressive and anxiety disorders.

Activities of Daily Living↗

PubMedDate not supplied

Prosthodontic status among old adults in Pomerania, related to income, education level, and general health (results of the Study of Health in Pomerania, SHIP).

PURPOSE: The aim of the study was to evaluate associations among prosthetic status, socioeconomic factors, and general health of subjects aged 55 to 79 years. The data were taken from the Study of Health in Pomerania (SHIP). MATERIALS AND METHODS: Socioeconomic information (age, sex, education level), medical information (number of diseases), and details on smoking and alcohol consumption were obtained. Prosthetic status in the maxilla and mandible was classified into complete denture (CD), removable partial denture (RPD), > or = 10 natural teeth or teeth replaced with fixed prosthodontics (10T+), and < or = nine natural teeth including fixed prosthodontics (9T-). RESULTS: The data of 1,877 subjects were evaluated. CDs in the maxilla were more frequent than in the mandible. RPDs were more frequent in the mandible and in the group aged 65 to 74 years. Of the individuals with a low education level, 47% had a CD in the maxilla, and only 21% had 10T+. However, of subjects with a high education level, 22% had a CD in the maxilla, and 54% had 10T+. The odds ratio of having a CD in the maxilla increased to 11.9 at the age of 75 to 79 years, compared to 0.6 at the age of 55 to 59 years. Logistic regression analyses showed that the risk of wearing a CD was significantly associated with old age, low education level, low income, smoking, and alcohol abuse, whereas the number of diseases (used as an indicator of general health) was not. CONCLUSION: Alcohol abuse, smoking, low education level, low income, and old age were significant predictors of wearing CDs.

Age Factors↗

PubMedDate not supplied

Study of Health in Pomerania (SHIP): Relationship among socioeconomic and general health factors and dental status among elderly adults in Pomerania.

OBJECTIVE: The aim of this study was to evaluate associations among the dental status, socioeconomic factors, and general health of 1,877 subjects between the ages of 55 and 79. METHOD AND MATERIALS: Socioeconomic information (age, sex, education level) and questions on smoking and alcohol abuse were taken from an interview; income and medical information (number of diseases) were taken from a self-administered questionnaire; and HbA1C and CDT (diabetes and alcoholism markers) were taken from blood analyses. RESULTS: Of the subjects, 73% had a low education level, and 27% of the subjects had a monthly income of < 1,000 Euro and 13% of > 2,000 Euro. Twenty-six percent of the subjects were edentulous, and 29% had 20 or more teeth. The odds ratio of edentulism increased to 9.0 (95% confidence interval = 7.0-11.5) at the ages of 75 to 79 years compared to ages 55 to 79. Logistic regression analyses showed that edentulism was significantly associated with age, low education level, low income, smoking, and alcohol abuse. However, the retention of more than 20 teeth was associated with age. CONCLUSIONS: Age, low income, low education level, smoking, and alcohol abuse seemed to be risk markers for edentulism; whereas, the number of diseases, diabetes, and gender were not.

Age Distribution↗

PubMedDate not supplied

Risk factors for high occlusal wear scores in a population-based sample: results of the Study of Health in Pomerania (SHIP).

PURPOSE: Using a population-based sample of the cross-sectional epidemiologic "Study of Health in Pomerania" (SHIP), this study evaluated whether certain occlusal and sociodemographic factors besides age and gender are risk factors for high dental wear. MATERIALS AND METHODS: Medical history and dental and sociodemographic parameters of 2,529 dentate subjects selected representatively and according to age distribution were checked for correlations with the occurrence of high occlusal wear symptoms using a multivariate logistic regression model. Occlusal wear was recorded using the attrition index by Ekfeldt et al and was age adjusted by determining high occlusal wear for every 10-year age group as index values > or = 90th percentile. RESULTS: The following independent variables were found to be correlated with high occlusal wear: male gender, odds ratio 2.2; frequent bruxism, odds ratio 2.5; loss of molar occlusal contact (Eichner classification), odds ratio from 1.5 to 3.1; edge-to-edge relation of incisors, odds ratio 1.7; unilateral buccolingual cusp-to-cusp relation, odds ratio 1.8; and unemployment, odds ratio 1.6. In contrast, anterior cross-bite, unilateral posterior cross-bite, and anterior crowding were protective for high occlusal wear levels, as shown by significantly reduced odds ratios. Gender-separated analysis showed that self-reported bruxism was a risk factor only for men. CONCLUSION: In addition to some occlusal factors, the main factors associated with occlusal wear were bruxism and gender.

Adult↗

PubMedDate not supplied

Gender differences in associations between occlusal support and signs of temporomandibular disorders: results of the population-based Study of Health in Pomerania (SHIP).

PURPOSE: The aim of this study was to investigate whether gender-dependent associations exist between signs of temporomandibular disorders (TMD) and occlusal support. MATERIALS AND METHODS: Stratified by gender, the data of 2,963 35- to 74-year-old participants from the epidemiologic Study of Health in Pomerania were used in logistic regression analyses with temporomandibular joint (TMJ) tenderness and muscle tenderness as the dependent variables. Occlusal support was classified according to the Eichner index, a classification system based on occluding pairs of teeth. The final model was adjusted for bruxism, age, and various sociodemographic data. RESULTS: Logistic regression analyses revealed increased odds ratios for TMJ tenderness in men with loss of all four molar and premolar supporting zones (odds ratio 3:9) and without antagonist contact (odds ratio 2:7). Significant relationships in men were also found between muscle tenderness and loss of one (odds ratio 2:1), three (odds ratio 2:1), or four supporting zones (odds ratio 2:7), and loss of any tooth contact (odds ratio 2:3). In women, significant associations between occlusal support and TMD signs were absent. Subjects with bruxism were more likely to have TMJ tenderness (odds ratio women 2:0, men 1:9). In women, an additional relationship existed between bruxism and muscle tenderness (odds ratio 1:7). The following habits showed no significance: gum chewing, unilateral chewing, and lip/tongue/cheek biting. CONCLUSION: Only in men was the loss of occlusal support significantly associated with muscle and TMJ tenderness. The association between bruxism and TMD signs supports the theory that repetitive adverse loading of the masticatory system may cause functional disturbances.

Adult↗

PubMedDate not supplied

The impact of tooth loss on general health related to quality of life among elderly Pomeranians: results from the study of health in Pomerania (SHIP-O).

PURPOSE: It is important to know whether tooth loss has an impact on an individual's quality of life, since tooth loss is common. The aim of this study was to determine whether oral status is associated with general health and related to quality of life. MATERIALS AND METHODS: Data of 1,406 subjects aged 60 to 79 years were taken from the Study of Health in Pomerania (SHIP). Sociodemographic (age, sex, and education level) and medical information (including the most common diseases in Germany) were gathered through an interview, and income data were obtained from a self-administered questionnaire. The prosthetic status in the maxilla and mandible was classified into complete denture or removable partial denture or with > or = 10 natural teeth including teeth replaced with fixed prosthodontics (> or = 10T) or with < or = 9 natural teeth including fixed prosthodontics (< or = 9T). The health-related quality of life was measured using the Short Form (SF-12) questionnaire. Multiple linear logistic regression analyses were used to identify the nonstandardized beta coefficient using physical and psychologic indices from the SF-12 as dependent variables and sociodemographic information, prosthetic status, and disease state as independent variables. RESULTS: Prosthetic status is related to the physical scale of the SF-12. Additionally, we found that < or = 9T had a significant effect on the physical index of general health-related quality of life. CONCLUSION: Reduced dentition without replacement of missing teeth by removable or fixed prosthodontics reduces the physical index of quality of life to the same extent as cancer or renal diseases.

Aged↗