Search

Copyright of Ernährung - Wissenschaft Und Praxis is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

In the late 1990s, a birth cohort study was conducted in the cities of Delmenhorst, Wilhelmshaven and Leer, where more than 3,000 newborn children were recruited in five hospitals. The baseline survey in the clinics was followed by three follow-up surveys 6, 12 and 24 months later. The prime concern of the study was to estimate prevalences and to conduct analyses concerning the association between breastfeeding as well as exposure to pets and the occurrence of allergy symptoms. Children living together with a dog in the same household were at higher risk of disease only if a familial predisposition of allergic diseases was present - without such a familial predisposition a dog in the same household seems to reduce the risk for atopic diseases during the first 2 years of life. A protective effect due to long breastfeeding could be observed in our study in particular in case of a paternal history of allergic diseases, whereas an exclusive maternal history of allergic diseases seems to increase the risk. The concept of the study has proved itself. Contacting mothers in obstetrical departments in hospitals as well as in medical offices of self-employed pediatricians has proven to be very practicable. With comparatively little effort a relatively large cohort was recruited, which allowed us to analyze longitudinal data, adequately taking into account several confounders as well as effect-modifying factors.

The ICD-coding quality for outpatients' diagnoses by German physicians was analysed in a sample of five million members of the German Statutary Health Insurance System. New federal legislation coming into effect in 2009 for the reimbursement of physicians is based on patients' morbidity risks and thus on the quality of a provider's ICD coding. A sample of physicians' billing data for 2001-2003 containing ICD codes for patients' morbidity and the billed services was linked with outpatients' prescription data for the time period 2002- 2003. As in 2001-2003 information on the certainty of diagnosis was not yet mandatory, only 7.4% of all diagnoses were labelled as either "suspected diagnosis", "excluded diagnosis" or "history of diagnosis", hampering coding validity measurements. Chronic disease persisted in the time window analysed showing only minor successive prevalence decreases after an initial dip of at least 6% in the calendar term following the index term. The immediate decrease following the initial term may be due to initially suspected disease not confirmed until the work up at subsequent visits is completed. The slight downward slope after six months may indicate minor undercoding of chronic diagnoses. Few acute diagnoses persisted for longer than two calendar terms making it unlikely that acute diagnoses were erroneously maintained for repetitive reimbursement. Undercoding of diagnosis was abundant in patients receiving insulin prescriptions, as a diagnosis of diabetes was often missing. Numerous drugs prescribed could not be associated with a corresponding diagnosis coded by physicians. We suggest that before reimbursements to physicians are based on ICD-coded morbidity, a re-analysis of the data should be performed containing information on diagnosis certainty (mandatory since 2004) and the recently updated catalogue on fees for medical procedures provided "Einheitlicher Bewertungsmassstab" (EBM).

As resources become scarce there is increasing demand on the public health services to create a system of community-based and jointly used health protection services. Cohort surveys that are currently more and more reduced contribute to both primary and secondary prevention. They enable third parties to implement further prevention projects. In addition, due to continuous quality assessment and standardization process, they yield valid data for developing target-group-specific prevention strategies as well as for evaluating preventive measures. In this respect public health services already fulfil the demand for prevention in the social environment as outlined in the forthcoming Prevention Act. Preventive measures in the field of dental health, atopic diseases and vaccination are presented as examples. The integration of data from continuous cohort surveys into a health reporting system as a basis for developing and evaluating health targets and prevention projects at the state level is demonstrated.

The aim of the study was to estimate the proportion of occupation-related lung cancer for males and females in Northern Germany. 1004 lung cancer cases (839 males, 165 females) were enrolled into an epidemiological case-control study in the study areas Bremen, the surroundings of Bremen and the Frankfurt/Main area. Population controls were matched for sex and region of residence. All patients born after 1913 of German nationality and with a histologically or cytologically verified carcinoma of the lung, the diagnosis not older than 3 months at the date of interview, were eligible. All individuals were personally interviewed with respect to their smoking and job history. Based on a published list of all jobs and branches of industries with sufficient evidence for lung carcinogenity (based on the reviews by IARC), the so called A-List, all individuals were classified regarding their lifelong occupational history. The same procedure was applied with regard to jobs and branches of industries with a suspected risk of lung cancer (List-B). The statistical analysis used conditional logistic regression, controlled for smoking. Being employed in a job of List-A for at least half a year was associated with a statistically significant odds ratio (OR) of 1.63 (p < 0.0001) and resulting attributable risk (AR) of 16% in males. For the B-List an OR of 1.34 and an AR of 10% resulted in males. The estimates of the attributable risk for jobs and branches of industry with a sufficient evidence of lung cancer risk is comparable to the estimates obtained by Doll and Peto for the US. If additionally jobs and branches of industries with a suspected risk for lung cancer is considered, it must be anticipated that approximately one quarter of all newly diagnosed male lung cancer cases in the study region may be caused by occupational risk factors. This should prompt to minimise occupational exposure.

In an interdisciplinary, multicentre case control study of the causal factors of the diffuse malignant mesothelioma (DMM) standardised histories where taken from n = 324 Patients suffering from DMM, n = 315 hospital control patients (KK) and n = 182 population controls (PK). For 66 DMM, 149 KK and 107 PK a risk from asbestos fibre dust at the workplace was not detectable. For latter persons indoor and outdoor asbestos exposure outside of the workplace were investigated. The following factors were examined: neighbourhood exposure from companies using asbestos, living in big cities and nearby main traffic roads, building materials containing asbestos, electric storage heaters and household contacts. For using electric storage heaters a statistically significant increased odds ratio (OR) was observed for DMM as well in comparison with KK (OR = 2.42; 95%-CI: 1.01-5.72) and in comparison for PK (OR = 2.91; 95%-CI: 1.08-7.80). Only outside of Hamburg an increased OR compared to KK was observed for people living in the neighbourhood of asbestos factories (OR = 16.3; 95%-CI: 1.35-196.8) and also, but only in Hamburg, compared to PK living nearby main traffic roads. There is only a trend for a mesothelioma-risk for household-contacts based on a few cases. In one DMM-patient without an occupational asbestos exposure the lung dust fibre analysis yielded 2.912 FB and 1.459 x 10(3) crocydolithe fibres per gram dried lung tissue. As a child he lived in the immediate vicinity of the blue asbestos mine in Wittenoom, Australia. Therefore in special cases a para-occupational asbestos or a neighbourhood asbestos exposure can be demonstrated as a risk factor of diffuse malignant mesothelioma.