Living conditions in eastern Germany have changed rapidly since unification in 1990 and little is known about how these changes affect the prevalence of atopic diseases. This study describes methods and prevalences of a large epidemiological project investigating determinants of childhood asthma and allergies in eastern (Dresden and Leipzig) and western (Munich) Germany in 1995/1996.Community based random samples of 9±11 yr old children in Dresden (n=3,017) and Munich (n=2,612), and of 5±7 yr old children in Dresden (n=3,300), Leipzig (n=3,167) and Munich (n=2,165) were studied by parental questionnaires, bronchial challenges with hypertonic saline, skin examination, skin-prick tests, and measurements of specific and total serum immunoglobulin (Ig)E using Phase II modules of the International Study of Asthma and Allergies in Childhood (ISAAC).In 9±11 yr old children, the prevalence of physician diagnosed asthma (7.9% versus 10.3%; p<0.01) and bronchial hyperresponsiveness (15.7% versus 19.9%; p<0.05) was lower in Dresden than in Munich. No difference between Munich and Dresden was observed in the prevalence of diagnosed hay fever, skin test reactivity to $1 allergen, and increased levels (>0.35 kU . L -1 ) of specific IgE against inhalant and food allergens. Symptoms and visible signs of atopic eczema tended to be more prevalent in Dresden. Similar East-West differences between the three study areas were seen in the younger age group.These findings are in line with recently observed increases in the prevalence of hay fever and atopic sensitization, but not of asthma and bronchial hyperresponsiveness, among 9±11 yr old children in Leipzig.

We examined the association between self-reported symptoms of asthma and allergic rhinitis and self-reported exposure to motor vehicle traffic in adolescents in Münster, Germany. A total of 3,703 German students age 12-15 years completed a written and video questionnaire in 1994-1995. We found positive associations between both wheezing and symptoms of allergic rhinitis during the past 12 months and self-reported frequency of truck traffic. The sex- and age-adjusted prevalence odds ratios and 95% confidence intervals (CI) for truck traffic, contrasting the categories "frequent" and "constant" against "never," were, for wheezing obtained by written questionnaire: 1.53 (95% CI = 1.15-2.05) and 2.15 (95% CI = 1.44-3.21); for wheezing obtained by video questionnaire: 1.61 (95% CI = 1.26-2.07) and 2.47 (95% CI = 1.74-3.52); and for symptoms of allergic rhinitis: 1.71 (95% CI = 1.36-2.15) and 1.96 (95% CI = 1.40-2.76), respectively. We found a similar positive association with self-reports on traffic noise. Putative confounding variables, including indicators of socio-economic status, smoking, etc, did not alter these associations substantially. The results correspond closely with findings of a survey carried out in 1991 in Bochum, Germany. Our results support the hypothesis that exposure to motor vehicle traffic is related to symptoms of asthma and allergic rhinitis in children, but we cannot rule out misclassification due to self-reports of traffic exposure.

OBJECTIVE -To assess the effects of antidiabetic drugs on the risk of heart failure in patients with type 2 diabetes.RESEARCH DESIGN AND METHODS -We conducted a retrospective cohort study with a newly diagnosed diabetes cohort of 25,690 patients registered in the U.K. General Practice Research Database, 1988 -1999. We categorized person-time drug exposures to monotherapies in insulin, sulfonylureas (SUs), metformins, and other oral hypoglycemic agents (i.e., acarbose, guar gum) and combination therapy including insulin, combination therapy without insulin, and triple combination therapy with or without insulin. A drug-free time interval served as a reference category. Cox interval-wise (piece-wise) regression analyses were used. The main outcome was incident heart failure.RESULTS -Among 43,390 drug exposure intervals for 25,690 patients who had a mean follow-up period of 2.5 years, 1,409 patients developed heart failure. Heart failure occurred most frequently in SU monotherapy exposure. After adjusting for duration of diabetes, the timing and order of treatments received, and known risk factors for heart failure, we found no differential effects among type-specific therapies. Patients with any drug use within the first year after diabetes diagnosis had a 4.75-fold higher risk (hazard ratio) for heart failure than those with drug-free status but had no increased risk during subsequent years.CONCLUSIONS -In conclusion, the use of any pharmacological therapy for type 2 diabetes appears to be associated with an increased risk of heart failure. This risk does not persist beyond the first year after diagnosis of diabetes and does not appear to differ among the types of drug therapy examined. This observation suggests that the severity of diabetes or the preclinical duration of diabetes and the need for drug therapy, and not the therapy itself, is an explanation for heart failure in patients with type 2 diabetes.

Treatment of bipolar disorder, particularly inpatient care, is costly to patients and health insurers. Further study is needed to find ways to reduce the overall cost of managing these patients without jeopardizing patient care.

In the MONICA Augsburg study the relationship between physical activity at work, cardiovascular risk factors, incidence of fatal and non-fatal myocardial infarction (MI) and total mortality was investigated in employed men. The MONICA Augsburg baseline survey of 1984/85 was designed as a cross-sectional study with follow-up. Physical activity was determined in 45-64 year old men by interview (n = 1074, 83.6%) and by a 7-day activity diary (n = 797, 62.0%). Employed men were categorized into an active versus inactive group based on interview data on physical activity at work (PAW) which had been validated against the 7-day activity diary. When stratified by PAW, age-adjusted means of diastolic (DBP) and systolic blood pressure (SBP) and total-cholesterol (T-C) were lower and the age-adjusted mean of HDL-cholesterol (HDL-C) was higher in active than in inactive men. A linear regression model controlling for age, body mass index, alcohol consumption, smoking, and heart rate confirmed this relationship for physical activity at work; regression coefficients: DBP: beta = -2.38 (95% confidence interval [CI] : -3.85(-)-0.91); SBP: beta = -2.87 (95% CI : -5.22(-)-0.52); T-C: beta = -2.80 (95% CI : -9.31-3.71); HDL-C: beta = 3.48 (95% CI : 1.28-5.79). Survey participants were followed-up for a period of 5.8 years. The incidence density (per 1000 person-years) of fatal plus non-fatal MI was 6.8 for active men versus 5.9 for inactive men; the incidence density for total mortality was 11.2 versus 5.9, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)