Metabolically Healthy, but Obese Individuals and Associations with Echocardiographic Parameters and Inflammatory Biomarkers: Results from the CARLA Study.

INTRODUCTION: The research on heterogeneity among obese individuals has identified the metabolically healthy, but obese (MHO) phenotype as a distinct group that does not experience the typical cardiovascular-related diseases (CVD). It is unclear if this group differs with regard to preconditions for CVDs. Our aim was to assess differences in echocardiographic parameters and inflammatory biomarkers between MHO and metabolically healthy, normal weight individuals (MHNW). METHODS: The analyses used data from 1412 elderly participants from a German population-based cohort study (CARLA), which collected detailed information on demographic, biochemical, and echocardiographic variables. Participants were subdivided into four groups (MHNW, MHO, MUNW (metabolically unhealthy, normal weight) and MUO (metabolically unhealthy, obese)) based on BMI≥30 kg/m2 (obese or normal weight) and presence of components of the metabolic syndrome. The clinical characteristics of the 4 groups were compared with ANOVA or Chi-Square test, in addition to two linear regression models for 16 echocardiographic parameters. The difference in inflammatory biomarkers (hsCRP, IL-6 and sTNF-RI) between the groups was examined with a multinomial logistic regression model. RESULTS: The MHO individuals were on average 64.2±8.4 years old, with a higher proportion of women (71.6%), low percentage of smokers, larger waist circumference (109.3±10.5 cm vs 89.1±10.8 cm, p<0.0001) and higher odds ratios for hsCRP, IL-6 and sTNF-RI compared to MHNW individuals. Linear regression models revealed greater left atrial (LA) diameter (2.73 (95% CI: 1.35-4.11) mm), LA volume (7.86 (95% CI: 2.88-12.83) mL), and left ventricular mass index (LVMI) (11.82 (95% CI: 4.43-19.22) g/m1.7) in the MHO group compared to the MHNW group. CONCLUSION: The MHO phenotype is associated with echocardiographic markers of cardiac remodeling (LA diameter, volume and LVMI) and higher odds ratios for inflammatory biomarkers.

Association between advanced glycation end products, their soluble receptor, and mortality in the general population: Results from the CARLA study.

BACKGROUND: Advanced glycation end products (AGEs) in the plasma are associated with a number of age-related diseases that possibly lead to reduced longevity. However, previous studies showed large inconsistencies in the association between AGEs or their soluble receptor (sRAGE) and mortality. We studied this association in a cohort study of general population and assessed the potential changes in this association over time. METHODS: We used data of 958 men and 802 women from the general population in Halle, Germany with a follow up of 12 years. The associations were assessed by means of Kaplan-Meyer survival curves and multivariable and time-varying Cox-regression. RESULTS: AGEs and sRAGE were either not or only weakly (and in the other direction than expected) associated with all-cause mortality after 12 years follow-up in men and women (AGEs: Hazard ratio (HR) = 0.93, 95% confidence interval (95%CI) = 0.83-1.05 for men; HR = 0.88, 95%CI = 0.74-1.05 for women; sRAGE: HR = 1.08, 95%CI = 0.95-1.23 for men; HR = 1.10, 95%CI = 0.92-1.30 for women). There was no change of the predictive values over the follow up time. Sub-analyses with participants with and without AGEs-related conditions (diabetes mellitus and decreased renal function), with age stratified groups (younger (<65 years) and older (≥65 years) participants), with cardiovascular disease mortality as the outcome and the AGE/sRAGE ratio as predictor provided similar results. CONCLUSIONS: Our findings suggest a lack of the expected association with mortality and contribute to the inconsistent findings for plasma-measured AGEs, sRAGE, and AGE/sRAGE ratio.

Advanced glycation end products and their ratio to soluble receptor are associated with limitations in physical functioning only in women: results from the CARLA cohort.

BACKGROUND: Advanced glycation end products (AGEs), modifications of proteins or amino acids, are increasingly produced and accumulated with age-related diseases. Recent studies suggested that the ratio of AGEs and their soluble receptor (sRAGE) is a more accurate biomarker for age-related diseases than each separately. We aim to investigate whether this also applies for physical functioning in a broad age-spectrum. METHODS: AGE and sRAGE levels, and physical functioning (SF-12 questionnaire) of 967 men and 812 women (45-83 years) were measured in the CARLA study. We used ordinal logistic regression to examine associations between AGEs, sRAGE, and AGE/sRAGE ratio with physical functioning in sex- and age-stratified models. RESULTS: Higher levels of AGEs and AGE/sRAGE ratio were associated with lower physical functioning only in women, even after consideration of classical lifestyle and age-related factors (education, BMI, smoking, alcohol consumption, diet, creatinine clearance, diabetes mellitus, lipid lowering and antihypertensive drugs) (odds ratio (OR) =0.86, 95%confidence interval = 0.74-0.98 and OR = 0.86, 95%CI = 0.75-0.98 for AGEs and AGE/sRAGE ratio respectively). We could not demonstrate a significant difference across age. CONCLUSIONS: We showed a sex-specific association between physical functioning and AGEs and AGE/sRAGE, but no stronger associations of the latter with physical functioning. Further investigation is needed in the pathophysiology of this association.

Measuring Cognitive Reserve (CR) - A systematic review of measurement properties of CR questionnaires for the adult population.

AIM: The aim of this systematic review was to summarize and critically appraise the quality of published literature on measurement properties of questionnaires assessing Cognitive Reserve (CR) in adults (>18 years). METHODS: We systematically searched for published studies on MEDLINE, PsycINFO, and Web of Science through August 2018. We evaluated the methodological quality of the included studies and the results on measurement properties based on a consensus-based standard checklist. RESULTS: The search strategy identified 991 publications, of which 37 were selected evaluating the measurement properties of six different questionnaires. Construct validity of the Cognitive Reserve Index questionnaire was most extensively evaluated, while evaluation of the remaining measurement properties of this questionnaire was scarce. Measurement properties of the Cognitive Reserve Questionnaire and the Cognitive Reserve Scale were assessed more completely. While the Lifetime of Experience Questionnaire seems to be the most thorough instrument, a finale recommendation for one specific questionnaire cannot be drawn, since about half of the measurement properties for each questionnaire were poorly or not assessed at all. CONCLUSIONS: There is a need of high quality methodological studies assessing measurement properties of CR questionnaires, especially regarding content validity, structural validity, and responsiveness. TRIAL REGISTRATION: PROSPERO Registration number CRD42018107766.

Ageing Investigation Using Two-Time-Point Metabolomics Data from KORA and CARLA Studies.

Ageing, one of the largest risk factors for many complex diseases, is highly interconnected to metabolic processes. Investigating the changes in metabolite concentration during ageing among healthy individuals offers us unique insights to healthy ageing. We aim to identify ageing-associated metabolites that are independent from chronological age to deepen our understanding of the long-term changes in metabolites upon ageing. Sex-stratified longitudinal analyses were performed using fasting serum samples of 590 healthy KORA individuals (317 women and 273 men) who participated in both baseline (KORA S4) and seven-year follow-up (KORA F4) studies. Replication was conducted using serum samples of 386 healthy CARLA participants (195 women and 191 men) in both baseline (CARLA-0) and four-year follow-up (CARLA-1) studies. Generalized estimation equation models were performed on each metabolite to identify ageing-associated metabolites after adjusting for baseline chronological age, body mass index, physical activity, smoking status, alcohol intake and systolic blood pressure. Literature researches were conducted to understand their biochemical relevance. Out of 122 metabolites analysed, we identified and replicated five (C18, arginine, ornithine, serine and tyrosine) and four (arginine, ornithine, PC aa C36:3 and PC ae C40:5) significant metabolites in women and men respectively. Arginine decreased, while ornithine increased in both sexes. These metabolites are involved in several ageing processes: apoptosis, mitochondrial dysfunction, inflammation, lipid metabolism, autophagy and oxidative stress resistance. The study reveals several significant ageing-associated metabolite changes with two-time-point measurements on healthy individuals. Larger studies are required to confirm our findings.

The role of nutrition, intimate partner violence and social support in prenatal depressive symptoms in rural Ethiopia: community based birth cohort study.

BACKGROUND: Depression during pregnancy has far-reaching adverse consequences on mothers, children and the whole family. The magnitude and determinants of prenatal depressive symptoms in low-resource countries are not well established. This study aims to describe the prevalence of prenatal depressive symptoms and whether it is associated with maternal nutrition, intimate partner violence and social support among pregnant women in rural Ethiopia. METHODS: This study is based on the baseline data from a large prospective, community-based, birth cohort study conducted in the South Western part of Ethiopia from March 2014 to March 2016. A total of 4680 pregnant women were recruited between 12 and 32 weeks of gestation. Depressed mood was assessed using the Patient Health Questionnaire (PHQ-9) scale and a cut off of ≥8 was taken to define prenatal depressive symptoms. Data collection was conducted electronically on handheld tablets and submitted to a secured server via an internet connection. Bivariate and multivariate logistic regression analyses were computed using IBM SPSS version 20 software. RESULT: The community based prevalence of depressive symptoms during pregnancy was 10.8% (95%Confidence Interval (CI): 9.92-11.70). Adjusting for confounding variables, moderate household food insecurity (OR 1.74; 95% CI: 1.31-2.32), severe household food insecurity (OR 7.90; 95% CI: 5.87-10.62), anaemia (OR = 1.30; 95% CI: 1.04-1.61) and intimate partner violence (OR 3.08; 95% CI: 2.23-4.25) were significantly associated with prenatal depressive symptoms. On the other hand, good social support from friends, families and husband reduced the risk of prenatal depressive symptoms by 39% (OR 0.61; 95% CI: 0.50-0.76). CONCLUSION: Prenatal depressive symptomatology is rather common during pregnancy in rural Ethiopia. In this community based study, household food insecurity, anaemia and intimate partner violence were significantly associated with prenatal depressive symptoms. Good maternal social support from friends, families and spouse was rather protective. The study highlights the need for targeted screening for depression and intimate partner violence during pregnancy. Policies aimed at reducing household food insecurity, maternal anaemia and intimate partner violence during pregnancy may possibly reduce depression.

Comparison of metabolite networks from four German population-based studies.

Background: Metabolite networks are suggested to reflect biological pathways in health and disease. However, it is unknown whether such metabolite networks are reproducible across different populations. Therefore, the current study aimed to investigate similarity of metabolite networks in four German population-based studies. Methods: One hundred serum metabolites were quantified in European Prospective Investigation into Cancer and Nutrition (EPIC)-Potsdam (n = 2458), EPIC-Heidelberg (n = 812), KORA (Cooperative Health Research in the Augsburg Region) (n = 3029) and CARLA (Cardiovascular Disease, Living and Ageing in Halle) (n = 1427) with targeted metabolomics. In a cross-sectional analysis, Gaussian graphical models were used to construct similar networks of 100 edges each, based on partial correlations of these metabolites. The four metabolite networks of the top 100 edges were compared based on (i) common features, i.e. number of common edges, Pearson correlation (r) and hamming distance (h); and (ii) meta-analysis of the four networks. Results: Among the four networks, 57 common edges and 66 common nodes (metabolites) were identified. Pairwise network comparisons showed moderate to high similarity (r = 63-0.96, h = 7-72), among the networks. Meta-analysis of the networks showed that, among the 100 edges and 89 nodes of the meta-analytic network, 57 edges and 66 metabolites were present in all the four networks, 58-76 edges and 75-89 nodes were present in at least three networks, and 63-84 edges and 76-87 edges were present in at least two networks. The meta-analytic network showed clear grouping of 10 sphingolipids, 8 lyso-phosphatidylcholines, 31 acyl-alkyl-phosphatidylcholines, 30 diacyl-phosphatidylcholines, 8 amino acids and 2 acylcarnitines. Conclusions: We found structural similarity in metabolite networks from four large studies. Using a meta-analytic network, as a new approach for combining metabolite data from different studies, closely related metabolites could be identified, for some of which the biological relationships in metabolic pathways have been previously described. They are candidates for further investigation to explore their potential role in biological processes.

Short-term blood pressure variability - variation between arm side, body position and successive measurements: a population-based cohort study.

BACKGROUND: Precise blood pressure (BP) measurements are central for the diagnosis of hypertension in clinical and epidemiological studies. The purpose of this study was to quantify the variability in BP associated with arm side, body position, and successive measurements in the setting of a population-based observational study. Additionally, we aimed to evaluate the influence of different measurement conditions on prevalence of hypertension. METHODS: The sample included 967 men and 812 women aged 45 to 83 years at baseline. BP was measured according to a standardized protocol with oscillometric devices including three sitting measurements at left arm, one simultaneous supine measurement at both arms, and four supine measurements at the arm with the higher BP. Hypertension was defined as systolic BP (SBP) ≥140 mmHg and/or diastolic BP (DBP) ≥90 mmHg. Variability in SBP and DBP were analysed with sex-stratified linear covariance pattern models. RESULTS: We found that overall, no mean BP differences were measured according to arm-side, but substantial higher DBP and for men also higher SBP was observed in sitting than in supine position and there was a clear BP decline by consecutive measurement. Accordingly, the prevalence of hypertension depends strongly on the number and scheme of BP measurements taken to calculate the index values. CONCLUSIONS: Thus, BP measurements should only be compared between studies applying equal measurement conditions and index calculation. Moreover, the first BP measurement should not be used to define hypertension since it overestimates BP. The mean of second and third measurement offers the advantage of better reproducibility over single measurements.

Cardiovascular Risk Factors Associated With Blood Metabolite Concentrations and Their Alterations During a 4-Year Period in a Population-Based Cohort.

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 discovery rate. BMI, alcohol consumption, and smoking were associated with lipid metabolism (reduced lyso- and acyl-alkyl-phosphatidylcholines and increased diacylphosphatidylcholines concentrations). Smoking showed positive associations with acylcarnitines, and BMI correlated inversely with nonessential amino acids. Fewer metabolites showed relative changes that were associated with baseline risk factors: increases in 5 different acyl-alkyl phosphatidylcholines were associated with lower alcohol consumption and BMI and with a healthier diet. Increased levels of tyrosine were associated with BMI. Sex-specific effects of smoking and BMI were found specifically related to acylcarnitine metabolism: in women higher BMI and in men more pack-years were associated with increases in acylcarnitines. CONCLUSIONS: This study showed sex-specific effects of lifestyle risks factors on human metabolism and highlighted their long-term metabolic consequences.

Depressive symptoms, life satisfaction and prevalence of sleep disturbances in the general population of Germany: results from the Heinz Nixdorf Recall study.

OBJECTIVES: It appears that not only depression, but also low life satisfaction (LS), is related to sleep disorder in the general population. We evaluate whether the prevalence of sleep disorder attributable to depressed mood is greater among participants with low LS. SETTING, PARTICIPANTS AND OUTCOME MEASURES: Analysis of cross-sectional data from 3880 cohort members from the German Heinz Nixdorf Recall study (2006-2008) aged 51-81 years. Standard mood (Center for Epidemiological Studies Depression scale (CES-D) for Depressive symptoms and a single-item life satisfaction measure) and sleep quality (Pittsburgh Sleep Quality Index, PSQI) measures were conducted as part of the survey. Multiple imputation was used to deal with missing data in outcome, exposures or covariates. Relative excess risk for interaction (RERI) and its 95% CIs were estimated using adjusted prevalence ORs. Owing to the study size, the precision of the measures of additive interaction is relatively low. RESULTS: We observed an association between depressed mood (5-units increase in CES-D score) (POR=1.7 (95% CI 1.6 to 1.8)) and sleep disorder, and between low LS (not very satisfied vs very satisfied) (POR=1.5 (1.1 to 2.2)) and sleep disorder. Also, we observed a synergistic effect between lower level of LS (not very satisfied) and depressed mood (score ≥ 16) on prevalence of sleep disorders (RERI=3.7 (-0.2 to 7.1)). Furthermore, these findings were corroborated in sensitivity analysis carried out with the complete case data set and in sex-specific analyses (RERI=5.5 (-0.4 to 11.3), and RERI=2.4 (-2.5 to 7.4) for men and women, respectively). CONCLUSIONS: Both depressed mood and LS are notably associated with sleep quality, and these relationships are best captured by considering their joint effects. Depression and LS need to be taken into consideration when analysing sleep quality.

Incidence of functional bi-temporal connections in the human brain in vivo and their relevance to epilepsy surgery.

The incidence of functional connections between human temporal lobes and their latencies were investigated using intracranial EEG responses to electrical stimulation with 1 msec single pulses in 91 patients assessed for surgery for treatment of epilepsy. The areas studied were amygdala, hippocampus, parahippocampal gyrus, fusiform gyrus, inferior and mid temporal gyrus. Furthermore, we assessed whether the presence of such connections are related to seizure onset extent and postsurgical seizure control. Responses were seen in any region of the contralateral temporal lobe when stimulating temporal regions in 30 patients out of the 91 (32.96%). Bi-hippocampal or bi-amygdalar projections were seen in only 5% of temporal lobes (N = 60) and between both fusiform gyri in 7.1% (N = 126). All other bilateral connections occurred in less than 5% of hemispheres. Depending on the structures, latencies ranged between 20 and 90 msec, with an average value of 60.2 msec. There were no statistical difference in the proportion of patients showing Engel Class I between patients with and without contralateral temporal connections. No difference was found in the proportion of patients showing bilateral or unilateral seizure onset among patients with and without contralateral temporal projections. The present findings corroborate that the functionality of bilateral temporal connections in humans is limited and does not affect the surgical outcome.

Lower morning to evening cortisol ratio is associated with cognitive impairment in men but not women: An analysis of 733 older subjects of the cross-sectional KORA-Age study.

BACKGROUND: A dysregulated hypothalamic-pituitary-adrenocortical axis (HPA) is thought to play a role in the pathophysiology of cognitive impairment. Surprisingly, little agreement exists on the association of cortisol and cognitive impairment. Thus, we sought to examine the association between cognitive function and salivary cortisol levels in a representative sample of older men and women. METHODS: A cross-sectional analysis was conducted among 733 study participants (65-90 years old, mean age=74.9) of the population-based KORA (Cooperative Health Research in the Region of Augsburg)-Age study. Associations were examined between cognitive function (determined by telephone interview for cognitive status-modified, TICS-m) and salivary cortisol measured upon waking (M1), 30min after awakening (M2), and in the late evening (E). RESULTS: In a dose response manner, lower morning (M1 and M2), and increased evening levels were observed in participants with probable dementia (4.5%, N=33) and slightly increased in those with mild cognitive impairment (MCI) (13.8%, N=101) compared to healthy individuals. Higher morning to evening ratios were associated with reduced odds of cognitive impairment, even after adjustments for important confounders (M1/E ratio: OR=1.50, 95% CI=1.08-2.07, M2/E ratio: 1.41, 1.01-1.95, per 1 standard deviation (SD) increase). However, the significant association of an increased risk for cognitive impairment was observed among men (M1/E: OR=1.94, 95% CI=1.24-3.02; M2/E=1.74, 1.12-2.71) but not women (M1/E: OR=1.11, 0.69-1.78; M2/E=1.09, 0.67-1.77). CONCLUSION: Our findings suggest that dysregulated HPA axis reactivity, evidenced by blunted diurnal cortisol responses, are associated with impaired cognitive function in an aged population.

Prevalence of use and level of awareness of CAM in older people - results from the KORA-Age study.

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 associated with a higher level of education in both men and women; with higher income in men; and with more actual diseases in women. CONCLUSION: Findings indicate that awareness of CAM is high even among people ≥65 years. Estimates for the prevalence of CAM use confirm the relevance of this treatment sector in the healthcare system for the elderly.

Aging without depression: a cross-sectional study.

OBJECTIVES: The aim of the study was to analyze the association between secure attachment style, loneliness, and social network as risk factors for late-life depression. METHODS: This cross-sectional study examined 969 subjects of the KORA-Age study. We applied the Relationship-Specific Attachment Scales for Adults (Beziehungsspezifische Bindungsskalen für Erwachsene, BBE), the UCLA Loneliness Scale, and the Social Network Index (SNI). Depression was operationalized through the Geriatric Depression Scale (GDS-15) and/or use of antidepressants. Logistic-regression models were calculated, sex-stratified, and controlled for age and living status. RESULTS: For men, lower depression scores were associated with higher attachment security scores (OR = 0.26, 95% CI = 0.15-0.44) and not reporting feelings of loneliness (OR = 0.27, 95% CI = 0.14-0.53). For women, independent determinants of not having late life depression consist of not feeling lonely (OR = 0.22, 95% CI = 0.13-0.38). DISCUSSION: Loneliness is a risk factor for late life depression in women and men, attachment style is a risk factor more for men, while social network size is not a risk factor.

[Obesity and symptoms of depression and anxiety in pre- and postmenopausal women: a comparison of different obesity indicators]. / Adipositas und Depressions- und Angstsymptome -bei prä- und post-menopausalen Frauen: Ein Vergleich verschiedener Adipositasmaße.

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 preventive importance in regard to the development of cardiovascular outcomes such as coronary heart disease.

Actitud de los estudiantes de medicina y enfermería hacia las personas que viven con VIH/sida / Attitude of medical and nursing students towards people living with HIV/AIDS

Los profesionales y estudiantes de Ciencias de la Salud tienen un papel importante en la atención de la salud hospitalaria de las personas que viven con VIH/sida (PVVS), su actitud es una barrera para su cuidado médico. Se realizó un estudio descriptivo transversal para determinar la actitud de los estudiantes de Medicina y Enfermería hacia las PVVS. La población en estudio la conformaron 1787 estudiantes, la muestra fue seleccionada mediante un muestreo estratificado con afijación proporcional, que quedó conformada por 226 estudiantes del programa de Medicina y 90 estudiantes del programa de Enfermería. La edad promedio fue de 20.98 ± 2.75 años y el 72.2% correspondió al sexo femenino. El 19.3% tuvo una actitud “favorable” hacia las PVVS. No se observaron diferencias estadísticamente significativas entre la actitud y las variables sexo y edad (p > 0.05). El 88.2% de los estudiantes de Medicina presentó una actitud desfavorable, no obstante, existen diferencias estadísticamente significativas entre la edad y la actitud de los estudiantes de Medicina (p = 0.009), mientras que en los estudiantes de Enfermería la actitud fue favorable en 25.6%; no se observaron diferencias estadísticamente significativas entre la edad y la actitud...

Job strain-associated inflammatory burden and long-term risk of coronary events: findings from the MONICA/KORA Augsburg case-cohort study.

BACKGROUND: We examined the association between job strain and coronary heart disease (CHD) and investigated the role of markers of inflammation and endothelial dysfunction as possible mediators of job strain-associated CHD risk. METHODS: The sample (n = 1027) included employed participants (35-64 years old, 68% male) from the population-based MONICA/KORA (Monitoring of Trends and Determinants in Cardiovascular Disease/Kooperative Gesundheitsforschung in der Region Augsburg) studies. At baseline Karasek's Job Strain Index was assessed during standardized personal interviews, and nine biological markers were measured (1984-1995). Participants were followed (average, 12 years) to assess incident events (sudden cardiac death or fatal and nonfatal myocardial infarction). In this case-cohort design, the final sample contained 114 cases and 913 noncases. RESULTS: Baseline distributions of cardiometabolic risk factors were significantly different between cases and noncases, with no detectable job strain-specific differences. However, cases with high job strain had higher monocyte chemoattractant protein-1, interleukin (IL)-8, and IL-18 compared with noncases with high job strain. High-sensitivity C-reactive protein, IL-6, and soluble intercellular adhesion molecule-1 were increased in cases versus noncases, regardless of work stress. Job strain was associated with incident coronary events in Cox proportional hazards models adjusted for age, sex, and survey (hazard ratio = 2.57, 95% confidence interval = 1.09-6.07) and after adjustment for CHD risk factors (2.35, 1.003-5.49). Adjustment for monocyte chemoattractant protein-1 or IL-8 increased this risk estimate by 14.5% or 9.4%, respectively, whereas adjustment for C-reactive protein and soluble intercellular adhesion molecule-1 led to decreased hazard ratios (-9.9% and -5.5%, respectively). CONCLUSIONS: Job strain increased CHD risk in healthy workers; the associated inflammatory burden may contribute to stress-related coronary pathogenesis.

Relationship between posttraumatic stress disorder and type 2 diabetes in a population-based cross-sectional study with 2970 participants.

OBJECTIVES: To evaluate the association of posttraumatic stress disorder (PTSD) with type 2 diabetes (T2D) or prediabetes in a large population-based sample. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.

Lifetime traumatic experiences and their impact on PTSD: a general population study.

OBJECTIVE: Exploring the relationship of exposure to a traumatic event and the subsequent onset of posttraumatic stress disorder (PTSD) in the population. METHODS: Posttraumatic stress disorder was assessed using the Impact of Event Scale (IES), Posttraumatic Diagnostic Scale (PDS) and interview data. Logistic regression analyses with sex, age, marital status, educational level and traumatic event characteristics were performed. Prevalences were standardised to the sex and age distribution of the German population. RESULTS: A total of 41 % of the subjects reported exposure to a trauma, leading to full PTSD in 1.7 % and to partial PTSD in 8.8 % of the participants. Logistic regression revealed accidents (OR 2.5, 95 % CI 1.3-4.7), nonsexual assault by known assailants (4.5, 2.1-9.8), combat/war experiences (5.9, 2.0-17.4), life-threatening illness (4.9, 2.7-8.9) and interpersonal conflicts (15.5, 2.5-96.0) as risk factors for full PTSD; risk factors for partial PTSD were accidents (3.2, 2.4-4.3), sexual (4.6, 2.2-9.6) or nonsexual (2.3, 1.4-3.8) assault by known assailants, life-threatening illness (6.2, 4.6-8.3), death of relatives (5.0, 3.2-7.8) and interpersonal conflicts (22.0, 8.3-58.1). CONCLUSIONS: Of subjects exposed to traumatic events, only a minority developed PTSD indicating a relationship between characteristics of the exposure and the individual and the onset of PTSD.

Validation and development of a shorter version of the resilience scale RS-11: results from the population-based KORA-age study.

BACKGROUND: The aim of this study was to assess reliability and validity of the Resilience Scale 11 (RS-11) and develop a shorter scale in a population-based study. METHODS: The RS-11 scale was administered to 3942 participants (aged 64 - 94 years) of the KORA-Age study. To test reliability, factor analyses were carried out and internal consistency (Cronbach's α) was measured. Construct validity was measured by correlating scores with psychological constructs. The criterion for a shorter scale was a minimum internal consistency of .80. Shorter models were compared using confirmatory factor analysis. Sensitivity and specificity of RS-5 to RS-11 was analyzed. RESULTS: Factor analysis of the RS-11 gave a 1-factor solution. Internal consistency was α = .86. A shorter version of the scale was developed with 5 items, which also gave a 1-factor solution and showed good validity. Internal consistency of this shorter scale: Resilience Scale 5 (RS-5) was α = .80. Sensitivity and specificity of RS-5 compared with RS-11 were .79 and .91 respectively. Both scales correlated significantly in expected directions with related constructs. CONCLUSIONS: The RS-11 and the RS-5 are reliable, consistent and valid instruments to measure the ability of elderly individuals to successfully cope with change and misfortune.