Johannes Siegrist

Publications of Johannes Siegrist

• Talking about smoking in primary care medical practice-Results of experimental studies from the US, UK and Germany.

  Authors: Olaf von dem Knesebeck, Anke Hoehne, Carol Link, Lisa Marceau, Ann Adams, Martin Roland, Stephen Campbell, Johannes Siegrist, John McKinlay

  Patient education and counseling. 05/2012;

  OBJECTIVE: To analyse effects of patient and physician characteristics on questions and advice about smoking in primary care practice and to examine country differences. METHODS: We conducted aOBJECTIVE: To analyse effects of patient and physician characteristics on questions and advice about smoking in primary care practice and to examine country differences. METHODS: We conducted a factorial experiment, employing filmed scenarios in which actors played the role of patients with symptoms of coronary heart disease (CHD) or type 2 diabetes. Versions were filmed with patient-actors of different gender, age, race, and socioeconomic status. The videotapes were presented to primary care physicians in the US, UK and Germany. Physicians were asked whether they would ask questions about smoking or give cessation advice. RESULTS: Female and older CHD patients are less likely to be asked or get advice about smoking in all three countries. Effects of physician attributes are weak and inconsistent. Compared to physicians in the US and the UK, German doctors are least likely to ask questions or give advice. CONCLUSIONS: Although all physicians viewed the same cases their questioning and advice giving differed according to patient attributes and country. Due to the experimental design external validity of the study may be limited. PRACTICE IMPLICATIONS: Findings have implications for medical education and professional training of physicians as well as for the organization and financing of health care.

• Long-term Effects of Psychosocial Work Stress in Midlife on Health Functioning After Labor Market Exit--Results From the GAZEL Study.

  Authors: Morten Wahrendorf, Grace Sembajwe, Marie Zins, Lisa Berkman, Marcel Goldberg, Johannes Siegrist

  The journals of gerontology. Series B, Psychological sciences and social sciences. 04/2012;

  Objectives.To study long-term effects of psychosocial work stress in mid-life on health functioning after labor market exit using two established work stress models. METHODS: In the frame of theObjectives.To study long-term effects of psychosocial work stress in mid-life on health functioning after labor market exit using two established work stress models. METHODS: In the frame of the prospective French Gazel cohort study, data on psychosocial work stress were assessed using the full questionnaires measuring the demand-control-support model (in 1997 and 1999) and the effort-reward imbalance model (in 1998). In 2007, health functioning was assessed, using the Short Form 36 mental and physical component scores. Multivariate regressions were calculated to predict health functioning in 2007, controlling for age, gender, social position, and baseline self-perceived health. RESULTS: Consistent effects of both work stress models and their single components on mental and physical health functioning during retirement were observed. Effects remained significant after adjustment including baseline self-perceived health. Whereas the predictive power of both work stress models was similar in the case of the physical composite score, in the case of the mental health score, values of model fit were slightly higher for the effort-reward imbalance model (R²: 0.13) compared with the demand-control model (R²: 0.11). CONCLUSIONS: Findings underline the importance of working conditions in midlife not only for health in midlife but also for health functioning after labor market exit.

• The mediating effect of social relationships on the association between socioeconomic status and subjective health - results from the Heinz Nixdorf Recall cohort study.

  Authors: Nico Vonneilich, Karl-Heinz Jöckel, Raimund Erbel, Jens Klein, Nico Dragano, Johannes Siegrist, Olaf von dem Knesebeck

  BMC public health. 04/2012; 12(1):285.

  ABSTRACT: BACKGROUND: Socioeconomic status (SES) is an important determinant of population health. Explanatory approaches on how SES determines health have so far included numerous factors, amongstABSTRACT: BACKGROUND: Socioeconomic status (SES) is an important determinant of population health. Explanatory approaches on how SES determines health have so far included numerous factors, amongst them psychosocial factors such as social relationships. However, it is unclear whether social relationships can help explain socioeconomic differences in general subjective health. Do different aspects of social relationships contribute differently to the explanation? Based on a cohort study of middle and older aged residents (45 to 75 years) from the Ruhr Area in Germany our study tries to clarify the matter. METHODS: For the analyses data from the population based prospective Heinz Nixdorf Recall (HNR) Study are used. As indicators of SES education, equivalent household income and occupational status were employed. Social relations were assessed by including structural as well as functional aspects. Structural aspects were estimated by the Social Integration Index (SII) and functional aspects were measured by availability of emotional and instrumental support. Data on general subjective health status was available for both baseline examination (2000-2003) and a 5-year follow-up (2006-2008). The sample consists of 4,146 men and women. Four logistic regression models were calculated: in the first model we controlled for age and subjective health at baseline, while in models 2 and 3, either functional or structural aspects of social relationships were introduced separately. Model 4 then included all variables. As former studies indicated different health effects of SES and social relations in men and women, analyses were conducted with the overall sample as well as for each gender alone. RESULTS: Prospective associations of SES and subjective health were reduced after introducing social relationships into the regression models. Percentage reductions between 2% and 30% were observed in the overall sample when all aspects of social relations were included. The percentage reductions were strongest in the lowest SES group. Gender specific analyses revealed mediating effects of social relationships in women and men. The magnitude of mediating effects varied depending on the indicators of SES and social relations. CONCLUSIONS: Social relationships substantially contribute to the explanation of SES differences in subjective health. Interventions for improving social relations which especially focus on socially deprived groups are likely to help reducing socioeconomic disparities in health.

• The Effort-Reward Imbalance Questionnaire in Greek: Translation, Validation and Psychometric Properties in Health Professionals.

  Authors: Pavlos Msaouel, Nikolaos C Keramaris, Alexandros P Apostolopoulos, Nikolaos Syrmos, Theocharis Kappos, Athanasios Tasoulis, Elli-Sophia Tripodaki, Eva Kagiampaki, Ioannis Lekkas, Johannes Siegrist

  Journal of occupational health. 02/2012;

  Objectives: The aim of the present study was to translate, adapt and validate the Effort-Reward Imbalance (ERI) questionnaire in a sample of Greek healthcare professionals. Methods: AnObjectives: The aim of the present study was to translate, adapt and validate the Effort-Reward Imbalance (ERI) questionnaire in a sample of Greek healthcare professionals. Methods: An internationally recommended methodology was followed to perform translation of the ERI instrument into the Greek language. The questionnaire was then randomly administered to 600 Greek physicians, nurses, physiotherapists and laboratory staff, and 456 questionnaires with no missing data on the ERI items were returned (76% response rate). Tool validation included assessment of internal consistency, factorial structure, discriminant validity and presence of floor or ceiling effects. Criterion validity was demonstrated by investigating the association of theoretically relevant ERI summary measurements with respondents' self-rated health. Results: The Greek version of the ERI questionnaire showed good psychometric properties. Cronbach's alpha values were 0.79, 0.72 and 0.75 for the three ERI scales of effort, reward and overcommitment respectively. Exploratory factor analysis yielded a 5-factor solution that closely reflected the original theoretical ERI model. Significant associations were found between respondents' age, gender and specific occupation with ERI scores. ERI ratio and "overcommitment" scores in the highest tertiles were associated with elevated odds ratios (OR) of below-average self-rated health (OR=5.38, 95% confidence intervals 1.77 to 16.38, p=0.003, and OR=3.41, 95% confidence intervals 1.39 to 8.38, p=0.007, respectively). Conclusions: The translated and adapted Greek version is comparable with the original ERI instrument in terms of validity and factorial structure and is suitable for assessment of the psychosocial work environment of Greek healthcare professionals.

• Psychometric properties and differential explanation of a short measure of effort-reward imbalance at work: A study of industrial workers in Germany.

  Authors: Jian Li, Adrian Loerbroks, Marc N Jarczok, Ina Schöllgen, Jos A Bosch, Daniel Mauss, Johannes Siegrist, Joachim E Fischer

  American journal of industrial medicine. 02/2012;

  BACKGROUND: We test the psychometric properties of a short version of the Effort-Reward Imbalance (ERI) questionnaire in addition to testing an interaction term of this model's main components onBACKGROUND: We test the psychometric properties of a short version of the Effort-Reward Imbalance (ERI) questionnaire in addition to testing an interaction term of this model's main components on health functioning. METHODS: A self-administered survey was conducted in a sample of 2,738 industrial workers (77% men with mean age 41.6 years) from a large manufacturing company in Southern Germany. The internal consistency reliability, structural validity, and criterion validity were analyzed. RESULTS: Satisfactory internal consistencies of the three scales: "Effort", "reward", and "overcommitment", were obtained (Cronbach's alpha coefficients 0.77, 0.82, and 0.83, respectively). Confirmatory factor analysis showed a good model fit of the data with the theoretical structure (AGFI = 0.94, RMSEA = 0.060). Evidence of criterion validity was demonstrated. Importantly, a significant synergistic interaction effect of ERI and overcommitment on poor mental health functioning was observed (odds ratio 6.74 (95% CI 5.32-8.52); synergy index 1.78 (95% CI 1.25-2.55)). CONCLUSIONS: This short version of the ERI questionnaire is a reliable and valid tool for epidemiological research on occupational health. Am. J. Ind. Med. © 2012 Wiley Periodicals, Inc.

• Physical activity and risk of cardiovascular disease-a meta-analysis of prospective cohort studies.

  Authors: Jian Li, Johannes Siegrist

  International journal of environmental research and public health. 02/2012; 9(2):391-407.

  In order to update and improve available evidence on associations of physical activity (PA) with cardiovascular disease (CVD) by applying meta-analytic random effects modeling to data fromIn order to update and improve available evidence on associations of physical activity (PA) with cardiovascular disease (CVD) by applying meta-analytic random effects modeling to data from prospective cohort studies, using high quality criteria of study selection, we searched the PubMed database from January 1980 to December 2010 for prospective cohort studies of PA and incident CVD, distinguishing occupational PA and leisure time PA, coronary heart disease (CHD) and stroke, respectively. Inclusion criteria were peer-reviewed English papers with original data, studies with large sample size (n ≥ 1,000) and substantial follow-up (≥5 years), available data on major confounders and on estimates of relative risk (RR) or hazard ratio (HR), with 95% confidence intervals (CI). We included 21 prospective studies in the overall analysis, with a sample size of more than 650,000 adults who were initially free from CVD, and with some 20,000 incident cases documented during follow-up. Among men, RR of overall CVD in the group with the high level of leisure time PA was 0.76 (95% CI 0.70-0.82, p < 0.001), compared to the reference group with low leisure time PA, with obvious dose-response relationship. A similar effect was observed among women (RR = 0.73, 95% CI 0.68-0.78, p < 0.001). A strong protective effect of occupational PA was observed for moderate level in both men (RR = 0.89, 95% CI 0.82-0.97, p = 0.008) and women (RR = 0.83, 95% CI 0.67-1.03, p = 0.089). No publication bias was observed. Our findings suggest that high level of leisure time PA and moderate level of occupational PA have a beneficial effect on cardiovascular health by reducing the overall risk of incident coronary heart disease and stroke among men and women by 20 to 30 percent and 10 to 20 percent, respectively. This evidence from high quality studies supports efforts of primary and secondary prevention of CVD in economically advanced as well as in rapidly developing countries.

• Elevated Levels of High-Sensitivity C-Reactive Protein are Associated with Mild Cognitive Impairment and its Subtypes: Results of a Population-Based Case-Control Study.

  Authors: Martha Dlugaj, Marcus Gerwig, Natalia Wege, Johannes Siegrist, Klaus Mann, Martina Bröcker-Preuß, Nico Dragano, Susanne Moebus, Karl-Heinz Jöckel, Beate Bokhof, Stefan Möhlenkamp, Raimund Erbel, Christian Weimar

  Journal of Alzheimer's disease : JAD. 01/2012; 28(3):503-514.

  As high-sensitivity C-reactive protein (hsCRP) seems to be associated with an increased risk of cognitive decline, this nested case-control study examined the relation of hsCRP and mild cognitiveAs high-sensitivity C-reactive protein (hsCRP) seems to be associated with an increased risk of cognitive decline, this nested case-control study examined the relation of hsCRP and mild cognitive impairment (MCI) at different time points. 148 MCI cases (106 amnestic, 42 non-amnestic (aMCI/naMCI)) and 148 matched controls were identified from a prospective population based cohort study of 4,359 participants (aged 50-80). HsCRP levels were measured 5 years before (baseline) and at the time of neuropsychological testing (follow-up). Odds ratios (OR) for hsCRP quartiles serum levels were calculated for the two time points using logistic regression analyses and were adjusted for cardiovascular covariates. In the fully adjusted model, baseline hsCRP levels were significantly associated with both MCI and aMCI (OR = 2.29, 95% confidence interval (CI), 1.01-5.15, first versus fourth quartile, respective OR = 2.73, 95% CI, 1.09-6.84). At follow-up, the fourth hsCRP quartile was associated with MCI (OR = 3.60, 95% CI, 1.55-8.33), aMCI (OR = 3.73, 95% CI, 1.52-9.17) and naMCI (OR = 3.66, 95% CI, 1.00-13.77). Elevated hsCRP levels, even detected five years before diagnosis, are associated with an at least twofold increased probability of MCI. These findings suggest that inflammation plays an important role in the development and presence of cognitive impairment.

• Subclinical coronary atherosclerosis predicts cardiovascular risk in different stages of hypertension: result of the Heinz Nixdorf Recall Study.

  Authors: Raimund Erbel, Nils Lehmann, Stefan Möhlenkamp, Sofia Churzidse, Marcus Bauer, Hagen Kälsch, Axel Schmermund, Susanne Moebus, Andreas Stang, Ulla Roggenbuck, Martina Bröcker-Preuss, Nico Dragano, Christian Weimar, Johannes Siegrist, Karl-Heinz Jöckel

  Hypertension. 11/2011; 59(1):44-53.

  Prehypertension is a frequent condition and has been demonstrated to increase cardiovascular risk. However, the association with coronary atherosclerosis as part of target organ damage is not wellPrehypertension is a frequent condition and has been demonstrated to increase cardiovascular risk. However, the association with coronary atherosclerosis as part of target organ damage is not well understood. We investigated the cross-sectional relationship and longitudinal outcome between blood pressure categories and coronary artery calcification (CAC), quantified by electron beam computed tomography, in 4181 participants from the population-based Heinz Nixdorf Recall Study cohort. At baseline, we observed a continuous increase in calcium scores with increasing blood pressure categories. During a median follow-up period of 7.18 years, 115 primary end points (2.8%; fatal and nonfatal myocardial infarction) and 152 secondary end points (3.6%; stroke and coronary revascularization) occurred. We observed a continuous increase in age- and risk factor-adjusted secondary endpoints (hazard ratios [95% CI]) with increasing blood pressure categories (referent: normotension) in men: prehypertension, 1.80 (0.53-6.13); stage 1 hypertension, 2.27 (0.66-7.81); and stage 2 hypertension, 4.10 (1.27-13.24) and in women: prehypertension, 1.13 (0.34-3.74); stage 1 hypertension, 2.14 (0.67-6.85); and stage 2 hypertension, 3.33 (1.24-8.90), respectively, but not in primary endpoints. Cumulative event rates were determined by blood pressure categories and the CAC. In prehypertension, the adjusted hazard ratios for all of the events were, for CAC 1 to 99, 2.05 (0.80-5.23; P=0.13); 100 to 399, 3.12 (1.10-8.85; P=0.03); and ≥400, 7.72 (2.67-22.27; P=0.0002). Risk of myocardial infarction and stroke in hypertension but also in prehypertension depends on the degree of CAC. This marker of target-organ damage might be included, when lifestyle modification and pharmacotherapeutic effects in prehypertensive individuals are tested to avoid exposure to risk and increase benefit.

• Job strain in relation to body mass index: pooled analysis of 160 000 adults from 13 cohort studies.

  Authors: S T Nyberg, K Heikkilä, E I Fransson, L Alfredsson, D De Bacquer, J B Bjorner, S Bonenfant, M Borritz, H Burr, A Casini [......] P Westerholm, H Westerlund, M Zins, J E Ferrie, T Theorell, A Steptoe, M Hamer, A Singh-Manoux, G D Batty, M Kivimäki

  Journal of internal medicine. 11/2011;

  Abstract.  Nyberg ST, Heikkilä K, Fransson EI, Alfredsson L, De Bacquer D, Bjorner JB, Bonenfant S, Borritz M, Burr H, Casini A, Clays E, Dragano N, Erbel R, Geuskens GA, Goldberg M, Hooftman WE,Abstract.  Nyberg ST, Heikkilä K, Fransson EI, Alfredsson L, De Bacquer D, Bjorner JB, Bonenfant S, Borritz M, Burr H, Casini A, Clays E, Dragano N, Erbel R, Geuskens GA, Goldberg M, Hooftman WE, Houtman IL, Jöckel K-H, Kittel F, Knutsson A, Koskenvuo M, Leineweber C, Lunau T, Madsen IEH, Magnusson Hanson LL, Marmot MG, Nielsen ML, Nordin M, Oksanen T, Pentti J, Rugulies R, Siegrist J, Suominen S, Vahtera J, Virtanen M, Westerholm P, Westerlund H, Zins M, Ferrie JE, Theorell T, Steptoe A, Hamer M, Singh-Manoux A, Batty GD, Kivimäki M, for the IPD-Work Consortium (Finnish Institute of Occupational Health, Helsinki, Finland; Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; Jönköping University, Jönköping, Sweden; Ghent University, Ghent, Belgium; National Research Centre for the Working Environment, Copenhagen, Denmark; Versailles-Saint Quentin University, Versailles, France; Centre for Research in Epidemiology and Population Health, Villejuif, France; Bispebjerg University Hospital, Copenhagen, Denmark; Centre for Maritime Health and Safety, Esbjerg, Denmark; Université Libre de Bruxelles, Brussels, Belgium; University Duisburg-Essen, Essen, Germany; West-German Heart Center Essen, University Duisburg-Essen, Essen, Germany; TNO, Hoofddorp, the Netherlands; Mid Sweden University, Sundsvall, Sweden; University of Helsinki, Helsinki, Finland; Stockholm University, Stockholm, Sweden; University College London, London, UK; Bispebjerg University Hospital, Copenhagen, Denmark; Umeå University, Umeå, Sweden; Finnish Institute of Occupational Health, Turku, Finland; Harvard School of Public Health, Boston, MA, USA; University of Copenhagen, Copenhagen, Denmark; University of Düsseldorf, Düsseldorf, Germany; University of Turku, Turku; Folkhälsan Research Center, Helsinki; Turku University Hospital, Turku, Finland; Uppsala University, Uppsala; Karolinska Institutet, Stockholm, Sweden; University of Bristol, Bristol; University of Edinburgh, Edinburgh, UK; and University of Helsinki, Helsinki, Finland). Job strain in relation to body mass index: pooled analysis of 160 000 adults from 13 cohort studies. J Intern Med 2011; doi: 10.1111/j.1365-2796.2011.02482.x. Background.  Evidence of an association between job strain and obesity is inconsistent, mostly limited to small-scale studies, and does not distinguish between categories of underweight or obesity subclasses. Objectives.  To examine the association between job strain and body mass index (BMI) in a large adult population. Methods.  We performed a pooled cross-sectional analysis based on individual-level data from 13 European studies resulting in a total of 161 746 participants (49% men, mean age, 43.7 years). Longitudinal analysis with a median follow-up of 4 years was possible for four cohort studies (n = 42 222). Results.  A total of 86 429 participants were of normal weight (BMI 18.5-24.9 kg m(-2) ), 2149 were underweight (BMI < 18.5 kg m(-2) ), 56 572 overweight (BMI 25.0-29.9 kg m(-2) ) and 13 523 class I (BMI 30-34.9 kg m(-2) ) and 3073 classes II/III (BMI ≥ 35 kg m(-2) ) obese. In addition, 27 010 (17%) participants reported job strain. In cross-sectional analyses, we found increased odds of job strain amongst underweight [odds ratio 1.12, 95% confidence interval (CI) 1.00-1.25], obese class I (odds ratio 1.07, 95% CI 1.02-1.12) and obese classes II/III participants (odds ratio 1.14, 95% CI 1.01-1.28) as compared with participants of normal weight. In longitudinal analysis, both weight gain and weight loss were related to the onset of job strain during follow-up. Conclusions.  In an analysis of European data, we found both weight gain and weight loss to be associated with the onset of job strain, consistent with a 'U'-shaped cross-sectional association between job strain and BMI. These associations were relatively modest; therefore, it is unlikely that intervention to reduce job strain would be effective in combating obesity at a population level.

• Welfare regimes, labour policies and unhealthy psychosocial working conditions: a comparative study with 9917 older employees from 12 European countries.

  Authors: Nico Dragano, Johannes Siegrist, Morten Wahrendorf

  Journal of epidemiology and community health. 09/2011; 65(9):793-9.

  Recent analyses explored associations of welfare state regimes with population health, with particular interest in differences between social protection-oriented versus more liberal regimes. LittleRecent analyses explored associations of welfare state regimes with population health, with particular interest in differences between social protection-oriented versus more liberal regimes. Little is known about such associations with work-related health. The aims of this contribution are (1) to study variations of quality of work according to type of welfare regime and (2) to analyse differences in the size of effects of quality of work on workers' health according to type of welfare regime. The authors use cross-sectional and longitudinal data from two studies ('Survey of Health, Ageing and Retirement in Europe' and the 'English Longitudinal Study on Ageing') with 9917 employed men and women (aged 50 to 64) in 12 European countries. Psychosocial quality of work is measured by low control and effort-reward imbalance at work. Depressive symptoms are introduced as a health indicator. Linear multilevel models and logistic regression analyses are performed to test the hypotheses. In addition to the welfare regime typology, the authors introduce labour policy and economy-related macro indicators. Between-country variations in quality of work are largely explained by macro indicators and welfare regimes, with poorer quality of work in countries with less emphasis on older workers' protection. Moreover, in the Liberal and Southern welfare regime, effects of quality of work on depressive symptoms are relatively strongest (adjusted ORs varying from 1.45 to 2.64). Active labour policies and reliable social protection measures (eg, Scandinavian welfare regime) exert beneficial effects on the health and well-being of older workers. More emphasis on improving quality of work among this group is warranted.

• Effects of job strain on fatigue: cross-sectional and prospective views of the job content questionnaire and effort-reward imbalance in the GAZEL cohort.

  Authors: Grace Sembajwe, Morten Wahrendorf, Johannes Siegrist, Remi Sitta, Marie Zins, Marcel Goldberg, Lisa Berkman

  Occupational and environmental medicine. 08/2011;

  Objectives The objectives this study were (1) to investigate correlations between measures of psychosocial workplace stress as measured in separate years by the Job Content Questionnaire (JCQ) andObjectives The objectives this study were (1) to investigate correlations between measures of psychosocial workplace stress as measured in separate years by the Job Content Questionnaire (JCQ) and Effort-Reward Imbalance (ERI) scales; (2) to establish a valid measure of psychosocial job stress with its components (by identifying the individual and interactive associations of job stress components) and (3) to use the component measures to assess the risk of psychosocial strain at work on fatigue. Methods The JCQ and ERI from the annual survey of the GAZEL cohort established in 1989 initially with 20 624 respondents were used to investigate the associations of workplace stress on mental and physical fatigue in two separate years (1998 and 2006). First, the JCQ measures from separate years (1997 and 1999) were combined to create a measure for the same year as ERI (1998). The new measure was validated for internal and external consistency. Using logistic regression, the subcomponents of stress (upper tertiles of psychological demands, physical demands, decision latitude, social support, effort, reward, ERI and overcommitment) were tested for associations with the highest reporting of mental and physical fatigue. Results By combining JCQ responses from 1997 to 1999, we were able to increase the amount of information available on psychosocial factors in 1998. Psychometric properties of the workplace stress scales also showed expected factor loadings. Workplace psychosocial factors had greater associations with fatigue among men than women. Although psychosocial factors became less predictive of fatigue at 8 years of follow-up, associations between fatigue and psychosocial components (overcommitment, social support and rewards) remained significant. Conclusions These analyses continue to validate the various subcomponents scales of workplace stress as measured by the JCQ and effort-reward imbalance model in GAZEL. They also highlight the importance of psychosocial work factors in the experience of overall fatigue even after an 8-year follow-up.

• Population-based distribution and psychometric properties of a short cognitive performance measure in the population-based Heinz Nixdorf Recall Study.

  Authors: Natalia Wege, Martha Dlugaj, Johannes Siegrist, Nico Dragano, Raimund Erbel, Karl-Heinz Jöckel, Susanne Moebus, Christian Weimar

  Neuroepidemiology. 07/2011; 37(1):13-20.

  Providing a valid and sensitive measure of different domains of cognitive performance in epidemiologic studies of early old-age populations presents a methodological challenge, given the broad rangeProviding a valid and sensitive measure of different domains of cognitive performance in epidemiologic studies of early old-age populations presents a methodological challenge, given the broad range of variability in cognitive functioning in this age group. (1) To provide data on the distribution of cognitive performance scores in a representative sample of an early old-age population, and (2) to assess psychometric properties of a short cognitive performance measure developed within the framework of a cohort study. Population-based cohort study. As part of the second examination of the Heinz Nixdorf Recall Study, 4,145 participants aged 50-80 years underwent a short cognitive performance assessment composed of 5 subtests with a mean duration of 7.31 min. Additionally, a subsample of 656 participants had a detailed neuropsychological and neurological examination. Age- and education-specific cognitive performance scores in the total sample were calculated. Based on data from the subsample, concurrent validity was examined by comparing findings with a clinically validated neuropsychological assessment. In the total sample, younger and more highly educated participants had higher scores of cognitive performance. In the subsample, a good accuracy [area under the curve (AUC) = 0.81 (0.74-0.87)] of the short cognitive performance assessment compared with results from a clinically established Alzheimer disease assessment scale and diagnosis of mild cognitive impairment [AUC = 0.82 (0.78-0.82)] was observed. This brief, cognitive performance measure, documenting good psychometric properties, can be useful in future epidemiological investigations exploring different domains and overall cognitive functioning in early old-age populations.

• Perceived rewards at work and cardiovascular health.

  Authors: Johannes Siegrist

  Psychosomatic medicine. 06/2011; 73(6):434-5.

• Quantification of coronary atherosclerosis and inflammation to predict coronary events and all-cause mortality.

  Authors: Stefan Möhlenkamp, Nils Lehmann, Susanne Moebus, Axel Schmermund, Nico Dragano, Andreas Stang, Johannes Siegrist, Klaus Mann, Karl-Heinz Jöckel, Raimund Erbel

  Journal of the American College of Cardiology. 03/2011; 57(13):1455-64.

  This study sought to determine whether the evaluation of the combined presence of coronary artery calcium (CAC) and high-sensitivity C-reactive protein (hsCRP) improves discrimination andThis study sought to determine whether the evaluation of the combined presence of coronary artery calcium (CAC) and high-sensitivity C-reactive protein (hsCRP) improves discrimination and stratification of hard coronary events and all-cause mortality in the general population. Coronary atherosclerosis is a chronic inflammatory disease. Both hsCRP as a measure of inflammation and CAC as a measure of coronary plaque burden have been shown to improve risk appraisal. Framingham risk variables, hsCRP, and CAC were measured in 3,966 subjects without known coronary artery disease or acute inflammation. After 5 years, incident coronary deaths, nonfatal myocardial infarction, and all-cause mortality were determined. CAC and hsCRP independently predicted 91 coronary events (adjusted hazard ratios [HRs]: log(2)(CAC+1) = 1.25 [95% confidence interval (CI): 1.16 to 1.34], p < 0.0001; hsCRP = 1.11 [95% CI: 1.02 to 1.21], p = 0.019) and 130 deaths (adjusted HRs: log(2)(CAC+1) = 1.12 [95% CI: 1.06 to 1.19], p < 0.0001; hsCRP = 1.11 [95% CI: 1.04 to 1.19], p = 0.004). For coronary events, net reclassification improvement (NRI) was 23.8% (p = 0.0007) for CAC and 10.5% (p = 0.026) for hsCRP. Adding CAC to Framingham risk variables and hsCRP further improved discrimination of coronary risk but not vice versa. Among persons without CAC, those with hsCRP >3 mg/l versus <3 mg/l had a significantly higher coronary risk (p = 0.006). For all-cause mortality, integrated discrimination improvement (IDI) was positive when CAC or hsCRP were added to age and sex (+0.51%, p < 0.001 and +0.43%, p = 0.012, respectively). Adjusted HRs in the highest versus lowest category of a risk index derived from established CAC and hsCRP thresholds (i.e., CAC = 100 and hsCRP = 3 mg/l) were 5.92 (95% CI: 3.14 to 11.16) for coronary events and 3.02 (95% CI: 1.82 to 5.01) for all-cause mortality (p < 0.0001 each). The adjusted HR for coronary events in intermediate risk subjects was 6.98 (95% CI: 2.47 to 19.73), p < 0.001. The risk of coronary events and all-cause mortality that is mediated by the presence of coronary atherosclerosis and systemic inflammation can be estimated by CAC and hsCRP. An improvement in coronary risk prediction and discrimination was predominantly driven by CAC, whereas hsCRP appears to have a role especially in persons with very low CAC scores.

• Diagnosis and Management of Depression in 3 Countries: Results From a Clinical Vignette Factorial Experiment.

  Authors: Carol L Link, Theodore A Stern, Rebecca S Piccolo, Lisa D Marceau, Sara Arber, Ann Adams, Johannes Siegrist, Olaf von dem Knesebeck, John B McKinlay

  The primary care companion to CNS disorders. 01/2011; 13(5).

  Objective: International differences in disease prevalence rates are often reported and thought to reflect different lifestyles, genetics, or cultural differences in care-seeking behavior. However,Objective: International differences in disease prevalence rates are often reported and thought to reflect different lifestyles, genetics, or cultural differences in care-seeking behavior. However, they may also be produced by differences among health care systems. We sought to investigate variation in the diagnosis and management of a "patient" with exactly the same symptoms indicative of depression in 3 different health care systems (Germany, the United Kingdom, and the United States).Method: A factorial experiment was conducted between 2001 and 2006 in which 384 randomly selected primary care physicians viewed a video vignette of a patient presenting with symptoms suggestive of depression. Under the supervision of experienced clinicians, professional actors were trained to realistically portray patients who presented with 7 symptoms of depression: sleep disturbance, decreased interest, guilt, diminished energy, impaired concentration, poor appetite, and psychomotor agitation or retardation.Results: Most physicians listed depression as one of their diagnoses (89.6%), but German physicians were more likely to diagnose depression in women, while British and American physicians were more likely to diagnose depression in men (P = .0251). American physicians were almost twice as likely to prescribe an antidepressant as British physicians (P = .0241). German physicians were significantly more likely to refer the patient to a mental health professional than British or American physicians (P < .0001). German physicians wanted to see the patient in follow-up sooner than British or American physicians (P < .0001).Conclusions: Primary care physicians in different countries diagnose the exact same symptoms of depression differently depending on the patient's gender. There are also significant differences between countries in the management of a patient with symptoms suggestive of depression. International differences in prevalence rates for depression, and perhaps other diseases, may in part result from differences among health care systems in different countries.

• Does socioeconomic status affect the association of social relationships and health? A moderator analysis.

  Authors: Nico Vonneilich, Karl-Heinz Jöckel, Raimund Erbel, Jens Klein, Nico Dragano, Simone Weyers, Susanne Moebus, Johannes Siegrist, Olaf von dem Knesebeck

  International journal for equity in health. 01/2011; 10:43.

  ABSTRACT: Social relations have repeatedly been found to be an important determinant of health. However, it is unclear whether the association between social relations and health is consistentABSTRACT: Social relations have repeatedly been found to be an important determinant of health. However, it is unclear whether the association between social relations and health is consistent throughout different status groups. It is likely that health effects of social relations vary in different status groups, as stated in the hypothesis of differential vulnerability. In this analysis we explore whether socioeconomic status (SES) moderates the association between social relations and health. In the baseline examination of the Heinz Nixdorf Recall study, conducted in a dense populated Western German region (N = 4,814, response rate 56%), SES was measured by income and education. Social relations were classified by using both structural as well as functional measures. The Social Integration Index was used as a structural measure, whilst functional aspects were assessed by emotional and instrumental support. Health was indicated by self-rated health (1 item) and a short version of the CES-D scale measuring the frequency of depressive symptoms. Based on logistic regression models we calculated the relative excess risk due to interaction (RERI) which indicates existing moderator effects. Our findings show highest odds ratios (ORs) for both poor self-rated health and more frequent depressive symptoms when respondents have a low SES as well as inappropriate social relations. For example, respondents with low income and a low level of social integration have an OR for a high depression score of 2.85 (95% CI 2.32-4.49), compared to an OR of 1.44 (95% CI 1.12-1.86) amongst those with a low income but a high level of social integration and an OR of 1.72 (95% CI 1.45-2.03) amongst respondents with high income but a low level of social integration. As reference group those reporting high income and a high level of social integration were used. The analyses indicate that the association of social relations and subjective health differs across SES groups as we find moderating effects of SES. However, results are inconsistent as nearly all RERI scores are positive but do not reach a significant level. Also moderating effects vary between women and men and depending on the indicators of SES and social relations used. Thus, the hypothesis of differential vulnerability can only partially be supported. In terms of practical implications, psychosocial and health interventions aiming towards the enhancement of social relations should especially consider the situation of the socially deprived.

• Coronary artery calcium score improves cardiovascular risk prediction in persons without indication for statin therapy.

  Authors: Stefan Möhlenkamp, Nils Lehmann, Philip Greenland, Susanne Moebus, Hagen Kälsch, Axel Schmermund, Nico Dragano, Andreas Stang, Johannes Siegrist, Klaus Mann, Karl-Heinz Jöckel, Raimund Erbel

  Atherosclerosis. 12/2010; 215(1):229-36.

  Recent revision to the Canadian Cardiovascular Society (CCS) guidelines on cardiovascular disease (CVD) risk stratification provides expanded recommendations for statin therapy. If CVD risk in theRecent revision to the Canadian Cardiovascular Society (CCS) guidelines on cardiovascular disease (CVD) risk stratification provides expanded recommendations for statin therapy. If CVD risk in the remaining individuals can further be stratified and discriminated by additional risk assessment using coronary artery calcium (CAC) scoring is unknown. In a retrospectively analyzed subgroup comprising 1934 participants from the Heinz Nixdorf Recall study, who did not meet criteria for statin therapy based on current CCS guidelines, traditional CVD risk variables and CAC were measured. Between 2000 and 2008, incident CVD events, i.e. coronary deaths, non-fatal myocardial infarction, coronary revascularization, stroke and CV death were determined. Those 43 participants who experienced 55 CVD events (5-year risk to first event: 2.2% (1.6-3.0%)) had higher CAC scores than those who did not (p<0.0001). In multiple Cox regression analysis including age, sex, total-/HDL-cholesterol ratio, and antihypertensive medication, log2(CAC+1) remained an independent predictor of CVD events (HR=1.21 (1.09-1.33), p<0.001). Measures of discrimination improved with the addition of CAC into the model: the incremental discrimination improvement was 0.0167, p=0.014. Net reclassification improvement using risk categories of 0-<3%, 3-10% and >10% was 25.1%, p=0.01, largely driven by a 32.6% correct up-classification in persons with events. Yet, only 38 (2%) of participants were identified being at high risk using CAC imaging in addition to traditional risk factor assessment. Adding CAC to traditional risk assessment in persons without indication for statin therapy improves discrimination. However, reclassification to the high risk category and overall event rates seem too low to justify liberal CAC testing in all these individuals.

• Effort-reward imbalance at work and cardiovascular diseases.

  Authors: Johannes Siegrist

  International journal of occupational medicine and environmental health. 10/2010; 23(3):279-85.

  Working conditions and employment arrangements make a significant contribution to the burden of cardiovascular disease, in particular in modern societies where mental and emotional demands andWorking conditions and employment arrangements make a significant contribution to the burden of cardiovascular disease, in particular in modern societies where mental and emotional demands and threats are becoming widespread. Occupational research has identified health-adverse features of modern work with the help of theoretical models. One such model, effort-reward imbalance, has been developed by this author and his group and has been widely tested in epidemiological and experimental studies. The model claims that stressful experience at work is elicited by a lack of reciprocity between efforts spent at work and rewards received in return, where rewards include money, promotion prospects, job security, and esteem. Results demonstrate elevated risks of coronary heart disease among employees exposed to effort-reward imbalance. Moreover, in ambulatory and experimental investigations, elevated heart rate and blood pressure and altered secretion of stress hormones were observed under these conditions. Although additional scientific evidence is needed, available findings call for practical measures towards improving quality of work, most importantly at the level of single companies and organisations. This conclusion is supported by first results from intervention studies that are guided by this theoretical approach. In view of the burden of cardiovascular disease attributable to unfavourable working conditions, such efforts are well justified and need to be extended in order to promote healthy work.

• Work and family stress is associated with menstrual disorders but not with fibrocystic changes: cross-sectional findings in Chinese working women.

  Authors: Mei Zhou, Natalia Wege, Huakang Gu, Li Shang, Jian Li, Johannes Siegrist

  Journal of occupational health. 10/2010; 52(6):361-6.

  To explore the separate and combined effects of work and family stress on menstrual disorders and fibrocystic changes in Chinese working women. Data were obtained from a cross-sectional study ofTo explore the separate and combined effects of work and family stress on menstrual disorders and fibrocystic changes in Chinese working women. Data were obtained from a cross-sectional study of 1,642 female railway workers. The Effort-Reward Imbalance Questionnaire and Family Stress Scale were used to measure work stress and family stress, respectively; the menstrual and breast conditions were evaluated by gynecologic interview and a medical examination. Multivariate log-binomial regression was performed to analyze the associations. Menstrual disorders were found in 59.3% of female workers, and 54.8% had fibrocystic changes. The risk of menstrual disorders was significantly elevated with respect to work and family stress. The highest risk was found in the group with combined exposure to both work and family stress (RR with 95% CI 1.33 (1.18-1.49)). No significant association between stress and fibrocystic changes was observed. Menstrual disorders were associated with stress from work and family life, but not fibrocystic changes, in working women. Tailored intervention measures reducing the burden of stressful psychosocial work and family environment are needed to improve women's reproductive well-being.

• Coronary risk stratification, discrimination, and reclassification improvement based on quantification of subclinical coronary atherosclerosis: the Heinz Nixdorf Recall study.

  Authors: Raimund Erbel, Stefan Möhlenkamp, Susanne Moebus, Axel Schmermund, Nils Lehmann, Andreas Stang, Nico Dragano, Dietrich Grönemeyer, Rainer Seibel, Hagen Kälsch, Martina Bröcker-Preuss, Klaus Mann, Johannes Siegrist, Karl-Heinz Jöckel

  Journal of the American College of Cardiology. 10/2010; 56(17):1397-406.

  The purpose of this study was to determine net reclassification improvement (NRI) and improved risk prediction based on coronary artery calcification (CAC) scoring in comparison with traditional riskThe purpose of this study was to determine net reclassification improvement (NRI) and improved risk prediction based on coronary artery calcification (CAC) scoring in comparison with traditional risk factors. CAC as a sign of subclinical coronary atherosclerosis can noninvasively be detected by CT and has been suggested to predict coronary events. In 4,129 subjects from the HNR (Heinz Nixdorf Recall) study (age 45 to 75 years, 53% female) without overt coronary artery disease at baseline, traditional risk factors and CAC scores were measured. Their risk was categorized into low, intermediate, and high according to the Framingham Risk Score (FRS) and National Cholesterol Education Panel Adult Treatment Panel (ATP) III guidelines, and the reclassification rate based on CAC results was calculated. After 5 years of follow-up, 93 coronary deaths and nonfatal myocardial infarctions occurred (cumulative risk 2.3%; 95% confidence interval: 1.8% to 2.8%). Reclassifying intermediate (defined as 10% to 20% and 6% to 20%) risk subjects with CAC <100 to the low-risk category and with CAC ≥400 to the high-risk category yielded an NRI of 21.7% (p = 0.0002) and 30.6% (p < 0.0001) for the FRS, respectively. Integrated discrimination improvement using FRS variables and CAC was 1.52% (p < 0.0001). Adding CAC scores to the FRS and National Cholesterol Education Panel ATP III categories improved the area under the curve from 0.681 to 0.749 (p < 0.003) and from 0.653 to 0.755 (p = 0.0001), respectively. CAC scoring results in a high reclassification rate in the intermediate-risk cohort, demonstrating the benefit of imaging of subclinical coronary atherosclerosis. Our study supports its application, especially in carefully selected individuals with intermediate risk.