Bernhard Th. Baune

Individual development of preschool children-prevalences and determinants of delays in Germany: a cross-sectional study in Southern Bavaria

BackgroundEven minor abnormalities of early child development may have dramatic long term consequences. Accurate prevalence rates for a range of developmental impairments have been difficult to establish. Since related studies have used different methodological approaches, direct comparisons of the prevalence of developmental delays are difficult. The understanding of the key factors affecting child development, especially in preschool aged children remains limited. We used data from school entry examinations in Bavaria to measure the prevalence of developmental impairments in pre-school children beginning primary school in 1997–2009.MethodsThe developmental impairments of all school beginners in the district of Dingolfing- Landau, Bavaria were assessed using modified “Bavarian School Entry Model” examination from 1997 to 2009 (N=13,182). The children were assessed for motor, cognitive, language and psychosocial impairments using a standardised medical protocol. Prevalence rates of impairments in twelve domains of development were estimated. Using uni- and multivariable logistic regression models, association between selected factors and development delays were assessed.ResultsThe highest prevalence existed for impairments of pronunciation (13.8%) followed by fine motor impairments (12.2%), and impairments of memory and concentration (11.3%) and the lowest for impairments of rhythm of speech (3.1%). Younger children displayed more developmental delays. Male gender was strongly associated with all developmental impairments (highest risk for fine motor impairments = OR 3.22, 95% confidence interval 2.86-3.63). Preschool children with siblings (vs. children without any siblings) were at higher risk of having impairments in pronunciation (OR 1.31, 1.14-1.50). The influence of the non-German nationality was strong, with a maximum risk increase for the subareas of grammar and psychosocial development. Although children with non-German nationality had a reduced risk of disorders for the rhythm of speech and pronunciation, in all other 10 subareas their risk was increased.ConclusionsIn preschool children, most common were delays of pronunciation, memory and concentration. Age effects suggest that delays can spontaneously resolve, but providing support at school entry might be helpful. Boys and migrant children appear at high risk of developmental problems, which may warrant tailored intervention strategies.

Das chronische Schmerzsyndrom aus Sicht der Gesundheitswissenschaften

Schmerzen zählen zu den häufigsten Beschwerden in der Bevölkerung. Chronische, schwer behandelbare Schmerzerkrankungen sind von zunehmender medizinischer und ökonomischer Bedeutung in den westlichen Industrienationen in den vergangenen Jahren geworden. In dem vorliegenden Artikel wird die Public Health Bedeutung chronischer Schmerzerkrankungen erörtert. Resultate epidemiologischer Studien betonen die Bedeutung chronischer Schmerzen bei einer Vielzahl von Patienten mitzum Teil schwerwiegenden sozialmedizinischen Konsequenzen, zeigen Risikofaktoren für Schmerzerkrankungen auf und geben Hinweise auf versorgungsepidemiologische Fragestellungen in der Schmerztherapie. Auch in Deutschland haben sich in den vergangenen Jahren schmerztherapeutische Organisationsund Versorgungsstrukturen in der Schmerztherapie herausgebildet, die in diesem Artikel in international vergleichender Weise vorgestellt werden. Gesundheitsförderung und Prävention, die als Kerngebiete der Gesundheitswissenschaften gelten, werden mit Bezug auf chronische Schmerzen am Beispiel von Rückenprogrammen, Rückenschulen, Psychoedukationsprogrammen und gemeindebezogenen Interventionsmöglichkeiten erläutert. Die vorliegenden Ergebnisse stellen die Bedeutung der Gesundheitswissenschaften mit ihren multidisziplinären Forschungs- und Praxisfeldern für die Versorgung chronischer Schmerzpatienten her aus.AbstractThe symptom of pain is a common medical problem in the public. Chronic pain causes considerable suffering and disability within the community and many lost working days. Results of several epidemiological studies emphasise the social and economic dimension of chronic pain, describe risk factors for the development of chronic pain and provide information on use and potential use of resources in pain clinics and in general practice. The current structure of supply of chronic pain patients in the German health care system is described and the development of pain management in Germany is explained in consideration of international progress in this field. The science of public health is concerned with chronic pain in the subjects of e.g. epidemiology, prevention and health promotion. In the review results of several empirical investigations of these public health relevant subjects are introduced and the impact of community-based intervention for prevention and health promotion in the field of chronic pain is underlined. The science of public health with its multidisciplinary research opportunities and fields of activity could take responsibility for chronic pain patients.