Bremen Institute for Prevention Research and Social Medicine BIPS

Bremen, Germany

Bremen Institute for Prevention Research and Social Medicine BIPS

Bremen, Germany
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Hense S.,Bremen Institute for Prevention Research and Social Medicine BIPS | Pohlabeln H.,Data Management | De Henauw S.,Ghent University | Eiben G.,Gothenburg University | And 6 more authors.
Sleep | Year: 2011

Study Objectives: To investigate differences and a possible effect modification by geographical region in the association between sleep duration and overweight. Design: Cross-sectional. Setting: Primary schools and preschools in 8 European countries. Participants: 7867 children aged 2 to 9 years. Interventions: Not applicable. Measurements: Nocturnal sleep duration was assessed as part of a parental 24-h recall. Height and weight were measured by standardized procedures across centers. Data on personal, social, environmental and behavioral factors were collected using a standardized parental questionnaire. Results: Sleep duration differed (P < 0.001) between European regions and normal vs. overweight children. A dose-dependent inverse association between sleep duration and overweight could be seen, with crude odds ratios ranging from 1.73 (99% CI 1.33; 2.25) for sleeping between 10 and 11 h to 3.81 (99% CI 2.85; 5.09) for sleeping less than 9 h (reference category > 11 h). This persisted after adjustment, but remained significant only for sleeping less than 9 h per night (north: OR = 1.70; 99% CI 1.13; 2.58 vs. south: OR = 2.84; 99% CI 1.57; 5.12) if stratified by region. No effect modification by region could be found, but adjustment for region accounted for changes in the effect estimate for sleeping less than 9 h (OR = 2.22; 99% CI 1.64; 3.02). The association was stronger in school children than in preschool children. Conclusion: Geographic region and related aspects - even if they do not seem to modify the association between sleep and overweight - should in any case be taken in consideration as a confounding factor on this association.


Hense S.,Bremen Institute for Prevention Research and Social Medicine BIPS | Barba G.,National Research Council Italy | Pohlabeln H.,Data Management | De Henauw S.,Ghent University | And 6 more authors.
Sleep | Year: 2011

Study Objectives: To compare nocturnal sleep duration in children from 8 European countries and identify its determinants. Design: Cross-sectional. Setting: Primary schools and preschools participating in the IDEFICS study. Participants: 8,542 children aged 2 to 9 years from 8 European countries with complete information on nocturnal sleep duration. Interventions: Not applicable. Measurements: Nocturnal sleep duration was assessed by means of a computer based parental 24-h recall. Data on personal, social, environmental, and behavioral factors were collected by means of standardized parental questionnaire. Physical activity was surveyed with accelerometers. Results: Nocturnal sleep duration in the participating countries ranged from 9.5 h (SD 0.8) in Estonia to 11.2 h (SD 0.7) in Belgium and differed significantly between countries (P < 0.001) in univariate as well as in multivariate analyses, with children from northern countries sleeping the longest. Sleep duration decreased by about 6 min with each year of age over all countries. No effect of season, daylight duration, overweight, parental education level, or lifestyle factors could be seen. Conclusion: Sleep duration differs significantly between countries. Our findings allow for the conclusion that regional affiliation, including culture and environmental characteristics, seems to overlay individual determinants of sleep duration. © Copyright 2011 Associated Professional Sleep Societies, LLC.


Brzoska P.,Bielefeld University | Voigtlander S.,Bielefeld University | Spallek J.,Bielefeld University | Spallek J.,Johannes Gutenberg University Mainz | And 2 more authors.
European Journal of Epidemiology | Year: 2010

In Germany, the proportion of foreign national residents receiving an invalidity pension is higher than that of Germans. Lower utilization and effectiveness of medical rehabilitation are presumed to be the main reasons. We aimed to examine whether differences in utilization and effectiveness of medical rehabilitation between Germans and foreign nationals are attributable to differences in socio-demography, socio-economic background and health status. Utilization of rehabilitation was analyzed for household members aged 18 years or above enrolled in the German Socio-Economic Panel in 2002-2004 (n = 19,521). Effectiveness of rehabilitation was defined by the occupational performance at the end of rehabilitation. It was examined by using an 80% random sample of all completed medical rehabilitations in the year 2006 funded by the German Statutory Pension Insurance Scheme (n = 634,529). Our study shows that foreign nationals utilize medical rehabilitation less often than Germans (OR = 0.68; 95%-CI = 0.50; 0.91). For those who do, medical rehabilitation is less effective (OR for low occupational performance = 1.50; 95%-CI = 1.46; 1.55). Both findings are only partially attributable to socio-demographic, socio-economic and health characteristics: After adjusting for these factors, ORs for utilization and low occupational performance were 0.66 (95%-CI = 0.49; 0.90) and 1.20 (95%-CI = 1.16; 1.24), respectively. It can be concluded that differences in the utilization and effectiveness of medical rehabilitation between Germans and foreign nationals cannot be explained only by socio-economic differences or poorer health before rehabilitation. In addition, factors such as the ability of the rehabilitative care system to accommodate clients with differing expectations, and migrant-specific characteristics such as cultural differences, seem to play a role. © 2010 Springer Science+Business Media B.V.


Behr S.,Bremen Institute for Prevention Research and Social Medicine BIPS | Andersohn F.,Charité - Medical University of Berlin | Garbe E.,Bremen Institute for Prevention Research and Social Medicine BIPS
Pharmacoepidemiology and Drug Safety | Year: 2010

Purpose: Intracerebral hemorrhage (ICH) is the most serious complication of oral anticoagulation. This study investigated the risk of ICH for phenprocoumon which is the most widely used oral anticoagulant in Germany. Methods: We conducted a nested case-control study in a cohort of 13.4 million insurants of 4 German statutory health insurances (SHIs) who were continuously enrolled for 6 months prior to cohort entry. Cases were patients hospitalized for ICH. Ten controls were matched to each case by SHI, birth year, and sex using incidence density sampling. Rate ratios (RR) of ICH for current phenprocoumon use as compared to non-use were estimated from odds ratios calculated by conditional logistic regression analyses considering multiple risk factors. Results: Analysis of the full cohort revealed a strong increase in incidence of ICH with increasing age. In the nested case-control study including 8138 cases of ICH and 81 373 matched controls, we observed an increased risk of ICH for current phenprocoumon exposure that varied with age. The phenprocoumon-associated risk of ICH was lower in older age groups with RRs from 4.20 (95% confidence interval (CI) 2.44-7.21) for phenprocoumon users less than 55 years of age to 2.43 (95%CI, 1.81-3.27) for those older than 85 years. Our study confirmed known risk factors of ICH. Discussion: Phenprocoumon exposure was associated with an increased risk of ICH. The interaction of risk for phenprocoumon with age was unexpected and needs further study. Copyright © 2010 John Wiley & Sons, Ltd.


Spallek J.,Bielefeld University | Spallek J.,Bremen Institute for Prevention Research and Social Medicine BIPS | Zeeb H.,Bremen Institute for Prevention Research and Social Medicine BIPS | Razum O.,Bielefeld University
Emerging Themes in Epidemiology | Year: 2011

Empirical findings show that morbidity and mortality risks of migrants can differ considerably from those of populations in the host countries. However, while several explanatory models have been developed, most migrant studies still do not consider explicitly the situation of migrants before migration. Here, we discuss an extended approach to understand migrant health comprising a life course epidemiology perspective. The incorporation of a life course perspective into a conceptual framework of migrant health enables the consideration of risk factors and disease outcomes over the different life phases of migrants, which is necessary to understand the health situation of migrants and their offspring. Comparison populations need to be carefully selected depending on the study questions under consideration within the life course framework. Migrant health research will benefit from an approach using a life course perspective. A critique of the theoretical foundations of migrant health research is essential for further developing both the theoretical framework of migrant health and related empirical studies. © 2011 Spallek et al; licensee BioMed Central Ltd.


Kraut A.A.,Bremen Institute for Prevention Research and Social Medicine BIPS | Schink T.,Bremen Institute for Prevention Research and Social Medicine BIPS | Schulze-Rath R.,Sanofi S.A. | Mikolajczyk R.T.,Bremen Institute for Prevention Research and Social Medicine BIPS | Garbe E.,Bremen Institute for Prevention Research and Social Medicine BIPS
BMC Infectious Diseases | Year: 2010

Background: Human papilloma virus (HPV) types 6 and 11 account for 90 percent of anogenital warts (AGW). Assessment of a potential reduction of the incidence of AGW following introduction of HPV vaccines requires population-based incidence rates. The aim of this study was to estimate incidence rates of AGW in Germany, stratified by age, sex, and region. Additionally, the medical practitioner (gynaecologist, dermatologist, urologist etc.) who made the initial diagnosis of AGW was assessed.Methods: Retrospective cohort study in a population aged 10 to 79 years in a population-based healthcare insurance database. The database included more than 14 million insurance members from all over Germany during the years 2004-2006. A case of AGW was considered incident if a disease-free period of twelve months preceded the diagnosis. To assess regional variation, analyses were performed by federal state.Results: The estimated incidence rate was 169.5/100,000 person-years for the German population aged 10 to 79 years. Most cases occurred in the 15 to 40 years age group. The incidence rate was higher and showed a peak at younger ages in females than in males. The highest incidence rates for both sexes were observed in the city-states Berlin, Hamburg and Bremen. In females, initial diagnosis of AGW was most frequently made by a gynaecologist (71.7%), whereas in males, AGW were most frequently diagnosed by a dermatologist (44.8%) or urologist (25.1%).Conclusions: Incidence of AGW in Germany is comparable with findings for other countries. As expected, most cases occurred in the younger age groups. The frequency of diagnoses of AGW differs between sexes and women and men receive treatment by doctors of different specialties. © 2010 Kraut et al; licensee BioMed Central Ltd.


Behrens T.,Bremen Institute for Prevention Research and Social Medicine BIPS | Pohlabeln H.,Bremen Institute for Prevention Research and Social Medicine BIPS | Mester B.,Bremen Institute for Prevention Research and Social Medicine BIPS | Langner I.,Bremen Institute for Prevention Research and Social Medicine BIPS | And 2 more authors.
Occupational and Environmental Medicine | Year: 2012

Introduction: In a previous analysis of a case-control study of testicular cancer nested in a cohort of automobile workers, we observed an increased risk for testicular cancer among workers who had ever been involved in occupational metal-cutting tasks. We investigated whether this risk increase was due to exposure to metal-working fluids (MWF). Methods: Occupational exposure to MWF was assessed in detail using a job-specific questionnaire for metal-cutting work. We calculated ORs and associated 95% CIs individually matched for age (±2 years) and adjusted for a history of cryptorchidism by conditional logistic regression. Results: The prevalence of exposure to MWF was 39.8% among cases and 40.1% among controls. For total germ cell tumours and seminomas we did not observe risk increases for metal-cutting tasks or occupational exposure to MWF (OR 0.95; 95% CI 0.69 to 1.32 and OR 0.88; 95% CI 0.58 to 1.35, respectively). However, dermal exposure to oil-based MWF was associated with an increased risk for non-seminomatous testicular cancer. Dermal exposure to oil-based MWF for more than 5000 h showed particularly high risk estimates (OR 4.72; 95% CI 1.48 to 15.09). Discussion: Long-term dermal exposure to oil-based MWF was a risk factor for the development of nonseminomatous testicular germ cell cancer. Possible measures to reduce exposure include the introduction of engineering control measures such as venting or enclosing of machines, and enforcing the use of personal protective equipment during metal cutting.


Krille L.,Johannes Gutenberg University Mainz | Hammer G.P.,Johannes Gutenberg University Mainz | Merzenich H.,Johannes Gutenberg University Mainz | Zeeb H.,Bremen Institute for Prevention Research and Social Medicine BIPS
European Journal of Radiology | Year: 2010

Background: The frequent use of computed tomography is a major cause of the increasing medical radiation exposure of the general population. Consequently, dose reduction and radiation protection is a topic of scientific and public concern. Aim: We evaluated the available literature on physicians' knowledge regarding radiation dosages and risks due to computed tomography. Methods: A systematic review in accordance with the Cochrane and PRISMA statements was performed using eight databases. 3091 references were found. Only primary studies assessing physicians' knowledge about computed tomography were included. Results: 14 relevant articles were identified, all focussing on dose estimations for CT. Overall, the surveys showed moderate to low knowledge among physicians concerning radiation doses and the involved health risks. However, the surveys varied considerably in conduct and quality. For some countries, more than one survey was available. There was no general trend in knowledge in any country except a slight improvement of knowledge on health risks and radiation doses in two consecutive local German surveys. Conclusions: Knowledge gaps concerning radiation doses and associated health risks among physicians are evident from published research. However, knowledge on radiation doses cannot be interpreted as reliable indicator for good medical practice. © 2009 Elsevier Ireland Ltd. All rights reserved.


Garbe E.,Bremen Institute for Prevention Research and Social Medicine BIPS | Jobski K.,Bremen Institute for Prevention Research and Social Medicine BIPS | Schmid U.,Bremen Institute for Prevention Research and Social Medicine BIPS
Pharmacoepidemiology and Drug Safety | Year: 2012

PurposeOral morphine is the first-choice opioid for moderate to severe cancer pain. Transdermal fentanyl is an alternative in patients with stable requirements of high-potency opioids (HPO) or if drugs cannot be taken orally. Drug regulatory authorities have issued several alerts to use transdermal fentanyl only for chronic pain and in HPO-tolerant patients to minimise the risk of severe opioid side effects. The aim of this study was to characterise utilisation of transdermal fentanyl in Germany. MethodsThe analysis was based on data from four German statutory health insurances from the years 2004-2006. Descriptive analyses were performed in new users of transdermal fentanyl to assess HPO-naïvety, potential difficulties with the oral route in HPO-naïve patients and the number of transdermal fentanyl dispensations. The initial dose in new users was assessed in 2005-2006 after marketing of transdermal fentanyl 12.5μg/hour. ResultsOf 35262 patients with new use of transdermal fentanyl, 29793 (84.5%) were assessed as HPO-naïve. Of those, 21596 (72.5%) did not have diagnoses indicating difficulties with the oral route. For 71.2% of the HPO-naïve new users of transdermal fentanyl, the first dose exceeded the recommended dose of 12.5μg/hour, and 49.3% of them received only one prescription of the drug. ConclusionsTransdermal fentanyl was used as a first-choice opioid, which may increase the risk of serious opioid side effects, in a substantial number of HPO-naïve patients. Inappropriate prescribing included also high initial doses in HPO-naïve patients and possible prescription for acute pain in a considerable proportion of patients. © 2011 John Wiley & Sons, Ltd.


Rohmel J.,Bremen Institute for Prevention Research and Social Medicine BIPS
Biometrical Journal | Year: 2011

For the all pairwise comparisons for equivalence of k (k≥2) treatments Lauzon and Caffo proposed simply to divide the type I error level α by k-1 to achieve a Bonferroni-based familywise error control when declaring pairs of two treatments equivalent. This rule is shown to be too liberal for k≥4. It works for k=3 yet for reasons not considered by Lauzon and Caffo. Based on the two one-sided testing procedures and using the closure test principle we develop valid alternatives based on Bonferroni's inequality. The set H of intersection hypotheses reveals a rich structure, leading to the possibility to present H as a directed acyclic graph (DAG). This in turn allows using some graph theoretical theorems and eases proving properties of the resulting multiple testing problems. © 2011 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

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