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      Rationale and Design of the Hamburg City Health Study

      , 1 , 2 , 3 , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 3 , 12 , 13 , 14 , 15 , 3 , 16 , 14 , 17 , 17 , 13 , 3 , 18 , 19 , 18 , 20 , 21 , 22 , 23 , 24 , 25 , 3 , 8 , 26 , 3 , 3 , 27 , 28 , 28 , 29 , 30 , 19 , 15 , 34 , 31 , 9 , 2 , 32 , 3 , 33 , 34 , 3 , 10 , 21 , 35 , 36 , 2 , 32 , 12 , 1 , 2 , 24 , 22 , 3 , 29 , 25 , 23 , 3 , 20 , 1 , 2 , 38 , 6 , 1 , 3 , 3 , 2 , 37 , 1 , 2 , 3 , 1 , 2

      European Journal of Epidemiology

      Springer Netherlands

      Epidemiology, Prospective cohort study, Risk factors, Prevention, Coronary heart disease, Stroke, Dementia, Cancer, Health care, Vascular diseases, Oral health, Psychiatric and psychosomatic disorders, Ocular diseases, Respiratory diseases, Obesity, Nutrition, Lifestyle, Sexual dysfunction, Survivorship, Resilience, MRI imaging, Cardiac MRI, Brain MRI, Health service research, Hamburg

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          There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

          Abstract

          The Hamburg City Health Study (HCHS) is a large, prospective, long-term, population-based cohort study and a unique research platform and network to obtain substantial knowledge about several important risk and prognostic factors in major chronic diseases. A random sample of 45,000 participants between 45 and 74 years of age from the general population of Hamburg, Germany, are taking part in an extensive baseline assessment at one dedicated study center. Participants undergo 13 validated and 5 novel examinations primarily targeting major organ system function and structures including extensive imaging examinations. The protocol includes validate self-reports via questionnaires regarding lifestyle and environmental conditions, dietary habits, physical condition and activity, sexual dysfunction, professional life, psychosocial context and burden, quality of life, digital media use, occupational, medical and family history as well as healthcare utilization. The assessment is completed by genomic and proteomic characterization. Beyond the identification of classical risk factors for major chronic diseases and survivorship, the core intention is to gather valid prevalence and incidence, and to develop complex models predicting health outcomes based on a multitude of examination data, imaging, biomarker, psychosocial and behavioral assessments. Participants at risk for coronary artery disease, atrial fibrillation, heart failure, stroke and dementia are invited for a visit to conduct an additional MRI examination of either heart or brain. Endpoint assessment of the overall sample will be completed through repeated follow-up examinations and surveys as well as related individual routine data from involved health and pension insurances. The study is targeting the complex relationship between biologic and psychosocial risk and resilience factors, chronic disease, health care use, survivorship and health as well as favorable and bad prognosis within a unique, large-scale long-term assessment with the perspective of further examinations after 6 years in a representative European metropolitan population.

          Electronic supplementary material

          The online version of this article (10.1007/s10654-019-00577-4) contains supplementary material, which is available to authorized users.

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          Most cited references 40

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          The PHQ-9: validity of a brief depression severity measure.

          While considerable attention has focused on improving the detection of depression, assessment of severity is also important in guiding treatment decisions. Therefore, we examined the validity of a brief, new measure of depression severity. The Patient Health Questionnaire (PHQ) is a self-administered version of the PRIME-MD diagnostic instrument for common mental disorders. The PHQ-9 is the depression module, which scores each of the 9 DSM-IV criteria as "0" (not at all) to "3" (nearly every day). The PHQ-9 was completed by 6,000 patients in 8 primary care clinics and 7 obstetrics-gynecology clinics. Construct validity was assessed using the 20-item Short-Form General Health Survey, self-reported sick days and clinic visits, and symptom-related difficulty. Criterion validity was assessed against an independent structured mental health professional (MHP) interview in a sample of 580 patients. As PHQ-9 depression severity increased, there was a substantial decrease in functional status on all 6 SF-20 subscales. Also, symptom-related difficulty, sick days, and health care utilization increased. Using the MHP reinterview as the criterion standard, a PHQ-9 score > or =10 had a sensitivity of 88% and a specificity of 88% for major depression. PHQ-9 scores of 5, 10, 15, and 20 represented mild, moderate, moderately severe, and severe depression, respectively. Results were similar in the primary care and obstetrics-gynecology samples. In addition to making criteria-based diagnoses of depressive disorders, the PHQ-9 is also a reliable and valid measure of depression severity. These characteristics plus its brevity make the PHQ-9 a useful clinical and research tool.
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            EuroQol--a new facility for the measurement of health-related quality of life.

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            In the course of developing a standardised, non-disease-specific instrument for describing and valuing health states (based on the items in Table 1), the EuroQol Group (whose members are listed in the Appendix) conducted postal surveys in England, The Netherlands and Sweden which indicate a striking similarity in the relative valuations attached to 14 different health states. The data were collected using a visual analogue scale similar to a thermometer. The EuroQol instrument is intended to complement other quality-of-life measures and to facilitate the collection of a common data set for reference purposes. Others interested in participating in the extension of this work are invited to contact the EuroQol Group.
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              The AUDIT alcohol consumption questions (AUDIT-C): an effective brief screening test for problem drinking. Ambulatory Care Quality Improvement Project (ACQUIP). Alcohol Use Disorders Identification Test.

               K Bush,  D R Kivlahan,  S Fihn (1998)
              To evaluate the 3 alcohol consumption questions from the Alcohol Use Disorders Identification Test (AUDIT-C) as a brief screening test for heavy drinking and/or active alcohol abuse or dependence. Patients from 3 Veterans Affairs general medical clinics were mailed questionnaires. A random, weighted sample of Health History Questionnaire respondents, who had 5 or more drinks over the past year, were eligible for telephone interviews (N = 447). Heavy drinkers were oversampled 2:1. Patients were excluded if they could not be contacted by telephone, were too ill for interviews, or were female (n = 54). Areas under receiver operating characteristic curves (AUROCs) were used to compare mailed alcohol screening questionnaires (AUDIT-C and full AUDIT) with 3 comparison standards based on telephone interviews: (1) past year heavy drinking (>14 drinks/week or > or =5 drinks/ occasion); (2) active alcohol abuse or dependence according to the Diagnostic and Statistical Manual of Mental Disorders, Revised Third Edition, criteria; and (3) either. Of 393 eligible patients, 243 (62%) completed AUDIT-C and interviews. For detecting heavy drinking, AUDIT-C had a higher AUROC than the full AUDIT (0.891 vs 0.881; P = .03). Although the full AUDIT performed better than AUDIT-C for detecting active alcohol abuse or dependence (0.811 vs 0.786; P<.001), the 2 questionnaires performed similarly for detecting heavy drinking and/or active abuse or dependence (0.880 vs 0.881). Three questions about alcohol consumption (AUDIT-C) appear to be a practical, valid primary care screening test for heavy drinking and/or active alcohol abuse or dependence.
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                Author and article information

                Contributors
                a.jagodzinski@uke.de
                Journal
                Eur J Epidemiol
                Eur. J. Epidemiol
                European Journal of Epidemiology
                Springer Netherlands (Dordrecht )
                0393-2990
                1573-7284
                8 November 2019
                8 November 2019
                2020
                : 35
                : 2
                : 169-181
                Affiliations
                [1 ]Department of General and Interventional Cardiology, University Heart and Vascular Center, Hamburg, Germany
                [2 ]German Center for Cardiovascular Research (DZHK) Partner Site Hamburg/Lübeck/Kiel, Munich, Germany
                [3 ]GRID grid.13648.38, ISNI 0000 0001 2180 3484, Epidemiological Study Center, , University Medical Center Hamburg-Eppendorf (UKE), ; Hamburg, Germany
                [4 ]Oncology Clinic, Finsen Center, Copenhagen, Denmark
                [5 ]GRID grid.417390.8, ISNI 0000 0001 2175 6024, Survivorship Research Unit, , The Danish Cancer Society Research Center, ; Copenhagen, Denmark
                [6 ]GRID grid.13648.38, ISNI 0000 0001 2180 3484, Institute for Medical Biometry and Epidemiology (IMBE), , University Medical Center Hamburg-Eppendorf (UKE), ; Hamburg, Germany
                [7 ]GRID grid.13648.38, ISNI 0000 0001 2180 3484, Faculty of Medicine, , University Medical Center Hamburg-Eppendorf (UKE), ; Hamburg, Germany
                [8 ]GRID grid.13648.38, ISNI 0000 0001 2180 3484, Department of Prosthetic Dentistry, Center for Dental and Oral Medicine, , University Medical Center Hamburg-Eppendorf, ; Hamburg, Germany
                [9 ]GRID grid.13648.38, ISNI 0000 0001 2180 3484, Department of Diagnostics and Interventional Radiology and Nuclear Medicine, , University Medical Center Hamburg-Eppendorf (UKE), ; Hamburg, Germany
                [10 ]GRID grid.13648.38, ISNI 0000 0001 2180 3484, Department for Forensic Medicine, , University Medical Center Hamburg-Eppendorf (UKE), ; Hamburg, Germany
                [11 ]GRID grid.13648.38, ISNI 0000 0001 2180 3484, Institute for Health Services Research in Dermatology, , University Medical Center Hamburg-Eppendorf (UKE), ; Hamburg, Germany
                [12 ]GRID grid.13648.38, ISNI 0000 0001 2180 3484, Department of Periodontics, Preventive and Restorative Dentistry, , University Medical Center Hamburg-Eppendorf (UKE), ; Hamburg, Germany
                [13 ]Department of Vascular Medicine, University Heart and Vascular Center, Hamburg, Germany
                [14 ]GRID grid.13648.38, ISNI 0000 0001 2180 3484, Department of Otolaryngology, Head and Neck Surgery, Head and Neurocenter, , University Medical Center Hamburg-Eppendorf (UKE), ; Hamburg, Germany
                [15 ]GRID grid.13648.38, ISNI 0000 0001 2180 3484, Department of Oncology, Hematology, BMT with Section Pneumology, , University Medical Center Hamburg-Eppendorf (UKE), ; Hamburg, Germany
                [16 ]GRID grid.13648.38, ISNI 0000 0001 2180 3484, Institute for Sexual Research and Forensic Psychiatry, , University Medical Center Hamburg-Eppendorf (UKE), ; Hamburg, Germany
                [17 ]GRID grid.13648.38, ISNI 0000 0001 2180 3484, Institute for Systemic Neurosciences, , University Medical Center Hamburg-Eppendorf (UKE), ; Hamburg, Germany
                [18 ]GRID grid.13648.38, ISNI 0000 0001 2180 3484, Clinic of Neuroradiological Diagnostics and Intervention, , University Medical Center Hamburg-Eppendorf (UKE), ; Hamburg, Germany
                [19 ]GRID grid.13648.38, ISNI 0000 0001 2180 3484, Department of Psychiatry and Psychotherapy, , University Medical Center Hamburg-Eppendorf (UKE), ; Hamburg, Germany
                [20 ]GRID grid.13648.38, ISNI 0000 0001 2180 3484, Department of Neurology, , University Medical Center Hamburg-Eppendorf (UKE), ; Hamburg, Germany
                [21 ]Department for Cardiovascular Surgery, University Heart and Vascular Center, Hamburg, Germany
                [22 ]GRID grid.13648.38, ISNI 0000 0001 2180 3484, Department of Oral and Maxillofacial Surgery, , University Medical Center Hamburg-Eppendorf (UKE), ; Hamburg, Germany
                [23 ]GRID grid.13648.38, ISNI 0000 0001 2180 3484, Prostate Cancer Center, Martini-Clinic, , University Medical Center Hamburg-Eppendorf (UKE), ; Hamburg, Germany
                [24 ]GRID grid.13648.38, ISNI 0000 0001 2180 3484, Department of Medical Psychology, , University Medical Center Hamburg-Eppendorf (UKE), ; Hamburg, Germany
                [25 ]GRID grid.13648.38, ISNI 0000 0001 2180 3484, Institute for Occupational and Maritime Medicine (ZfAM), , University Medical Center Hamburg-Eppendorf (UKE), ; Hamburg, Germany
                [26 ]GRID grid.13648.38, ISNI 0000 0001 2180 3484, Medical Clinic and Polyclinic III, , University Medical Center Hamburg-Eppendorf (UKE), ; Hamburg, Germany
                [27 ]GRID grid.13648.38, ISNI 0000 0001 2180 3484, Institute for Medical Sociology, , University Medical Center Hamburg-Eppendorf (UKE), ; Hamburg, Germany
                [28 ]GRID grid.13648.38, ISNI 0000 0001 2180 3484, Institute for Health Economics and Healthcare Research, , University Medical Center Hamburg-Eppendorf (UKE), ; Hamburg, Germany
                [29 ]GRID grid.13648.38, ISNI 0000 0001 2180 3484, Clinic of Ophthalmology, , University Medical Center Hamburg-Eppendorf (UKE), ; Hamburg, Germany
                [30 ]GRID grid.13648.38, ISNI 0000 0001 2180 3484, Institute of Human Genetics, , University Medical Center Hamburg-Eppendorf (UKE), ; Hamburg, Germany
                [31 ]GRID grid.13648.38, ISNI 0000 0001 2180 3484, Institute for Psychosomatic Medicine and Psychotherapy, , University Medical Center Hamburg-Eppendorf (UKE), ; Hamburg, Germany
                [32 ]GRID grid.9026.d, ISNI 0000 0001 2287 2617, Department of Electrophysiology, Hamburg University Heart Center, , University Heart and Vascular Center, ; Hamburg, Germany
                [33 ]GRID grid.13648.38, ISNI 0000 0001 2180 3484, Competence Center for Epidemiology and Health Services Research for Healthcare Professionals (CVcare), Institute for Health Services Research in Dermatology and Nursing (IVDP), , University Medical Center Hamburg-Eppendorf (UKE), ; Hamburg, Germany
                [34 ]GRID grid.13648.38, ISNI 0000 0001 2180 3484, Institute for Tumor Biology, , University Medical Center Hamburg-Eppendorf (UKE), ; Hamburg, Germany
                [35 ]GRID grid.13648.38, ISNI 0000 0001 2180 3484, Department of Pathology, , University Medical Center Hamburg-Eppendorf (UKE), ; Hamburg, Germany
                [36 ]GRID grid.13648.38, ISNI 0000 0001 2180 3484, Department of General Practice and Primary Care, , University Medical Center Hamburg-Eppendorf (UKE), ; Hamburg, Germany
                [37 ]GRID grid.13648.38, ISNI 0000 0001 2180 3484, Competence Center for Health Services Research in Dermatology (CVderm), Institute for Health Services Research in Dermatology and Nursing (IVDP), , University Medical Center Hamburg-Eppendorf (UKE), ; Hamburg, Germany
                [38 ]GRID grid.452624.3, Airway Research Center North, , German Center for Lung Research, ; Grosshansdorf, Germany
                Article
                577
                10.1007/s10654-019-00577-4
                7125064
                31705407
                © The Author(s) 2019

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

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