Neuroticism, extraversion, stressful life events and asthma: a cohort study of middle-aged adults.

BACKGROUND: Stressful life events can trigger asthma exacerbations, but could also contribute to the development of incident asthma. However, only few studies have investigated the association between stressful life events and adult asthma prospectively. Likewise, stress-related personality traits (e.g. neuroticism and extraversion) may increase asthma risk, but this has been examined in only one prospective study. We therefore aimed to investigate the association between neuroticism, extraversion, stressful life events and incident asthma. METHODS: A population-based sample of 5114 middle-aged adults completed questionnaires between 1992 and 1995. Among those alive in 2002/2003, 4010 (83%) were followed-up by questionnaires. Exposures of interest included neuroticism, extraversion and three stressful life events (unemployment, having broken off a life partnership and death of a close person). Associations with incident asthma were estimated by multivariable risk ratios (RR) and 95% confidence intervals (95% CI) using Poisson regression. RESULTS: High vs low neuroticism predisposed to developing asthma (RR = 3.07, 95% CI = 1.71-5.48), but high extraversion did not (RR = 1.30, 95% CI = 0.79-2.15). Having broken off a life partnership significantly increased asthma risk (RR = 2.24, 95% CI = 1.20-4.21) in contrast to death of a close person (RR = 1.06, 95% CI = 0.64-1.75) or unemployment (RR = 1.65, 95% CI = 0.72-3.78). CONCLUSIONS: High levels of neuroticism may increase the risk of asthma in middle-aged adults. Having broken off a life partnership was the only stressful event, which was associated with incident asthma. Synthesized with evidence from earlier studies, this could reflect that interpersonal conflicts may increase asthma risk, possibly along an immunological pathway.

The cohort of long-term survivors at the German childhood cancer registry.

BACKGROUND: With the increasing number of long-term survivors among patients diagnosed with cancer during childhood, questions concerning late effects have become a major research topic. To ascertain late effects, it is necessary to contact former patients. An essential requirement for such studies is a long-term surveillance (LTS) of former childhood cancer patients in their adolescence and their adulthood. The paper describes the role of the German Childhood Cancer Registry (GCCR) in LTS. A cohort of long-term survivors has been built up over the years. The characteristics of this LTS cohort and strategies for further improvement of LTS will be presented. PATIENTS AND METHODS: Since 1980 the GCCR systematically ascertains all malignant neoplasms and benign brain tumours in children under the age of 15 years at diagnosis. Participants are followed up actively by the treating hospitals and the clinical study groups in the first years after diagnosis, and by the GCCR thereafter. Late effects are accessed within the Scientific Society for Paediatric Oncology and Haematology (GPOH) of different groups with different focal points. Those groups are the GCCR (secondary malignant neoplasms), LESS (late effects after chemotherapy), RiSK (late effects after radiotherapy), and the working group on quality of life (quality of life and data on life circumstances). Additionally, the GCCR provides logistics for contacting patients during LTS. The LTS is supported by a recent basic publication ("position paper") by the GPOH. Newly diseased cancer cases are reported to the GCCR very completely. The GCCR contains mainly epidemiological data. Accessorily, the GCCR ascertains a minimum of data for each patient which enables population-based studies involving long-term survivors of childhood cancer. RESULTS: Out of 37 291 children diagnosed with cancer between 1980 and 2004, 8 896 died (until spring 2007). From those not deceased, 21 987 (77.4%) can be followed up further (i.e. current address is known). For about 70% of the patients in the LTS cohort, follow-up data are available and not older than 5 years. Our experience shows that about 80% of former childhood cancer patients agree to continued data storage at the GCCR, 4% explicitly refuse their consent, the remaining do not answer. LTS for patients with leukemia and lymphomas is particularly complete, whereas for patients with brain tumours it is less complete. CONCLUSIONS: The LTS is considered highly relevant concerning aspects of clinical quality assurance and epidemiological research. The GCCR can guarantee a continuing development and improvement of existing procedures for LTS. The GCCR expects to achieve contacting a high percentage of former childhood cancer patients also in future LTS, even after long periods of time.

[Registries for rare diseases. Compliance and data protection]. / Register zu seltenen Krankheiten : Patientencompliance und Datenschutz.

For rare diseases, clinical and epidemiological research suffers from very small numbers of cases. A comprehensive collection of data and information in registries is an essential precondition to improve this situation. To this end, a number of disease specific networks have started collecting data with support from the German Ministry of Research. The past experiences of the German Childhood Cancer Registry show that voluntary participation, based on informed consent, can result in a satisfactory completeness of data collection and, thus, enable successful medical research. There are several ways to build registries and research networks conforming to the data protection rules.

Assessment of cognitive status in the elderly using telephone interviews.

OBJECTIVE: To examine the feasibility to assess cognitive status in the elderly using telephone interviews. RESEARCH DESIGN AND METHODS: From January to December 2003, 740 participants of the ongoing Heidelberg longitudinal study (HeiDE) aged 70 years or more were eligible for a telephone interview on cognitive status. Validated instruments to assess cognitive status, including the Telephone Interview of Cognitive Status (TICS) and the East Boston Memory Test (EBMT, immediate and delayed recall), the Verbal Fluency Test, the HAWIE-"Vocabulary Test" and the HAWIE-"General Knowledge", a prospective memory test, and a digit span backwards-test were translated into German, if applicable. RESULTS: Out of 740 participants at the age of 70 or older, 473 participants were interviewed (64.9%). The total score of the TICS (maximum=best: 41) ranged from 21 to 40 (mean 33.5, SD 3.1; median 34.0). The EBMT scores (immediate recall; maximum=best: 12) ranged from 4 to 12 (mean 9.2, SD 1.7; median 9.0). CONCLUSIONS: Cognitive status could be successfully assessed by telephone interview in elderly participants of an ongoing population-based cohort study. Specifically, some of the tests showed pronounced variability allowing cross-sectional analyses whereas others seem more valuable for longitudinal assessment.