Impfprävention im Kindes- und Jugendalter

This article identifies successful vaccination strategies, obstacles to such strategies and the role that schools can play in terms of health education by analysing vaccination rates among children in the Federal State of Brandenburg. The analysis is based on the vaccination status of Brandenburg's children at day care centres and schools in relation to the social status of their parents, the extent to which preventive examinations (U up to J1) is taken advantage of and regional location. Furthermore, an evaluation is rendered of the vaccination awareness campaign which has been carried out in sixth grade students since 2002 to assess the impact of health promotion at schools. In the Federal State of Brandenburg vaccination coverage among infants and toddlers is good, with approximately 94% having received complete basic vaccination in 2003. By contrast, there are marked deficits among tenth grade schoolchildren in terms of refresher vaccinations, basic hepatitis B vaccinations and the second measles, mumps and rubella (MMR) vaccinations. Vaccination status is strongly dependent on the social status of parents and the extent to which preventive medical examinations and regional medical health-care provision are utilized. Systematic checking of vaccination documents by the public health services promotes vaccination awareness. Prevention by vaccination is most effective when combined with preventive medical examinations, effective local vaccination management and interdisciplinary interventions: education at schools, systematic tracking of vaccination documents combined with the provision of vaccinations in doctors' surgeries and additionally by the public health services.     

Herausforderungen bei der Charakterisierung und der Verbesserung der Ernährungssituation im Kindes- und Jugendalter

Meeting children's nutritional needs is of fundamental importance for their immediate and later health, well-being, and performance. Age-adapted reference values of nutrient intake form the basis for analysis of the current situation and for policy planning, but for many nutrients they cannot be precisely defined due to inadequate scientific data. Therefore, such values are often extrapolated from adult reference values based on age-adapted mean body weight or body surface data, although such extrapolation does not reflect age-related physiological changes. There are considerable differences between various expert recommendations, in part also due to differences in definitions and underlying concepts for deriving reference values. Improvements and international harmonization are urgently needed. Nutritional needs of many children and adolescents are not adequately met at present. A particularly obvious indication is the epidemic-like increase of pediatric overweight and obesity, which could result in markedly increased prevalences of later metabolic syndrome, diabetes, and cardiovascular diseases. Contributing to increasing childhood obesity are low physical activity, changing eating culture and behavior, frequent consumption of high-fat foods with high energy density, and increasing portion sizes. Changes are urgently needed and might be achievable with close collaboration between scientists, public institutions, and industry.     

Kardiovaskuläre Risikofaktoren im Kindes- und Jugendalter

Being overweight in childhood causes several cardiovascular risk factors which in turn contribute to accelerated atherosclerosis. Being overweight itself represents a risk factor, but also contributes to an increased prevalence of arterial hypertension, dyslipidemia and impaired glucose tolerance. Thus, cardiovascular prevention should be included in the management of obese children. Most of all, therapy of adiposity should be performed, as weight reduction and increased fitness represent protective factors. Moreover, a detailed cardiovascular workup and therapy of secondary vascular disease must also be performed. Subclinical changes at the level of the endothelium may be diagnosed using modern imaging techniques such as the measurement of the intima–media thickness of the carotid artery. In general, the overweight child should be considered as a future patient with vascular disease! The following article focuses on the prevalence, diagnostics and therapeutic options in the cardiovascular management of overweight children.     

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.     

Essstörungen im Kindes- und Jugendalter

Eating disorders are included in the category of mental and behavioural disorders (ICD 10). They are among the most common chronic health problems encountered in children and adolescents. A total of 7,498 children and adolescents (weighted) aged 11 to 17 years answered the SCOFF questionnaire, a screening instrument to identify cases of suspected eating disorder. Parallel to the SCOFF questionnaire, further factors for possible eating disorders, such as the Body Mass Index (BMI), information on abnormal behaviour (using the Strengths and Difficulties Questionnaire, SDQ) smoking, sexual and body self-image assessment, were gathered to substantiate the results. In total, 21.9 % of the children and adolescents in Germany aged 11 to 17 years showed symptoms of eating disorders. With 28.9%, girls are more frequently affected than boys (15.2 %); this difference is highly significant. In the presence of almost identical initial values, the rate of subjects with abnormal SCOFF scores increases, starting from age 11 years, in girls as they age, while it drops in boys. Children and adolescents with low socioeconomic status (SES) are, with 27.6 %, almost twice as often affected than those with high SES (15.6 %). Migrants have an approx. 50 % higher rate compared to non-migrants. A 2.5-fold increase in the percentage of individuals with normal weight who perceive themselves as too fat is found among those with abnormal SCOFF scores. Individuals with abnormal SCOFF scores smoke more and report more frequently about sexual harassment. Because of the severity, the tendency to chronification and the protracted therapy of the clinically apparent disorders, effective concepts for prevention should be developed.     

Essstörungen im Kindes- und Jugendalter

The most important eating disorders are anorexia and bulimia, which most frequently occur for the first time during adolescence and continue into adulthood. Medical complications and accompanying psychological disturbances cause a significant mortality rate of up to 6% in anorexia and up to 3% in bulimia. The pathogenesis of eating disorders is still unclear. Current etiological concepts are multidimensional including biological, individual, familial, and sociocultural factors. In spite of a great variety of therapeutic possibilities, the prognosis for eating disorders is quite poor. In the long term, only about 50% of the persons affected overcome their illness. Preventive measures are therefore indispensable.     

Depressive Störungen im Kindes- und Jugendalter

Depressive disorders in children and adolescents are widespread, cause a strong impairment in everyday life and are of great risk for further development. This paper gives an overview on the symptomatology, epidemiology, comorbid disorders and the further course of the disorder. Etiologic factors are presented and empiric studies concerning the treatment of depressive disorders in children and adolescents are summarized. Based on the empirical evidence and clinical experience suggestions for the treatment are provided.     

Das Unfallgeschehen im Kindes- und Jugendalter – Aktuelle Prävalenzen,Determinanten und Zeitvergleich

Background

In Germany and worldwide, unintentional injuries (UI) are a major health threat for children and adolescents. The first follow-up of the German Health Interview and Examination Survey for Children and Adolescents (KiGGS Wave 1, 2009–2012) continued the national UI monitoring that started with the KiGGS baseline study (2003–2006). The present analysis provides updated information and for the first time gives indications on time trends.

Methods

KiGGS Wave 1 is a combined nationwide cross-sectional and longitudinal survey by the Robert Koch Institute (RKI) providing information about 12,368 participating children and adolescents (0–17 years old; response rates: 38.8?% first time invited, 72.9?% reinvited). Parents were asked about their children’s UI and poisonings via telephone interviews. Information on UI is available for 11,665 children and adolescents (1–17 years old). The 12-month prevalence rate and 95?% confidence interval were calculated, and KiGGS Wave 1 was compared with the KiGGS baseline study. The Rao–Scott chi-square test corrected over the F distribution was used to test for the statistical significance of subgroup differences and trend effects.

Results

Within the previous 12 months, 15.5?% of all children and adolescents aged 1–17 years were medically treated for UI. UI were significantly more prevalent among boys (17.0?%) than among girls (14.0?%), and 3.4?% of the subjects had more than one accident leading to UI. One in eight children and adolescents who suffered UI stayed in hospital (12.3?%) for inpatient treatment for at least one night. The home, childcare and educational institutions, and sports facilities/playgrounds were the predominant accident locations. Compared to the baseline study, neither the overall prevalence of UI nor the gender- and age-specific patterns changed significantly.

Conclusion

Since a large proportion of UI is avoidable, knowledge of high-risk subgroups and accident locations is of particular use for prevention. KiGGS Wave 1 makes an important contribution to the comprehension of these issues. The transfer of research into practice is of particular importance for the avoidance of UI.     

Hormonelle Folgestörungen bei Adipositas im Kindes- und Jugendalter

There are a number of rare endocrine causes of obesity including defined genetic syndromes. However, there are frequent alterations in endocrine functions in obesity, which are characteristic of the obese state, including disorders of insulin secretion and function, alterations in the function of the growth hormone–IGF-1 axis, the hypothalamic–pituitary–thyroid axis, the hypothalamic–pituitary–adrenal axis, and pubertal development. The characteristic endocrine alterations in obesity may have an influence on energy metabolism and energy storage. Alterations in glucocorticoid production and metabolism and the impaired growth hormone production for example show that these secondary endocrine changes may facilitate further increase in weight. Notwithstanding this, all described endocrine changes are completely or partially reversible under calorie restriction and weight loss.     

Ist eine Therapie der Adipositas im Kindes- und Jugendalter ��berhaupt m?glich?

The question of whether or not treatment of obesity in children and adolescents is possible, feasible, or effective cannot be answered at the present time. Obesity is the most common chronic disorder in the industrialized societies. Its impact on individual lives as well as on health economics has to be recognized by physicians and the public alike: obesity at a young age is a major burden for the economy. Huge sums of money are thought to be spent on diet foods, products, and programs to lose weight. Treatments aim to reduce weight and as a consequence cardiovascular risks and other comorbidities. By doing so, economic costs could also substantially be reduced. In addition and most importantly, for the individual the impact of a given treatment on quality of life and social participation might be even more important than the medical benefit as such: especially since children and adolescents very often cannot estimate the medical burden of long-term sequelae of their obesity. Apart from individual therapies, interventions on a population base might be more cost effective and more important. However, the effectiveness of such interventions should also be assessed prospectively and continuously.     

Schmerzen bei Kindern und Jugendlichen in Deutschland: Prävalenz und Inanspruchnahme medizinischer Leistungen

As part of the German Health Interview and Examination Survey for Children and Adolescents (KiGGS), representative data were collected on pain in 14,959 children and adolescents aged 3 to 17 years in Germany. The results are reported separately for 11-17-year olds, who were asked themselves, and 3-10 year olds, whose parents reported on their pain. Among the 3-10 year olds, the prevalence of pain over three months was 64.5% and among the 11-17 year olds it was 77.6% (71.1% altogether for the 3-17 year old children). Pain prevalence increased significantly with age; in all age groups girls reported pain significantly more often than boys of the same age. In the 3-10 year olds the most common pain localisation was stomach pains, followed by pain in the head and throat. Children and adolescents aged 11 to 17 most often reported headaches, followed by pains in the stomach and back. Pain occurring at least once a week in the last three months was reported by 24.3% of the 11-17 year old children and adolescents and by 9.9% of the 3-10 year old children suffering from pain. More than half (54.1%) of the 3-10 year olds and more than one third of the 11-17 year olds (35.9%) who reported recurrent principal pain consulted a doctor for this reason; 36.7% and 46.7% respectively took medicine. These results show that pain is a relevant problem in children and adolescents in Germany.     

Depressive Störungen und aggressiv-dissoziale Störungen im Kindes- und Jugendalter

Mental disorders belong to the most frequent disorders in the community and lead to noticeable functional impairments. The lifetime prevalence of clinical depression (ICD-10 diagnoses F33, F34) up to age 25 is 12.7%, showing a female-male ratio of 2:1. From adolescence onwards, persistence rates of depressive disorders are comparably as high as those found in externalizing disorders. Subclinical depression (ICD-10 subthreshold disorders) at ages 8 and 13 increases the risk for later clinically relevant mental disorders. Conduct disorders (ICD-10 diagnoses F91, F92) are the most frequent mental disorders in children and adolescents with lifetime prevalence rates of 22.4% up to age 25. Conduct disorders show unfavorable courses beginning at preschool age. Precursors of later disorders can be detected as early as toddlerhood. Adverse family factors in childhood and early externalizing problems of the child were most predictive for later conduct disorders. Therefore, the need for early prevention of conduct disorders is highlighted. The focus should be on families with low socioeconomic status (objective: strengthening family and child resources). For depressive disorders, we recommend testing and evaluating the indicated prevention programs in adolescence (objective: strengthening the resources of the adolescent).     

­­­Inanspruchnahme der ambulanten und stationären medizinischen Versorgung in Deutschland

The article provides representative benchmarks and trends for the use of medical and therapeutic services in Germany on the basis of the German Health Interview and Examination Survey for Adults (DEGS1) and the German National Health Interview and Examination Survey 1998 (GNHIES98) from the years 2008–2011 and 1997/98, respectively. DEGS1 shows that women seek most medical services more often than men. Differences by gender decreased with age. In almost all services, an increase in utilisation is recorded with age. There are large differences in utilisation depending on self-rated health, as opposed to fewer differences by social status, health insurance and region. At both time points, the proportion of the population that utilised outpatient or inpatient medical assistance at least once a year, is almost unchanged high. At the same time, a significant reduction in the annual number of contacts with medical practices and the length of hospital stay was recorded as well as an increase of the consulted specialist groups. This may be explained due to regulation effects of earlier reforms. An English full-text version of this article is available at SpringerLink as supplemental.     

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.     

Was hat die Arbeitsgemeinschaft Adipositas im Kindes- und Jugendalter durch die Zertifizierung von Behandlungseinrichtungen, Adipositas-Trainern und Adipositas-Trainer-Akademien erreicht?

There is a vast choice of behavioral therapy for obesity in children and adolescents, with wide differences in quality. In order to provide orientation for families, physicians, and health insurance companies, the German Working Group on Obesity in Children and Adolescents (AGA), which is affiliated with the German Obesity Society (DAG) and the German Pediatric Society (DGKJ), offers to certify institutions providing patient education programs for obese children and adolescents, obesity trainers, and academies for obesity trainers. Currently, 60 institutions offer obesity care, while 81 obesity trainers and 8 trainer academies are certified. This article summarizes requirements for certification and preliminary experience.