[Mortality trends among the elderly in East and West Germany during the past decades].
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Biomedical subjects
Publications and source records attributed to K E Bergmann.
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Following a long-term decline, death rates due to infectious diseases in West-Berlin men have dramatically increased since 1983. The Berlin mortality statistics introduced AIDS as a specific cause of death only in 1989. However, opportunistic infections, a negligible quantity until 1983, and pointing to AIDS as the underlying cause, show a steep increase in the mid and late eighties. In terms of Potential Years of Life Lost, AIDS-related mortality amounts to 8 percent of total mortality in West-Berlin men in 1989/1990.
In order to identify newborns at risk for atopic diseases, we developed a family questionnaire and selected specific answers which were suitable to identify atopic family members. The validity of the questionnaire was evaluated by the Phadiatop test results of 793 mothers and 353 fathers. As both screening instruments do not measure the same, the Phadiatop test identifies sensitization to inhalant allergens and the history reflects the clinical manifestation of atopic disease, the agreement between sensitization and manifestation is incomplete. Sensitivity and specificity of the questionnaire screening conditions to reproduce the Phadiotop test result was 64% and 84% for mothers, and 58% and 88% for fathers, respectively. The relative risk for lifetime prevalence of atopic manifestations in Phadiatop positive over negative mothers was calculated to be 3.88 (95% confidence interval = 3.12 to 4.81), and for Phadiatop positive over negative fathers to amount 4.84 (95% confidence interval 3.25 to 7.23). A few relevant answers of 20 were identified by logistic regression analysis to predict the Phadiatop test result nearly, as well as the total questionnaire.
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Iron deficiency may develop in prolonged breast feeding. Introduction of beikost (supplementary nutrition) is recommended in Germany for infants after 4 months of age. In a prospective study 73 exclusively breastfed infants at the age of 16 weeks were assigned to one of two feeding groups: 35 infants received a meat vegetable dinner fortified with iron-2-sulfate (3 mg iron per 100 kcal) as their first supplementary food. At 20 weeks of age a milk based rice cereal (MBRC) without iron fortification was added as a second beikost meal. The other group comprised 38 infants who first received a MBRC fortified with iron-3-pyrophosphate (3 mg iron per 100 kcal). At 20 weeks of age a non iron fortified vegetable potato dinner was introduced. After 6 months of age the iron fortified meat vegetable dinner was offered to all infants once a day. 26 infants who did not receive this dinner but otherwise were consulted and treated identically served as controls at 12 months of age. At 6 months of age values of hemoglobin, MCV, serum iron, ferritin, and transferrin saturation were higher in the meat dinner group compared to the cereal first group. At 12 months of age this was also true for the meat dinner group compared to the controls. However, the differences were minor and statistically not significant. Whereas most of the indicators of iron nutritional status were within the lower normal range, and total iron intake was below the levels recommended by German and American authorities, recommending two iron fortified beikost meals between age 7 and 12 months appears to be justified.
Recommending breast feeding supports a trend "back to nature". However, there are believers in the unbiased goodness of nature, who claim effects of mothers milk, e.g. protection from the evils of civilization, that are not confirmed by current scientific knowledge. As nature is not uniquely good (it feeds the donkey and the lion), and as biology is not perfect, breast feeding does not guarantee an uneventful infancy and childhood. There is even a pathology of breast feeding that the pediatrician should be familiar with.- The proven benefits, claimed effects, and some risks of breast feeding are reviewed on the basis of research results, and conclusions are drawn to make breast feeding as uneventful an experience as possible. Potential fields of research are being identified.
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The decisions of an individual about his food intake depend upon a variety of internal and external signals. The present contribution describes the physiological mechanisms controlling food intake to preserve body composition and performance. Centers within the hypothalamus including their connections to higher and lower structures within the central nervous system, especially to the limbic system, are involved in the control a food intake. Neuropeptides and neurotransmitters usually initiate more complex actions including the search for food and satiety phenomena. Their production and release are influenced by food consumption as well as intake of specific nutrients, sensorial perceptions, and a variety of other factors. Vagal reflexes and gastro-intestinal hormones, fat cell size, physical activity, and thermogenesis also influence perceptions of hunger and satiety. A model satisfactorily describing the interactions between all known factors that control food intake is still missing. The path from hunger to satiety could be described as sequences of cascades similar to the various steps in blood clotting. Control of food intake during early life dependably relies on energy requirement, and can be utilized for ad-libitum feeding. Obesity and anorexia nervosa are manifestations of disturbed control over food intake. Neuropharmacology offers several therapeutic approaches to specific conditions. However, by and large abnormalities of food intake control have to be treated by behavioral modification.
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In a representative sample population of 421 two-year-old Frankfurt children studied for vitamin-D nutritional status, only one case of subclinical rickets was discovered. 93.3% of the children have been a regular vitamin-D supplements during the first 12 month of life, but only 32.7% of them continued to receive the supplement beyond the age of one year. Risk groups were not identified, neither with regard to ethnic groups, nor smaller vitamin-D doses, or any other aspect.
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Hair zinc concentration was measured in centimeter sections of hair strands obtained from 17 mothers after delivery of newborn infants with spina bifida cystica. Thirty unselected healthy mothers and their normal newborn infants served as the controls. In the mothers of the diagnosis group, mean hair zinc concentration (216.2 microgram/g; SD = 43.2) was significntly higher than in the controls (181.6 microgram/g; SD = 31.4); it increased during pregnancy, whereas it decreased in the controls during the same time, and it was positively correlated to the hair zinc concentration of the newborn infants, while no such correlation could be detected in the controls. In the diagnosis group, mean birth weight (2808 g; SD = 382) and length (48.5 cm; SD = 2.3) of the term infants were significantly lower than in the control group (3310 g; SD = 382, and 51.2 cm; SD = 1.9, respectively). It is speculated that the differences in the zinc and growth parameters between the diagnosis and control group indicate an abnormality of zinc availability or metabolism in the mothers of infants with spina bifida.
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