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Data on the effect of the September 11, 2001 (9/11) terror attacks on suicide rates remain inconclusive. Reportedly, even people located far from the attack site have considerable potential for personalizing the events that occurred on 9/11. Durkheim's theory states that suicides decrease during wartime; thus, a decline in suicides might have been expected after 9/11. We conducted a time series analysis of 164,136 officially recorded suicides in Germany between 1995 and 2009 using the algorithm introduced by Box and Jenkins. Compared with the average death rate, we observed no relevant change in the suicide rate of either sex after 9/11. Our estimates of an excess of suicides approached the null effect value on and within a 7-day period after 9/11, which also held when subsamples of deaths in urban or rural settings were examined. No evidence of Durkheim's theory attributable to the 9/11attacks was found in this sample.

Objective: To study the association between socioeconomic status (SES) and annual relative change in anthropometric markers in the general German adult population., Methods: Longitudinal data of 56,556 participants aged 18-83 years from seven population-based German cohort studies (CARLA, SHIP, KORA, DEGS, EPIC-Heidelberg, EPIC-Potsdam, PopGen) were analyzed by meta-analysis using a random-effects model. The indicators of SES were education and household income., Results: On average, all participants gained weight and increased their waist circumference over the study's follow-up period. Men and women in the low education group had a 0.1 percentage points greater annual increase in weight (95% CI men: 0.06-0.20; and women: 0.06-0.12) and waist circumference (95% CI men: 0.01-0.45; and women: 0.05-0.22) than participants in the high education group. Women with low income had a 0.1 percentage points higher annual increase in weight (95% CI 0.00-0.15) and waist circumference (95% CI 0.00-0.14) than women with high income. No association was found for men between income and obesity markers., Conclusions: Participants with lower SES (education and for women also income) gained more weight and waist circumference than those with higher SES. These results underline the necessity to evaluate the risk of weight gain based on SES to develop more effective preventive measures., (© 2016 The Obesity Society.)

Background: There is convincing evidence of an association between the QT interval on electrocardiograms and general mortality. However, results are inconclusive regarding the extent to which this association depends on ventricular mass and size., Methods: Data were obtained from the prospective, population-based CARLA study, with a mean follow-up of 8.8 years, after exclusion of subjects with atrial fibrillation (919 men, 797 women aged 45-83 years remained eligible). Echocardiographic parameters were left ventricular mass index, left ventricular diastolic dimension index, diastolic interventricular septum thickness, diastolic left ventricular posterior wall and the relative left ventricular wall thickness. Heart rate-corrected QT interval (QTc) was measured with standard 12-lead electrocardiograms using the MEANS algorithm. The association between QTc and survival was modelled using Cox-regression models (crude- and covariate-adjusted). Values were standardized by dividing the QTc by the standard deviation. The association between QTc and survival was assessed in terms of tertiles of echocardiographic parameters., Results: In covariate-adjusted models, QTc was associated with general mortality (hazard ratio (HR): 1.19; 95% confidence interval (CI): 1.03, 1.38). Compared with higher tertiles, subjects in the lowest tertile of left ventricular mass index (HR=1.73, 95% CI: 1.26, 2.36) showed the strongest association with general mortality, which was also true for the lowest tertile of diastolic left ventricular posterior wall thickness (HR=1.49, 95% CI: 1.10, 2.02)., Conclusion: In the general population, the association between QTc and general mortality is strongest in subjects with low left ventricular mass index and diastolic thickness of the left ventricular posterior wall, thus the prognostic value of QTc needs to be interpreted with regard to these echocardiographic parameters., (© The European Society of Cardiology 2015.)

Our objective was to investigate the association of change of anthropometric measurements and the incidence of type 2 diabetes mellitus (T2DM) within a pooled sample of 2 population-based cohorts.A final sample of 1324 women and 1278 men aged 31 to 83 years from 2 prospective cohorts in Germany, the CARLA (Cardiovascular Disease - Living and Ageing in Halle) and the SHIP study (Study of Health in Pomerania), were pooled. The association of change of body weight and waist circumference (WC) with incidence of T2DM was assessed by calculating sex-specific hazard ratios (HRs). We investigated the absolute change of markers of obesity as well as change relative to the baseline value and estimated crude and adjusted HRs. Furthermore, we conducted the analyses stratified by obesity status and age (<60 vs ≥60 years) at baseline.Associations were found for both change of body weight and WC and incidence of T2DM in the crude and adjusted analyses. In the stratified study sample, those participants with a body mass index of <30 kg/m at baseline showed considerably lower HRs compared with obese women and men for both weight and WC. In the age-stratified analysis, we still found associations between change of weight and WC and incident T2DM with only marginal differences between the age groups.Our study showed associations of change of weight and WC as markers of obesity with incidence of T2DM. Keeping a healthy and primarily stable weight should be the goal for preventing the development of T2DM.

Background: Arterial hypertension is a common disease with high prevalence in the general population. Left ventricular hypertrophy (LVH) is an independent risk factor in arterial hypertension. Electrocardiographic indices like the Sokolow-Lyon index (SLI) are recommended as diagnostic screening methods for LVH. We assessed the diagnostic performance of the SLI in a cohort of a large general population., Methods: We used electrocardiographic and echocardiographic data from the prospective, population-based cohort study CARdio-vascular Disease, Living and Ageing in Halle (CARLA). Linear and logistic regression models were used to assess the association of SLI with LVH. To assess the impact of the body-mass-index (BMI), we performed interaction analyses., Results: AUC of SLI to predict LVH was 55.3 %, sensitivity of the SLI was 5 %, specificity 97 %. We found a significant association of SLI after covariate-adjustment with echocardiographically detected LVH (increase of left-ventricular mass index, LVMI 7.0 g/m(2) per 1 mV increase of SLI, p < 0.0001). However, this association was mainly caused by an association of SLI with the left-ventricular internal diameter (LVIDd, increase of 0.06 cm/m(2) per 1 mV increase of SLI, p < 0.0001). In obese (BMI > 30 kg/m(2)) we found the strongest association with an increase of 9.2 g/m(2) per 1 mV., Conclusions: Although statistically significant, relations of SLI and echocardiographic parameters of LVH were weak and mainly driven by the increase in LVIDd, implicating a more eccentric type of LVH in the collective. The relations were strongest when obese subjects were taken into account. Our data do not favour the SLI as a diagnostic screening test to identify patients at risk for LVH, especially in non-obese subjects without eccentric LVH.

Background: There is evidence that chronic inflammation is associated with the progression/development of chronic renal failure; however, relations in subjects with preserved renal function remain insufficiently understood., Objective: To examine the association of inflammation with the development of renal failure in a cohort of the elderly general population., Methods: After excluding subjects with reduced estimated glomerular filtration rate (eGFR<60 mL/min/1.73 m2) and missing data, the cohort incorporated 785 men and 659 women (aged 45-83 years). Follow-up was performed four years after baseline. Covariate adjusted linear and logistic regression models were used to assess the association of plasma/serum concentrations of soluble tumour necrosis factor receptor 1 (sTNF-R1), C-reactive protein (CRP), and interleukin 6 (IL-6) with change in eGFR/creatinine. The areas under the curve (AUCs) from receiver operating characteristics (ROCs) were estimated., Results: In adjusted models sTNF-R1 was distinctively associated with a decline in eGFR in men (0.6 mL/min/1.73 m2 per 100 pg/mL sTNF-R1; 95% CI: 0.4-0.8), but not in women. A similar association could not be found for CRP or IL-6. Estimates of sTNF-R1 in the cross-sectional analyses were similar between sexes, while CRP and IL-6 were not relevantly associated with eGFR/creatinine., Conclusion: In the elderly male general population with preserved renal function sTNF-R1 predicts the development of renal failure.

Background: Previous research found an association of CRP with QT time in population based samples. Even more, there is evidence of a substantial involvement of the tumor necrosis factor-alpha system in the pathophysiology of cardiac arrhythmia, while the role of Interleukin 6 remains inconclusive., Objective: To determine the association between inflammation with an abnormally prolonged QT-time (APQT) in men and women of the elderly general population., Methods: Data descend from the baseline examination of the prospective, population-based Cardiovascular Disease, Living and Ageing in Halle (CARLA) Study. After exclusion of subjects with atrial fibrillation and missing ECG recording the final study cohort consisted of 919 men and 797 women. Blood parameters of inflammation were the soluble TNF-Receptor 1 (sTNF-R1), the high-sensitive C-reactive protein (hsCRP), and Interleukin 6 (IL-6). In accordance with major cardiologic societies we defined an APQT above a QT time of 460 ms in women and 450 ms in men. Effect sizes and the corresponding 95% confidence intervals (CI) were estimated by performing multiple linear and logistic regression analyses including the analysis of sex differences by interaction terms., Results: After covariate adjustment we found an odds ratio (OR) of 1.89 (95% CI: 1.13, 3.17) per 1000 pg/mL increase of sTNF-R1 in women, and 0.74 (95% CI: 0.48, 1.15) in men. In the covariate adjusted linear regression sTNF-R1 was again positively associated with QT time in women (5.75 ms per 1000 pg/mL, 95% CI: 1.32, 10.18), but not in men. Taking possible confounders into account IL-6 and hsCRP were not significantly related to APQT in both sexes., Conclusion: Our findings from cross-sectional analyses give evidence for an involvement of TNF-alpha in the pathology of APQT in women.

Objective: To determine if people dying from cancer are able to prolong their own life in order to experience a certain biographical event, or whether the appearance of such an occasion leads to increased deaths before the event., Methods: We compared numbers of cancer deaths during a period of 1 week before and after biographically important occasions, which were birthday, Christmas and Easter. As a psychogenic postponement or hastening of death is most likely in chronic diseases (as opposed to accidents or cardiovascular events), we included cancer deaths only. We estimated relative risks (RRs) with their corresponding Bonferroni corrected CIs to assess effects of biographical events. All registered cancer deaths in Germany from 1995 to 2009 were included (3 257 520 individual deaths). Numbers of deaths were corrected for seasonality., Results: Considering all cases, there were noticeably more deaths than expected in the week preceding Christmas, leading to an RR of dying after the event of 0.987 (CI 0.978 to 0.997). Estimates indicating a hastening of death were consistent over several subgroups. Other occasions showed inconsistent results, especially there was no convincing postponement effect in our data., Conclusions: While there is no evidence of different death numbers before and after Easter and birthdays, the appearance of Christmas seems to increase deaths.