The Impact of Migration Background on the Health Outcomes of Preschool Children: Linking a Cross-Sectional Survey to the School Entrance Health Examination Database in Bavaria, Germany.

AIM OF THE STUDY: This study investigated the impact of migration background on the health outcomes of preschool children from families of various social status levels. METHODS: During the school entrance health examination (Schuleingangsuntersuchung (SEU)) from October 2012 to August 2013, the parents of 5052 preschool children (62% response rate) participated in a cross-sectional health survey within the framework of health-monitoring units (Gesundheits-Monitoring-Einheiten (GME)) in Bavaria, Germany. They were handed a self-administered questionnaire with questions relating to the language spoken at home and other socio-demographic characteristics. By applying the record linkage method, 3747 participants were correctly linked to the corresponding data of the SEU. Based on the merged dataset, 4 definitions of migration background were explored regarding demographic indicators, the parents' mother tongue, and the language spoken at home. The association between migration background and health outcomes of preschool children was analyzed using multivariable logistic regression models separately. The risk estimates were presented for the study population and stratified into high, medium, and low social status. The models were repeated for each of the 4 migration background variables. RESULTS: The results show significant associations between migration background and health outcomes of preschool children (except in pronunciation). A migration background had the strongest impact on the development of word/sentence formation disorder. Compared to non-migrant preschool children, migrant children had twice the chances for full vaccination coverage (OR [95% CI]: 2.4 [1.9-3.1]) but only half the chance to participate in all health examinations from U1 to U9 (0.5 [0.4-0.6]). These children were also at two-fold increased risk to be overweight/obese (2.2 [1.7-2.8]). Moreover, preschool children with double-sided migration from medium social status families faced the highest risk for word/sentence formation disorder (9.5 [5.6-16.1] with SEU definition and 23.3 [10.3-52.6] with GME definition of a migration background). CONCLUSIONS: Future prevention programs at the preschool level should focus on children with double-sided migration from medium social status families. With respect to social and cultural integration, the definition of migration background based on the language spoken at home should be appropriate for future SEUs.

Prevention of Sudden Infant Death Syndrome (SIDS) in Bavaria - evaluation of a prevention campaign.

BACKGROUND: With simple prevention measures SIDS (Sudden Infant Death Syndrome) incidence rates can be reduced. A cross-sectional survey in Bavaria in 2005 showed that maternity units fall short in acting as role models and informing parents regarding SIDS prevention and that parents did not sufficiently apply prevention measures. An information campaign in Bavaria was initialized and evaluated after 18 months. METHODS: Flyers and posters for SIDS prevention using consistent information were developed for dissemination by the relevant occupational groups. The campaign impact was assessed in repeating the cross-sectional survey. RESULTS: A response rate of 99% for the maternity units and 60% for the parent questionnaires could be achieved. Significant improvements (p<0.05) in the maternity units regarded a higher proportion of parents informed about SIDS prevention measures (97 vs. 92%) and an increased use of sleeping bags (37 vs. 12%), whereas the proportion of children placed in supine position to sleep was not increased. More parents reported to have obtained advice for SIDS prevention (83 vs. 73%) and to have used sleeping bags (66 vs. 56%). A subgroup analysis revealed poorer information and implementation of the recommendations in families with three or more children and less educated families. CONCLUSIONS: After initiation of the information campaign reported knowledge about SIDS prevention measures increased. Continuing shortfalls exist regarding maternity units acting as role models and implementation of the recommendations by the parents. Future interventions should focus in particular on the role model function of maternity units and target groups.

Improvement of survival in sex cord stromal tumors - an observational study with more than 25 years follow-up.

OBJECTIVE: To highlight aspects of malignant ovarian sex cord stromal tumors, effects of treatment, and developments over the past 28 years. DESIGN: Population-based cohort study. SETTING: Gynecological departments within the catchment-area of the Munich Cancer Registry and associated with the project group 'Malignant Ovarian Tumors' of the Munich Cancer Center. SAMPLE: One hundred and forty-five women with an invasive single sex cord stromal tumor diagnosed between 1978 and 2005. METHODS: Overall survival was estimated with the Kaplan-Meier method, relative survival was computed by the ratio of observed to expected survival rate. The impact of age, International Federation of Gynecology and Obstetrics (FIGO)-stage, residual tumor, and chemotherapy was examined by multivariate analysis (Cox regression model). MAIN OUTCOME MEASURES: Overall and relative survival and multivariate adjusted overall survival. RESULTS: Survival data showed a five-/10-year overall survival of 55.8%/42.8% (relative survival 58.6%/49.2%) for women diagnosed before 1988 and 89.1%/78.3% (relative survival 92.7%/85.2%) for women diagnosed after 1988. After adjustment for age and FIGO-stage, the following hazard ratios and 95% confidence intervals (95% CI) for treatment methods resulted: 3.3 (95% CI 1.5-7.0) for women with compared to women without residual tumor and 2.2 (95% CI 1.2-4.2) for women with chemotherapy compared to women where no chemotherapy was given. CONCLUSIONS: Improvements in survival may be attributed to a stage-shift toward more favorable stages at diagnosis and to advances in treatment such as improved surgery without residual tumor. There is no evidence for any benefit of adjuvant chemotherapy. Surgery remains the cornerstone of treatment, yet the benefit of postoperative therapy is still under debate.