[Utilization of outpatient medical services and satisfaction with care in children and adolescents with a migration background-results of the KiGGS study]. / Inanspruchnahme ambulant ärztlicher Leistungen und Zufriedenheit mit der Versorgung bei Kindern und Jugendlichen mit Migrationshintergrund ­ Ergebnisse der KiGGS-Studie.

BACKGROUND AND AIM: Reasons for lower use of medical services by children and adolescents with migration background have not yet been investigated. The aim is therefore to identify factors that are related to the utilization of outpatient medical care and subjective patient satisfaction as well as explain differences according to migration background. METHODS: On the basis of the "German Health Interview and Examination Survey for Children and Adolescents" (KiGGS, baseline study: 2003-2006), in which 17,640 children and adolescents participated, prevalences with 95% confidence intervals as well as multivariate binary logistic regression analyzes on the relationship between migration background, country of origin, the use of outpatient medical care services in the last 12 months, and satisfaction with the last medical treatment were calculated. RESULTS: Children up to age 13 with two-sided migration background had lower utilization of specialist doctors compared to those without migration background (OR = 0.64 [0.56-0.74]). However, among the 14- to 17-year-olds, the utilization did not differ significantly (OR = 0.79 [0.60-1.03]). The lower use of outpatient medical care is associated with a shorter length of stay and limited German language skills. In addition, parents from Poland and the former Soviet Union are less likely to be very satisfied with the last outpatient treatment of their 0­ to 13-year-old child, even after adjustments for German language skills and length of stay. CONCLUSION: To make it easier for children with migration background to access specialist services, it is important to reduce language barriers in outpatient medical care and to promote processes of intercultural opening.

[The health status of children and adolescents with migration background in Germany : Results from KiGGS Wave 2]. / Zur gesundheitlichen Lage von Kindern und Jugendlichen mit Migrationshintergrund in Deutschland : Ergebnisse aus KiGGS Welle 2.

BACKGROUND: Even though 36.5% of children and adolescents living in Germany have a migration background (MB), data on the health of this population is scarce. With population-based data from the German Health Interview and Examination Survey for Children and Adolescents (KiGGS Wave 2, 2014-2017), reliable statements can be given. METHODS: Data from KiGGS Wave 2 is used in order to report on general health status, mental health, and the distribution of allergic diseases among children and adolescents aged 3-17 years (n = 13,568). To determine overweight, standardized measurements of body weight and height (n = 3463) were used. In addition to the MB (none/one-sided/two-sided), the socioeconomic status (SES) is considered. In multivariate analyses among children and adolescents with MB, SES and the parents' duration of stay in Germany were included. RESULTS: Participants with a two-sided MB show lower prevalence of neurodermatitis (3.5% vs. 6.9%) and ADHS (2.0% vs. 5.1%) than those without a migration background and higher prevalence of fair to poor general health status (6.1% vs. 3.9%). Children and adolescents with a two-sided migration background are more often affected by overweight than those without migration background (22.1% vs. 12.2%). After considering SES, the chances of a diagnosed neurodermatitis and ADHS remain higher and the chances for overweight are lower in children and adolescents with a migration background than among those without migration background. If only children with MB are considered, SES and partially the parents' duration of stay in Germany are associated with health outcomes. CONCLUSION: Differences in the general health status of children and adolescents with and without MB vary depending on the observed indicators. The heterogeneity of children and adolescents with MB, e.g. regarding SES and parents' duration of stay, should be considered when planning and implementing measures of health promotion.

The Montreal Cognitive Assessment (MoCA) in a population-based sample of Turkish migrants living in Germany.

OBJECTIVES: Data on cognitive testing in migrants in Germany are scarce. We aimed to evaluate the Montreal Cognitive Assessment (MoCA) in Turkish migrants in Berlin and its association with demographics and health-related variables. METHOD: For this cross-sectional study, a random sample of persons with Turkish names was drawn from the registration-office. Cognitive function was assessed using the MoCA; 0 = worst, 30 = best total score. Multivariable linear regression models were calculated to determine associated factors with the total MoCA-score. RESULTS: In our analyses we included 282 participants (50% female), mean age 42.3 ± 11.9 years (mean ± standard deviation (SD)). The mean ± SD MoCA score was 23.3 ± 4.3. In the multivariable analysis, higher education (ß = 2.68; p < 0.001), and chosing the German version of the MoCA (ß = -1.13; p = 0.026), were associated with higher MoCA-scores, whereas higher age (ß = -0.08; p = 0.002) was associated with lower MoCA scores. CONCLUSION: In our study, a higher educational level, lower age, and German as the preferred test language (as compared to Turkish) were positively associated with the cognitive performance of Berliners with Turkish roots. To examine neurocognitive health of migrants, longitudinal population-based and clinical cohort studies that specifically compare migrants and their descendants with the original population of their home countries are required.

Longitudinal change in health-related quality of life in people with prevalent and incident type 2 diabetes compared to diabetes-free controls.

OBJECTIVE: The objective of this analysis is to compare people with prevalent type 2 diabetes, incident type 2 diabetes and without diabetes with respect to longitudinal change in health-related quality of life (HRQOL) when adjusting for baseline determinants of HRQOL. RESEARCH DESIGN AND METHODS: Primary baseline and follow-up data from three regional and one national population-based cohort studies in Germany were pooled for analysis. HRQOL was measured using physical and mental health summary scores (PCS and MCS) from the German version of the Short Form Health Survey with 36 or 12 items. Mean score change per observation year was compared between the three groups (prevalent diabetes, incident diabetes, no diabetes) based on linear regression models. RESULTS: The analysis included pooled data from 5367 people aged 45-74 years at baseline. Of these, 85.5% reported no diabetes at baseline and follow-up, 6.3% reported diabetes at both baseline and follow-up (prevalent diabetes), and 8.2% reported diabetes only at follow-up (incident diabetes). Over a mean observation period of 8.7 years, annual decline in HRQOL scores is pronounced at 0.27-0.32 (PCS) and 0.34-0.38 (MCS) in the group with prevalent diabetes compared with people without diabetes. Those with incident diabetes showed intermediate values but did not differ significantly from people without diabetes after adjustment for covariates in the full model. CONCLUSION: Compared with data from cross-sectional analysis, the HRQOL loss associated with prevalent diabetes appears to be much larger than previously assumed.

Acculturation and health-related quality of life: results from the German National Cohort migrant feasibility study.

OBJECTIVES: We assessed the association between acculturation and health-related quality of life (HRQoL) among persons with a Turkish migrant background in Germany. METHODS: 1226 adults of Turkish origin were recruited in four German cities. Acculturation was assessed using the Frankfurt Acculturation Scale resulting in four groups (integration, assimilation, separation and marginalization). Short Form-8 physical and mental components were used to assess the HRQoL. Associations were analysed with linear regression models. RESULTS: Of the respondents, 20% were classified as integrated, 29% assimilated, 29% separated and 19% as marginalized. Separation was associated with poorer physical and mental health (linear regression coefficient (RC) = -2.3, 95% CI -3.9 to -0.8 and RC = -2.4, 95% CI -4.4 to -0.5, respectively; reference: integration). Marginalization was associated with poorer mental health in descendants of migrants (RC = -6.4, 95% CI -12.0 to -0.8; reference: integration). CONCLUSIONS: Separation and marginalization are associated with a poorer HRQoL. Policies should support the integration of migrants, and health promotion interventions should target separated and marginalized migrants to improve their HRQoL.

Updated prevalence rates of overweight and obesity in 4- to 10-year-old children in Germany. Results from the telephone-based KiGGS Wave 1 after correction for bias in parental reports.

The nationwide 'German Health Interview and Examination Survey for Children and Adolescents' (KiGGS), conducted in 2003-2006, showed an increase in the prevalence rates of overweight and obesity compared to the early 1990s, indicating the need for regular monitoring. Recently, a follow-up-KiGGS Wave 1 (2009-2012)-was carried out as a telephone-based survey, providing parent-reported height and weight from 5155 children aged 4-10 years. Since parental reports lead to a bias in prevalence rates of weight status, a correction is needed. From a subsample of KiGGS Wave 1 participants, measurements for height and weight were collected in a physical examination. In order to correct prevalence rates derived from parent reports, weight status categories based on parent-reported and measured height and weight were used to estimate a correction formula according to an established procedure. The corrected prevalence rates derived from KiGGS Wave 1 for overweight, including obesity, in children aged 4-10 years in Germany showed that stagnation is reached compared to the KiGGS baseline study (2003-2006). CONCLUSION: The rates for overweight, including obesity, in Germany have levelled off. However, they still remain at a high level, indicating a need for further public health action. What is Known: • In the last decades, prevalence of overweight and obesity has risen. Now a days, the prevalence seems to be stagnating. • In Germany, prevalence estimates of overweight and obesity are only available from regional or non-representative studies. What is New: • This article gives an update for prevalence rates of overweight and obesity amongst children aged 4-10 years in Germany based on a nationwide and representative sample. • Results show that stagnation in prevalence rates for overweight in children in Germany is reached.

[The health of children and adolescents from families with insecure residence status compared to children with permanent residence permits: analysis of KiGGS data 2003-2006]. / Gesundheit von Kindern und Jugendlichen aus Familien mit ungesichertem Aufenthaltsstatus im Vergleich zu Kindern mit und ohne Migrationshintergrund: Auswertung der KiGGS-Daten 2003-06.

BACKGROUND: The health of children and adolescents from families with insecure residence status could be poorer compared to other children with permanent residence permits in Germany due to exposure before and during flight. Their insecure residence status and their comparably low social status in the destination country may contribute towards access barriers to health care. However, selection effects might also lead to better health compared to other children in the destination country. This study compares the health status of children and adolescents with insecure residence status to that of other children with and without migration background in Germany. METHODS: We use data from the Health Interview and Examination Survey for Children and Adolescents (KiGGS). In multivariable logistic regression models we analyze the associations between children's residence status and their subjective and mental health, as well as their utilization of emergency services and vaccination status while adjusting for the children's social status and migration background. RESULTS AND CONCLUSION: Among 17,245 children, 197 (1.1 %) had an insecure residence status. Adjusting only for age and sex, an insecure residence status is associated with poorer subjective health (OR=3.12 (2.07-4.94)), mental problems (OR=1.83 (1.16-2.87)), an incomplete vaccination status (OR=2.0 (1.33-3.0)) and the use of emergency health services (OR=2.28 (1.2-4.36)). After adjusting also for social and migration status, only the association with the use of emergency care remains significant (OR=2.53 (1.18-5.43)). This association possibly indicates barriers to the use of regular primary care services, which requires further research.

Lower Prevalence of Atopic Dermatitis and Allergic Sensitization among Children and Adolescents with a Two-Sided Migrant Background.

In industrialized countries atopic diseases have been reported to be less likely in children and adolescents with a migrant background compared to non-migrants. This paper aimed at both examining and comparing prevalence of asthma, allergic rhinoconjunctivitis and atopic dermatitis and allergic sensitization to specific IgE antibodies in children and adolescents with and without a migrant background. Using data of the population-based German Health Interview and Examination Survey for children and adolescents (KiGGS;n = 17,450; 0-17 years), lifetime and 12-month prevalence of atopic diseases and point prevalence of 20 common allergic sensitizations were investigated among migrants compared to non-migrants. Multiple regression models were used to estimate the association of atopic disease and allergic sensitization with migrant background. In multivariate analyses with substantial adjustment we found atopic dermatitis about one-third less often (OR 0.73, 0.57-0.93) in participants with a two-sided migrant background. Statistically significant associations between allergic sensitizations and a two-sided migrant background remained for birch (OR 0.73, 0.58-0.90), soybean (OR 0.72, 0.54-0.96), peanut (OR 0.69, 0.53-0.90), rice (OR 0.64, 0.48-0.87), potato (OR 0.64, 0.48-0.85), and horse dander (OR 0.58, 0.40-0.85). Environmental factors and living conditions might be responsible for the observed differences.

Updated prevalence rates of overweight and obesity in 11- to 17-year-old adolescents in Germany. Results from the telephone-based KiGGS Wave 1 after correction for bias in self-reports.

BACKGROUND: The nationwide "German Health Interview and Examination Survey for Children and Adolescents" (KiGGS), conducted in 2003-2006, showed an increase in the prevalence rates of overweight and obesity compared to the early 1990s, indicating the need for regularly monitoring. Recently, a follow-up-KiGGS Wave 1 (2009-2012)-was carried out as a telephone-based survey, providing self-reported height and weight. Since self-reports lead to a bias in prevalence rates of weight status, a correction is needed. The aim of the present study is to obtain updated prevalence rates for overweight and obesity for 11- to 17-year olds living in Germany after correction for bias in self-reports. METHODS: In KiGGS Wave 1, self-reported height and weight were collected from 4948 adolescents during a telephone interview. Participants were also asked about their body perception. From a subsample of KiGGS Wave 1 participants, measurements for height and weight were collected in a physical examination. In order to correct prevalence rates derived from self-reports, weight status categories based on self-reported and measured height and weight were used to estimate a correction formula according to an established procedure under consideration of body perception. The correction procedure was applied and corrected rates were estimated. RESULTS: The corrected prevalence of overweight, including obesity, derived from KiGGS Wave 1, showed that the rate has not further increased compared to the KiGGS baseline survey (18.9 % vs. 18.8 % based on the German reference). CONCLUSION: The rates of overweight still remain at a high level. The results of KiGGS Wave 1 emphasise the significance of this health issue and the need for prevention of overweight and obesity in children and adolescents.

Development and validation of correction formulas for self-reported height and weight to estimate BMI in adolescents. Results from the KiGGS study.

OBJECTIVE: The use of reported instead of measured height and weight induces a bias in prevalence rates for overweight and obesity. Therefore, correction formulas are necessary. METHODS: Self-reported and measured height and weight were available from the German Health Interview and Examination Survey for Children and Adolescents (KiGGS) baseline study (2003-2006) from 3,468 adolescents aged 11-17 years. With regression analyses, correction formulas for height and weight were developed. Cross-validation was conducted in order to validate and compare the formulas. Corrected BMI was calculated, and corrected prevalence rates were estimated. Sensitivity, specificity, and predictive values for overweight and obesity were calculated. RESULTS: Through the correction procedure, the mean differences between reported and measured height and weight become remarkably smaller and thus the estimated prevalence rates more accurate. The corrected proportions for overweight and obesity are less under-reported, while the corrected proportions for underweight are less over-reported. Sensitivity for overweight and obesity increased after correction. Specificity remained high. CONCLUSION: The validation process showed that the correction formulas are an appropriate tool to correct self-reports on an individual level in order to estimate corrected prevalence rates of overweight and obesity in adolescents for studies which have collected self-reports only.

Bacterial infections in childhood: A risk factor for gastrointestinal and other diseases?

BACKGROUND: There is evidence for post-infectious irritable bowel syndrome (PI-IBS) in adults, but little is known about PI-IBS in children. The nationwide representative German Health Interview and Examination Survey for Children and Adolescents (KiGGS) assessed children's health. OBJECTIVE AND METHODS: We identified 643 children (50.1% males) in the KiGGS cohort (N = 15,878, 51% males) with a history of Salmonella infection. The number was validated comparing this group with the known infection statistics from the Robert Koch-Institute registry. We compared this group to the remaining KiGGS cohort (n = 12,951) with respect to sociodemographic characteristics, pain and quality of life. To check for specificity, we repeated the comparisons with a group with a history of scarlet fever. RESULTS: Infection statistics predicted 504 cases of Salmonella infection in the KiGGS cohort, indicating high validity of the data. In children between 3 and 10 years with a history of Salmonella infection, significantly more abdominal pain (31.7% versus 21.9%, p < 0.001) and headache (27.2% versus 15.1%, p < 0.001) were reported. This group showed lower quality of life (p < 0.001). Comparison to a group of scarlet fever-infected children revealed poor specificity of the data. CONCLUSION: Differences found between children with and without Salmonella infection reveal the role of gastrointestinal infection in the development of post-infectious abdominal problems, but poor specificity may point toward a psychosocial ("somatization") rather than a Salmonella-specific mechanism.

Calibration of blood pressure data after replacement of the standard mercury sphygmomanometer by an oscillometric device and concurrent change of cuffs.

Oscillometric blood pressure (BP) measurement devices are increasingly replacing standard mercury sphygmomanometers and generalizability of validation studies to other environments, for example, national survey environments, is assumed. We compared BP measurements according to two highly standardized German national survey BP protocols: a standard mercury sphygmomanometer and an oscillometric device, Datascope Accutorr Plus, each with specific manufacturer-provided cuffs and cuff-selection rules. A sample of 105 adults were subjected to alternate same-arm BP measurements according to the principles of the International Protocol revision 2010 for the validation of BP-measuring devices in adults of the European Society of Hypertension. In all, 315 BP measurement pairs were obtained. The mean systolic blood pressure (SBP) and diastolic blood pressure (DBP) were higher by the standard mercury old protocol and increased with BP, age, and pulse pressure, and were associated with the ratios of the cuff width to the arm circumference. The mean systolic difference (datascope new protocol-standard mercury old protocol) in participants with old protocol: for SBP<120 was -3.5 ± 4.9 mmHg (n=162), for SBP 120-139 (n=108) was -6.4 ± 5.8 mmHg, and for SBP ≥ 140 (n=45) was -11.9 ± 7.2 mmHg. For DBP<80/80-89/≥ 90 in 230/67/18 participants, the differences were -1.9 ± 5.0/-6.8 ± 5.9/-7.6 ± 5.2 mmHg. A calibration formula for SBP derived from linear regression modeling includes SBP, sex, age, pulse pressure, and the difference in the cuff-width to arm-circumference ratios for the two devices (for DBP without age). Our study suggests that even in a highly standardized national survey environment, reported agreement from validation studies may not be replicable and comparisons in the specific clinical or research setting can be useful before replacing the mercury device completely.

Reviewing the topic of migration and health as a new national health target for Germany.

OBJECTIVES: To review migration and health as a potential new national health target for Germany. METHODS: The theme was evaluated along 13 standardized criteria preset by the Health Targets Network. For each of the criteria an expert opinion based on an extensive (but nonsystematic) review of literature is presented. RESULTS: Migrants differ in many health-related aspects from the majority population in Germany. Despite having some health advantages, their health status, on average, is lower than that of non-migrants. They also experience barriers in health care and cannot participate in the society on equal terms with the majority population. Different measures to improve the health situation of migrants are available, but their current implementation in the health system is limited in several ways. Present data on the health of migrants is inadequate and limits migrant-sensitive health reporting. CONCLUSION: The evaluation of potential health targets based on standardized criteria is a valuable tool for health policy formulation. The present documentation can assist other countries in evaluating migration and health as a national health target. It may also contribute to similar activities at the European level.

Comparing sampling strategies to recruit migrants for an epidemiological study. Results from a German feasibility study.

BACKGROUND: In 2011, almost 20.0% of the population of Germany had a migration background. Studies on their health tend to have low participation rates. The aim of our study was to compare different sampling strategies and to test different approaches to recruit migrants for an epidemiological study. METHODS: Four recruitment centres of the German National Cohort recruited persons of Turkish origin and ethnic German immigrants from former Soviet Union countries. A register-based (random samples from residents' registration offices) and a community-orientated strategy were applied. Participants underwent a medical examination and self-completed a questionnaire. RESULTS: Used approaches: The community-orientated strategies comprised the acquisition of key persons from migrant networks to support the recruitment, invitation talks and distribution of study materials in migrant settings, etc. The identifying variables in the registry data were name, nationality or country of birth. All but one centres used bilingual study material and study staff. PARTICIPATION: When comparing the two strategies, the register-based participation rates ranged from 10.1 to 21.0% (n = 668 participants) and the community-oriented recruitment resulted in 722 participants. CONCLUSION: Register-based recruitment should use a combination of name, nationality and country of birth in order not to be limited to identifying persons with a foreign nationality. However, according to the study staff, the community-oriented approach involving key persons of the same cultural background leads to a better acceptance by the participants. Also, it covers a more heterogeneous group. Yet, it is time-consuming and needs considerably more staff. Further research should establish the effectiveness of a combination of both strategies.

Disagreement of the two oscillometric blood pressure measurement devices, Datascope Accutorr Plus and Omron HEM-705CP II, and bidirectional conversion of blood pressure values.

OBJECTIVE(S): Oscillometric blood pressure (BP) measurement devices frequently replace the standard mercury sphygmomanometer. Comparisons of oscillometric devices are rare, but their agreement is important to ensure comparability of BP data. This study aims to compare two oscillometric devices, Datascope Accutorr Plus and Omron HEM-705CP II, and to develop BP conversion models. METHODS: A sample of 109 adults aged 21-64 years were subjected to alternate same-arm BP measurements according to the International Protocol revision 2010 for the validation of BP measuring devices in adults of the European Society of Hypertension. RESULTS: A total of 327 BP measurement pairs were obtained. Datascope systolic blood pressure (SBP) pairs, in mmHg, were optimal (<120) for n=188, prehypertensive (120-139) for n=107, and hypertensive (≥140) for n=32 [diastolic blood pressure (DBP)<80 (n=261)/80-89 (n=57)/≥90 (n=9)]. The mean Omron values were higher and the difference increased with BP [mean differences, Omron minus Datascope, within BP ranges were (in mmHg): SBP 1.1±4.7, 3.0±5.5, and 9.3±6.7 and DBP 0.2±3.3, 2.3±3.4, and 5.1±3.9] and pulse pressure (>50 mmHg, SBP difference 5.6±6.3). The prevalence of hypertensive BP was 11% with Omron and 5% with Datascope. Bidirectional conversion models of SBP and DBP values include BP, pulse pressure, age, sex, and the difference in the ratio of cuff width to arm circumference. CONCLUSION: The disagreement in oscillometric devices can reach a magnitude that could be of interest for clinical and epidemiological contexts. Conversion formulas with BP, pulse pressure, sex, age, and the cuff width to arm circumference ratio may help to improve comparability.

Applying a correction procedure to the prevalence estimates of overweight and obesity in the German part of the HBSC study.

BACKGROUND: Prevalence rates for overweight and obesity based on self-reported height and weight are underestimated, whereas the prevalence rate for underweight is slightly overestimated. Therefore a correction is needed. Aim of this study is to apply correction procedures to the prevalence rates developed on basis of (self-reported and measured) data from the representative German National Health Interview and Examination Survey for Children and Adolescents (KiGGS) to (self-reported) data from the German Health Behaviour in School Aged Children (HBSC) study to determine whether correction leads to higher prevalence estimates of overweight and obesity as well as lower prevalence rates for underweight. METHODS: BMI classifications based on self-reported and measured height and weight from a subsample of the KiGGS study (2,565 adolescents aged 11-15) were used to estimate two different correction formulas. The first and the second correction function are described. Furthermore, the both formulas were applied to the prevalence rates from the HBSC study (7,274 adolescents aged 11-15) which are based on self-reports collected via self-administered questionnaires. RESULTS: After applying the first correction function to self-reported data of the HBSC study, the prevalence rates of overweight and obesity increased from 5.5% to 7.8% (compared to 10.4% in the KiGGS study) and 2.7% to 3.8% (compared to 7.8% in the KiGGS study), respectively, whereas the corrected prevalence rates of underweight and severe underweight decreased from 8.0% to 6.7% (compared to 5.7% in the KiGGS study) and from 5.5% to 3.3% (compared to 2.4% in the KiGGS study), respectively. Application of the second correction function, which additionally considers body image, led to further slight corrections with an increase of the prevalence rates for overweight to 7.9% and for obese to 3.9%. CONCLUSION: Subjective BMI can be used to determine the prevalence of overweight and obesity among children and adolescents. Where there is evidence of bias, the prevalence estimates should be corrected using conditional probabilities that link measured and subjectively assessed BMI from a representative validation study. These corrections may be improved further by considering body image as an additional influential factor.

Patterns of sensitization to inhalant and food allergens - findings from the German Health Interview and Examination Survey for Children and Adolescents.

BACKGROUND: To assess the prevalence of allergic sensitization and to analyze patterns of sensitization to common inhalant and food allergens in a nationwide representative sample of children and adolescents in Germany. METHODS: Data were collected from 2003 to 2006 within the KiGGS, the national Health Interview and Examination Survey covering a representative sample of 17,641 children and adolescents in Germany. Immunoglobulin E (IgE) antibodies to 20 specific allergens (11 inhalant and 9 food allergens) were quantitatively measured in a subsample of 12,988 KiGGS participants aged 3-17 years using the ImmunoCAP system. Serum concentrations ≥0.35 kU/l indicate sensitized participants. An exploratory factor analysis was performed in order to identify sensitization patterns. RESULTS: Sensitization to at least 1 of the 20 tested allergens was detected in 40.2% [95% confidence interval (CI) 39.0-41.4] of the participants. The highest sensitization prevalences were found for pollen from Timothy grass (22.7%; 21.5-23.9) and rye (21.2%; 20.0-22.4). Sensitization was more prevalent in boys than in girls and prevalence increased generally with increasing age. We identified seven sensitization groups, namely (in descending order of magnitude) 'Timothy grass/rye', 'house-dust mites', 'food/mugwort', 'birch/apple', 'animals', 'cow's milk/egg white' and 'moulds'. CONCLUSIONS: Allergic sensitization is common in German children and adolescents. The fact that sensitization potentially leads to clinically relevant allergic diseases stresses the public health relevance of this topic. Whether the grouping reflects the propensity for persons to be sensitized to multiple allergens within a group, or whether it is due to IgE cross-reactivity between different allergens of similar structure is still being discussed.

Personal attributes that influence the adequate management of hypertension and dyslipidemia in patients with type 2 diabetes. Results from the DIAB-CORE Cooperation.

BACKGROUND: Hypertension and dyslipidemia are often insufficiently controlled in persons with type 2 diabetes (T2D) in Germany. In the current study we evaluated individual characteristics that are assumed to influence the adequate treatment and control of hypertension and dyslipidemia and aimed to identify the patient group with the most urgent need for improved health care. METHODS: The analysis was based on the DIAB-CORE project in which cross-sectional data from five regional population-based studies and one nationwide German study, conducted between 1997 and 2006, were pooled. We compared the frequencies of socio-economic and lifestyle factors along with comorbidities in hypertensive participants with or without the blood pressure target of<140/90 mmHg. Similar studies were also performed in participants with dyslipidemia with and without the target of total cholesterol/HDL cholesterol ratio<5. Furthermore, we compared participants who received antihypertensive/lipid lowering treatment with those who were untreated. Univariable and multivariable logistic regression models were used to assess the odds of potentially influential factors. RESULTS: We included 1287 participants with T2D of whom n=1048 had hypertension and n=636 had dyslipidemia. Uncontrolled blood pressure was associated with male sex, low body mass index (BMI), no history of myocardial infarction (MI) and study site. Uncontrolled blood lipid levels were associated with male sex, no history of MI and study site. The odds of receiving no pharmacotherapy for hypertension were significantly greater in men, younger participants, those with BMI<30 kg/m(2) and those without previous MI or stroke. Participants with dyslipidemia received lipid lowering medication less frequently if they were male and had not previously had an MI. The more recent studies HNR and CARLA had the greatest numbers of well controlled and treated participants. CONCLUSION: In the DIAB-CORE study, the patient group with the greatest odds of uncontrolled co-morbidities and no pharmacotherapy was more likely comprised of younger men with low BMI and no history of cardiovascular disease.