The Relevance of Leisure Noise to Hearing Threshold Shifts: A Longitudinal Analysis Among Adolescents.

PURPOSE: The aim of this study was to analyze the association of total leisure noise exposure and hearing threshold shifts over 5 years among adolescents enrolled in the Ohrkan cohort study. METHOD: The Ohrkan cohort of 2,148 students aged 13-19 years was recruited from 2009 to 2011 and followed up 5 years later. Complete baseline and follow-up reports on exposure and outcome were available for 989 participants. Leisure noise exposure was assessed by questionnaires, and clinical audiometric examinations were performed. Two outcomes were defined: occurrence of the Niskar notch pattern and audiometry showing maximum hearing threshold values at 3, 4, and 6 kHz (both ears). Longitudinal analysis using generalized estimating equations was performed. RESULTS: High total leisure noise exposure, defined as an energy equivalent of a 40-hr week of > 85 dBA, was estimated for 32.7% of students at baseline and 63.8% at follow-up. A noise notch was observed in 1.1% of adolescents at baseline and 3.3% at follow-up. At baseline, the maximum measured threshold shift was 55 dB, which increased to 85 dB at the follow-up. Longitudinal analysis did not reveal an association between leisure noise exposure and hearing thresholds. Hearing threshold shifts or noise notches were associated with sex, school type, and time point of measurement. CONCLUSIONS: No relationship was found between leisure noise and hearing thresholds. Male adolescents and those attending secondary general schools, with graduation following completion of ninth or 10th grade, had a greater likelihood of developing hearing threshold shifts. Prevention programs should focus on these risk groups. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.19233462.

Change in exposure of children to second-hand smoke with impact on children's health and change in parental smoking habits after smoking ban in Bavaria - a multiple cross-sectional study.

BACKGROUND: Concerns about smoking displacement from public places to private amenities aroused following smoking ban implementation in Bavaria in 2008. We analysed children's exposure to second-hand smoke (SHS) before and after the ban, its effect on children's health and prevalence of active smoking in adults. METHODS: Six cross-sectional surveys (n = 32,443) on pre-school children in Bavaria were analysed, two surveys before the smoking ban in years 2004 and 2005 (S1 and S2) and four after the ban in 2008, 2012, 2014 and 2016 (S4, S6, S7 and S8). Using multivariable logistic regression, we analysed change in children's intra- and extrauterine SHS exposure and its adverse health effects (Asthma, wheezing, bronchitis and neurodermatitis) as well as change in parental active smoking. RESULTS: The response rates were 78% for S1, 73% for S2, 61% for S4, 62% for S6, 56% for S7 and 54% for S8. Odds of parents never smoked at home in presence of children increased significantly from before to after the ban with odds ratios (OR) 1.17 (CI95% 1.01-1.35), 1.65 (CI95% 1.39-1.95), 2.85 (CI95% 2.32-3.51), 2.24 (CI95% 1.84-2.72) and 3.66 (CI95% 2.89-4.63) for S2, S4, S6, S7 and S8, respectively with S1 as reference. Compared to S4, odds of parents who were not actively smoking is significantly higher in S7 (OR = 1.13 (CI95% 1.03-1.24)) and S8 (OR = 1.24 (CI95% 1.13-1.36)). The odds of mothers who never smoked during pregnancy increased over time with OR = 1.22 (CI95% 1.06-1.40) for S2 and 1.57 (CI95% 1.33-1.86) for S8 compared to S1. Adverse health effects related to children's exposure to SHS are significantly less in S8 compared to S1. CONCLUSION: After 11 years of smoking ban in Bavaria, smoking displacement to homes was disproved. Exposure of children to SHS intrauterine and at home is decreasing. Number of parents who are not actively smoking is increasing over time. Prevalence of health problems in children related to exposure to SHS is decreasing.

Atopic diseases and airway-related symptoms in Bavarian pre-schoolers: determinants and association with immunization.

BACKGROUND: Atopic diseases are among the most common chronic conditions in childhood. Causes of allergies are manifold. The aim of this paper is to evaluate risk factors for atopic diseases and unremitting wheeze and to examine if there is an association between measles, mumps and rubella (MMR) vaccination and atopic dermatitis, asthma and unremitting wheeze in Bavarian pre-schoolers. METHODS: Parents filled out a questionnaire on children's health and environmental and socioeconomic factors. The questionnaire was administered within the Health Monitoring Units in a cross-sectional study in Bavaria, Germany (2014/2015). Data on vaccinations were obtained via the School Entrance Examination, a mandatory examination for pre-school children in Bavaria. Rates of influential factors of atopic diseases and wheeze, MMR and DTP (diphtheria, pertussis and tetanus) vaccination were calculated for all children stratified by health outcomes. To examine if there is an association between MMR vaccination and health outcomes, a multiple logistic regression analysis was performed. RESULTS: Data were available for 3237 individuals. Symptoms and diseases were more frequent in boys. Higher parental education was associated with a higher prevalence of atopic dermatitis. There were no significant associations between any of the health outcome groups and MMR vaccination in the multiple logistic regression models with adjustment for potential confounders. CONCLUSIONS: The present study is in line with the current state of research that MMR vaccination is not associated with atopic diseases.

Longitudinal analysis of leisure noise exposure among adolescents with special focus on portable listening devices: the OHRKAN cohort study.

The aim was to investigate leisure noise exposure and sociodemographic determinants of risky leisure noise exposure over five years in 2148 students visiting grade 9 of any school type in a German city from 2009-2011. Within the OHRKAN cohort study, leisure noise exposure was calculated from literature-retrieved sound pressure levels (SPLs) and self-reported duration of 18 leisure activities at baseline and two follow-ups. Risky exposure was defined as exceeding 85 dB(A) averaged over a 40-h-week. Determinants of risky total leisure noise (TLN) exposure and risky exposure to portable listening devices (PLDs) were investigated using generalised estimating equations (GEEs). Up to 73% of students exceeded noise levels of 85 dB(A) at some timepoint. The noise exposure and importance of different leisure activities changed with increasing age. Risky exposure to TLN and PLDs was associated with lower education, single parent households and being male. Risky PLD exposure was additionally associated with a migrant background. Current prevention measures for leisure noise exposure must be extended to at-risk groups. Besides enhancing campaigns in lower education schools, acoustical insulation in sports halls, noise warnings on tools or in videogames could address especially men. Migrants need education about healthy PLD use in their native language if necessary.

Asthmatic/wheezing phenotypes in preschool children: Influential factors, health care and urban-rural differences.

BACKGROUND: Different wheezing and asthmatic phenotypes turned out to indicate differences in etiology, risk factors and health care. We examined influential factors and urban-rural differences for different phenotypes. METHODS: Parents of 4732 children filled out a questionnaire concerning children's health and environmental factors administered within the Health Monitoring Units (GME) in a cross-sectional study in Bavaria, Germany (2014/2015). To classify respiratory symptoms, five phenotype groups were built: episodic, unremitting and frequent wheeze, ISAAC (International Study of Asthma and Allergies in Children) - asthma and physician-diagnosed asthma (neither of the groups are mutually exclusive). For each phenotype, health care variables were presented and stratified for residence. Urban-rural differences were tested by Pearson's chi-squared tests. Multivariable logistic regression was performed to analyze associations between influential factors and belonging to a phenotype group, and to compare groups with regard to health care variables as outcome. RESULTS: Risk factors for wheezing phenotypes were male gender (OR = 2.02, 95%-CI = [1.65-2.48]), having older siblings (OR = 1.24, 95%-CI = [1.02-1.51]), and preterm delivery (OR = 1.61, 95%-CI = [1.13-2.29]) (ORs for unremitting wheeze). 57% of children with ISAAC asthma and 74% with physician-diagnosed asthma had performed allergy tests. Medication intake among all groups was more frequent in rural areas, and physician's asthma diagnoses were more frequent in urban areas. CONCLUSIONS: In accordance with previous research this study confirms that male gender, older siblings and preterm delivery are associated with several wheezing phenotypes. Overall, low numbers of allergy tests among children with physician's diagnoses highlight a discrepancy between common practice and current knowledge and guidelines. Residential differences in health care might encourage further research and interventions strategies.

Exploring the associations between parent-reported biological indoor environment and airway-related symptoms and allergic diseases in children.

OBJECTIVES: Asthma and allergic rhinitis are diseases which require special attention in childhood. Risk factors for these diseases are manifold and include environmental factors. Previous studies have shown associations between indoor mould and respiratory diseases in children. Besides indoor mould, organic waste storage, potted plants, pets and crowding could influence the microbial indoor environment at home and the respiratory health of children. Our aim was therefore to explore the associations of these factors with airway-related symptoms and respiratory diseases in preschoolers. METHODS: In this cross-sectional study we evaluated data based on parent-questionnaires regarding the health of their children from the 2014/2015 Health Monitoring Units (GME) in Bavaria. Bivariate and multivariate odds ratios (OR) with 95% confidence intervals (95%-CI) were calculated with logistic regression to explore associations between exposures (visible mould, organic waste storage, potted plants, pets and crowding) and outcome variables (doctor diagnosed allergic rhinitis with symptoms in the last 12 months, doctor diagnosed asthma with symptoms in the last 12 months, 12 month prevalence of symptoms such as dry cough at night without a cold, wheeze, wheeze attacks and allergic rhinitis symptoms). RESULTS: We analysed data from 4732 children (response rate 56.7%) with a mean age of 5.3 years. Visible mould was present in 4.7% of all households and associated with doctor diagnosed asthma with symptoms in the last 12 months [aOR 2.16 (95%-CI 1.01-4.63)], wheeze in the last 12 months [aOR 1.60 (95%-CI 1.0-2.50)] and allergic rhinitis symptoms in the last 12 months [aOR 1.75 (95%-CI 1.07-2.87)]. Crowding was associated with dry cough at night without a cold in the last 12 months [aOR 1.71 (95%-CI 1.42-2.05). The other indoor factors showed no association with respiratory health of the children. CONCLUSION: Our results, in line with previous studies, showed positive associations between visible mould at home and airway-related symptoms and allergic diseases in children irrespective of the effect of the other considered indoor exposures. Despite the low prevalence of mould exposure in our study population, our results suggest intervention should be taken for those who do have visible mould exposure at home.

Hospitalization cost at childbirth: Health parameters and colonization with antimicrobial resistant bacteria and methicillin susceptible Staphylococcus aureus.

OBJECTIVE: Antimicrobial resistant bacteria (AMR) are of public health and economic relevance. However, there is a lack of data regarding AMR colonization in pregnant women and in newborns. Furthermore, there are few studies analyzing hospital's net income (revenues and costs). STUDY DESIGN: The cross-sectional study took place in two Bavarian clinics. Available data regarding women and newborns were collected using a standardized questionnaire, personal IDs and medical records in addition to AMR/MSSA screening. Economic data consisted of estimated hospitalization costs, calculated using a billing system called G-DRG (German-Diagnosis Related Groups) as well as real hospitalization costs (e.g. staff, medical and non-medical infrastructure costs). RESULTS: Data from 635 pregnant women and 566 newborns were included. While AMR colonization has shown no significant association with clinical complications, or net hospital income; primipara status and medical condition during pregnancy did. AMR colonization did not have a significant influence on the health status of pregnant women or of the newborns. Net hospital income for pregnant women was mostly negative in 2014. In 2014 and 2015 the majority of the cases had a net income between ±€ 1000. Newborns with clinical complications differed significantly in Apgar score at 1min, weight, body length and AMR colonization of the pregnant woman and/or the newborn (p<=0.05). CONCLUSION: Results indicate that colonization does not lead to increased costs during hospitalization considering real hospitalization costs as well as G-DRG estimated costs. Both DRG groups had similar MSSA and AMR prevalence and health status. In future studies, a Centralized Cost Accounting as billing method and an improved possibility of AMR coding in G-DRG catalog would be desirable.

[Respiratory and allergic diseases of children : Temporal trends, urban-rural differences, and in association with environmental tobacco smoke exposure]. / Atemwegs- und Allergieerkrankungen bei Kindern : Zeitliche Trends, Stadt-Land-Unterschiede und Assoziationen mit einer Tabakrauchexposition.

BACKGROUND/OBJECTIVES: Ten years after the establishment of health monitoring units (GME) in Bavaria, temporal trends and urban-rural differences in parent-reported respiratory and allergic diseases as well as environmental tobacco smoke (ETS) exposure in preschoolers were analyzed in an explorative manner. Furthermore, associations between diseases and ETS exposure were studied. METHODS: Parent questionnaires were used as part of the school entrance examination in two cross sectional studies (S1:2004/2005, n 1 = 6350; S2:2012/2013, n 2 = 5052). Temporal trends and urban-rural-differences were tested by X2 tests. Associations between diseases and exposures were studied using multiple logistic regression analysis. RESULTS: The lifetime prevalence of atopic dermatitis declined from S1-S2 from 12.4 to 11.1 %, whereas those for hay fever, asthma, bronchitis and pseudocroup remained stable. In S1 and S2, bronchitis was less often reported in cities. The other diseases showed no urban-rural differences. The prevalence of children's ETS exposure at home declined from S1-S2 from 14.3 to 7.2 % and was generally higher in cities than in rural regions. There was no positive association between diseases and children's ETS exposure at home. In S2 an association was found between asthma and current parental smoking (OR = 1.60; 95 % CI = (1.10-2.32)). CONCLUSION: The GME provide important data for regional distribution of respiratory and allergic diseases and ETS exposure of preschoolers in Bavaria. The results of the study are important for further development of questionnaires, which will be used in future GME.

Children's exposure to second-hand smoke before and after the smoking ban in Bavaria-a multiple cross-sectional study.

BACKGROUND: The federal state of Bavaria, Germany enforced a comprehensive smoking ban across all enclosed public areas in 2008 to protect non-smokers from second-hand smoke (SHS). Evidence against displacement of smoking to homes is abundant, however long-term assessments are few. We aim to report prevalence of children's SHS exposure before and after the ban, parental smoking behaviour and exposure risk factors. METHODS: Cross-sectional data of children aged 5-6 years old in Bavaria (n = 22 944) were collected in 2004/5 and 2005/6 (S1 and S2) before the ban and after in 2008/9 and 2012/13 (S4 and S6). Parents reported their child's home SHS exposure, in enclosed public areas and private cars. Adjusted multivariable logistic regression assessed changes across time and predicted risk factors. RESULTS: Children's home SHS exposure before the ban was 14.3% (S1), 14.1% (S2) and 12.8% (S4) directly after the ban to 7.2% (S6) (P<0.0001). The proportion of homes where at least one parent smoked significantly reduced from 12.78% (S1) to 4.94% (S6) (P<0.0001) and homes with voluntary smoke-free rules increased. Exposure in cafes, restaurants and private cars also decreased. No significant changes in the proportion of parents that ceased smoking due to the ban were found. Among others, low parental education, crowding and unemployment were risk factors for higher SHS exposure. CONCLUSION: Since the smoking ban, no long-term displacement of SHS to homes was observed. Social smoking norms appear to have shifted in favour of the ban. Social inequalities still exist and should be addressed to further minimise SHS exposure.

Association of sociodemographic and environmental factors with the mental health status among preschool children-Results from a cross-sectional study in Bavaria, Germany.

AIM: It has been reported that a great proportion of mental health disorders have an origin in early childhood. In order to evaluate factors possibly associated with children's health, the health monitoring units have been established since 2004 in six study regions in Bavaria, Germany. The second health monitoring survey, implemented in 2005-06, focuses on the mental health status of preschool children. The goal of this study is (1) to examine the association of sociodemographic and environmental factors with mental health and (2) to analyze the applicability of the results of the health monitoring units to all preschool children in Bavaria by calculating weighting factors. METHODS: Data on 6206 preschool children are available. Logistic regression analysis is applied to analyze possible associations with mental health. A weighting method is applied to correct for deviances compared to the whole population of preschool children in Bavaria (N=132,783). RESULTS: 11% of preschool children show mental health problems. Regarding different indicators of sociodemographic status, low household income [unadjusted OR 3.34, 95% CI: 2.23-4.98] shows the strongest association of mental health problems. Non-accessibility of green space [unadjusted OR 2.74, 95% CI: 1.87-4.00] is also strongly associated with mental health. The results of the unweighted and weighted analysis are similar. CONCLUSION: Our findings suggest that sociodemographic status and factors in the living environment show associations with mental health of children. Based on the results of the unweighted and weighted analyses, the second health monitoring analysis shows little deviances compared to data of all Bavarian preschool children. Therefore, the results can be compared to all Bavarian preschool children.

No further increase in the parent reported prevalence of allergies in Bavarian preschool children: Results from three cross-sectional studies.

BACKGROUND: After three decades of an increase in the prevalence of asthma and allergies, new findings show a plateau in the prevalence of industrialized nations. The objective of this study was to determine whether there was a change in the parent reported prevalence of asthma and allergies among Bavarian preschool children since 2004. METHODS: A parent questionnaire was administered as part of the Bavarian school entrance examination in three cross-sectional studies from 2004/2005, 2006/2007 and 2012/2013. The questionnaire included items on allergy testing history, identified allergens, symptoms (e.g. wheezing, itchy eyes, rash), medically diagnosed asthma, hay fever and atopic dermatitis. Logistic regression was performed to observe time patterns and adjust for risk factors. RESULTS: Data were available for 6350 (2004/2005), 6483 (2006/2007) and 5052 (2012/2013) individuals. Symptoms and diseases were more frequent in boys, except for allergies which affect the skin. From 2004 to 2012 the parent reported prevalence of asthma (2.6% to 2.8%), hay fever (4.7% to 4.0%) and atopic dermatitis (12.4% to 11.1%) either remained quite stable or decreased not significantly. CONCLUSIONS: Results from these three cross-sectional surveys of parent reports suggest that the parent reported prevalences of asthma and allergies are quite stable with small fluctuations since 2004 for Bavarian preschool children. Future research is needed to determine if this trend will continue.