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Hammer T, Braisch U, Rothenbacher D, Denkinger M, Dallmeier D. Relationship between hemoglobin and grip strength in older adults: the ActiFE study. Aging Clin Exp Res 2024; 36:59. [PMID: 38451343 PMCID: PMC10920471 DOI: 10.1007/s40520-024-02698-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 01/05/2024] [Indexed: 03/08/2024]
Abstract
INTRODUCTION Although anemia is associated with low muscle strength, hemoglobin has been rarely studied considering ferritin. AIM To analyze the association between hemoglobin and grip strength in community-dwelling older adults. METHODS We used data from a German cohort of adults ≥ 65 years, excluding those with CRP > 10 mg/L or taking iron supplements. Grip strength (kg) was measured using a Jamar dynamometer. Analysis was performed using multiple linear regression, adjusted for established confounders. Due to interaction, age-stratified (< 80, 80 +), further sex-stratified analysis in those < 80 years old and ferritin-stratified in men < 80 years were performed. RESULTS In total, 1294 participants were included in this analysis (mean age 75.5 years, 549 (42.3%) women, 910 (70.3%) < 80 years). On average, hemoglobin and grip strength were 14.9 g/dL and 41.3 kg for men, 13.9 g/dL and 25.1 kg for women. Hemoglobin was significantly positively associated with grip strength only among women < 80 years (β 0.923 [95% CI 0.196, 1.650]). For men < 80 years, the association was significant when ferritin was ≥ 300 µg/L (β 2.028 [95% CI 0.910, 3.146]). No association was detected among those participants 80 + . DISCUSSION AND CONCLUSIONS Our data show an association between hemoglobin and grip strength only in women < 80 years old. For men < 80 years, the association was only significant with ferritin levels ≥ 300 µg/L. Considering the decreasing levels of hemoglobin and grip strength and the high prevalence of iron deficiency in older adults further analyses investigating this relationship with more iron specific parameters such as transferrin saturation are warranted.
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Affiliation(s)
- Theresa Hammer
- Research Unit on Ageing at Agaplesion Bethesda Clinic Ulm, Ulm, Germany
- Institute for Geriatric Research, Ulm University, Ulm, Germany
| | - Ulrike Braisch
- Research Unit on Ageing at Agaplesion Bethesda Clinic Ulm, Ulm, Germany
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | | | - Michael Denkinger
- Research Unit on Ageing at Agaplesion Bethesda Clinic Ulm, Ulm, Germany
- Institute for Geriatric Research, Ulm University, Ulm, Germany
- Medical Faculty, Ulm University, Ulm, Germany
| | - Dhayana Dallmeier
- Research Unit on Ageing at Agaplesion Bethesda Clinic Ulm, Ulm, Germany.
- Medical Faculty, Ulm University, Ulm, Germany.
- Department of Epidemiology, Boston University School of Public Health, Boston, USA.
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Steenblock J, Braisch U, Brefka S, Thomas C, Eschweiler GW, Rapp M, Metz B, Maurer C, von Arnim CAF, Herrmann ML, Wagner S, Denkinger M, Dallmeier D. Frailty index and its association with the onset of postoperative delirium in older adults undergoing elective surgery. BMC Geriatr 2023; 23:90. [PMID: 36774453 PMCID: PMC9921654 DOI: 10.1186/s12877-022-03663-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 11/30/2022] [Indexed: 02/13/2023] Open
Abstract
BACKGROUND The association of frailty based on the accumulation of deficits with postoperative delirium (POD) has been poorly examined. We aimed to analyze this association in older patients undergoing elective surgery. METHODS Preoperative data was used to build a 30-item frailty index (FI) for participants of the PAWEL-study. Delirium was defined by a combination of I-CAM and chart review. Using logistic regressions models we analysed the association between frailty and POD adjusting for age, sex, smoking, alcohol consumption, education and type of surgery. RESULTS Among 701 participants (mean age 77.1, 52.4% male) median FI was 0.27 (Q1 0.20| Q3 0.34), with 528 (75.3%) frail participants (FI ≥ 0.2). Higher median FI were seen in orthopedic than cardiac surgery patients (0.28 versus 0.23), and in women (0.28 versus 0.25 in men). Frail participants showed a higher POD incidence proportion (25.4% versus 17.9% in non-frail). An increased odds for POD was observed in frail versus non-frail participants (OR 2.14 [95% CI 1.33, 3.44], c-statistic 0.71). A 0.1 increment of FI was associated with OR 1.57 [95% CI 1.30, 1.90] (c-statistic 0.72) for POD. No interaction with sex or type of surgery was detected. Adding timed-up-and-go-test and handgrip strength to the FI did not improve discrimination. CONCLUSION Our data showed a significant association between frailty defined through a 30-item FI and POD among older adults undergoing elective surgery. Adding functional measures to the FI did not improve discrimination. Hence, our preoperative 30-item FI can help to identify patients with increased odds for POD. TRIAL REGISTRATION PAWEL and PAWEL-R (sub-) study were registered on the German Clinical Trials Register (number DRKS00013311 and DRKS00012797).
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Affiliation(s)
- Janina Steenblock
- Agaplesion Bethesda Clinic, Ulm, Germany ,Geriatric Center Ulm/Alb-Donau, Ulm, Germany ,grid.410712.10000 0004 0473 882XInstitute for Geriatric Research, University Clinic Ulm, Ulm, Germany ,grid.6582.90000 0004 1936 9748Medical Faculty, Ulm University, Ulm, Germany
| | - Ulrike Braisch
- Agaplesion Bethesda Clinic, Ulm, Germany ,Geriatric Center Ulm/Alb-Donau, Ulm, Germany ,grid.6582.90000 0004 1936 9748Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Simone Brefka
- Agaplesion Bethesda Clinic, Ulm, Germany ,Geriatric Center Ulm/Alb-Donau, Ulm, Germany ,grid.410712.10000 0004 0473 882XInstitute for Geriatric Research, University Clinic Ulm, Ulm, Germany
| | - Christine Thomas
- Department of Old Age Psychiatry and Psychotherapy, Klinikum Stuttgart, Stuttgart, Germany ,grid.7708.80000 0000 9428 7911Department of Neurology and Neurophysiology, Medical Center-University of Freiburg, Freiburg, Germany ,grid.239395.70000 0000 9011 8547Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215 USA
| | - Gerhard W. Eschweiler
- grid.411544.10000 0001 0196 8249Geriatric Center at the University Hospital Tuebingen, Tuebingen, Germany
| | - Michael Rapp
- grid.11348.3f0000 0001 0942 1117Department of Social and Preventive Medicine, University of Potsdam, Am Neuen Palais 10, 14469 Potsdam, Germany
| | - Brigitte Metz
- Geriatric Center Karlsruhe, ViDia Christian Clinics Karlsruhe, Karlsruhe, Germany
| | - Christoph Maurer
- grid.5963.9Center for Geriatric Medicine and Gerontology, University of Freiburg, Freiburg im Breisgau, Germany
| | - Christine A. F. von Arnim
- grid.411984.10000 0001 0482 5331Department of Geriatrics, University Medical Center Göttingen, Göttingen, Germany
| | - Matthias. L. Herrmann
- grid.7708.80000 0000 9428 7911Department of Neurology and Neurophysiology, Medical Center-University of Freiburg, Freiburg, Germany ,grid.411544.10000 0001 0196 8249Geriatric Center at the University Hospital Tuebingen, Tuebingen, Germany
| | - Sören Wagner
- grid.239395.70000 0000 9011 8547Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215 USA ,grid.419842.20000 0001 0341 9964Department of Anaesthesiology, Klinikum Stuttgart, Kriegsbergstrasse 60, 70174 Stuttgart, Germany
| | - Michael Denkinger
- Agaplesion Bethesda Clinic, Ulm, Germany ,Geriatric Center Ulm/Alb-Donau, Ulm, Germany ,grid.410712.10000 0004 0473 882XInstitute for Geriatric Research, University Clinic Ulm, Ulm, Germany ,grid.6582.90000 0004 1936 9748Medical Faculty, Ulm University, Ulm, Germany
| | - Dhayana Dallmeier
- Agaplesion Bethesda Clinic, Ulm, Germany. .,Geriatric Center Ulm/Alb-Donau, Ulm, Germany. .,Medical Faculty, Ulm University, Ulm, Germany. .,Department of Epidemiology, Boston University School of Public Health, Boston, USA.
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Braisch U, Koenig W, Rothenbacher D, Denkinger M, Friedrich N, Felix SB, Ittermann T, Dörr M, Dallmeier D. N-terminal pro brain natriuretic peptide reference values in community-dwelling older adults. ESC Heart Fail 2022; 9:1703-1712. [PMID: 35199488 PMCID: PMC9065825 DOI: 10.1002/ehf2.13834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 01/17/2022] [Accepted: 01/23/2022] [Indexed: 11/06/2022] Open
Abstract
AIMS Available upper reference levels (URLs) in older adults for N-terminal pro brain natriuretic peptide (NT-proBNP), an established biomarker for heart failure, are mainly based on small samples. We aimed to identify NT-proBNP URL in a population-based reference sample of individuals aged ≥65 years. METHODS AND RESULTS We analysed established NT-proBNP predictors using quantile regression among 2459 participants of two-independent population-based cohorts located in Germany, the Activity and Function in the Elderly Study (ActiFE, n = 1450) and the Study of Health in Pomerania (SHIP-TREND-0, n = 1009). Based on predictors a reference population of 441 subjects (ActiFE, n = 227; SHIP-TREND-0, n = 214) without history of diabetes, cardiovascular, or pulmonary diseases and with systolic blood pressure (BP) <140 mmHg, diastolic BP ≥60 and ≤90 mmHg, haemoglobin in men ≥14 and ≤18 g/dL and in women ≥12 and ≤16 g/dL, GFR ≥60 mL/min/1.73 m2 , CRP <5 mg/L, BMI ≥18 and ≤33 kg/m2 , and hs-cTnI <40 ng/L were built with NT-proBNP median levels and 97.5% quantiles reported stratified by sex and age. In a secondary analysis the URL among 97 SHIP-TREND-0 participants with a left ventricular ejection fraction (LVEF) ≥50 and no diastolic dysfunction were estimated. The median age in the identified reference sample was 70 years, with 41.9% and 40.2% male participants in ActiFE and SHIP-TREND-0, respectively. We observed an age-dependent increment of NT-proBNP levels with higher values in women compared to men. Notably, NT-proBNP levels were >125 ng/L in 165 participants (37.4%), with NT-proBNP URL (97.5% quantiles) equal to 663, 824, 592, and 697 ng/L in men, and 343, 463, 2641, 1276 ng/L in women for ages 65-69, 70-74, 75-79, and 80+ years, respectively. In the secondary analysis with a LVEF ≥50 and no diastolic dysfunction (35 men and 62 women) NT-proBNP levels >125 ng/L were still observed in 38 (39.2%) participants. CONCLUSIONS This reference sample of apparently healthy asymptomatic older adults showed an age-related increment of NT-proBNP levels with URL markedly higher than the European Society of Cardiology recommended cut-off of 125 ng/L for the diagnosis of heart failure in ambulatory settings. Identifying URL in those ≥80 years remains complex. Our results attempt to provide a frame for the further investigation of age-specific NT-proBNP cut-offs in older adults. Considering the demographic changes, further evaluation of NT-proBNP URL in larger samples of older adults followed by the validation of age-specific cut-off values for the identification of heart failure in those 65 years or older are urgently needed.
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Affiliation(s)
- Ulrike Braisch
- Research Unit on Ageing, AGAPLESION Bethesda Clinic, Ulm, Germany.,Geriatric Center Ulm/Alb-Donau, Ulm, Germany.,Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Wolfgang Koenig
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany.,German Heart Center Munich, Technical University of Munich, Munich, Germany.,German Centre for Cardiovascular Research, partner site Munich Heart Alliance, Munich, Germany
| | | | - Michael Denkinger
- Research Unit on Ageing, AGAPLESION Bethesda Clinic, Ulm, Germany.,Geriatric Center Ulm/Alb-Donau, Ulm, Germany.,Institute for Geriatric Research, Ulm University, Ulm, Germany
| | - Nele Friedrich
- Institute for Clinical Chemistry and Laboratory Medicine, University Medicine Greifswald, Greifswald, Germany.,German Centre for Cardiovascular Research, partner site Greifswald, Greifswald, Germany
| | - Stephan B Felix
- German Centre for Cardiovascular Research, partner site Greifswald, Greifswald, Germany.,Department of Internal Medicine B, University Medicine Greifswald, Greifswald, Germany
| | - Till Ittermann
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Marcus Dörr
- German Centre for Cardiovascular Research, partner site Greifswald, Greifswald, Germany.,Department of Internal Medicine B, University Medicine Greifswald, Greifswald, Germany
| | - Dhayana Dallmeier
- Research Unit on Ageing, AGAPLESION Bethesda Clinic, Ulm, Germany.,Geriatric Center Ulm/Alb-Donau, Ulm, Germany.,Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
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Leinert C, Brefka S, Braisch U, Denninger N, Mueller M, Benzinger P, Bauer J, Bahrmann A, Frey N, Katus HA, Geisler T, Eschweiler G, Klaus J, Seufferlein T, Schuetze K, Gebhard F, Dreyhaupt J, Muche R, Pahmeier K, Biermann-Stallwitz J, Wasem J, Flagmeier L, Dallmeier D, Denkinger M. A complex intervention to promote prevention of delirium in older adults by targeting caregiver's participation during and after hospital discharge - study protocol of the TRAnsport and DElirium in older people (TRADE) project. BMC Geriatr 2021; 21:646. [PMID: 34784883 PMCID: PMC8594294 DOI: 10.1186/s12877-021-02585-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 10/25/2021] [Indexed: 12/14/2022] Open
Abstract
Background Among potentially modifiable risk factors for delirium, transfers between wards, hospitals and other facilities have been mentioned with low evidence. TRADE (TRAnsport and DElirium in older people) was set up to investigate i) the impact of transfer and/or discharge on the onset of delirium in older adults and ii) feasibility and acceptance of a developed complex intervention targeting caregiver’s participation during and after hospital discharge or transfer on cognition and the onset of delirium in older adults. Methods The study is designed according to the guidelines of the UK Medical Research Council (MRC) for development and evaluation of complex interventions and comprises two steps: development and feasibility/piloting. The development phase includes i) a multicenter observational prospective cohort study to assess delirium incidence and cognitive decline associated with transfer and discharge, ii) a systematic review of the literature, iii) stakeholder focus group interviews and iv) an expert workshop followed by a Delphi survey. Based on this information, a complex intervention to better and systematically involve family caregivers in discharge and transport was developed. The intervention will be tested in a pilot study using a stepped wedge design with a detailed process and health economic evaluation. The study is conducted at four acute care hospitals in southwest Germany. Primary endpoints are the delirium incidence and cognitive function. Secondary endpoints include prevalence of caregiver companionship, functional decline, cost and cost effectiveness, quality of discharge management and quality of admission management in admitting hospitals or nursing homes. Data will be collected prior to discharge as well as after 3, 7 and 90 days. Discussion TRADE will help to evaluate transfer and discharge as a possible risk factor for delirium. In addition, TRADE evaluates the impact and modifiability of caregiver’s participation during patient’s transfer or discharge on delirium incidence and cognitive decline providing the foundation for a confirmatory implementation study. Trial registration DRKS (Deutsches Register für klinische Studien) DRKS00017828. Registered on 17th September 2019. Retrospectively registered. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-021-02585-0.
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Affiliation(s)
- Christoph Leinert
- Agaplesion Bethesda Clinic Ulm, Zollernring 26, 89073, Ulm, Germany. .,Geriatric Center Ulm/ Alb-Donau, Ulm, Germany. .,Institute for Geriatric Research, Ulm University, Ulm, Germany.
| | - Simone Brefka
- Agaplesion Bethesda Clinic Ulm, Zollernring 26, 89073, Ulm, Germany.,Geriatric Center Ulm/ Alb-Donau, Ulm, Germany.,Institute for Geriatric Research, Ulm University, Ulm, Germany
| | - Ulrike Braisch
- Agaplesion Bethesda Clinic Ulm, Zollernring 26, 89073, Ulm, Germany.,Institute for Geriatric Research, Ulm University, Ulm, Germany.,Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Natascha Denninger
- Center for Research, Development and Transfer, Rosenheim Technical University of Applied Sciences, Rosenheim, Germany.,International Graduate Academy, Institute for Health and Nursing Science, Medical Faculty, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Martin Mueller
- Faculty of Applied Health and Social Sciences, Rosenheim Technical University of Applied Sciences, Rosenheim, Germany
| | - Petra Benzinger
- Center for Geriatric Medicine, Agaplesion Bethanien Krankenhaus Heidelberg, Heidelberg University, Heidelberg, Germany.,Institute of Health and Generations, Faculty of Social and Health Studies, University of Applied Sciences Kempten, Kempten, Germany
| | - Juergen Bauer
- Center for Geriatric Medicine, Agaplesion Bethanien Krankenhaus Heidelberg, Heidelberg University, Heidelberg, Germany
| | - Anke Bahrmann
- Department of Cardiology, Angiology and Pneumology, University Hospital of Heidelberg, Heidelberg, Germany
| | - Norbert Frey
- Department of Cardiology, Angiology and Pneumology, University Hospital of Heidelberg, Heidelberg, Germany
| | - Hugo A Katus
- Department of Internal Medicine, University Hospital of Heidelberg, Heidelberg, Germany
| | - Tobias Geisler
- Department of Cardiology, University Hospital Tuebingen, Tuebingen, Germany
| | - Gerhard Eschweiler
- Geriatric Center at the University Hospital Tuebingen, Tuebingen, Germany
| | - Jochen Klaus
- Department of Medicine I, University Hospital Ulm, Ulm, Germany
| | | | - Konrad Schuetze
- Department of Trauma-, Hand-, and Reconstructive Surgery, Ulm University, Albert-Einstein-Allee 23, 89081, Ulm, Germany
| | - Florian Gebhard
- Department of Trauma-, Hand-, and Reconstructive Surgery, Ulm University, Albert-Einstein-Allee 23, 89081, Ulm, Germany
| | - Jens Dreyhaupt
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Rainer Muche
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Kathrin Pahmeier
- Institute for Health Care Management and Research, University of Duisburg-Essen, Essen, Germany
| | | | - Juergen Wasem
- Institute for Health Care Management and Research, University of Duisburg-Essen, Essen, Germany
| | - Lena Flagmeier
- AOK - Allgemeine Ortskrankenkasse Baden-Wuerttemberg, Stuttgart, Germany
| | - Dhayana Dallmeier
- Agaplesion Bethesda Clinic Ulm, Zollernring 26, 89073, Ulm, Germany.,Geriatric Center Ulm/ Alb-Donau, Ulm, Germany.,Department of Epidemiology, Boston University School of Public Health, Boston, USA
| | - Michael Denkinger
- Agaplesion Bethesda Clinic Ulm, Zollernring 26, 89073, Ulm, Germany.,Geriatric Center Ulm/ Alb-Donau, Ulm, Germany.,Institute for Geriatric Research, Ulm University, Ulm, Germany
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Kremer KM, Braisch U, Rothenbacher D, Denkinger M, Dallmeier D. Systolic Blood Pressure and Mortality in Community-Dwelling Older Adults: Frailty as an Effect Modifier. Hypertension 2021; 79:24-32. [PMID: 34689594 DOI: 10.1161/hypertensionaha.121.17530] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Current evidence is insufficient to support different hypertension treatment targets in older adults. We evaluated whether frailty modifies the association between systolic blood pressure (SBP) and 8-year all-cause mortality in community-dwelling older adults. Longitudinal data from the ActiFE Ulm study (Activity and Function in the Elderly in Ulm; Germany) was collected. The association between SBP and mortality was analyzed using Cox proportional hazards models adjusted for age, sex, education, smoking, alcohol consumption, sleep disturbance, diastolic blood pressure, and antihypertensive medications, evaluating the presence of effect modification by frailty according to a frailty index based on the accumulation of deficits. Among 1170 participants (median age 73.9 years, 41.6% women), the prevalence of history of hypertension was 53.8% (median SBP, 144.0 mm Hg [interquartile range, 135.0-149.5], median diastolic blood pressure 78.0 mm Hg [interquartile range, 71.0-86.5]). The median follow-up time was 8.1 years, detecting 268 deaths. We identified 251 (21.5%, 114 deaths) frail participants (frailty index ≥0.2). Effect modification by frailty was detected. Among non-frail a J-shaped association was found with hazard ratio, 4.01 (95% CI, 1.13-14.28) for SBP<110 mm Hg, hazard ratio, 0.92 (95% CI, 0.53-1.59) for SBP 140-150 mm Hg, and hazard ratio, 1.98 (95% CI, 0.75-5.27) for SBP≥160 mm Hg. For frail older adults, a tendency toward lower risk among those with SBP≥130 mm Hg was observed. Our results suggest the presence of effect modification by frailty indicating a possible protective effect for elevated SBP in frail older adults with respect to all-cause mortality even after adjusting for diastolic blood pressure and antihypertensive treatment.
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Affiliation(s)
- Kaj-Marko Kremer
- Research Unit on Ageing, Agaplesion Bethesda Clinic Ulm, Germany (K.-M.K., U.B., M.D., D.D.).,Geriatrisches Zentrum Ulm/Alb-Donau, Ulm, Germany (K.-M.K., U.B., M.D., D.D.).,Institute of Geriatric Research, Ulm University, Germany. (K.-M.K., M.D.)
| | - Ulrike Braisch
- Research Unit on Ageing, Agaplesion Bethesda Clinic Ulm, Germany (K.-M.K., U.B., M.D., D.D.).,Geriatrisches Zentrum Ulm/Alb-Donau, Ulm, Germany (K.-M.K., U.B., M.D., D.D.).,Institute of Epidemiology and Medical Biometry, Ulm University, Germany. (U.B., D.R.)
| | - Dietrich Rothenbacher
- Institute of Epidemiology and Medical Biometry, Ulm University, Germany. (U.B., D.R.)
| | - Michael Denkinger
- Research Unit on Ageing, Agaplesion Bethesda Clinic Ulm, Germany (K.-M.K., U.B., M.D., D.D.).,Geriatrisches Zentrum Ulm/Alb-Donau, Ulm, Germany (K.-M.K., U.B., M.D., D.D.).,Institute of Geriatric Research, Ulm University, Germany. (K.-M.K., M.D.)
| | - Dhayana Dallmeier
- Research Unit on Ageing, Agaplesion Bethesda Clinic Ulm, Germany (K.-M.K., U.B., M.D., D.D.).,Geriatrisches Zentrum Ulm/Alb-Donau, Ulm, Germany (K.-M.K., U.B., M.D., D.D.).,Department of Epidemiology, Boston University School of Public Health, Boston, MA (D.D.)
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Dallmeier D, Braisch U, Rapp K, Klenk J, Rothenbacher D, Denkinger M. Frailty Index and Sex-Specific 6-Year Mortality in Community-Dwelling Older People: The ActiFE Study. J Gerontol A Biol Sci Med Sci 2020; 75:366-373. [PMID: 30789659 DOI: 10.1093/gerona/glz051] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Considering that mortality rate and deficit accumulation varies considerably in men and women, we performed a sex-stratified analysis of the association between an estimated frailty index (eFI) with 6-year mortality in the Activity and Function in the Elderly (ActiFE) Study. METHODS We constructed an eFI using a score (0 [no deficit] to 1 [deficit]) from 32 baseline items representing multiple domains. eFI represents the sum of all scores divided by 32. Cox proportional hazards models adjusted for age, smoking, alcohol intake, and education were used to evaluate this association. RESULTS Among 1,204 participants (57.5% men), 18.5% men and 26.0% women were frail (eFI ≥ 0.2) with an age-adjusted mean eFI of 0.13 (95% confidence interval [CI] 0.12, 0.13) and 0.15 (95% CI 0.15, 0.16), respectively. Mortality rate in men (146 deaths) was 34.4 (95% CI 29.3, 40.5) and in women (50 deaths) 15.1 (95% CI 11.5, 19.9) per 1,000 person-years. A 0.1 increment of eFI was associated with a hazard ratio (HR) of 1.94 (95% CI 1.60, 2.35) in men and 2.06 (95% CI 1.58, 2.69) in women. Frail versus nonfrail men and women had a HR of 2.46 (95% CI 1.74, 3.48), and 2.98 (95% CI 1.55, 5.70), respectively. We detected sex differences in the order of the eight common contributor items to the eFI. CONCLUSIONS We observed a statistically significant difference for the age-adjusted eFI and the frailty prevalence in men and women. However, our analysis does not suggest the presence of effect modification by sex in the association with mortality.
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Affiliation(s)
- Dhayana Dallmeier
- Agaplesion Bethesda Clinic, Research Unit on Aging, Ulm, Germany.,Geriatric Center Ulm/Alb-Donau, Ulm University, Germany
| | - Ulrike Braisch
- Agaplesion Bethesda Clinic, Research Unit on Aging, Ulm, Germany.,Geriatric Center Ulm/Alb-Donau, Ulm University, Germany.,Institute of Epidemiology and Medical Biometry, Ulm University, Germany
| | - Kilian Rapp
- Department of Clinical Gerontology, Robert Bosch Hospital, Stuttgart, Germany
| | - Jochen Klenk
- Institute of Epidemiology and Medical Biometry, Ulm University, Germany.,Department of Clinical Gerontology, Robert Bosch Hospital, Stuttgart, Germany
| | | | - Michael Denkinger
- Agaplesion Bethesda Clinic, Research Unit on Aging, Ulm, Germany.,Geriatric Center Ulm/Alb-Donau, Ulm University, Germany
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7
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Gerhard T, Mayer K, Braisch U, Dallmeier D, Jamour M, Klaus J, Seufferlein T, Denkinger M. [Validation of the geriatrie-check for identification of geriatric patients in emergency departments]. Z Gerontol Geriatr 2020; 54:106-112. [PMID: 32112273 PMCID: PMC7946687 DOI: 10.1007/s00391-020-01699-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Accepted: 01/16/2020] [Indexed: 11/12/2022]
Abstract
Hintergrund Der Geriatrie-Check wurde im Rahmen des Geriatriekonzept Baden-Württemberg zur Identifikation geriatrischer Patienten in der Notaufnahme entwickelt. Ziel Bestimmung der konvergenten und prädiktiven Validität des Geriatrie-Checks zu Identifikation und Verlaufsprädiktion geriatrischer Patienten in der Notaufnahme. Material und Methoden Prospektive Kohortenstudie zwischen November 2015 und April 2016 mit 146 Patienten, älter als 70 Jahre, der internistischen Notaufnahme der Uniklinik Ulm. Getrennte Erhebung durch Ärzte und Pflegende: Identification of Seniors at Risk (ISAR), Geriatrie-Check, weitere kognitive und funktionelle Assessments und als Endpunkte: Veränderung von Pflegestufe, Barthel-Index, Wohnform. Ergebnisse Der ISAR klassifizierte n =117 Patienten als geriatrisch, der Geriatrie-Check n =107. Die Übereinstimmung betrug 78,1 %. Mit dem ISAR als Goldstandard zeigte der Geriatrie-Check eine Sensitivität von 82,0 % und eine Spezifität von 62,1 %. Der positiv- bzw. negativ-prädiktive Wert lag bei 89,7 % bzw. 46,1 %. Mit dem ISAR als Goldstandard war die Einschätzung der Pflege präziser als die der Ärzte überlegen (Sensitivität 70,5 % vs. 58 %; Spezifität 88,9 % vs. 83,3 %). Die prädiktive Validität 5 Monate nach Aufnahme bezüglich oben genannter Endpunkte war am besten für die Einschätzung durch Pflege und Ärzte (insbesondere die Spezifität). Beide Tests waren sehr sensitiv, aber wenig spezifisch. Diskussion Der Geriatrie-Check ist dem ISAR vergleichbar. Die konvergente Validität unterscheidet sich nur wenig. Beide, ISAR und Geriatrie-Check, sind etwas sensitiver als Ärzte und Pflege. Bezüglich der prädiktiven Validität sind Ärzte und Pflege den Scores überlegen. Ein Algorithmus aus ISAR oder Geriatrie-Check mit nachfolgender Einschätzung durch Arzt oder Pflege könnte sich für eine bedarfsgerechte Ressourcenallokation am besten eignen.
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Affiliation(s)
- Tobias Gerhard
- Geriatrische Forschung der Universität Ulm, AGAPLESION Bethesda Ulm, Zollernring 26, 89073, Ulm, Deutschland.,Geriatrisches Zentrum Ulm/Alb-Donau, Universitätsklinikum Ulm, Ulm, Deutschland
| | - Kristina Mayer
- Geriatrische Forschung der Universität Ulm, AGAPLESION Bethesda Ulm, Zollernring 26, 89073, Ulm, Deutschland.,Geriatrisches Zentrum Ulm/Alb-Donau, Universitätsklinikum Ulm, Ulm, Deutschland
| | - Ulrike Braisch
- Geriatrische Forschung der Universität Ulm, AGAPLESION Bethesda Ulm, Zollernring 26, 89073, Ulm, Deutschland.,Geriatrisches Zentrum Ulm/Alb-Donau, Universitätsklinikum Ulm, Ulm, Deutschland.,Institut für Epidemiologie und Medizinische Biometrie, Universität Ulm, Ulm, Deutschland
| | - Dhayana Dallmeier
- Geriatrische Forschung der Universität Ulm, AGAPLESION Bethesda Ulm, Zollernring 26, 89073, Ulm, Deutschland.,Geriatrisches Zentrum Ulm/Alb-Donau, Universitätsklinikum Ulm, Ulm, Deutschland
| | - Michael Jamour
- Geriatrische Rehabilitationsklinik Ehingen, Ehingen, Deutschland
| | - Jochen Klaus
- Klinik für Innere Medizin I, Universitätsklinikum Ulm, Ulm, Deutschland
| | | | - Michael Denkinger
- Geriatrische Forschung der Universität Ulm, AGAPLESION Bethesda Ulm, Zollernring 26, 89073, Ulm, Deutschland. .,Geriatrisches Zentrum Ulm/Alb-Donau, Universitätsklinikum Ulm, Ulm, Deutschland.
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8
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Dallmeier D, Braisch U, Denkinger M, Koenig W, Rothenbacher D. P6246Three-year change in high-sensitivity cardiac troponin T and total mortality in older adults - The ActiFE Study. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
High sensitivity cardiac troponin-T (hs-cTnT) levels in asymptomatic older adults have been associated with adverse outcomes such as total mortality. In this context little is known about the implications of changes over time in this population.
Purpose
We aimed to investigate the three-year change of hs-cTnT and its association with subsequent total mortality in a cohort of community dwelling older adults.
Methods
We measured hs-cTnT at baseline (BL) and at three-year follow-up (FU) in participants at the Activity and Function in the Elderly (ActiFE) Study. Having those with BL und FU hs-cTnT <5 ng/L (undetectable) as the reference group (Group 1, n=156) five categories were built among those with an increment of hs-cTnT overtime: For those with undetectable BL: FU 5 to <14 ng/L (Group 2, n=295), FU ≥14 ng/L (Group 3, n=24). Among those with BL levels between 5 to <14 ng/L: FU 5 to <14 ng/L (Group 4, n=101), FU ≥14 ng/L (Group 5, n=96). Group 6 included those with BL and FU >14 ng/L (n=74). Using Cox proportional hazards models we evaluated the association between the identified groups and total mortality adjusting for age, sex, education, history of cardiovascular disease (CVD), chronic kidney disease (CKD), number of medications, CRP, and NT-proBNP measured at FU.
Results
Among 746 participants (median age at FU 75.9 years, 58.9% male) we observed a total of 98 deaths (median FU 4.8 years) with a mortality rate of 28.6 [95% CI 23.5, 34.9] per 1000 person-years. Those with undetectable hs-cTnT levels at both time point (Group 1, reference group) had the lowest mortality rate (5.2 [95% CI 2.0, 13.9] per 1000 person-years) and were noted to be most likely younger, women, with BMI ≥18.5 but <30 kg/m2, and had less comorbidities. The highest mortality rates were observed in i) those who went from undetectable levels at BL to FU levels ≥14 ng/L (Group 3: 95.4 [95% CI 49.6, 183.4] per 1000 person-years), and in ii) those with hs-cTnT levels >14 ng/L at both time points (Group 6: 100.4 [95% CI 69.8, 144.5] per 1000 person-years). These both groups showed the highest median hs-cTnT at FU (16.7 and 30.1 ng/L respectively), and the highest incidence proportion from BL to FU of CVD and CKD. Highest FU median levels of CRP were measured in Group 3, of NT-proBNP in Group 6. In the multivariable analysis we observed a significant increased hazard for total mortality with a hazard ratio of 5.62 [95% CI 1.57, 20.14] for those in Group 3 and 3.87 [95% CI 1.17, 12.80] for those in Group 6, when compared to the reference group.
Conclusion
Evaluating trajectories of hs-cTnT even in asymptomatic older adults could help to identify those subjects with a high risk to die even after adjustment for other covariates including NT-proBNP. Further research is needed in order to identify pathophysiological mechanisms behind these changes in older adults, and the possible effect of preventive measures in the identified risk groups.
Acknowledgement/Funding
This work was supported by a grant from the Ministry of Science, Research and Arts, state of Baden-Wuerttemberg, Germany.
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Affiliation(s)
- D Dallmeier
- Agaplesion Bethesda Clinic Ulm, Ulm, Germany
| | - U Braisch
- Agaplesion Bethesda Clinic Ulm, Ulm, Germany
| | - M Denkinger
- Agaplesion Bethesda Clinic Ulm, Ulm, Germany
| | - W Koenig
- Deutsches Herzzentrum Muenchen Technical University of Munich, Munich, Germany
| | - D Rothenbacher
- University of Ulm, Institute of Epidemiology and Medical Biometry, Ulm, Germany
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9
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Braisch U, Muche R, Rothenbacher D, Landwehrmeyer GB, Long JD, Orth M. Identification of symbol digit modality test score extremes in Huntington's disease. Am J Med Genet B Neuropsychiatr Genet 2019; 180:232-245. [PMID: 30788902 DOI: 10.1002/ajmg.b.32719] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Revised: 12/14/2018] [Accepted: 02/08/2019] [Indexed: 11/09/2022]
Abstract
Studying individuals with extreme phenotypes could facilitate the understanding of disease modification by genetic or environmental factors. Our aim was to identify Huntington's disease (HD) patients with extreme symbol digit modality test (SDMT) scores. We first examined in HD the contribution of cognitive measures of the Unified Huntington's Disease Rating Scale (UHDRS) in predicting clinical endpoints. The language-independent SDMT was used to identify patients performing very well or very poorly relative to their CAG and age cohort. We used data from REGISTRY and COHORT observational study participants (5,603 HD participants with CAG repeats above 39 with 13,868 visits) and of 1,006 healthy volunteers (with 2,241 visits), included to identify natural aging and education effects on cognitive measures. Separate Cox proportional hazards models with CAG, age at study entry, education, sex, UHDRS total motor score and cognitive (SDMT, verbal fluency, Stroop tests) scores as covariates were used to predict clinical endpoints. Quantile regression for longitudinal language-independent SDMT data was used for boundary (2.5% and 97.5% quantiles) estimation and extreme score analyses stratified by age, education, and CAG repeat length. Ten percent of HD participants had an extreme SDMT phenotype for at least one visit. In contrast, only about 3% of participants were consistent SDMT extremes at two or more visits. The thresholds for the one-visit and two-visit extremes can be used to classify existing and new individuals. The identification of these phenotype extremes can be useful in the search for disease modifiers.
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Affiliation(s)
- Ulrike Braisch
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | - Rainer Muche
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | | | | | - Jeffrey D Long
- Department of Psychiatry, University of Iowa, Iowa City, Iowa.,Department of Biostatistics, University of Iowa, Iowa City, Iowa
| | - Michael Orth
- Department of Neurology, Ulm University, Ulm, Germany
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10
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Senel M, Mojib-Yezdani F, Braisch U, Bachhuber F, Lewerenz J, Ludolph AC, Otto M, Tumani H. CSF Free Light Chains as a Marker of Intrathecal Immunoglobulin Synthesis in Multiple Sclerosis: A Blood-CSF Barrier Related Evaluation in a Large Cohort. Front Immunol 2019; 10:641. [PMID: 30984199 PMCID: PMC6449445 DOI: 10.3389/fimmu.2019.00641] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Accepted: 03/08/2019] [Indexed: 01/22/2023] Open
Abstract
Objectives: The importance of immunoglobulin G (IgG) oligoclonal bands (OCB) in the diagnosis of multiple sclerosis (MS) was reaffirmed again in the recently revised MS diagnostic criteria. Since OCB testing is based on non-quantitative techniques and demands considerable methodological experience, measurement of CSF immunoglobulin free light chains (FLC) has been suggested as quantitative alternative to OCB. We aimed to establish reference values for FLC measures and evaluate their diagnostic accuracy with regard to the diagnosis of MS. Methods: Immunoglobulin kappa (KFLC) and lambda (LFLC) free light chains were prospectively measured by nephelometry in CSF and serum sample pairs in 1,224 patients. The analyzed cohort included patients with MS, other autoimmune or infectious inflammatory diseases of the nervous system as well as 989 patients without signs for nervous system inflammation. Results: Regarding diagnosis of MS, the diagnostic sensitivity and specificity of intrathecal KFLC ratio were 93.3 and 93.7% using the CSF-serum albumin ratio-dependent reference values, 92.0 and 95.9% for intrathecal KFLC ratio applying the ROC-curve determined cut-off levels, 62.7 and 98.3% for IgG index, 64.0 and 98.8% for intrathecal IgG synthesis according to Reiber diagrams, and 94.7 and 93.3% for OCB. Diagnostic sensitivity and specificity of intrathecal LFLC were clearly lower than KFLC. Conclusions: Intrathecal KFLC and OCB showed the highest diagnostic sensitivities for MS. However, specificity was slightly lower compared to other quantitative IgG parameters. Consequently, CSF FLC may not replace OCB, but it may support diagnosis in MS as a quantitative parameter.
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Affiliation(s)
- Makbule Senel
- Department of Neurology, University of Ulm, Ulm, Germany
| | | | - Ulrike Braisch
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | | | - Jan Lewerenz
- Department of Neurology, University of Ulm, Ulm, Germany
| | | | - Markus Otto
- Department of Neurology, University of Ulm, Ulm, Germany
| | - Hayrettin Tumani
- Department of Neurology, University of Ulm, Ulm, Germany.,Specialty Hospital of Neurology Dietenbronn, Schwendi, Germany
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11
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Mayer B, Braisch U, Meule M, Allgoewer A, Richter S, Muche R. Effect of data self-collection as an activating teaching method in a statistical software course in medical biometry - a pilot study. GMS J Med Educ 2018; 35:Doc9. [PMID: 29497694 PMCID: PMC5827190 DOI: 10.3205/zma001156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Figures] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Revised: 10/26/2017] [Accepted: 12/04/2017] [Indexed: 06/08/2023]
Abstract
Background: Biostatistics is an integral part of the studies of human medicine. Students learn the basics of analyzing and interpreting study results. It is important to demonstrate the subject's relevance by means of appropriate measures to maximize learning success. We investigated whether an active involvement of students in the process of data collection may improve test performance and motivation among medical students. Methods: We conducted a pilot study comparing active involvement of students (n1=45) in the process of data collection and standard education (n2=26). All students of this pilot study participated in an observational study assessing their preferences regarding sweets or salty munchies, and students of the experimental group subsequently used this data set during the exercises throughout the semester. Primary and secondary endpoints were examination success and motivation respectively. Results: Superiority of the activating teaching method could not be demonstrated (intervention: 109.0 points (SD 8.8), control: 113.8 points (SD 6.5)). The course ratings were superior in the intervention group (median grade 1 vs. median grade 2 in the control group), although this was not a significant improvement (p=0.487). Conclusions: Biostatistics education should incorporate approaches contributing to a better understanding of learning contents. Possible reasons why this pilot study failed to prove superiority of the intervention were a lack of sample size as well as the good grades in the control group. The presented teaching concept has to be evaluated by means of a larger sample enabling more valid conclusions. Furthermore, the considered research question in the experimental group may be changed to a more relevant one for medical practice.
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Affiliation(s)
- Benjamin Mayer
- Ulm University, Institute for Epidemiology and Medical Biometry, Ulm, Germany
| | - Ulrike Braisch
- Ulm University, Institute for Epidemiology and Medical Biometry, Ulm, Germany
| | - Marianne Meule
- Ulm University, Institute for Epidemiology and Medical Biometry, Ulm, Germany
| | - Andreas Allgoewer
- Ulm University, Institute for Epidemiology and Medical Biometry, Ulm, Germany
| | - Silvia Richter
- Ulm University, Institute for Epidemiology and Medical Biometry, Ulm, Germany
| | - Rainer Muche
- Ulm University, Institute for Epidemiology and Medical Biometry, Ulm, Germany
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12
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Dallmeier D, Braisch U, Koenig W, Denkinger M, Rothenbacher D. Longitudinal changes of N-Terminal pro-Brain Natriuretic Peptide (NT-proBNP) and total mortality in elderly people: the ActiFE Study. Das Gesundheitswesen 2017. [DOI: 10.1055/s-0037-1605866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- D Dallmeier
- Agaplesion Bethesda Klinik Ulm, Forschungsabteilung, Ulm
- Geriatrisches Zentrum Ulm/Alb-Donau, Ulm Universität, Ulm
| | - U Braisch
- Agaplesion Bethesda Klinik Ulm, Forschungsabteilung, Ulm
- Geriatrisches Zentrum Ulm/Alb-Donau, Ulm Universität, Ulm
- Ulm Universität, Inst. für Epidemiologie und medizinische Biometrie, Ulm
| | - W Koenig
- Ulm Universität, Innere Medizin II, Ulm
- Deutsches Herzzentrum München, München
| | - M Denkinger
- Agaplesion Bethesda Klinik Ulm, Forschungsabteilung, Ulm
- Geriatrisches Zentrum Ulm/Alb-Donau, Ulm Universität, Ulm
| | - D Rothenbacher
- Ulm Universität, Inst. für Epidemiologie und medizinische Biometrie, Ulm
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13
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Braisch U, Dallmeier D, Koenig W, Rothenbacher D, Denkinger MD. Association of established N-Terminal pro-Brain Natriuretic Peptide predictors varies across quantiles in older people: The ActiFE Study. Das Gesundheitswesen 2017. [DOI: 10.1055/s-0037-1605816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- U Braisch
- Agaplesion Bethesda Klinik Ulm, Forschungsabteilung, Ulm
- Geriatrisches Zentrum Ulm/Alb-Donau, Universität Ulm, Ulm
- Universität Ulm, Inst. für Epidemiologie und Medizinische Biometrie, Ulm
| | - D Dallmeier
- Agaplesion Bethesda Klinik Ulm, Forschungsabteilung, Ulm
- Geriatrisches Zentrum Ulm/Alb-Donau, Universität Ulm, Ulm
| | - W Koenig
- Universität Ulm, Innere Medizin II, Ulm
- Deutsches Herzzentrum München, München
| | - D Rothenbacher
- Universität Ulm, Inst. für Epidemiologie und Medizinische Biometrie, Ulm
| | - MD Denkinger
- Agaplesion Bethesda Klinik Ulm, Forschungsabteilung, Ulm
- Geriatrisches Zentrum Ulm/Alb-Donau, Universität Ulm, Ulm
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14
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Dallmeier D, Braisch U, Klenk J, Rothenbacher D, Denkinger M. Frailty and risk of mortality in community dwelling older adults: results of the ActiFE study. Das Gesundheitswesen 2017. [DOI: 10.1055/s-0037-1605794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- D Dallmeier
- Agaplesion Bethesda Klinik Ulm, Forschungsabteilung, Ulm
- Geriatrisches Zentrum Ulm/Alb-Donau, Ulm Universität, Ulm
| | - U Braisch
- Agaplesion Bethesda Klinik Ulm, Forschungsabteilung, Ulm
- Geriatrisches Zentrum Ulm/Alb-Donau, Ulm Universität, Ulm
- Ulm Universität, Inst. für Epidemiologie und medizinische Biometrie, Ulm
| | - J Klenk
- Ulm Universität, Inst. für Epidemiologie und medizinische Biometrie, Ulm
| | - D Rothenbacher
- Ulm Universität, Inst. für Epidemiologie und medizinische Biometrie, Ulm
| | - M Denkinger
- Agaplesion Bethesda Klinik Ulm, Forschungsabteilung, Ulm
- Geriatrisches Zentrum Ulm/Alb-Donau, Ulm Universität, Ulm
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15
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Klenk J, Peter RS, Braisch U, Dallmeier D, Denkinger M, Rothenbacher D. Einfluss der Temperatur bei der Analyse von Änderungen der objektiv gemessenen körperlichen Aktivität über die Zeit in der ActiFE-Ulm Studie. Das Gesundheitswesen 2017. [DOI: 10.1055/s-0037-1605938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- J Klenk
- Universität Ulm, Institut für Epidemiologie und Medizinische Biometrie, Ulm
- Robert-Bosch-Krankenhaus Stuttgart, Abteilung für Geriatrie und Klinik für geriatrische Rehabilitation, Stuttgart
| | - RS Peter
- Universität Ulm, Institut für Epidemiologie und Medizinische Biometrie, Ulm
| | - U Braisch
- Universität Ulm, Institut für Epidemiologie und Medizinische Biometrie, Ulm
- Agaplesion Bethesda Klinik, Ulm
| | | | | | - D Rothenbacher
- Universität Ulm, Institut für Epidemiologie und Medizinische Biometrie, Ulm
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16
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Grund S, Denkinger M, Braisch U, Marburger C, Runge M, Jamour M. UTILITY OF THE SPPB FOR SHORT-TERM OUTCOME PREDICTION OF MULTIMORBID GERIATRIC REHABILITANTS. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.3328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- S. Grund
- Diakonissenkrankenhaus Mannheim, Mannheim, Germany,
- Agaplesion Bethesda Klinik Ulm, Ulm, Germany
| | | | - U. Braisch
- Biometrie Universität Ulm, Ulm, Germany,
- Agaplesion Bethesda Klinik Ulm, Ulm, Germany
| | | | - M. Runge
- Privatpraxis, Esslingen am Neckar, Germany,
| | - M. Jamour
- Geriatrische Rehabilitationsklinik Ehingen, Ehingen, Germany,
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17
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Braisch U, Hay B, Muche R, Rothenbacher D, Landwehrmeyer GB, Long JD, Orth M. Identification of extreme motor phenotypes in Huntington's disease. Am J Med Genet B Neuropsychiatr Genet 2017; 174:283-294. [PMID: 27868347 DOI: 10.1002/ajmg.b.32514] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Accepted: 10/27/2016] [Indexed: 11/05/2022]
Abstract
The manifestation of motor signs in Huntington's disease (HD) has a well-known inverse relationship with HTT CAG repeat length, but the prediction is far from perfect. The probability of finding disease modifiers is enhanced in individuals with extreme HD phenotypes. We aimed to identify extreme HD motor phenotypes conditional on CAG and age, such as patients with very early or very late onset of motor manifestation. Retrospective data were available from 1,218 healthy controls and 9,743 HD participants with CAG repeats ≥40, and a total of about 30,000 visits. Boundaries (2.5% and 97.5% quantiles) for extreme motor phenotypes (UHDRS total motor score (TMS) and motor age-at-onset) were estimated using quantile regression for longitudinal data. More than 15% of HD participants had an extreme TMS phenotype for at least one visit. In contrast, only about 4% of participants were consistent TMS extremes at two or more visits. Data from healthy controls revealed an upper cut-off of 13 for the TMS representing the extreme of motor ratings for a normal aging population. In HD, boundaries of motor age-at-onset based on diagnostic confidence or derived from the TMS data cut-off in controls were similar. In summary, a UHDRS TMS of more than 13 in an individual carrying the HD mutation indicates a high likelihood of motor manifestations of HD irrespective of CAG repeat length or age. The identification of motor phenotype extremes can be useful in the search for disease modifiers, for example, genetic or environmental such as medication. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Ulrike Braisch
- Institute of Epidemiology and Medical Biometry, Ulm University, Germany
| | - Birgit Hay
- Institute of Epidemiology and Medical Biometry, Ulm University, Germany
| | - Rainer Muche
- Institute of Epidemiology and Medical Biometry, Ulm University, Germany
| | | | | | - Jeffrey D Long
- Department of Psychiatry, University of Iowa, Iowa City, Iowa.,Department of Biostatistics, University of Iowa, Iowa City, Iowa
| | - Michael Orth
- Department of Neurology, Ulm University, Germany
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18
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Geibel MA, Carstens S, Braisch U, Rahman A, Herz M, Jablonski-Momeni A. Radiographic diagnosis of proximal caries-influence of experience and gender of the dental staff. Clin Oral Investig 2017; 21:2761-2770. [PMID: 28233170 DOI: 10.1007/s00784-017-2078-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Accepted: 02/07/2017] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The aim of this study was to examine the influence of experience and gender on the radiographic detection of proximal caries lesions and on therapeutic decisions. MATERIALS AND METHODS A survey of 220 examiners (students and employees at three universities and dentists in the field) was taken using a standardized written questionnaire concerning radiographic diagnosis and therapy planning. An expert opinion of four dentists was determined as radiographic reference. A mixed effect logistic regression model was used for statistical evaluation and the odds ratio and p values were calculated (α = 0.05). RESULTS Examiners with experience had an almost four times greater chance of a correct assessment, if proximal caries lesion was present or not, than examiners with low experience (OR 3.7 (95% CI 2.4-5.8)). No gender-specific differences were discovered (OR women vs. men 0.9 (95% CI 0.6-1.4)). There was a relationship between the severity of the burnout effect on the x-ray and false positive caries diagnosis. Overall, 43% of respondents would plan invasive treatment in the enamel on a patient at low risk of caries and 78% on a high-risk patient. The results showed that the more experienced practitioners would be more likely to postpone restorative therapy on proximal caries until the lesion reached a later stage. CONCLUSIONS The results of this study suggest that examiner's experience influences the radiographic diagnosis of proximal lesions. No gender-specific differences could be found. CLINICAL RELEVANCE Examiner's professional experience is an important factor when radiography is included for detection and treatment planning of proximal lesions.
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Affiliation(s)
- Margrit-Ann Geibel
- Department of Dentomaxillofacial Surgery, University of Ulm, Albert-Einstein-Allee 11, 89081, Ulm, Germany.
| | - S Carstens
- Department of Dentomaxillofacial Surgery, University of Ulm, Albert-Einstein-Allee 11, 89081, Ulm, Germany
| | - U Braisch
- Institute of Epidemiology and Medical Biometry, University of Ulm, Schwabstraße 13, 89075, Ulm, Germany
| | - A Rahman
- Department of Conservative Dentistry, Periodontology and Preventive Dentistry, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany
| | - M Herz
- Department of Conservative Dentistry and Periodontology, Tuebingen University Hospital, Osianderstraße 2-8, 72076, Tuebingen, Germany
| | - A Jablonski-Momeni
- Department of Pediatric and Community Dentistry, Philipps University, Georg-Voigt-Straße 3, 35033, Marburg, Germany
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Braisch U, Martinez-Horta S, MacDonald M, Orth M. Important but not Enough - Information about HD Related Topics and Peer and Professional Support for Young Adults from HD Families. J Huntingtons Dis 2016; 5:379-387. [PMID: 27983563 DOI: 10.3233/jhd-160218] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The number of people affected by Huntington's disease (HD) is far greater than those with manifest HD because it also includes those at risk, both HD gene mutation carriers and family members not carrying the HD mutation. Many relevant needs of young adults from HD families may not be met at present. This includes advice on important life decisions e.g. family planning and having children, psychological support and treatment of medical conditions. OBJECTIVE To survey the opinion of young adults from HD families about relevance and availability of information and support regarding several aspects of HD. METHODS An online anonymous questionnaire translated into ten languages contained questions regarding the importance and availability of information and support about HD related topics, and attitudes towards research. Answers were captured in categories or on Likert scales. RESULTS Information about HD related topics and the availability of peer and professional support are very important for young adults from HD families. In addition, with the exception of general information about HD, or predictive testing, the vast majority of respondents stated that they did not receive enough information on other important topics, for instance regarding legal advice and they did not feel supported enough by healthcare professionals. HD research was considered to be of high value, though most did not participate in HD research. CONCLUSION The results of this survey can help devise a strategy to address these unmet needs and also to facilitate research participation of more young adults from HD families.
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Affiliation(s)
- Ulrike Braisch
- Institute of Epidemiology and Medical Biometry, Ulm University, Germany
| | - Saul Martinez-Horta
- Biomedical Research Institute Sant Pau (IIB-Sant Pau). Movement Disorders Group. Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Marcy MacDonald
- Center for Human Genetic Research, Massachusetts General Hospital, Boston, MA, USA
| | - Michael Orth
- Department of Neurology, Ulm University, Germany
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Braisch U, Geiss K, Radespiel-Tröger M, Meyer M. Population-Based Effects of Mammography Screening in Bavaria on the Distribution of TNM-T Categories with Respect to Different Histological Subgroups. Breast Care (Basel) 2012; 7:303-9. [PMID: 23904833 PMCID: PMC3515788 DOI: 10.1159/000341369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2024] Open
Abstract
BACKGROUND Organized mammography screening was implemented in Bavaria in 2003, with a target population of about 1.5 million women (aged 50-69 years). We evaluated the population-based effects of mammography screening on the distribution of tumor-node-metastasis (TNM)-T categories with regard to different histological subgroups of breast cancer. PATIENTS AND METHODS Women diagnosed with breast cancer between 2002 and 2008 were included. The annual age-specific incidence rates separated by T category were calculated for different histological subgroups and plotted against time. Time trends were analyzed not only in the screening population but also based on women aged 15-49 and ≥70 years, respectively. Furthermore, correlation coefficients were calculated in order to evaluate the possible association between participation rate and incidence of certain TNM-T categories. RESULTS With ductal carcinomas, the incidence of early-stage tumors shows a strong increase in the screening population and a significant correlation with the participation rate, whereas with lobular carcinomas there is a stagnation of incidence in women aged 50-69 years irrespective of TNM-T category. CONCLUSIONS Short-term effects of mammography screening can already be demonstrated. However, depending on breast cancer type, not all women appear to benefit from screening. The expected long-term reduction of breast cancer mortality remains to be seen.
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Affiliation(s)
- Ulrike Braisch
- Population-Based Cancer Registry Bavaria, Erlangen, Germany
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Braisch U, Meyer M, Radespiel-Tröger M. Risk of tobacco-related multiple primary cancers in Bavaria, Germany. BMC Cancer 2012; 12:250. [PMID: 22708674 PMCID: PMC3492164 DOI: 10.1186/1471-2407-12-250] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2011] [Accepted: 05/14/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND With the prospect of increasing prevalence of cancer, the issue of multiple primary cancers becomes more relevant. The aim of this study was to estimate the risk of developing a tobacco-related subsequent primary cancer (TRSPC) in persons with a tobacco-related first primary cancer (TRFPC) compared with the general population in Bavaria, Germany. METHODS Using data from the Population-Based Cancer Registry Bavaria, we analyzed TRFPC and TRSPC diagnosed in Bavaria between 2002 and 2008 to estimate the relative and absolute risk of developing TRSPC using standardized incidence ratios (SIR) and excess absolute risks (EAR). RESULTS 121,631 TRFPC in men and 75,886 respective cancers in women were registered, which in 2.5% of male and 1.2% of female cancer patients were followed by at least one TRSPC. In both males and females, the highest increased risks compared to the general population were found within the group of cancer in the mouth/pharynx, oesophagus, larynx, and lung/bronchus. CONCLUSIONS With respect to cancer in the mouth/pharynx, oesophagus, larynx, lung/bronchus, kidney, urinary bladder and urinary tract, smoking was confirmed as a shared risk factor based on our finding of mutually significantly increased risks of TRSPC. The results of this study illustrate the importance of smoking cessation and of continued follow-up care especially of smokers with the aforementioned TRFPC to detect TRSPC at an early stage.
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Affiliation(s)
- Ulrike Braisch
- Population-Based Cancer Registry Bavaria, Östliche Stadtmauerstr. 30, 91054, Erlangen, Germany
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