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Gao L.,German Cancer Research Center | Gao L.,Peking Union Medical College | Weck M.N.,German Cancer Research Center | Stegmaier C.,Epidemiological Cancer Registry of Saarland | And 2 more authors.
Annals of Epidemiology | Year: 2010

Purpose: Moderate alcohol consumption has been suggested to facilitate the elimination of Helicobacter pylori infection as the result of its antibacterial effect. We aimed to assess the associations of current and lifetime alcohol consumption as well as serum gamma-glutamyltransferase (GGT), an established biomarker of alcohol consumption, with H. pylori infection in a large population-based study. Methods: In the baseline examination of the ESTHER study, serological measurements of antibodies against H. pylori and GGT measurements were taken in 9733 subjects ages 50 to 74 years. Information on lifestyle factors and medical history were obtained by self-administered standardized questionnaire. Results: A significant inverse association, in dose-response manner, was observed between both current and lifetime alcohol consumption and H. pylori seropositivity. The estimates based on lifetime consumption were more pronounced than the results for current consumption, and such inverse associations were found both for men and women. Stronger relations were observed for those who only drank wine or mixed drinkers compare with those who only drank beer. Furthermore, there was a significant inverse dose-response relationship between serum GGT levels and H. pylori seropositivity, which was selectively observed among alcohol drinkers. Conclusions: In conclusion, our results support the hypothesis that moderate alcohol consumption may facilitate elimination of H. pylori. © 2010 Elsevier Inc. All rights reserved.


Wild B.,University of Heidelberg | Herzog W.,University of Heidelberg | Schellberg D.,University of Heidelberg | Lechner S.,University of Heidelberg | And 5 more authors.
International Journal of Geriatric Psychiatry | Year: 2012

Objective The aim of the study was to determine the association between the prevalence of clinically significant depression and age in a large representative sample of elderly German people. Methods In the second follow-up (2005-2007) of the ESTHER cohort study, the 15-item geriatric depression scale (GDS-15) as well as a sociodemographic and clinical questionnaire were administered to a representative sample of 8270 people of ages 53 to 80years. The prevalence of clinically significant depression was estimated using a GDS cut-off score of 5/6. Prevalence rates were estimated for the different age categories. Association between depression and age was analyzed using logistic regression, adjusted for gender, co-morbid medical disorders, education, marital status, physical activity, smoking, self-perceived cognitive impairment, and anti-depressive medication. Results Of the participants, 7878 (95.3%) completed more than twelve GDS items and were included in the study. The prevalence of clinically significant depression was 16.0% (95%CI=[15.2; 16.6]). The function of depression prevalence dependent on age group showed a U-shaped pattern (53-59: 21.0%, CI=[18.9; 23.3]; 60-64: 17.7%, CI=[15.7; 19.7]; 65-69: 12.6%, CI=[11.2; 14.0]; 70-74: 14.4%, CI=[12.6; 16.0]; 75-80: 17.1%, CI=[14.9; 19.4]). Adjusted odds ratios showed that the chances of being depressive decrease with the age category but remain relatively stable for people aged 65 and over. Conclusions The prevalence of depression in the elderly seems to be associated with the age category. Adjusted odds ratios showed that people aged 60 and older had lower chances of being depressive than people aged 53 to 59years. © 2011 John Wiley & Sons, Ltd.


Maatouk I.,University of Heidelberg | Wild B.,University of Heidelberg | Herzog W.,University of Heidelberg | Wesche D.,University of Heidelberg | And 6 more authors.
Journal of Hypertension | Year: 2012

Objective: The aim of the study was to assess the longitudinal association between cardiovascular risk factors including albuminuria and other variables (e.g. awareness of hypertension, number of types of antihypertensive drugs, comorbidity), and health-related quality of life (HRQOL) in a large cohort of patients with hypertension, over a follow-up period of 5 years. Methods: Nine thousand nine hundred and fifty-three participants of the ESTHER (Epidemiologische Studie zu Chancen der Verhütung, Früherkennung und optimierten Therapie chronischer Erkrankungen) study-a population-based cohort study of middle-aged and older adults aged 50-74 years at baseline-were recruited by general practitioners (GPs) in 2000-2002 and included in the follow-up (2005-2007). HRQOL at baseline and follow-up was measured using the Short-Form General Health Survey (SF-12). Mental component scores (MCS) and physical component scores (PCS) were calculated. Multiple linear regression models were used to determine longitudinal predictors of HRQOL at follow-up. Results: Four thousand, two hundred and three patients with hypertension (98.2%) responded to the SF-12 both at baseline and after 5 years and were therefore included in the study. Smoking status, BMI, diabetes, macroalbuminuria, comorbid diseases, history of depression, and lower HRQOL at baseline predicted lower PCS at the 5-year follow-up. Lower MCS after 5 years was predicted by smoking status, dyslipidaemia, a reported history of depression, and HRQOL at baseline. No significant association was detected between awareness of hypertension and any HRQOL component score after 5 years. Conclusions: Macroalbuminuria and other variables related to increased cardiovascular risk have a negative impact on PCS. Suggestions of a link of treatment and awareness of hypertension with HRQOL from previous cross-sectional studies are not supported by our longitudinal findings. © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins.


Saum K.-U.,German Cancer Research Center | Dieffenbach A.K.,German Cancer Research Center | Muller H.,German Cancer Research Center | Holleczek B.,Epidemiological Cancer Registry of Saarland | And 2 more authors.
European Journal of Epidemiology | Year: 2014

The frailty index (FI), defined by a deficit accumulation approach, has emerged as a promising concept in gerontological research, but applications have been mostly restricted to populations from Canada and the United States aged 65 years or older. Baseline data from the German ESTHER cohort study (N 9,886; age 50-75; mean follow-up 8.7 years) were used to create a FI through a deficit accumulation approach. For estimation of frailty prevalence, we used cut-points for the FI to define three categories (non-frail 0 to ≤0.20; pre-frail >0.20 to <0.45; frail ≥0.45). We assessed variation of the FI by age and sex: 10-year survival according to baseline FI was assessed by Kaplan-Meier curves and bivariate and multivariate Cox proportional hazard models. Cubic splines were used to assess sex-specific dose-response associations. Prevalence of frailty was 9.2 and 10.5 % in women and men, respectively. Age-specific prevalence of frailty ranged from 4.6 % in 50-54 year old participants to 17.0 % in 70-75 year old participants. Below 60 years of age, men had a higher FI than women. However, the FI showed a stronger increase with age among women (3.1 % per year) than among men (1.7 % per year) and was higher among women than men in older age groups. Adjusted hazard ratios (95 % confidence intervals) for all-cause mortality were 1.08 (0.84-1.39), 1.32 (1.05-1.66), 1.77 (1.41-2.22), and 2.60 (2.11-3.20) for the 2nd, 3rd, 4th, and 5th quintile of the FI compared to 1st quintile, respectively. There was a strong dose-response relationship between the FI and total mortality among both men and women and both younger (<65 years) and older subjects. We found sex differences in the FI and its increase with age, along with a consistent strong association of the FI with mortality in both sexes, even for age group 50-64. © 2014 Springer Science+Business Media.


Saum K.-U.,German Cancer Research Center | Muller H.,German Cancer Research Center | Stegmaier C.,Epidemiological Cancer Registry of Saarland | Hauer K.,University of Heidelberg | And 2 more authors.
Journal of the American Geriatrics Society | Year: 2012

Objectives To develop and evaluate a modification of the Fried frailty assessment using population-independent cutpoints and to determine frailty prevalence of community-dwelling elderly people in a German population. Design Cross-sectional analysis of 8-year follow-up data of a large German cohort study. Setting Saarland, Germany. Participants Three thousand one hundred twelve community-dwelling adults aged 59 and older. Measurements Frailty was operationalized using modified Fried frailty criteria. Criteria were categorized according to quintiles (lowest-quintile approach) or using population- independent cutpoints derived from the literature (population-independent approach). Agreement and construct validity of frailty classification according to both approaches were evaluated according to weighted kappa (κ) and Spearman rank correlation (rSp). Associations between frailty and covariates were assessed using multiple logistic regression models. Results Although more participants were identified as frail according to the population-independent index (8.9%) than the lowest-quintile index (6.5%), agreement and correlation of frailty classification using both approaches was high (κ = 0.75 and rSp = 0.84). Sex differences in frailty prevalence were more pronounced when the population-independent approach was used (women 11.4%; men 6.1%). Similarly strong significant associations with sociodemographic, lifestyle, and medical factors such as older age, female sex, smoking, and obesity were seen for both approaches. Conclusion The modified Fried index using literature-derived cutpoints independent from the frailty criteria distributions in the underlying study population showed good correlation with the lowest-quintile approach and enables prevalence estimates that are directly comparable between different populations. © 2012, The American Geriatrics Society.


Wild B.,University of Heidelberg | Herzog W.,University of Heidelberg | Lechner S.,University of Heidelberg | Niehoff D.,University of Heidelberg | And 6 more authors.
Journal of Psychosomatic Research | Year: 2012

Objective: The aim of the study was the gender specific analysis of cross-sectional and longitudinal associations between body mass index class (BMI-class) and symptoms of depression in a representative sample of elderly German people. Methods: At the baseline of the ESTHER study (2000-2002), 9953 participants completed a comprehensive questionnaire including items regarding weight, height, and depression history. After five years, 7808 participants again completed the questionnaire and the 15-item geriatric depression scale (GDS-15). BMI was classified into five classes: normal weight, 18.5≤BMI<25; overweight, 25≤BMI<30; obesity class I, 30≤BMI<35; obesity class II, 35≤BMI<40; obesity class III, BMI≥40. Results: Logistic regression analysis for the cross-sectional data at five-year follow-up, adjusted for age, education, marital status, smoking, multimorbidity, physical activity, self-perceived cognitive impairment, and use of antidepressants, showed that the odds for depression were significantly elevated for women in obesity class II and significantly decreased for overweight men. The longitudinal analysis showed a similar pattern: Women in obesity classes II and III at baseline had significantly higher odds for being depressive five years later than women with normal weight at baseline (class II: OR=1.67; 95%CI=[1.06; 2.64]; class III: OR=2.93; 95%CI=[1.37; 6.26]; overweight men had lower odds than normal-weight men (OR=0.69; 95%CI=[0.51;0.92]). Conclusion: The relationship between obesity and symptoms of depression appears to be heterogeneous across BMI-classes. Women are more affected than men by obesity class II and III; overweight appears to be associated with reduced risk of depression in elderly men. © 2012 Elsevier Inc.


PubMed | German Cancer Research Center, Epidemiological Cancer Registry of Saarland and University of Heidelberg
Type: Journal Article | Journal: International journal of geriatric psychiatry | Year: 2015

The aim of this study was to evaluate the association between loneliness in elderly people with the use of psychotropic drugs.A subsample of 3111 participants (ages 55-85) of the large population-based German ESTHER study was included in the study. Loneliness was measured by using a three-item questionnaire. Two subgroups were defined according to their degrees of loneliness. Psychotropic drugs were categorized by study doctors. Logistic regression analyses were conducted to determine the association between loneliness subgroups and the use of psychotropic drugs adjusted for psychosocial variables, multimorbidity, depression, anxiety, and somatic symptom severity.Of the participants 14.1% (95%-CI=[12.9; 15.4]) were estimated to have a high degree of loneliness (women>men); 19% (95%-CI=[17.6; 20.4]) of the participants used psychotropic drugs, 8.4% (95%-CI=[7.5; 9.5]) antidepressants. Logistic regression analysis showed that more lonely participants had significantly higher odds for using psychotropic drugs (OR: 1.495; 95%-CI=[1.121; 1.993]). Depression severity, somatic symptom severity, and female gender were also positively associated with the use of psychotropic drugs.A high degree of subjective loneliness in the elderly is associated with the use of psychotropic drugs, even after adjustment for somatic and psychological comorbidities and psychosocial variables.


Gao L.,German Cancer Research Center | Weck M.N.,German Cancer Research Center | Raum E.,German Cancer Research Center | Stegmaier C.,Epidemiological Cancer Registry of Saarland | And 2 more authors.
International Journal of Epidemiology | Year: 2010

Background: Early-life social environment has been suggested to play an important role during the development of Helicobacter pylori-related gastric diseases. We aimed to assess the association of sibship size with H. pylori infection and chronic atrophic gastritis (CAG) in a population-based study from Germany. Methods: In the baseline examination of ESTHER, a study conducted in Saarland, serological measurements of pepsinogen I and II and H. pylori antibodies were taken in 9444 participants aged 50-74 years. Information on potential risk factors and medical history were obtained by self-administered standardized questionnaire. Results: A strong dose-response relationship between sibship size and H. pylori seroprevalence was observed (P < 0.01). Adjusted odds ratios (ORs) 95% confidence interval (CI) for H. pylori seropositivity for subjects with 4, 5, 6 and 7 or more siblings compared with subjects without siblings were 1.45 (1.20-1.77), 1.83 (1.50-2.22) and 1.84 (1.47-2.31), respectively. A large sibship size was also associated with an increased risk of CAG with an adjusted OR of 1.42 (1.01-2.01) for 7 or more compared with less than or equal to 2 siblings. This association was attenuated but not entirely elimi- nated after additional adjustment for H. pylori infection. Notably, a significant association between large sibship size and CAG was also found among H. pylori-negative subjects. Conclusions: Our results suggest that large sibship size is associated with increased H. pylori prevalence and CAG risk. The association with CAG risk may be mediated at least in part by H. pylori infection. However, mechanisms other than H. pylori infection may contribute to the 'sibling effect' as well. © The Author 2009; all rights reserved. Published by Oxford University Press on behalf of the International Epidemiological Association.


Jansen L.,German Cancer Research Center | Herrmann A.,German Cancer Research Center | Stegmaier C.,Epidemiological Cancer Registry of Saarland | Singer S.,University of Leipzig | And 2 more authors.
Journal of Clinical Oncology | Year: 2011

Purpose: To compare long-term quality of life (QoL) of colorectal cancer survivors with QoL in the general population and investigate changes in QoL of survivors during the 10 years after diagnosis. Patients and Methods: Health-related QoL was assessed 1, 3, 5, and 10 years after diagnosis in a population-based cohort starting with 439 patients with colorectal cancer from Saarland, Germany, using the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Core 30. QoL after 5 and 10 years and time course of QoL during the 10 years after diagnosis were compared with controls from the general population of Germany, after controlling for sex and age. Results: Overall, 234 and 196 patients were still alive after 5 and 10 years, respectively. Of these survivors, 178 (76%) responded in the 5-year follow-up, 133 (68%) in the 10-year follow-up, and 117 (60%) participated in all follow-ups. Over the entire follow-up, younger survivors (age at diagnosis, < 60 years) reported restrictions in role, social, emotional, and cognitive functioning and specific problems like constipation, diarrhea, fatigue, and insomnia. Older survivors (age at diagnosis, ≥ 70 years) reported comparable or even better QoL than controls within the first 3 to 5 years after diagnosis and comparable to worse QoL 5 to 10 years after diagnosis. Conclusion: Although younger survivors continuously reported detriments in various QoL dimensions during the 10-year period after diagnosis, detriments in older survivors became apparent in the long run only. © 2011 by American Society of Clinical Oncology.


Kramer H.U.,German Cancer Research Center | Muller H.,German Cancer Research Center | Stegmaier C.,Epidemiological Cancer Registry of Saarland | Rothenbacher D.,German Cancer Research Center | And 3 more authors.
European Journal of Epidemiology | Year: 2012

Although a positive association between type 2 diabetes mellitus (T2DM) and colorectal cancer is well established, uncertainty exists about risk differences in diabetic men and women when considering colorectal neoplasia (CN). The main objective was to examine gender- specific associations of T2DM with CN in a population- based cohort study of adults in Germany. This analysis is based on participants of the ESTHER-study, a population- based cohort study. Participants were 50-74 years old at baseline and underwent colonoscopy during 5 year follow- up. CN detected at colonoscopy were validated by medical records review. Total and gender-specific associations of T2DM at baseline and CN were estimated using log-binomial regression. Overall, 55 cases of CN were detected in 166 participants with T2DM and 328 cases in 1,360 participants without T2DM. In women, CN was found in 32 % of participants with T2DM and in 18 % without T2DM (adjusted prevalence ratio (PR): 1.66 95 % CI 1.04-2.64). In men, prevalence for CN was 35 % for those with T2DM and 33 % for those without T2DM (adjusted PR = 1.01; 95 % CI 0.71-1.43). T2DM might have a stronger impact on CN among women than among men. Further research should examine possible reasons for these differences. © The Author(s) 2012.

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