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Zusammenfassung Die Bedeutung der Depression als Risikofaktor bei der Entstehung und Progression der koronaren Herzerkrankung (KHK) und mögliche Pathomechanismen sind Gegenstand der vorliegenden Arbeit. Zur Abschätzung der Vorhersage... more
Zusammenfassung Die Bedeutung der Depression als Risikofaktor bei der Entstehung und Progression der koronaren Herzerkrankung (KHK) und mögliche Pathomechanismen sind Gegenstand der vorliegenden Arbeit. Zur Abschätzung der Vorhersage kardiovaskulärer Ereignisse liegen vier Metaanalysen mit ≥100.000 eingeschlossenen Probanden aus Bevölkerungsstudien mit einem adjustierten relativen Risiko von 1.60–1.90 vor. Neben verhaltenswirksamen Effekten (Ernährung, Bewegung, Rauchen, mangelnde Medikamententreue) werden drei zentrale psychobiologische Pathomechanismen diskutiert.
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Social Determinants of Health (SDOH) consider social, political, and economic factors that contribute to health disparities in patients and populations. The most common health‐related SDOH exposures are food and housing insecurity,... more
Social Determinants of Health (SDOH) consider social, political, and economic factors that contribute to health disparities in patients and populations. The most common health‐related SDOH exposures are food and housing insecurity, financial instability, transportation needs, low levels of education, and psychosocial stress. These domains describe risks that can impact health outcomes more than health care. Epidemiologic and translational research demonstrates that SDOH factors represent exposures that predict harm and impact the health of individuals. International and national guidelines urge health professionals to address SDOH in clinical practice and public health. The further implementation of these recommendations into basic and translational research, however, is lagging. Herein, we consider a precision health framework to describe how SDOH contributes to the exposome and exacerbates physiologic pathways that lead to chronic disease. SDOH factors are associated with various ...
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BackgroundMany machine learning heuristics integrate well with Electronic Medical Record (EMR) systems yet often fail to surpass traditional statistical models for biomedical applications.ObjectiveWe sought to compare predictive... more
BackgroundMany machine learning heuristics integrate well with Electronic Medical Record (EMR) systems yet often fail to surpass traditional statistical models for biomedical applications.ObjectiveWe sought to compare predictive performances of 12 machine learning and traditional statistical techniques to predict the occurrence of Hospital Acquired Pressure Injuries (HAPI).MethodsEMR information was collected from 57,227 hospitalizations acquired from Dartmouth Hitchcock Medical Center (April 2011 to December 2016). Twelve classification algorithms, chosen based upon classic regression and recent machine learning techniques, were trained to predict HAPI incidence and performance was assessed using the Area Under the Receiver Operating Characteristic Curve (AUC).ResultsLogistic regression achieved a performance (AUC = 0.91 ± 0.034) comparable to the other machine learning approaches. We report discordance between machine learning derived predictors compared to the traditional statist...
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OBJECTIVE To determine a just and consistent practice for creating nursing assignments. BACKGROUND Traditional methods of assigning patients to nurses may lead to unbalanced nursing workload. This article describes the ongoing,... more
OBJECTIVE To determine a just and consistent practice for creating nursing assignments. BACKGROUND Traditional methods of assigning patients to nurses may lead to unbalanced nursing workload. This article describes the ongoing, hospital-wide effort to evaluate and implement a nursing assignment tool based on electronic health record (EHR) functionality and auto-calculated nursing workload scores. METHODS EHR records of individual patient workload scores from all hospital units were collected from August 2017 to June 2018. A nurse-specific total workload score was summed for each staff. Then, each hospital unit's mean nurse workload score and standard deviation, along with the unit's nurse-to-patient ratio, were used to calculate levels of high, medium, and low nursing workload measurement (NWM). RESULTS Mean patient-specific workload scores varied greatly across hospital units. Unit-specific nurse-to-patient ratios were factored into NWM scores to create ranges for assignmen...
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Background— The effects of lifestyle risk factors considered collectively on the human metabolism are to date unknown. We aim to investigate the association of these risk factors with metabolites and their changes during 4 years. Methods... more
Background— The effects of lifestyle risk factors considered collectively on the human metabolism are to date unknown. We aim to investigate the association of these risk factors with metabolites and their changes during 4 years. Methods and Results— One hundred and sixty-three metabolites were measured in serum samples with the AbsoluteIDQ kit p150 (Biocrates) following a targeted metabolomics approach, in a population-based cohort of 1030 individuals, aged 45 to 83 years at baseline. We evaluated associations between metabolite concentrations (28 acylcarnitines, 14 amino acids, 9 lysophosphocholines, 72 phosphocholines, 10 sphingomyelins and sum of hexoses) and 5 lifestyle risk factors (body mass index [BMI], alcohol consumption, smoking, diet, and exercise). Multilevel or simple linear regression modeling adjusted for relevant covariates was used for the evaluation of cross-sectional or longitudinal associations, respectively; multiple testing correction was based on false discov...
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Research Interests: Biomarkers, Medicine, Humans, Internal Medicine, Hypertension, and 15 moreBlood Pressure, Female, Male, Clinical Sciences, Aged, Middle Aged, C reactive protein, Hypokalemia, Adult, Cardiovascular Diseases, Predictive value of tests, Hyperaldosteronism, Case Control Studies, Glycopeptides, and Cardiovascular medicine and haematology
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To evaluate the association of posttraumatic stress disorder (PTSD) with type 2 diabetes (T2D) or prediabetes in a large population-based sample. In 2970 subjects (aged 32-81 years) drawn from the population-based cross-sectional study... more
To evaluate the association of posttraumatic stress disorder (PTSD) with type 2 diabetes (T2D) or prediabetes in a large population-based sample. In 2970 subjects (aged 32-81 years) drawn from the population-based cross-sectional study KORA F4 from the Augsburg region (Southern Germany) a PTSD screening was performed employing the posttraumatic diagnostic scale, the impact of event scale, and interview data. The exposure variable PTSD was sub-classified into partial and full PTSD and additionally in subjects with traumatic event but no PTSD" to "The exposure variable PTSD was classified into (1) no traumatic event (2) traumatic event, but no PTSD, (3) partial PTSD, (4) full PTSD. A total of 50 (1.7%) subjects qualified for full PTSD, whereas 261 (8.8%) qualified for partial PTSD. A total of 333 subjects (11.2%) suffered from T2D and 498 (16.8%) from prediabetes as assessed by an oral glucose tolerance test and physicians' validation. The associations of PTSD with T2D and prediabetes were estimated by multinomial logistic regression analyses with adjustments for sociodemographic characteristics, metabolic risk factors or psychopathological conditions. In the model adjusted for sociodemographic characteristics and metabolic risk factors, full PTSD was significantly associated with T2D (OR: 3.90, 95% CI: 1.61-9.45, p=0.003) compared to subjects with no traumatic event. Significance remained after additional adjustment for other psychopathological conditions (OR: 3.56, 95% CI: 1.43-8.85, p=0.006). Regarding prediabetes, no significant associations were observed. Suffering from PTSD might activate chronic stress symptoms and trigger physiological mechanisms leading to T2D. Prospective studies are needed to investigate temporal and causal relationships between PTSD and T2D.
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INTRODUCTION Hospital-acquired pressure injuries (HAPIs) increase patient mortality and length of stay (LOS). Twenty-eight full-thickness HAPIs occurred in fiscal year 2015 (FY15), and that trend continued into FY16 with 14 injuries on... more
INTRODUCTION Hospital-acquired pressure injuries (HAPIs) increase patient mortality and length of stay (LOS). Twenty-eight full-thickness HAPIs occurred in fiscal year 2015 (FY15), and that trend continued into FY16 with 14 injuries on multiple units throughout a tertiary acute care center with 400 beds. To address this trend, a multidisciplinary Pressure Injury Prevention (PIP) team was created. OBJECTIVE This report is a description of ongoing, hospital-wide efforts to understand the common factors of HAPI causality and to establish corrective action plans institutionally to prevent similar events in the future. METHODS The team goals were to document the occurrence of HAPIs across all hospital units, reduce preventable full-thickness PIs to zero, and recommend institution-wide changes as those opportunities were recognized. RESULTS Since the committee's inception in July 2015, an 89% reduction of full-thickness HAPIs, with only 2 full-thickness HAPIs in FY17 and 3 in FY18, ha...
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Acute stress alters anti-bacterial defenses, but the neuroimmunological mechanisms underlying this association are not yet well understood. Metallothionein (MT), a cysteine-rich protein, is a stress response protein that is induced by a... more
Acute stress alters anti-bacterial defenses, but the neuroimmunological mechanisms underlying this association are not yet well understood. Metallothionein (MT), a cysteine-rich protein, is a stress response protein that is induced by a variety of chemical, biological, and psychological stressors, and MT has been shown to influence immune activities. We investigated MT's role in the management of anti-bacterial responses that occur during stress, using a C57BL/6 (B6) strain that has targeted disruptions of the Mt1 and Mt2 genes (B6-MTKO), and a B6 strain that has additional copies of Mt (B6-MTTGN). The well-characterized listeriosis model was used to examine immune mechanisms that are altered by a 1-h stress treatment (cold-restraint, CR) administered just prior to bacterial infection. Intriguingly, MT gene doses both greater and lower than that of wild-type (WT) B6 mice were associated with improved host defenses against Listeria monocytogenes (LM). This augmented protection wa...
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A recent study found genome-wide significant association between common variation in the gene neurocan (NCAN, rs1064395) and bipolar disorder (BD). In view of accumulating evidence that BD and schizophrenia partly share genetic risk... more
A recent study found genome-wide significant association between common variation in the gene neurocan (NCAN, rs1064395) and bipolar disorder (BD). In view of accumulating evidence that BD and schizophrenia partly share genetic risk factors, we tested this single-nucleotide polymorphism for association with schizophrenia in three independent patient-control samples of European ancestry, totaling 5061 patients and 9655 controls. The rs1064395 A-allele, which confers risk for BD, was significantly over-represented in schizophrenia patients compared to controls (p=2.28×10(-3); odds ratio=1.11). Follow-up in non-overlapping samples from the Schizophrenia Psychiatric GWAS Consortium (5537 patients, 8043 controls) provided further support for our finding (p=0.0239, odds ratio=1.07). Our data suggest that genetic variation in NCAN is a common risk factor for BD and schizophrenia.
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A ssociations between well-being, serum levels of insulin-like growth factor 1 (IGF-I), and its primary binding protein IGFBP-3, were examined in an epidemiologic study. The influence of physical activity on the effect of hormones on... more
A ssociations between well-being, serum levels of insulin-like growth factor 1 (IGF-I), and its primary binding protein IGFBP-3, were examined in an epidemiologic study. The influence of physical activity on the effect of hormones on well-being was considered. Cross-sectional data from participants of the KORA-Age study (n=985, age 64-93) was analyzed in sex-specific multivariable regressions of well-being (World Health Organization (WHO) -5) or ill-being (geriatric depression scale (GDS) -15). Models were adjusted for age, physical activity, sleep, BMI, smoking, and cognition. Adjusted WHO-5 means demonstrated the interaction between hormone quintiles with physical activity. Full models indicated that increased IGFBP-3 positively associated with well-being in women (β estimate=0.14, standard error (SE)=0.06) and less so in men (β=0.11, SE=0.07). IGF-I associated positively with depression (β=0.11, SE=0.06) and negatively with well-being (β=-0.11, SE=0.06) in women. Similar but not ...
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Research Interests: Psychology, Medicine, Oxytocin, Humans, Smoking, and 15 moreFemale, Male, Psychoneuroendocrinology, Psychosocial, Risk factors, Aged, Risk Factors, Cross Sectional Studies, Life Change Events, Confidence Interval, Object Attachment, Motor activity, Adverse effect, Psychology and Cognitive Sciences, and Medical and Health Sciences
Research Interests: Personality Disorders, Adolescent, Medicine, Cardiovascular Risk, Affect, and 15 moreHumans, Negative Affect, Personality Assessment Inventory, Female, Male, Cluster Analysis, Interpersonal Relations, Aged, Middle Aged, Adult, Odds ratio, Cardiovascular Diseases, Negative affectivity, Personality Inventory, and Medical and Health Sciences
Zusammenfassung Die Bedeutung der Depression als Risikofaktor bei der Entstehung und Progression der koronaren Herzerkrankung (KHK) und mögliche Pathomechanismen sind Gegenstand der vorliegenden Arbeit. Zur Abschätzung der Vorhersage... more
Zusammenfassung Die Bedeutung der Depression als Risikofaktor bei der Entstehung und Progression der koronaren Herzerkrankung (KHK) und mögliche Pathomechanismen sind Gegenstand der vorliegenden Arbeit. Zur Abschätzung der Vorhersage kardiovaskulärer Ereignisse liegen vier Metaanalysen mit ≥100.000 eingeschlossenen Probanden aus Bevölkerungsstudien mit einem adjustierten relativen Risiko von 1.60–1.90 vor. Neben verhaltenswirksamen Effekten (Ernährung, Bewegung, Rauchen, mangelnde Medikamententreue) werden drei zentrale psychobiologische Pathomechanismen diskutiert.
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Late progressions can be observed with all solid cancers. With the term dormancy a potential cause is offered for these observations. In this article we present a point of view from a cancer registry and analyze clinical data about... more
Late progressions can be observed with all solid cancers. With the term dormancy a potential cause is offered for these observations. In this article we present a point of view from a cancer registry and analyze clinical data about metastasis (MET)-free survival, post-MET survival, and overall survival to quantify late progressions. If dormancy is a characteristic of the MET process then all types of MET, including local recurrences, regional MET in the lymph nodes, or distant MET in organs, must be considered. First, it can be deduced from clinical data that the initiation of secondary foci is a temporally sequential process, which can begin years, or days, before a R0-resection. Second, the growth time of these different MET can be estimated from the survival time and generally takes years. Third, remarkable growth differences of these secondary foci must be considered which already can be correlated, in part, with molecular subgroups. Within these subgroups, growth is quite homogeneous. These three factors of MET growth largely explain the variability of observed relapse-free survival times. In contrast, the term dormancy is vague. It is an appealing metaphor with strong analogies such as circulating tumor cells of hematological neoplasms or dormant tumor cells in transplanted organs. But late MET can be the result of a number of very different causes. Where a disseminated tumor cell lodges, in niches or in specific organs, how long a tumor cell circulates before settling and establishing a focus, or whether the tumor cell has differential growth or even cell quiescence phases, determined by a dynamic equilibrium of divisions and apoptosis, could all contribute to the differential occurrence of MET. MET detection may also be delayed by adjuvant treatment, and all causal variants can be functionally equivalent, delay MET diagnosis, and appear as a slow growing tumor. But time of initiation and the growth of tiny foci are inaccessible and impossible to measure in humans. Therefore, the term tumor dormancy conceals our ignorance of the multi-step MET process. Because it is such a cloudy and elusive term it cannot be clinically relevant. It is a hypothetical construct that fails to offer new research perspectives, additional prognostic factors or an opportunity for novel therapy.
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Research Interests: Psychology, Dementia, Cognition, Medicine, Humans, and 15 moreInternal Medicine, Circadian Rhythm, Female, Male, Aged, Middle Aged, Odds ratio, Cognitive Function, Morning, Cross sectional Study, Cross Sectional Studies, Cognition disorders, confounding, hydrocortisone, and Medical and Health Sciences
Background: Despite the growing proportion of older adults in Europe there is only limited knowledge of CAM use among the elderly. This analysis aims to provide estimates for the prevalence of CAM use in persons with an age of ≥65, and to... more
Background: Despite the growing proportion of older adults in Europe there is only limited knowledge of CAM use among the elderly. This analysis aims to provide estimates for the prevalence of CAM use in persons with an age of ≥65, and to investigate correlations of CAM use with demographic characteristics. Methods: Based on participants of the MONICA/KORA studies S1-S4 who were born before 1944, a random sample of 1,079 was selected for comprehensive medical examinations. Questions were presented in structured face-to-face interviews conducted from February to November 2009. Results: Data on CAM use were available for 1,026 subjects with a mean age of 76 years, ranging from 65 to 93 years. 14% of the participants were unaware of CAM. The overall prevalence of CAM use was estimated 37% with minor differences between age groups, but clear differences between male (29%) and female (44%) participants. 1-year prevalence of CAM use was 22% (16% males, 28% females). 1-year of CAM use was ...
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Research Interests: Medicine, Psychosomatic Medicine, Germany, Prospective studies, Humans, and 15 moreFemale, Male, Body Mass Index, Risk factors, Aged, Middle Aged, Adult, Job Control, Risk Factors, Type 2 Diabetes Mellitus, Occupational Diseases, Job Strain, Confidence Interval, Psychology and Cognitive Sciences, and Medical and Health Sciences
ABSTRACT This study examines differences in the rates of depression and anxiety symptoms in overweight vs. normal weight women before and after the menopause. In a population sample of 1 416 participants of the KORA-Survey F3 2004-2005... more
ABSTRACT This study examines differences in the rates of depression and anxiety symptoms in overweight vs. normal weight women before and after the menopause. In a population sample of 1 416 participants of the KORA-Survey F3 2004-2005 (age 35-74 years), body mass index (BMI), waist circumference (WC), waist-to-hip-ratio (WHR) und waist-to-height-ratio (WHtR) were measured via physical examination. Depression and anxiety were assessed with the Hospital Anxiety and Depression Scale. Compared with normal weight, obesity was associated with depression in premenopausal women. This held for elevated BMI-, WC- and WHtR-scores (OR=3.7, 4.2, and 2.8), underlining the relevance of both general and abdominal obesity. Menopausal status may be a moderator for the association of obesity and depression, which - given the interaction between these 2 risk factors - may be of preven-tive importance in regard to the development of cardiovascular outcomes such as coronary heart disease.
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Research Interests: Endocrinology, Psychology, Depression, Pathogenesis, Medicine, and 15 moreGermany, Humans, Internal Medicine, Hypertension, Blood Pressure, Aldosterone, Female, Male, Body Mass Index, Aged, Middle Aged, Adult, Cross Sectional Studies, Psychology and Cognitive Sciences, and Medical and Health Sciences
Research Interests: Psychology, Cognitive Science, Cognition, Medicine, Logistic Regression, and 15 morePopulation, Humans, Female, Feasibility Studies, Male, Clinical Sciences, Geriatric Psychiatry, Aged, Questionnaires, Analysis of Variance, Geriatric Assessment, Logistic Models, Cognition disorders, Psychiatric Status Rating Scales, and mass Screening
Two thirds of female breast cancer patients and more than 80 % of malignant melanoma patients are diagnosed with localised disease and good prognosis with a 5-year relative survival of more than 90 % in Germany. This study was conducted... more
Two thirds of female breast cancer patients and more than 80 % of malignant melanoma patients are diagnosed with localised disease and good prognosis with a 5-year relative survival of more than 90 % in Germany. This study was conducted to present quality of life (QoL) data from a German population-based cohort of female breast cancer and melanoma patients without recurrence for approximately 2 years after initial diagnosis. In 2003-2004, patients with localised breast cancer and melanoma were recruited from the Munich Cancer Registry (Upper Bavaria, Germany) to answer QoL questionnaires. Differences between breast cancer and melanoma patients were investigated with regard to age and aspects of communication with their medical caregivers. One thousand three hundred and four breast cancer and 348 melanoma patients were included. Breast cancer patients were about 7 years older and had significantly lower QoL and higher symptom scores than melanoma patients. Communication needs were generally similar in both groups; however, breast cancer patients experienced more empathy from their medical caregivers. In breast cancer patients, communication was an independent factor for all QoL functioning scores. Even when faced with a similarly good prognosis, breast cancer patients have a worse QoL than melanoma patients 2 years after diagnosis. An explanation may be more distinctive surgery and systemic therapy, older patients with comorbidities and misunderstood risk communication in breast cancer patients that may stoke anxiety and fears. Further reasons could be unceasing public discussion about breast cancer and its instrumentalisation for political purposes.
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With a frequent occurrence of approximately 10.6% in adult populations, anxiety disorders are among the most common mental health problems worldwide. Although anxiety disorders are rather prevalent, their underlying biochemical mechanisms... more
With a frequent occurrence of approximately 10.6% in adult populations, anxiety disorders are among the most common mental health problems worldwide. Although anxiety disorders are rather prevalent, their underlying biochemical mechanisms remain unclear. As a functional endpoint of all biological events, the metabolome represents the most precise and direct molecular expression of a phenotype. Combining metabolic information with proteome data, systems biology can draw an even more comprehensive picture of the biological processes. Here, we provide a review summarizing the results from human as well as animal studies analyzing metabolic and proteomic traits in different tissues for associations with anxiety. In addition, we give an overview of animal studies that applied a systems biology approach using metabolic as well as proteomic data to identify anxiety-related pathways.