Übergewicht und Adipositas bei Kindern und Jugendlichen

There is a worldwide increase of overweight and obesity not only in adults, but also in children. Data used to estimate prevalence are, however, collected in differing age groups using nonstandardized measurements and instruments and refer to differing time periods. Moreover, various reference systems to classify overweight and obesity exist, thus, adding to the difficulty in comparing countries. In this paper, these problems are discussed in detail. The most common reference systems are introduced, and their impact on the estimation of the prevalence of overweight and obesity is demonstrated. Based on available data of the global situation, maps that depict the worldwide distribution of the prevalence of overweight and obesity in children and adolescents are presented. Finally, these maps will be discussed critically. Although it may be assumed that these data are collected according to the best quality standards available, the lack of a unified protocol to conduct studies on childhood obesity hampers the comparability of data between countries. Obvious limitations in that respect are the use of different reference systems, differing sampling schemes, and differing age groups. More subtle limitations result from, e.g., different measurement methods, including self-reported weight and height.     

Zahn- und Kieferfehlstellungen – gesundheitliche Relevanz und Behandlung

Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz - Zahn- und Kieferfehlstellungen gehören zu den häufigsten Mundgesundheitsbeeinträchtigungen beim Menschen. Der...     

Umfassende Pflege und Betreuung Schwerkranker und Sterbender am Beispiel ausgewählter Symptome und Interventionen

The special care and attention due to terminally ill and dying patients will be demonstrated in this contribution with the help of specifically chosen paradigm cases and examples. The paper focuses on the needs of dying patients and their (nurs ing) relatives during the last days/hours of life (48-72 hours). Noisy, rattling breathing (death-rattle) and dry mouth (xerostomia) will be introduced as selected symptoms and phenomena together with basic stimulation and subcutaneous therapy as corresponding nursing interventions. Especially subcutaneous therapy has been shown to be a simple, non-invasive, and outstandingly effective option for easing symptoms and suffering of terminally ill people. Furthermore, this contribution wants to stimulate the critical reflection of carers within their own organizational structure in order to foster patient focused, competent, and comprehensive therapy, care, and attention of terminally ill and dying patients during their last days of life.     

Morbidität und Gesundheitsversorgung bei GKV- und PKV-Versicherten

Background

It has rarely been analyzed whether there are differences in Germany concerning morbidity and healthcare between insured by statutory health insurance (Gesetzliche Krankenversicherung, GKV) and insured by private health insurance (Private Krankenversicherung, PKV). In addition, the available studies are very scattered and no review has been published yet. The study presented here aims at closing this gap and at discussing recommendations for future analyses.

Methods

By searching for publications in the Medline and PubMed databanks, only a very few studies could be identified in this manner Thus, our search was extended to include a number of German institutes and organizations working in the field of public health and health systems research. In addition, we checked all references listed in the relevant publications.

Results

A total of 18 relevant publications could be identified; however, just four of them were found via Medline and PubMed. The empirical analyses show that the GKV insured are often less healthy than the PKV insured, and that they more often go to primary care physicians. A potential disadvantage of GKV insured concerning healthcare can be seen in regard to new, innovative drugs, organ transplantations, financial burden due to co-payments, waiting times, and communication between patient and physician.

Conclusion

Most studies show that there are large differences between GKV-insured and PKV-insured, concerning health status as well as healthcare. However, due to methodological weaknesses, some of these results are difficult to interpret. More studies focusing on specific age groups (e.g., children) are needed, and the methodological standard (e.g., statistical control for other factors such as income, distinction between different subgroups of insured) must also be raised. Finally, systematic differences between GKV and PKV should be considered in all analyses comparing these two schemes, such as differences in the availability of data concerning healthcare.     

AMTS für und mit Patienten,digital und interprofessionell

Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz -     

Personale, familiäre und soziale Schutzfaktoren und gesundheitsbezogene Lebensqualität chronisch kranker Kinder und Jugendlicher

INTRODUCTION: The present publication describes chronic conditions of children and adolescents (asthma, ADHD, obesity) in relation to personal, familial and social resources and to health-related quality of life (HRQOL). A database of these investigations is the German health interview and examination survey of children and adolescents (KiGGS), which is representative for 0 to 17 year-olds. The above mentioned chronic conditions occur frequently in this age group and are assumed to have an influence on quality of life and to be related to a lower level of protective factors. METHODS: The investigations used the data of 6813 children and adolescents within the age group of 11 to 17 who participated in the KiGGS study. Information about diagnosed chronic conditions was given by the parents within the framework of the computerassisted medical interview (CAPI) and by completing questionnaires. The personal, familial and social protection factors as well as the quality of life were assessed by the questionnaires, filled in by the adolescents themselves. Instruments used were the Social Support Scale, the Family Climate Scale and KINDL-R. RESULTS: Children and adolescents with asthma seem to have no deficits in the health-related quality of life and in the field of protective factors. This differs from the situation of the obese children as well as from the children with ADHD. Both groups show significant deficits in the health-related quality of life and protection factors. DISCUSSION: The chronic conditions investigated show remarkable differences in the scale values for measuring protective factors and health-related quality of life. Possible explanations are: For asthma as a chronic disease with somatic manifestation effective treatments and therapies exist, so that it has nearly no influence on the self-assessed quality of life. ADHD and obesity result in a decrease of quality of life and in the field of protective factors, possibly caused by social stigmatisation, isolation and demotivation of the concerned children and adolescents. Therefore it is important to support those children and adolescents to cope with their disease-related problems. The results illustrate that in addition to the immediate effects of chronic conditions on the concerned children and their families, it is the quality of life and the familial and social environment that should be specifically addressed in further studies.     

Demografie und Spendeaktivit?t von Blut- und Plasmaspendern in Deutschland

The Robert Koch Institute collects and evaluates nationwide data on the incidence and prevalence of transfusion-relevant infections among blood and plasma donors in Germany. Since 2006 data not only on the number of donations tested but also on the number of the respective donors have become available. The demographic profile and donation frequencies of German whole blood, plasma and platelet donors in 2010 and the percentages among the general population are described and compared to data from 2006. Although the general population eligible to donate blood is on the decline since 2003, with a loss of 2% between 2006 and 2010, this has not led to a decrease in the number of blood donors and donations. Instead, the number of new and repeat whole blood donors increased by 8% and 7%, respectively. At the same time, the number of new plasma donors grew by 23%, that of repeat plasma donors by 41%. In 2010 more than 4.3% of the population aged 18-68 years was active as repeat whole blood donors; 0.4% repeatedly donated plasma or platelets. Since 2006 the percentage of donors among the general population increased significantly, especially among the youngest age group (18-24 years). Donation frequency varied depending on donor age and sex, with an average of 1.9 per year for whole blood donations, 12.5 for plasmapheresis and 5.0 for plateletpheresis. While the donation frequency for whole blood remained unchanged since 2006, the frequency of apheresis donations increased, especially among older donors. By recruiting more new donors and retaining and reactivating existing ones more effectively, the number of whole blood and apheresis donations was augmented.     

Schlafdauer und ��bergewicht

Sleep deprivation is considered a serious risk factor with a relevant public health impact due to its multiple effects, which we are just beginning to understand. This is underlined by the growing number of studies in recent decades that have investigated the association between sleep duration and overweight. This review gives an overview of the current state of research and potential biological mechanisms. Evidence from epidemiological studies suggests an association between short sleep duration and overweight in children as well as in adults. Different biological mechanisms have been discussed in this context with a special focus on hormonal changes as the potential mediator. To include sleep in a comprehensive strategy to prevent overweight, interventional studies that analyze the potentially protective effect of prolonged sleep duration are necessary.     

Zuständigkeiten und Konzepte zur ärztlichen Ausbildung und Weiterbildung

Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz - Die ärztliche Ausbildung findet an medizinischen Fakultäten der Universitäten statt. Die ärztliche...     

Ärztliche und stationäre Versorgung im Kindes- und Jugendalter

At a young age, health care is mainly provided by doctors in private practice. In this study, the health care of children and adolescents in Thuringia is analysed. Data base is the federal state module Thuringia (2010–2012, n = 4884; 0–17 years), which was conducted by the Robert Koch Institute as part of KiGGS wave 1 (2009–2012). The health care of children and adolescents is described based on 7 indicators: total medical visits, paediatrician visits, general practitioner visits, hospitalisation, health screening examinations and vaccination against human papillomavirus (HPV). Prevalence and mean values with 95?% confidence intervals were reported, and with logistic and linear regressions, the significance of the group differences was examined. Results show that 93.9?% of children and adolescents aged 0–17 years in Thuringia went in the last 12 months to doctors in private practice; the average number of doctor visits was 6.6 contacts. 75.1?% of 0? to 17-year-olds were treated by a paediatrician, and 29.9?% visited a general practitioner. In addition, 13.1?% of 0? to 17-year-olds in Thuringia have spent at least one night in hospital in the last 12 months; the average number of hospital nights was 7.2. With 90.5?%, the majority of the children aged 7–13 years completed the health screening program for children (U3–U9, without U7a). 67.5?% of the 14- to 17-year-old girls were vaccinated against HPV with at least one dose (lifetime prevalence), and 56.3?% have received a full vaccination with 3 doses. In addition, 62.0?% of 14- to 17-year-old girls went at least once to a gynaecologist. There are significant differences by gender, age, socio-economic status and place of residence (urban/rural). In summation, the results indicate a high utilisation rate by children and adolescents in Thuringia. Additionally, the findings point out prevention potentials such as the vaccination against HPV.     

Gesundheitlicher und di?tetischer Wert des Obstes und der Obstprodukte

Ohne Zusammenfassung     

Umgang mit W?sche und Abfall in Alten- und Pflegeheimen

Management of infectious diseases in nursing homes is as important as it is in hospitals. Therefore, a standardized questionnaire was used for the detailed assessment of the handling of laundry and garbage with a special focus on methicillin-resistant staphylococcus aureus (MRSA) in 22?nursing homes in Germany. The study focused on the prevention of occupational diseases in the nursing home staff. Despite a few isolated problems, the situation of MRSA-positive patients was not as alarming as expected: guidelines for MRSA as published by KRINKO were often followed by the healthcare workers. However, general problems with managing garbage and laundry were identified. Many nursing homes lacked protective clothing and a sufficient garbage management plan. In addition, the handling of laundry was a problem in that the clothing of the patients and the working clothes of the staff were often washed at home rather than in accredited laundries. Thus, the awareness for hygienic problems needs to be raised, e.g., by expanding hygienic control for the nursing homes.     

Ernährung,Bewegung und Substanzkonsum von Kindern und Jugendlichen

The term health behaviour combines both health-promoting and health-risk components. In this study, the health behaviour of children and adolescents in Thuringia is analysed. The database was a representative subsample of the federal state module Thuringia, which was conducted by the Robert Koch Institute as part of the German Health Interview and Examination Survey for Children and Adolescents (KiGGS) wave 1 (2010–2012; n = 4,096; 3–17 years). Health behaviour was described based on nine indicators: fruit and vegetable consumption, soft drink consumption, breakfast at home, physical activity, sport, swimming ability, alcohol consumption, smoking and water pipe consumption (shisha smoking). Prevalence and mean values with 95?% confidence intervals were reported, and based on logistic or linear regression, the significance of the group differences was examined. The results show that 43.4?% of children and adolescents in Thuringia ate fruits and vegetables daily, 44.5?% consumed soft drinks less than once a week, and 67.9?% had breakfast at home every weekday. In addition, 31.0?% of children and adolescents in Thuringia were physically active at least 60 min a day, 69.8?% did sports for at least 2 h a week, and 81.5?% can swim. Additionally, 15.9?% of adolescents in Thuringia had hazardous alcohol consumption, 14.4?% currently smoked, and 20.0?% smoked a water pipe. Differences existed with regard to gender, age, socio-economic status (SES) of the family and residence (urban/rural). In summary, many of the children and adolescents in Thuringia demonstrate relatively positive health behaviour. However, the results also indicate groups at higher risk of unhealthy behaviour, such as children and adolescents from families with low SES.     

Nutzung von schulischen und außerschulischen Freizeitangeboten durch Kinder und Jugendliche

Background

Participation in extracurricular school activities and structured leisure-time activities as well as desire for additional opportunities for activities were assessed in children and adolescents with physician-diagnosed obesity and normal weight children and adolescents.

Methods

A sample of 8- to 14-year-old German children and adolescents (491 with diagnosed obesity, 540 with normal weight) took part in a survey conducted nationwide. ANOVAs were conducted with the between-subject factors of gender, age group and obesity (diagnosis yes/no) and the repeated measure factors of context (within or outside school) and domain (sports, music, creative, computer, foreign languages).

Results

Regardless of obesity diagnosis, children and adolescents favour activities in sports, computer, music, creative areas and foreign languages. In spite of a general preference for sports, effects for gender and age were observed: boys prefer sports and computer activities whereas girls prefer music and creative activities; participation in school-based activities declined with age. In primary school no differences emerged between children with diagnosed obesity and controls. Starting in 5th grade, differences emerged; participants with a diagnosis of obesity would like more school-based computer activities whereas controls would like more school-based sports activities. Overall, children and adolescents with obesity would like more opportunities to engage in computer-based activities and foreign languages.

Conclusions

School-based extracurricular activities should be expanded, based on further activities requested by students. It may be important to develop school-based activities that combine different areas of interest in order to promote physical activity also for sedative behaviour.     

Hürden und Aussichten neuer antimikrobieller Konzepte in Forschung und Entwicklung

Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz - Antimikrobielle Resistenzen (AMR) entwickeln sich weltweit zum ernsten Problem für das Gesundheitswesen. Über...     

Pr?vention und Therapie von ��bergewicht und Adipositas im Kindes- und Jugendalter aus gesundheits?konomischer Sicht

This article provides an overview of the costs associated with overweight and obesity in children and adolescents, and of the cost effectiveness of preventive and therapeutic interventions. First, the results of cost-of-illness studies from the international literature are presented. These studies show ambiguous results, but indicate moderate excess costs due to obesity for this age group. Subsequently, this paper describes the methods that can be used to analyze the cost effectiveness of preventive and therapeutic interventions. Problems arise from the necessity to estimate long-term effects on costs and health consequences of multiple, associated diseases. A number of economic evaluations of preventive and therapeutic interventions published in the scientific literature have reported favorable cost effectiveness. In order to increase the efficiency of health care, more cost-effective services for overweight and obesity should be developed and used.     

Kinderschutz und Frühe Hilfen aus Sicht der Kinder- und Jugendmedizin

Demands for prevention in the areas of child protection, child development and early education are increasingly being discussed in the health care system, social services and the educational and school system. Concepts in health care include health promotion, risk assessment and primary and secondary prevention. Child protection promotes strategies such as early social support services and at-risk screening and educational systems advocate early intervention and concepts to enhance child development. The complexity of children's developmental needs and their living environments require a comprehensive approach of all three systems and integration of services and interventions. Each child's needs must be individually analysed and services tailored appropriately. A case vignette demonstrates and analyses typical problems of interacting systems. A systemic view of systems of care allows planning of efficient and sustainable social and health care policies.     

Prävalenz und Charakteristika von Kindern und Jugendlichen mit speziellem Versorgungsbedarf im Kinder- und Jugendgesundheitssurvey (KiGGS) in Deutschland

In order to arrive at population-based estimates on the prevalence and characteristics of children and adolescents with specific health care needs (CSHCN), screening instruments focussing on the consequences of physical, mental and behavioral problems rather than on medical diagnoses have been developed. One of the most feasible and widely tested instruments, the CSHCN screener was added to the self-administered questionnaire for parents of children participating in the German Health Interview and Examination Survey for Children and Adolescents (KiGGS). The overall weighted prevalence of CSHCN was 16.0% among boys and 11.4% among girls. Children at kindergarten or school age were more than 2-3 times more likely to screen positive compared to toddlers. Up to 14 years, the sex difference persisted through all age groups and was most pronounced between the ages of 3 and 10 years. Children with a migrant background had significantly lower rates of CSHCN compared to non-migrants. This was particularly true for boys (8.0% vs. 17.1%). CSHCN status was not related to social status, urbanization or residence in former West vs. former East Germany. Except for the lack of association with social status, these results are in good accordance with observations from the US National Survey of CSHCN.     

Altern und Sexualität

This contribution describes sexual desire, activity and satisfaction of people aged 45-91 years on the basis of an empirical study conducted in the German-speaking part of Switzerland. Sexual desire and activity diminish with age but there is a great variability. Sexual satisfaction remains stable in elderly people. Physical, hormonal and neuronal changes cause a greater vulnerability for sexual problems but relationship, psychosocial and biographical factors as well as coping strategies have a strong moderating effect. The medicalization of the sexuality of aging people is critically depicted. Recommendations for health care practitioners are given.