RESUMEN
BACKGROUND: Since 2009, all newborns in Germany have been entitled to universal neonatal hearing screening (UNHS). UNHS with tracking of test results leads to earlier detection of hearing disorders. The Association of German Hearing Screening Centers (Verband Deutscher Hörscreening-Zentralen, VDHZ) was founded to promote nationwide tracking, validity and quality control of UNHS results. OBJECTIVES: A comparable data structure in the different screening centers, with uniform definitions of primary parameters is essential for the nationwide evaluation of UNHS results. To address the question of whether a data structure with comparable definitions already exists or still has to be created, the existing structures and primary parameter definitions in the hearing screening centers should be investigated and compared. METHODS: A survey was conducted in all hearing screening centers to assess how data on the primary UNHS parameters defined in pediatric guidelines was gathered. In the case of discrepancies, uniform definitions were created. Finally, the practicability of these definitions was evaluated. RESULTS: Due to differing definitions of primary parameters, some of the data were not comparable between the individual centers. Therefore, uniform definitions were created in a consensus process. In the centers, the screening method, the two-step first screening and the result of the first screening now correspond to these uniform definitions. Other parameters, e.g. the total number of newborns, still vary widely, rendering the comparison of screening rates almost impossible. CONCLUSION: Valid evaluation of UNHS not only requires nationwide establishment of hearing screening centers, but also unified data structures and parameter definitions.
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Trastornos de la Audición/clasificación , Trastornos de la Audición/diagnóstico , Pruebas Auditivas/normas , Tamizaje Masivo/normas , Tamizaje Neonatal/normas , Guías de Práctica Clínica como Asunto , Terminología como Asunto , Audiología/normas , Femenino , Alemania , Humanos , Recién Nacido , Masculino , Otolaringología/normasRESUMEN
BACKGROUND: Since 01.01.2009 in Germany a newborn hearing screening (UNHS) is obligatory for every child. The UNHS is part of the guidelines for the prevention of diseases for children up to 6 years of age (Kinder-Richtlinien). 2 years after its introduction in Bavaria, we now evaluate whether the UNHS has been implemented successfully,and if the quality criteria of the guidelines have been met. METHODS: In the guidelines details for the procedure and screening quality are given. The UNHS data from the screening facilities in Bavaria were evaluated for process quality criteria like screening coverage, screening method, REFER rate (rate of failed tests) and child age at diagnosis. RESULTS: More than 96 % of all newborns were screened. The REFER rate for 2010 was 4.5 %. Only 18 % of the controls were done by a paediatric audiologist.In 38.5 % of the newborns an intervention of the screening centre was necessary to assure controlling of a failed screening test. In 2009 the median age at diagnosis for a bilateral hearing loss was 5.5 months, and the start of therapy was 6.2 months. CONCLUSION: In Bavaria the UNHS was implemented successfully. A tracking system for all children who failed the hearing screening test is pivotal for the early diagnosis of children with bilateral hearing deficiency.
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Implementación de Plan de Salud/organización & administración , Pérdida Auditiva Bilateral/congénito , Pruebas Auditivas , Tamizaje Neonatal/organización & administración , Diagnóstico Tardío , Alemania , Adhesión a Directriz , Pérdida Auditiva Bilateral/diagnóstico , Pérdida Auditiva Bilateral/terapia , Humanos , Recién Nacido , Emisiones Otoacústicas Espontáneas , Prevención SecundariaRESUMEN
BACKGROUND: Nutritional intervention with hydrolysed infant formulas has been shown efficacious in preventing eczema in children predisposed to allergy. However, this preventive effect has never been related to the natural course of eczema in children with or without a family history of allergy. The aim of this study therefore was to compare the course of eczema in predisposed children after nutritional intervention to the natural course of eczema. METHOD: The prospective German birth cohort study GINIplus includes a total of 5991 children, subdivided into interventional and non-interventional groups. Children with a familial predisposition for allergy whose parents agreed to participate in the prospective, double-blind intervention trial (N=2252) were randomly assigned at birth to one of four formulas: partially or extensively hydrolysed whey, extensively hydrolysed casein (eHF-C) or standard cow's milk formula. Children with or without familial predisposition represented the non-interventional group (N=3739). Follow-up data were taken from yearly self-administered questionnaires from 1 up to 6 years. The outcome was physician-diagnosed eczema and its symptoms. The cumulative incidence of eczema in predisposed children with or without nutritional intervention was compared with that of non-predisposed children who did not receive intervention. Cox regression was used to adjust for confounding. RESULTS: Predisposed children without nutritional intervention had a 2.1 times higher risk for eczema [95% confidence interval (CI) 1.6-2.7] than children without a familial predisposition. The risk was smaller with nutritional intervention even levelling out to 1.3 (95% CI 0.9-1.9) in children fed eHF-C formula. CONCLUSION: Although direct comparability is somewhat restricted, the data demonstrate that early intervention with hydrolysed infant formulas can substantially compensate up until the age of 6 years for an enhanced risk of childhood eczema due to familial predisposition to allergy.
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Eccema , Fórmulas Infantiles , Hidrolisados de Proteína , Animales , Caseínas/química , Bovinos , Niño , Preescolar , Estudios de Cohortes , Método Doble Ciego , Eccema/epidemiología , Eccema/prevención & control , Femenino , Humanos , Hipersensibilidad/epidemiología , Hipersensibilidad/prevención & control , Incidencia , Lactante , Fórmulas Infantiles/administración & dosificación , Fórmulas Infantiles/química , Recién Nacido , Masculino , Leche/química , Proteínas de la Leche/química , Modelos de Riesgos Proporcionales , Hidrolisados de Proteína/administración & dosificación , Hidrolisados de Proteína/química , Encuestas y Cuestionarios , Factores de Tiempo , Resultado del Tratamiento , Proteína de Suero de LecheRESUMEN
BACKGROUND: Only a few studies have analyzed the value of early sensitization in predicting the development of atopic disease. The relevance of low immunoglobulin (Ig) E antibody levels in this respect also remains unclear. OBJECTIVE: To investigate the relevance of sensitization in 12-month-old children in the development of atopic disease by the age of 6 years. METHODS: We analyzed data for 1290 children with a positive family history of atopy from the prospective, multicenter German Infant Nutritional Intervention (GINIplus) study and investigated the relationship between the presence of detectable specific IgE antibodies at the age of 12 months and the development of atopic disease by the age of 6 years. RESULTS: In all, 10.9% of children analyzed developed sensitization. At the age of 6 years, 20.6% of children with early sensitization had eczema compared to 9.4% of those without (odds ratio [OR], 2.31; 95% confidence interval [CI], 1.42-3.74). The corresponding figures were 15.4% vs 7.3% for allergic rhinitis (OR, 2.22; CI, 1.31-3.78) and 10.2% vs 2.6% (OR, 3.93; 95% CI, 1.98-7.76) for asthma. Children with early sensitization to aeroallergens had the greatest risk of subsequent atopic disease. Early sensitization did not increase risk in children without eczema within the first year of life. Very low specific IgE levels (0.18-0.34 kU/L) were not significantly associated with any of the outcomes analyzed. CONCLUSION: Sensitization to common food allergens and to aeroallergens in particular during the first year of life was found to be a strong predictor for the development of atopic disease by the age of 6 years in children with a positive family history of atopy.
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Hipersensibilidad/epidemiología , Inmunoglobulina E/sangre , Alérgenos/inmunología , Niño , Preescolar , Femenino , Estudios de Seguimiento , Alemania/epidemiología , Humanos , Hipersensibilidad/inmunología , Lactante , Modelos Logísticos , Masculino , Análisis MultivarianteRESUMEN
OBJECTIVES: To estimate long-term exposure to traffic-related air pollutants on an individual basis and to assess adverse health effects using a combination of air pollution measurement data, data from geographical information systems (GIS) and questionnaire data. METHODS: 40 measurement sites in the city of Munich, Germany were selected at which to collect particulate matter with a 50% cut-off aerodynamic diameter of 2.5 microm (PM2.5) and to measure PM2.5 absorbance and nitrogen dioxide (NO2). A pool of GIS variables (information about street length, household and population density and land use) was collected for the Munich metropolitan area and was used in multiple linear regression models to predict traffic-related air pollutants. These models were also applied to the birth addresses of two birth cohorts (German Infant Nutritional Intervention Study (GINI) and Influence of Life-style factors on the development of the Immune System and Allergies in East and West Germany (LISA)) in the Munich metropolitan area. Associations between air pollution concentrations at birth address and 1-year and 2-year incidences of respiratory symptoms were analysed. RESULTS: The following means for the estimated exposures to PM2.5, PM2.5 absorbance and NO2 were obtained: 12.8 microg/m3, 1.7x10(-5) m(-1) and 35.3 mug/m3, respectively. Adjusted odds ratios (ORs) for wheezing, cough without infection, dry cough at night, bronchial asthma, bronchitis and respiratory infections indicated positive associations with traffic-related air pollutants. After controlling for individual confounders, significant associations were found between the pollutant PM2.5 and sneezing, runny/stuffed nose during the first year of life (OR 1.16, 95% confidence interval 1.01 to 1.34) Similar effects were observed for the second year of life. These findings are similar to those from our previous analysis that were restricted to a subcohort in Munich city. The extended study also showed significant effects for sneezing, running/stuffed nose. Additionally, significant associations were found between NO2 and dry cough at night (or bronchitis) during the first year of life. The variable "living close to major roads" (<50 m), which was not analysed for the previous inner city cohort with birth addresses in the city of Munich, turned out to increase the risk of wheezing and asthmatic/spastic/obstructive bronchitis. CONCLUSIONS: Effects on asthma and hay fever are subject to confirmation at older ages, when these outcomes can be more validly assessed.