[The use of medical services and the utilization rate in screening programs in relation to social class: results of a representative survey in Bavaria]. / Schichtspezifische Inanspruchnahme medizinischer Leistungen und Vorsorgeverhalten in Bayern: Ergebnisse einer repräsentativen Bevölkerungsbefragung.

OBJECTIVES: This article aims to analyse utilisation of medical services and screening programmes in relation to social class. METHODS: 2051 adults in Bavaria were interviewed using computer-assisted telephone interview (CATI) in 1999/2000. Social class was established from the income-adjusted Winkler social category index. Data were standardised by age and sex. If social class differences were found, separate analyses for education and income effects were conducted. RESULTS: Higher education was found to be associated with visits to specialist and vaccinations. The purchase of over-the-counter medication was related to higher education and family income. Frequency of HIV-tests was higher in higher social classes but not related to higher education or better financial situation. Utilisation rates for screening programmes for various types of cancer were similar in all social classes. CONCLUSIONS: The results show that social class differences in health behaviour in Bavaria prevail. Positive health behaviour is often associated with higher education. Compared to earlier findings social class effects on the utilisation of cancer screening appears less pronounced. Preventive measures seem to have reached all social classes to a similar degree.

Certain hydrolyzed formulas reduce the incidence of atopic dermatitis but not that of asthma: three-year results of the German Infant Nutritional Intervention Study.

BACKGROUND: Recommendations for primary prevention of allergic diseases in high-risk children include feeding with hydrolyzed formulas if breast-feeding is insufficient. OBJECTIVE: The primary objective of the German Infant Nutritional Intervention study was to investigate the allergy preventive effect of 3 hydrolyzed formulas compared with cow's milk formula in the first 3 years of life in a randomized, double-blind trial. METHODS: Between 1995 and 1998, 2252 newborns with atopic heredity were allocated to a group receiving cow's milk formula, partially or extensively hydrolyzed whey formula, or extensively hydrolyzed casein formula as a milk substitute for the first 4 months if breast-feeding was insufficient. Main outcome parameters were allergic manifestations, atopic dermatitis (AD), and asthma. RESULTS: After 3 years, 396 of 2252 children (17.6%) had dropped out. Breast-fed infants without formula feeding during the intervention (n = 889) were considered separately. A significant reduction of the incidence of AD was achieved with the extensively hydrolyzed casein formula in the intention-to-treat (ITT; n = 1363) and per protocol (PP; n = 904) analyses (ITT: population odds ratio [95% CI], 0.67 [0.45-0.99]; PP: adjusted odds ratio [OR(adj)], 0.53 [0.32-0.88]), and with the partially hydrolyzed whey formula in the PP analysis (ITT: population odds ratio, 0.76 [0.52-1.11]; PP:OR(adj), 0.60 [0.37-0.97]). None of the formulas reduced the incidence of asthma. CONCLUSION: The risk for AD, but not for asthma, can be reduced with certain cow's milk hydrolyzates in high-risk infants when breast-feeding is insufficient. CLINICAL IMPLICATIONS: Early nutritional intervention in high-risk children has significant influence on the incidence of AD, but not of asthma.

Effect of breast-feeding on the development of atopic dermatitis during the first 3 years of life--results from the GINI-birth cohort study.

OBJECTIVE: To investigate if exclusive breast-feeding for 4 months is associated with atopic dermatitis during the first 3 years of life. STUDY DESIGN: Data on 3903 children were taken from yearly parental-administered questionnaires from a birth cohort study in Germany (recruited 1995-1998) comprised of a noninterventional (NI) and an interventional (I) subgroup. Outcomes were physician-diagnosed atopic dermatitis (AD) and itchy rash. Multiple logistic regression was performed for the entire cohort and stratified by family history of allergy and by study group adjusting for a fixed set of risk factors for allergies. RESULTS: Exclusive breast-feeding (52 % of children) was not associated with higher risk for AD either in the entire cohort (OR(adj,) 0.95; 95% CI, 0.79-1.14) or if stratified by family history of AD. In the I subgroup, but not in the NI subgroup, exclusive breast-feeding showed a significant protective effect on AD if compared with conventional cow's milk formula (OR(adj), 0.64; 95% CI, 0.45-0.90). CONCLUSION: These findings do not support the hypothesis that exclusive breast-feeding is a risk factor for development of atopic dermatitis but is protective if compared with conventional cow's milk. Observational studies might not be able to effectively control for selection bias and reverse causation.