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Mikolajczyk R.T.,Bremen Institute for Prevention Research and Social Medicine | Mikolajczyk R.T.,Bielefeld University | Zhang J.,U.S. National Institutes of Health | Zhang J.,Shanghai JiaoTong University | And 5 more authors.
The Lancet | Year: 2011

Definition of small for gestational age in various populations worldwide remains a challenge. References based on birthweight are deficient for preterm births, those derived from ultrasound estimates might not be applicable to all populations, and the individualised reference can be too complex to use in developing countries. Our aim was to create a generic reference for fetal weight and birthweight that overcame these deficiencies and could be readily adapted to local populations. We used the fetal-weight reference developed by Hadlock and colleagues and the notion of proportionality proposed by Gardosi and colleagues and made the weight reference easily adjustable according to the mean birthweight at 40 weeks of gestation for any local population. For application and validation, we used data from 24 countries in Africa, Latin America, and Asia that participated in the 2004-08 WHO Global Survey on Maternal and Perinatal Health (237 025 births). We compared our reference with that of Hadlock and colleagues (non-customised) and with that of Gardosi and colleagues (individualised). For every reference, the odds ratio (OR) of adverse perinatal outcomes (stillbirths, neonatal deaths, referral to higher-level or special care unit, or Apgar score lower than 7 at 5 min) for infants who were small for gestational age versus those who were not was estimated with multilevel logistic regression. OR of adverse outcomes for infants small for gestational age versus those not small for gestational age was 1·59 (95 CI 1·53- 1·66) for the non-customised fetal-weight reference compared with 2·87 (2·73-3·01) for our country-specific reference, and 2·84 (2·71-2·99) for the fully individualised reference. Our generic reference for fetal-weight and birthweight percentiles can be easily adapted to local populations. It has a better ability to predict adverse perinatal outcomes than has the non-customised fetal-weight reference, and is simpler to use than the individualised reference without loss of predictive ability. None. © 2011 Elsevier Ltd.


El Ansari W.,University of Gloucestershire | Stock C.,University of Southern Denmark | Mikolajczyk R.T.,Bielefeld University | Mikolajczyk R.T.,Bremen Institute for Prevention Research and Social Medicine
Nutrition Journal | Year: 2012

Background: The transition of young people from school to university has many health implications. Food choice at the university can differ because of childhood food consumption patterns, sex and the living arrangements. Food consumption may change especially if students are living away from home. We aimed to assess food consumption patterns among university students from four European countries and how they differ by their living arrangements. Methods: We analysed data from a cross-country survey assessing health and health behaviours of students. The sample comprised a total of 2402 first year undergraduate students from one university in each of the countries of Germany, Denmark, Poland and Bulgaria. Food consumption was assessed by means of a food frequency questionnaire with 9 food groups (indicators). Results: Students food consumption patterns differed across the countries. Frequent consumption of unhealthy items was common. Bulgarian students reported most often frequent consumption of sweets and cakes and snacks (e.g. chips and fast food). Polish students reported the least frequent consumption of vegetables and a low consumption of fruits. Across all countries except Bulgaria, men reported substantially more often frequent consumption of snacks than women. Students living at parental home consumed more fruit, vegetables, and meat than those who resided outside of their family home in all studied countries. There was more variation with regard to cakes and salads with more frequent consumption of cakes among Bulgarian female students and Danish male students and more frequent consumption of salads among Danish female students not living at parental home, compared to students from other countries. Conclusions: Nutrition habits of university students differed across countries and by sex. Students living at parental home displayed more healthy nutrition habits, with some exceptions. © 2012 El Ansari et al.; licensee BioMed Central Ltd.


Mikolajczyk R.T.,Bremen Institute for Prevention Research and Social Medicine | Iannotti R.J.,National Health Research Institute | Iannotti R.J.,Eunice Kennedy Shriver National Institute of Child Health and Human Development | Farhat T.,National Health Research Institute | Thomas V.,National Health Research Institute
BMC Public Health | Year: 2012

Background: Perceived body appearance and body satisfaction are potentially related to weight problems and poor health. The purpose of this study was to examine how gender, and ethnic differences in body satisfaction, perceived body appearance and weight status change by age in a representative sample of U.S. adolescents 11-17 years old. Methods. We used the US Health Behavior in School-Aged Children (HBSC) 2001 survey which assessed perceived body appearance, body satisfaction, self-reported body mass index (BMI) and socio-demographic indicators. The associations between age and perceived appearance, age and body satisfaction, and between z-transformed BMI and body satisfaction were analyzed using separate non-parametric regression models for both genders and the three ethnic groups. Results: Body satisfaction did not vary significantly by age except for an increase with age in the proportion of Non-Hispanic White girls who perceived themselves as too fat. Although boys did not report being too fat unless their BMI was above the age- and gender-specific median, one third of Non-Hispanic White girls felt too fat at or below the age- and gender-specific median. Compared to other ethnicities, African-American students perceived appearance was significantly more positive and they were less likely to perceive themselves overweight at higher BMI scores. However, during adolescence, the positive self-reported perceived appearance of African-American boys dropped substantially while it remained relatively stable in African-American girls. Conclusions: There were substantial differences in body satisfaction and perceived appearance across the three largest ethnic groups of school-age children in the U.S. Stability across age indicates that these perceptions are most likely established before the age of 10 and underline the importance of primary schools and parents in prevention. Special attention should be directed to the dramatic loss of positive perceived appearance among African-American boys. © 2012 Mikolajczyk et al.; licensee BioMed Central Ltd.


Sagel U.,Bielefeld University | Sagel U.,analyse BioLab GmbH | Sagel U.,Lower Austria State Hospital Of St Polten Lilienfeld | Kramer A.,Bielefeld University | And 2 more authors.
BMC Infectious Diseases | Year: 2011

Background: Despite three decades of prenatal screening program for toxoplasmosis in Austria, population-based estimates for the incidence of maternal infections with Toxoplasma gondii during pregnancy are lacking. We studied the incidence of primary maternal infections during pregnancy in the Federal State of Upper Austria.Methods: Screening tests for 63,416 women and over 90,000 pregnancies (more than 84.5% of pregnancies in the studied region) in the time period between 01.01.2000 and 31.12.2007 were analysed. The incidence of toxoplasmosis was estimated indirectly by binomial and directly by interval censored regression.Results: During the studied period, 66 acute infections (risk of 0.07% per pregnancy) were detected, but only 29.8% of seronegative women were tested at least three times during their pregnancies. The seroprevalence of Toxoplasma antibodies among all tested women was 31%. Indirectly estimated incidence (from differences in prevalence by age) was 0.5% per pregnancy, while directly estimated incidence (interval censored regression) was 0.17% per pregnancy (95% confidence interval: 0.13-0.21%).Conclusions: Calculating incidence from observed infections results in severe underreporting due to many missed tests and potential diagnostic problems. Using statistical modelling, we estimated primary toxoplasmosis to occur in 0.17% (0.13-0.21%) of all pregnancies in Upper Austria. © 2011 Sagel et al.; licensee BioMed Central Ltd.


Reiss K.,Bielefeld University | Spallek J.,Bielefeld University | Spallek J.,Bremen Institute for Prevention Research and Social Medicine | Razum O.,Bielefeld University
International Journal for Equity in Health | Year: 2010

Background. It can be assumed that resettlers (ethnic German immigrants from the Former Soviet Union) show similar smoking patterns as persons in their countries of origin at the time of migration. We analysed how the smoking prevalence among resettlers differs from that among the general population of Germany and whether the prevalence differs between groups with increasing duration of stay. Methods. To estimate the smoking prevalence we used the scientific-use-file (n = 477,239) of the German 2005 microcensus, an annual census representing 1% of all German households. Participation in the microcensus is obligatory (unit-nonresponse <7%). We stratified the prevalence of smoking among resettlers and the comparison group (population of Germany without resettlers) by age, sex, educational level and duration of stay. In total, 14,373 (3% of the total) persons were identified as resettlers. Results. Female resettlers with short duration of stay had a significantly lower smoking prevalence than women in the comparison group. With increasing duration of stay their smoking prevalence appears to converge to that of the comparison group (e.g.: high educational level, age group 25-44 years: short duration of stay 15%, long duration of stay 24%, comparison group 28%). In contrast, the smoking prevalence among male resettlers with short duration of stay was significantly higher than that among men in the comparison group, but also with a trend towards converging (e.g.: high educational level, age group 25-44 years: short duration of stay 44%, long duration of stay 35%, comparison group 36%). Except for female resettlers with short duration of stay, the participants with low educational level had on average a higher smoking prevalence than those with a high educational level. Conclusions. This is the first study estimating the smoking prevalence among resettlers by duration of stay. The results support the hypothesis that resettlers brought different smoking habits from their countries of origin shortly after migration. The observed convergence of the smoking habits with increasing duration of stay is in line with the hypothesis of migration as 'health transition'. However, due to the cross-sectional design of the study, further research is needed to confirm these findings. © 2010 Reiss et al; licensee BioMed Central Ltd.


Jordan I.,Justus Liebig University | Hebestreit A.,Bremen Institute for Prevention Research and Social Medicine | Swai B.,Kilimanjaro Christian Medical Center | Krawinkel M.B.,Justus Liebig University
Breast Cancer Research and Treatment | Year: 2013

Breast cancer is the leading cause of death among women worldwide. Studies in industrialised countries identified age at menarche, age at first full-term pregnancy, and lactation as determining factors in the aetiology of breast cancer. 115 female breast cancer patients (cases) and 230 age- and district-matched women clinically free from breast cancer (controls) were interviewed about their reproductive history and socioeconomic condition. Semi-structured interviews including anthropometric measurements were conducted by trained enumerators. The median age was 50 years (min/max 26 to 85 years). Estimated median BMI at age 20 was 21 kg/m2 in both cases and controls. Median lifelong lactation of the mothers was 96 months (cases) and 108 months (controls). A high BMI at 20 years was associated with an increased breast cancer risk (OR 1.31 95% CI 1.11-1.55, P < 0.01). The odds ratio for lifelong lactation was slightly below one (OR 0.99 95% CI 0.98-1.00, P < 0.01). There was no significant association in risk for BMI at interview (median 25 kg/m2 of cases and 26 kg/m2 of controls), age at menarche (median 16 years), and age at first full-term pregnancy (median 20 years). The association of increased risk with higher BMI at age 20 years remained significant after stratification for menopause (premenopausal: OR 1.41 95% CI 1.10-1.81, P = 0.01; postmenopausal: OR 1.38 95% CI 1.06-1.80, P = 0.02). Late age at menarche and prolonged lifelong lactation were associated with a risk reduction among premenopausal women (ORmenarche 0.74 95% CI 0.56-1.00, P = 0.05; ORlactation 0.98 95% CI 0.97-0.99, P < 0.01). In conclusion, long-standing lactation and reproductive behaviour are associated with a lower breast cancer risk in the region. As current changes in lifestyle affect age at menarche, reproductive behaviour, and nutritional status, an increased incidence of breast cancer is to be expected. Preventive efforts should include advice on reproductive and breastfeeding behaviour. © 2010 Springer Science+Business Media, LLC.


Timmer A.,Bremen Institute for Prevention Research and Social Medicine
Cochrane database of systematic reviews (Online) | Year: 2011

The effect of psychological interventions in inflammatory bowel diseases (IBD) is controversial. To assess the effects of psychological interventions (psychotherapy, patient education, relaxation techniques) on health related quality of life, coping, emotional state and disease activity in IBD. We searched the specialized register of the IBD/FBD Group, CENTRAL (Issue 5, 2010) and from inception to April 2010: Medline, Embase, LILACS, Psyndex, CINAHL, PsyInfo, CCMed, SOMED and Social SciSearch. Conference abstracts and reference lists were also checked. Randomized, quasi-randomized and non randomized controlled trials of psychological interventions in children or adults with IBD with a minimum follow up time of 2 months. Data were extracted and study quality was independently assessed by two raters. Pooled standardized mean differences (SMD) and 95% confidence intervals (CI) were calculated using a random effects model. Twenty-one studies were eligible for inclusion (1745 participants, 8 RCT, 4 QRCT, 8 NRCT; 19 in adults, 2 in adolescents). Most studies used multimodular approaches. The risk of bias was high for all studies.In adults, psychotherapy had no effect on quality of life at around 12 months (3 studies, 235 patients, SMD -0.07; 95% CI -0.33 to 0.19), emotional status (depression, 4 studies, 266 patients, SMD 0.03; 95% CI -0.22 to 0.27) or proportion of patients not in remission (5 studies, 287 patients, OR 0.85; 95% CI 0.48 to 1.48). Results were similar at 3 to 8 months. There was no evidence for statistical heterogeneity or subgroup effects based on type of disease or intensity of the therapy. In adolescents, there were positive short term effects of psychotherapy on most outcomes assessed including quality of life (2 studies, 71 patients, SMD 0.70; 95% CI 0.21 to 1.18) and depression (1 study, 41 patients, SMD -0.62; 95% CI -1.25 to 0.01).Educational interventions were ineffective with respect to quality of life at 12 months (5 studies, 947 patients, SMD 0.11; 95% CI -0.02 to 0.24), depression (3 studies, 378 patients, SMD -0.08; 95% CI -0.29 to 0.12) and proportion of patients not in remission (3 studies, 434 patients, OR 1.00; 95% CI 0.65 to 1.53). There is no evidence for efficacy of psychological therapy in adult patients with IBD in general. In adolescents, psychological interventions may be beneficial, but the evidence is limited. Further evidence is needed to assess the efficacy of these therapies in subgroups identified as being in need of psychological interventions, and to identify what type of therapy maybe most useful.


Zeeb H.,Bremen Institute for Prevention Research and Social Medicine | Hammer G.P.,Johannes Gutenberg University Mainz | Blettner M.,Johannes Gutenberg University Mainz
Journal of Radiological Protection | Year: 2012

Aircrew and passengers are exposed to low-level cosmic ionising radiation. Annual effective doses for flight crew have been estimated to be in the order of 2-5mSv and can attain 75mSv at career end. Epidemiological studies in this occupational group have been conducted over the last 15-20years, usually with a focus on radiation-associated cancer. These studies are summarised in this note. Overall cancer risk was not elevated in most studies and subpopulations analysed, while malignant melanoma, other skin cancers and breast cancer in female aircrew have shown elevated incidence, with lesser risk elevations in terms of mortality. In some studies, including the large German cohort, brain cancer risk appears elevated. Cardiovascular mortality risks were generally very low. Dose information for pilots was usually derived from calculation procedures based on routine licence information, types of aircraft and routes/hours flown, but not on direct measurements. However, dose estimates have shown high validity when compared with measured values. No clear-cut dose-response patterns pointing to a higher risk for those with higher cumulative doses were found. Studies on other health outcomes have shown mixed results. Overall, aircrew are a highly selected group with many specific characteristics and exposures that might also influence cancers or other health outcomes. Radiation-associated health effects have not been clearly established in the studies available so far. © 2012 IOP Publishing Ltd.


Behrens T.,Bremen Institute for Prevention Research and Social Medicine | Mester B.,Bremen Institute for Prevention Research and Social Medicine | Fritschi L.,University of Western Australia
Occupational and Environmental Medicine | Year: 2012

Objectives: An immense body of knowledge has been created by establishing various job-exposure matrices (JEMs) to assess occupational exposures in communityand industry-based cohort studies. These JEMs could be made available to occupational epidemiologists using knowledge-sharing technologies, thereby saving considerable amounts of time and money for researchers investigating occupation-related research questions. In this paper, the authors give an example of how a detailed JEM can be easily transformed into a jobspecific module (JSM) for use in community-based studies. Methods: OccIDEAS is operationalised as a web-based software, combining the use of JSMs with an individual expert exposure assessment to assess occupational exposures in various industries according to a set of predefined rules. The authors used a JEM focusing on endocrine-disrupting chemicals from a German study on testicular cancer in the automobile industry to create a JSM in OccIDEAS. Results: The JEM was easily translated into OccIDEAS requiring about 50 h of work by an epidemiologist familiar with the German JEM to learn about the OccIDEAS structure, establish the required set of exposure rules and to translate the JEM into OccIDEAS. Language did not represent an obstacle for translation either. To make the data available in an international context, an interpreter had to translate the German tasks and exposures after they were coded into OccIDEAS. Conclusions: JEMs which are constructed based on identifying tasks that determine exposure can be easily transformed into a JSM. Occupational epidemiologists are invited to contribute to the international scope of OccIDEAS by providing their previously established JEMs to make existing data on occupational exposures widely available to the epidemiological community.


Pohlabeln H.,Bremen Institute for Prevention Research and Social Medicine
Journal of investigational allergology & clinical immunology : official organ of the International Association of Asthmology (INTERASMA) and Sociedad Latinoamericana de Alergia e Inmunología | Year: 2010

BACKGROUND: The association between breastfeeding and the risk of atopic diseases in children is controversial. While some studies support the theory of a decreased risk of asthma and allergic diseases due to breastfeeding, others have failed to confirm such a protective effect, and even suggest increased risk. The aim of this longitudinal study was to investigate the association between breastfeeding and the prevalence of atopic diseases in 2-year-old children. METHODS: Data on 1685 children from a birth cohort were collected from questionnaires completed by parents at birth and at 6, 12, and 24 months. By means of logistic regression and considering confounders such as family history and socioeconomic status, we analyzed the association between exclusive breastfeeding and the development of allergic reactions in 2-year-old children. RESULTS: Exclusive breastfeeding for >4 months was associated with an increased risk of asthma and atopic dermatitis in children without a parental history of allergic diseases (odds ratio [OR] = 1.62; 95% confidence interval [Cl], 1.02-2.56). Children whose fathers only had a history of allergic disease strongly benefited from exclusive breastfeeding for >4 months (OR = 0.39; 95%-CI: 0.18-0.83) whereas those whose mothers only had such a history had an increased risk of asthma and atopic dermatitis (OR: 2.31; 95%-CI: 1.16-4.60). CONCLUSION: In children with a family history of allergy, it seems to be important to distinguish between maternal and paternal predisposition as children whose fathers have a history of atopic disease seem to benefit most from breastfeeding for >4 months.

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