Unterrichtsablauf in der Waldorfschule (German Edition)

We received questionnaires Steiner group and control group and had to exclude 12 persons, who were outside the predefined age range 11 Steiner, 1 control.

Furthermore, 39 persons from the control group, who reported having attended a Steiner school, were excluded from the analyses. Overall, the response was similar in both groups In the control group, response rate was lower in males compared to females Information on age and sex of Steiner non-responders was not available, because data of the Steiner school group were handled in the respective schools.

In general, controls were found to have slightly more missing responses than Steiner school attendees 0. While distribution of age, sex and family status was similar in both groups, former Steiner school attendees as well as their parents had a higher educational status compared to controls. Steiner school attendees reported more often focus on balanced diet and physical activities by their parents in their childhood than the control subjects did Table 1.

Most prevalent diseases were hypertension Back pain, headache and joint pain were most often reported to cause moderate or worse symptom burden. In general, for several diseases and symptoms, reported prevalence was lower in former Steiner school attendees compared to the general population. Unadjusted odds ratios of disease prevalence ranged from 0. These adjusted odds ratios for Steiner school attendance for disease prevalence range from 0.

The difference of BMI was 0. All odds ratios for each variable in Model 3 are reported in Table 2 and Table 3. For example, in the adjusted analysis the odds ratio for former Steiner school attendees compared to controls for hypertension is 0. Self-reports on actual behaviour like physical activities on more than 5 days a week OR 1. In general, apart from sociodemographic variables, the actual lifestyle features such as attention towards physical activity showed a stronger impact on outcomes than lifestyle features during childhood like parents' attention towards physical activity.

Comparisons of adjusted odds ratios from sensitivity analyses are given in Figure 3. BMI differences between Steiner group and controls seemed to have no impact on risk of disease report. Restriction of analysis to German citizens attenuates the effect of Steiner school attendance, e.

Restriction to the analysis of persons, who reported to have been attending a Steiner school between 7 and 14 years of age, increased the effect considerably in joint pain and insomnia; however, from the Steiner school students excluded in this analysis did not give this information, leaving it unclear whether those attended Steiner schools during the age of 7 to 14 years or not.

The results from the post-hoc sensitivity analyses with imputed datasets show only small differences and are presented in Tables S1 and S2. We found that the responders from the Steiner school group had lower life time prevalence estimates for some self-reported diseases diagnosed by a physician and documented less self-reported complaints and symptoms as compared to a general population group.

Furthermore, former Steiner school attendees had a significantly lower BMI and spent less days in the hospital within the past 12 months. After adjusting for possible confounders, Steiner schools attendees still had significantly lower risk for allergic rhinitis and osteoarthritis as well as symptom burden from back pain, insomnia, joint pain, gastrointestinal symptoms and imbalance.

Adjusted analysis showed that beneficial health effects of attendance to Steiner schools are associated with sociodemographic factors as well as with actual and childhood lifestyle. To our knowledge this is the first large comparative survey looking into health status of former Steiner school attendees later in life. Major advantages of the study are the large sample drawn from Steiner schools as well as the random sample from the German population from different German regions, the assessment of different diseases relevant from a public-health perspective, as well as the adjustment for a large number of potentially relevant confounders.

Limitations affect the validity of data collection, as all information was self-reported. Self-reports might be less valid for some diseases than for others. Also, given the retrospective data collection, inaccurate recall might occur, especially in questions regarding childhood. Thus, most missing responses were observed for variables with focus on childhood. However, since absolute numbers of missing values are rather small the impact on effect estimates should be minor.

Furthermore, Steiner attendees may have answered differently than participants in the control group after reading about the research aims which focused on health issues related to their own upbringing lifestyle, although we tried to avoid to draw attention towards this issue, for example by asking more generally about spiritual or religious orientation of participants' parents. In general, given the study design, all results are at risk to be influenced by confounding from unmeasured variables.

In general, the associations between possible risk or protective factors and health outcomes need to be considered as exploratory assessments which are at risk to be substantially biased and can give only little insight in the possible health promoting aspects of Steiner school education.

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We did not adjust for multiple testing. Thus this must be considered when interpreting p-values. Also, our results are presented as odds ratios and would overestimate the effect if they were interpreted as risk ratios. Considering these points, the presented odds ratios from sociodemographic and lifestyle factors can only serve for hypothesis generation and should not interpreted as exact causal effect estimates. We fitted the same statistical model on all outcomes to allow comparison of the effect of attending a Steiner school over all outcomes.

While for some outcomes the model might include many covariates compared to observed events, for other outcomes this was unproblematic.

However, within extensive sensitivity analysis with different modelling strategies dummy coding instead of dichotomization variables, adjustment for propensity scores, not presented effect estimates and standard errors of Steiner school attendance did not vary relevantly. The major challenge in this study was to disentangle the relations between attendance to Steiner school in childhood and possible confounders. Actual socioeconomic status and health behaviour could be a result of Steiner school education or as well be correlated to attending Steiner schools, e.

Therefore, many differences between both groups can be considered to be possible confounders, but could represent effects of Steiner school education as well. Thus, adjustment for actual lifestyle in statistical analysis could lead to underestimation of effects of Steiner school attendance.

Furthermore, we fitted the same model for all outcomes, although effects of variables on outcomes might differ. Also, it is plausible that relations between Steiner school attendance and lifestyle change over time, especially when keeping in mind that education of study responders took place sometime between the late s and s, depending on their respective age.

We cannot rule out a time period effect but by adjusting for age we tried to control for this effect in our analyses to a certain degree. In some prior studies anthroposophic lifestyle was found to be protective against allergy development [7] — [10] , in others this was not the case [14] — [16]. We found that allergies were equally frequent in former Steiner school attendees and control group, but adjustment for potential confounders resulted in a significantly reduced risk of allergic rhinitis among former Steiner school attendees.

The prevalence estimates of other diseases that are often caused by allergic reactions such as atopic dermatitis and asthma did not differ between the groups. Ruling out this cause of error, we found smaller differences for diseases in our study: In adjusted analysis, the difference in osteoarthritis prevalence was statistically significant. In Steiner schools there is a focus on a balance between intellectual, emotional and physical activities compared to a more intellectual focussed education in other schools. Steiner predicts in his philosophy that this could have protective effects especially for arthritic diseases [23].

However, to follow this hypothesis would require a different type of research. In both groups, lifetime prevalence of diabetes Steiner 2. For depression, we found a lifetime prevalence of 9. This could indicate an underestimation of the true prevalence because of a lack of validity from self-reported assessments. This has been the largest and most comprehensive study to date examining the association of attending Steiner schools in childhood with a broad range of illnesses in adults. Our results showed that the prevalence of most widespread diseases including cardiovascular outcomes, diabetes, cancer, depression, COPD and asthma did not differ significantly between former Steiner school attendees compared to adults who attended public schools in childhood.

However, osteoarthritis and allergic rhinitis were reported less often by Steiner school attendees considering adjustment for possible confounders including sociodemographic variables, actual and childhood lifestyle features. Interestingly, we found stronger associations of Steiner school attendance with current health complaints: To our knowledge this is the first time that a link between a specific pedagogic framework in childhood and health status in later life was investigated.

However, our results must be interpreted with caution since the present analysis was exploratory and bias and residual confounding cannot be ruled out. Future studies should evaluate possible long-term health benefits of Steiner schools and anthroposophic lifestyle in prospective cohort studies, ideally starting in early childhood with sufficient follow-up into adulthood. Health status and outcomes should be assessed in regular intervals and by objective measurements where possible.

To assess the effects of Steiner schools on health and health perception, special emphasis should be put on comparability of groups in terms of socioeconomic status and education. One strategy could be to select controls that had attended some other specialized school and could be more similar to Steiner school attendees.

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However, parent-reported data is crucial, particularly in young children, to assess lifestyle factors including diet and physical activity outside of school as well as indoor and outdoor environmental exposures. Sensitivity Analysis using multiple imputation. The authors wish to thank all study participants for their time and the staff involved at the schools for their efforts while collecting the data.

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Furthermore we would like to thank P. Kamtsiuris Berlin, Germany and Prof. Patzlaff Alfter, Germany for their valuable contributions to the discussion of the study design and the interpretation of the results. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. National Center for Biotechnology Information , U. Published online Sep Erik von Elm, Editor. Author information Article notes Copyright and License information Disclaimer. The authors have the following interest.

Christoph Hueck is employed by Freie Hochschule Stuttgart, one of the funders of this study. This does not alter their adherence to all the PLOS ONE policies on sharing data and materials, as detailed online in the guide for authors. Received Sep 24; Accepted Jul This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are properly credited.

Abstract Background It is speculated that attending Steiner schools, whose pedagogical principles include an account for healthy psycho-physical development, may have long-term beneficial health effects. Methods We included former Steiner school attendees from 4 schools in Berlin, Hanover, Nuremberg and Stuttgart and randomly selected population controls. Results Steiner school attendees and controls were eligible for analysis.

Conclusions The risk of most examined diseases did not differ between former Steiner school attendees and the general population after adjustment for sociodemographics, current and childhood lifestyle features, but symptom burden from some current health complaints was reported less by former Steiner school attendees.

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Methods Study design, setting, and sample The study was designed as a multicentre, cross-sectional survey comparing former Steiner School attendees with a random sample of the general population. Assessment of sociodemographics and health behaviour Study participants were asked to fill out a postal questionnaire, which was based on the German Health Survey [18] , [19]. Assessment of health status Outcomes of the study were self-reports on 16 diseases diagnosed at least once by a physician: Statistical Analysis Sample size calculation was conducted using the prevalence of hypertension Showing all editions for 'Teaching of arithmetic and the Waldorf School plan.

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