BMC Public Health 2006, 6:268 http://www.biomedcentral.com/1471-2458/6/268 Competing interests The author(s) declare that they have no competing inter- ests. Authors' contributions AE planned and conducted the study and drafted the first version of the manuscript. RTM performed the statistical analysis and wrote the final version of the manuscript. UL and AK contributed to study design and conceptualiza- tion. All authors read and approved the final manuscript. Acknowledgements During preparation of the study AE was funded by an unrestricted educa- tional grant provided by DAAD. There was no other external funding for the study. We would like to thank Juergen Breckenkamp for the help during the conceptual preparation of this study and the staff who helped in various stages of the data collection. We also thank Annette Maxwell and Reinhard Bornemann for their comments on a previous version of this manuscript. References 1. 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