This study investigates whether mortality inequalities based on individual- and area-level deprivation exist at older ages in Germany, and whether there are differences between eastern and western Germany.Data on population and death counts according to the individual-level socioeconomic status of male German pensioners aged 65+ years in Germany in 2002–2004 were obtained from the German Federal Pension Fund. Area-level characteristics for the 439 German districts were incorporated. Multilevel Poisson models were fitted.Individual-level socioeconomic mortality inequalities exist among elderly men in Germany. After controlling for differential population composition in the districts, we found that district-level factors contribute to the explanation of mortality inequalities in (western) Germany. The analysis further indicated that mortality and mortality inequalities tend to be higher in more economically deprived districts, and that minor mortality differences attributable to regional conditions exist in eastern Germany.The results showed that regional conditions have moderate effects on health inequalities at older ages in (western) Germany, when the differential population composition in the districts is controlled for.
A community-based intervention is described that targets oral health self-care practices among Hispanic children in the United States and is being tested in an ongoing trial. Descriptive results of baseline oral health variables are presented.As of January 2013, 284 Hispanic children of ages 5–7 enrolled in the Healthy Families Study in Nashville, TN, USA. Families are randomized to one of two culturally appropriate interventions.At baseline, 69.6 % of children brushed at least twice daily, and 40.6 % brushed before bed daily. One-third of parents did not know if their children’s toothpaste contained fluoride.This intervention fills the need for community-based interventions to improve oral health self-care practices that are culturally appropriate in Hispanic families.
Infants born to families at risk of malnutrition were studied prospectively from the beginning of the 3rd trimester of the mother's pregnancy until the child reached 3 yr of age to ascertain the effects of nutritional supplementation and/or a maternal education program on their cognitive development. Four hundred thirty-three families were assigned randomly to six groups: group A served as a control; group B received the supplement from the age of 6 months to 3 yr; group C received the supplement during the 3rd trimester of pregnancy and the first 6 months of the child's life; and group D received the supplement throughout the entire study period. In addition, group A1 was enrolled in a maternal education program but received no nutritional supplement and group B1 received both treatments. The Griffiths test of infant development was administered at 4, 6, 12, 18, 24, and 36 months of age, and the Corman-Escalona Einstein scale was administered at each age up to 18 months. Children who received food supplementation performed better than those who did not, especially on subtests that were primarily motoric. The effect of food supplementation on behavior appeared to be contemporaneous. In addition, the treatment effects were more pronounced for girls than for boys in this sample. Although these interventions reduced the gap in cognitive performance between lower and upper socioeconomic classes, a disparity nevertheless remained by the end of the study.
Three groups of patients with insulin-dependent diabetes mellitus, ascertained by different procedures, were investigated for HLA-A, B, C and D antigens (n=164), and a subset (n=93) for HLA-DR. Both HLA-D/DR3 and D/DR4 were strongly positively associated and D/DR2 was negatively associated with insulin-dependent diabetes. HLA-DR4 was found to be a better marker for insulin-dependent diabetes than Dw4. The HLA-B associations (B8, B15 and B18) were clearly secondary to the increases of HLA-D/DR3 and D/DR 4. The HLA associations did not differ between familial and isolated cases indicating that these two groups may well have a common genetic background. Based on analysis of HLA-haplotype sharing in affected sibling pairs, a simple dominant model of inheritance could be ruled out, and a simple recessive model was found unlikely. The relative risks for the HLA-Dw3,4 and HLA-DR3,4 phenotype were 21.2 and 44.4 respectively and exceeded those of both the HLA-Dw3 and HLA-DR3 (5.6 and 4.3) as well as the HLA-Dw4 and DR4 (10.1 and 10.5) phenotypes. This argues against an intermediate genetic model but further studies are needed to clarify whether there is more than one susceptibility gene for insulin-dependent diabetes mellitus within the HLA-system.
To investigate the prevalence of diabetic autonomic neuropathy, five simple bedside tests, beat-to-beat variation during quiet respiration, beatto-beat variation during forced respiration, heart rate and blood pressure response to standing, heart rate response to exercise, and heart rate response to Valsalva's manoeuvre were applied to 75 male insulindependent diabetics, mean age 40 years, (range 30–49 years). The subjects were subdivided into three groups according to duration of diabetes, which was between 0 and 40 years. Twenty-eight healthy age-matched male controls were also studied. The prevalence of diabetic autonomic neuropathy in the whole diabetic population indicated by abnormal response in beat-to-beat variation during forced respiration was 27%. Diabetic autonomic neuropathy increased in frequency with duration of disease. Patients with nephropathy or proliferative retinopathy had a significantly higher prevalence of diabetic autonomic neuropathy as indicated by abnormal beat-to-beat variation during forced respirations (p<0.01) than patients without these complications.