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Search Results: 1 - 10 of 196219 matches for " Angela D?ring "
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Longitudinal beta regression models for analyzing health-related quality of life scores over time
Hunger Matthias,Dring Angela,Holle Rolf
BMC Medical Research Methodology , 2012, DOI: 10.1186/1471-2288-12-144
Abstract: Background Health-related quality of life (HRQL) has become an increasingly important outcome parameter in clinical trials and epidemiological research. HRQL scores are typically bounded at both ends of the scale and often highly skewed. Several regression techniques have been proposed to model such data in cross-sectional studies, however, methods applicable in longitudinal research are less well researched. This study examined the use of beta regression models for analyzing longitudinal HRQL data using two empirical examples with distributional features typically encountered in practice. Methods We used SF-6D utility data from a German older age cohort study and stroke-specific HRQL data from a randomized controlled trial. We described the conceptual differences between mixed and marginal beta regression models and compared both models to the commonly used linear mixed model in terms of overall fit and predictive accuracy. Results At any measurement time, the beta distribution fitted the SF-6D utility data and stroke-specific HRQL data better than the normal distribution. The mixed beta model showed better likelihood-based fit statistics than the linear mixed model and respected the boundedness of the outcome variable. However, it tended to underestimate the true mean at the upper part of the distribution. Adjusted group means from marginal beta model and linear mixed model were nearly identical but differences could be observed with respect to standard errors. Conclusions Understanding the conceptual differences between mixed and marginal beta regression models is important for their proper use in the analysis of longitudinal HRQL data. Beta regression fits the typical distribution of HRQL data better than linear mixed models, however, if focus is on estimating group mean scores rather than making individual predictions, the two methods might not differ substantially.
Uric Acid Is More Strongly Associated with Impaired Glucose Regulation in Women than in Men from the General Population: The KORA F4-Study
Christa Meisinger, Angela Dring, Doris St?ckl, Barbara Thorand, Bernd Kowall, Wolfgang Rathmann
PLOS ONE , 2012, DOI: 10.1371/journal.pone.0037180
Abstract: Objective High serum uric acid (UA) levels are associated with the metabolic syndrome, type 2 diabetes and cardiovascular disease. It is largely unknown whether there are gender-specific differences regarding the association between UA and prediabetic states. We examined the possible association between UA levels and known as well as newly diagnosed diabetes (NDD), isolated impaired fasting glucose (i-IFG), isolated impaired glucose tolerance (i-IGT), and combined IFG/IGT in a population-based sample of 32-to-81-year-old men and women. Research Design and Methods An oral glucose tolerance test was carried out in all 2,740 participants without known diabetes of the Cooperative Health Research in the Region of Augsburg (KORA) F4 Study conducted between 2006 and 2008 in Southern Germany. Serum UA was analysed by the uricase method. Results In women after multivariable adjustment the associations between UA and i-IFG (OR 1.57, 95% CI 1.15–2.14), IFG/IGT (OR 1.52, 1.07–2.16), NDD (OR 1.67, 95% CI 1.28–2.17), and known diabetes (OR 1.47, 95% CI 1.18–1.82) remained significant, but the association with i-IGT (OR 1.14, 95% CI 0.95–1.36) lost significance. In contrast in men, after multivariable adjustment there was only a significant association between UA levels and i-IFG (OR 1.49, 95% CI 1.21–1.84), all other associations were non-significant (i-IGT: OR 1.09, IFG/IGT: OR 1.06, NDD: OR 0.91, known diabetes: OR 1.04; all p-values>0.05). Conclusions Serum UA concentrations were associated with different categories of impaired glucose regulation in individuals from the general population, particularly in women. Further studies investigating the role of UA in the development of derangements in glucose metabolism are needed.
Reproductive Factors and Serum Uric Acid Levels in Females from the General Population: The KORA F4 Study
Doris St?ckl, Angela Dring, Barbara Thorand, Margit Heier, Petra Belcredi, Christa Meisinger
PLOS ONE , 2012, DOI: 10.1371/journal.pone.0032668
Abstract: Objective Hyperuricemia is associated with an increased risk of metabolic and cardiovascular diseases. There are pronounced sex differences in the levels of uric acid. It is largely unknown whether or not reproductive parameters which induce hormonal changes are responsible for this. We examined if there are associations between reproductive parameters and uric acid levels in a female population-based sample. Methods In this cross-sectional analysis, data of 1530 women aged 32 to 81 years participating in the KORA F4 study, conducted between 2006 and 2008 in Southern Germany were used. Reproductive parameters were obtained by standardized interviews. Uric acid levels were tested by the uricase method. The whole study sample and stratified in pre- and postmenopausal women was analyzed. Results Menopausal status and earlier age at menarche were associated with higher serum uric acid levels (age-adjusted: p-values 0.003, <0.001 respectively; after multivariable adjustment, including BMI: p-values 0.002, 0.036). A history of oral contraceptive use showed an association with uric acid levels only after multivariable adjustment (p-value 0.009). Hot flushes showed an association with uric acid levels only after age-adjustment (p-value 0.038), but lost significance after adding other confounders. Other reproductive factors, including parity, current or ever use of hormone replacement therapy, current use of oral contraceptives, hysterectomy, bilateral oophorectomy, or depressive mood related to menopausal transition were not associated with uric acid levels. Conclusions Postmenopausal status, earlier age at menarche and a history of oral contraceptive use were independently associated with higher serum uric acid concentrations in women from the general population. Further studies, especially longitudinal population-based studies investigating the relationship of female reproductive parameters with uric acid levels are necessary to confirm our findings.
Multimorbidity and health-related quality of life in the older population: results from the German KORA-Age study
Matthias Hunger, Barbara Thorand, Michaela Schunk, Angela Dring, Petra Menn, Annette Peters, Rolf Holle
Health and Quality of Life Outcomes , 2011, DOI: 10.1186/1477-7525-9-53
Abstract: The EQ-5D was administered in the population-based KORA-Age study of 4,565 Germans aged 65 years or older. A generalised additive regression model was used to assess the effects of chronic conditions on HRQL and to account for the nonlinear associations with age and body mass index (BMI). Disease interactions were identified by a forward variable selection method.The conditions with the greatest negative impact on the EQ-5D index were the history of a stroke (regression coefficient -11.3, p < 0.0001) and chronic bronchitis (regression coefficient -8.1, p < 0.0001). Patients with both diabetes and coronary disorders showed more impaired HRQL than could be expected from their separate effects (coefficient of interaction term -8.1, p < 0.0001). A synergistic effect on HRQL was also found for the combination of coronary disorders and stroke. The effect of BMI on the mean EQ-5D index was inverse U-shaped with a maximum at around 24.8 kg/m2.There are important interactions between coronary problems, diabetes mellitus, and the history of a stroke that negatively affect HRQL in the older German population. Not only high but also low BMI is associated with impairments in health status.Multimorbidity, defined as the coexistence of two or more chronic conditions, is a common phenomenon among the older population worldwide: two recent population-based studies indicated that the prevalence of multimorbidity ranges between 40% and 56% in the general population aged 65 years and older [1,2]. Multimorbidity is known to negatively affect health outcomes including mortality, hospitalisation, and readmission [3].Health-related quality of life (HRQL) is a health outcome measure which is increasingly used to assess the medical effectiveness of interventions and to support allocation decisions in the health care sector. Generic HRQL instruments like the EQ-5D are appropriate for non-disease-specific analyses and allow comparisons between patient groups with different medical conditions [
Association between Markers of Fatty Liver Disease and Impaired Glucose Regulation in Men and Women from the General Population: The KORA-F4-Study
Ina-Maria Rückert,Margit Heier,Wolfgang Rathmann,Sebastian E. Baumeister,Angela Dring,Christa Meisinger
PLOS ONE , 2012, DOI: 10.1371/journal.pone.0022932
Abstract: To investigate whether the elevated liver enzymes gamma-glutamyltransferase (GGT), glutamate-pyruvate transaminase (GPT), glutamate-oxalacetate transaminase (GOT) and alkaline phosphatase (AP) and non-alcoholic fatty liver disease (NAFLD) respectively are independently associated with pre-diabetic states, namely impaired fasting glucose (IFG) and impaired glucose tolerance (IGT) or known and newly diagnosed diabetes (NDD), in men and women from the general German population.
Association of daily tar and nicotine intake with incident myocardial infarction: Results from the population-based MONICA/KORA Augsburg Cohort Study 1984 - 2002
Qiu-Li Zhang, Jens Baumert, Karl-Heinz Ladwig, H-Erich Wichmann, Christa Meisinger, Angela Dring
BMC Public Health , 2011, DOI: 10.1186/1471-2458-11-273
Abstract: The study was based on 4,099 men and 4,197 women participating in two population-based MONICA Augsburg surveys between 1984 and 1990 and followed up within the KORA framework until 2002. During a mean follow-up of 13.3 years, a number of 307 men and 80 women developed an incident MI event. Relative risks were calculated as hazard ratios (HRs) estimated by Cox proportional hazards models adjusted for cardiovascular risk factors.In the present study, male regular smokers consumed on average more cigarettes per day than female regular smokers (20 versus 15) and had a higher tar and nicotine intake per day. In men, the MI risk compared to never-smokers increased with higher tar intake: HRs were 2.24 (95% CI 1.40-3.56) for 1-129 mg/day, 2.12 (95% CI 1.37-3.29) for 130-259 mg/day and 3.01 (95% CI 2.08-4.36) for ≥ 260 mg/day. In women, the corresponding associations were comparable but more pronounced for high tar intake (HR 4.67, 95% CI 1.76-12.40). Similar associations were observed for nicotine intake.The present study based on a large population-based sample adds important evidence of cumulative effects of tar and nicotine intake on the risk of incident MI. Even low or medium tar and nicotine intake revealed substantial risk increases as compared to never-smokers. Therefore, reduction of tar and nicotine contents in cigarettes cannot be seen as a suitable public health policy in preventing myocardial infarction.Cigarette smoking is a central issue in public health policy as it has been shown to be associated with an elevated risk of various cardiovascular diseases and types of cancer [1,2]. Smoking has been determined as one of the most important risk factors for myocardial infarction (MI) [3-5], but it was shown that smoking cessation can reduce this risk [6]. Many countries and international agencies have made great efforts to change smoking behaviour and to encourage smokers to quit smoking, e.g. by preventing initiation of tobacco use, promoting cessation among ado
Urban-rural disparities in smoking behaviour in Germany
Henry V?lzke, Hanne Neuhauser, Susanne Moebus, Jens Baumert, Klaus Berger, Andreas Stang, Ute Ellert, André Werner, Angela Dring
BMC Public Health , 2006, DOI: 10.1186/1471-2458-6-146
Abstract: We used a nationwide German census representative for the general population of Germany. A number of 181,324 subjects aged 10 years or older were included. Information on the average daily usage of cigarettes that have or had been smoked formerly or currently was available in subjects who have ever smoked. A daily consumption of more than 20 cigarettes was considered heavy smoking. Logistic regression analyses were performed sex-stratified and adjusted for relevant confounders.Analyses revealed inhabitants of metropolitan areas to be more likely current smokers than inhabitants of rural areas (odds ratio 1.56, 95%-confidence interval 1.51; 1.62). Among current and former smokers those who lived in urban communities had also increased odds for being heavy smokers than those who lived in rural communities.We conclude that living in an urban and particularly living in a metropolitan area is a determinant of both smoking and severity of current smoking. Tobacco control programs should recognize the difference in living conditions between rural and urban areas.Life in urban areas might be more stressful than life in rural areas. Populations that experience higher levels of stressful events have higher proportions of current smokers who also smoke more heavily than populations with respective lower levels [1]. This health behaviour model of stress in which populations under stress engage in behaviour which is highly detrimental to health has repeatedly been demonstrated in the context of low income and social status which may lead to an increased risk of smoking [2-5]. Communities can produce stress in individuals but can also provide the coping resources that help modify these stressors. Therefore, it is a priori not clear whether a higher or even a lower prevalence of smoking can be assumed in individuals living in urban areas compared to those living in rural areas. In particular the association between living in metropolitan regions and smoking has yet received suffic
Neutrino Oscillations from Dirac and Majorana Masses
D. Ring
Physics , 1996, DOI: 10.1103/PhysRevD.55.5767
Abstract: We present a scenario of neutrino masses and mixing angles. Each generation includes a sterile right handed neutrino in addition to the usual left handed one. We assume a hierarchy in their Dirac masses similar to, but much larger than the hierarchies in the quarks and charged leptons. In addition, we include a Majorana mass term for the sterile neutrinos only. These assumptions prove sufficient to accomodate scales of mass differences and mixing angles consistent with all existing neutrino oscillation data.
Gravitational Back Reaction of Hawking modes
D. Ring
Physics , 2005,
Abstract: The radiation rate of an evaporating black hole is calculated in a toy model in which the geometry outside the collapsing matter is described by a Vaidya metric. When back reaction consistency is imposed, the singularity in the blueshift factor near the horizon is softened, suppressing the evaporation rate in the Schwarzschild case by the fourth power of the external time, thus rendering the hole eternal.
Age at Menarche and Its Association with the Metabolic Syndrome and Its Components: Results from the KORA F4 Study
Doris St?ckl, Christa Meisinger, Annette Peters, Barbara Thorand, Cornelia Huth, Margit Heier, Wolfgang Rathmann, Bernd Kowall, Heidi St?ckl, Angela Dring
PLOS ONE , 2011, DOI: 10.1371/journal.pone.0026076
Abstract: Objective The metabolic syndrome is a major public health challenge and identifies persons at risk for diabetes and cardiovascular disease. The aim of this study was to examine the association between age at menarche and the metabolic syndrome (IDF and NCEP ATP III classification) and its components. Design 1536 women aged 32 to 81 years of the German population based KORA F4 study were investigated. Data was collected by standardized interviews, physical examinations, and whole blood and serum measurements. Results Young age at menarche was significantly associated with elevated body mass index (BMI), greater waist circumference, higher fasting glucose levels, and 2 hour glucose (oral glucose tolerance test), even after adjusting for the difference between current BMI and BMI at age 25. The significant effect on elevated triglycerides and systolic blood pressure was attenuated after adjustment for the BMI change. Age at menarche was inversely associated with the metabolic syndrome adjusting for age (p-values: <0.001 IDF, 0.003 NCEP classification) and additional potential confounders including lifestyle and reproductive history factors (p-values: 0.001, 0.005). Associations remain significant when additionally controlling for recollected BMI at age 25 (p-values: 0.008, 0.033) or the BMI change since age 25 (p-values: 0.005, 0.022). Conclusion Young age at menarche might play a role in the development of the metabolic syndrome. This association is only partially mediated by weight gain and increased BMI. A history of early menarche may help to identify women at risk for the metabolic syndrome.
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