The effect of environmental tobacco smoke exposure on allergic sensitization and allergic rhinitis in adults

BACKGROUND

There is only little and furthermore conflicting knowledge about the relationship between passive smoking and allergy in adults. In this work, we assess the association between exposure to environmental tobacco smoke (ETS) at home or at work, and allergic sensitization and allergic rhinitis in 4093 German adults.

METHODS

Our study population comes from the German National Health Survey 1998 of which we analyzed 4093 adults (17-79 years) being non-smokers and having complete information on passive smoking and allergy. The association between ETS exposure and allergic sensitization and allergic rhinitis was assessed using logistic regression models.

RESULTS

The effect of ETS exposure on allergic sensitization was biggest at the workplace [adjusted OR = 1.17 (0.97, 1.41)]; the same could be observed with respect to allergic rhinitis [adjusted OR = 1.20 (0.96, 1.51)]. There was no effect of ETS exposure at home on both allergic sensitization [adjusted OR = 0.99 (0.76, 1.29)] and allergic rhinitis [adjusted OR = 1.05 (0.76, 1.43)] in our analysis.

CONCLUSIONS

The findings from our study show a statistically non-significant tendency that exposure to ETS at the workplace increases allergic sensitization and allergic rhinitis in adults. This tendency could not be observed with respect to ETS exposure at home.

PRACTICAL IMPLICATIONS

Exposure to ETS at the workplace should be minimized in order to reduce the risk of allergic sensitization, and allergic rhinitis.

Patterns of alcohol consumption and Helicobacter pylori infection: results of a population-based study from Germany among 6545 adults

BACKGROUND

Moderate alcohol consumption has been suggested to facilitate elimination of Helicobacter pylori infection.

AIM

To investigate the relationship between alcohol consumption and infection with H. pylori, with particular consideration of the role of age, different alcoholic beverages and specific drinking habits.

METHODS

These issues were addressed in the German National Health Survey, conducted in a representative population sample between October 1997 and March 1999. Overall, 6545 subjects provided data on frequency and average amount of different alcoholic beverages consumed. H. pylori infection status was measured by serum immunoglobulin G antibodies.

RESULTS

Seroprevalence of the infection was highest among subjects who reported drinking no alcohol (49.3%) and lowest among subjects consuming 25-50 g alcohol/day (35.2%, adjusted odds ratio = 0.60, 95% confidence interval: 0.48-0.75). This inverse association was consistently seen for different alcoholic beverages and in all age groups and it was particularly pronounced among women and among regular but moderate drinkers. There was also an inverse dose-response relationship between the frequency of alcohol consumption and H. pylori infection.

CONCLUSIONS

This analysis supports suggestions that regular but moderate consumption of alcohol from various sources may facilitate elimination of H. pylori infection.

[Laboratory tests in The Child and Adolescent Health Survey]

Laboratory tests will be performed as part of the National Health Survey for Children and Adolescents to identify health risks and to determine the seroprevalence of disease markers. The parameters were selected from haematology, clinical chemistry, allergology, endocrinology and serology of infectious diseases as indicators of individual health risks, to validate information collected by means of the questionnaires and to identify age specific immunity gaps of vaccine-preventable diseases.

[The Child and Adolescent Health Survey: collection of health behavior data from parents and children]

The first German Health Survey for Children and Adolescents will start in 2003. During three years, a representative sample of children and adolescents between 0 and 18 years of age shall be examined and will, together with their parents, be interviewed on health-relevant issues. With this survey, health information on about 18,000 children will be gathered. The health behaviour of the parents as far as their children's health is concerned, as well as the personal health behaviour during adolescence will be assessed, since this will be highly relevant for future health. Questions on nutrition behaviour, eating disorders, alcohol consumption, smoking as well as leisure-time behaviour, with special emphasis on physical activity, will be asked. These questions were tested for feasibility in a one-year pilot study. With this survey, the occurrence of certain unhealthy behaviour characteristics may be documented and risk groups may be identified. This may help to conceptualize prevention measures.

[The Child and Adolescent Health Survey--a foundation for prevention, health promotion and health goals]

At the beginning of the 21st century, the German Health Interview and Examination Survey of Children and Adolescents will for the first time provide the data essential for programmes of disease prevention and health promotion as well as for the development of health targets. This it will create key information for an evidence-based health policy. The results of the study can be projected to the general population of children and adolescents in Germany. The data will be collected conjunct at the level of the individual subject. They will facilitate valid and distinct description of prevalent physical, psychological and social health problems, as well as on who has them under which circumstances and settings. Information on the impact, e.g., in terms of utilisation of the health system or impairments of quality of life, will also be available from the same subjects. In addition, indicators of risks to health in later life are included. Hence, the data will support prevention of health problems in infancy, childhood and adolescence as well as of chronic diseases in later life. Finally, the data shall be a basis for the definition of new reference values for many variables. This will improve valid and clear judgement not only in epidemiological studies but also in medical care.

[The National Child and Adolescent Health Survey. The complete concept]

The German National Health Interview and Examination Survey for Children and Adolescents aims at obtaining generalisable and practically convertible data and knowledge of the health situation of children and adolescents aged between 0 and 18 and living in Germany. After an extensive preparatory period of conceptional work by the Robert Koch Institute the beginning of this study is planned for spring 2003. Over a period of three years a representative sample of 18,000 young people will be medically examined and will be interviewed together with their parents. The investigational programme of the survey consists of a central part encompassing questionnaires and medical analyses of the most important health topics in childhood and adolescence. In addition, complementary modules will analyse subpopulations in-depth and extensively for specific aspects and questions. These modules are usually developed and financed by cooperating partners of the Robert Koch Institute. Soon after completion of the survey data first results will be made freely available to the scientific community in Public Use Files. These Files will become relevant sources for future health reporting addressing children and adolescents. Furthermore, they represent a reliable data base for epidemiological research and prevention programmes.

[Pilot study of The Child and Adolescent Health Survey: methodological aspects and procedure]

In the pilot study of the National Health Survey for Children and Adolescents which has been conducted under the responsibility of the Robert Koch Institute from March 12th 2001 to March 15th 2002, 1,630 children and adolescents from 0 to 17 years as well as their parents have been included. Methodological issues have been very prominent. Questionnaires regarding properties, indicators (for example for psychic well-being) were developed and evaluated, different methods of access to the study participants as well as methods to increase the motivation to participate in the study were tested, and the property for generalisation or validity of the obtained information was investigated. The conduct of the pilot study resulted in a number of experiences and findings that will contribute to an optimised approach in the main course of the survey.

A comparison of serum total cholesterol levels and their determinants between the Federal Republic of Germany and the United States

Mean serum total cholesterol levels appear to be higher in the Federal Republic of Germany (FRG) than in the United States (US) while coronary heart disease death rates are lower. The study examined possible factors for the difference including possible differences in laboratory methodology. Cross-sectional data from the first two waves of the German National Health Surveys (1984-1986 and 1987-1989; n = 9709) and from the Second National Health and Nutrition Examination Survey (1976-1980; n = 7832) were compared for men and women 25-69 years of age. The influence of age, body mass index, diet, cigarette smoking, education, income, use of oral contraceptives or antihypertensive agents, alcohol consumption and potential differences in laboratory measurement were explored using multiple regression techniques separately for men and women for ages 25-39, 40-59 and 60-69 years of age. Overall ages, unadjusted mean total cholesterol levels were higher in German than US men (6.02 vs. 5.64 mmol/l) and in German than US women (6.04 vs. 5.80 mmol/l) as were HDL cholesterol levels (men: 1.30 vs 1.14 mmol/l; women: 1.65 vs. 1.38 mmol/l). Adjusting for lifestyle factors explained, on the average, 40% of the differences in mean total cholesterol of which half or 20% was accounted for by adjusting for alcohol intake. Adjusting for possible laboratory differences explained, on the average, an additional 30% of the differences. Frequency of alcohol intake was the most important factor in explaining differences in mean HDL cholesterol levels. Adjustment for differences in alcohol intake had negligible effects on reducing the differences in mean non-HDL cholesterol.

[The Federal Health Survey: response, composition of participants and non-responder analysis]

The first German Health Survey was carried out from October 1997 to March 1999. In the survey, 7,124 subjects of a representative sample of the residential population aged between 18 and 79 years were interviewed and medically examined. The response rate was 61.4%; 0.4% of the sample participated only partly in the study. Moreover, 16.0% of the non-respondents filled in a short questionnaire. This results in (although partly limited) information from 77.8% of the sample. The sample also comprises aliens living in Germany. More than 15% of the non-respondents could not be addressed to participate in the study because they were never reached personally. According to the statements in the short questionnaire, non-respondents and respondents differ in particular items such as e.g. education. The differences between the individual answers concerning the important question of the general health status can be classified as negligible. Weighting factors were calculated to arrive at representative information on the 18 to 79 year-old population.

[Prevalence of diabetes mellitus in the adult German population]

In the German National Health Interview and Examination Survey 7,124 subjects of a representative sample of the 18 to 79 year old population having their residence in Germany were interviewed and medically examined. Using a self-administered questionnaire as well as a subsequent personal interview by a physician, the participants were questioned regarding past and present diseases. Based on the data of the physicians' interviews, the prevalence rate for diabetes was 4.7% for men and 5.6% for women in the examined age-group. There is a strong increase of the prevalence with age. According to the present data nearly every fifth women in the age range from 70 to 79 years is suffering from diabetes mellitus. The disease is much more frequent in the new federal states (former GDR) than in the old ones (former West Germany). About one fourth of the diabetics uses insulin, far more than 40% are on oral antidiabetics. According to the interrogation of the physicians, about half of the diabetics not using any drugs are not even on a diet (ca. 15%). The portion of undetected diabetics in the examined population is estimated to be about 1% considering the values of blood and urine parameters (glucose in serum and urine, fructosamine, HbA1c).

[The German Health Survey. 1997/98]

The first German Health Survey, a representative study of the health status of the population in unified Germany, was started in October 1997. In this project which is being carried out by the Robert Koch Institute on behalf of the Federal Ministry of Health about 7,200 study participants aged between 18 and 79 are going through a medical check-up and are interviewed as to health-relevant issues. The German National Health Survey consists of a core survey and supplementary modules. These modules are, for the most part, carried out in subsamples of the study population. They partially have been designed and co-financed by cooperating institutions of the RKI. This time, the opportunity given to the individual Länder to increase the size of the sample was realized by Bavaria. This practised principle of a modular structure and co-financing may be regarded as a model and serve as an example for the cost effective implementation of such extensive health surveys. As a result, the German National Health Examination Survey will yield information enabling the RKI to deliver relevant health reports on a federal level and, therefore, to support decisions in health policy. The demand for representative population-based data will be met by supply of survey data as a file for public use.

Enhancement of the effect of methotrexate on collagen II induced arthritis in mice by nicotinamide

Treatment with a combination of 10 mg/kg i.p. methotrexate and 100 mg/kg i.p. nicotinamide inhibits the development of collagen II induced arthritis in male DBA/1 X B.10(4R) mice, as assessed by the arthritic index and whole blood chemiluminescence. The effect is much more pronounced than with either methotrexate or nicotinamide alone at the same concentrations. Determination of GOT and GPT levels in the blood revealed that the treatment causes no toxic side effects on the liver.

Increased prevalence of sensitization against aeroallergens in adults in West compared with East Germany

BACKGROUND

An increased prevalence of allergic diseases and atopic sensitization as assessed by skin-prick testing in children in West compared with East Germany has been reported.

OBJECTIVES

This study was designed to evaluate whether such a difference is also present in adults, and if this can be shown when using a serological test for allergic sensitization.

METHODS

Two large samples representative for all adults between 25 and 69 years of age were drawn in West (1991, n = 5313) and East Germany (1992, n = 2617). A serological test screening for IgE-antibodies to common aeroallergens (SX1) was performed. A questionnaire was used to assess the presence of clinical respiratory allergy, known possible risk factors for allergies and confounding variables.

RESULTS

Allergic sensitization decreased with age. Significantly more subjects < 45 years of age had a positive allergy test in West as compared to East Germany. The prevalence of clinical allergy was also higher in West Germany. This difference was significant in younger adults and was independent of other risk factors identified. These additional risk factors encompassed younger age, higher educational level, male sex, and living in a community with more than 100,000 inhabitants.

CONCLUSION

Sensitization to common aeroallergens as determined by a multiple allergen RAST test in adults below 45 years of age living in West Germany is increased compared to East Germany. This increase cannot be explained by genetic differences and is similar to the West to East decreasing gradient in allergies reported from studies in children employing skin-prick tests.

Fatty acid patterns in triglycerides, diglycerides, free fatty acids, cholesteryl esters and phosphatidylcholine in serum from vegetarians and non-vegetarians

The differences in the fatty acid spectra of serum samples obtained from vegetarians (62 females, 40 males) and non-vegetarians (70 females, 38 males) were evaluated in a matched-pair study design. This study population made it possible to examine 48 female and 31 male pairs whose age difference did not exceed 3 years. The pairs were further matched by education, social status and health-consciousness. The fatty acid pattern of whole serum total lipids and HDL total lipids were determined by GLC. In particular linoleic, linolenic, oleic and docosahexaenoic acid reveal statistically significant differences due to different nutritional habits. A subsample (n = 20) of sera from the 2 groups was investigated by separation of lipid classes by TLC and GLC on a SP 2,340 fused-silica capillary column in order to separate cis-trans fatty acids additionally. This part of the study gives detailed information concerning the fatty acid composition of cholesteryl esters, triglycerides, diglycerides, free fatty acids and phosphatidylcholine. In all those fractions the fatty acid profiles reflect the dietary consumption of lipids. Palmitoleic, vaccenic and docosahexaenoic acid as markers of omnivorous nutrition reach levels of 5, 5 and 3% respectively in non-vegetarians, while they remain remarkably lower in vegetarians. The most prominent difference is the higher amount of linoleic acid in all lipid classes of vegetarian serum samples. The highest amount of trans fatty acids (up to 3%) was detected in di- and triglycerides.

[Oral glucose tolerance test in women in relation to menstrual cycle (author's transl)]

A standardized 50 g glucose tolerance test was given twice to 192 women with regular menstrual cycle within an interval of some weeks. The data showed that higher blood sugar values and glucosuria occurred significantly more often in the second half of the menstrual cycle, which was true also for women using monophasic type contraceptives. However, the reproducibility of tests--performed twice in the second half of the menstrual cycle--was only 24%, as compared to about 60%, when the first test was performed during menstruation or in the first half between two bleedings. Therefore, the latter intervalls seem to be the most appropriate time to perform a glucose tolerance test on premenopausal women.

[A comparision of different methods and reagents for the determination of gamma-glutamyl transferase in serum (author's transl)]

Four commercially available kinetic photometric tests for the determination of gamma-glutamyl transferase were compared. Test A is based on the substrate L-gamma-glutamyl-4-nitroanilide; test B uses this same substrate dissolved in hydrochloric acid. C1 and C2 are tests from different suppliers; both use the substrate L-gamma-glutamyl-3-carboxy-4-nitroanilide, and all other constituents are the same as quoted by the suppliers. Parallel determinations were performed on 1017 native sera and 12 control sera. Compared with values from test A, two of the three other tests showed statistically significant differences in the diagnostically important range 10 to 50 U/l. Significant differences were also observed between the results from the apparently identical tests, C1, and C2. The values obtained for control sera showed a dependence on the test procedure and/or composition.