Gianni Varnaccia

Occupational Injuries in Germany: Population-Wide National Survey Data Emphasize the Importance of Work-Related Factors

Unintentional injuries cause much of the global mortality burden, with the workplace being a common accident setting. Even in high-income economies, occupational injury figures remain remarkably high. Because risk factors for occupational injuries are prone to confounding, the present research takes a comprehensive approach. To better understand the occurrence of occupational injuries, sociodemographic factors and work- and health-related factors are tested simultaneously. Thus, the present analysis aims to develop a comprehensive epidemiological model that facilitates the explanation of varying injury rates in the workplace. The representative phone survey German Health Update 2010 provides information on medically treated occupational injuries sustained in the year prior to the interview. Data were collected on sociodemographics, occupation, working conditions, health-related behaviors, and chronic diseases. For the economically active population (18–70 years, n = 14,041), the 12-month prevalence of occupational injuries was calculated with a 95% confidence interval (CI). Blockwise multiple logistic regression was applied to successively include different groups of variables. Overall, 2.8% (95% CI 2.4–3.2) of the gainfully employed population report at least one occupational injury (women: 0.9%; 95% CI 0.7–1.2; men: 4.3%; 95% CI 3.7–5.0). In the fully adjusted model, male gender (OR 3.16) and age 18–29 (OR 1.54), as well as agricultural (OR 5.40), technical (OR 3.41), skilled service (OR 4.24) or manual (OR 5.12), and unskilled service (OR 3.13) or manual (OR 4.97) occupations are associated with higher chances of occupational injuries. The same holds for frequent stressors such as heavy carrying (OR 1.78), working in awkward postures (OR 1.46), environmental stress (OR 1.48), and working under pressure (OR 1.41). Among health-related variables, physical inactivity (OR 1.47) and obesity (OR 1.73) present a significantly higher chance of occupational injuries. While the odds for most work-related factors were as expected, the associations for health-related factors such as smoking, drinking, and chronic diseases were rather weak. In part, this may be due to context-specific factors such as safety and workplace regulations in high-income countries like Germany. This assumption could guide further research, taking a multi-level approach to international comparisons.

Das Unfallgeschehen bei Kindern und Jugendlichen in Deutschland

Compared to adults, children and adolescents run a considerably higher risk of suffering unintentional injuries (UI). To prevent UI, detailed knowledge of the overall accident occurrence and the determinants of UI is needed. This article gives an overview of the data sources covering the occurrence of UI among children and adolescents in Germany. According to the Robert Koch Institutes German Health Interview and Examination Survey for Children and Adolescents (KiGGS), approximately 15.3 % of children and adolescents (1-17 years) in Germany suffer at least one UI within 12 months. Most accidents (60.7 %) occur at home or during leisure-time activities. In 2011, the German Statutory Accident Insurance (DGUV) registered more than 1.4 million accidents among children in day-care facilities and students in educational institutions. According to official statistics, in the same year, more than 50,000 children and adolescents were injured in traffic accidents. Moreover, the Federal Statistical Office registered 260,534 hospital admissions due to injuries and poisonings among children and adolescents. All data sources revealed age- and sex-specific differences. Boys suffer UI more frequently than girls do and they show higher injury rates in adolescence than during childhood. While UI among children mostly happen at home, road traffic and leisure-time accidents increase in occurrence during adolescence. In Germany, there are numerous initiatives dedicated to the prevention of UI in children and adolescents. The creation of target group-specific prevention measures is complicated by the fact that the methodological approaches of existing data sources differ considerably.

Factors influencing childhood obesity – the establishment of apopulation-wide monitoring system in Germany

Obesity poses a danger to childhood health and can continue to have a negative impact on health into adulthood. Currently, about 15% of children and adolescents in Germany are overweight or obese. Moreover, significant data on the multifactorial causes of childhood obesity that is systematically recorded, regularly updated and obtainable at the nationwide level are not yet available in Germany. As such, the Robert Koch Institute is establishing a population-wide system to monitor the factors that are relevant to childhood obesity (AdiMon). AdiMon will be available by the end of 2017. This paper outlines the methodological approach that is being used to establish AdiMon and describes the current results of the project (the development of an initial set of core indicators). The project began by undertaking a systematic literature review aimed at piecing together the latest knowledge on factors that influence childhood obesity. The factors that were identified were then sorted according to relevance, and appropriate indicators were selected. This was followed up by research into data sources that – as far as possible – provide significant data that are regularly collected but that also provide for regional differentiation. Work is currently underway to analyse these indicators and data sources. Once this work has been completed, the indicator set will be finalised and the results published on the internet. Population-wide monitoring of factors relevant to childhood obesity takes the following types of indicators into account: behavioural factors (such as physical activity), biological factors (such as genetic predisposition), prenatal and early-childhood factors (such as breastfeeding), psychosocial factors (such as parents’ health consciousness), environmental factors (such as playgrounds in the local area), contextual factors (such as a migrant background) and prevention measures as well as measures to promote health (such as expenditure by statutory health insurers). The population-wide monitoring uses the following data sources: epidemiological studies, social sciences surveys, official statistics and geo-information systems, as well as routine, economic and media data. This paper demonstrates that population-wide monitoring can provide significant information about the distribution and causes of obesity in childhood, and thus enable the need for action to be recognised at an early stage, initial approaches for preventive measures to be identified and developments to be tracked over time. OBESITY · INDICATORS · HEALTH MONITORING · CHILDREN · PREVENTION Authors: Gianni Varnaccia, Johannes Zeiher, Cornelia Lange, Susanne Jordan Journal of Health Monitoring · 2017 2(2) DOI 10.17886/RKI-GBE-2017-047 Robert Koch Institute, Berlin Journal of Health Monitoring Journal of Health Monitoring 2017 2(2) 86 CONCEPTS & METHODS Factors influencing childhood obesity – the establishment of a population-wide monitoring system in Germany

Adipositasrelevante Einflussfaktoren im Kindesalter –Aufbau eines bevölkerungsweiten Monitorings in Deutschland

Adipositas gefährdet bereits im Kindesalter die Gesundheit und kann bis ins Erwachsenenalter negative gesundheitliche Folgen haben. Etwa 15 % der Kinder und Jugendlichen in Deutschland sind übergewichtig oder adipös. Systematisch erfasste, regelmäßig aktualisierte und bundesweit aussagekräftige Daten über die multifaktoriellen Ursachen kindlicher Adipositas sind in Deutschland bisher nicht gebündelt verfügbar. Deswegen wird am Robert Koch-Institut bis Ende 2017 ein bevölkerungsweites Monitoring adipositasrelevanter Einflussfaktoren im Kindesalter (AdiMon) aufgebaut. Dieser Beitrag beschreibt das methodische Vorgehen beim Aufbau des Monitorings und präsentiert den Projektstand: ein erstes Set an Kernindikatoren. Zu Beginn wurde eine systematische Literaturrecherche durchgeführt, um den aktuellen Wissensstand zu adipositasrelevanten Einflussfaktoren im Kindesalter zusammenzutragen. Anschließend wurden die identifizierten Faktoren hinsichtlich ihrer Relevanz gefiltert und geeignete Indikatoren gebildet. Für die gebildeten Indikatoren wurden Datenquellen recherchiert, die – soweit möglich – bevölkerungsweit aussagekräftige Informationen liefern, die regelmäßig erhoben werden und regionale Differenzierungen erlauben. Aktuell wird daran gearbeitet, die Auswahl der Indikatoren zu prüfen und die identifizierten Datenquellen zu erschließen. Anschließend soll die Indikatorenauswahl finalisiert und das Ergebnis auf einer Website angeboten werden. Das bevölkerungsweite Monitoring adipositasrelevanter Einflussfaktoren im Kindesalter umfasst Indikatoren folgender Einflussbereiche: verhaltensbezogene Faktoren (z. B. körperliche Aktivität), biologische Faktoren (z. B. genetische Prädisposition), pränatale und frühkindliche Faktoren (z. B. Stillen), psychosoziale Faktoren (z. B. Gesundheitsbewusstsein der Eltern), verhältnisbezogene Faktoren (z. B. Spielplätze in der Wohnumgebung), Kontextfaktoren (z. B. Migrationshintergrund) und Maßnahmen der Prävention und Gesundheitsförderung (z. B. Ausgaben der gesetzlichen Krankenversicherung). Als Datenquellen werden epidemiologische Studien, sozialwissenschaftliche Erhebungen, amtliche Statistiken, Routine-, Wirtschaftsund Mediendaten sowie Geoinformationssysteme erschlossen. Der Beitrag verdeutlicht, dass ein bevölkerungsweites Monitoring aussagekräftige Informationen über die Verbreitung von Adipositas im Kindesalter und deren Ursachen liefern kann und somit die Chance bietet, Handlungsbedarfe frühzeitig zu erkennen, Ansatzpunkte für Präventionsmaßnahmen zu identifizieren und zeitliche Entwicklungen zu verfolgen. ADIPOSITAS · INDIKATOREN · GESUNDHEITSMONITORING · KINDER · PRÄVENTION Autorinnen und Autoren: Gianni Varnaccia, Johannes Zeiher, Cornelia Lange, Susanne Jordan Journal of Health Monitoring · 2017 2(2) DOI 10.17886/RKI-GBE-2017-034 Robert Koch-Institut, Berlin Hier gelangen Sie zum Journal of Health Monitoring 2017/2: »Gesundheitsverhalten in Deutschland und Europa« kapitelweise Journal of Health Monitoring Adipositasrelevante Einflussfaktoren im Kindesalter – Aufbau eines bevölkerungsweiten Monitorings in Deutschland Journal of Health Monitoring 2017 2(2) 91 CONCEPTS & METHODS Ein flussfaktoren (z. B. Stillen) ausschließlich in dieser Lebensphase vor oder werden maßgeblich in dieser Lebensphase geprägt (z. B. Ernährungsverhalten). Insbesondere im Hinblick auf die Tatsache, dass es im Schulalter zu einem deutlichen Anstieg der AdipositasPrävalenz kommt [6], ist es wichtig, bereits vor der Einschulung die Ursachen kindlicher Adipositas in den Blick zu nehmen. Mit dem Indikatorensystem des bevölkerungsweiten Monitorings soll der (Fach-)Öffentlichkeit eine Zusammenstellung wissenschaftlich fundierter Informationen über die Ursachen und die Verbreitung kindlicher Adipositas verfügbar gemacht werden, um Handlungsbedarfe frühzeitig erkennen, Anknüpfungspunkte für Präventionsmaßnahmen identifizieren und zeitliche Entwicklungen verfolgen zu können. Dieser Beitrag beschreibt das methodische Vorgehen beim Aufbau des bevölkerungsweiten Monitorings und präsentiert den Projektstand in Form von Kernindikatoren.

732 Falls – only a health risk for the elderly? Results of the “german health update”

Background Unintentional injuries (UIs) caused by falls are an important public health issue in ageing populations. This paper describes the incidence and consequences of falls in the adult population in Germany; the focus is on age and gender differences. Methods The representative phone survey “German Health Update 2010” (n = 22,050) provides information on up to three medically treated UIs within twelve months. Analyses focus on the characteristics of falls compared to other types of UIs. Frequencies and 95% confidence intervals (CI: 95) were calculated and logistic regression was applied to control for confounders. Results Like UIs in general, falls are more frequent in younger than in older age, particularly in men. The prevalence decreases from 5.3% (CI95: 4.2–6.7) in men aged 18–29 to 1.8% (CI95: 1.0–3.3) in men aged 70 and over. However, at the same time, the proportion of falls among all UIs rises with age: from 22.7% (CI95: 18.4–27.7) to 52.6% (CI95: 32.7–71.7) in men and from 20.1% (CI95:15.2–26.0) to 63.9% (CI95: 47.7–77.5) in women. The proportion of falls that occur at home also increases significantly with age: from 14% to over 50%. Still, among the elderly, about one third of falls occurs in public places (among pedestrians). The consequences of UIs caused by falls are often serious: 34.4% (CI95:29.8–39.4) of all falls cause bone fractures (all UIs: 20.4%; CI95: 18.3–22.6). One-quarter (26.8%; CI95: 22.4–31.7) result in hospitalisation (all UIs: 18.3%; CI95: 16.2–20.5). Moreover, the need for physical therapy and rehabilitation is higher after falling compared to all other UIs. Conclusions The data demonstrate the severity of UIs caused by falls and reveal important age and gender specific patterns. Older people are no more at risk than younger people, but the consequences for them are more serious than for the younger. Consequently, fall-related UIs are of importance in all ages and require age and gender specific approaches to prevention.

Das Unfallgeschehen bei Kindern und Jugendlichen in Deutschland@@@Unintentional injuries among children and adolescents in Germany: Datenquellen und Ergebnisse@@@Data sources and results

Compared to adults, children and adolescents run a considerably higher risk of suffering unintentional injuries (UI). To prevent UI, detailed knowledge of the overall accident occurrence and the determinants of UI is needed. This article gives an overview of the data sources covering the occurrence of UI among children and adolescents in Germany. According to the Robert Koch Institutes German Health Interview and Examination Survey for Children and Adolescents (KiGGS), approximately 15.3 % of children and adolescents (1-17 years) in Germany suffer at least one UI within 12 months. Most accidents (60.7 %) occur at home or during leisure-time activities. In 2011, the German Statutory Accident Insurance (DGUV) registered more than 1.4 million accidents among children in day-care facilities and students in educational institutions. According to official statistics, in the same year, more than 50,000 children and adolescents were injured in traffic accidents. Moreover, the Federal Statistical Office registered 260,534 hospital admissions due to injuries and poisonings among children and adolescents. All data sources revealed age- and sex-specific differences. Boys suffer UI more frequently than girls do and they show higher injury rates in adolescence than during childhood. While UI among children mostly happen at home, road traffic and leisure-time accidents increase in occurrence during adolescence. In Germany, there are numerous initiatives dedicated to the prevention of UI in children and adolescents. The creation of target group-specific prevention measures is complicated by the fact that the methodological approaches of existing data sources differ considerably.

Unintentional injuries among children and adolescents in Germany : data sources and results

Compared to adults, children and adolescents run a considerably higher risk of suffering unintentional injuries (UI). To prevent UI, detailed knowledge of the overall accident occurrence and the determinants of UI is needed. This article gives an overview of the data sources covering the occurrence of UI among children and adolescents in Germany. According to the Robert Koch Institutes German Health Interview and Examination Survey for Children and Adolescents (KiGGS), approximately 15.3 % of children and adolescents (1-17 years) in Germany suffer at least one UI within 12 months. Most accidents (60.7 %) occur at home or during leisure-time activities. In 2011, the German Statutory Accident Insurance (DGUV) registered more than 1.4 million accidents among children in day-care facilities and students in educational institutions. According to official statistics, in the same year, more than 50,000 children and adolescents were injured in traffic accidents. Moreover, the Federal Statistical Office registered 260,534 hospital admissions due to injuries and poisonings among children and adolescents. All data sources revealed age- and sex-specific differences. Boys suffer UI more frequently than girls do and they show higher injury rates in adolescence than during childhood. While UI among children mostly happen at home, road traffic and leisure-time accidents increase in occurrence during adolescence. In Germany, there are numerous initiatives dedicated to the prevention of UI in children and adolescents. The creation of target group-specific prevention measures is complicated by the fact that the methodological approaches of existing data sources differ considerably.