[Regional differences in health behaviour in bavaria - a multilevel analysis of a representative population questionnaire in combination with socioeconomic structural data]. / Regionale Unterschiede des Gesundheitsverhaltens in Bayern - Mehrebenenanalyse einer bevölkerungsrepräsentativen Befragung in Verbindung mit sozioökonomischen Strukturdaten.

OBJECTIVES: There are regional differences in mortality in Bavaria. Although these regional dif-ferences in mortality were associated with behavioural risk factors and socioeconomic factors in a study conducted for this reason, the quantitative effect of behavioural risk factors and socio-economic factors as well as the regional structure on the individual health as a predictor of mortality were not known. METHODS: Persons between the age of 18 and 80 were interviewed with the Behavioral Risk Factor Surveillance System (BRFSS) in two Bavarian regions with high mortality, two Bavarian regions with low mortality and in the capital of Bavaria, Munich. For regional structural data, the INKAR database was used. Data were analysed descriptively, with a multivariable-adjusted logistic regression and with a multilevel analysis. RESULTS: There were lower proportions of persons with a good or very good state of health as well as adverse results for overweight/adipositas, the behavioural risk factors for doing sports, smoking and consuming fruits and vegetables and the socioeconomic factors education and unemployment in the two regions with high mortality "Ostbayerische Grenzregion" and "Oberfranken". In a multivariable adjusted logistic regression, the body mass index, smoking, doing sports, climbing stairs, consuming alcohol, being satisfied with the job and the interaction between education and marital status were found to have an influence on the individual health. The small remaining regional component could be explained in the multilevel analysis by different variables which describe the economical situation of the regions. CONCLUSIONS: In accordance with the study hypotheses, a consistency between behavioural risk factors and regional differences in mortality could be observed. Socioeconomic influences and a small regional component are involved. In addition to specific prevention programmes for the target groups, structural support is also meaningful with regard to its potential health impact.

[Switching sickness funds and risk compensation mechanisms in the statutory health insurance system in Germany--empirical results from the cooperative health research in the region of Augsburg (KORA)]. / Kassenwechsel und Risikostrukturausgleich in der gesetzlichen Krankenversicherung -- empirische Befunde der Kooperativen Gesundheitsforschung in der Region Augsburg (KORA).

Since 1996, all citizens of the Federal Republic of Germany who are insured in the statutory health insurance system are entitled to switch their sickness fund. The rationale of this regulation was to strengthen elements of competition in this system in order to stimulate the sickness funds to improve the efficiency of health care and to respond to consumers' preferences. Simultaneously, to avoid the implicit incentives for sickness funds to engage in risk selection, a risk compensation mechanism was introduced, including as morbidity-related risk adjusters age, sex and incapacity to work. Based on the KORA survey S4 (1999/2001) we take the case of switching behaviour in the region of Augsburg, and analyse whether this risk adjustment scheme was working effectively. The results show that persons changing their sickness fund were characterised by a comparatively smaller burden of chronic diseases and by a less frequent utilization of inpatient health care. Under these conditions, differences in the contribution rates do not accurately reflect differences in the performance and efficiency of sickness funds. Moreover, the migration of good risk to sickness funds with favourable contribution rates threatens the principle of financial solidarity. Therefore, the system of risk equalisation has to be developed towards measuring the risk volume borne by the sickness funds more precisely than hitherto.

Radiographic defect depth and width for prognosis and description of periodontal healing of infrabony defects.

BACKGROUND: The aims of the present study were to evaluate 1) defect depth and width as a prognostic factor and 2) change in defect width as a describing parameter of periodontal healing in infrabony defects treated by regenerative therapy after 6 and 24 months. METHODS: In 24 patients with advanced periodontitis, 39 infrabony defects were treated by guided tissue regeneration (GTR) using expanded polytetrafluoroethylene (ePTFE) (n = 7) or bioabsorbable barriers (n = 32). Clinical parameters were assessed and 39 standardized radiographs (in triplicate) were taken before and 6 and 24 months after surgery. Using a computer-assisted analysis, the depth, width, and angle of the bony defects were measured. RESULTS: Statistically significant vertical clinical attachment gains (CAL-V: 3.15 +/- 1.63 mm to 3.31 +/- 1.65 mm; P<0.001) and bony fill (1.30 +/- 2.53 mm; P<0.01 to 1.54 +/- 2.70 mm; P<0.005) were observed 6 and 24 months postsurgically. In a multilevel regression analysis CAL-V gain was predicted by baseline CAL-V (P <0.0001), actual smoking (P <0.05), and age (P <0.1). Bony fill could be predicted by baseline height of the infrabony component (P<0.0001), gingival index at baseline (P<0.05), and actual smoking (P <0.01). In narrow (<26 degrees) and deep (> or = 3 mm) infrabony defects bony fill was more pronounced than in wide and shallow defects (P <0.05). CONCLUSIONS: Improvement achieved by guided tissue regeneration in infrabony defects can be maintained up to 24 months after surgery. Narrow and deep infrabony defects respond radiographically and to some extent clinically more favorably to GTR therapy than wide and shallow defects. However, depth of the infrabony component was a stronger prognostic parameter than defect angle. Actual smoking impairs the results of GTR therapy in infrabony defects.

The association between baseline lung function and bronchial responsiveness to methacholine.

It has been reported that females show an increased frequency of bronchial hyperresponsiveness (BHR) compared to males and that this difference is abolished after taking into account differences in baseline FEV1. The aim of our study was to analyse how the distribution of BHR in males and females depends on the definition of BHR. Special emphasis was paid to the question whether the prevalence rates of BHR according to different definitions were related to baseline characteristics of the subjects and baseline lung function in the same manner. We analysed the data obtained within the European Community Respiratory Health Survey (ECRHS) in the Eastern German population sample of Erfurt aged 20-65 years (n = 931). In logistic regression analyses of different definitions of BHR, we used as parameters age, height, gender, smoking habits, baseline forced expiratory volume in one second (FEV1), forced vital capacity (FVC), and FEV1 as a percent of FVC (FEV1% FVC). Symptoms and reported diagnosis of asthma did not significantly depend on gender or age. When BHR was defined as the provocative dose causing a 20% fall in FEV1, BHR was more prevalent in females than in males (27.6% vs. 13.2%). Similar gender differences were found when defining BHR via a 10% fall in FEV1 or by using corresponding cut-off values of the linear dose-response slopes of the percent decline in FEV1 (DRS). Multiple linear regression analyses of various transformations of the DRS also indicated a higher degree of BHR in females. Independently of the definition chosen, however, the gender difference in the prevalence of BHR disappeared when height and FEV1 or FEV1% FVC or appropriate combinations were included in the model. The reciprocally transformed DRS showed the best resolution of the spectrum of bronchial responsiveness. These data are compatible with the hypotheses that (1) estimates of the distribution of BHR are distorted by differences in the methacholine dosage per lung size and that (2) airway geometry affects the measurement of BHR. It appears that these factors and not intrinsic differences in BHR between males and females contribute to the gender differences in the prevalence of BHR. Furthermore, our data support the superiority of the dose response slope for the analysis of bronchial responsiveness in epidemiologic surveys.

Renal function and renotropic effects of secretin in cystic fibrosis.

In ten cystic fibrosis patients and nine age-matched controls, renal function was determined before and after infusion of secretin. Under baseline conditions creatinine excretion and clearance were significantly elevated, exclusively due to those patients who were homozygous for the DF508 mutation (153 vs 132 ml/min*1.73m2), whereas the glomerular filtration rate, measured by inulin clearance showed no difference. Renal plasma flow and the fractional reabsorption rates of electrolytes were similar in patients and controls. During secretin infusion renal plasma flow increased and the fractional reabsorption rates of electrolytes decreased in both groups. The patients had a increased metabolic clearance (2900 vs 1660 ml/min*m2) and endogenous production rate (9,9 vs 2,5 pmol/min*m2) of of secretin. In conclusion global renal function and electrolyte handling, in particular chloride permeability, are unchanged in cystic fibrosis. Individuals expressing the DF508 genotype showed a selective elevation of creatinine excretion and clearance. The secretion and metabolic clearance of secretin are increased in cystic fibrosis.

Severity of childhood asthma by socioeconomic status.

BACKGROUND: A review of studies on the association between childhood asthma and socioeconomic status (SES) in industrialized countries leads to the conclusion that there does not seem to be a clear association. A study from Aberdeen published 25 years ago, however, shows that among children with asthma, severe asthma is most prevalent in the lower social class, but this distinction between grades of asthma severity has been largely ignored since. METHODS: We screened all fourth grade schoolchildren of German nationality in Munich (4434 children, response rate 87 percent), distinguishing three severity grades in the same way as the study in Aberdeen. RESULTS: Prevalences of childhood asthma are reported by severity grade and SES. Prevalence of severe asthma was found to be significantly higher in the low as compared with the high socioeconomic group (Odds ratio = 2.37; 95 percent confidence interval: 1.28-4.41). This association could not be explained by established risk factors. CONCLUSIONS: More attention should be paid to the association between severe asthma and SES, with measures such as targeting early diagnosis and treatment towards low socioeconomic groups.

Dose response for heritable translocations induced by acrylamide in spermatids of mice.

A heritable translocation test was carried out with acrylamide (AA) to obtain a dose-response relationship for induction of reciprocal translocations in late spermatids of the mouse. Male C3H/E1 mice were treated with single i.p. doses of 50 and 100 mg/kg of acrylamide and mated 7-16 days after treatment to untreated female 102/E1 mice. Translocation carriers among the F1 progeny were selected by a sequential procedure of fertility testing and cytogenetic analysis including G-band karyotyping to determine the chromosomes involved in the respective translocations. The translocation frequencies observed with 50 mg/kg and 100 mg/kg of AA were 0.6% and 2.7%, respectively. The historical control translocation frequency was 0.04%. Doubling dose estimates based on these and previous data are discussed.

[Effects of passive smoking on the pediatric respiratory tract]. / Auswirkungen des Passivrauchens auf den kindlichen Respirationstrakt.

OBJECTIVE: To explore the risk of parental smoking to the respiratory health of their children data of a cross sectional study on fourth-grade schoolchildren in Munich and Southern Bavaria were analysed. METHODS: Allergic and asthmatic diseases and symptoms, risk factors like family history, indoor pollution and parental smoking were evaluated by a questionnaire. Pulmonary function tests were performed in 7284 school children aged (9-11 years). Lung function values were adjusted for height, weight, sex and other confounders. RESULTS: The children, whose parents smoke at home, had significantly lower levels of peak flow, MEF75, MEF50 and MEF25 compared to children from non-smoking families, with a dose-response relationship. Smoking of more than 20 cigarettes at home is associated with a mean decrease in MEF75 of 5.7%, in MEF50 of 4.9% and in Peak Flow of 4.9% (p < 0.001). The prevalence of cough and wheezing increased with increasing smoking rates of the parents. CONCLUSIONS: Passive exposure to smoke has direct measurable dose-dependent effects on the respiratory system of children.

Characterization of Cat-2t, a radiation-induced dominant cataract mutation in mice.

A dominant cataract mutation was detected recently among the offspring of x-ray-irradiated male mice. The mutation, which causes total lens opacity, has provisionally been designated by the gene symbol Cat-2t. In the lenses of heterozygous and homozygous Cat-2t mutants, the epithelial and fiber cells were swollen and the lens capsule was ruptured. The histologic analysis demonstrated a complete destruction of the cellular organization of the lens, which might be caused by its altered developmental processes. The data derived from biochemical investigations indicate that biochemistry of the cataractous Cat-2t lenses is affected: the osmotic state as indicated by the increased water content and increased Na(+)-K(+)-adenosinetriphosphatase (ATPase) activity; the energy state as indicated by the decreased adenosine triphosphate (ATP) concentration; and the redox state as indicated by the enhanced content of oxidized glutathione. Additionally, the lenticular protein composition is altered because of the presence of vimentin in the water-soluble fraction. This cannot be explained by the enhanced crosslinking activity of transglutaminase. The changes of the osmotic, energy, and redox states are considered to be secondary in relation to the altered lenticular development. In contrast, the variations concerning vimentin and transglutaminase might be a biochemical indication of the changed development. Possible similarities to other dominantly expressed murine cataract mutants are discussed.

Osmotic state of lenses in three dominant murine cataract mutants.

Three newly detected dominant cataract mutations (Asc-1, Cat-3vao, Tcm) were investigated for effects on osmotic alterations in the lenses of heterozygotes. The lens wet weight was reduced in two mutant lines (Cat-3vao and Tcm), and the water content in the lenses of the Cat-3vao mice was increased. Moreover, in the cataractous lenses from Cat-3vao mice, the sodium-potassium-adenosine triphosphatase (Na(+)-K(+)-ATPase) activity was enhanced and the ATP concentration, correspondingly decreased. The osmotic variations observed in the Cat-3vao mutants might have been due to a metabolic response to the yet unknown, primary pathological event. The lenses of the other two mutant lines (Asc-1 and Tcm) revealed no alterations that could be related to osmotic stress. In no mutant line investigated could a decrease in Na(+)-K(+)-ATPase activity be demonstrated that was similar to the causative factor in the Nakano mutant line. The Cat-3vao mice exhibited some similarities to the Philly mutant line.

Oxidative stress and inherited cataracts in mice.

To determine whether an unbalanced redox state might accompany the development of particular inherited mouse cataracts, the lenticular content of oxidized glutathione (GSSG) and the activity of superoxide dismutase (SOD) were chosen as markers. For wild-type lenses, an enhanced GSSG content could be observed in females as compared to males. Such a sex effect could not be detected for the SOD activity. In the mutants, GSSG content in cataractous lenses was found to be enhanced in 2 of 7 cases; the increases in other mutants were not significant. Changes of the SOD activity were even less consistent and only a random correlation of GSSG content and SOD activity with cataractogenesis could be deduced.