Residential crowding and asthma in preschool children, a cross-sectional study

BACKGROUND

Asthma is the most common chronic disease in children, and associations with crowding have been reported. The aim of this study was to explore possible associations of crowding with asthma in children.

METHODS

Seven cross-sectional surveys with preschool children were conducted within the framework of the health monitoring units in Bavaria, Germany, from 2004 to 2014. Residential crowding was defined as habitation of more than one person per room or less than 20m² living space per person. Logistic regression models examined temporal changes in crowding, applying the first survey as reference. The relationship between crowding and physician-diagnosed asthma, asthma defined by the International Study of Asthma and Allergies in Childhood (ISAAC) and asthma symptoms were analyzed.

RESULTS

Analyzing temporal changes of crowding rates did not reveal any differences over the years. However, the stratified descriptive analysis indicated a crowding increase in time in urban households where parents had a low education level (47.9% in 2004/05, 55.8% in 2014/15). No association was found between crowding and the variables "physician-diagnosed asthma" in 2014/15, "asthma defined by ISAAC" in 2014/15, or "wheezing" in 2014/15. A positive association with cough was identified in 2014/15 after adjusting for confounders (aOR=1.42 [95% CI: 1.20-1.69]).

CONCLUSIONS

In general, residential crowding did not change from 2004 to 2014; however, there seems to be a small upsurge for children with low-educated parents, living in urban areas over the years. A statistically significant association between crowding and cough was only found in the survey from 2014/15.

[Exposure of Pupils to Recreational Noise from Portable Listening Devices and Possible Preventive Measures]

Background and Objectives: Exposure to recreational noise is becoming increasingly important due to a change in leisure behavior amongst children and adolescents. The aim of this pilot study was to assess exposure of 6^th grade pupils to recreational noise from portable listening devices (PLD). Furthermore, preventive measures to reduce recreational noise exposure should be identified. Methods: In "Ohrkan Kids", 38 Bavarian pupils aged 11 to 14 were interviewed regarding their music listening behavior using a standardized questionnaire. In addition, measurements of commonly used volume settings on the children's portable listening devices were carried out. Furthermore, the German Social Accident Insurance (DGUV), health insurance companies as well as health and education ministries of the German federal states were surveyed regarding their activities in the prevention of recreational noise exposure. Results: Based on the questionnaire data for weekly usage, 10 out of 31 children (32.3%) exceeded the upper exposure value of 85 dB recommended by labor protection law. Taking actually measured values, 9 out of 31 children (29%) exceeded this level. The DGUV and some federal states carry out specific projects for the prevention of recreational noise exposure. Conclusion: The large number of children with hazardous music consumption indicates that measures for the prevention of noise-induced hearing loss are already required for 11 to 14 year olds. To maximize the number of children addressed, age-appropriate and target-group-specific preventive measures are needed. As there are only few studies which examined the effectiveness of awareness campaigns for the prevention of recreational noise, any future prevention projects should be evaluated with an increased focus on estimating their effectiveness.

[The impact of migration background on children's secondhand smoke exposure. A cross-sectional study within the health monitoring units (GME) in Bavaria, Germany]

AIM OF THE STUDY

Differences in children's secondhand smoke (SHS) exposure were examined by migration-specific characteristics, socioeconomic factors and living conditions, as well as with regard to the parents SHS knowledge and SHS attitudes.

STUDY POPULATION AND METHODS

Data from 5,336 pre-school children (29% migrants) were collected in a cross-sectional study in 2008/2009 in Germany through parental questionnaire (response rate: 61%). Using multiple logistic regression, the association of migration background and children's SHS exposure was analysed.

RESULTS

Children with a migration background are at an increased risk of SHS exposure in their homes. Multivariate analyses show that adjusting for socioeconomic factors and parental knowledge of how to protect their children from SHS reduces the estimates of migration background significantly. Compared to children without migration background, the chance of SHS exposure for children with migration background is still increased (OR [95% CI]: 1.57 [1.23-2.01]). Children of Turkish-speaking families, compared to children from German-speaking families, are most often burdened by SHS (3.05 [2.18-4.26]).

CONCLUSION

Migrant-sensitive tobacco prevention in selected risk groups is necessary to provide support for creating smoke-free homes for children.

Effect of classroom air quality on students' concentration: results of a cluster-randomized cross-over experimental study

To assess the effect of indoor air quality as indicated by the median carbon dioxide (CO₂) level in the classroom on the concentration performance (CP) of students, a cross-over cluster-randomized experimental study was conducted in 20 classrooms with mechanical ventilation systems. Test conditions 'worse' (median CO₂ level on average 2115 ppm) and 'better' (median CO₂ level on average 1045 ppm) were established by the regulation of the mechanical ventilation system on two days in one week each in every classroom. Concentration performance was quantified in students of grade three and four by the use of the d2-test and its primary parameter 'CP' and secondary parameters 'total number of characters processed' (TN) and 'total number of errors' (TE). 2366 d2-tests from 417 students could be used in analysis. In hierarchical linear regression accounting for repeated measurements, no significant effect of the experimental condition on CP or TN could be observed. However, TE was increased significantly by 1.65 (95% confidence interval 0.42-2.87) in 'worse' compared to 'better' condition. Thus, low air quality in classrooms as indicated by increased CO₂ levels does not reduce overall short-term CP in students, but appears to increase the error rate.

PRACTICAL IMPLICATIONS

This study could not confirm that low air quality in classrooms as indicated by increased CO₂ levels reduces short-term concentration performance (CP) in students; however, it appears to affect processing accuracy negatively. To ensure a high level of accuracy, good air quality characterized, for example, by low CO₂ concentration should be maintained in classrooms.

[Breast-feeding training programme as intervention approach at the hospital level: results of evaluation of the first phase of the STELLA study]

BACKGROUND

The health-promoting short- and long-term effects of breast-feeding are supported by a vast scientific literature. The Bavarian prospective cohort study 2005/2006 showed regional variations of breast-feeding rates. Furthermore, improvement in counselling mothers, particularly with regard to prevention and handling of breast-feeding problems, has a great potential for health promotion. The objective of this study is to promote breast-feeding in maternity clinics by improving the surrounding conditions.

STUDY DESIGN

A clinic-based and community-related intervention trial was carried out in Lower Bavaria as a model region with below average breast-feeding rates. (1) INTERVENTION: an advanced training of maternity ward professionals of 10 hospitals and after-care midwives was performed from May until December 2008. The training programme was based on the WHO/UNICEF criteria of the "Ten Steps to Successful Breastfeeding" to deepen the breast-feeding knowledge and to improve the breast-feeding management. (2) EVALUATION: A singular assessment of the advanced training programme was undertaken concerning an increase of knowledge and the practicability in clinical everyday life by participants; improvements of the maternity wards were assessed via structural interviews with maternity ward staff before and after intervention.

RESULTS

Approximately 85% (n=378) of the staff of the 10 maternity clinics attended the training course. The survey after the training programme (response rate 83%) indicated that more than 80% of the participants stated to have learned something new and to be able to use the knowledge acquired for their own practice. Results of the clinic interviews showed a transfer of training contents into clinical work routines. Improvements at interview date were shown best for bonding (all 10 maternity clinics), for additional feeding (8 maternity clinics) as well as for 24-h rooming-in and mother counselling (7 maternal clinics each).

CONCLUSION

Training of maternity ward professionals accounts for baby-friendly conditions in maternity clinics. Most willingness for improvements was shown by maternity ward staff particularly for bonding between mother and child as well as for additional feeding. Considerable differences between the hospitals were observed for the promotion of infant formulas before and after the intervention.