The first few months of life represent a window of opportunity for neonatal oral tolerance induction and prevention of allergy. Maternal rather than paternal atopic status has a greater effect on the atopic outcome of the progeny, which raises the question of whether maternal factors such as immune status, breastfeeding, and immunologic constituents of breast milk and dietary and environmental exposure have a role. In mice, breastfeeding has a role in tolerance induction and protection against asthma using adoptive nursing models. In epidemiologic studies, there is conflicting evidence regarding the protective impact of breastfeeding against allergic diseases, which may be attributable at least in part to differences in breast milk composition, the genetic predisposition of the infants, or gene–environment interactions. This chapter will review epidemiologic studies assessing the protective role of breast milk and the impact of maternal interventions during lactation on development of atopic diseases in children. The immunologic composition of breast milk will also be discussed.

Introduction: Preterm birth is a global scourge, the leading cause of perinatal mortality and morbidity. This study set out to identify the principal risk factors for preterm birth, based on the German Health Interview and Examination Survey for Children and Adolescents (KiGGS). A range of possible factors influencing preterm birth were selected for inclusion in the questionnaire, covering factors such as gender, national origin, immigrant background, demography, living standard, family structure, parental education and vocational training.Methods: All data were taken from the aforementioned KiGGS survey conducted between 2003 and 2006. A total of 17641 children and adolescents (8656 girls and 8985 boys) drawn from 167 German towns and municipalities deemed to be representative of the Federal Republic of Germany were included in the study. Gestational age at birth was available for 14234 datasets. The questionnaire included questions from the following areas as possible factors influencing preterm birth: gender, national origins, immigrant background, demography, living standard, family structure, parental education and vocational training.Results: The preterm birth rate was 11.6%, higher than that of other national statistical evaluations. Around 57.4% of multiple pregnancies and 10% of singleton pregnancies resulted in preterm delivery. Multiple pregnancy was found to be the most important risk factor (OR 13.116). With regard to national origins and immigration background, mothers from Turkey, the Middle East, and North Africa had a higher incidence of preterm birth. Preterm birth was more prevalent in cities and large towns than in small towns and villages.Conclusion: Risk factors associated with preterm birth were identified. These should help with the early identification of pregnant women at risk. The preterm birth rate in our survey was higher than that found in other national statistical evaluations based on process data. More than half of all multiple pregnancies ended in preterm birth.

Vitamin D kann der Organismus aus Vorstufen unter der Wirkung von Sonnenlicht selbst bilden. Wenn die Sonnenwirkung nicht ausreicht, muss es als Mikronährstoff zugeführt werden, weil es sonst zu Mangelerscheinungen kommt, v. a. zu Störungen der Mineralisation von Hartgeweben. Im Kinder- und Jugendgesundheitssurvey (KiGGS), der ersten repräsentativen Erhebung zur Gesundheit der nachwachsenden Generation, wurde neben vielen anderen Merkmalen auch 25(OH)D gemessen, der seit Langem beste Indikator für den Vitamin-D-Versorgungszustand.

Vitamin D deficiency causes rickets and osteomalacia. As vitamin D metabolites have hormonal functions and bind to receptors of at least 38 different tissues the present study investigated whether low 25-hydroxyvitamin D [25(OH)D] levels of children and adolescents are associated with effects on physical, mental and social health as well as health risks. A total of 17,641 participants constitute the basis of the German Child and Adolescent Health Survey (KiGGS). From the second of three study years onwards, 10,015 serum 25(OH)D values were available from a total of 12,340 remaining participants (81 %). These were analyzed for associations with selected physical, mental and social health indicators. Using the statistical package IBM SPSS 20.0 bivariate and multivariable models were computed. In the first 3 years of life injuries, infections, developmental retardation, sleeping problems and poorer health were significantly (p < 0.01) associated with low values of 25(OH)D. In adolescents psoriasis, sleeping problems, poorer health, retarded development, poorer school performance, emotional and behavioral problems, lower quality of life and elevated cardiovascular risk factors were significantly (p < 0.01) more frequent if the 25(OH)D level was below 70 nmol/l (28 ng/ml). The evidence from cross-sectional studies is limited; however, the high quality of the representative data, control for confounding in multivariable models as well as the dose-response relationships and biological plausibility make these results highly relevant and presently confer them the highest possible evidence. The results support an impact of vitamin D deficiency on physical, mental and social health. Vitamin D should receive more attention in daily practice and dietary supplementation should be administered when necessary. Vitamin D deficiency is only a contributing factor and cannot on its own explain most of the problems reported. The recommended threshold value is 70 nmol/l (28 ng/ml). Longitudinal studies and randomized controlled trials (RCT) on the effectiveness of vitamin D supplementation are essential. The basic provision of vitamin D in the population should be improved.

Ziel von Babylotse Plus ist die früh-/rechtzeitige Identifizierung von Überforderung u. Unterstützungsbedarf junger Familien perinatal. Dies geschieht durch einen systematischen, niederschwelligen Zugang, für den ein Screening auf psychosoziale Risikoindikatoren entwickelt wurde. Dessen diagnostische Genauigkeit wurde untersucht.

Im Juni 1909 wurde das Kaiserin Auguste Victoria Haus in Berlin als erstes präventiv-pädiatrisches Institut eröffnet mit dem Ziel, die Säuglingssterblichkeit im Deutschen Reich zu senken. Dieses Ziel wurde erreicht. Seither ist ein beispielloser Rückgang der Sterblichkeit in allen Altersgruppen zu verzeichnen, und die Lebenserwartung stieg auf etwa das Doppelte an. Mit dem „Rückzug des Todes” entwickelte sich ein grundlegend verändertes Verständnis von Gesundheit und ein völlig neues Spektrum von Krankheiten. Der vorliegende Beitrag beschreibt exemplarisch diesen Wandel und erläutert, warum es trotz der Verbesserungen der Gesundheitslage heute mehr Krankheiten gibt. Welche der „neuen Krankheiten” einer frühen Prävention zugänglich sind, wird tabellarisch präsentiert.

In June 1909, The Empress Auguste Victoria House in Berlin was opened. This first institute for preventive paediatrics had the objective to overcome infant mortality in Germany. This objective was attained. Since then, an unprecedented decrease of mortality in all age groups occurred as well as a doubling of life expectancy. With this "retreat of death", our concepts of health changed fundamentally, and a new spectrum of diseases emerged. This article discusses some mile stones of this change, and explains why we find more illness despite the great improvement in the field of health. The "new diseases" amenable to early prevention are presented in a table. To make disease prevention successful requires the participation of the individual. Therefore, it is important to know the demand to make a good programme effective in the population. Empirical results of a nationwide representative study on the demand by expecting and young parents for preventive consultation are presented. Anticipatory guidance of young parents is a modern approach to health promotion and disease prevention. A controlled trial shows that this approach improved knowledge, behaviour, health risk indicators, health, and development during the first two years after delivery. Future studies should focus on long term effects of early health promotion.

UNLABELLED:Knowledge of the risks of smoking during pregnancy induces only part of the pregnant women to give up smoking. How many pregnant women in Germany smoke from the beginning to delivery, and what characterises these smokers, is the topic of this article.METHODS:Results from the German Mikrozensus, several national surveys, perinatal statistics and Euro-scip III are presented, compared, and assessed. Findings of our own studies conducted between 1999 and 2002 at the obstetric department and gynacological practices in Berlin allow an insight into the magnitude of "underreporting".RESULTS:In the ages 15-45 years 36-45 % of German women smoke, prevalence rates that probably are valid even for the beginning of pregnancy. While smoking prevalence in men has decreased during the last 20 years, there is an increasing trend in women. The prevalence is higher in pregnant women of low social status, living with smoking partners and those of German nationality. At most, half of the women give up smoking during pregnancy. Assuming an "underreporting" in pregnant women of at least one third, the prevalence of smoking up to delivery is 24 %. Although 76 % of the practicing gynacologists in Berlin feel responsible for smoking counselling, only 12 % are convinced that it is successful.CONCLUSIONS:A quarter of the pregnant women in Germany smoke through to delivery, which means that 150 000 newborns per year have been exposed to passive smoking in utero, and its long-term health effects, which is a national disaster.

Das diabetische Fußsyndrom ist weiterhin ein bedeutendes medizinisches und ökonomisches Problem des Gesundheitswesens.

Im Rahmen des bundesweiten Kinder- und Jugendgesundheitssurveys (KiGGS) wurden bei 17.641 Jungen und Mädchen eine Reihe anthropometrischer Messgrößen standardisiert erhoben. Für den kompletten Altersbereich (0–17 Jahre) wurden hierzu Körpergröße und Körpergewicht, Kopfumfang und Oberarmlänge sowie 2 Hautfaltendicken (Trizeps, Subscapula) ermittelt; ab dem 6. Lebensjahr kam die Messung der Ellbogenbreite hinzu, ab 11 Jahren wurden zudem der Taillen- und Hüftumfang bestimmt. Für alle Parameter werden pro Alter (in Jahren) und Geschlecht Mittelwerte inklusive Konfidenzintervalle angegeben. Mediankurven veranschaulichen den Altersgang nach Geschlecht für jedes Körpermaß. Die komplexen Altersverläufe der Körpermaße, verbunden mit einer erheblichen Geschlechterspezifität, zeigen die ganze Dynamik der körperlichen Entwicklung bei Jungen und Mädchen. Auf Basis der Hautfaltenmessungen wurde der Körperfettanteil abgeschätzt. Dicke und Lage der Hautfalten sowie der berechnete Taille-Hüfte-Index wird als Indikator für die geschlechterspezifische Fettverteilung eingesetzt. Mit Hilfe des Frame-Indexes wird versucht, Aussagen über die Skelettrobustizität zu machen. Für die ermittelten Körpermaße sind kaum regionale Unterschiede nachweisbar. Dafür zeigen Kopfumfang, Frame-Index und alle Parameter, die einen starken Zusammenhang mit dem Körperfett aufweisen, einen signifikanten Sozialstatusgradienten. Kinder und Jugendliche mit Migrationshintergrund haben im Mittel eine geringere Körpergröße, einen größeren Taillenumfang und einen höheren Körperfettanteil.

KIGGS is a health survey on 17,641 children and adolescents in 167 communities representative for Germany, conducted between May 2003 and May 2006. Of the perinatal indicators, only a small proportion of data important for long-term outcomes was available for statistical analysis, and is presented here. In the past 20 years the mean weight gain during pregnancy has increased significantly by 2 kg, the mean birth weight has increased significantly by an average of 50 g, there has been no significant time trend for smoking and alcohol consumption in pregnancy. Birth weight and pregnancy weight gain of the mother correlate significantly. Pregnancy weight gain explains 5% of the birth weight in first-born infants. 17-18% of the mothers smoked during pregnancy, 4 times as many in the lower than the upper social class. 14% of the mothers consumed alcohol in pregnancy, but only 1% regularly. Only 5% of the migrants, but 3 times as many of the non-migrants consumed alcohol in pregnancy, and 2 1/2 times as many of the upper class compared to the lower class. With respect to smoking and alcohol consumption during pregnancy there seems to be an urgent need for political action.

Die Erhebungen des Kinder- und Jugendgesundheitssurvey (KiGGS) zwischen Mai 2003 und Mai 2006 erfassten insgesamt 17.641 Kinder und Jugendliche in 167 für die Bundesrepublik repräsentativen Städten und Gemeinden. Mit den derzeit verfügbaren Daten zu perinatalen Risiken für die Gesundheit und Entwicklung von Kindern wurden folgende Ergebnisse gewonnen: In den zurückliegenden 20 Jahren ist die durchschnittliche Gewichtszunahme während der Schwangerschaft signifikant um mehr als 2 kg angestiegen, das mittlere Geburtsgewicht signifikant um durchschnittlich 50 g angestiegen und kein sicherer zeitlicher Trend beim Rauchen und Alkoholkonsum in der Schwangerschaft erkennbar. Zwischen Gewichtszunahme in der Schwangerschaft und dem Geburtsgewicht besteht eine signifikante Korrelation, für Erstgeborene erklärt sie etwa 5% der Varianz des mittleren Geburtsgewichts. 17–18% der Frauen gaben an, während der Schwangerschaft geraucht zu haben, in der niedrigen Sozialstatusgruppe waren es etwa 4-mal so viele wie in der hohen. Etwa 14% der Schwangeren konsumierten Alkohol gelegentlich, regelmäßig getrunken haben unter 1%. Nur 5% der Mütter von Kindern mit Migrationshintergrund, aber 3-mal so viele Mütter von Kindern ohne Migrationshintergrund konsumierten Alkohol in der Schwangerschaft und 2,5- mal so viele in der sozialen Oberschicht wie in der Unterschicht. Beim Rauchen und beim Alkoholkonsum in der Schwangerschaft besteht gesundheitspolitisch dringender Handlungsbedarf.

TOPIC:We studied those characteristics of mothers that are related to occupational activity two years after the birth of the first child. Differences in the health-related quality of life between working mothers and mothers who are not working were also analysed, taking other parameters into account, in particular household income.METHODOLOGY:311 mothers with a first child were given a questionnaire on the quality of life based on WHOQOL-BREF, on depression (also surveyed one year before for 139 mothers), on their work situation, socio-demography and other possible confounders. The probability of vocational activity was analysed using logistic regression and the influence of multiple roles on the quality of life was analysed using multiple linear regression.RESULTS:About 60% of mothers were not working two years after the birth of their first child, 25% were working part-time and 11% full time, with 4% in training or education. Working mothers were more likely to have a higher level of education (60% vs. 31%) and less likely to have a household income below the poverty line (13% vs. 47%). The results of the logistic regression showed that the odds ratio for being employed was six times higher for mothers with higher education than mothers with a lower level of education [OR 5.99; 95% confidence interval (CI) 2.58-13.91], whereas the odds ratio for mothers with additional children against those with only one child was 0.14; (95% CI 0.05-0.40), and for mothers with German nationality against those of other ethnicities the odds ratio was 2.37 (95% CI 1.12-5.04). Working mothers give more positive ratings than non-working mothers for their physical and mental quality of life (both p<0.01), their social relationships (p<0.05), as well as their global quality of life and their depression score (p<0.10). Even after adjusting for the depression score one year before working mothers reported less depression (p<0.05). The influence of income on the quality of life was low, except for the assessment of the quality of the environment, and this explains only a small part of the positive effect of the vocational activity.CONCLUSIONS:Vocational activity of mothers of two-year old children reduces the risk of poverty and additionally contributes to an improved physical and mental quality of life of the mother and also to improved social relationships.

The diabetic foot syndrome is an important medical and economic problem of health care. The working group of the diabetic foot of the German diabetes society established a system for accrediting hospitals or outpatient clinics to treat diabetic wounds. Basis is to proof the quality of structure and procedures and the outcome evaluation. Each participating center (n=130; 46 hospitals and 84 outpatient departments) documented consecutively 30 patients. The outcome evaluation was performed 6 months after the initial presentation. We present the outcome data of 3864 cases (hospitalized [H] 1367; outpatients [O] 2497) (guideline: www.ag-fuss-ddg.de). Initially 1214 Patients (31%) were stage Wagner 1 (W1) and 1223 patients W2. W3 were diagnosed for 868 patients (22.5%), W4 for 10.4% and stage 5 in 15 cases (0.4%). After 6 months ulcerations of 2006 patients (55%) were completely healed and 993 at stage W1 (27%). The improvement of wounds were statistical significant. Stage 3 (H: 31% vs. O: 17%), stage 2 (H: 20% vs. O: 5%) and stage 5 (H: 0.7% vs. 0.2%) were significant increased in the hospitalized group. W1 (H: 15% vs. O: 40%) was higher in outpatients, stage 2 was similar in both groups. For 33% of patients a concomitant infection was diagnosed (H: 31%; O: 34%). Arterial occlusive disease was similar between hospitalized and outpatients. Significantly higher was Armstrong grade D in the hospitalized group (45.4% vs. 25.3%). Most of the lesions healed (p=0.001), but 3.9% (n=171) had a major amputation (above ankle) and 17% (n=666) a minor surgical manipulation (H: 25.6%; O: 12.7%; p<0.001). There was a clear correlation of outcome with Wagner and Armstrong grade. 179 patients (4.6%) died during the observation time. The mortality was significant (p<0.001) higher in hospitalized patients (7% vs. 3.3%). These data represent the first analyses of the treatment outcome of diabetic foot lesions in specialized centers in Germany. The data reflect a perspicuous lower rate of amputations in the accrediting centers compared to the up to nowavailable epidemiological data in Germany.

2003 wurde erstmalig eine Zertifizierung ambulanter und stationärer Fußbehandlungseinrichtungen durch die AG Fuß in der DDG etabliert. Die Voraussetzungen zur Zertifizierung orientierten sich u.a. an internationalem Consens. Sie wurden zwischenzeitlich überarbeitet und entsprechen inhaltlich den inzwischen veröffentlichten IDF Guidelines 2005. Erfasst werden Parameter der Struktur-, Prozess und der Ergebnisqualität (St, Vincent-Ziele). 2005 waren in der Bundesrepublik 178 Fußbehandlungseinrichtungen zertifiziert, davon 112 ambulante (66 Praxen und 46 Klinikambulanzen) und 66 stationäre Einrichtungen. Die regionale Verteilung zeigt ein deutliches West-Ost-Gefälle mit 1/ 17000 Diabetiker in Rheinland-Pfalz und 1 pro 430000 Diabetiker in Sachsen. Eine flächendeckende Versorgung mit zertifizierten Fußbehandlungseinrichtungen scheint sich jedoch auszubilden. Bei der ersten Analyse wurden Daten von über 5500 Patienten ausgewertet. Major-Amputationen wurden bei 6,5% der Patienten, Minor-Amputationen bei 22,3% durchgeführt. Die 6-Monats- Mortalität betrug 2,9% (im Krankenhaus verstarben bei den stationären Patienten 3,8%). 49,6% der Läsionen (von 3500 Patienten) waren nach 6 monatiger ambulanter Behandlung geheilt. Die Häufigkeit einer Neuroosteoarthropathie betrug 12,8%(11,9% stationär), die Häufigkeit einer Neuropathie 91%, die einer peripheren arteriellen Verschlusskrankheit 59% (53% ambulant, 68% stationär). 22% der ambulant behandelten Patienten wurden stationär aufgenommen. Die Arbeitsgemeinschaft Fuß hat eine umfassende Qualitätssicherungsmaßnahme für Fußbehandlungseinrichtungen initiiert und bundesweit etabliert, die der Forderung des Gesetzgebers nach „geeigneten“ Behandlungseinrichtungen gerecht wird. Darüber hinaus ergeben sich aus dem QM erstmalig nennenswerte konkrete Daten zur Ergebnisqualität spezialisierter Einrichtungen.