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Daniel Tajdar,1 Ingmar Schäfer,1 Dagmar Lühmann,1 Regina Fertmann,2 Tim Steinberg,1 Hendrik van den Bussche,1 Martin Scherer1 1Department of Primary Care at Hamburg University Medical Center, Hamburg, Germany; 2Hamburg Authority for Work, Health, Social Affairs, Family and Integration, Hamburg, GermanyCorrespondence: Daniel Tajdar, Department of Primary Care at Hamburg University Medical Center, Building W37 Martinistraße 52, Hamburg, 20246, Germany, Tel +4940741052400, Fax +4940741040225, Email daniel.tajdar@gmail.comPurpose: Health literacy (HL) intervention could be a potential prevention strategy to reduce the risk of metabolic syndrome (MS), but the association between low HL and MS is controversial. Therefore, the aim of this study was to investigate whether low HL is associated with obesity, diabetes, and hypertension, considering them as one cluster.Methods: We used data from the Hamburg Diabetes Prevention Survey, a population-based cross-sectional study in Germany. The 1349 eligible subjects were 18– 60 years old. The European Health Literacy Questionnaire (HLS-EU-Q16) was used to assess HL. Depending on the reported number of metabolic syndrome conditions (CMS), four groups were categorized as follows: “ 0”, any “ 1”, any “ 2” and “ 3” CMS. Ordered logistic regression was used to analyze the relationship between HL level (independent variable) and the reported number of CMS (dependent variable) adjusted for age, gender and education.Results: 63.9% of subjects (n=862) reported having “ 0”, 25.7% (n=346) only “ 1”, 8.2% (n=111) only “ 2” and 2.2% (n=30) “ 3” of the three CMS. In the group with sufficient HL, rates of “ 1,” “ 2,” or “ 3” CMS were lower than in the group with problematic or inadequate HL. Subjects with inadequate HL showed a 1.62-fold higher risk of having a higher number of CMS than subjects with sufficient HL (OR 1.62; 95% CI 1.13 to 2.31). The risk increased with each life year (OR 1.05; 95% CI 1.04 to 1.06), and was higher in persons with low education (OR 2.89; 95% CI 2.08 to 4.01) than in highly educated persons. Women showed lower risk (OR 0.73; 95% CI 0.58 to 0.91) than men.Conclusion: Lower HL was associated with a higher number of MS conditions. Our findings suggest that HL intervention on health-promoting behaviors could help reduce MS risk in people with limited HL.Keywords: diabetes, overweight, health literacy intervention

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Background: Low health literacy is believed to be associated with behaviours that increase the risk of type 2 diabetes. But there is limited knowledge on the relation between health literacy (HL) and diabetes risk, and whether improving HL could be a potential prevention strategy. Therefore, the main purpose of this study was to examine the link between HL and diabetes risk among non-diabetic adults., Methods: We used data from the Hamburg Diabetes Prevention Survey, a population-based cross-sectional study in Germany. One thousand, two hundred and fifty-five non-diabetic subjects aged 18-60 years were eligible. The German Diabetes Risk Score (GDRS, ranging 0 to 123 points) was used to determine the individual risk of type 2 diabetes. The short version of the European Health Literacy Questionnaire (HLS-EU-Q16, ranging 0 to 16 points) was applied to assess the individual self-reported HL. Subjects were asked to self-estimate their diabetes risk, which was then compared with the calculated GDRS. Descriptive statistics were calculated to investigate group differences in the GDRS and self-estimated diabetes risk. Linear as well as logistic regression models were performed to analyse potential influencing variables of the GDRS as well as incorrect self-estimated diabetes risk. In three nested statistical models for each outcome, these analyses were adjusted for age, gender, educational level and the presence of chronic conditions., Results: According to the criteria of the GDRS, 996 (79.4%) subjects showed "low risk", 176 (14.0%) "still low risk", 53 (4.2%) "elevated risk", and 30 (2.4%) "high to very high risk" to develop type 2 diabetes within the next 5 years. In the statistical models including all control variables, subjects with "inadequate HL" scored 2.38 points higher on the GDRS (95% CI 0.378 to 4.336; P = 0.020) and had a 2.04 greater chance to estimate their diabetes risk incorrectly (OR 2.04; 95% CI 1.33 to 3.14; P = 0.001) compared to those with "sufficient HL"., Conclusion: The risk of type 2 diabetes is increased in people with inadequate self-reported HL. People with high diabetes risk and inadequate HL might be provided with educational programs to improve diabetes knowledge and reduce behavioural risk factors.

Background: The German Prevention Act came into force in 2015 with the aim of strengthening prevention of disease and health promotion, focussing on settings-based approaches. An established field of public health action is thus strengthened and expanded by a set of rules that has largely come into force as a social security law. The implementation of legislation is to be accompanied by the establishment of a prevention reporting system., Aims: Types of reporting are contextualized and delimited from one another by means of the planning stages of the public health action cycle with their different goals, content and data sources., Results: Prevention reports must reflect not only the state of health and intervention features but also intended and unintended structural changes in the public health action field. Due to its obvious relevance to the envisioned settings, the local level seems to be of particular importance. Special attention also deserves legally unintended shifts of tasks from public to social security financing. A reporting system misconceived primarily as evidence reporting would be likely to fail the intended strengthening of settings-based approaches and instead would favour downstream measures that are easier to evaluate., Competing Interests: Stefanie March wird im Rahmen der EVA64-Studie, der Bundesweit einheitlichen Wissenschaftlichen Evaluation von Modellprojekten nach § 64b SGB V, finanziert. Die Förderung dieser Studie erfolgt von einem Konsortium bestehend aus 89 Gesetzlichen Krankenkassen. Alle weiteren Autor/innen geben an, dass kein Interessenkonflikt besteht., (© Georg Thieme Verlag KG Stuttgart · New York.)

Insufficiently treated diabetes mellitus can lead to severe comorbidities. National and international analyses show a continuous increase in diabetes prevalence over the last decades. Currently, an indicator-based national diabetes surveillance system is implemented at the Robert Koch Institute (RKI) to monitor and report on diabetes development on the basis of available primary and secondary data. The aim of the meeting was to go into deeper discussions and to integrate expectations and expertise of the federal states into the design of the national surveillance system. A close collaboration between the RKI and the federal states is intended.

Public health and city planning have common roots, and in many places they are now reuniting under the heading of urban health. To organize this field adequately requires a broad, integrative view of medical care, health promotion, and health in all urban policies. Given current crises and developments including climate change and globalization, such a wider perspective should also be useful for Germany. Using the City State of Hamburg as an example and combining historic and systematic approaches, we explore the preconditions for in-depth analyses. Our results show that health is a significant topic of Hamburg urban policy, featuring a broad range of structures, processes and actors, both within the health sector and far beyond. Health promotion over the last 30 years evolved notably from a niche topic into an established field with remarkable cooperative structures. The tradition of comprehensive reporting on urban health in Hamburg that was initiated more than 200 years ago is no longer alive today. However, local health reporting keeps integrating a wide range of diverse topics. Communication among the Hamburg health actors - beyond straightforward medical quality assurance - does not seem to focus on critical evaluations, e. g. concerning social and ecologic sustainability. A prerequisite for in-depth analyses including external comparisons is to secure permanent access to relevant sources. Robust approaches to this end, however, seem to be lacking., (© Georg Thieme Verlag KG Stuttgart · New York.)

Background: Participants of the Longitudinal Urban Cohort Ageing Study (LUCAS) were recruited from patients 60 years and older from general practitioner's offices in Hamburg. This is different from the usual methods of drawing representative samples., Objectives: The research question addressed the comparability of LUCAS results with those from cross-sectional surveys with participants randomly chosen from a population list. Therefore, the LUCAS data collected in four waves during the first 12 years were compared with data (age, gender) from the Hamburg Statistics Office (HSO), and selected characteristics (socio-demography, health, mobility) from three representative cross-sectional surveys in older Hamburg citizens., Methods: First, HSO data compiled in population pyramids for older men and women were compared with equivalent pyramids based on the LUCAS data at recruitment (2000/01) and in waves 2 to 4. Second, characteristics worded identically in the cross-sectional surveys and the simultaneous LUCAS waves were compared., Results: The LUCAS population pyramids were in good accordance at all time points with those of the general older population in Hamburg (except ages 60-64 in men in 2000). Good comparability was also found for health related characteristics from the three representative studies and simultaneous LUCAS waves (e. g. need of nursing care in 2012: LUCAS 7.1 %; Hamburg 7.4 %)., Conclusions: Information on health in old age generated periodically in the LUCAS cohort was largely comparable with that from representative cross-sectional studies and statistics registries. Older people are frequently under-represented in epidemiological studies. Therefore, the LUCAS data may provide useful information for Hamburg and similar metropolitan areas in Germany.

Background: The interactions between rising life expectancy, morbidity and development of disability warrant interdisciplinary research on functional disability, health promotion and prevention as well as healthcare provision for older people. Therefore, the interdisciplinary LUCAS (Longitudinal Urban Cohort Ageing Study) research consortium of university and non-university institutions was established and is coordinated by the research department of the Albertinen-Haus at the University of Hamburg. The aim is to study particular aspects of functional competence, the changes with ageing, to detect pre-clinical signs of functional decline and to address questions on how to maintain functional competence and to prevent adverse outcomes. The research questions have their origin in problems of practical healthcare provision in the different settings of communities, hospitals and nursing homes. The articles of LUCAS subprojects report selected results from the first project phase (2007-2010) which was funded by the German Federal Ministry of Education and Research (BMBF) (Research program"Health in the elderly").)., Methods: The LUCAS subprojects 1-7 applied a true cohort study design with embedded randomized controlled intervention studies and cross-sectional studies for comparative purposes and to prepare intervention studies to be performed in the second project phase., Conclusions: Results from the first project phase provided new instruments to screen and to assess functional competence in older people (population-based screening). In the second project phase these will be evaluated according to practicability and usefulness. Furthermore, parts of the results will be used by the health reporting system in Hamburg and for intervention studies performed by LUCAS subprojects during the second project phase (LUCAS II).

Objective: To determine the long-term outcome in patients with Wegener's granulomatosis (WG) over 4 decades in an academic hospital unit specializing in rheumatology., Methods: We included 290 patients, divided them into 2 cohorts, and compared them with the historical cohort of 155 patients. Comparisons were retrospective regarding disease manifestations, therapy, mortality, and incidence of malignancies. The historical cohort (cohort 1) included 155 patients diagnosed between 1966 and 1993, cohort 2 included 123 patients diagnosed between 1994 and 1998, and cohort 3 included 167 patients diagnosed between 1999 and 2002., Results: Over time, the interval between first symptoms and diagnosis was reduced by half (from 8 months to 4 months). Organ manifestations were similar in the 3 cohorts, and more than 80% of patients still required cyclophosphamide (CYC); however, the median cumulative dose was reduced significantly (from 67 gm in cohort 1 to 36 gm in cohort 2 and to 24 gm in cohort 3). The standardized mortality ratios (SMRs) declined (from 2.1 in cohort 1 to 1.41 in cohort 2 and to 1.03 in cohort 3), with fewer deaths related to WG and/or therapy (86.4% in cohort 1, 76.9% in cohort 2, 50% in cohort 3), decreasing relapse rates (63.9% in cohort 1, 51.2% in cohort 2, 35.3% in cohort 3), and no increased rate of malignancies. Compared with young females, young males had a considerably higher SMR (8.87 [95% confidence interval 4.05-16.8]) and more frequent renal manifestations (54.4% versus 33.8%)., Conclusion: Mortality of WG patients declined over the last 4 decades, probably due to improved diagnostic and therapeutic procedures and increased awareness of WG, which led to earlier diagnosis and therapy, reduction in relapse rates, and lower cumulative CYC dose with fewer deaths related to therapy., (Copyright © 2011 by the American College of Rheumatology.)

Study objective was to investigate the extent of lead exposure via tap water in Hamburg and the relevance of preventive strategies. Two hundred and forty-eight non-smoking young women participated in the cross-sectional study program and 52 women completed the intervention program. In the cross-sectional study program most women (N = 178) didn't know anything about the material of the plumbing system at their homes. Participants with lead in the tap water above the detection limit of 5 microg/l (N = 142) showed significantly higher blood lead levels (median 31 microg/l) compared to those with no detectable lead in the tap water (N = 106; median blood lead 24 microg/l, p < = 0.001). There is a close correlation between the average lead concentration in the tap water and blood lead concentrations (N = 142 value pairs, Spearman's rho 0.43, p < = 0.0001). In the intervention program, the women were asked to minimize exposure by flushing water or to exclude it by consuming bottled water. Intervention lowered blood lead-level significantly (median decrease of 11 microg/l, p < = 0.001). "Minimizers" could lower their blood lead levels by about 21% of the initial value, "excluders" by about 37% (ns, p < = 0.17). The majority judged neither minimizing nor excluding tap water as practicable health preventive behaviour pattern in the long run. Lead in tap water stands for an avoidable surplus exposure. These results underline the relevance of health care preventive measures for the most sensitive groups.

All available polycyclic aromatic hydrocarbon (PAH) concentration data in ambient air obtained over the past 10 years in Germany were evaluated to clarify whether it is justified to use benzo(a)pyrene (BaP) as a marker compound for the total PAH exposure. The data basis comprises annual mean concentrations from 1990 to 1998 supplied by the emission protection authorities of the federal states with additional information on the region, year and site of measurement. The data are very heterogeneous with respect to sample size, the number of individual PAHs analyzed, place of origin and year. Nine of 25 individual compounds with sufficient sample size (74