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BACKGROUND Interaction between respiratory multimorbidity and lung function has not been examined in longitudinal population studies. We aimed to assess the association of multimorbidity of asthma and rhinitis with lung function and bronchial hyperresponsiveness in comparison with single and no allergies from early school age to young adulthood. METHODS In 1990, the Multicenter Allergy Study birth cohort recruited 1314 newborns from 5 German cities. At 7, 13, and 20 years, we performed lung function and bronchial challenge tests. We assessed symptoms, medications, and doctor's diagnoses for asthma and rhinitis for 3 outcomes: current multimorbidity (both coexisting), asthma only, and rhinitis only. RESULTS From 7 to 20 years, multimorbidity prevalence more than doubled from 3.5% to 7.7%, current asthma only (without rhinitis co-occurring) decreased by half from 2.8% to 1.3%, and current rhinitis only (without asthma co-occurring) increased from 14.3% to 41.6%. Resting lung function parameters differed between allergic and asymptomatic participants but showed no considerable differences between the allergic phenotypes. Frequency and severity of bronchial hyperresponsiveness were particularly associated with multimorbidity. At the age of 20 years, participants with multimorbidity showed a clearly higher severity in hyperresponsiveness compared to participants who suffered only asthma (P = .049) or rhinitis (P = .008) or were asymptomatic (P

Vitamin-D-Mangel verursacht Rachitis und Osteomalazie. Da Vitamin-D-Metaboliten hormonale Funktionen haben und in mindestens 38 unterschiedlichen Geweben Rezeptoren dafur nachgewiesen wurden, geht die vorliegende Arbeit der Frage nach, inwieweit niedrige 25-Hydroxyvitamin-D[25(OH)D]-Werte von Kindern und Jugendlichen auch mit Auswirkungen auf die korperliche, seelische und soziale Gesundheit sowie auf Gesundheitsrisiken assoziiert sind. Die Daten des Kinder- und Jugendgesundheitssurvey (KiGGS; n = 17.641) wurden fur die Analyse der Beziehungen der 25(OH)D-Werte mit Daten zu Lebensqualitat, einzelnen Krankheiten, Entwicklung und Verhalten der Teilnehmer herangezogen. Dafur standen ab dem zweiten von 3 Untersuchungsjahren 10.015 25(OH)D-Werte der verbliebenen 12.340 Falle (81 %) zur Verfugung. Fur bivariate Analysen und multivariable Modellierung kam IBM SPSS 20.0 zum Einsatz. In den ersten 3 Lebensjahren waren die Haufigkeiten von Verletzungen, Infektionskrankheiten, langsamerer Entwicklung, Schlafstorungen und schlechterem allgemeinem Gesundheitszustand signifikant mit erniedrigten 25(OH)D-Werten assoziiert (p

Hintergrund Vitamin D kann der Organismus aus Vorstufen unter der Wirkung von Sonnenlicht selbst bilden. Wenn die Sonnenwirkung nicht ausreicht, muss es als Mikronahrstoff zugefuhrt werden, weil es sonst zu Mangelerscheinungen kommt, v. a. zu Storungen der Mineralisation von Hartgeweben. Im Kinder- und Jugendgesundheitssurvey (KiGGS), der ersten reprasentativen Erhebung zur Gesundheit der nachwachsenden Generation, wurde neben vielen anderen Merkmalen auch 25(OH)D gemessen, der seit Langem beste Indikator fur den Vitamin-D-Versorgungszustand.

Background The occurrence of allergic multimorbidity (coexistence of asthma, allergic rhinitis and eczema) has not been evaluated longitudinally from early childhood up to adulthood in a population-based study sample. We aimed to determine the prevalence of allergic multimorbidity up to age 20 stratified by parental allergies and sex/gender using extensive prospective follow-up data from two decades of a birth cohort study. Methods In 1990, we recruited 1314 healthy newborns from 6 maternity wards across Germany for the population-based MAS birth cohort study. The sample was purposely risk-enriched by increasing the proportion of children at high allergy risk (i.e. at least 2 allergic family members among parents and siblings) from 19% in the source population to 38% in the final sample. The remaining 62% of all MAS children had a low or no allergy risk. Symptoms, medication and doctor's diagnoses of allergic diseases have been assessed using standardized questionnaires including validated ISAAC questions in 19 follow-up assessments up to age 20. Allergic multimorbidity at each time point was defined as the coexistence of at least 2 of the following diseases in one participant: asthma, allergic rhinitis and eczema. Results Response at age 20 was 72% (n = 942) of all recruited participants. At age 20, 18.5% (95% CI, 15.0–22.5%) of all participants with allergic parents had 2 or 3 concurrent allergies as compared to only 6.3% (95% CI, 4.3–9.0%) of those with non-allergic parents. At this age, allergic multimorbidity was similar in women and men (12.7% (95% CI, 9.7–16.2%) vs. 11.6% (95% CI, 8.9–14.8%)), whereas single allergic diseases were slightly more common in women than men (24.2% (95% CI, 20.2–28.5%) vs. 20.1% (95% CI, 16.6–24.0%)). Asthma occurred more frequently with coexisting allergic rhinitis and/or eczema than as a single entity from pre-puberty to adulthood. Conclusion Having parents with allergies is not only a strong predictor to develop any allergy, but it strongly increases the risk of developing allergic multimorbidity. In males and females alike, coexisting allergies were increasingly common throughout adolescence up to adulthood. Particularly asthma occurred in both sexes more frequently with coexisting allergies than as a single entity.

Verhaltensauffälligkeiten im Kindesalter stellen einen Risikofaktor für psychische Auffälligkeiten und verminderte schulische Leistungsfähigkeit dar. Die Studie untersucht, ob eine geringere Funktionalität im Grundschulalter die Auftretenswahrscheinlichkeit von Schulproblemen in der Adoleszenz erhöht. Fragebogendaten der 9-, 11- und 15-Jahres Nachuntersuchungen der MAS-Geburtskohorte (N=1314 Baselineerhebung bei Geburt; 47.9 % Mädchen, 52.1 % Jungen) werden ausgewertet. Erhoben werden Funktionalität auf den Dimensionen Psychisches Wohlergehen, Körperlicher Status, Soziale Beziehungen und Alltagsfunktionsfähigkeit zu 9 Jahren sowie das Vorkommen von Schulproblemen mit 11 und 15 Jahren. Eine geringere Funktionalität im Alter von 9 Jahren geht mit einer erhöhten Auftretenswahrscheinlichkeit von Schulproblemen mit 11 (adjustierte Odds Ratio [aOR]=3.53, 95 %Konfidenzintervall [KI] 2.20 – 5.66) und 15 Jahren (aOR=3.22, 95 %KI 1.85 – 5.62) einher. Diese Effekte zeigen sich deutlicher für Jungen als für Mädchen. Bereits Grundschulkinder können Einschränkungen in ihrer Funktionalität zeigen, welche über Jahre stabil zu bleiben scheinen und mit Schulproblemen in der Adoleszenz einhergehen können.

Aim:To compare the growth attainment of preterm children and their cardiovascular risk factors at adolescence with the values measured in term children in Germany.Methods:About 17,641 children aged 0 to Results:About 11.8% of the 16,737 children with complete and valid data had been born preterm. After adjustment for covariates the estimated z-scores over the total age range were larger in term compared to preterm children for length/height (PConclusions:Preterm-born German adolescents remained significantly shorter, lighter, and had a smaller head circumference than term-born adolescents, but the risk indicators for cardiovascular diseases were not higher.

Die Zahngesundheit von Kindern hat sich in Deutschland in den letzten drei Jahrzehnten insgesamt gunstig entwickelt. Dazu haben das Engagement der Kinderarzte und die breite Verwendung von Fluoriden entscheidend beigetragen. Leider geht das Vorkommen von Milchzahnkaries in den letzten Jahren kaum noch zuruck, in manchen Regionen steigt es sogar wieder an. Das muss nicht sein, denn Zahnkaries ist weitgehend vermeidbar.

In June 1909, The Empress Auguste Victoria House in Berlin was opened. This first institute for preventive paediatrics had the objective to overcome infant mortality in Germany. This objective was attained. Since then, an unprecedented decrease of mortality in all age groups occurred as well as a doubling of life expectancy. With this "retreat of death", our concepts of health changed fundamentally, and a new spectrum of diseases emerged. This article discusses some mile stones of this change, and explains why we find more illness despite the great improvement in the field of health. The "new diseases" amenable to early prevention are presented in a table. To make disease prevention successful requires the participation of the individual. Therefore, it is important to know the demand to make a good programme effective in the population. Empirical results of a nationwide representative study on the demand by expecting and young parents for preventive consultation are presented. Anticipatory guidance of young parents is a modern approach to health promotion and disease prevention. A controlled trial shows that this approach improved knowledge, behaviour, health risk indicators, health, and development during the first two years after delivery. Future studies should focus on long term effects of early health promotion.

UNLABELLED Knowledge of the risks of smoking during pregnancy induces only part of the pregnant women to give up smoking. How many pregnant women in Germany smoke from the beginning to delivery, and what characterises these smokers, is the topic of this article. METHODS Results from the German Mikrozensus, several national surveys, perinatal statistics and Euro-scip III are presented, compared, and assessed. Findings of our own studies conducted between 1999 and 2002 at the obstetric department and gynacological practices in Berlin allow an insight into the magnitude of "underreporting". RESULTS In the ages 15-45 years 36-45 % of German women smoke, prevalence rates that probably are valid even for the beginning of pregnancy. While smoking prevalence in men has decreased during the last 20 years, there is an increasing trend in women. The prevalence is higher in pregnant women of low social status, living with smoking partners and those of German nationality. At most, half of the women give up smoking during pregnancy. Assuming an "underreporting" in pregnant women of at least one third, the prevalence of smoking up to delivery is 24 %. Although 76 % of the practicing gynacologists in Berlin feel responsible for smoking counselling, only 12 % are convinced that it is successful. CONCLUSIONS A quarter of the pregnant women in Germany smoke through to delivery, which means that 150 000 newborns per year have been exposed to passive smoking in utero, and its long-term health effects, which is a national disaster.

Background: Phenotypes of childhood-onset asthma are characterized by distinct trajectories and functional features. For atopy, definition of phenotypes during childhood is less clear. Objective: We sought to define phenotypes of atopic sensitization over the first 6 years of life using a latent class analysis (LCA) integrating 3 dimensions of atopy: allergen specificity, time course, and levels of specific IgE (sIgE). Methods: Phenotypes were defined by means of LCA in 680 children of the Multizentrische Allergiestudie (MAS) and 766 children of the Protection against allergy: Study in Rural Environments (PASTURE) birth cohorts and compared with classical nondisjunctive definitions of seasonal, perennial, and food sensitization with respect to atopic diseases and lung function. Cytokine levels were measured in the PASTURE cohort. Results: The LCA classified predominantly by type and multiplicity of sensitization (food vs inhalant), allergen combinations, and sIgE levels. Latent classes were related to atopic disease manifestations with higher sensitivity and specificity than the classical definitions. LCA detected consistently in both cohorts a distinct group of children with severe atopy characterized by high seasonal sIgE levels and a strong propensity for asthma; hay fever; eczema; and impaired lung function, also in children without an established asthma diagnosis. Severe atopy was associated with an increased IL-5/IFN-gamma ratio. A path analysis among sensitized children revealed that among all features of severe atopy, only excessive sIgE production early in life affected asthma risk. Conclusions: LCA revealed a set of benign, symptomatic, and severe atopy phenotypes. The severe phenotype emerged as a latent condition with signs of a dysbalanced immune response. It determined high asthma risk through excessive sIgE production and directly affected impaired lung function.

The first few months of life represent a window of opportunity for neonatal oral tolerance induction and prevention of allergy. Maternal rather than paternal atopic status has a greater effect on the atopic outcome of the progeny, which raises the question of whether maternal factors such as immune status, breastfeeding, and immunologic constituents of breast milk and dietary and environmental exposure have a role. In mice, breastfeeding has a role in tolerance induction and protection against asthma using adoptive nursing models. In epidemiologic studies, there is conflicting evidence regarding the protective impact of breastfeeding against allergic diseases, which may be attributable at least in part to differences in breast milk composition, the genetic predisposition of the infants, or gene–environment interactions. This chapter will review epidemiologic studies assessing the protective role of breast milk and the impact of maternal interventions during lactation on development of atopic diseases in children. The immunologic composition of breast milk will also be discussed.

TOPIC: We studied those characteristics of mothers that are related to occupational activity two years after the birth of the first child. Differences in the health-related quality of life between working mothers and mothers who are not working were also analysed, taking other parameters into account, in particular household income. METHODOLOGY: 311 mothers with a first child were given a questionnaire on the quality of life based on WHOQOL-BREF, on depression (also surveyed one year before for 139 mothers), on their work situation, socio-demography and other possible confounders. The probability of vocational activity was analysed using logistic regression and the influence of multiple roles on the quality of life was analysed using multiple linear regression. RESULTS: About 60% of mothers were not working two years after the birth of their first child, 25% were working part-time and 11% full time, with 4% in training or education. Working mothers were more likely to have a higher level of education (60% vs. 31%) and less likely to have a household income below the poverty line (13% vs. 47%). The results of the logistic regression showed that the odds ratio for being employed was six times higher for mothers with higher education than mothers with a lower level of education [OR 5.99; 95% confidence interval (CI) 2.58-13.91], whereas the odds ratio for mothers with additional children against those with only one child was 0.14; (95% CI 0.05-0.40), and for mothers with German nationality against those of other ethnicities the odds ratio was 2.37 (95% CI 1.12-5.04). Working mothers give more positive ratings than non-working mothers for their physical and mental quality of life (both p

Die Erhebungen des Kinder- und Jugendgesundheitssurvey (KiGGS) zwischen Mai 2003 und Mai 2006 erfassten insgesamt 17.641 Kinder und Jugendliche in 167 fur die Bundesrepublik reprasentativen Stadten und Gemeinden. Mit den derzeit verfugbaren Daten zu perinatalen Risiken fur die Gesundheit und Entwicklung von Kindern wurden folgende Ergebnisse gewonnen: In den zuruckliegenden 20 Jahren ist die durchschnittliche Gewichtszunahme wahrend der Schwangerschaft signifikant um mehr als 2 kg angestiegen, das mittlere Geburtsgewicht signifikant um durchschnittlich 50 g angestiegen und kein sicherer zeitlicher Trend beim Rauchen und Alkoholkonsum in der Schwangerschaft erkennbar. Zwischen Gewichtszunahme in der Schwangerschaft und dem Geburtsgewicht besteht eine signifikante Korrelation, fur Erstgeborene erklart sie etwa 5% der Varianz des mittleren Geburtsgewichts. 17–18% der Frauen gaben an, wahrend der Schwangerschaft geraucht zu haben, in der niedrigen Sozialstatusgruppe waren es etwa 4-mal so viele wie in der hohen. Etwa 14% der Schwangeren konsumierten Alkohol gelegentlich, regelmasig getrunken haben unter 1%. Nur 5% der Mutter von Kindern mit Migrationshintergrund, aber 3-mal so viele Mutter von Kindern ohne Migrationshintergrund konsumierten Alkohol in der Schwangerschaft und 2,5- mal so viele in der sozialen Oberschicht wie in der Unterschicht. Beim Rauchen und beim Alkoholkonsum in der Schwangerschaft besteht gesundheitspolitisch dringender Handlungsbedarf.

Introduction: Preterm birth is a global scourge, the leading cause of perinatal mortality and morbidity. This study set out to identify the principal risk factors for preterm birth, based on the German Health Interview and Examination Survey for Children and Adolescents (KiGGS). A range of possible factors influencing preterm birth were selected for inclusion in the questionnaire, covering factors such as gender, national origin, immigrant background, demography, living standard, family structure, parental education and vocational training. Methods: All data were taken from the aforementioned KiGGS survey conducted between 2003 and 2006. A total of 17 641 children and adolescents (8656 girls and 8985 boys) drawn from 167 German towns and municipalities deemed to be representative of the Federal Republic of Germany were included in the study. Gestational age at birth was available for 14 234 datasets. The questionnaire included questions from the following areas as possible factors influencing preterm birth: gender, national origins, immigrant background, demography, living standard, family structure, parental education and vocational training. Results: The preterm birth rate was 11.6 %, higher than that of other national statistical evaluations. Around 57.4 % of multiple pregnancies and 10 % of singleton pregnancies resulted in preterm delivery. Multiple pregnancy was found to be the most important risk factor (OR 13.116). With regard to national origins and immigration background, mothers from Turkey, the Middle East, and North Africa had a higher incidence of preterm birth. Preterm birth was more prevalent in cities and large towns than in small towns and villages. Conclusion: Risk factors associated with preterm birth were identified. These should help with the early identification of pregnant women at risk. The preterm birth rate in our survey was higher than that found in other national statistical evaluations based on process data. More than half of all multiple pregnancies ended in preterm birth.

Der Kinder- und Jugendgesundheitssurvey soll reprasentative, gultige Daten und Erkenntnisse zur gesundheitlichen Situation von Kindern und Jugendlichen in Deutschland als entscheidende Voraussetzung fur die Bewertung und die Verbesserung von deren gesundheitlicher Lage schaffen. Forschung und insbesondere Blutentnahmen an nichteinwilligungsfahigen Personen erfordern eine profunde ethische und rechtliche Uberprufung. Der Beitrag befasst sich damit, welche medizinethischen Empfehlungen und welche rechtlichen Grundsatze in Deutschland fur die Bewertung relevant sind. Nach geltendem deutschen Recht konnen Eltern zu Blutentnahmen bei ihren Kindern nur zustimmen, wenn diese in deren individuellem gesundheitlichen Interesse liegen. Ein „gruppenspezifischer Nutzen“, wie er von Medizinethikern national und international als Voraussetzung fur ethische Akzeptabilitat (bei minimalem Risiko der Untersuchungen) ebenfalls fur sinnvoll und wichtig angesehen wird, und der in dem geplanten Survey in jedem Falle gegeben ware, genugt deutschen Rechtsanspruchen nicht. Im Pretest hat sich der potenzielle individuelle Nutzen der Blutentnahmen bestatigt: Viele Kinder hatten biochemisch nachweisbare Gesundheitsrisiken (z. B. verborgener Nahrstoffmangel, allergische Sensibilisierung, Hinweise auf Impflucken oder langfristige Gesundheitsrisiken), die ohne Blutuntersuchung nicht feststellbar gewesen waren. Bei uber 90% der Kinder waren nach schriftlicher Einwilligung der Eltern und Jugendlichen sowie informeller Zustimmung der Kinder, die in jedem einzelnen Falle berucksichtigt wurde, Blutentnahmen moglich. Nach der Befragung einer Unterstichprobe ist die Akzeptanz insgesamt gut.

To investigate the trend in the prevalence of neonatal macrosomia and to evaluate the influences of potential determinants, key features of 206 308 hospital deliveries (97% of all) in Berlin in the years 1993-99, collected by the Berlin Medical Board, were analysed using SPSS 10.0. After exclusion of multiple births and preterm infants, there was a significant increase over 7 years (P0.01) in the prevalence of birthweightsor= 4000 g, maternal ageor= 30 years, height ofor= 165 cm, prepregnancy BMI (body mass index)or= 26 kg/m2 and pregnancy weight gain16 kg, but no substantial trend in the prevalence of recognised diabetes or maternal smoking. The adjusted model (OR [95% CI]) for delivering a newbornor= 4000 g was statistically significant for post-term delivery (2.56 [2.39, 2.75]), women agedor= 30 years (1.06 [1.02-1.11]),or= 165 cm tall (1.94 [1.87,2.01]), multiparae (1.98 [1.91, 2.05]), not smoking in pregnancy (2.03 [1.93, 2.14]), prepregnancy BMIor= 26 compared with20 (4.01 [3.77, 4.26]), pregnancy weight gainor= 16 kg compared with10 kg (3.37.[3.22, 3.53]) and for recognised diabetes (1.85.[1.69, 2.04]). It is speculated that this increase in the prevalence of neonatal macrosomia may contribute to the secular trend of overweight and obesity under affluent living conditions.

At the beginning of the 21st century, the German Health Interview and Examination Survey of Children and Adolescents will for the first time provide the data essential for programmes of disease prevention and health promotion as well as for the development of health targets. This it will create key information for an evidence-based health policy. The results of the study can be projected to the general population of children and adolescents in Germany. The data will be collected conjunct at the level of the individual subject. They will facilitate valid and distinct description of prevalent physical, psychological and social health problems, as well as on who has them under which circumstances and settings. Information on the impact, e.g., in terms of utilisation of the health system or impairments of quality of life, will also be available from the same subjects. In addition, indicators of risks to health in later life are included. Hence, the data will support prevention of health problems in infancy, childhood and adolescence as well as of chronic diseases in later life. Finally, the data shall be a basis for the definition of new reference values for many variables. This will improve valid and clear judgement not only in epidemiological studies but also in medical care.

The German National Health Interview and Examination Survey for Children and Adolescents aims at obtaining generalisable and practically convertible data and knowledge of the health situation of children and adolescents aged between 0 and 18 and living in Germany. After an extensive preparatory period of conceptional work by the Robert Koch Institute the beginning of this study is planned for spring 2003. Over a period of three years a representative sample of 18,000 young people will be medically examined and will be interviewed together with their parents. The investigational programme of the survey consists of a central part encompassing questionnaires and medical analyses of the most important health topics in childhood and adolescence. In addition, complementary modules will analyse subpopulations in-depth and extensively for specific aspects and questions. These modules are usually developed and financed by cooperating partners of the Robert Koch Institute. Soon after completion of the survey data first results will be made freely available to the scientific community in Public Use Files. These Files will become relevant sources for future health reporting addressing children and adolescents. Furthermore, they represent a reliable data base for epidemiological research and prevention programmes.

Laboratory tests will be performed as part of the National Health Survey for Children and Adolescents to identify health risks and to determine the seroprevalence of disease markers. The parameters were selected from haematology, clinical chemistry, allergology, endocrinology and serology of infectious diseases as indicators of individual health risks, to validate information collected by means of the questionnaires and to identify age specific immunity gaps of vaccine-preventable diseases.

In the pilot study of the National Health Survey for Children and Adolescents which has been conducted under the responsibility of the Robert Koch Institute from March 12 th 2001 to March 15 th 2002,1,630 children and adolescents from 0 to 17 years as well as their parents have been included. Methodological issues have been very prominent. Questionnaires regarding properties, indicators (for example for psychic well-being) were developed and evaluated, different methods of access to the study participants as well as methods to increase the motivation to participate in the study were tested, and the property for generalisation or validity of the obtained information was investigated. The conduct of the pilot study resulted in a number of experiences and findings that will contribute to an optimised approach in the main course of the survey.

The National Health Survey for Children and Adolescents intends a comprehensive description of the health status of children and adolescents. In this context physical examination of children and adolescents permits collection of objective data concerning physical development, certain body functions and selected performance parameters. Most important are indicators pointing towards increasing developmental and health problems in children and adolescents, which are partly predictive for the health status as an adult. Body measurements including stages of puberty will be taken, the blood pressure measured, vision tests carried out, coordination skills and endurance tested. Besides, if acute symptoms are detected, severity of atopic dermatitis is recorded. The methods and instruments have been tested in a pilot study over a period of one year and were optimised for the main study.

Die aktuelle epidemiologische Datenlage zur Gesundheit von Kindern und Jugendlichen offenbart die Notwendigkeit einer reprasentativen Gesundheitserhebung fur die 0- bis 17-Jahrigen. Ein uber mehrere Jahre entwickeltes Konzept fur einen Kinder- und Jugendgesundheitssurvey wurde in einer einjahrigen Pilotphase mit 1630 Kindern und Jugendlichen getestet. Die dabei gewonnenen Erfahrungen sowie Gutachterempfehlungen werden in einem im Jahr 2003 beginnenden Gesundheitssurvey fur ca. 20.000 Kinder und Jugendliche umgesetzt. Diese bislang groste reprasentative Studie zur Gesundheit der heranwachsenden Generation in Deutschland wird gemeinsam vom Bundesministerium fur Gesundheit, dem Bundesministerium fur Bildung und Forschung und dem Robert Koch-Institut finanziert. Dabei sollen uber drei Jahre in der ganzen Bundesrepublik zufallig ausgewahlte Kinder und Jugendliche im Alter von 0 bis 17 Jahren gesundheitlich untersucht und befragt werden. Bei den jungeren Kindern sind die Angaben der Eltern wesentliche Informationsquelle zum Gesundheitszustand der Kinder. Die durch den Survey gewonnenen Informationen werden nicht nur die Basis fur eine fundierte bundesweite Gesundheitsberichterstattung zu Kindern und Jugendlichen sein, sondern auch Ansatzpunkte fur Interventions- und Praventionsstrategien liefern. Die Daten werden schnellstmoglich der Fachoffentlichkeit als Public Use File zur weiteren Analyse zur Verfugung gestellt.

Background The results of numerous studies on the influence of breastfeeding in the prevention of atopic disorders are often contradictory. One of the most important problems is confounding by other lifestyle factors. Objective The aim of the present study was to analyse the effect of any breastfeeding duration on the prevalence of atopic eczema in the first seven years of life taking into account other risk factors. Methods In an observational birth cohort study 1314 infants born in 1990 were followed-up for seven years. At 3, 6, 12, 18, 24 months and every year thereafter, parents were interviewed and filled in questionnaires, children were examined and blood was taken for in vitro allergy tests. Generalized Estimation Equations (GEE)-models were used to model risk factors for the prevalence of atopic eczema and for confounder adjustment Results Breastfeeding was carried out for longer if at least one parent had eczema, the mother was older, did not smoke in pregnancy, and the family had a high social status. The prevalence of atopic eczema in the first seven years increased with each year of age (OR 1.05; 95% CI 1.01-1.09 for each year), with each additional month of breastfeeding (1.03; 1.00-1.06 for each additional month), with a history of parental atopic eczema (2.06; 1.38-3.08), and if other atopic signs and symptoms appeared, especially specific sensitization (1.53; 1.25-1.88), and asthma (1.41; 1.07-1.85). Although breastfeeding should be recommended for all infants, it does not prevent eczema in children with a genetic risk. Conclusion Parental eczema is the major risk factor for eczema. But in this study, each month of breastfeeding also increased the risk.

Allergic rhinitis (AR) is one of the most common chronic diseases, usually starting in the first 2 decades of life. Information on predictors, risk, and protective factors is missing because of a lack of long-term prospective studies.Our aim was to examine early-life environmental and lifestyle determinants for AR up to age 20 years.In 1990, the Multicenter Allergy Study included 1314 newborns in 5 German cities. Children were evaluated at 19 time points. A Cox regression model examined the associations between 41 independent early-life factors and onset of AR (as the primary outcome), including sensitization against aeroallergens and the secondary outcomes of nonallergic rhinitis and AR plus asthma.Two hundred ninety subjects had AR within 13,179 person years observed. The risk of AR was higher with a parental history of AR (adjusted hazard ratio [aHR], 2.49; 95% CI, 1.93-3.21), urticaria (aHR, 1.32; 95% CI, 1.00-1.74), or asthma (aHR, 1.29; 95% CI, 0.95-1.75). Early allergic sensitization (aHR, 4.53; 95% CI, 3.25-6.32), eczema within the first 3 years of life (aHR, 1.83; 95% CI, 1.38-2.42), male sex (aHR, 1.28; 95% CI, 1.02-1.61), and birthday in summer or autumn (aHR, 1.26; 95% CI, 1.00-1.58) were independent predictors of AR up to age 20 years. None of the other socioeconomic, environmental, lifestyle, pregnancy, and birth-related factors were associated with AR.Only nonmodifiable factors, particularly early allergic sensitization or eczema and parental AR, predicted AR up to age 20 years. No modifiable aspects of early-life environment or lifestyle were identified as targets for primary prevention.

Die Rauchpravalenz von Schwangeren hangt vom Sozialstatus ab. Welchen Einfluss haben intrauterine Tabakexposition und Sozialstatus auf das Geburtsgewicht? Es wurden hierzu die Daten der multizentrischen Allergiestudie von 1990 herangezogen, welche prospektiv in 4 Universitatskliniken und 2 stadtischen Krankenhausern der Bundesrepublik-West durch Fragebogen erhoben wurden. Es konnten 5395 (71 %) im Jahr 1990 geborene Neugeborene und deren Mutter in die Analyse eingeschlossen werden. Die Auswertung erfolgte mittels bivariater und multivariater linearer Regressionsanalyse. 28,6 % der befragten Frauen rauchten wahrend der Schwangerschaft. Die Neugeborenen von Frauen mit niedriger Bildung hatten ein niedrigeres Geburtsgewicht als die Neugeborenen von Frauen mit hoherer Bildung (p = 0,06). Dieser Effekt wurde verstarkt, wenn die Mutter wahrend der Schwangerschaft geraucht hatten (p < 0,001). In Deutschland scheinen die Auswirkungen eines niedrigeren Bildungsstandes auf das Geburtsgewicht geringer zu sein als die der vermeidbaren Einflussgrose Rauchen. Smoking prevalence during pregnancy usually depends on social status. Our aim was to evaluate the influence of intrauterine tobacco exposure and social status on birth weight. The investigation is based on data from a prospective multicenter atopy study (MAS90) carried out in four University hospitals and two municipal hospitals in Western Germany. We included 5395 (71 %) newborn babies delivered in 1990 and their mothers. Data was supplied by a questionnaire, taken during the first week after childbirth, and analysed using both bivariate and multivariate linear regression. 28.6 % of the interviewed women smoked during pregnancy. Newborns of women with lower educational status weighed less than those of women with higher educational status (p = 0.06). This difference became statistically significant (p < 0.001) in cases were the mother smoked during pregnancy. In Western Germany the influence of the educational level of pregnant women on their babies' birth weight seems to be smaller than the impact of smoking.

Background Allergic diseases are more prevalent in affluent countries, which has been attributed to life-style factors. Life-style habits may also differ between socioeconomic (SES) classes. The objective of this paper therefore was to evaluate if SES had an impact on the development of atopic disorders. Methods A total of 1314 German children were followed-up in an observational birth cohort study to 6 years of age. Parents filled in questionnaires, and had multi-allergen screening tests for sensitization. Indoor allergen concentrations were determined by ELISA. Children were examined regularly up to 6 years, specific serum IgE values were determined by CAP-Rast-Feia. Results The risk of aeroallergen sensitization (odds ratio 1.76; 95% CI 1.30–2.37), and the lifetime prevalence of hay fever (2.36; 1.76–3.17), and asthma (1.74; 1.08–2.80), but not of atopic dermatitis (AD: 0.90; 0.54–1.51) was elevated in parents of high compared to low SES. With high SES the risk of smoking in pregnancy (0.35; 0.23–0.51), in the home (0.31; 0.21–0.46), pet ownership (0.37; 0.26–0.55), high mite (0.42; 0.25–0.74), and high cat (0.38; 0.18–0.82) allergen concentration in house dust was reduced, but elevated for breastfeeding over more than 6 months (4.67; 2.9–7.48). In children, even after controlling for other risk factors, only the risk of AD from 3 to 6 years (2.42; 1.42–4.14) was elevated in families with high SES, but not of AD in infancy or of any other atopic disorder. Conclusions While parents of high SES have a higher prevalence of inhalative allergies, their favourable life-style prevents the development of atopic disorders in their children, except for AD beyond infancy.

OBJECTIVES: This study determined the effects of social changes in East Germany since 1989 on patterns of injury mortality. METHODS: Death certificate data regarding injuries from 1980 through 1995 and police data regarding traffic injuries in East Germany from 1980 through 1998 were compared with similar data from West Germany. RESULTS: The number of motor vehicle-related injuries and deaths in East Germany increased dramatically between 1989 and 1991, whereas those in West Germany declined slightly. The increased mortality in the more rural East has especially involved young men driving automobiles on rural roads and has persisted since reunification of East and West Germany. Falls, other accidents, and suicides have shown no such effect. Homicide among East German men has increased but remains uncommon. CONCLUSIONS: Recent social changes in East Germany, including increased access to motor vehicles and decreased restrictions on personal freedom, have been associated with increased motor vehicle crashes and mortality, especially among young men and on rural roads.

BACKGROUND Are expecting parents prepared to change their lifestyle to benefit their unborn child? Do they see a need for more knowledge and competence to be good parents? What are the key expectations with respect to pregnancy, delivery conditions, and infant health care? To answer these questions, a study presented them to expecting and young parents in Germany. METHODS 123 delivery units were selected to represent the 1120 delivery facilities of Germany identified in 1997 from all accessible sources. 109 participated, and of 7862 distributed questionnaires 5900 (75%) were filled-in completely by parents. RESULTS Most parents (73%) expect information about pregnancy, birth and child health care in any instance. 25% would request information but only in problem situations. Preferred topics were prevention of diseases of the mother and her child (97%), intra-uterine development, preparation for delivery as well as breastfeeding, and nutrition of the infant (90% each). Although books had been the most frequent source of information, pediatricians, midwives, and gynecologists received the highest scores for satisfaction with their advice. The majority of expecting and new parents wished to get personal advice. For the choice of the delivery place, 59% had consulted friends and relatives, 43% their gynecologist. The most important criteria for their decision were high medical standards (95%), the hospital's attitude towards breast feeding and rooming-in (94% each), as well as the availability of neonatal care (89%). Also of prime interest were mother-child-contact immediately after delivery (99%), and well-rested personnel (96%). CONCLUSIONS Across social classes, most expecting and new parents see a need of a broad spectrum of topics in health information and education related to pregnancy, delivery and the expected infant. As far as delivery is concerned, most expect a perfect combination of modern medical care and safety on the one hand, and the undisturbed humane experience of the birth on the other.

Der aufbereitete und pseudonymisierte Datensatz der Krankenhausabgangsdiagnose-Statistik der DDR wurde hinsichtlich der krankenhausbezogenen Fall-Fatalitat fur geschlossene proximale Femurfrakturen (ICD-9 820.0, 820.2, 820.8) untersucht. Die Fall-Fatalitat von 20,2% nach durchschnittlich 60 Tagen ist im internationalen Vergleich und im Vergleich mit vorhandenen Daten fur die alten Bundeslander hoch. Neben dem erwarteten Einfluss des Lebensalters war eine verminderte Sterblichkeit bei transzervikalen (intrakapsularen) Frakturen, bei Frauen und bei Sitz der behandelnden Klinik in Ost-Berlin zu beobachten. Diese nach Alter, Geschlecht, und Frakturtyp adjustierte Reduktion der Sterblichkeit in Ost-Berlin gegenuber den anderen Bezirken der DDR auf ein Drittel erklart sich am wahrscheinlichsten durch eine bessere medizinische Versorgung in Ost-Berlin als Hauptstadt der DDR. Die bei dieser Modellanalyse beobachteten Disparitaten geben auch einen generellen Hinweis auf den Einfluss des medizinischen Versorgungsniveaus auf die mit dieser bevolkerungsmedizinisch bedeutsamen Erkrankung verbundene Sterblichkeit.

The increasing and extreme death toll of infants and children during the nineteenth century in industrializing countries was the starting signal for public recognition of the vulnerability of young children and their mothers and for public preventive measures. These ranged from city planning to improved hygiene, vaccinations against deadly infections, and mother education in infant care. While child survival and physical health are still prominent issues in many developing countries, prevention of, or compensation for, early social and psychological risks for later major problems have come into scientific and public focus during the past 60 years.

Natural processes do not always function perfectly. In breastfeeding, problems are encountered in up to 80% of mother-infant dyads. Altogether, in Western societies, the difficulties reduce the breastfeeding rate within the first months drastically. To deal with the problems of breastfeeding efficiently requires a profound understanding of its physiology, as well as of its psychological and social determinants. This review focuses on the current knowledge of breastfeeding physiology, only touching the psychosocial factors, which are included in the promotion strategies. Subsequently, it scrutinizes definitions, incidences, prevention, and treatment of breastfeeding problems faced most frequently by nursing mothers and their consultants. Not all measures used in counseling mothers and not all treatments for the most common medical problems withstand a careful evaluation on the basis of current scientific data. However, applying proven prevention strategies will significantly improve the well being of mothers and their infants, and may contribute to an affective attitude that increases the success, frequency, and duration of breastfeeding.

Background The lack of longitudinal data analyses from birth to adulthood is hampering long-term asthma prevention strategies. Objective We aimed to determine early-life predictors of asthma incidence up to age 20 years in a birth cohort study by applying time-to-event analysis. Methods In 1990, the Multicenter Allergy Study included 1314 newborns in 5 German cities. Children were evaluated from birth to age 20 years at 19 time points. Using a Cox regression model, we examined the associations between 36 early-life factors and onset of asthma based on a doctor's diagnosis or asthma medication (primary outcome), typical asthma symptoms, or allergic asthma (including positive IgE measurements). Results Response at 20 years was 71.6%. Two hundred eighteen subjects met the primary outcome criteria within 16,257 person years observed. Asthma incidence was lower in participants who were vaccinated (measles, mumps, and rubella vaccine/tick-borne encephalitis vaccine/BCG vaccine: adjusted hazard ratio [HR], 0.66 [95% CI, 0.47-0.93]). Up to age 20 years, asthma incidence was higher in subjects who had parents with allergic rhinitis (adjusted HR, 2.24 [95% CI, 1.67-3.02]), started day care early or late (before 18 months: adjusted HR, 1.79 [95% CI, 1.03-3.10]; after 3 years: adjusted HR, 1.64 [95% CI, 0.96-2.79]), had mothers who smoked during pregnancy (adjusted HR, 1.79 [95% CI, 1.20-2.67]), had poor parents (adjusted HR, 1.55 [95% CI, 1.09-2.22]), and had parents with asthma (adjusted HR, 1.65 [95% CI, 1.17-2.31]). Not associated with asthma were aspects of diet and breast-feeding, pet ownership, presence of older siblings, and passive smoking. Conclusion Parental asthma and nasal allergy increase asthma incidence in offspring up to adulthood. Avoiding tobacco smoke exposure during pregnancy, receiving vaccinations in early childhood, and starting day care between 1.5 and 3 years of age might prevent or delay the development of asthma.

Fetuses and breastfed children depend on the maternal docosahexaenoic acid (DHA) supply, which might have long-lasting consequences. We studied the growth of 6-year-old children whose mothers received supplemental DHA from midpregnancy to 3 months after delivery. One hundred and forty-four pregnant women had been randomized to receive one of three vitamin-mineral supplements, one supplying an additional 200 mg/day DHA. Of the original sample, 120 children were measured at age 6 years with standardized methods. As one objective of the follow-up was to investigate the DHA influence on normal growth, the DHA group was compared with the pooled controls after exclusion of five premature infants. The weight, length, body mass index (BMI), head circumference, and skin-fold thickness at 6 years were similar in the 41 children of the DHA group and the 74 controls. Longitudinally, the BMI z-scores of the DHA group increased up at a later age than that of the controls. We found a highly significant negative correlation between height at 6 years and the increase in red blood cell DHA concentration of mothers from 22 to 37 weeks of pregnancy. We conclude that DHA supplements during midpregnancy corrected a low maternal DHA status (which correlated with children’s height) and was favorable in regard to the BMI development up to 6 years.

Background IgE sensitization against grass pollen is a cause of seasonal allergic rhinitis. Objective We sought to investigate the evolution at the molecular level and the preclinical predictive value of IgE responses against grass pollen. Methods The German Multicentre Allergy Study examined a birth cohort born in 1990. A questionnaire was administered yearly, and blood samples were collected at 1, 2, 3, 5, 6, 7, 10, and 13 years of age. Grass pollen–related seasonal allergic rhinitis (SARg) was diagnosed according to nasal symptoms in June/July. Serum IgE antibodies to Phleum pratense extract and 8 P pratense molecules were tested with immune-enzymatic singleplex and multiplex assays, respectively. Results One hundred seventy-seven of the 820 examined children had SARg. A weak monomolecular/oligomolecular IgE response to P pratense was observed very frequently before SARg onset. These initial IgE responses increased in concentration and molecular complexity during the preclinical and clinical process. A typical progression of IgE sensitization was observed: Phl p 1 (initiator in >75% of cases); then Phl p 4 and Phl p 5; then Phl p 2, Phl p 6, and Phl p 11; and then Phl p 12 and Phl p 7. At age 3 years, IgE sensitization predicted SARg by age 12 years (positive predictive value, 68% [95% CI, 50% to 82%]; negative predictive value, 84% [95% CI, 80% to 87%]). At this preclinical prediction time, the number of recognized molecules and the serum levels of IgE to P pratense were significantly lower than at 3 or more years after SARg onset. Conclusions The IgE response against grass pollen molecules can start years before disease onset as a weak monosensitization or oligosensitization phenomenon. It can increase in serum concentration and complexity through a "molecular spreading" process during preclinical and early clinical disease stages. Testing IgE sensitization at a preclinical stage facilitates prediction of seasonal allergic rhinitis at its molecular monosensitization or oligosensitization stage.

There is epidemiological evidence, especially from longitudinal studies, that clinical manifestations of atopy as well as IgE antibodies against food and aeroallergens show a systematic sequence of events. The atopic march begins with food allergy associated gastrointestinal disorders and atopic dermatitis followed by respiratory allergies, i.e. asthma and atopic rhino-conjunctivitis. Detectable food antibodies, especially against egg and milk proteins, usually precede or accompany the early clinical symptoms and signs. Similarly, aeroallergen sensitization, first against indoor allergen antibodies, succeeded by outdoor allergen antibodies, precede the clinical manifestation of respiratory allergy. Early atopic events, either manifestation or sensitization can be used as risk markers or even predictors of atopic disorders to implement preventive measures. Early atopic dermatitis as well as elevated serum IgE antibodies against food allergens in the first two years of life in combination with a family history can be used as a predictor for aeroallergen sensitization.