Stressful life events evidently have an impact on development of allergic diseases, but the mechanism linking stress to pathological changes of immune system function is still not fully understood. The aim of our study was to investigate the relationship between stressful life events, neuropeptide and cytokine concentrations in children as well as the association between early stressful life events and atopic eczema (AE). Within the LISA plus (Life style - Immune system - Allergy) study, blood samples from children of 6 years of age were analyzed for concentration of the neuropeptides vasoactive intestinal peptide (VIP), somatostatin (SOM), substance P (SP) and the Th1/Th2 cytokines IFN-γ and IL-4. Life events such as severe disease or death of a family member, unemployment or divorce of the parents were assessed with a questionnaire filled in by the parents. Furthermore, lifetime prevalence of AE and incidence after the assessment period of life events were compared. Our data suggest that separation/ divorce of parents increase childrens risk of developing AE later in life. Children with separated/divorced parents showed high VIP levels and high concentrations of the Th2 cytokine IL-4 in their blood. Severe diseases and death of a family member were neither associated with neuropeptide levels nor with cytokine concentrations. Unemployment of the parents was associated with decreased IFN-γ concentrations in childrens blood but not with neuropeptide levels. Thus, the neuropeptide VIP might be a mediator between stressful life events and immune regulation contributing to the Th2-shifted immune response in children with separated/divorced parents.

Beratung zur Reduktion gesundheitsschädlicher Verhaltensweisen ist ein wichtiger Baustein der Prävention insbesondere kardiovaskulärer Erkrankungen. In der Hausarztpraxis werden entsprechende Ansätze bislang nur teilweise umgesetzt. Es wurde untersucht, welche Rolle Hausärzte in der Verhaltensprävention einnehmen können und wollen, wie sie ihre zeitlichen Ressourcen für Beratung einschätzen und wie sie Möglichkeiten der Delegation von Beratungsaufgaben gegenüberstehen. 50% der Brandenburger Hausärzte (n=748) wurden nach dem Zufallsprinzip für die Versendung eines selbst entwickelten Fragebogens ausgewählt. Ihre Einschätzungen wurden mithilfe von Likert-Skalen erfasst. Die Datenerhebung erfolge anonymisiert. Der Rücklauf betrug 37% (n=274). Nahezu alle Befragten sehen es als ihre Aufgabe an, Patienten zu einem gesundheitsgerechten Lebensstil zu informieren und auch zu motivieren. Die eigene Beratungskompetenz wird mehrheitlich positiv eingeschätzt (besonders gut für das Thema körperliche Bewegung, relativ schlecht für die Themen Rauchen und sexuelles Risikoverhalten). Die zeitlichen Ressourcen werden meist als unzureichend eingeschätzt. Eine Delegation von Beratungsaufgaben an medizinische Fachangestellte wird vielfach für sinnvoll gehalten, bislang aber nur vereinzelt praktiziert. Die meisten Hausärzte schätzen ihre Beratungskompetenz positiv ein und stellen einen hohen Anspruch an das eigene verhaltenspräventive Engagement. Derzeit kann dieser Anspruch nur unzureichend eingelöst werden. Die Rolle der Hausärzte in Hinblick auf präventive Beratung sollte klarer definiert werden.

Introduction: Improving individual health behaviour is a promising approach especially in cardiovascular prevention. In general practice, preventive advice-giving is hitherto put into practice insufficiently. The study explores which role general practitioners are willing and able to play in behaviour-oriented prevention.Methods: 50% of general practitioners in Brandenburg (n=748) were randomly selected for the study. A standardised questionnaire was mailed to them in which their attitudes towards preventive advice-giving were measured using Likert scaling. Participation was anonymous.Results: 37% of the physicians answered the questionnaire. Almost all of them see it as their responsibility to inform patients about possible reduction of lifestyle-dependent health risks and to motivate them accordingly. Self-assessment concerning advisory skills is predominantly positive (best for physical activity, worst for smoking cessation and sexual risk behaviour advice). Time resources for behaviour-oriented prevention are sparse. For this reason, the delegation of many advisory tasks to physician assistants is regarded positively.Conclusion: Most physicians see themselves as willing and able to perform behaviour-oriented prevention. Nevertheless, realising this task seems to be difficult, e.g., concerning the frame conditions of general practice. The role of general practitioners in prevention and health promotion should be defined more accurately.

Comparable international data on food and nutrient intake is often hindered by the lack of a common instrument to assess food intake. The objective of this study was within the Global Allergy and Asthma European Network of Excellence (GA2LEN), we developed and piloted a food frequency questionnaire (FFQ) to assess its validity in Europe. Five countries participating in GA2LEN took part in the pilot study. A total of 200 adults aged 31–75 years were invited to complete a FFQ in two occasions and to give a blood sample. The intra-class correlation coefficient (ICC) was used to assess repeatability of the FFQ. Plasma phospholipid fatty acids (FAs) were analysed by gas chromatography. Pearson correlation was used to analyse the correlation between estimated dietary FA intake and plasma phospholipid FA levels. A total of 177 participants (89%) had complete data on FFQ1 and plasma phospholipid FAs. In all, 152 participants (76%) completed both FFQs. ICCs between macronutrients ranged from 0.70 (saturated FAs) to 0.78 (proteins) and between 0.70 (retinol) and 0.81 (vitamin D) for micronutrients. Dietary n-3 FAs showed a good correlation with total plasma phospholipid n-3 FAs and with docosahexaenoic acid in the whole sample (0.40) and in individual countries. Poor correlations were observed for other FAs. The GA2LEN FFQ is an appropriate tool to estimate dietary intake for a range of nutrients across Europe regardless of cultural and linguistic differences. The FFQ seems to be useful to estimate the intake of n-3 FAs but not other FAs.

To cite this article: Hastan D, Fokkens WJ, Bachert C, Newson RB, Bislimovska J, Bockelbrink A, Bousquet PJ, Brozek G, Bruno A, Dahlén SE, Forsberg B, Gunnbjörnsdóttir M, Kasper L, Krämer U, Kowalski ML, Lange B, Lundbäck B, Salagean E, Todo‐Bom A, Tomassen P, Toskala E, van Drunen CM, Bousquet J, Zuberbier T, Jarvis D, Burney P. Chronic rhinosinusitis in Europe – an underestimated disease. A GA2LEN study. Allergy 2011; 66: 1216–1223.

Einleitung: Einige Studien konnten einen Zusammenhang zwischen frühen psychosozialen Lebensereignissen und Belastungssituationen mit der Entwicklung allergischer Erkrankungen im Kindesalter zeigen. Zielsetzung dieser Analyse der Multizentrischen Allergiestudie (MAS) war es deshalb, den Zusammenhang von Schwierigkeiten im frühen familiären Zusammenleben mit der Entwicklung allergischer Erkrankungen bis ins Schulalter zu untersuchen. Material und Methoden: In MAS, einer Geburtskohortenstudie mit 1314 rekrutierten Kindern in fünf deutschen Städten, wurden mittels Selbstausfüllfragebogen zu verschiedenen Zeitpunkten innerhalb der ersten beiden Lebensjahre des Studienkindes Informationen zu Schwierigkeiten des familiären Zusammenlebens erhoben. Gefragt wurde nach der allgemeinen Stimmung in der Familie, Gesundheit, Lebenszufriedenheit sowie Verständnis zwischen den Eltern und zwischen Eltern und Kind. Als Zielgrößen wurden allergische Erkrankungen im Kindergarten- und Grundschulalter berücksichtigt. Kindliches Wheezing (typisches Asthmasymptom), allergische Rhinitis und atopische Dermatitis wurden durch standardisierte, an ISAAC angelehnte Elternfragebögen, erfasst. Wenn zu mindestens einem Zeitpunkt im Alter zwischen drei und zehn Jahren Symptome berichtet wurden, wurde das Kind als erkrankt gewertet. Ergebnisse: In die Auswertung konnten insgesamt 1039 Kinder eingeschlossen werden. Von diesen Kindern litten im Alter von 3–10 Jahren 11% an Wheezing, 21% an allergischer Rhinitis und 31% an atopischer Dermatitis. Wheezing war mit allen erhobenen Aspekten des familiären Zusammenlebens in den ersten 2 Lebensjahren assoziiert. Besonders deutliche Zusammenhänge zeigten sich für schlechte Stimmung in der Familie allgemein (OR* 1,38; 95% CI [1,14–1,82]), niedrige Lebenszufriedenheit (OR* 1,42; 95% CI [1,04–1,95]) und mangelndes Verständnis zwischen den Eltern und dem Kind (OR* 1,40; 95% CI [1,01–1,94]). Weder für allergische Rhinitis noch für atopische Dermatitis zeigten sich Zusammenhänge mit einer der Einflussgrößen. (*OR adjustiert für elterliche Allergie, Schulbildung der Mutter und Studienort). Schlussfolgerung: Unsere Ergebnisse bestätigen für das Auftreten von Asthmasymptomen andere Studien, die einen Zusammenhang zwischen dem Zusammenleben in der Familie und allergischen Erkrankungen bei Kindern

Keil T, Bockelbrink A, Reich A, Hoffmann U, Kamin W, Forster J, Schuster A, Willich SN, Wahn U, Lau S. The natural history of allergic rhinitis in childhood.
Pediatr Allergy Immunol 2010: 21: 962–969.
© 2010 John Wiley & Sons A/S

OBJECTIVE The increasing prevalence of obesity requires particularly primary care providers to take action. The aim of this study was to analyze general practitioners (GPs) encounters with overweight and obese patients in primary care to test the hypothesis that patients with a BMI ≥ 30 kg/m² would have longer consultations focusing on lifestyle-related issues like nutrition and physical activity than those with a BMI < 30 kg/m². DESIGN Cross sectional comparison of audiotaped encounters of patients with a BMI ≥ 30 kg/m² and those with a BMI < 30 kg/m². SETTING Twelve GP surgeries in Berlin, Germany. PARTICIPANTS Fifty patients who agreed to have preventive check-up encounters audiotaped. MAIN OUTCOME MEASURES Based on the Roter Interaction ANALYSIS System (RIAS) we assessed duration of encounter and the prevalence of GP statements regarding cardiovascular risks, nutrition and physical activity. RESULTS An increased BMI was found to be a predictor for the length of encounters (P = 0.01), whereas the content of talks was mainly determined by the individual of GP and sex of the GP. Statements regarding cardiovascular risks were most frequent, followed by those regarding nutrition and physical activity. In this study the assessed physiological parameters were not associated with the specific contents of preventive encounters like nutrition or physical activity (P > 0.05). CONCLUSIONS Our results indicate that GPs rarely use the check-up program to conduct lifestyle consultations with obese patients. Barriers to lifestyle counseling and possible solutions are discussed with a view to promoting individualized and target management of overweight patients.

Focus on Alternative and Complementary TherapiesVolume 9, Issue s1 p. 7-7 CAM in allergies – determinants of use A Bockelbrink, A Bockelbrink Institute of Medical Statistics and Epidemiology Technical University Munich, Ismaningerstr. 22, Munich, 81675, GermanySearch for more papers by this authorJ Ring, J Ring Department of Dermatology and Allergy Technical University Munich, am Biederstein, Munich, GermanySearch for more papers by this authorHE Wichmann, HE Wichmann Institute of Epidemiology and Institute of Medical Data Processing, Biometrics and Epidemiology, GSF National Research Centre for Environment and Health, Ludwig-Maximilians-University Munich, Munich, GermanySearch for more papers by this authorT Schäfer, T Schäfer Department of Social Medicine, Medical University Lübeck, Lübeck, GermanySearch for more papers by this author A Bockelbrink, A Bockelbrink Institute of Medical Statistics and Epidemiology Technical University Munich, Ismaningerstr. 22, Munich, 81675, GermanySearch for more papers by this authorJ Ring, J Ring Department of Dermatology and Allergy Technical University Munich, am Biederstein, Munich, GermanySearch for more papers by this authorHE Wichmann, HE Wichmann Institute of Epidemiology and Institute of Medical Data Processing, Biometrics and Epidemiology, GSF National Research Centre for Environment and Health, Ludwig-Maximilians-University Munich, Munich, GermanySearch for more papers by this authorT Schäfer, T Schäfer Department of Social Medicine, Medical University Lübeck, Lübeck, GermanySearch for more papers by this author First published: 14 June 2010 https://doi.org/10.1111/j.2042-7166.2004.tb04496.xRead the full textAbout ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article. Volume9, Issues1March 2004Pages 7-7 RelatedInformation

Background and Purpose:Despite numerous studies suggesting a relationship between paradoxical embolism from a patent foramen ovale (PFO) and stroke, the role of PFO as a risk factor for cerebral ischaemia remains controversial. We therefore sought to determine the association between a RLS detected by contrast-enhanced transcranial Doppler ultrasonography (c-TCD) and recurrent stroke in an unselected population sample.Methods:We analyzed the records of 763 patients with diagnosis of cerebral ischaemia at our institution. All patients had undergone TCD-based detection of RLS. Embolic signals have been measured both under resting conditions and after performing a Valsalva maneuver. For follow-up, all patients were contacted by mail, which included a standardized questionnaire. Endpoints of follow-up were defined as recurrence of cerebral ischaemia, occurrence of myocardial infarction or death from any cause.Results:Follow-up data were available in 639 patients (83.7%). At baseline, a RLS was detected in 140 (28%) men and in 114 (42%) women. Ten shunt-carriers (1.6%) and 32 patients (5.0%) without RLS had suffered a recurrent stroke. After adjustment for age, sex, and atrial fibrillation, the hazard ratio of RLS for stroke recurrence was 0.86 (95% CI 0.41-1.79). The condition of RLS at rest adjusted for age, sex, stroke subtype, and cardiovascular risk factors was not found to increase the risk of stroke substantially (HR 1.16 [95% CI 0.41-3.29])Conclusion:Our data suggest that the risk of recurrent stroke in subjects with PFO is not significantly increased in comparison with subject without it.

Objective: Recent studies point that Cancer Related Fatigue (CRF) has a large influence on the quality of life of non-metastasized breast cancer patients even years after an adjuvant therapy. Very few analyses have yet tested the significance of the rest-activity-rhythm. In our study we therefore applied the scales of the autonomic regulation (aR) (subscale rest/activity-regulation (RA.aR)), the Cancer Fatigue Scale (CFS-D) and the sleep-protocol of the German Society for Sleep Research and Sleep-Medicine (DGSM).Method: From 16 patients with breast cancer, 17 age-matched control, and 13 healthy elderly women the CFS-D, aR, the Hospital Anxiety and Depression scale (HADS), the Herdecke questionnaire of quality of life (HLQ), the DGSM sleep-protocol, and a long-term-ECG are being acquired.Results: Mean age of breast cancer patients is 48.7 (K = 48.0; S = 79:4) and Karnofsky-index (KPI) 92.5%. In spite of a good KPI and an adjuvant chemotherapy 2.2 years back, they show higher values for CFS-D and HADS, lower aR, RA.aR, and HLQ, more nocturnal arousals, and a non-restorative sleep (all p <= 0.01).Conclusion: In patients with breast cancer without metastases, CRF is increased after 2.2 years and is associated with a disturbed rest/activity-regulation, insomniac disorders and distress. This has to be taken into account in the design and performance of rehabilitation measures in patients with breast cancer.

Background: Stress has been suggested to impact the onset and exacerbation of eczema and other atopic disorders. Whether early exposure to stress-related factors might exert long-term effects remains to be clarified.Objective: The objective of this study was to investigate whether stress-related maternal factors during pregnancy are associated with childhood eczema during the first 6 years of life.Methods: Data from 3004 children from a prospective German birth cohort study (LISA) were analyzed. Information from maternity certificates and questionnaire information on unwanted pregnancy were used to evaluate stress-related maternal factors during pregnancy. Prevalence data for physician-diagnosed eczema were available up to the age of 6 years.Results: Maternal factors during pregnancy were positively associated with childhood eczema in terms of cumulative prevalence up to the age of 2 years (adjusted odds ratio, 1.48; 95% confidence interval, 0.95-2.30) after adjusting for potential confounders, Beyond the second year no increased risk was observed.Conclusions: The results of this study suggest that stress-related maternal factors during pregnancy are associated with an increased risk of childhood eczema during the first 2 years of life. The impact of postnatal stress such as parental divorce or separation on this association could not be clarified. Future studies should therefore further elucidate how prenatal and postnatal stress interact and whether prenatal stress might have a programming effect. If future studies confirm the findings of this study, reducing maternal stress during pregnancy might be a possible target in the primary prevention of eczema during childhood.

Background: The development and the quantitative relationship between allergen‐specific IgE (S‐IgE) responses and total IgE (T‐IgE), during childhood and adolescence have not been described and understood in detail. The objective of this study was to describe and compare the longitudinal trends of serum levels of S‐IgE and T‐IgE during childhood.Methods: We analysed data from participants in the MAS birth cohort study at 2, 5, 7 and 10 years of age (n = 273) and at 1, 3, 5, 6, 7, 10 and 13 years (n = 84). Total‐IgE and the overall level of specific‐IgE against nine locally relevant airborne and food allergens were determined by FEIA (ImmunoCAP). Allergic rhino‐conjunctivitis and asthma were ascertained by questionnaires.Results: Longitudinal patterns of T‐IgE levels from age 1 to 13 years were highly heterogeneous (declining, flat or increasing with different profiles). From 5 years of age, logarithmic (log10) transformed values of T‐IgE and of S‐IgE levels tend to follow a parallel trend, so that their relation remained constant throughout school age. A flat trend of T‐IgE vs a constantly increasing trend of T‐IgE was associated with a low or, respectively, high rate of wheezing at 13 years of age.Conclusions: Beginning at the age of 5 years, total serum IgE levels in children from an industrialized country evolved in parallel with overall S‐IgE levels. Therefore, variations in T‐IgE levels at school age closely reflect variations in overall S‐IgE levels. Further studies are required to strengthen the biological and clinical implication of this novel finding.

Summary Background Allergic rhinoconjunctivitis and asthma evolve dynamically throughout childhood. Yet, data on the evolution of serum levels of IgE antibodies against airborne allergens throughout the first decade of life are scarce. Objective To describe the patterns of new and persistent sensitization against airborne allergens including remission from birth to 10 years of age and the long‐term clinical outcomes up to the age of 13 years. Methods In 273 children from the Multi‐Centre Allergy Study, a German birth cohort, IgE levels were determined against airborne allergens ( Dermatophagoides pteronyssinus , cat and dog dander, birch and grass species pollens) at 2, 5, 7, and 10 years of age (ImmunoCAP, Phadia); allergic rhino‐conjunctivitis and asthma were ascertained at the 13 years of age through a standardized questionnaire (International Study of Asthma and Allergies in Childhood). Results The prevalence of sensitization to each allergen increased steadily throughout childhood, and a hierarchy of sensitization prevalence (grass>birch>mites>cat>dog) was maintained from 5 years of age onwards. A mono‐sensitization state was relatively short (measurable half‐life=3 years) as additional sensitizations were acquired frequently, and relatively soon after the first one. Remission of weak sensitization (UNICAP classes 1–2) was also quite frequent, especially before 5 years of age. By contrast, stronger IgE responses (>3.5 kU/L) were invariably persistent. Early sensitization was associated with a higher tendency for poly‐sensitization at 10 years of age and allergic rhino‐conjunctivitis and/or asthma at 13 years of age. Conclusions IgE responses against airborne allergens undergo dynamic changes throughout childhood, with a high frequency of new sensitization or remission. The long‐term persistence and the clinical impact of IgE responses are affected by the intensity of IgE sensitization and the age of its onset.

Background and purpose:Despite numerous studies, the role of patent foramen ovale (PFO) as a risk factor for stroke due to paradoxical embolism is still controversial. On the assumption that specific lesion patterns, in particular multiple acute ischaemic lesions on diffusion-weighted magnetic resonance imaging, indicate a cardioembolic origin, we compared the MRI findings in stroke patients with right-to-left shunt (RLS) and those without.Methods:The records of 486 patients with diagnosis of cerebral ischaemia were reviewed. For detection of RLS, contrast-enhanced transcranial Doppler (c-TCD) was carried out in all patients. An MRI scan of the brain was performed in all patients. Affected vascular territories were divided into anterior cerebral artery, middle cerebral artery, vertebrobasilar artery system including posterior cerebral artery, brain stem and cerebellar stroke, and strokes occurring in more than one territory.Results:We did not find a specific difference in neuroradiological lesion patterns in patients with RLS compared with patients without RLS. In particular, 23 of 165 patients (13.9%) with RLS showed multiple ischaemic lesions on MRI in comparison with 45 of 321 patients (14.0%) without RLS (P = 0.98). These findings also applied for the subgroup of cryptogenic strokes with and without RLS.Conclusion:We found no association between an ischaemic lesion pattern that is considered as being typical for stroke due to cardiac embolism and the existence of PFO. Therefore, our findings do not provide any support for the common theory of paradoxical embolism as a major cause of stroke in PFO carriers.

The treatment of children is a core domain of anthroposophic medicine (AM) since its beginnings almost 80 years ago. However, a systematic analysis of AM-therapies in paediatric primary care is still missing. This study aims to investigate this field of AM. A total of 38 primary care physicians in Germany participated in this prospective, multicentre observational study. Prescriptions, diagnoses, and non-pharmacological therapies were reported for each consecutive patient. Multiple logistic regression was used to determine factors associated with anthroposophic prescriptions. During the 1-year study period (year 2005), a total of 107,903 prescriptions for 18,440 children under 12 years (48.1% female) were included. The most frequent single diagnoses were acute upper respiratory tract infections (URTI) (22.7%), bronchitis (9.0%), and otitis media (6.6%). Anthroposophic medication accounted for 41.8% of all drugs prescribed and decreased with patient age (47.3% under 2 years, 41.1% 2–6 years, and 37.4% 6–11 years; p for trend <0.001). The Odds Ratio (OR) for receiving an anthroposophic remedy was significantly greater than 1 for the first consultation (OR=1.19; CI: 1.16–1.23), for disorders of conjunctiva (OR=2.47; CI: 2.27–2.70), otitis media (OR=1.50; CI: 1.43–1.59), URTI (OR=1.28; CI: 1.23–1.33), other diseases of the respiratory system (OR=1.15; CI: 1.07–1.24), symptoms involving the digestive system and abdomen (OR=1.39; CI: 1.28–1.51), and general symptoms and signs (OR=1.25; CI: 1.16–1.36). The chance for a prescription of an anthroposophic remedy decreased with patient age (OR=0.96; CI: 0.95–0.96), treatment by a paediatrician (OR=0.43; CI: 0.42–0.44), chronic lower respiratory diseases (OR=0.87; CI: 0.82–0.92), and noninfective enteritis and colitis (OR=0.82; CI: 0.75–0.89). Of the 2475 therapeutic procedures prescribed (26.7% anthroposophic), the most frequent were physiotherapy, speech therapy, logopaedics, and breathing therapy. This study is the first to provide a systematic overview of everyday anthroposophic practice for children in primary care. We found that AM in terms of an integrative medicine combines conventional and anthroposophical concepts. More detailed studies on indications and drug classes should be conducted in the future to complement and specify these findings.