@article{MuellerPetersDoringetal.2011, author = {M{\"u}ller, Martin and Peters, A. and Doring, A. and Ladwig, K.-H. and Holle, R. and Meisinger, C. and Linkohr, B. and Autenrieth, C. and Baumeister, S. and Behr, J. and Bergner, A. and Bickel, H. and Bidlingmaier, M. and Dias, A. and Emeny, R.T. and Fischer, B. and Grill, E. and Gorzelniak, L. and Hansch, H. and Heidbreder, S. and Heier, M. and Horsch, A. and Huber, D. and Huber, R.M. and Jorres, R.A. and Kaab, S. and Karrasch, and Kirchberger, and Klug, and Kranz, and Kruch, and Lacruz, and Lang, and Mielk, and Nowak, and Schneider, and Schulz, and Seidel, and Strobl, and Thorand, and Wende, and Weidenhammer, and Zimmermann, and Wichmann,}, title = {Multimorbidity and successful aging: the population-based KORA-Age study}, series = {Zeitschrift f{\"u}r Gerontologie und Geriatrie}, journal = {Zeitschrift f{\"u}r Gerontologie und Geriatrie}, editor = {Springer Nature,}, year = {2011}, abstract = {Background Multimorbidity in the older population is well acknowledged to negatively affect health-related quality of life (HRQL). Several studies have examined the independent effects of single diseases; however, little research has focused on interaction between diseases. The purpose of this study was to assess the impact of six self-reported major conditions and their combinations on HRQL measured by the EQ-5D. Methods 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. Results 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. Conclusions 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.}, language = {en} } @article{PetersDoringLadwigetal.2011, author = {Peters, A. and Doring, A. and Ladwig, K.-H. and Meisinger, C. and Linkohr, B. and Autenrieth, C. and Baumeister, S.E. and Behr, J. and Bergner, A. and Bickel, H. and Bidlingmaier, M. and Dias, A. and Emeny, R.T. and Fischer, B. and Grill, E. and Gorzelniak, L. and Hansch, H. and Heidbreder, S. and Heier, M. and Horsch, A. and Huber, D. and R. M., Huber and Jorres, R.A. and Kaab, S. and Karrasch, S. and Kirchberger, I. and Klug, G. and Kranz, B. and Kuch, B. and Lacruz, M.E. and Lang, O. and Mielck, A. and Nowak, D. and Perz, S. and Schneider, A. and Schulz, H. and M{\"u}ller, Martin and Seidl, H. and Strobl, R. and Thorand, B. and Wende, R. and Weidenhammer, W. and Zimmermann, A.-K. and Wichmann, H.-E. and Holle, R.}, title = {Multimorbidity and successful aging: the population-based KORA-Age study}, series = {Health and quality of life outcomes}, journal = {Health and quality of life outcomes}, editor = {BioMed Central,}, year = {2011}, abstract = {Background Multimorbidity in the older population is well acknowledged to negatively affect health-related quality of life (HRQL). Several studies have examined the independent effects of single diseases; however, little research has focused on interaction between diseases. The purpose of this study was to assess the impact of six self-reported major conditions and their combinations on HRQL measured by the EQ-5D. Methods 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. Results 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. Conclusions 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.}, language = {en} } @article{WeitereAltenburgerAnlangeretal.2021, author = {Weitere, Markus and Altenburger, Rolf and Anlanger, Christine and Baborowski, Martina and B{\"a}rlund, Ilona and Beckers, Liza-Marie and Borchardt, Dietrich and Brack, Werner and Brase, Lisa and Busch, Wibke and Chatzinotas, Antonis and Deutschmann, Bj{\"o}rn and Eligehausen, Jens and Frank, Karin and Graeber, Daniel and Griebler, Christian and Hagemann, Jeske and Herzsprung, Peter and Hollert, Henner and Inostroza, Pedro A. and J{\"a}ger, Christoph G. and Kallies, Ren{\´e} and Kamjunke, Norbert and Karrasch, Bernhard and Kaschuba, Sigrid and Kaus, Andrew and Klauer, Bernd and Kn{\"o}ller, Kay and Koschorreck, Matthias and Krauss, Martin and Kunz, Julia V. and Kurz, Marie J. and Liess, Matthias and Mages, Margarete and M{\"u}ller, Christin and Muschket, Matthias and Musolff, Andreas and Norf, Helge and P{\"o}hlein, Florian and Reiber, Lena and Risse-Buhl, Ute and Schramm, Karl-Werner and Schmitt-Jansen, Mechthild and Schmitz, Markus and Strachauer, Ulrike and von T{\"u}mpling, Wolf and Weber, Nina and Wild, Romy and Wolf, Christine and Brauns, Mario}, title = {Disentangling multiple chemical and non-chemical stressors in a lotic ecosystem using a longitudinal approach}, series = {Science of the Total Environment}, volume = {769}, journal = {Science of the Total Environment}, pages = {144324}, year = {2021}, abstract = {Meeting ecological and water quality standards in lotic ecosystems is often failed due to multiple stressors. However, disentangling stressor effects and identifying relevant stressor-effect-relationships in complex environmental settings remain major challenges. By combining state-of-the-art methods from ecotoxicology and aquatic ecosystem analysis, we aimed here to disentangle the effects of multiple chemical and non-chemical stressors along a longitudinal land use gradient in a third-order river in Germany. We distinguished and evaluated four dominant stressor categories along this gradient: (1) Hydromorphological alterations: Flow diversity and substrate diversity correlated with the EU-Water Framework Directive based indicators for the quality element macroinvertebrates, which deteriorated at the transition from near-natural reference sites to urban sites. (2) Elevated nutrient levels and eutrophication: Low to moderate nutrient concentrations together with complete canopy cover at the reference sites correlated with low densities of benthic algae (biofilms). We found no more systematic relation of algal density with nutrient concentrations at the downstream sites, suggesting that limiting concentrations are exceeded already at moderate nutrient concentrations and reduced shading by riparian vegetation. (3) Elevated organic matter levels: Wastewater treatment plants (WWTP) and stormwater drainage systems were the primary sources of bioavailable dissolved organic carbon. Consequently, planktonic bacterial production and especially extracellular enzyme activity increased downstream of those effluents showing local peaks. (4) Micropollutants and toxicity-related stress: WWTPs were the predominant source of toxic stress, resulting in a rapid increase of the toxicity for invertebrates and algae with only one order of magnitude below the acute toxic levels. This toxicity correlates negatively with the contribution of invertebrate species being sensitive towards pesticides (SPEARpesticides index), probably contributing to the loss of biodiversity recorded in response to WWTP effluents. Our longitudinal approach highlights the potential of coordinated community efforts in supplementing established monitoring methods to tackle the complex phenomenon of multiple stress.}, language = {en} }