[Therapeutic approaches for obesity and comorbidities in young immigrants]. / Therapieansätze bei Adipositas und ihren Folgeerkrankungen bei jugendlichen Patienten mit Migrationshintergrund.

The prevalence of overweight and obesity is higher in children and adolescents with a migrational background. However, if the country of origin is taken into account, the picture of these differences becomes more complex and more heterogeneous. Predictors for obesity and the ethnic differences are manifold and can be roughly differentiated into cultural, social and individual causes as well as into causes related to the process of acculturation. There are special problems in the long-term health care of obese adolescents with a migrational background. The most important are (1) treatment delay, (2) different concepts of a healthy (problematic) body weight, (3) barriers in diagnostics and treatment of rare secondary disorders and (4) puberty-related changes in lifestyle (increased media use, decreased physical activity and unfavourable daily routines). Therapeutic approaches are only sustainable and effective when the underlying concepts are multiprofessional and multimodal, and are embedded into the family and cultural contexts. Adolescents with a migrational background need culture-adapted nutrition, exercise and media consumption counselling. Such offers have to be (further) developed in accordance with family background, with youth culture and adolescent stage of development.

[Situation and perspectives of public health in Germany--research and teaching. Position paper of the German Public Health Association]. / Situation und Perspektiven von Public Health in Deutschland--Forschung und Lehre. Positionspapier der Deutschen Gesellschaft für Public Health e. V.

This position paper of the German Public Health Association describes current situation and perspectives of public health in Germany with emphasis on research and teaching. It outlines those measures necessary for strengthening of public health research in Germany.

Gender-specific predictors of early mortality after coronary artery bypass graft surgery.

BACKGROUND: Female gender is a risk factor for early mortality after coronary artery bypass graft surgery (CABG). Yet, the causes for this excess mortality in women have not been fully explained. OBJECTIVES: To analyse gender differences in early mortality (30 days post surgery) after CABG and to identify variables explaining the association between female gender and excess mortality, taking into account preoperative clinical and psychosocial, surgical and postoperative risk factors. METHODS: A total of 1,559 consecutive patients admitted to the German Heart Institute Berlin (2005-2008) for CABG were included in this prospective study. A comprehensive set of prespecified preoperative, surgical and postoperative risk factors were examined for their ability to explain the gender difference in early mortality. RESULTS: Early mortality after CABG was higher in women than in men (6.9 vs. 2.4 %, HR 2.91, 95 % CI 1.70-4.96, P < 0.001). Women were older than men (+4.7 years, P < 0.001), had lower self-assessed preoperative physical functioning (-16 points on a scale from 0 to 100, P < 0.001), and had higher rates of postoperative low cardiac output syndromes (6.6 vs. 3.3 %, P = 0.01), respiratory insufficiency (9.4 vs. 5.3 %, P = 0.006) and resuscitation (5.2 vs. 1.8 %, P = 0.001). The combination of these factors explained 71 % of the gender difference in early mortality; age and physical functioning alone accounted for 61 %. Adjusting for these variables, HR for female gender was 1.36 (95 % CI 0.77-2.41, P = 0.29). CONCLUSIONS: Age, physical function and postoperative complications are key mediators of the overmortality of women after aortocoronary bypass surgery. Self-assessed physical functioning should be more seriously considered in preoperative risk assessment particularly in women.

[Continuative approaches of social structure for health inequality research--which perspective opens up the concept of living conditions?]. / Weiterführende Sozialstrukturmodelle für die gesundheitliche Ungleichheitsforschung--Welche Perspektiven eröffnet der Lebenslagen-Ansatz?

For the last 30 years the appropriateness of social strata concepts has been discussed controversially in Germany. It was hypothesised that changes in the social structure resulting in a greater heterogeneity of social living conditions has decreased the relevance of social strata concepts. However, socio-epidemiological research still revealed a strong social gradient, indicating that health risks are still depending on individual social background. Nevertheless, enhanced models of social stratification could be fruitful for socio-epidemiological research, particularly with respect to the objective of reducing health inequality. The 'concept of living conditions' is one of the continuative social strata approaches, which is based on a multidimensional concept of social inequality. First use of this concept provided promising results in obtaining a more precise description of health-related living conditions. In this paper, the concept is presented in more detail, spotlighting on questions about conceptual realisation as well as empirical implementation. The paper aims to encourage a wider discussion about the use of these concepts for socio-epidemiological research and medical sociological theory.

[Dietary interventions and social care for treating obesity in children]. / Therapie der Adipositas aus sozialpädiatrischer, ernährungstherapeutischer und gesundheitswissenschaftlicher Sicht.

The prevalence of obesity and associated comorbidities among children and adolescents has risen worldwide throughout the past 3 decades. To break this trend, population-based activities in health promotion/prevention and health care are necessary. Studies showed that long-term eating behavior improvement with the cooperation of the patient's family together with child-friendly organization support both individual therapeutic improvements as well as a relevant reduction of obesity prevalence. A significant BMI reduction can be achieved with a normal varied diet, whose energetic value is 300-400 kcal/day below the patient's daily energetic needs, due to the lower consumption of fat and sugar. This requires, however, that the entire family be willing to change their unhealthy eating behaviors (e.g., soft drinks and fast food) and to introduce regular meals into their daily routine. Sensibly, most therapies combine diet therapy with increased physical activity and parental training. Controlled media consumption, active leisure-time behavior, and a structured daily routine are further conditions for successful weight reduction. The high-risk groups for pediatric obesity, i.e., families with migration background and/or low socioeconomic status, have been poorly reached by established programs.

[The influence of migration background and parental education on childhood obesity and the metabolic syndrome]. / Adipositas bei Kindern und Jugendlichen - Einfluss von Migrationshintergrund und Bildung der Eltern auf das Auftreten eines metabolischen Syndroms.

Obesity and metabolic syndrome are important risk factors for cardiovascular diseases. In this study, the influence of migration background and parental education on the degree of obesity and the presence of the metabolic syndrome (MS) in children and adolescents (N=492) requiring sociopediatric care were investigated. Two regression models were computed with the dependent variables BMI-SDS and MS, respectively. Age, gender, migration background, and parental education were used as independent variables. When controlling for age and gender, higher BMI-SDS were found among Turkish patients (ß=0.21; p=0.002) and patients with other migration backgrounds (ß=0.11; p=0.085) compared to German patients. The BMI-SDS values were also higher among patients from families with a low parental education level compared to those with a higher education level (ß=0.31; p<0.001). The key risk factor for MS is the BMI-SDS (OR: 8.9; p=0.011). No influence could be determined for migration background and parental education, when controlling for age, gender, and BMI-SDS. Obesity therapy should be increasingly tailored to the needs of identified risk groups. This will also allow for a targeted prevention of comorbidities.

Ethnicity and comorbidities in an overweight and obese multiethnic childhood cohort in Berlin.

AIM: This study aims to analyse the association between ethnicity, elevated metabolic parameters and metabolic syndrome (MS) in a multiethnic cohort of overweight to obese children and adolescents. METHODS: For 1053 patients, standard deviation of body mass index (BMI-SDS) was calculated and metabolic parameters (fasting blood glucose, fasting insulin, homeostasis model assessment-IR, lipids, blood pressure) were measured. MS was defined by WHO criteria. Bivariate and multivariate analyses were performed. Adjusted differences in BMI-SDS and metabolic parameters between different migration groups were assessed with linear regression models. The risk for MS was calculated with multiple logistic regression models. RESULTS: Forty-eight per cent of the children were German, 25% Turkish and 27% had another ethnicity. Concerning weight status, 23% are overweight, 31% obese and 46% extremely obese with higher rates among the immigrant population. Multivariable models indicate significant associations between elevated metabolic parameters and higher BMI-SDS values. Overall prevalence of MS was 32.3%. MS was detected significantly more often among Turkish patients (40.4%) compared to Germans (27.3%; p=0.02). Logistic regression analysis showed a greater risk for MS with older age (OR=1.09; p=0.003) and Turkish ethnicity (OR=1.62; p=0.02). CONCLUSION: Nearly all patients had symptoms of MS, and 40% had MS showing that this highly health-threatening condition is quite common. Therefore, effective therapy and prevention efforts must be developed for this high risk group. More migration-specific research regarding insulin resistance, MS and Type 2 DM is needed.

[Association between health-related quality of life and selected indicators for 10- to 15-year-old girls in Berlin]. / Einflussfaktoren auf die gesundheitsbezogene Lebensqualität von 10- bis 15-jährigen Mädchen in Berlin.

OBJECTIVE: The state of knowledge on health-related quality of life (HRQOL) is incomplete. The influence of social and behavioural factors on HRQOL of 10- to 15-year-old girls was investigated. METHOD: The Berlin School Children's Cohort (BSCOC-cross-sectional study 2006-2007) included 1 842 girls and their parents (n=1 683) in Berlin. Height and body weight were measured. A standardised questionnaire to capture the HRQOL of the girls (KINDL(®) questionnaire) and possible influencing factors was used. The association of the variables age, social situation, migration background, family situation, weight status, menarche status, eating behaviour and illness in the last weeks with the HRQOL and its partial scales were controlled for using the Kruskal-Wallis test. Variables which showed a statistically significant relationship with HRQOL were included as independent variables in a linear regression model with the outcome variable HRQOL to test their influence and quantify it. RESULTS: In comparison to the KINDL reference values (KiGGS), the HRQOL values of the assessed girls are lower. Quality of life is unfavourably swayed by age, low social status, two-sided migration background, sickness in the last few weeks, little physical activity, unfavourable eating behaviour, overweight and obesity and when post-menarche. With the exception of migration background and menarche status, all results were confirmed in the multivariate model. CONCLUSION: The results of the linear regression model demonstrate a higher importance of body and behaviour-related factors and places and confirm the relevance of past prevention and health promotion in the named areas also for the HRQOL of the girls.

[Female life courses and health--results of a study of national survey data of 50-69-year-old women in East and West Germany]. / Weibliche Lebensverläufe und Gesundheit--Ergebnisse einer Untersuchung nationaler Surveydaten 50-69jähriger Frauen aus Ost- und Westdeutschland.

The aim of the study was to examine the impact of different forms of combining family and paid work on the health status of women. The study was a secondary analysis of cross-sectional data from the National Health Survey and included 1530 women, aged 50 to 69 years, from East and West Germany. Three groups were composed to describe different forms of family and occupation in the life course (family or occupational career, combination of family and occupation). Additionally, aspects of the social situation, resources and burdens as well as indicators of health behaviour were included in the analyses. The most remarkable result was a significantly worse state of health of employed and childless women (occupational career), aged 50 to 59 years. This finding remained after adjustment for different potential factors of influence. Considering the increasing proportion of women without children in modern societies, longitudinal analyses would be necessary to investigate the long term effect of familial and occupational factors on the health status of women.