Adrian Loerbroks

Prevalence, Correlates and Characteristics of Chronic Pruritus: A Population-based Cross-sectional Study

Pruritus is the most frequent symptom in dermatology. Its impact on quality of life is substantial. Epidemiological data on chronic pruritus (>6 weeks) at the population level is sparse, but is important in order to understand the burden and risk factors of this distressing symptom. The aim of this population-based cross-sectional study was to estimate the point, 12-month and lifetime prevalence of chronic pruritus, assessing its association with sociodemographic variables and describing its characteristics. A validated postal questionnaire was sent to 4,500 individuals in from the German General population. Three contact attempts were made. The response rate was 57.8% (n=2,540). The point prevalence of chronic pruritus was 13.5% (95% confidence interval (95% CI) 12.2-14.9%), 12-month prevalence 16.4% (15.0-17.9%) and lifetime prevalence 22.0% (20.4-23.7%). Multivariate analyses found only ethnic origin independently associated with chronic pruritus. The impact of chronic pruritus on quality of life and emotional well-being appears to depend on severity rather than on the presence of the symptom alone. This is the first study to investigate various prevalence estimates of chronic pruritus at the population level. Despite its limitations (self-report and potential self-selection) this study indicates a high burden of chronic pruritus in society.

Vitamin D levels predict all-cause and cardiovascular disease mortality in subjects with the metabolic syndrome: The Ludwigshafen Risk and Cardiovascular Health (LURIC) study

OBJECTIVE Optimal vitamin D levels are associated with reduced cardiovascular and all-cause mortality. We investigated whether optimal 25-hydroxyvitamin D (25[OH]D) is protective in individuals with the metabolic syndrome. RESEARCH DESIGN AND METHODS The Ludwigshafen Risk and Cardiovascular Health (LURIC) study is a cohort study of subjects referred for coronary angiography between 1997 and 2000, from which 1,801 with the metabolic syndrome were investigated. Mortality was tracked for a median of 7.7 years. Multivariable survival analysis was used to estimate the association between 25(OH)D levels and mortality. RESULTS Most subjects (92%) had suboptimal levels of 25(OH)D (<75 nmol/L), with 22.2% being severely deficient (<25 nmol/L). During follow-up, 462 deaths were recorded, 267 (57.8%) of which were cardiovascular in origin. After full adjustment, including the metabolic syndrome components, those with optimal 25(OH)D levels showed a substantial reduction in all-cause (hazard ratio [HR] 0.25 [95% CI 0.13–0.46]) and cardiovascular disease mortality (0.33 [0.16–0.66]) compared with those with severe vitamin D deficiency. For specific cardiovascular disease mortality, there was a strong reduction for sudden death (0.15 [0.04–0.63]) and congestive heart failure (0.24 [0.06–1.04]), but not for myocardial infarction. The reduction in mortality was dose-dependent for each of these causes. CONCLUSIONS Optimal 25(OH)D levels substantially lowered all-cause and cardiovascular disease mortality in subjects with the metabolic syndrome. These observations call for interventional studies that test whether vitamin D supplementation provides a useful adjunct in reducing mortality in these subjects.

Physical activity and risk of cardiovascular disease: what does the new epidemiological evidence show?

Purpose of review Abundant evidence has documented inverse associations of physical activity and the risk of cardiovascular disease (CVD). However, the effects of different types of physical activity (e.g., leisure time and occupational physical activity) are still poorly understood. Recent findings Drawing on recommended and established guidelines for study selection, we identified and included 23 prospective epidemiological studies published during the last 2 years. These studies included a total of more than 790 000 adults at baseline with some 22 000 incident cases occurring during follow-up. Our findings suggest that moderate and high levels of leisure time physical activity are associated with a moderately reduced risk of CVD. In contrast, moderate and high levels of occupational physical activity showed weak positive associations, that is, a slightly increased risk of CVD. Summary This updated meta-analysis supports the notion of primary prevention of CVD through engagement in leisure time physical activity. The role of occupational physical activity in CVD prevention is questionable.

Predictors of overweight and obesity in five to seven-year-old children in Germany: Results from cross-sectional studies

BackgroundChildhood obesity is a serious public health problem and epidemiological studies are important to identify predictive factors. It is the aim of this study to analyse factors associated with overweight/obesity in samples of German children.Methods35,434 five to seven year-old children (50.9% boys) participated in cross-sectional studies between 1991 and 2000 in several rural and urban areas in East and West Germany. Weight and height were measured and body mass index was calculated. International cut-off points, recommended by the International Obesity Task Force, were used to classify childhood overweight and obesity.Predictive modelling was employed to analyse independently associated factors, using logistic regression to adjust for confounding.Results15.5% were overweight, and 4.3% were obese. Female sex, other than German nationality, smoking in the living place and increasing birth weight were found to increase the odds of overweight and obesity, while increasing educational level, living space > 75 m2 and breastfeeding for more than three months were inversely associated.ConclusionThe findings add to the evidence informing public health action, both through health promotion strategies (promoting breastfeeding, tackling smoking) and wider societal change management (addressing children from migrant families and families with low educational level).

The prevalence of gestational diabetes in advanced economies

Abstract Aims: One of the first steps in optimizing future prevention and appropriately allocating resources to future diagnosis and treatment of Gestational diabetes (GDM) is to quantify its burden. The aim of this study was therefore to conduct a systematic review of current international literature on the prevalence of GDM with a focus on advanced economies. Methods: Based on literature searches with the database “PubMed” we included studies with a publication date between 2000 and 2011. All studies were classified independently by two authors. In accordance with the PRISMA Statement we identified 27 original studies. Results: The prevalence of GDM varies substantially between populations with a range of 1.7–11.6%. Patient self-reports yield higher prevalence estimates than values that are based on medical diagnosis or clinical diagnostic tests. Prevalence seems to vary considerably within Europe with higher prevalence values being observed in Southern Europe than in Northern and Central Europe. Prevalence values from studies from Australia and North America were within this range. Conclusion: This review provides a comprehensive and sound summary of the current state of research on the prevalence of GDM in advances economies as a first step in identifying starting points for future interventions.

The association of asthma and wheezing with major depressive episodes: an analysis of 245 727 women and men from 57 countries

BACKGROUND Epidemiological studies have shown that asthma is positively associated with depression. Most of this evidence stems from individual studies conducted in Western populations (e.g. Europe, North America and Australia). It is still unclear whether such findings generalize to non-Western countries. To address this question, the present study investigated the association of asthma and wheezing with depression in a large multi-national sample. METHODS We used data from the 2002 World Health Survey. Participants reported physician-diagnosed asthma and attacks of wheezing within the past 12 months. Questions on depressive symptoms, their duration and persistence were used to define presence of a major depressive episode (MDE) within the past 12 months. ORs and 95% CIs were estimated by logistic regression for the entire sample, by continent (Australia, Europe, South America, Asia and Africa) and by country. Complete information was available for 57 countries. RESULTS Both asthma and wheezing were associated with MDE in the entire sample (OR=2.37, 95% CI=2.10-2.66 and OR=3.06, 95% CI=2.75-3.40, respectively). Similar associations were found for all continents with generally stronger ORs in South America, Asia and Africa for both asthma (ORs ≥ 1.8) and wheezing (ORs  ≥ 2.8). On the country level, wheezing showed a consistent pattern of association with MDE. Similar patterns were found for asthma. CONCLUSIONS Despite a range of country differences that could affect the association of asthma with depression, such as access to health care, the results of this study indicate that the co-occurrence of asthma and depression is a universal phenomenon.

Inflammation and cardiorespiratory control: the role of the vagus nerve.

Inflammation and immunity have been implicated in a wide variety of diseases and disorders ranging from asthma to cardiovascular disease to hemorrhagic shock. In this review we will briefly consider the evidence for the neural concomitants of immunomodulation. First, we will briefly review the anatomy and physiology of the cardiorespiratory system. Then we will review the anatomy and physiology of neural-immune communication. The nucleus of the solitary tract is a site of integration of both the afferent and efferent neural regulation of the cardiorespiratory as well as the immune system. Then we will provide an overview of what is known about neuroimmunomodulation from both animal and human studies including neuroimaging and clinical studies. Finally, we will discuss a possible role of this neural circuitry in asthma related health disparities.

Incidence and determinants of chronic pruritus: a population-based cohort study.

Epidemiological data on chronic pruritus (> 6 weeks) in the general population are sparse. We aimed to provide data on the incidence and prevalence of chronic pruritus, and identify its determinants based on cross-sectional and longitudinal analyses. A cohort of 1,190 participants from a cross-sectional baseline-study (response rate: 57.8%) was followed up after one year. The questionnaire assessed occurrence of chronic pruritus, medical, lifestyle and psychosocial variables. Incident chronic pruritus was defined as reported chronic pruritus at follow-up in those subjects free-of-the-symptom at baseline. Cross-sectional analyses of data from the follow-up assessments addressed potential associations of medical, lifestyle and psychosocial factors with prevalent chronic pruritus. Longitudinal analyses examined sociodemographic factors as potential predictors of incident chronic pruritus. The follow-up response rate was 83.1%. The mean age of subjects was 56 years, and 58% were female. The 12-month cumulative-incidence equalled 7.0% (95% confidence interval (95% CI) 5.2-9.2%. Lifetime prevalence was 25.5% (95% CI 21.8-27.8%). Incidence was significantly associated with age. Determinants of prevalent chronic pruritus in multi-variable analyses were: liver disease, asthma, eczema and dry skin within the medical domain, an elevated body mass index within the lifestyle domain and higher anxiety scores within the psychosocial domain. Findings suggest a considerable 12-month incidence and lifetime prevalence and provide important directions for future research.

Which leukocyte subsets predict cardiovascular mortality? From the LUdwigshafen RIsk and Cardiovascular Health (LURIC) Study

OBJECTIVE White blood cells are known to predict cardiovascular mortality, but form a highly heterogeneous population. It is therefore possible that specific subtypes disproportionally contribute to the prediction of cardiovascular outcomes. Therefore, we compared leukocyte subsets alone and in conjunction with an established inflammatory marker, C-reactive protein, for predicting death due to cardiovascular disease in a high-risk population. METHODS Patients, 3316, (mean [SD] age, 62 [10] years) scheduled for coronary angiography were prospectively followed up. Neutrophil, monocyte and lymphocyte counts were determined. Neutrophil and monocyte subsets were further analysed on the basis of surface expression of CD11b, CD18, CD31, CD40 and CD58. Lymphocytes were further subdivided into CD3, CD4, CD8, and CD19 subsets. The association between each marker and subsequent cardiovascular mortality was assessed using multivariable Cox regression models. RESULTS During a median follow-up period of 7.8 years, 745 (22.5%) patients died, of which 484 were due to cardiovascular events. After entering conventional risk factors and removing patients with a current infection, neutrophil count (HR [95% CI]=1.90 [1.39, 2.60], P<0.001) and the neutrophil/lymphocyte ratio (HR [95% CI]=1.68 [1.24, 2.27], P=0.003) emerged as independent predictors of cardiovascular mortality. After mutual adjustment, neutrophil count (HR [95% CI]=1.87 [1.35, 2.50], P<0.001) out-performed C-reactive protein (HR [95% CI] 1.32 [0.99, 1.78], P=0.06) as a predictor of cardiovascular mortality. CONCLUSIONS Due to its predictive potential and inexpensive determination, assessment of high neutrophil counts may represent an important marker, possibly improving cardiovascular mortality risk prediction.

Cortisol is significantly correlated with cardiovascular responses during high levels of stress in critical care personnel

Objective: Everyday stressors elicit adaptive changes in the hypothalamic-pituitary-adrenal (HPA) axis and the autonomic nervous system. Data on the relationship between these two systems under real-life conditions are sparse. We, therefore, sought to examine the association between HRV and salivary cortisol, which were recorded simultaneously in a stress-exposed, prospective, occupational cohort. Methods: The study population comprised 88 nurses. We recorded heart rate (HR) and HRV during 301 working shifts. Participants provided salivary cortisol samples at the beginning of their work shift and every 2 hours thereafter. Samples were collected during three investigation periods spread over 9 months. Change scores for cortisol were calculated as deviations from the expected circadian baseline. Change scores from the grand diurnal mean in the time domain-based root mean square of successive differences served to index alterations in HRV. To account for the temporal delay between changes in HR/HRV and changes in salivary cortisol, the latter were compared with the changes in HR/HRV observed 15 minutes to 45 minutes before the cortisol sampling. Results: During periods of high stress as indexed by high cortisol levels, we found significant associations between cortisol levels and HR (r = .48, p < .001) and HRV (r = −.28, p = .05). However, during low stress periods, these associations were attenuated and became nonsignificant. Conclusions: These data suggest a relative independence in the regulation of the HPA axis and the autonomic nervous system in response to everyday stressors but synchrony of both systems in highly stressful situations. ANS = autonomic nervous system; bpm = beats per minute; CV = coefficient of variation; HPA = hypothalamic-pituitary-adrenal; HRV = heart rate variability; RMSSD = root mean square of successive differences; CI = confidence interval.