Study of Health in Pomerania

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The Study of Health in Pomerania (SHIP) is a population-based epidemiological study consisting of two independent cohorts (SHIP and SHIP-TREND). The SHIP investigates common risk factors, subclinical disorders and manifest diseases with highly innovative non-invasive methods in the high-risk population of northeast Germany. The study is not interested in one specific disease. The SHIP study´s main aims include the investigation of health in all its aspects and complexity involving the collection and assessment of data relevant to the prevalence and incidence of common, population-relevant diseases and their risk factors.

The aims of both studies are: (i) investigation of the long-term progression of subclinical findings, their determinants and prognostic values (SHIP-2); (ii) analysis of the secular trend of subclinical and overt diseases and their determinants in a high-risk population (SHIP-TREND vs SHIP-0); and (iii) assessment of the prevalence of subclinical findings (SHIP-TREND).

For SHIP-0, a sample of 7008 women and men aged 20 to 79 years was drawn in the cities of Greifswald, Stralsund and Anklam and 29 communities in the surrounding region which is part of West Pomerania, a region in the northeast of Germany, adjacent to the Baltic Sea in the north and to the Polish border in the east. West Pomerania is the north-eastern part of Mecklenburg-Vorpommern, one of the 16 federal German states.

A separate stratified random sample of 8016 adults aged 20–79 years was drawn for SHIP-TREND in the same area.

Currently, data are collected for the second examination follow-up of the first SHIP cohort (SHIP-2) and baseline examinations of the second SHIP cohort (SHIP-TREND).

SHIP-0: Data collection was conducted between October 1997 and May 2001.

SHIP-1 follow-up examination: SHIP-0 participants were invited again. The first 5-year-follow-up was conducted between October 2002 and September 2006.

SHIP-2 follow-up examination: The 11-year follow-up has started in June 2008 and was completed in autumn 2012.

SHIP-Trend-0: A new sample was drawn for a new cohort, which was examined between September 2008 and summer 2012.

The following table shows all the instruments which are integrated in the SHIP examination.

The West Pomeranian population indicate a high prevalence of common risk factors and diseases. Especially overweight and obesity are more prevalent than in other German regions. Gallstone diseases are very common and 30% of all adults suffer from hepatic steatosis. The prevalence of arterial hypertension and left ventricular hypertrophy is much higher in the West Pomeranian adult population. In the Northeast of Germany nearly 50% - 60% indicate these diseases.

SHIP is the first population based cohort study worldwide which includes whole-body MRI. The aims of the following main whole body-MRI study are:

(1)To provide prevalence estimates for different MR findings in a general adult population.

(2)To establish population-based MRI reference parameters for various organs and organ parts such as left and right ventricular size or volume of liver, spleen, kidney, prostate,^[1] and brain structures . Clinical MR reference parameters currently in use were derived from small, nonrepresentative samples and are thus prone to selection bias.

(3)To correlate MR findings with clinical examination results, metabolomic and genome-wide analysis in order to help elucidate the complex associations that exist between risk factors and diseases.

Additionally to the standard whole-body MRI protocol (right figure) men have the option to undergo contrast-enhanced cardiac MRI and MR angiography and women cardiac MRI and MR mammography. Participants with a drug allergy or allergy to any kind of contrast agent are excluded from the contrast-enhanced modules and only undergo standard protocol.

Two trained radiologists review all scans independently to evaluated images for presence or absence of pathological findings. In case of a difference between the two observer a third reading is performed to reach a consensus on the discrepant finding.

Pathological findings are categorized using the method chosen by Bryan et al. for the Cardiovascular Health Study. This method classifies all findings into 4 basic categories. The management of pathological findings and communication with study participants are defined in a standardized protocol accepted by the local ethics committee. Participants with category IV findings are immediately transferred to a clinical specialist. Cases with positive findings of category II and III are referred to an Advisory Board established when the study began. and having as permanent members specialists from medical, surgical, neurological, epidemiological and radiological departments. Upon presentation of cases they reach a consensus about whether to recommend further clinical work-up or not. Participants in whom relevant findings are made get informed about the abnormality and recommendation of the Advisory Board.

SHIP-LEGEND stands for Life-Events and Gene-Environment interaction in Depression; its main aim is the identification of genetic factors which interact with stress and traumatic events to increase the risk of major depressive disorders. SHIP is the basis for this research. Between July 2007 and August 2010 n=2393 probands were interviewed. The interviewer assessed stress, traumas and strains in childhood and adulthood of the probands. Additionally diagnostic interviews were performed to diagnose current and lifetime mental disorders (DSM-IV). A broad range of questionnaires were administered to assess e.g. alexithymia (Toronto Alexithymia Scale 20), aversive childhood conditions (Childhood Trauma Questionnaire), depression (Beck Depression Inventory-2), resilience (RS-25) and personality traits (NEO-FFI).

SHIP is funded by following institutions: Federal Ministry of Education and Research, Ministry of Cultural Affairs as well as the Social Ministry of the Federal State of Mecklenburg-West Pomerania, Federal Ministry of Nutrition, Agriculture and Consumer’s Safety, German Research Foundation, Competence Network Heart Failure, Competence Network Diabetes, German Asthma and COPD Network, Genopathomik, Alfried Krupp von Bohlen und Halbach Foundation, Alexander v. Humboldt Foundation, Leibniz Society, Siemens AG, Health Care Sector (Erlangen, Germany), Pfizer Pharma GmbH (SBU Endocrinology and Ophthalmology; Berlin Germany), Novo Nordisk (Mainz, Germany), Data Input GmbH (Darmstadt, Germany), GABA International AG (Therwil, Switzerland), Imedos Systems (Jena, Germany) and Heinen and Löwenstein (Bad Ems, Germany).

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• Baumeister SE, Völzke H, Marschall P, John U, Schmidt CO, Alte D. Impact of fatty liver disease on health care utilization and costs in the general population: a 5-year observation. Gastroenterology 2008;134:85-94
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• Dörr M, Wolff B, Robinson DM, John U, Lüdemann J, Meng W, Felix SB, Völzke H. The association of thyroid function with cardiac mass and left ventricular hypertrophy. J Clin Endocrinol Metab 2005;90:673-677
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• Study of Health in Pomerania (SHIP)- official homepage
• Greifswald Approach to Individualized Medicine (GANI_MED)- official homepage
• Institut für Community Medicine