Hannelore Neuhauser

The challenge of comprehensively mapping children's health in a nation-wide health survey: Design of the German KiGGS-Study

BackgroundFrom May 2003 to May 2006, the Robert Koch Institute conducted the German Health Interview and Examination Survey for Children and Adolescents (KiGGS). Aim of this first nationwide interview and examination survey was to collect comprehensive data on the health status of children and adolescents aged 0 to 17 years.Methods/DesignParticipants were enrolled in two steps: first, 167 study locations (sample points) were chosen; second, subjects were randomly selected from the official registers of local residents. The survey involved questionnaires filled in by parents and parallel questionnaires for children aged 11 years and older, physical examinations and tests, and a computer assisted personal interview performed by study physicians. A wide range of blood and urine testing was carried out at central laboratories. A total of 17 641 children and adolescents were surveyed – 8985 boys and 8656 girls. The proportion of sample neutral drop-outs was 5.3%. The response rate was 66.6%.DiscussionThe response rate showed little variation between age groups and sexes, but marked variation between resident aliens and Germans, between inhabitants of cities with a population of 100 000 or more and sample points with fewer inhabitants, as well as between the old West German states and the former East German states. By analysing the short non-responder questionnaires it was proven that the collected data give comprehensive and nationally representative evidence on the health status of children and adolescents aged 0 to 17 years.

German health interview and examination survey for adults (DEGS) - design, objectives and implementation of the first data collection wave

BackgroundThe German Health Interview and Examination Survey for Adults (DEGS) is part of the recently established national health monitoring conducted by the Robert Koch Institute. DEGS combines a nationally representative periodic health survey and a longitudinal study based on follow-up of survey participants. Funding is provided by the German Ministry of Health and supplemented for specific research topics from other sources.Methods/designThe first DEGS wave of data collection (DEGS1) extended from November 2008 to December 2011. Overall, 8152 men and women participated. Of these, 3959 persons already participated in the German National Health Interview and Examination Survey 1998 (GNHIES98) at which time they were 18–79 years of age. Another 4193 persons 18–79 years of age were recruited for DEGS1 in 2008–2011 based on two-stage stratified random sampling from local population registries. Health data and context variables were collected using standardized computer assisted personal interviews, self-administered questionnaires, and standardized measurements and tests. In order to keep survey results representative for the population aged 18–79 years, results will be weighted by survey-specific weighting factors considering sampling and drop-out probabilities as well as deviations between the design-weighted net sample and German population statistics 2010.DiscussionDEGS aims to establish a nationally representative data base on health of adults in Germany. This health data platform will be used for continuous health reporting and health care research. The results will help to support health policy planning and evaluation. Repeated cross-sectional surveys will permit analyses of time trends in morbidity, functional capacity levels, disability, and health risks and resources. Follow-up of study participants will provide the opportunity to study trajectories of health and disability. A special focus lies on chronic diseases including asthma, allergies, cardiovascular conditions, diabetes mellitus, and musculoskeletal diseases. Other core topics include vaccine-preventable diseases and immunization status, nutritional deficiencies, health in older age, and the association between health-related behavior and mental health.

Epidemiology of vertigo

Purpose of reviewEpidemiological findings on the distribution, determinants and outcome of vertigo can be used for clinical decision making and can help understand the underlying causes of vestibular diseases. This article gives an overview of the epidemiology of the vestibular symptom vertigo and of four specific vestibular disorders: benign paroxysmal positional vertigo, migrainous vertigo, Menières disease and vestibular neuritis. Recent findingsBased on a neurotologic survey of the general population, 1-year prevalence estimates for vertigo were 4.9%, for migrainous vertigo 0.89% and for benign paroxysmal positional vertigo 1.6%. Diagnostic positional manoeuvres and treatments for benign paroxysmal positional vertigo, however, are still not being done by most doctors. The female preponderance among patients with benign paroxysmal positional vertigo and migrainous vertigo may be linked to migraine but is not fully understood. A recently reported prevalence of Menières disease of 0.51% is much higher than previous estimates. Follow-up studies have shown benign paroxysmal positional vertigo recurrence rates of 50% at 5 years and a persistence of dizziness related to anxiety in almost a third of patients 1 year after vestibular neuritis. SummaryThe epidemiology of vertigo and vestibular disorders is still an underdeveloped field. Recent studies have underscored the impact of vertigo at the population level, but its determinants and outcome are not well known yet.

Burden of Dizziness and Vertigo in the Community

BACKGROUND Dizziness and vertigo are common, however, the cause often remains unexplained. The percentage of vertigo of vestibular origin in individuals with unselected dizziness has not been well examined, and its underestimation may lead to diagnostic bias in primary care. The purpose of this study was to reassess the burden of dizziness in the community and to quantify the contribution of vertigo of vestibular origin. METHODS A nationally representative sample of 4869 adults living in Germany was screened for moderate or severe dizziness, and 1003 individuals with dizziness underwent validated neurotologic interviews to differentiate vestibular vertigo from nonvestibular dizziness according to explicit diagnostic criteria. RESULTS Dizziness/vertigo had a prevalence of 22.9% in the last 12 months and an incidence (first episode of dizziness/vertigo) of 3.1%. For vestibular vertigo, the prevalence was 4.9% [corrected] and the incidence was 1.4%. We also found that 1.8% of unselected adults consulted a physician in the last 12 months for [corrected] dizziness/vertigo (0.9% for vestibular vertigo). Compared with nonvestibular dizziness, vestibular vertigo was more frequently followed by medical consultation (70% vs 54%; P < .001), sick leave (41% vs 15%; P < .001), interruption of daily activities (40% vs 12%; P < .001), and avoidance of leaving the house (19% vs 10%; P = .001). However, more than half of the participants with vestibular vertigo reported nonvestibular diagnoses. Age- and sex-adjusted health-related quality of life was lower in individuals with dizziness and vertigo compared with dizziness-free control subjects. CONCLUSIONS The occurrence of dizziness and vertigo is frequent and associated with a considerable personal and health care burden. Vestibular vertigo accounts for a considerable percentage of this burden, which suggests that diagnosis and treatment of frequent vestibular conditions are important issues in primary care.

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

ZusammenfassungIm Rahmen des Kinder- und Jugendgesundheitssurveys (KiGGS) wurden repräsentative Daten zu Schmerzen bei 14.959 Kindern und Jugendlichen im Alter von 3–17 Jahren in Deutschland erhoben. Die Ergebnisse werden getrennt berichtet für 11- bis 17-Jährige, die selbst befragt wurden, und für die 3- bis 10-Jährigen, über deren Schmerzen die Eltern berichteten. Die 3-Monats-Prävalenz von Schmerzen betrug in der Gruppe der 3- bis 10-Jährigen 64,5% und in der Gruppe der 11- bis 17- Jährigen 77,6% (insgesamt für die 3- bis 17-jährigen Kinder 71,1%). Die Schmerzprävalenz nahm signifikant mit dem Alter zu, Mädchen berichteten in allen Altersgruppen signifikant häufiger über Schmerzen als gleichaltrige Jungen. Häufigste Schmerzlokalisationen war bei den 3- bis 10-Jährigen der Bauch gefolgt von Kopf und Hals. Kinder und Jugendliche im Alter von 11–17 Jahren berichteten am häufigsten über Kopfschmerzen, gefolgt von Bauch- und Rückenschmerzen. Schmerzen, die mindestens einmal in der Woche in den letzten 3 Monaten auftraten, wurden für 24,3% der 11- bis 17-jährigen Kinder und Jugendlichen und für 9,9% der 3- bis 10-Jährigen Kinder mit Schmerzen angegeben. Mehr als die Hälfte (54,1%) der 3- bis 10-Jährigen und mehr als ein Drittel der 11- bis 17-Jährigen (35,9%) mit Angaben zu wiederkehrenden Hauptschmerzen konsultierten deswegen einen Arzt, Medikamente nahmen jeweils 36,7% bzw. 46,7% der Schmerzbetroffenen. Die Ergebnisse belegen, dass Schmerzen bei Kindern und Jugendlichen ein ernst zu nehmendes Problem darstellen.AbstractAs 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.

Body mass index percentiles for children and adolescents in Germany based on a nationally representative sample (KiGGS 2003―2006)

Objective:To present body mass index (BMI) percentiles representative for children in Germany and to compare them with the currently used percentiles by Kromeyer–Hauschild (KH) and international percentiles of the World Health Organisation (WHO) and the International Obesity Task Force (IOTF).Methods:Representative examination survey of 17 641 children and adolescents aged 0–17 years living in Germany (KiGGS 2003–2006 study, response rate 67%) with standardized measurement of height and weight.Results:Generally, BMI in KiGGS was higher than in the reference populations from previous decades. KiGGS shows an asymmetric upward shift of the BMI distribution from about age 6 years and an earlier adiposity rebound compared with KH. The BMI peak in the first year of life is shown by KiGGS and WHO, but much less by KH. The cut-offs for overweight and obesity determined with the IOTF methodology in KiGGS (percentiles corresponding to BMI 25 and 30 kg/m2 at 18 years of age) were similar to IOTF cut-offs from age 18 to 10 years but systematically lower for younger children.Conclusions:The KiGGS BMI percentiles appear more valid for Germany than present alternatives and should be used for population monitoring. Despite their methodological limitations, the general shape of the older German KH references is confirmed by KiGGS for the ages 2–17 years. In order not to obscure the increase in obesity rates in the last decades, we therefore propose to continue using KH for individual diagnosis and estimation of the prevalence of overweight and obesity in this age range.

[Pain in children and adolescents in Germany: the prevalence and usage of medical services. Results of the German Health Interview and Examination Survey for Children and Adolescents (KiGGS)].

ZusammenfassungIm Rahmen des Kinder- und Jugendgesundheitssurveys (KiGGS) wurden repräsentative Daten zu Schmerzen bei 14.959 Kindern und Jugendlichen im Alter von 3–17 Jahren in Deutschland erhoben. Die Ergebnisse werden getrennt berichtet für 11- bis 17-Jährige, die selbst befragt wurden, und für die 3- bis 10-Jährigen, über deren Schmerzen die Eltern berichteten. Die 3-Monats-Prävalenz von Schmerzen betrug in der Gruppe der 3- bis 10-Jährigen 64,5% und in der Gruppe der 11- bis 17- Jährigen 77,6% (insgesamt für die 3- bis 17-jährigen Kinder 71,1%). Die Schmerzprävalenz nahm signifikant mit dem Alter zu, Mädchen berichteten in allen Altersgruppen signifikant häufiger über Schmerzen als gleichaltrige Jungen. Häufigste Schmerzlokalisationen war bei den 3- bis 10-Jährigen der Bauch gefolgt von Kopf und Hals. Kinder und Jugendliche im Alter von 11–17 Jahren berichteten am häufigsten über Kopfschmerzen, gefolgt von Bauch- und Rückenschmerzen. Schmerzen, die mindestens einmal in der Woche in den letzten 3 Monaten auftraten, wurden für 24,3% der 11- bis 17-jährigen Kinder und Jugendlichen und für 9,9% der 3- bis 10-Jährigen Kinder mit Schmerzen angegeben. Mehr als die Hälfte (54,1%) der 3- bis 10-Jährigen und mehr als ein Drittel der 11- bis 17-Jährigen (35,9%) mit Angaben zu wiederkehrenden Hauptschmerzen konsultierten deswegen einen Arzt, Medikamente nahmen jeweils 36,7% bzw. 46,7% der Schmerzbetroffenen. Die Ergebnisse belegen, dass Schmerzen bei Kindern und Jugendlichen ein ernst zu nehmendes Problem darstellen.AbstractAs 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.

Regional differences in the prevalence of known Type 2 diabetes mellitus in 45–74 years old individuals: Results from six population‐based studies in Germany (DIAB‐CORE Consortium)

Diabet. Med. 29, e88–e95 (2012)

Vertigo: epidemiologic aspects.

Vertigo is a frequent symptom in the general population with a 12-month prevalence of 5% and an incidence of 1.4% in adults. Its prevalence rises with age and is about two to three times higher in women than in men. The epidemiology of vertigo and underlying specific vestibular disorders is still an underdeveloped field despite its usefulness for clinical decision making and its potential for improving patient care. In this article, the authors give an overview on the epidemiology of vertigo as a symptom and of four specific vestibular disorders: benign paroxysmal positional vertigo (BPPV), vestibular migraine, Ménières disease, and vestibular neuritis.

Vestibular migraine Long-term follow-up of clinical symptoms and vestibulo-cochlear findings

Objective: The aim of the study was to assess the evolution of clinical symptoms and vestibulo-cochlear function in patients with definite vestibular migraine (dVM). Methods: We reassessed 61 patients (54 women, 7 men, aged 24–76 years) with dVM according to validated diagnostic criteria after a median follow-up time of 9 years (range, 5.5–11). Assessment comprised a clinical interview and neurotologic examination, including pure-tone audiometry and caloric testing. Results: The majority of patients (87%) had recurrent vertigo at follow-up. Frequency of vertigo was reduced in 56%, increased in 29%, and unchanged in 16%. Impact of vertigo was severe in 21%, moderate in 43%, and mild in 36%. Eighteen percent reported mild persistent unsteadiness. Interictal ocular motor abnormalities had increased from 16% initially to 41% of patients at follow-up. The most frequent finding was positional nystagmus (PN), in 28%, including definite central-type PN in 18%. However, only 1 of 9 patients with ocular motor abnormalities at initial presentation showed similar findings on follow-up. Concomitant cochlear symptoms with vertigo had increased from 15% initially to 49%. Eleven patients (18%) had developed mild bilateral sensorineural hearing loss, which also involved the low-frequency range. Conclusions: The majority of patients continue to have recurrent vertigo in the long-term evolution of VM, and the impact of vertigo may remain severe. Whereas interictal ocular motor abnormalities may show some variation over time, vestibulo-cochlear dysfunction progresses slowly in some patients with VM. Interictal central-type PN may help distinguish VM from peripheral vestibular disorders such as Ménière disease.