In this study, associations between current asthma and possible determinants were studied using data of the German Health Interview and Examination Survey for Children and Adolescents ("Studie zur Gesundheit von Kindern und Jugendlichen in Deutschland," KiGGS). In this nationwide cross-sectional survey, 17,461 subjects aged 0-17 years were examined between 2003 and 2006. Data collection included a medical examination of the child, an interview of the parents, and written questionnaires. Apart from prevalence estimates, multivariate logistic regression analyses were performed. Increasing age and male sex, previous atopic diseases of the child, a positive family history of allergic diseases and low birth weight were significant risk factors of asthma, as were overweight and moldy walls in the residence. Breast feeding was not associated with a reduced risk of asthma. Low age at delivery of the mother and living in rural or provincial regions were shown to be protected. Overall, this study suggests that allergies of the parents and previous atopic disease of the child are the strongest determinants of asthma. However, environmental factors (mold on walls, living in rural and provincial towns) and lifestyle factors could also modify asthma risk.

Im vorliegenden Beitrag wurden Zusammenhänge zwischen einer bestehenden Asthmaerkrankung und möglichen diesbezüglichen Einflussfaktoren auf der Datenbasis der „Studie zur Gesundheit von Kindern und Jugendlichen in Deutschland“ (KiGGS) untersucht. In dieser bundesweiten Querschnittstudie wurden zwischen 2003 und 2006 17.641 null- bis 17-jährige Kinder und Jugendliche untersucht. Die Datenerfassung umfasste eine ärztliche Untersuchung des Kindes, ein Interview der Eltern und schriftliche Fragebögen. Neben Prävalenzschätzungen wurden multivariate logistische Regressionsanalysen durchgeführt. Zunehmendes Alter und männliches Geschlecht, eine atopische Vorerkrankung des Kindes, eine positive Familienanamnese für allergische Erkrankungen sowie ein niedriges Geburtsgewicht erhöhten das Risiko für Asthma bronchiale signifikant, ebenso Übergewicht und schimmlige Wände in der Wohnung. Das Stillen hatte keine schützende Wirkung. Ein niedriges Alter der Mutter bei der Geburt und Leben in ländlichen oder kleinstädtischen Regionen erwiesen sich als protektiv. Insgesamt zeigte sich, dass die genetische Prädisposition und eine atopische Vorerkrankung des Kindes die stärksten Risikofaktoren für Asthma bronchiale sind. Aber auch Umweltfaktoren (schimmlige Wände, Leben in ländlichen und kleinstädtischen Gemeinden) und einzelne Lebensstilfaktoren spielten eine modifizierende Rolle.

Since long, socio-economic status, often expressed as an index, is known to correlate with health outcomes like behavioural problems. We constructed a new index that encapsulated not only economic and social but also environmental stressors (ESES), using data of the German Health Interview and Examination Survey for Children and Adolescents, a nation-wide representative surveillance of 17,641 participants aged between 0-17 years. Different factors were selected to account for socio-economic stress (low parental education, low household income, low occupational status of the householder), domestic stress (living in large cities, exposure to tobacco smoke at home, crowded housing, mouldy walls), and prenatal stress (maternal smoking during pregnancy, drinking alcohol during pregnancy). Prior to the calculation of ESES, the different factors were multiplied by weights which were estimated by multivariate linear regression on a number of health outcomes. ESES was then used to predict emotional and social problems (SDQ scores). The resulting ORs were compared with those obtained for an established socio-economic index (SEI). ESES was superior to SEI as it could more clearly identify children and adolescents with emotional or social problems. Different types of stressors (i.e. socio-economic stress, domestic stress and prenatal stress) contributed independently to emotional and social problems.

Chemical intolerance (CI) is a widespread occupational and public health problem characterized by symptoms that reportedly result from low-levels of chemical exposure. The mechanisms behind CI are unknown, however modifications of the chemical senses (rather than toxic processes) have been suggested as key components. The aim of this study was to investigate whether individuals with self-reported CI report more sensory irritation during masked acrolein exposure compared to controls without CI.Individuals with CI (n = 18) and controls without CI (n = 19) were exposed in an exposure chamber. Each participant took part in two exposure conditions – one with heptane (the masking compound), and one with heptane and acrolein at a dose below previously reported sensory irritation thresholds. The exposures lasted for 60 min. Symptoms and confidence ratings were measured continuously throughout the exposure as were measurements of electrodermal activity and self-reported tear-film break-up time. Participants were blind to exposure condition.Individuals with CI, compared with controls reported greater sensory irritation in the eyes, nose and throat when exposed to acrolein masked with heptane. There was no difference during exposure to heptane.Masked exposure to acrolein at a concentration below the previously reported detection threshold is perceived as more irritating by individuals with CI compared with controls. The results indicate that there is altered trigeminal reactivity in those with CI compared to controls.

Within a subsample of an out-patient based study on environment related complaints we investigated, whether VOC concentrations and ventilation rates in patients‘ dwellings are statistically associated with complaints, e.g. fatigue and appraised affinity towards infections. In the dwellings of around 50 patients, volatile organic compounds, ventilation rates and humidity were measured, each under worst case conditions. An environmentalmedicine questionnaire (including items regarding fatigue, competitiveness and infections) was administered. Statistical analysis indicates an association between ventilation rate and complaints (low ventilation leads to more self-reported fatigue and infections) but no association between VOC and complaints, although a significant correlation exists between ventilation and VOC. This study focussing on home environ ments is consistent with findings of epidemiological studies in other environmental settings (e. g. office buildings). Because of the small sample size and some methodological limitations, the results of this study needs to be interpreted carefully. Further home environmental studies are needed in order to consolidate findings or to draw firm conclusions.

The aim of this article was to re-evaluate and possibly modify the standardized Environmental Worry Scale (EWS) by Hodapp et al. [1996. Evaluation eines Fragebogens zur Erfassung von Umweltbesorgnis. Z. Gesundheitspsychologie IV(1), 22–36] with regard to its content and structure. In order to do this, 161 participants were chosen as a reference group to take part in a survey. The data were analyzed and a factor analysis yielded two instead of one component of worry, namely “personal” and “general” environmental worry, leading to a new evaluation method. This revised evaluation method was then applied to patients (n=227) with or without self-reported multiple chemical sensitivity (MCS) and thus used in the context of reported health complaints. The outlined results indicate that the assessment of worry as proposed by Hodapp et al. [1996. Evaluation eines Fragebogens zur Erfassung von Umweltbesorgnis. Z. Gesundheitspsychologie IV(1), 22–36] should be elaborated by the newly developed evaluation method with which a ratio determined by “personal” and “general” worry can be calculated. In addition to analyzing the absolute quantity of worry, the calculated ratio allows to draw conclusions on the structure of worry. It will be discussed to what extent the results present new insights into the role of worry among patients suffering from environmental diseases.

In this multicentre Study on Multiple chemical sensitivity (MCS) 291 Consecutive environmental medicine (FM) outpatients were examined in several environmental medicine outpatient centres/units throughout Germany in 2000/2003. Of the EM outpatients, 89 Were Male (30.6%) and 202 were female (69.4(%), aged 22-80 (mean 48 years, S.D. = 12 years). The sample was representative for university-based environmental outpatient departments and represented a cross-sectional study design with in integrated clinical-based case-control comparison (MCS vs. non-MCS). Three classifications of MCS were used: self-reported MCS (sMCS), clinically diagnosed MCS (cMCS), and formalised computer-assisted MCS with two variants (f1MCS, f2MCS). Data were collected by means of an environmental medicine questionnaire, psychosocial questionnaires, the German version of the Composite International Diagnostic Interview (CIDI). and a medical baseline documentation. as well as special examinations in partial projects on olfaction and genetic Susceptibility markers.The hypothesis guided evaluation of the project showed that the patients heterogenic health complaints did not indicate a characteristic set of symptoms For MCS. No systematic Connection Could be observed between complaints and the triggers Implicated, nor was there any evidence for a genetic predisposition or obvious disturbances of the olfactory system. The standardised psychiatric diagnostics applying CIDI demonstrated that the EM patients in general and the subgroup With MCS ill particular suffered more often from mental disorders compared to an age and gender matched sample of the general population and that in Most patients these disorders commenced many years before environment-related health complaints.Our results do not support file assumption of a toxicogenic-somatic basis of the MCS phenomenon. In contrast, numerous indicators for the relevance of behavioural accentuations, psychic alterations or psychosomatic impairments were found in the group of EM-outpatients With Subjective "environmental illness". (C) 2008 Elsevier GmbH. All rights reserved.

UNLABELLED:A single-blinded study was performed to analyze whether indoor environments with and without mold infestation differ significantly in microbial volatile organic compounds (MVOC) concentrations. Air sampling for MVOC was performed in 40 dwellings with evident mold damage and in 44 dwellings, where mold damage was excluded after a thorough investigation. The characteristics of the dwellings, climatic parameters, airborne particles and air exchange rates (AER) were recorded. The parameters mold status, characteristics of the interiors and measured climatic parameters were included in the multiple regression model. The results show no significant association between most of the analyzed MVOC and the mold status. Only the compounds 2-methyl-1-butanol and 1-octen-3-ol indicated a statistically significant, but weak association with the mold status. However, the concentrations of the so-called MVOC were mainly influenced by other indoor factors. 2-Methylfuran and 3-methylfuran, often used as main indicators for mold damage, had a highly significant correlation with the smoking status. These compounds were also significantly correlated with the humidity and the AER. The compounds 3-methyl-1-butanol, 2-hexanone, 3-heptanone and dimethyl disulfide were weakly correlated with the recorded parameters, the humidity being the strongest influencing factor. Only 2-methyl-1-butanol and 1-octen-3-ol showed a statistically significant association with the mold status; however, only a small portion (10% in this case) of the total variability could be explained by the predictor mold status; they do not qualify as indicator compounds, because such minor correlations lead to a too excessive part of incorrect classifications, meaning that the diagnostic sensitivity and specificity of these compounds are too low.PRACTICAL IMPLICATIONS:The assumption that mold infestations might be detected by microbial VOC emissions must be considered with great reservation. The major part of the total variability of the measured MVOC concentrations originates from not known influencing factors and/or from factors not directly associated with the mold status of the dwellings (confounders). More specific and sensitive markers for the assessment of the mold status should be found, if the screening for mold infestations should be performed by volatile organic compounds.

Between 1999 and 2003 all consecutive outpatients of the environmental medicine unit of the Charité hospital in Berlin were invited to participate in a study on environmentally related disorders. One hundred and sixty-nine of the patients completed a psychosocial questionnaire which comprised SCL-90-R and 14 other tests. When compaired with clinical controls, SCL-90-R mean scores of the environmental patients (EP) were found to lie in between those of inpatients of a psychosomatic clinic and melanoma aftercare patients; but they were, with exception of the somatisation dimension, much closer to the latter. Application of the TwoStep Cluster™ component of SPSS resulted in three subgroups with high, moderate and low scores which were significantly different (p<0.001) although separation was incomplete (87% correct identification; cross-validated discriminant analysis). With all subgroups, scores for somatisation, depression and obsessive compulsion were highest and those for phobic anxiety and psychoticism were lowest. SCL-90-R scores correlated well with results of the Freiburg Personality Inventory, Whiteley Index of hypochondriasis, the short form health questionnaire (SF-36), and the Composite International Diagnostic Interview (CIDI). Hierarchical grouping (average linkage between groups), performed with involvement of SCL-90-R data from literature, resulted in a dendrogram with three distinct groups and three outliers. EP with low SCL-90-R scores were assigned to a group which comprised also general populations (USA, Germany), allergy patients, and melanoma controls. Those with moderate SCL-90-R scores were placed in a group together with chronic pain patients, and 26 ‘environmentally ill’ subjects. The third subgroup of EP formed a cluster with our psychosomatic controls, psychosomatic patients from another study, depressed people, and patients undergoing psychotherapy. The three outliers of the dendrogram, however, were SCL-90-R profiles obtained from persons with toxic waste exposure, neurotoxic workplace exposure or with solvent-induced chronic toxic encephalopathy.

Robert Koch Institute; Department of Environmental Medicine; Berlin, Germany EDITOR’S NOTE: Please see the erratum in this issue related to this letter to the editor.

BACKGROUNDA nationwide, environmental outpatient-based multi-center two-phase study on Multiple Chemical Sensitivity (MCS) was conducted from 1999 until 2004. The aim of the study was to characterize more precisely the health-complaints relevant for the MCS-phenomenon. A standardized psychiatric interview (CIDI), used to identify frequency, character and duration of psychiatric disorders and their chronological relation to the environment-related health complaints of the patients, formed part of the extensive diagnostic procedure.METHOD251 (86.3%) of the 291 attendees of the environmental outpatient departments in Aachen, Berlin, Bredstedt, Freiburg, Giessen and Munich, were examined using the German version (M-CIDI/DIA-X) of the Composite International Diagnostic Interview.RESULTS83.7% (lifetime prevalence rate) fulfilled the diagnostic criteria of at least one psychiatric disorder, with the 12-month and 4-week prevalence rates being 76.5% and 64.5%, respectively. Environmental outpatients, in all prevalence periods, had significantly higher rates of psychiatric disorders than the comparable general population. Somatoform disorders were most frequently diagnosed, followed by depressive and phobic disorders. For 81.2% of the patients the psychiatric disorder started long before the environment-related health complaints (average 17 years).CONCLUSIONSThis study confirms the results of earlier studies, i.e. that patients with environment-related health complaints suffer from psychiatric disorders more frequently than the general population. The high environmental outpatients really suffer from psychosomatic complaints, but attribute the causes to the environment. Application of specific therapeutic regimen is recommended for those patients, whose psychiatric disorders are safeguarded diagnostically and for whom a relevant exposure is unlikely.

In order to validate microbial methods for the detection of mold infestations in indoor areas in a first step the sampling of airborne fungal spores with an impaction method was checked. When the group "moldy apartments" was compared with the group "non-moldy apartments", only the genera Aspergillus and Penicillium were in significantly higher concentrations in the infested rooms (nutrient: malt extract agar). As these two genera appeared complementarily in moldy homes as a rule, a sum score was calculated by the logistic regression model. With this sum score cutoff(50) values were calculated: 110 cfu/m(3) for airborne fungal spores (Sigma A + P) without correction for the outdoor situation and 80 cfu/m(3) (Sigma A + P) with correction for the outdoor air concentration. With these cutoff(50) values a very good classification (high sensitivity and high specificity) concerning moldy and non-moldy apartments was achieved.