Effects of a Brief Web-Based "Social Norms"-Intervention on Alcohol, Tobacco and Cannabis Use Among German University Students: Results of a Cluster-Controlled Trial Conducted at Eight Universities.

Background and Aim: "Social norms" (SN)-interventions are aimed at changing existing misperceptions regarding peer substance use by providing feedback on actual norms, thereby affecting personal substance use. It is unknown whether SN-intervention effects previously demonstrated in US students can be replicated in German students. The aim of the INSIST-study was to examine the effects of a web-based SN-intervention on substance use. Design: Cluster-controlled trial. Setting: Eight Universities in Germany. Participants and Measurements: Students were recruited at four intervention vs. four delayed intervention control Universities. 4,463 students completed baseline, 1,255 students (59% female) completed both baseline and 5-months follow-up web-based surveys on personal and perceived peer substance use. Intervention participants received feedback contrasting personal and perceived peer use with previously assessed use and perceptions of same-sex, same-university peers. Intervention effects were assessed via multivariable mixed logistic regression models. Findings: Relative to controls, reception of SN-feedback was associated with higher odds for decreased alcohol use (OR: 1.91, 95% CI 1.42-2.56). This effect was most pronounced in students overestimating peer use at baseline and under or accurately estimating it at follow-up (OR: 6.28, 95% CI 2.00-19.8). The OR was 1.33 (95% CI 0.67-2.65) for decreased cannabis use in students at intervention Universities and was statistically significant at 1.70 (95% CI 1.13-2.55) when contrasting unchanged and decreased with increased use. Regarding tobacco use and episodes of drunkenness, no intervention effects were found. Conclusions: This study was the first cluster-controlled trial suggesting beneficial effects of web-based SN-intervention on alcohol and cannabis use in a large sample of German University students. Clinical Trial Registration: The trial registration number of the INSIST-study is DRKS00007635 at the "German Clinical Trials Register."

Cross-sectional and longitudinal associations between sleep duration, sleep quality, and bone stiffness in European children and adolescents.

In this large perspective cohort among European children and adolescents, we observed that daytime napping was positively associated with bone stiffness, while short or long sleep duration combined with poor sleep quality was associated with less bone stiffness. Our findings are important for obtaining optimal bone stiffness in childhood. INTRODUCTION: To examine the cross-sectional and longitudinal associations between sleep duration, sleep quality, and bone stiffness index (SI) in European children and adolescents. METHODS: Four thousand eight hundred seventy-one children aged 2-11 years from the IDEFICS study and 861 children aged 6-15 years from the subsequent I.Family study were included. Sleep duration (i.e., nocturnal sleep and daytime napping) and sleep quality (i.e., irregularly bedtime routine, have difficulty falling asleep and trouble getting up in the morning) were reported by self-administrated questionnaires. Nocturnal sleep duration was converted into age-specific z-scores, and total sleep duration was classified into short, adequate, and long based on the National Sleep Recommendation. Calcaneal SI of both feet were measured using quantitative ultrasound. Linear mixed-effects models with country as a random effect were used, with adjustments for sex, age, pubertal status, family socioeconomic status, physical activity, screen time, body mass index, and daylight duration. RESULTS: Nocturnal sleep duration z-scores were positively associated with SI percentiles among participants with adequate sleep duration at baseline. Moreover, the positive association between daytime napping and SI percentiles was more pronounced in participants with adequate sleep duration at baseline, while at 4-year follow-up was more pronounced in participants with short sleep duration. In addition, extreme sleep duration at baseline predicted lower SI percentiles after 4 years in participants with poor sleep quality. CONCLUSION: The positive associations between nocturnal sleep, daytime napping and SI depended on total sleep duration. Long-term detrimental effect of extreme sleep duration on SI only existed in individuals with poor sleep quality.

Socially disadvantaged city districts show a higher incidence of acute ST-elevation myocardial infarctions with elevated cardiovascular risk factors and worse prognosis.

BACKGROUND: The importance of socioeconomic status (SES) for coronary heart disease (CHD)-morbidity is subject of ongoing scientific investigations. This study was to explore the association between SES in different city-districts of Bremen/Germany and incidence, severity, treatment modalities and prognosis for patients with ST-elevation myocardial infarctions (STEMI). METHODS: Since 2006 all STEMI-patients from the metropolitan area of Bremen are documented in the Bremen STEMI-registry. Utilizing postal codes of their home address they were assigned to four groups in accordance to the Bremen social deprivation-index (G1: high, G2: intermediate high, G3: intermediate low, G4: low socioeconomic status). RESULTS: Three thousand four hundred sixty-two consecutive patients with STEMI admitted between 2006 and 2015 entered analysis. City areas with low SES showed higher adjusted STEMI-incidence-rates (IR-ratio 1.56, G4 vs. G1). This elevation could be observed in both sexes (women IRR 1.63, men IRR 1.54) and was most prominent in inhabitants <50 yrs. of age (women IRR 2.18, men IRR 2.17). Smoking (OR 1.7, 95%CI 1.3-2.4) and obesity (1.6, 95%CI 1.1-2.2) was more prevalent in pts. from low SES city-areas. While treatment-modalities did not differ, low SES was associated with more extensive STEMIs (creatine kinase > 3000 U/l, OR 1.95, 95% CI 1.4-2.8) and severe impairment of LV-function post-STEMI (OR 2.0, 95% CI 1.2-3.4). Long term follow-up revealed that lower SES was associated with higher major adverse cardiac or cerebrovascular event (MACCE)-rates after 5 years: G1 30.8%, G2 35.7%, G3 36.0%, G4 41.1%, p (for trend) = 0.02. This worse prognosis could especially be shown for young STEMI-patients (<50 yrs. of age) 5-yr. mortality-rates(G4 vs. G1) 18.4 vs. 3.1%, p = 0.03 and 5-year-MACCE-rates (G4 vs. G1) 32 vs. 6.3%, p = 0.02. CONCLUSIONS: This registry-data confirms the negative association of low socioeconomic status and STEMI-incidence, with higher rates of smoking and obesity, more extensive infarctions and worse prognosis for the socio-economically deprived.

Parents' evaluation of the IDEFICS intervention: an analysis focussing on socio-economic factors, child's weight status and intervention exposure.

INTRODUCTION: From April 2008 to August 2010 the Identification and prevention of Dietary- and lifestyle-induced health EFfects In Children and infantS (IDEFICS) intervention aimed to encourage healthier diets, higher physical activity levels and lower stress levels among European children and their families. While the intervention was intended to improve children's health, we also wished to assess whether there were unwelcome aspects or negative side-effects. Therefore all parents of children who participated in the IDEFICS intervention were asked for their views on different aspects of the intervention. METHODS: A total of 10,016 parents of children who participated in the IDEFICS survey and who were involved in the intervention were invited to complete a questionnaire on positive and negative impacts of the intervention. Responses to each of the statements were coded on a four point Likert-type scale. Demographic data were collected as part of the baseline (T0 ) and first follow-up (T1 ) surveys; intervention exposure data was also collected in the T1 follow-up survey. Anthropometric data was collected in the same surveys, and child's weight status was assessed according to Cole and Lobstein. After initial review of the univariate statistics multilevel logistic regression was conducted to analyse the influence of socio-economic factors, child's weight status and intervention exposure on parental responses. RESULTS: In total 4,997 responses were received. Approval rates were high, and few parents reported negative effects. Parents who reported higher levels of exposure to the intervention were more likely to approve of it and were also no more likely to notice negative aspects. Less-educated and lower income parents were more likely to report that the intervention would make a lasting positive difference, but also more likely to report that the intervention had had negative effects. Parents of overweight and obese children were more likely to report negative effects - above all, that 'the intervention had made their child feel as if he/she was "fat" or "overweight." ' CONCLUSION: While the results represent a broad endorsement of the IDEFICS intervention, they also suggest the importance of vigilance concerning the psychological effects of obesity interventions on overweight and obese children.

Adherence to combined lifestyle factors and their contribution to obesity in the IDEFICS study.

BACKGROUND: The Identification and prevention of Dietary- and lifestyle-induced health EFfects In Children and infantS (IDEFICS) study investigated the aetiology of childhood obesity and developed a primary prevention programme. METHODS: Pre-intervention adherence to key behaviours related to childhood obesity, namely water/sweetened drink, fruit/vegetable consumption, daily TV time, physical activity, family time and adequate sleep duration, was measured at baseline. Adherence to international recommendations was converted into a composite score ranging from 0 (none) to 6 (adhering to all). Data on adherence were available for 7,444 to 15,084 children aged 2-9.9 years, depending on the behaviour. By means of multi-level logistic regression models adjusted for age, sex and country, we calculated odds ratios (OR) and 95% confidence intervals (CI) to estimate the relationship between adherence to these recommendations and the risk of being overweight/obese. RESULTS: Adherence ranged from 15.0% (physical activity) to 51.9% (TV time). As adherence increased, a lower chance of being overweight/obese was observed; adhering to only one key behaviour (score = 1) meant an OR = 0.81 (CI: 0.65-1.01) compared with non-adherence (score = 0), while adhering to more than half of the key behaviours (score ≥ 4) halved the chance for overweight/obesity (OR = 0.54, CI: 0.37-0.80). Adherence to physical activity, TV and sleep recommendations was the main driver reducing the chance of being overweight. Overweight/obese children were more likely not to adhere to at least one of the recommended behaviours (19.8%) than normal-weight/thin children (12.9%) CONCLUSION: The selected key behaviours do not contribute equally to a reduced chance of being overweight. Future interventions may benefit most from moving more, reducing TV time and getting adequate sleep.

Adherence to the obesity-related lifestyle intervention targets in the IDEFICS study.

BACKGROUND/OBJECTIVES: To address behaviours associated with childhood obesity, certain target values are recommended that should be met to improve children's health. In the IDEFICS (Identification and prevention of Dietary- and lifestyle-induced health Effects in Children and infantS) study such lifestyle recommendations were conveyed as six key messages. Here, we investigate the adherence of European children to these messages. METHODS: The IDEFICS intervention was based on the intervention mapping approach with the following six targets: increase water consumption (to replace sugar-containing beverages), increase fruit/vegetable consumption, reduce daily screen time, increase daily physical activity, improve the quality of family life and ensure adequate sleep duration. Internationally recommended target values were applied to determine the prevalence of children meeting these targets. RESULTS: In a cohort of 18,745 children participating in the IDEFICS baseline survey or newly recruited during follow-up, data on the above lifestyle behaviours were collected for a varying number of 8302 to 17,212 children. Information on all six behaviours was available for 5140 children. Although 52.5% of the cohort was classified in the highest category of water consumption, only 8.8% met the target of an intake of fruits/vegetables five times a day. The prevalence of children adhering to the recommendation regarding total screen time-below 1 h for pre-school children and 2 h for school children-was 51.1%. The recommended amount of at least 60 min of moderate-to-vigorous physical activity per day was fulfilled by 15.2%. Family life of the child measured by various indicators was considered as satisfactory in 22.8%. Nocturnal sleep duration of 11 (10) hours or more in pre-school (school) children was achieved by 37.9%. In general, children in northern countries and younger children showed better adherence to the recommendations. Only 1.1% of the children adhered to at least five of these recommendations. CONCLUSIONS: Current adherence of children to lifestyle recommendations to prevent childhood obesity is low where observed differences with respect to country, age and gender call for targeted intervention.

Metabolic syndrome in young children: definitions and results of the IDEFICS study.

OBJECTIVE: To estimate the prevalence of the metabolic syndrome (MetS) using reference standards obtained in European children and to develop a quantitative MetS score and describe its distribution in children. DESIGN AND METHODS: Population-based survey in eight European countries, including 18745 children 2.0 to 10.9 years, recruited during a second survey. Anthropometry (weight, height and waist circumference), blood pressure and serum-fasting triglycerides, HDL cholesterol, glucose and insulin were measured. We applied three widely accepted definitions of the pediatric MetS and we suggest a new definition, to guide pediatricians in decisions about close monitoring or even intervention (values of at least three of the MetS components exceeding the 90th or 95th percentile, respectively). We used a z-score standardisation to calculate a continuous score combining the MetS components. RESULTS: Among the various definitions of MetS, the highest prevalence (5.5%) was obtained with our new definition requiring close observation (monitoring level). Our more conservative definition, requiring pediatric intervention gives a prevalence of 1.8%. In general, prevalences were higher in girls than in boys. The prevalence of metabolic syndrome is highest among obese children. All definitions classify a small percentage of thin or normal weight children as being affected. The metabolic syndrome score shows a positive trend with age, particularly regarding the upper percentiles of the score. CONCLUSIONS: According to different definitions of pediatric MetS, a non-negligible proportion of mostly prepubertal children are classified as affected. We propose a new definition of MetS that should improve clinical guidance. The continuous score developed may also serve as a useful tool in pediatric obesity research. It has to be noted, however, that the proposed cutoffs are based on a statistical definition that does not yet allow to quantify the risk of subsequent disease.

Prevalence of overweight and obesity in European children below the age of 10.

BACKGROUND: There is a lack of common surveillance systems providing comparable figures and temporal trends of the prevalence of overweight (OW), obesity and related risk factors among European preschool and school children. Comparability of available data is limited in terms of sampling design, methodological approaches and quality assurance. The IDEFICS (Identification and prevention of Dietary- and lifestyle-induced health Effects in Children and infantS) study provides one of the largest European data sets of young children based on state-of-the-art methodology. OBJECTIVE: To assess the European distribution of weight status according to different classification systems based on body mass index (BMI) in children (2.0-9.9 years). To describe the prevalence of weight categories by region, sex, age and socioeconomic position. DESIGN: Between 2007 and 2010, 18,745 children from eight European countries participated in an extensive, highly standardised protocol including, among other measures, anthropometric examinations and parental reports on socio-demographic characteristics. RESULTS: The combined prevalence of OW/obesity ranges from more than 40% in southern Europe to less than 10% in northern Europe. Overall, the prevalence of OW was higher in girls (21.1%) as compared with boys (18.6%). The prevalence of OW shows a negative gradient with social position, with some variation of the strength and consistency of this association across Europe. Overall, population groups with low income and/or lower education levels show the highest prevalence of obesity. The use of different reference systems to classify OW results in substantial differences in prevalence estimates and can even reverse the reported difference between boys and girls. CONCLUSIONS: There is a higher prevalence of obesity in populations from southern Europe and in population groups with lower education and income levels. Our data confirm the need to develop and reinforce European public health policies to prevent early obesity and to reduce these health inequalities and regional disparities.

[External quality assurance of the first wave of the German Health Interview and Examination Survey for Adults (DEGS1)]. / Externe Qualitätssicherung der ersten Welle der Studie zur Gesundheit Erwachsener in Deutschland (DEGS1).

The quality management concept for the first wave of the German Health Interview and Examination Survey for Adults (DEGS1) included in addition to conducting internal quality assurance (QS) also the supervision by an external independent institute. After a restricted tendering procedure, the Leibniz Institute for Prevention Research and Epidemiology-BIPS was commissioned to conduct the external quality assurance. The external quality control included the review of the operation manuals, the training of the field staff, the execution of field work (including measurements), and the monitoring of sampling, response and data management. For the realization of the controls in these areas, test criteria were developed to reveal shortcomings early and to give recommendations for the internal quality assurance. This paper briefly describes the concept and the execution of the accompanying external quality assurance with regard to the above mentioned areas. An English full-text version of this article is available at SpringerLink as supplemental.

[A birth cohort study on allergic diseases among toddlers in Northwest Germany]. / Geburtskohortenstudie zu allergischen Erkrankungen bei Kleinkindern in Nordwestdeutschland.

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.

Role of medical history and medication use in the aetiology of upper aerodigestive tract cancers in Europe: the ARCAGE study.

BACKGROUND: The study aimed to investigate the role of medical history (skin warts, Candida albicans, herpetic lesions, heartburn, regurgitation) and medication use (for heartburn; for regurgitation; aspirin) in the aetiology of upper aerodigestive tract (UADT) cancer. METHODS: A multicentre (10 European countries) case-control study [Alcohol-Related CAncers and GEnetic susceptibility (ARCAGE) project]. RESULTS: There were 1779 cases of UADT cancer and 1993 controls. History of warts or C. albicans infection was associated with a reduced risk [odds ratio (OR) 0.80, 95% confidence interval (CI) 0.68-0.94 and OR 0.73, 95% CI 0.60-0.89, respectively] but there was no association with herpetic lesions, heartburn, regurgitation or medication for related symptoms. Regurgitation was associated with an increased risk for cancer of the oesophagus (OR 1.47, 95% CI 0.98-2.21). Regular aspirin use was not associated with risk of UADT cancer overall but was associated with a reduced risk for cancer of oesophagus (OR 0.51, 95% CI 0.28-0.96), hypopharynx (OR 0.53, 95% CI 0.28-1.02) and larynx (OR 0.74, 95% CI 0.54-1.01). CONCLUSIONS: A history of some infections appears to be a marker for decreased risk of UADT cancer. The role of medical history and medication use varied by UADT subsites with aspirin use associated with a decreased risk of oesophageal cancer and suggestive of a decreased risk of hypopharyngeal and laryngeal cancers.

Intra- and inter-observer reliability in anthropometric measurements in children.

INTRODUCTION: Studies such as IDEFICS (Identification and prevention of dietary- and lifestyle-induced health effects in children and infants) seek to compare data across several different countries. Therefore, it is important to confirm that body composition indices, which are subject to intra- and inter-individual variation, are measured using a standardised protocol that maximises their reliability and reduces error in analyses. OBJECTIVE: To describe the standardisation and reliability of anthropometric measurements. Both intra- and inter-observer variability of skinfold thickness (triceps, subscapular, biceps, suprailiac) and circumference (neck, arm, waist, hip) measurements were investigated in five different countries. METHODS: Central training for fieldwork personnel was carried out, followed by local training in each centre involving the whole survey staff. All technical devices and procedures were standardised. As part of the standardisation process, at least 20 children participated in the intra- and inter-observer reliability test in each centre. A total of 125 children 2-5 years of age and 164 children 6-9 years of age took part in this study, with a mean age of 5.4 (± 1.2) years. RESULTS: The intra-observer technical error of measurement (TEM) was between 0.12 and 0.47 mm for skinfold thickness and between 0.09 and 1.24 cm for circumference measurements. Intra-observer reliability was 97.7% for skinfold thickness (triceps, subscapular, biceps, suprailiac) and 94.7% for circumferences (neck, arm, waist, hip). Inter-observer TEMs for skinfold thicknesses were between 0.13 and 0.97 mm and for circumferences between 0.18 and 1.01 cm. Inter-observer agreement as assessed by the coefficient of reliability for repeated measurements of skinfold thickness and circumferences was above 88% in all countries. CONCLUSION: In epidemiological surveys it is essential to standardise the methodology and train the participating staff in order to decrease measurement error. In the framework of the IDEFICS study, acceptable intra- and inter-observer agreement was achieved for all the measurements.

Frequency of allergic diseases in 2-year-old children in relationship to parental history of allergy and breastfeeding.

BACKGROUND: The association between breastfeeding and the risk of atopic diseases in children is controversial. While some studies support the theory of a decreased risk of asthma and allergic diseases due to breastfeeding, others have failed to confirm such a protective effect, and even suggest increased risk. The aim of this longitudinal study was to investigate the association between breastfeeding and the prevalence of atopic diseases in 2-year-old children. METHODS: Data on 1685 children from a birth cohort were collected from questionnaires completed by parents at birth and at 6, 12, and 24 months. By means of logistic regression and considering confounders such as family history and socioeconomic status, we analyzed the association between exclusive breastfeeding and the development of allergic reactions in 2-year-old children. RESULTS: Exclusive breastfeeding for >4 months was associated with an increased risk of asthma and atopic dermatitis in children without a parental history of allergic diseases (odds ratio [OR] = 1.62; 95% confidence interval [Cl], 1.02-2.56). Children whose fathers only had a history of allergic disease strongly benefited from exclusive breastfeeding for >4 months (OR = 0.39; 95%-CI: 0.18-0.83) whereas those whose mothers only had such a history had an increased risk of asthma and atopic dermatitis (OR: 2.31; 95%-CI: 1.16-4.60). CONCLUSION: In children with a family history of allergy, it seems to be important to distinguish between maternal and paternal predisposition as children whose fathers have a history of atopic disease seem to benefit most from breastfeeding for >4 months.

Life course social mobility and risk of upper aerodigestive tract cancer in men.

The aim of this study was to explore associations between social mobility and tumours of the upper aero-digestive tract (UADT), focussing on life-course transitions in social prestige (SP) based on occupational history. 1,796 cases diagnosed between 1993 and 2005 in ten European countries were compared with 1585 controls. SP was classified by the Standard International Occupational Prestige Scale (SIOPS) based on job histories. SIOPS was categorised in high (H), medium (M) and low (L). Time weighted average achieved and transitions between SP with nine trajectories: H --> H, H --> M, H --> L, M --> H, M --> M, M --> L, L --> H, L --> M and L --> L were analysed. Odds ratios (ORs) and 95%-confidence intervals [95%-CIs] were estimated with logistic regression models including age, consumption of fruits/vegetables, study centre, smoking and alcohol consumption. The adjusted OR for the lowest versus the highest of three categories (time weighted average of SP) was 1.28 [1.04-1.56]. The distance of SP widened between cases and controls during working life. The downward trajectory H --> L gave an OR of 1.71 [0.75-3.87] as compared to H --> H. Subjects with M --> M and L --> L trajectories ORs were also elevated relative to subjects with H --> H trajectories. The association between SP and UADT is not fully explained by confounding factors. Downward social trajectory during the life course may be an independent risk factor for UADT cancers.

Prevalence and determinants of childhood overweight and obesity in European countries: pooled analysis of the existing surveys within the IDEFICS Consortium.

OBJECTIVE: To pool and analyse, according to standardized criteria and using harmonized variables, the existing databases of surveys on childhood overweight and obesity carried out from 1995 to 2005 in different European countries by research groups participating in the IDEFICS project. METHODS: Detailed information from seven surveys in five European countries was collected. A common database was built after harmonization of the single studies regarding sample size and age distribution. Variables were critically reviewed and harmonized according to a common protocol. On the pooled database, descriptive comparative analyses on the prevalence of overweight/obesity and association analyses of these conditions with perinatal, parental and environmental factors were performed. RESULTS: Starting from total number of 74,871 children, data of 18,626 children were included in the common database (Belgium, n=1766; Cyprus, n=5540; Estonia, n=583; Italy, n=4480 and Sweden, n=6257). After the exclusion of children outside the defined age ranges (4-5 and 9-11 years), the analysis was conducted on 1738 younger and 12,923 older children. Relevant differences in the prevalence of overweight/obesity were observed between countries in both age groups, the highest values being observed in Italy. Age- and gender-related associations between the risk of obesity/overweight and perinatal, parental and environmental factors were observed. An increased risk of high blood pressure in overweight/obese children was consistently observed. CONCLUSIONS: The results of this collaborative work of European research centres, although providing potentially useful findings, confirmed that the validity of comparisons between communities depends critically on the comparability of the survey methods. To monitor the current epidemic of childhood obesity and develop appropriate prevention strategies, a coordinated European approach is needed to collect homogeneous sets of epidemiological data.

Exposure to pets and the risk of allergic symptoms during the first 2 years of life.

BACKGROUND: Currently, there is a lack of consensus regarding the influence of household pets on the development of allergic diseases in childhood. OBJECTIVE: The aim of this birth cohort study was to analyze the relationship between pet ownership at time of birth and the prevalence of atopic diseases approximately 2 years later. METHODS: A few days after the delivery of their babies, we asked 3132 mothers of German nationality whether they kept household pets like dogs, cats, or birds. Two years later, we asked whether their children had developed bronchial asthma, eczema, or hay fever. We then used logistic regression models to analyze whether there was an association between the development of allergic reactions among the children and pet ownership at the time of birth. RESULTS: In families without a history of atopic disease, the prevalence of asthma and eczema among 2-year-old children was significantly lower in those families that owned a dog at the time the children were born (odds ratio [OR], 0.52; 95% confidence interval [CI], 0.33-0.83). In contrast, in families with a history of atopic disease, early dog exposure was associated with a higher prevalence of asthma and eczema in 2-year-old children (OR, 1.43; 95% CI, 0.95-2.15). Comparable analyses assessing the influence of cats and birds in the home showed no effect on the development of atopic diseases in early childhood. CONCLUSIONS: This study confirms the findings of several earlier studies suggesting a negative association between dog ownership and the development of atopic diseases in early childhood, although the effect was only observed in families without a history of atopic disorders.

[Quality of diagnostic ICD coding for outpatients in Germany]. / Die ICD-Kodierqualität für Diagnosen in der ambulanten Versorgung.

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).

[Public health service as cooperative partner in prevention]. / Der öffentliche Gesundheitsdienst als Kooperationspartner in der Prävention.

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.