Association of serum caffeine concentrations with serum glucose levels in caffeine-drug users and non-users - results of German National Health Surveys.

The purpose of this study was to explore the association of serum caffeine concentrations with serum glucose levels in caffeine-drug users and non-users, aiming at the chronic effects of caffeine on glucose metabolism in comparison with known acute effects of caffeine. Eight hundred and fourteen caffeine-drug users and 623 non-users were identified from German National Health Surveys. Their serum caffeine concentrations and glucose levels were measured. The associations of caffeine concentrations with glucose levels were established by correlation analysis and multivariable regression analysis in caffeine-drug users and non-users separately. Antidiabetic therapy was considered. Caffeine concentrations were closely positively correlated to serum glucose levels in caffeine-drug users (Spearman r = 0.117, p = 0.001; partial r = 0.102, p = 0.020) particularly in women (Spearman r = 0.155, p < 0.001; partial r = 0.150, p = 0.005) although the correlation was weak as shown by multivariable regression analysis. The serum glucose levels were significantly higher (5.403 +/- 0.033 vs. 5.306 +/- 0.037 mmol/l) whereas the magnesium level was significantly lower (0.8941 +/- 0.0026 vs. 0.9024 +/- 0.0030 mmol/l) in caffeine-drug users than in non-users. No associations of caffeine concentrations with serum glucose levels were found in any groups of caffeine-drug non-users in our study. Whereas acute intake of caffeine-drugs may impair glucose metabolism, chronic intake of caffeine exclusively from diet has little effects on glucose metabolism and therefore may not contribute to the risk reduction of type 2 diabetes that was found in recent coffee consumption studies.

[Drug therapy of asthma. Results of the 1998 German National Health Interview and Examination Survey]. / Arzneimitteltherapie des Asthma bronchiale. Ergebnisse des Bundes-Gesundheitssurveys 1998.

The lifetime prevalence of bronchial asthma in adults is approximately 5%. Recommended drug therapy of this condition depends largely on its severity and varies from the on demand use of bronchodilators as a single measure up to the additional and sometimes permanent use of inhaled and/or systemic glucocorticoids. In this study, the prevalence and drug therapy of bronchial asthma were analysed in a representative sample of the resident population in Germany aged 18-79 years. We also report about health care utilization, like hospital stay, emergency treatments and use of ambulant medical care, and its associations with asthma medication. Of those study participants who affirmed a medical diagnosis of asthma, 17.3% used corticoid drugs continuously, 19.1% occasionally and 61.8% never. Use of medical services after an asthma attack was reported most often by those who took corticoid drugs regularly. Older people with asthma mostly used glucocorticoids regularly, while in very young patients the occasional use of corticoids was reported more often. When looking at the actual drug use (7 days before the examination) according to the drug usage questionnaire, anti-asthma drugs were mentioned as follows: 47.8% of persons with asthma, diagnosed during the last 4 weeks, used inhaled adrenergic drugs, 34.8% inhaled glucocorticoids, 2.1% systemic adrenergic drugs and 19.3% systemic theophyllines. The measured serum concentrations of theophylline were below 5 mg/l in 34.4%, between 5 and 8 mg/l in 28.1%, between 8 and 20 mg/l in 35.9% and somewhat over 20 mg/l in 1.6%. Our data suggest that especially young asthmatics may not be sufficiently treated with anti-inflammatory therapy, but further studies are needed. If such a deficit can be confirmed, measures for better adherence of therapy to existing guidelines should be considered. Our results, especially on serum concentrations of theophylline, suggest that therapeutic drug monitoring (TDM) of serum samples is not only an important tool in health surveys, but also suitable for increasing the safety and quality of drug treatment in asthmatics.

Reliable identification and quantification of trichothecenes and other mycotoxins by electron impact and chemical ionization-gas chromatography-mass spectrometry, using an ion-trap system in the multiple mass spectrometry mode. Candidate reference method for complex matrices.

Highly toxic mycotoxins like the trichothecenes can be found as contaminants from the metabolism of fungi in food and food preparations. They can be identified and quantified with great accuracy by GC/MS-measurements. Reliable analytical methods are urgently needed because such mycotoxins are not only toxic substances occurring in nature but also are in the list of biological weapons (e.g. T2-toxin, HT-2-toxin) and have some potential for terroristic attacks. By using GC/MS in the EI- and NCI- or PCI-mode and MS(n)-measurements with a 30 m Rtx 5MS fused-silica capillary column it is possible to identify and quantify all relevant mycotoxins either as underivatized substances or as their TMS-derivatives in extracts from food, food preparations or beverages with very complex matrix-derived background. This method can also be used to determine free ricinine as a biological marker for ricine in terroristic attacks. So laborious and time-consuming steps of sample-preparation can often be diminished. The LOD is in the range of 10-50 pg and the LOQ with linear calibration curves is in the range of 50-5000 pg. The high specificity of these methods helps not only to detect the existence of intentional terroristic or natural food contamination but also to avoid faulty alarm with unnecessary panic in the public. Furthermore, these methods have a high potential in ameliorating the safety of basic food and food products.

[Self-medication with over-the-counter (OTC) preparations in Germany]. / Selbstmedikation mit Over-the-Counter-(OTC-)Präparaten in Deutschland.

Self-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.

Determination of tocopherols, tocopherolquinones and tocopherolhydroquinones by gas chromatography-mass spectrometry and preseparation with lipophilic gel chromatography.

Lipophilic gel chromatography using Sephadex LH-20 helps in separating alpha-, beta- + -gamma, and delta-tocopherol and also in separation of their oxidation products e.g. the tocopherolquinones or other oxidation products. This preseparation can help to overcome analytical problems due to the complexity of synthesis mixtures of tocopherol oxidation procedures as well as in separation of complex physiological matrices. Determination of the preseparated tocopherols, tocopherolquinonesand tocopherolhydroquinones can then be achieved by means of GC-MS measurement of the free substances or their trimethylsilyl derivatives.

[The Child and Adolescent Health Survey as a source of data for assessment of the essential aspects of health care in childhood and adolescence]. / Der Kinder- und Jugendgesundheitssurvey als Datenquelle zur Beschreibung wesentlicher Aspekte der gesundheitlichen Versorgung im Kindes- und Jugendalter.

The German National Health Survey for Children and Adolescents aims at collecting representative data on the health status of the population in the 0 to 18 years age bracket. Examination of about 18.000 participants is planned. In this cross-sectional study relevant data concerning health services will be gathered. These include parameters of health care demands, health insurance, vaccination status and drug utilisation. The data collection will start in the first quarter of 2003 and will probably be terminated in the last quarter of 2005. The study design has been tested in a pilot study for one year and was adapted to the demands of this specific health survey. The instruments used for data collection are a self-administered questionnaire as well as a standardised, computer-based medical interview.

Co- and multimedication in users of ASA and vitamin E drugs in the Federal Republic of Germany. Results of the Federal Health Surveys 1984-1999.

OBJECTIVE: Because ASA- and vitamin E-drugs belong to the most used OTC-medications and adverse drug reactions are depending on the quantity and type of comedication we describe the pattern of usage for ASA- and vitamin E-drugs along with the total drug consumption in Germany. STUDY POPULATION, MATERIAL AND METHODS: Study participants (n = 22.560) were screened in five German health surveys (1984-1999). Total drug usage was monitored with a standardized questionnaire. Blood and serum samples were examined for clinical chemistry and hematological data as well as for selected active substances of drugs. The tocopherols and salicylic acid as the main metabolite of ASA were measured by HPLC in serum samples. RESULTS: The incidence of OTC-drug usage is high in our population. The salicylic acid concentration in the serum samples depends clearly on the reason of usage and remains fairly stable for analgesic use but decreases steadily from 1984 to 1999 for use as antiplatelet drug due to formulations with lower amount of ASA/tablet. The serum concentration of alpha-tocopherol was steadily increasing in users of vitamin E-drugs as well as in no-drug-users. CONCLUSION: Because the frequency of comedication is very high, the risk of adverse drug reactions seems to be a problem that should be considered more seriously by physicians.

Quantitative determination of alpha-, beta-, gamma- and delta-tocopherols in human serum by high-performance liquid chromatography and gas chromatography-mass spectrometry as trimethylsilyl derivatives with a two-step sample preparation.

Using a two-step sample preparation with Extrelut and silica gel extraction in Pasteur pipettes it is possible to quantify all tocopherols in human serum samples by means of normal-phase HPLC with fluorescence detection (lambda(ex) 295 nm, lambda(em) 330 nm) or by GC-MS of their trimethylsilyl (TMS) derivatives. The method has been used in pharmacoepidemiological studies concerning the exposition with vitamin E-containing drugs in Germany. The recovery for all tocopherols is 98% and the limit of detection is 50 pg for alpha-tocopherol in the HPLC and 40 pg for all TMS-tocopherols in the GC-MS method using the selected ion monitoring mode with a well-tuned GCQ system. Linearity of calibration is excellent for both methods over the full physiological relevant range. Due to the low sample amount needed, the method is suitable for epidemiological and paediatric research.

Consumption of calcium antagonists: results of the German national health surveys.

PURPOSE: In generating firm conclusions concerning the efficacy and safety of drugs, the description of the exposed population should be one of the first steps in pharmacoepidemiological studies. The present investigation describes the frequency of usage and calcium antagonists in relation to sociodemographic data and parameters of morbidity statistics. Additionally statements are made concerning co-medication, drug tolerability and side-effects. METHODS: In four studies conducted between 1985 and 1998 a representative sample (total approximately 19,000 study participants) of the general population aged 25-69 years and resident in the area of the former Federal Republic of Germany (FRG) was interviewed about their total drug use up to 7 days before the day of investigation using a standardized questionnaire. Relevant health data, lifestyle and behaviour characteristics as well as data on morbidity and important physiological parameters were collected in all investigations. RESULTS: From 1985 to 1990, the use of calcium channel blockers increased for men from 3.4 to 4.6% and for women from 3.7 to 4.1%. In the last survey (1998) only 2.5% of the male and 3.4% of the female study population were users of this drug group. No statistically significant differences in the usage of calcium channel blockers between males and females were found in any of the surveys. The most frequent indication (42.7%) for the use of calcium antagonists was hypertension. The usage of calcium antagonists with the indication 'hypertension' increased from 21.7% in 1985 to 74.8% in 1998. Considering the whole observational period more than half of all preparations contained nifedipine as the active agent. The percentage of nifedipine-containing drugs consumed decreased from 56.7% in 1985 to 26.7% in 1998. More than 90% of all users of calcium channel blockers assessed the tolerability of this drug group as very good. The average percentage of registered side-effects reached 3.4%, with the highest number of adverse drug reactions for the nifedipine-containing calcium antagonists. More than 90% of all users of calcium antagonists were subject to co-medication of one or more drugs. The most frequently used additional medication belonged to the group of cardiac drugs. Compared to study participants without medication in the past 7 days, users of calcium channel blockers showed significantly higher mean values for serum glucose and systolic blood pressure. CONCLUSIONS: Collecting data on drug use as part of health surveys makes it possible to assess the usage of calcium antagonists in relation to relevant health conditions in real daily life situations as presented by the subjects. Although drug utilization surveys of this kind can give essential information concerning real drug usage, their results are subject to some methodological restraints. Statements concerning causal inferences of observed consumption trends are possible only with limitations. For this purpose, methods of analytical epidemiology must be used with a longitudinal study design. Copyright (c) 2000 John Wiley & Sons, Ltd.

[Subjective statements regarding use of selected drug groups--initial results of the 1998 Federal Health Survey]. / Subjektive Angaben zur täglichen Anwendung ausgewählter Arzneimittelgruppen--Erste Ergebnisse des Bundes-Gesundheitssurveys 1998.

This publication presents data concerning the daily frequency of usage for 34 selected drug-groups. The results are based on standardized medical interviews done with a representative sample of the German resident population aged 18 to 79 years during the German National Health Interview and Examination Survey 1998. Nearly 52% of the interviewed men and women report the daily use of drugs at least from one of the above mentioned 34 groups during the last year before the interview. In both sexes the prevalence of drug-usage rises steadily with age. Women are more often drug-users than men with approximately doubled daily drug-usage in some medication groups. With worsening of the health status the sex-specific differences of drug-usage diminish. For females aged 18 to 45 years the rank-order of drug-usage is as follows: oral contraceptives (33.0%), thyroid drugs (11.5%), vitamins (7.6%). For males of the same age group the rank order in the 'new Bundesländer' is as follows: antihypertensives (4.7%), drugs against common cold and grippe (3.8%) and vitamins (3.8%). In the 'old Bundesländer' the rank-order for males is the following: vitamins (5.0%), antihypertensives (2.1%) and thyroid drugs (1.9%). For those study participants older than 45 years, drug groups for therapy of cardiovascular diseases become prominent and are the most often used medications with daily use. This could be observed for males and females. The results give a first impression concerning the drug-usage pattern in an adult resident population in Germany. The discussion of the results has to consider, that the answers given in the interviews strongly depend on the memory of the study participants and their lay-understanding of the different groups of the questionnaire. Further it has to be considered that the 34 drug-groups did not cover the whole medication pattern.

[Social class and health]. / Sozialschicht und Gesundheit.

This publication deals with the German social class and their interactions with health or illness. The analysis uses the data of the German National Health Interview and Examination Survey 1998. The results are as follows: During the last decade the proportion of inhabitants of lower social class has decreased in favour of the proportions of middle and upper social classes. The formerly observed differences between the eastern part (former GDR) and the western part of Germany have diminished or have even levelled to zero. Even today men in Germany belong more often to the upper social class than women. For the risk factors smoking, massive obesity and inactivity in sports a distinct gradient concerning the social class can be observed. Those belonging to lower social class are more often smokers, have significantly more often massive obesity and show more seldom activities in sports. Hypertension and hypercholesterolemia are more often observed in men of the upper social class than in those belonging to lower class while for women both mentioned risk factors are more often seen in the lower social class. With respect to morbidity different patterns can be observed. NIDDM, chronic bronchitis and gastric and duodenal ulcer are examples for higher prevalence data in the lower social class while allergic rhinitis can be observed more often in the higher class. The level of complaints is higher in the lower class than in the upper class. By differentiating according to the eastern or western part clear differences emerge concerning social class especially in the 'old Bundesländer' (western part). Members of the upper class estimates their health status clearly to be better than those study participants belonging to the lower class. This perhaps can be explained by their lower level of complaints. The contentedness concerning live and health-status is higher in the upper than in the lower class. Respecting the highest level of education, class-specific differences concerning drug utilization are observed doubly frequent in the 'old Bundesländer' compared to the 'new Bundesländer'. According to the level of complaints and the prevalence of diseases most drug groups are used more often in the lower than in the upper class whereas drugs with presumed preventive potential are clearly more often consumed in the upper class.

Fatty acid patterns in triglycerides, diglycerides, free fatty acids, cholesteryl esters and phosphatidylcholine in serum from vegetarians and non-vegetarians.

The differences in the fatty acid spectra of serum samples obtained from vegetarians (62 females, 40 males) and non-vegetarians (70 females, 38 males) were evaluated in a matched-pair study design. This study population made it possible to examine 48 female and 31 male pairs whose age difference did not exceed 3 years. The pairs were further matched by education, social status and health-consciousness. The fatty acid pattern of whole serum total lipids and HDL total lipids were determined by GLC. In particular linoleic, linolenic, oleic and docosahexaenoic acid reveal statistically significant differences due to different nutritional habits. A subsample (n = 20) of sera from the 2 groups was investigated by separation of lipid classes by TLC and GLC on a SP 2,340 fused-silica capillary column in order to separate cis-trans fatty acids additionally. This part of the study gives detailed information concerning the fatty acid composition of cholesteryl esters, triglycerides, diglycerides, free fatty acids and phosphatidylcholine. In all those fractions the fatty acid profiles reflect the dietary consumption of lipids. Palmitoleic, vaccenic and docosahexaenoic acid as markers of omnivorous nutrition reach levels of 5, 5 and 3% respectively in non-vegetarians, while they remain remarkably lower in vegetarians. The most prominent difference is the higher amount of linoleic acid in all lipid classes of vegetarian serum samples. The highest amount of trans fatty acids (up to 3%) was detected in di- and triglycerides.

[Determination of the urinary metabolites hydroxyindole-acetic acid, vanillyl mandelic acid and homovanillic acid by means of lipophilic gel chromatography and gas chromatography (author's transl)]. / Bestimmung der Urinmetaboliten Hydroxyindolessigsäure, Vanillinmandelsäure und Homovanillinsäure mit lipophiler Gelchromatographie und Gaschromatographie

A specific and practicable method is described for the quantitative determination of urinary phenol- and indole-carboxylic acids. High specificity is achieved by a preliminary separation of the free acids (extracted from the urine sample) with the aid of organophilic gel chromatography on Sephadex LH 20, followed by gas chromatographic analysis of the silyl derivatives of the acids. The organophilic gel chromatography of the free acids shows a high recovery rate in the micro- and submicrogram range. The difficulties encountered in other techniques in the derivatisation and gas chromatographic separation of the individual components are avoided by using the preliminary separation, and by using N-methyl-N-trimethylsilyl-trifluoroacetamide for the derivatisation. Use of this preparation technique with a direct read-out gas chromatograph with automatic sample introduction, gives high accuracy and precision, and a facility for the determination of a wide range of aromatic acids in urine.