Martina Dören

Cohort Profile: The Study of Health in Pomerania

Henry Volzke, y Dietrich Alte,1y Carsten Oliver Schmidt, Dorte Radke, Roberto Lorbeer, Nele Friedrich, Nicole Aumann, Katharina Lau, Michael Piontek, Gabriele Born, Christoph Havemann, Till Ittermann, Sabine Schipf, Robin Haring, Sebastian E Baumeister, Henri Wallaschofski, Matthias Nauck, Stephanie Frick, Andreas Arnold, Michael Junger, Julia Mayerle, Matthias Kraft, Markus M Lerch, Marcus Dorr, Thorsten Reffelmann, Klaus Empen, Stephan B Felix, Anne Obst, Beate Koch, Sven Glaser, Ralf Ewert, Ingo Fietze, Thomas Penzel, Martina Doren, Wolfgang Rathmann, Johannes Haerting, Mario Hannemann, Jurgen Ropcke, Ulf Schminke, Clemens Jurgens, Frank Tost, Rainer Rettig, Jan A Kors, Saskia Ungerer, Katrin Hegenscheid, Jens-Peter Kuhn, Julia Kuhn, Norbert Hosten, Ralf Puls, Jorg Henke, Oliver Gloger, Alexander Teumer, Georg Homuth, Uwe Volker, Christian Schwahn, Birte Holtfreter, Ines Polzer, Thomas Kohlmann, Hans J Grabe, Dieter Rosskopf, Heyo K Kroemer, Thomas Kocher, Reiner Biffar,17,y Ulrich John20y and Wolfgang Hoffmann1y

Menopausal status and hepatic steatosis in a general female population

Population-based studies showed that non-alcoholic hepatic steatosis is less common in women than in men. Anti-oestrogens double the risk of non-alcoholic steatohepatitis,1 which may be interpreted as indirect evidence for a protective role of endogenous oestrogens against steatohepatitis. Experimental evidence further suggests that oestradiol causes a reduction of hepatic steatosis in mice unable to produce oestrogens.2 We thus hypothesised that the menopause as a natural state of oestrogen deficiency might increase the risk of hepatic steatosis. The Study of Health in Pomerania is a cross-sectional population-based survey in northeast Germany.3 We restricted our analyses to 808 women aged 40–59 years without seropositivity to hepatitis B antigen and anti-hepatitis C virus. The study was approved by the ethics committee of the University of Greifswald. All participants gave written informed consent. Menopause was defined as 12 consecutive months of amenorrhoea or cessation of menstruation after iatrogenic intervention. Serum glutamate oxaloacetate …

Superior compliance and efficacy of continuous combined oral estrogen-progestogen replacement therapy in postmenopausal women

OBJECTIVE We assessed compliance, relief of climacteric symptoms, and impact on lumbar bone mineral density in two groups of 140 patients treated with a sequential estrogen-progestogen or a continuous combined replacement therapy in comparison with controls. STUDY DESIGN Patients were randomized to 2 mg of estradiol valerate daily and 5 mg of medroxyprogesterone acetate daily for 12 days per month sequentially to induce withdrawal bleeding (group A) or 2 mg of estradiol, 1 mg of estriol, and 1 mg of norethisterone acetate daily continuously to maintain amenorrhea (group B) or a control group (group C). RESULTS Compliance was 93% after 1 year and 73% after 2 years in group B and 66% and 49% in group A after 1 and 2 years, respectively. Improvement of climacteric symptoms was similar in groups A and B. Uterine bleeding in 24% of patients in group A and 3% in group B was the most frequent reason for discontinuation of drug intake. Only continuous combined therapy (group B) increased bone mineral density after 1 and 2 years compared with baseline: +13% and 17% (p = 0.01). In groups A and C no significant changes in bone mineral density were recorded. Compliance was unrelated to the age of menopause. CONCLUSION Continuous combined therapy is superior to sequential estrogen progestogen replacement in compliance and prevention of bone loss but not with regard to relief of climacteric symptoms.

The role of physical activity in the prevention of osteoporosis in postmenopausal women-An update.

CONTEXT AND OBJECTIVE Osteoporosis causes an increase in bone fragility. Its clinical significance mainly refers to (hip) fractures secondary to (low or moderate) trauma. In Europe and North America about 6% of men and 21% of women aged 50-84 years are classified to have osteoporosis. Although it is well accepted that exercise is essential for the management of osteoporosis, the exact role of physical activity in the primary and secondary prevention of osteoporotic fractures is still controversial. METHODS The MEDLINE database and reference lists of selected publications were systematically searched for randomized controlled trials and prospective cohort studies, respectively, published since January 2000 regarding the association of physical activity and osteoporosis in postmenopausal women. RESULTS Two prospective cohort studies indicate the clinical relevance of this association by showing an inverse relationship between physical activity and the risk of hip fracture. There is convincing evidence that physical activity effectively slows bone loss in postmenopausal women in a dose-dependent manner. Exercise programs may increase bone mineral density. CONCLUSION In order to maximize the goals of public health most effective, individually adapted, intense, high impact exercise programs are needed. However, they may be complicated to communicate and adherence on the population level may be hard to achieve. These programs must be weighed against popular and applicable existing programs (e.g. aerobic classes, Tai Chi, and walking) which appear to be easier to adhere to but appear to be less effective in the prevention of osteoporotic fractures in the individual postmenopausal women.

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.

Gender differences in the relation between number of teeth and systolic blood pressure

Background Tooth loss predicts total and circulatory mortality. The reasons for the increased mortality in subjects with a low number of teeth may be related to enhanced atherosclerosis, elevated arterial pressure and more frequent hypertension. The present study was designed to investigate whether there is an association between the number of teeth and arterial pressure or hypertension. Methods We used data of 4185 adult subjects (2150 women) collected for the population-based Study of Health in Pomerania. The number of teeth was counted by trained and certified dentists. Hypertension was defined as systolic blood pressure ≥ 140 mmHg or diastolic blood pressure ≥ 90 mmHg or use of antihypertensive medication. Multivariable analyses were adjusted for relevant confounders. Results The adjusted mean (standard error) systolic blood pressure in men having 0–6 teeth was 149.6 mmHg (1.3 mmHg) compared to 142.6 mmHg (1.2 mmHg) in men having 27–28 teeth (P < 0.05). The adjusted odds for hypertension in men with 0–6 teeth compared to men with 27–28 teeth were 1.91 (95% confidence interval 1.21; 3.02, P < 0.05). In women no such relations were found. Conclusion There is an inverse association between the number of teeth and systolic blood pressure and hypertension in men but not in women. The present findings partly explain the relation between tooth loss and mortality.

The impact of the Women's Health Initiative Randomized Controlled Trial 2002 on perceived risk communication and use of postmenopausal hormone therapy in Germany.

Objective:The purpose of this representative, nationwide telephone survey was to collect information about postmenopausal hormone therapy (HT) use in relation to womens knowledge about the Womens Health Initiative Randomized Controlled Trial 2002 (WHI-RCT) in Germany. Design:During July 2003, telephone interviews were conducted with randomly selected women aged 45 to 60 years (N = 10,030; response 59.9%; completed interviews n = 6,007). They were asked about information sources regarding the WHI-RCT, and use of HT in conjunction with it. Results:Most women stated that they knew about the WHI-RCT (88.6%), and those with high educational status appeared to have more information than those with middle or low educational status. Among informed women (uninformed excluded), 46.6% continued, 25.7% stopped, and 14.2% ceased use of HT before the WHI-RCT. The prevalence of lifetime use of HT was higher in West Germany (37.4%) than in East Germany (29.2%), the highest prevalence of use was in the group aged 55 to 59 years. The most common reason to continue HT was the benefit risk assessment by physicians (58%); the most common reason to stop HT were womens perceptions that the risks of HT exceeded the benefits (56%). If information was solely given by physicians, women were more likely to continue HT (60.4%), compared with mass media (46.1%), as a source of information. Conclusions:The survey demonstrates the impact of the WHI-RCT in Germany, and shows that both the media and advice given by physicians were important. Women who continued to use HT did so largely because of their physicians advice. Women who discontinued were mainly those who had a negative subjective perception about risk of HT.

Physical activity and postmenopausal health.

Physical activity leads to a 30-50 % reduction in cardiovascular disease in women. Moderate activities such as walking, gardening or light sports appear to have beneficial effects. Additional exercise training may enhance these effects. Moderate-intensity activities constitute a key recommendation for primary prevention. Vigorous intensity activity may render additional benefits. Recent recommendations suggest an increase to at least 60 minutes of cumulative daily physical activity. Practical recommendations for the prevention of osteoporosis are less clear. There is a relative abundance of randomised controlled trials assessing bone mineral density at various sites. Meta-analyses of these studies indicate a beneficial health effect of physical activity on prevention of bone loss. However, the effects seen appear to be relatively small. Two recent end-point studies examining hip and fragility fractures show stronger evidence for the protective potential of physical activity in bone health. Exercise throughout life, particularly weight-bearing, is assumed to be beneficial for bone health. Older people at risk of falling are advised to participate in tailored exercise programmes to improve strength and balance, since physical training might contribute to fracture prophylaxis by increasing mobility and general activity of ageing people. Beyond the promotion of regular physical activity, primary disease prevention requires the adoption of healthy life habits including dietary patterns, weight control, and avoiding smoking. In the light of the failure of postmenopausal hormone use to protect against heart disease, rethinking the role of exercise in maintaining postmenopausal health is of increasing importance.

Menopausal hormone therapy and risk of lung cancer—Systematic review and meta-analysis

OBJECTIVES Lung cancer rates increase among women in many regions of the world. To explore whether menopausal hormone therapy (MHT) plays a role. METHODS We conducted a systematic search of the literature and performed meta-analyses of cohort studies (C), case-control studies (CC), randomized controlled trials (RCTs), and cancer registry studies (CR) to analyse the impact of estrogen therapy (ET), estrogen/progestin therapy (EPT) and any hormone therapy (HT) on lung cancer risks. We explored associations between ever-use of therapies and risks, analysed annual changes of risk, and the impact of therapies on histological subtypes. We calculated summary odds ratios, relative risks, 95% confidence intervals (CI; fixed-effects model), and assessed heterogeneity across studies. Eighteen studies were eligible (9 CC, 4 C, 3 RCT, 2 CR). RESULTS We found a significant increase of risk - 76.2% - in non-smoking women with adenocarcinoma (CI 1.072-2.898) reporting ever-use of HT. Estrogen plus progestin therapy does not change the risk; however, the pooled analysis of 2 RCTs points at an increased risk (RR 1.359; CI 1.031-1.791). Our further results should be interpreted with caution as significances were found in analyses only when smoking and non-smoking women, various hormone regimens, or histological subtypes, respectively, were pooled. CONCLUSIONS Dedicated studies designed to more adequately delineate the role of MHT are necessary to substantiate whether use of MHT is a risk factor for this or other types of lung cancer.

[Self-medication with over-the-counter (OTC) preparations in Germany].

ZusammenfassungDie Selbstmedikation mit OTC-Präparaten gewinnt in Deutschland und international zunehmend an Bedeutung. In dieser Arbeit werden Prävalenz und Determinanten der Selbstmedikation mit OTC-Präparaten in einer repräsentativen Stichprobe der deutschen erwachsenen Wohnbevölkerung zwischen 18 und 79 Jahren untersucht. Zu diesem Zweck wurden im Arzneimittelsurvey als Teil des repräsentativen Bundes-Gesundheitssurveys (1998) 7.099 Teilnehmer ausführlich über ihre Arzneimittelanwendung während der letzten 7 Tage interviewt. Vollständige Informationen dazu liegen von 3.393 Männern und 3.594 Frauen vor. 17,6% der Männer und 10,8% der Frauen wenden ausschließlich selbst medizierte OTC-Arzneimittel an, während 12,3% bzw. 29,3% zusätzlich zu den OTC-Arzneimitteln ärztlich verordnete Arzneimittel anwenden. Determinanten der Selbstmedikation mit OTC-Arzneimitteln sind u. a. das Geschlecht, das Alter, der sozioökonomische Status und die Gemeindegröße. Am häufigsten werden Vitamine, Mineralstoffe und Analgetika eingesetzt. Die häufigste Selbstangabe zur Indikation der OTC-Medikation ist „Prävention“. Die Selbstmedikation mit OTC-Präparaten ist für Männer und Frauen in Deutschland von großer Bedeutung. Etliche Faktoren außerhalb des unmittelbar medizinischen Bereiches erscheinen hier wichtig. Der Aspekt eines gestiegenen Gesundheitsbewusstseins scheint für die Selbstmedikation relevant zu sein.AbstractSelf-medication with OTC drugs is attracting attention in developed countries. This study examines prevalence and determinants of OTC drug use in a representative sample of German adults aged 18–79 years. A total of 7099 participants of the Drug Utilisation Survey were interviewed regarding drug use including OTC use within the last 7 days prior to the interview. This survey is a part of the representative German National Health Interview and Examination Survey 1998. Complete information is available from 3393 men and 3594 women: 17.6% of men and 10.8% of women use self-medicated OTC drugs exclusively, whereas 12.3% and 29.3%, respectively, use OTC drugs in addition to prescribed drugs. Besides sex, factors such as age, socioeconomic status and community size determine self-medication with OTC drugs. The most commonly used self-medicated OTC drugs are vitamins, minerals and analgesics. The most commonly reported indication for self-medication with OTC drugs is “prevention”. Beside prescribed medication, self-medication with OTC drugs is an important part of drug usage for men and women in Germany. Health consciousness appears to be a significant factor to explain the prevalence OTC drug use.