Anja Marr

Impact of prior percutaneous coronary intervention on the outcome of coronary artery bypass surgery: A multicenter analysis

OBJECTIVES Do prior percutaneous coronary interventions adversely affect the outcome of subsequent coronary artery bypass grafting? We investigated this effect on a multicenter basis. METHODS Eight cardiac surgical centers provided outcome data of 37,140 consecutive patients who underwent isolated first-time coronary bypass grafting between January 2000 and December 2005. Twenty-two patient characteristics and outcome variables were retrieved. Three groups of patients were analysed for in-hospital mortality and in-hospital major adverse cardiac events: patients without a previous percutaneous coronary intervention, with 1 previous intervention, and with 2 or more previous percutaneous coronary interventions before bypass grafting. A total of 29,928 patients with complete information for prior percutaneous coronary intervention underwent final analysis. Unadjusted univariate and risk-adjusted multivariate logistic regression analysis as well as computed propensity score matching were performed, based on 14 major risk factors to correct for and minimize selection bias. RESULTS A total of 10.3% of patients had 1 previous percutaneous coronary intervention, and 3.7% of patients had 2 or more previous interventions. Risk-adjusted multivariate logistic regression analysis revealed a significant association of 2 or more previous percutaneous coronary interventions with in-hospital mortality (odds ratio [OR], 2.0; confidence interval [CI], 1.4-3.0; P = .0005) and major adverse cardiac events (OR, 1.5; CI, 1.2-1.9; P = .0013). After propensity score matching, conditional logistic regression analysis confirmed the results of adjusted analysis. A history of 2 or more previous percutaneous coronary interventions was significantly associated with in-hospital mortality (OR, 1.9; CI, 1.3-2.7; P = .0016) and major adverse cardiac events (OR, 1.5; CI, 1.2-1.9; P = .0019). CONCLUSIONS Multicenter analysis confirms that a history of multiple previous percutaneous coronary interventions increases in-hospital mortality and the incidence of major adverse cardiac events after subsequent coronary artery bypass grafting. Critical discussion of the treatment strategy in these patients is warranted.

Associations between former exposure to manganese and olfaction in an elderly population: Results from the Heinz Nixdorf Recall Study

HighlightsOlfaction tested in a population‐based cohort from a steel‐producing region.Cumulative exposure to inhalable Mn based on 4635 measurements.No association found between former exposure to Mn and impaired olfaction. Abstract Occupational exposure to manganese (Mn) has been associated with impairments in olfaction and motor functions, but it has yet to be determined if such effects persist upon cessation of exposure. The objective of this study was to evaluate the influence of former occupational Mn exposure on olfaction within the framework of a prospective cohort study among an elderly German population. Information on job tasks with recognized Mn exposure and data on odor identification assessed with Sniffin’ sticks was collected during the second follow‐up of the Heinz Nixdorf Recall Study. The study population consisted of 1385 men aged 55–86 years, 354 of whom ever worked in jobs with potential Mn exposure (median 58.3 &mgr;g/m3 years, interquartile range 19.0–185 &mgr;g/m3 years). Multiple exposure measures, including job tasks, cumulative Mn exposure, and Mn determined in blood samples (MnB) archived at baseline, were used to estimate effects of Mn on olfaction. Having ever worked as welder was associated with better olfaction compared to other blue‐collar workers without Mn exposure. Blue‐collar workers identified less odors in comparison to white‐collar workers. Concentrations of previous Mn exposure >185 &mgr;g/m3 years or MnB ≥15 &mgr;g/L were not associated with impaired olfaction. In addition to a strong age effect, participants with lower occupational qualification identified less odors. We found no relevant association of former Mn exposure at relatively low levels with impaired olfaction. Possible neurotoxic Mn effects may not be persistent after cessation.

A case-control study: occupational cooking and the risk of uveal melanoma.

BackgroundA European-wide population based case-control study (European rare cancer study) undertaken in nine European countries examined risk factors for uveal melanoma. They found a positive association between cooks and the risk of uveal melanoma. In our study we examine whether cooks or people who worked in cook related jobs have an increased uveal melanoma risk.MethodsWe conducted a case-control study during 2002 and 2005. Overall, 1653 eligible subjects (age range: 20-74 years, living in Germany) participated. Interviews were conducted with 459 incident uveal melanoma cases, 827 population controls, 180 ophthalmologist controls and 187 sibling controls. Data on occupational exposure were obtained from a self-administered postal questionnaire and a computer-assisted telephone interview. We used conditional logistic regression to estimate odds ratios adjusting for the matching factors.ResultsOverall, we did not observe an increased risk of uveal melanoma among people who worked as cooks or who worked in cook related jobs. When we restricted the source population of our study to the population of the Federal State of Northrhine-Westphalia, we observed an increased risk among subjects who were categorized as cooks in the cases-control analysis.ConclusionOur results are in conflict with former results of the European rare cancer study. Considering the rarity of the disease laboratory in vitro studies of human uveal melanoma cell lines should be done to analyze potential exposure risk factors like radiation from microwaves, strong light from incandescent ovens, or infrared radiation.

The distribution of blood concentrations of lead (Pb), cadmium (Cd), chromium (Cr) and manganese (Mn) in residents of the German Ruhr area and its potential association with occupational exposure in metal industry and/or other risk factors

OBJECTIVE This study investigated the metal distribution in blood samples from the general population and the risk of having high metal concentration for metal workers. METHODS Metal concentrations were determined in archived blood samples from 1411 men and 1410 women (median age 59 and 57 years, respectively) collected at baseline (2000-2003) of the prospective Heinz Nixdorf Recall Study. Retrospective information on working in metal industry was obtained from previous follow-up survey (2011-2014). Odds ratios (ORs) with 95% confidence intervals (CI) of having a metal concentration >90th percentile (P90) for working in metal industry were calculated using logistic regression with adjustment for covariates. RESULTS More men than women worked in metal industry (57 vs. 3 at baseline). Male metal workers had increased blood lead (Pb) (OR: 2.86; 95% CI: 1.38-5.91) and manganese (Mn) (OR: 2.92; 95% CI: 1.46-5.81). Smoking (≥30 cigarettes/day) strongly influenced cadmium (Cd) in blood (OR: 168; 95% CI: 55-510). Women had higher Mn (8.92μg/L) and Cd (0.36μg/L) concentrations than men (Mn: 8.11μg/L; Cd: 0.29μg/L). Blood Pb in women (29.2μg/L) was lower than in men (33.2μg/L). None of the studied risk factors was significantly associated with chromium and nickel concentrations above their 90th percentiles. CONCLUSIONS In this population-based cohort we found evidence that working in metal industry was predictive for having elevated blood Pb and Mn concentrations. However, the 95th percentiles of all investigated metals were not significantly influenced by metal-related occupations. The present study is supportive for gender-specific reference values to limit occupational exposure to Mn and Pb. The strong influence of smoking on blood Cd hinders establishing reference values.

Having Children, Social Characteristics, Smoking and the Risk of Uveal Melanoma: A Case-Control Study

ABSTRACT Purpose: We analyzed data from the Risk Factors for Uveal Melanoma (RIFA) study to evaluate possible associations between uveal melanoma risk and having children, socioeconomic level and smoking. Methods: The RIFA study was a German case-control study conducted from September 2002 to March 2005. The study population consisted of 455 incident uveal melanoma patients (20–74 years of age) and 827 matched (age, sex, region of residence) population controls. Odds ratios (OR) and 95% confidence intervals (CI) were estimated using conditional logistic regression. Results: Women with children showed an increased OR (1.59, 95% CI 0.95–2.66) for uveal melanoma development compared to women without children. We estimated decreased ORs for subjects with higher socioeconomic level compared to the lowest status (upper secondary school leaving certificate: OR 0.68, 95% CI 0.49–0.94; higher education: OR 0.60, 95% CI 0.38–0.96). Ever smokers showed an OR of 1.19 (95% CI 0.92–1.55) compared to never smokers. Conclusion: The observed association between lower socioeconomic level and increased odds for uveal melanoma possibly represents a higher occupational uveal melanoma risk for occupational categories that are usually associated with lower socioeconomic status. Concerning having children and uveal melanoma development, we hypothesize that the observed association is mediated through alpha-melanocyte-stimulating hormone, a hormone that increases during pregnancy and is linked to pigmentation alterations in pregnant women.

Occupational exposure to manganese and fine motor skills in elderly men: Results from the Heinz Nixdorf Recall Study

Objectives Exposure to manganese (Mn) may cause movement disorders, but less is known whether the effects persist after the termination of exposure. This study investigated the association between former exposure to Mn and fine motor deficits in elderly men from an industrial area with steel production. Methods Data on the occupational history and fine motor tests were obtained from the second follow-up of the prospective Heinz Nixdorf Recall Study (2011-2014). The study population included 1232 men (median age 68 years). Mn in blood (MnB) was determined in archived samples (2000-2003). The association between Mn exposure (working as welder or in other at-risk occupations, cumulative exposure to inhalable Mn, MnB) with various motor functions (errors in line tracing, steadiness, or aiming and tapping hits) was investigated with Poisson and logistic regression, adjusted for iron status and other covariates. Odds ratios (ORs) with 95% confidence intervals (CIs) were estimated for substantially impaired dexterity (errors >90th percentile, tapping hits <10th percentile). Results The median of cumulative exposure to inhalable Mn was 58 µg m-3 years in 322 men who ever worked in at-risk occupations. Although we observed a partly better motor performance of exposed workers at group level, we found fewer tapping hits in men with cumulative Mn exposure >184.8 µg m-3 years (OR 2.15, 95% CI 1.17-3.94). MnB ≥ 15 µg l-1, serum ferritin ≥ 400 µg l-1, and gamma-glutamyl transferase ≥74 U l-1 were associated with a greater number of errors in line tracing. Conclusions We found evidence that exposure to inhalable Mn may carry a risk for dexterity deficits. Whether these deficits can be exclusively attributed to Mn remains to be elucidated, as airborne Mn is strongly correlated with iron in metal fumes, and high ferritin was also associated with errors in line tracing. Furthermore, hand training effects must be taken into account when testing for fine motor skills.

Agreement of Self-Reported and Administrative Data on Employment Histories in a German Cohort Study: A Sequence Analysis

Collecting life course data is increasingly common in social and epidemiological research, either through record linkage of administrative data or by collecting retrospective interview data. This paper uses data on employment histories collected through both strategies, compares the attained samples, and investigates levels of agreements of individual histories. We use data from the German Heinz Nixdorf Recall Study with information on employment histories collected retrospectively from 2011 until 2014 (N = 3059). Administrative data from the German Institute for Employment Research (IAB) were linked to the survey data. After comparing respondents who provide self-reported histories with the subsample of the ones for which administrative data were available, we investigate the agreement of individual employment histories from the two sources (between 1975 and 2010) using sequence analyses. Almost all participants provided survey data on employment histories (97% of the sample), linkage consent was given by 93%, and administrative data were available for 63% of the participants. People with survey data were more likely to be female, to have a higher education, and to work self-employed and in the tertiary sector. The agreement of individual employment histories is high and similar across time, with a median level of agreement of 89%. Slightly lower values exist for women and people working in the tertiary sector, both having more complex histories. No differences exist for health-related factors. In conclusion, it is likely that missing consent and failed record linkage lead to sample differences; yet, both strategies provide comparable and reliable life course data.