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Background: Day care centre attendance is much more common in East than in West Germany. Although there is evidence that early day care might be protective against atopic diseases, several studies have shown a higher prevalence of childhood eczema in East Germany compared to West Germany., Objectives: To compare prevalence and cumulative incidence of eczema in a birth cohort study in East and West Germany and to identify risk factors that are associated with eczema, which might explain regional differences., Methods: We used data from the ongoing population-based birth cohort study Influence of Life-style factors on the development of the Immune System and Allergies in East and West Germany Plus the influence of traffic emissions and genetics. In 1997, 3097 children from study areas in East and West Germany were recruited. Cumulative incidence and 1-year prevalences of eczema up to the age of 6 years were determined from yearly questionnaires. Cox regression and generalized estimating equations/logistic regression were used to quantify regional differences and to identify risk factors that might explain them., Results: Prevalence and incidence of eczema were higher in children living in East Germany than those living in West Germany. We identified 11 risk factors that showed significant regional differences. From these factors, only 'day care attendance during the first 2 years of life' was significantly associated with eczema (odds ratio 1.56, 95% confidence interval CI 1.31-1.86). The regional differences in eczema could be explained by differences in early day care utilization., Conclusion: Day care centre attendance is associated with an increased prevalence and incidence of eczema. Regional differences in eczema prevalence could be explained by regional differences in utilization of early day care., (© 2010 John Wiley & Sons A/S.)

Background: At the time of the German reunification in 1990, manifestations of most allergic diseases were less prevalent in East than in West Germany. It was hypothesized that these East-West differences would diminish with lifestyle and pollution changes in East Germany., Objective: To investigate whether changes in the prevalence of asthma, hayfever, eczema or allergic sensitization in East Germany approached the levels seen in West Germany and to identify possible lifestyle or environmental factors that may influence this., Methods: Between 1991 and 2000, 6-year-old children from four areas in East Germany participated in an annual survey. Every 3rd year, a parallel survey was performed in four areas of West Germany. In total, 31 903 children were included. Parents completed a questionnaire regarding lifestyle factors and diagnoses and symptoms of asthma, hayfever and eczema. In sub-areas, eczema was clinically assessed by a dermatologist. Specific IgE sensitization was determined for 6121 children. Logistic regression was used to analyse differences in time trends and the influence of lifestyle and pollution changes., Results: Lifestyle and pollution changed significantly differently between East and West Germany. The trends in hayfever and in strong (specific IgE >3.5) sensitization against pollen, and particularly birch pollen, were steeper in East than in West Germany. The trend towards marked pollen sensitization was four times stronger (95% confidence interval 1.2-13.9) in East than in West Germany. Increasing numbers of only children, less single-room heating with fossil fuels and increasing importance of traffic-related pollution in East Germany partly explained these differences in time trends., Conclusions: Hayfever and sensitization against pollen were the most sensitive allergic manifestations to changes experienced specifically in East Germany. Influences of lifestyle (single-room heating, living as a single child) were important in explaining different trend developments.

The description and analysis of the utilisation of medical services is of particular importance reflecting childhood morbidity. Therefore, our aim was to describe episode- and person-based rates of hospital admission in Germany, by focusing on the three most important clinically relevant categories, accident injuries, respiratory and digestive diseases in children up to the age of 2 years. The analysis was based on data from the LISA-study, a prospective population based birth cohort study including 3097 full-term infants. Information was collected by parent questionnaires and data was analysed concerning gender, region and social status. In the age-group 7-24 months, 14.5% of all children were at least once hospitalised, 2.5% for accident injuries, 3.0% for respiratory and 4.7% for digestive diseases. More boys than girls were admitted to hospital due to respiratory diseases (4.2% vs. 1.7%) and more children from East compared to West Germany due to digestive diseases (7.2% vs. 3.5%). In families with median or low level education more children were admitted for digestive diseases than with high (6.5% and 6.5% vs. 3.6%). The number of hospitalisation episodes per person showed that most children were hospitalised only once during the period from 7 to 24 months. In conclusion this analysis shows that hospital admission is common and not equally distributed concerning sex, parental education and region in German children. Physicians should pay special attention to these susceptive subgroups and differences in health related behaviour and in the distribution of health facilities have to be reduced. Additionally, multiple admissions play only a minor role concerning hospital admission in children up to the age of 2 years.

Background: East-West comparison studies in Europe find higher prevalences of infectious airway diseases and lower prevalences of allergies in eastern areas. Pollution from sulphur dioxide (SO2) or total suspended particles (TSP) are discussed as causes of this difference., Methods: In four differently polluted areas of East Germany where pollution decreased dramatically between 1989 and 1995 cross-sectional studies in about 7-year-old children were repeated every year between 1991 and 1995. In two differently polluted areas of West Germany studies with the same design were done in 1991 and 1994. In all, 19090 children participated in the study. Thirteen different questions about airway diseases and allergies were evaluated. Logistic regression was used to adjust for confounding., Results: With the exception of pneumonia, all infectious airway diseases and irritations of the airways show a steeper temporal decrease in East than in West Germany or are positively associated with either SO2 or TSP in East Germany. For allergies and related symptoms no differences in time trends could be detected or no association with SO2 or TSP could be seen in East Germany., Conclusion: Most airway diseases were more frequent in East than in West Germany in 1991 and were associated with SO2 or TSP. The decrease in these pollutants between 1991 and 1995 has already had a favourable effect. An effect of SO2 or TSP pollution on allergies and related symptoms could not be detected. This pollution does not protect against the development of allergies.

Within an environmental health study, dermatologic examination of 1273 pre-school-age children (5-7 years old) was carried out in selected areas of East (n = 287) and West (n = 987) Germany in spring 1991. On the basis of comparable genetic background, the influence of a different exposure to air pollutants on the manifestation of atopic diseases was investigated. Halle an der Saale (East Germany) and Duisburg (North/South) as well as Essen (West Germany) were chosen as polluted study areas, whereas the countryside town of Borken (West Germany) served as a control region. Outdoor pollution with particles and SO2 was significantly higher in Halle an der Saale. Of the total study group, 12.9% suffered from atopic eczema at the time of examination. The prevalence was highest in East Germany (17.5%; adjusted odds ratio [OR] 1.39, confidence intervals [GI] 0.77-2.52, compared to Borken). The reported frequencies of hay fever and asthma in the total study population were 2% and 1.3%, respectively, without significant differences between study sites. Some 34.7% of the children showed at least one positive skin prick test reaction; significantly (P < 0.001) higher sensitization rates were obtained in western regions (Essen, Duisburg-South) than in the control region (Borken) and East Germany. Multivariate analysis of the prevalence of atopic eczema showed associations with parental predisposition (OR 1.52, CI 1.03-2.25), sex (for boys, OR 0.63, CI 0.43-0.92), location (Duisburg-South vs Borken OR 0.52, CI 0.30-0.96), month of investigation (May vs April, and March vs February OR 0.55, CI 0.37-0.81), contact with rabbits (for girls, OR 2.90, CI 1.36-6.19), animal fur in bedrooms (2.17, 1.01-4.67), indoor use of gas without hood (1.68, 1.11-2.56), and distance of homes from a busy road (< 50 m 1.71, 1.07-2.73). Nonsignificant associations were observed for history of helminthic infections (OR 1.61, CI 0.98-2.64) and high parental education level (OR 1.83, CI 0.83-4.02). In East and West Germany, atopic eczema seems to follow a course different from that of respiratory allergic diseases and specific sensitization, a fact which underlines the need for a differentiated analysis.

A number of air pollutants is known to affect the immune system resulting in alterations of the complement activity in serum. We determined the levels of C3c, one of the activation products of the component C3, in serum samples obtained from various population groups living in areas with different levels of air pollution in Northrhine-Westphalia (FRG). The results show that the serum C3c levels tend to be increased in subjects living in areas with elevated levels of air pollution. By applying a linear regression model it can be demonstrated that a significant part of the variance of the C3c concentrations is explained by the residence area factor after making allowance for the effect of various confounders. The increase of the serum C3c concentrations appears to result from an increased activation of the complement component C3. The underlying mechanisms as well as the pathophysiological significance of these findings are unknown.

Lead concentrations were measured in the deciduous teeth (incisors) of 302 children living in a lead-smelter area in the FRG (Stolberg, Rheinland) and of 86 children living in a nonpolluted rural area (Gummersbach, Bergisches Land). Blood lead levels were determined in 83 of the children living in the lead-smelter area. On average, tooth lead levels of children living in the smelter area (mean: 6.0 microgram/g; range: 1.49-38.5 microgram/g) were significantly higher than those of children living in the rural area (mean: 3.9 microgram/g; range: 1.6-9.4 microgram/g). Blood lead levels were 6.8-33.8 microgram/100 ml (mean: 14.3 microgram/100 ml). Children of lead-workers had on average higher tooth lead and blood lead levels than children of people who were not lead-workers. Tooth lead levels increased with increasing duration of residence in the lead-smelter area and with the degree of local environmental pollution by lead, as indicated by the lead content of the atmospheric dust fall-out around the children's homes. The correlation coefficient of tooth lead vs blood lead was 0.47. The intra-individual variability of tooth lead levels was low (r = 0.86), and tooth lead levels of brothers and sisters were similar (r = 0.75), suggesting that tooth lead may be used as a representative and reliable indicator of long-term lead exposure.

Between 1982 and 1986 several surveys were carried out to determine the levels of lead and cadmium in blood, urine, and shed deciduous teeth (incisors only) of children living in rural, suburban, urban, and industrial areas of North-West Germany. Blood lead (PbB) and blood cadmium (CdB) were measured in about 4000 children. In rural, suburban and urban areas the median PbB levels vary between 5.5 and 7 micrograms/dl, with 98th percentiles varying between 10 and 13 micrograms/dl. The median CdB levels are between 0.1 and 0.2 microgram/dl, with 95th percentiles between 0.3 and 0.4 microgram/l. Children from urban areas have significantly higher PbB levels than children from rural and suburban areas. Regarding CdB no differences could be detected. Children living in areas around lead and zinc smelters, particularly those living very close to the smelters, have substantially increased PbB and CdB levels. Children from lead worker families also have substantially increased PbB and CdB levels. The lead levels in shed milk teeth (PbT) were determined in about 3000 children. In rural, suburban and urban areas the median PbT levels are between 2 and 3 micrograms/g, with 95th percentiles between 4 and 7 micrograms/g. Children from urban areas have significantly higher PbT levels than children from rural and suburban areas. The highest PbT levels (on a group basis) are in children from nonferrous smelter areas. The median levels of lead in urine (PbU) are between 6 and 10 micrograms/g creatinine, with 95th percentiles between 20 and 30 micrograms/g creatinine. Children from polluted areas have higher PbU levels than children from less polluted areas. The median levels of cadmium in urine (CdU) are in the order of 0.1 microgram/g creatinine, with 95th percentiles being in the range of 0.5 and 1.0 microgram/g creatinine. Girls have higher CdU levels than boys. There are no differences between groups of children from different areas. Children from lead worker families have higher PbU and CdU levels than otherwise comparable children. The results of the present studies indicate a further decrease of PbB in children from North-West Germany since the CEC blood lead campaigns carried out in 1979 and 1981. The decrease of lead exposure also seems to be reflected by a decrease of tooth lead levels.

Results from neuropsychological tests, collected under double-blind-precautions, were evaluated for 115 schoolage children (mean age: 9.4 years) living in a lead smelter area (Stolberg, FRG). Tooth-lead concentrations (PbT) from shed incisor teeth as measures of longtime lead-exposure were available for these children (mean = 6.16 ppm; range: 1.9-38.5 ppm), and for 83 of them blood-lead concentrations (PbB) were available as well (mean = 14.3 micrograms/dl; range: 6.8-33.8 micrograms/dl). The following functional capacities were tested: intelligence (German WISC), perceptual-motor integration (Göttinger Formreproduktionstest = GFT, Diagnosticum for Cerebralschädigung = DCS), reaction performance (Wiener Determinationsgerät), finger-wrist tapping-speed, and repetitive cancellation-performance (Differentieller Leistungstest). In addition standardized behavior ratings were obtained by the examiners, the mothers, and the teachers. Multiple stepwise regression-analysis (forced solution) was calculated for outcome-variables and Pb-tooth, including age, sex, duration of labor, and socio-hereditary background as covariates. Significant (P less than 0.05) or near-significant (P less than 0.1) association was established between Pb-tooth and GFT-performance (errors), reaction-performance (false reactions), and four behavioral dimensions as rated by the mothers, namely distractability, restlessness, lack of information, and wasting of time; the proportion of explained variance never exceeded 6%, however. No significant association was found between PbT and WISC verbal-IQ after the effects of "socio-hereditary background" had been eliminated, although there was still a tendency for high level-children (PbT greater than 10 ppm) to be inferior to low level-children (PbT less than or equal to 4 ppm) by 4.6 IQ-points after correction for confounding. There was a near-significant, inverse relationship between finger-wrist tapping-speed and Pb-blood. The results are discussed within the framework of attention-deficit disorder, and compared to neurobehavioral Pb-effects from animal-experiments, which provide suggestive evidence for a causal relationship between developmental lead-exposure and certain neurobehavioral deficits.

Twelve different groups of fine mine dusts were examined for their in vivo aggressivity by intraperitoneal injection. Twelve months after injection of the dust, quantitative morphometric analysis of the lymph nodes was carried out to determine (a) the extent of the typical quartz reaction, (b) the in vivo cytotoxicity, (c) the size of the lymph nodes. Different fine dusts showed significant variations in parameter (a) and (c). In the second part of the investigation, the results of the lymph node tests and of in vitro cytotoxicity tests, and also the quartz contents of the dusts were fed into a data matrix and subjected to correlation analysis and principal component analysis. The following hypotheses were arrived at to explain the effect of the fine dust in vivo: (1) The amount of fine dust which penetrates into the lymph nodes is dependent on its in vitro cytotoxicity (Factor A). This is not related to the quartz content of the dust and is not inhibited by PVNO. (2) The specific fibrogenic activity of the fine dust within the lymph node is primarily dependent on its quartz content (Factor B). It appears that this effect is inhibited by PVNO. (3) The total fibrogenic activity depends on a combination of Factor A and B.

Sera of 122 persons were examined by the neutralization and latex-agglutination inhibition tests for antibodies against Polio type I, Coxsackie virus type A 9 and B 4, as well as Echo virus type 9. With increasing age there was a titre difference between latex-agglutination inhibiting and neutralizing antibodies, due to the earlier fall in the former. These antibodies, contrary to neutralizing ones, were in the lower titre region. The results confirmed the usefulness of the latex-agglutination inhibition test in the diagnosis of acute enterovirus infections.

Measurements of carboxyhemoglobin (COHb)-content from about 13,000 inhabitants of various sites in western North Rhine-Westphalia are presented. Analyses were part of surveys on the effects of air pollution conducted between 1975 and 1980 in five designated, polluted areas. Determinations were executed in the Medical Institute for Environmental Hygiene, Duesseldorf, on behalf of the Ministry of Labour, Health and Social Administration. Analysis of blood samples for CO-content was performed by gas chromatography. Carboxyhemoglobin levels were calculated by reference to the individual hemoglobin levels. Our surveys have been conducted during several years and included different seasons. Before 1977, fifty years old men were investigated. Until 1978, sixty years old men were studied. In 1979 and 1980, sixty years old women and ten years old children were additionally incorporated into the survey. Statistical analysis of data included variables which influence personal CO-burden such as smoking, and in the case of non-smokers indoor air exposure through passive smoking, use of gas facilities and heating in the flat, as well as occupational exposure. Besides, the influence of age, sex and location was considered. The average COHb-level of the populations under study was expressed as the median of the distribution. The distribution-free Mann-Whitney U-test served for assessment of differences between groups. As a further parameter, the percentage of the measurements greater than 2,5% COHb was chosen, because it was thought to be more relevant to risk populations, i.e. people suffering from Angina pectoris. As expected, tobacco smoking exerted the greatest influence on COHb-level. In non-smokers a trend, indicating a relationship between indoor air pollution and COHb-content could be observed. If high CO gas such as coke gas was used in flats with gas facilities COHb-levels were significantly raised. Surveys performed in 1979 and in 1980 showed a sex-dependent difference between median COHb saturations, women having lower values than men. The difference of these figures between adults and children is statistically significant. Comparisons between adult nonsmokers from various sites prompted a significant difference only in the case of the Oberbergischer Kreis (County), having the lowest median COHb-value. The highest COHb-levels by far were encountered in the city of Duisburg in January 1979, when very unfavourable meterological conditions (Smog alarm, degree 1) were present. The median COHb saturations reached on this occasion were very near to the limits considered to be critical for populations at special risk.