Ingrid-Katharina Wolf

Pharmacoepidemiology of common colds and upper respiratory tract infections in children and adolescents in Germany

BackgroundMedicines to treat common colds (CC) and upper respiratory tract infections (URTI) are widely used among children, but there are only few data about treatments actually applied for these diseases. In the present study we analyze the prevalence and correlations of self-medicated and prescribed drug use for the treatment of CCs and URTIs among children and adolescents in Germany.MethodsMedicine use during the week preceding the interview was recorded among 17,450 children (0–17 years) who participated in the drug interview of the 2003–2006 German Health Interview and Examination Survey for Children and Adolescents (KiGGS). The definition of CCs and URTIs in the present study included the WHO-ICD-10 codes J00, J01.0, J01.9, J02.0, J02.9, J03.0, J03.9, J04.0, J06.8, J06.9, J11.1, J11.8, R05 and R07.0. Using the complex sample method, the prevalence and associated socio-demographic factors of self-medication, prescribed medicines and antibiotics were defined.Results13.8% of the participating girls and boys use drugs to treat a CC or an URTI. About 50% of this group use prescribed medications. Among the users of prescribed medication, 11.5% use antibiotics for the treatment of these diseases. Looking at all prescribed medicines we find associations with younger age, immigration background, and lower social status. Antibiotic use in particular is associated with female sex, higher age, residency in the former East Germany and immigration background.ConclusionsThe use of medicines to treat CCs or URTIs is widespread among children and adolescents in Germany. Thus, longitudinal studies should investigate the risks associated with this drug use. Differences in socio-demographic variables regarding exposure to antibiotic use indicate that there could be an implausible prescribing behavior among physicians in Germany.

Möglichkeiten und Grenzen retrospektiver Todesursachenrecherchen im Rahmen bundesweiter epidemiologischer Studien

ZusammenfassungDie ursachenspezifische Mortalität bildet in longitudinal angelegten epidemiologischen Studien einen wichtigen Endpunkt, um kausale gesundheitliche Zusammenhänge zu erforschen und individuelle Verlaufsanalysen durchzuführen. Da in Deutschland kein nationales Mortalitätsregister existiert, werden länderspezifische datenschutzrechtliche Rahmenbedingungen und Zugangswege für die Todesursachenrecherche im Rahmen eines Pilotprojekts recherchiert und erprobt. Die Datengrundlage liefert eine Stichprobe verstorbener StudienteilnehmerInnen des Bundes-Gesundheitssurveys 1998. Unter den gegebenen Bedingungen ist die Recherche von Todesursachen in bundesweiten epidemiologischen Studien grundsätzlich möglich, allerdings mit einem hohen zeitlichen und personellen Aufwand verbunden. In Rheinland-Pfalz muss zeitnah recherchiert werden, da die Aufbewahrungsfrist für Todesbescheinigungen bei den Gesundheitsämtern auf eine Mindestfrist von fünf Jahren begrenzt ist. In Berlin gestaltet sich die Forschungssituation besonders schwierig, da die Todesbescheinigungen zwar beim Amt für Statistik drei Jahre lang aufbewahrt werden, aber das Amt für Statistik keine pseudonymisierten Daten herausgeben darf. In Berlin können über die Ärzte und Krankenhäuser, die die Todesbescheinigungen ausgestellt haben, und über das GKR Berlin-Brandenburg (unter Einhaltung der besonderen datenschutzrechtlichen Bedingungen des Krebsregistergesetzes) für einen Teil der Verstorbenen die Todesursachen recherchiert werden. In Nordrhein-Westfalen wird grundsätzlich die zu Lebzeiten eingeholte schriftliche Einwilligung zur Recherche der Todesursache unter explizitem Einschluss einer ärztlichen Schweigepflichtentbindung vorausgesetzt. In allen anderen Bundesländern sind Ausnahmeregelungen möglich, die in jedem Fall der Zustimmung des Landesdatenschutzbeauftragten bedürfen. Die Ergebnisse des Pilotprojekts unterstreichen die Forderung nach einem nationalen Mortalitätsregister. Bis zu dessen Etablierung könnte die pilotierte Vorgehensweise genutzt und in Zusammenarbeit zwischen Bundes- und Landesbeauftragten für Datenschutz sowie den obersten Landesgesundheitsbehörden weiter optimiert werden, um Datenverluste zu vermeiden und Ressourcen effizient einzusetzen.AbstractCause-specific mortality is an important endpoint in longitudinal epidemiological studies to research causal health links and carry out individual process analyses. As in Germany no national mortality register exists, state-specific data-protection conditions for and approaches to cause of death studies were researched and tested within the framework of a pilot project. The database was provided by a sample of deceased study participants from the 1998 nationwide health survey. Under the given conditions, cause of death research in a nationwide epidemiological study is possible in principle, but requires a great deal of time and effort. In Rhineland-Palatinate research needs to be carried out in a timely manner as the health authorities’ retention period for death certificates is limited to minimum of 5 years. In Berlin the research situation is particularly difficult as, while the death certificates are held 3 years by the statistics bureau, this department cannot release any pseudonymous data. In Berlin it is possible to research the cause of death for some of the deceased through the doctors and hospitals that issued the death certificates and through the GKR Berlin-Brandenburg (in keeping with the special data protection measures of the cancer registry). In North Rhine Westphalia the written consent obtained during people’s lifetimes, including an explicit release from medical confidentiality, is required to carry out cause of death research. In all other German states exceptions are possible, in all cases requiring the consent of the state’s data protection commissioners. The results of the pilot project underline the need for a national mortality register. Until this is established the approach used in the pilot study can be used and, working together with the state and national data protection authorities and with the highest national health authorities, can be further optimized in order to avoid losing data and to use resources efficiently.

Psychotropic drug use and alcohol consumption among older adults in Germany: results of the German Health Interview and Examination Survey for Adults 2008–2011

Objectives The use and combined use of psychotropic drugs and alcohol among older adults is a growing public health concern and should be constantly monitored. Relevant studies are scarce in Germany. Using data of the most recent national health survey, we analyse prevalence and correlates of psychotropic drug and alcohol use among this population. Methods Study participants were people aged 60–79 years (N=2508) of the German Health Interview and Examination Survey for Adults 2008–2011. Medicines used during the last 7 days were documented. Psychotropic drugs were defined as medicines acting on the nervous system (ATC code N00) excluding anaesthetics (N01), analgesics/antipyretics (N02B), but including opiate codeines used as antitussives (R05D). Alcohol consumption in the preceding 12 months was measured by frequency (drinking any alcohol-containing beverages at least once a week/a day) and quantity (alcohol consumed in grams/day; cut-offs: 10/20 g/day for women/men defining moderate and risky drinking). SPSS complex sample module was used for analysis. Results 21.4% of study participants use psychotropic medications, 66.9% consume alcohol moderately and 17.0% riskily, 51.0% drink alcohol at least once a week and 18.4% daily, 2.8% use psychotropic drugs combined with daily alcohol drinking. Among psychotropic drug users, 62.7% consume alcohol moderately, 14.2% riskily. The most frequently used psychotropic medications are antidepressants (7.9%) and antidementia (4.2%). Factors associated with a higher rate of psychotropic drug use are female sex, worse health status, certified disability and polypharmacy. Risky alcohol consumption is positively associated with male sex, smoking, upper social class, better health status, having no disability and not living alone. Conclusions Despite the high risk of synergetic effects of psychotropic drugs and alcohol, a substantial part of older psychotropic drug users consume alcohol riskily and daily. Health professionals should talk about the additional health risks of alcohol consumption when prescribing psychotropic drugs to older adults.

Possibilites and limitations of retrospective research on cause of death within the framework of a nationwide epidemiological study

ZusammenfassungDie ursachenspezifische Mortalität bildet in longitudinal angelegten epidemiologischen Studien einen wichtigen Endpunkt, um kausale gesundheitliche Zusammenhänge zu erforschen und individuelle Verlaufsanalysen durchzuführen. Da in Deutschland kein nationales Mortalitätsregister existiert, werden länderspezifische datenschutzrechtliche Rahmenbedingungen und Zugangswege für die Todesursachenrecherche im Rahmen eines Pilotprojekts recherchiert und erprobt. Die Datengrundlage liefert eine Stichprobe verstorbener StudienteilnehmerInnen des Bundes-Gesundheitssurveys 1998. Unter den gegebenen Bedingungen ist die Recherche von Todesursachen in bundesweiten epidemiologischen Studien grundsätzlich möglich, allerdings mit einem hohen zeitlichen und personellen Aufwand verbunden. In Rheinland-Pfalz muss zeitnah recherchiert werden, da die Aufbewahrungsfrist für Todesbescheinigungen bei den Gesundheitsämtern auf eine Mindestfrist von fünf Jahren begrenzt ist. In Berlin gestaltet sich die Forschungssituation besonders schwierig, da die Todesbescheinigungen zwar beim Amt für Statistik drei Jahre lang aufbewahrt werden, aber das Amt für Statistik keine pseudonymisierten Daten herausgeben darf. In Berlin können über die Ärzte und Krankenhäuser, die die Todesbescheinigungen ausgestellt haben, und über das GKR Berlin-Brandenburg (unter Einhaltung der besonderen datenschutzrechtlichen Bedingungen des Krebsregistergesetzes) für einen Teil der Verstorbenen die Todesursachen recherchiert werden. In Nordrhein-Westfalen wird grundsätzlich die zu Lebzeiten eingeholte schriftliche Einwilligung zur Recherche der Todesursache unter explizitem Einschluss einer ärztlichen Schweigepflichtentbindung vorausgesetzt. In allen anderen Bundesländern sind Ausnahmeregelungen möglich, die in jedem Fall der Zustimmung des Landesdatenschutzbeauftragten bedürfen. Die Ergebnisse des Pilotprojekts unterstreichen die Forderung nach einem nationalen Mortalitätsregister. Bis zu dessen Etablierung könnte die pilotierte Vorgehensweise genutzt und in Zusammenarbeit zwischen Bundes- und Landesbeauftragten für Datenschutz sowie den obersten Landesgesundheitsbehörden weiter optimiert werden, um Datenverluste zu vermeiden und Ressourcen effizient einzusetzen.AbstractCause-specific mortality is an important endpoint in longitudinal epidemiological studies to research causal health links and carry out individual process analyses. As in Germany no national mortality register exists, state-specific data-protection conditions for and approaches to cause of death studies were researched and tested within the framework of a pilot project. The database was provided by a sample of deceased study participants from the 1998 nationwide health survey. Under the given conditions, cause of death research in a nationwide epidemiological study is possible in principle, but requires a great deal of time and effort. In Rhineland-Palatinate research needs to be carried out in a timely manner as the health authorities’ retention period for death certificates is limited to minimum of 5 years. In Berlin the research situation is particularly difficult as, while the death certificates are held 3 years by the statistics bureau, this department cannot release any pseudonymous data. In Berlin it is possible to research the cause of death for some of the deceased through the doctors and hospitals that issued the death certificates and through the GKR Berlin-Brandenburg (in keeping with the special data protection measures of the cancer registry). In North Rhine Westphalia the written consent obtained during people’s lifetimes, including an explicit release from medical confidentiality, is required to carry out cause of death research. In all other German states exceptions are possible, in all cases requiring the consent of the state’s data protection commissioners. The results of the pilot project underline the need for a national mortality register. Until this is established the approach used in the pilot study can be used and, working together with the state and national data protection authorities and with the highest national health authorities, can be further optimized in order to avoid losing data and to use resources efficiently.

Association of psychotropic drug use with falls among older adults in Germany. Results of the German Health Interview and Examination Survey for Adults 2008-2011 (DEGS1)

Purpose To investigate the association of psychotropic drug use with falls among older adults in Germany based on data from the National Health Interview and Examination Survey for Adults 2008–2011 (DEGS1). Methods DEGS1 collected data on drug use in the past 7 days and on falls occurred in the last 12 months. Study participants were older adults aged 65–79 years with complete data on drug use and falls (N = 1,833). Odds ratio (OR) and 95% confidence intervals (95% CI) were derived from logistic regression models adjusting for potential confounders including socio-demographic characteristics, health-related behaviors (alcohol drinking), body mass index and health conditions (frailty, vision impairment, disability, polypharmacy, blood pressure) as well as use of potential falls-risk-increasing drugs. SPSS complex sample methods were used for statistical analysis. Results Compared to people without falls, people with falls (n = 370) had a higher psychotropic drug use (33.1% vs. 20.7%, p < .001). After adjusting for potential confounders, use of psychotropic drugs overall was associated with a higher risk of falls (OR 1.64, 95% CI 1.14–2.37). This was particularly true for the use of synthetic psychotropic drugs (1.57, 1.08–2.28), antidepressants overall (2.88, 1.63–5.09) or synthetic antidepressants (2.66, 1.50–4.73), specifically, selective serotonin reuptake inhibitors (SSRIs) (6.22, 2.28–17.0). Similar results were found for recurrent falls. Conclusions Use of psychotropic drugs overall, especially synthetic antidepressants like SSRIs, is associated with higher risks of falls and recurrent falls among community dwelling older adults aged 65–79 years in Germany.

Diabetes Surveillance in Germany – Background, concept andprospects

Diabetes mellitus is a chronic disease that is associated with serious health problems and high costs. According to estimates gained from nationally representative health surveys conducted by the Robert Koch Institute (RKI), 4.6 million adults aged 18 to 79 suffer from diabetes in Germany. In addition, around 1.3 million adults have undetected diabetes. A surveillance system is currently being established at the RKI in order to gather the data sources available on diabetes in Germany and to provide reliable and comparable findings on time trends covering the frequency, progress of treatment, prevention and care of the disease. Next to identifying trends, diabetes surveillance also needs to detect differences in epidemiology that are related to social status or geographic region. Diabetes surveillance at the RKI is being undertaken in close cooperation with stakeholders involved in science, health-care provision, health policy and health-system self-governance. Furthermore, its progress is accompanied by an interdisciplinary scientific advisory board. Diabetes surveillance involves the following key elements: 1) the development of a research-based conceptual framework that uses indicators to appropriately measure developments in the disease; 2) the establishment of standards for the use of existing data sources and the identification of barriers to data usage and gaps in the data; and 3) the implementation of focused health reporting that is geared towards the target group. In addition to policy consultations, diabetes surveillance must guarantee the provision of timely and continuous information to the public together with the Federal Agency for Health Education. The implementation of a diabetes surveillance in Germany should act as a model and serve as a basis with which to establish the surveillance of other noncommunicable diseases. In principle, indicator-based diabetes monitoring at the population level can be viewed as providing the body for evidence-based policy consultation and focused health policy. In turn, this should enable the implementation of effective disease prevention measures and high-quality care for all groups within the population. DIABETES MELLITUS · HEALTH MONITORING · DIABETES SURVEILLANCE · HEALTH REPORTING · PREVENTION

Proceedings of the International Workshop ‘Development of a National Diabetes Surveillance System in Germany – Core Indicators and Conceptual Framework’

equal contribution Diabetes mellitus is a chronic metabolic disease approximately affecting 6 million adults in Germany and more than 300 million people worldwide [1]. On average, nearly 8% of adults in high-income countries and 10% in middle or low-income countries have diabetes [2]. Patients with diabetes have an increased risk for cardiovascular diseases, renal impairments, blindness, peripheral neuropathy and amputations of the lower leg and for excess mortality [3]. Unknown or insufficiently treated diabetes bears a particularly high risk for longterm complications. Diabetes is associated with a high burden of disease and costs for individuals as well as for the health care system and society as a whole. Treatment and care of diabetes led to costs of almost 48 billion euros in Germany in 2009 [4]. Against this background, the Robert Koch Institute RKI (the German National Public Health Institute) was commissioned by the Federal Ministry of Health to develop a National Diabetes Surveillance System for Germany. In order to integrate existing international expertise in the development process, the RKI organized an international workshop with experts from the U.S., Canada and Europe. The Workshop ‘Development of a National Diabetes Surveillance System in Germany – Core Indicators and Conceptual Framework’ was held in Berlin, Germany on July 11–12, 2016 and pursued the following goals: (a) to share experience on existing surveillance systems and diabetes registries (b) to refine the conceptual framework of the diabetes surveillance in Germany and for harmonization of core indictors and (c) to strengthen international collaboration. Experts were invited to present their specific experiences in planning and implementing diabetes registries or surveillance approaches (S1-S6). The conceptual framework and aims of the diabetes surveillance project in Germany were presented in the first workshop contribution by Christa Scheidt-Nave, Robert Koch-institute RKI, Berlin Germany (S1). The U.S. experience in the gradually implementation over the last 20 years of a National Diabetes Surveillance System (USDSS) was presented by Edward Gregg, epidemiologist at the CDC in Atlanta (S2). How Denmark’s health care system profits from the opportunity for

Möglichkeiten und Grenzen retrospektiver Todesursachenrecherchen im Rahmen bundesweiter epidemiologischer Studien@@@Possibilites and limitations of retrospective research on cause of death within the framework of a nationwide epidemiological study

ZusammenfassungDie ursachenspezifische Mortalität bildet in longitudinal angelegten epidemiologischen Studien einen wichtigen Endpunkt, um kausale gesundheitliche Zusammenhänge zu erforschen und individuelle Verlaufsanalysen durchzuführen. Da in Deutschland kein nationales Mortalitätsregister existiert, werden länderspezifische datenschutzrechtliche Rahmenbedingungen und Zugangswege für die Todesursachenrecherche im Rahmen eines Pilotprojekts recherchiert und erprobt. Die Datengrundlage liefert eine Stichprobe verstorbener StudienteilnehmerInnen des Bundes-Gesundheitssurveys 1998. Unter den gegebenen Bedingungen ist die Recherche von Todesursachen in bundesweiten epidemiologischen Studien grundsätzlich möglich, allerdings mit einem hohen zeitlichen und personellen Aufwand verbunden. In Rheinland-Pfalz muss zeitnah recherchiert werden, da die Aufbewahrungsfrist für Todesbescheinigungen bei den Gesundheitsämtern auf eine Mindestfrist von fünf Jahren begrenzt ist. In Berlin gestaltet sich die Forschungssituation besonders schwierig, da die Todesbescheinigungen zwar beim Amt für Statistik drei Jahre lang aufbewahrt werden, aber das Amt für Statistik keine pseudonymisierten Daten herausgeben darf. In Berlin können über die Ärzte und Krankenhäuser, die die Todesbescheinigungen ausgestellt haben, und über das GKR Berlin-Brandenburg (unter Einhaltung der besonderen datenschutzrechtlichen Bedingungen des Krebsregistergesetzes) für einen Teil der Verstorbenen die Todesursachen recherchiert werden. In Nordrhein-Westfalen wird grundsätzlich die zu Lebzeiten eingeholte schriftliche Einwilligung zur Recherche der Todesursache unter explizitem Einschluss einer ärztlichen Schweigepflichtentbindung vorausgesetzt. In allen anderen Bundesländern sind Ausnahmeregelungen möglich, die in jedem Fall der Zustimmung des Landesdatenschutzbeauftragten bedürfen. Die Ergebnisse des Pilotprojekts unterstreichen die Forderung nach einem nationalen Mortalitätsregister. Bis zu dessen Etablierung könnte die pilotierte Vorgehensweise genutzt und in Zusammenarbeit zwischen Bundes- und Landesbeauftragten für Datenschutz sowie den obersten Landesgesundheitsbehörden weiter optimiert werden, um Datenverluste zu vermeiden und Ressourcen effizient einzusetzen.AbstractCause-specific mortality is an important endpoint in longitudinal epidemiological studies to research causal health links and carry out individual process analyses. As in Germany no national mortality register exists, state-specific data-protection conditions for and approaches to cause of death studies were researched and tested within the framework of a pilot project. The database was provided by a sample of deceased study participants from the 1998 nationwide health survey. Under the given conditions, cause of death research in a nationwide epidemiological study is possible in principle, but requires a great deal of time and effort. In Rhineland-Palatinate research needs to be carried out in a timely manner as the health authorities’ retention period for death certificates is limited to minimum of 5 years. In Berlin the research situation is particularly difficult as, while the death certificates are held 3 years by the statistics bureau, this department cannot release any pseudonymous data. In Berlin it is possible to research the cause of death for some of the deceased through the doctors and hospitals that issued the death certificates and through the GKR Berlin-Brandenburg (in keeping with the special data protection measures of the cancer registry). In North Rhine Westphalia the written consent obtained during people’s lifetimes, including an explicit release from medical confidentiality, is required to carry out cause of death research. In all other German states exceptions are possible, in all cases requiring the consent of the state’s data protection commissioners. The results of the pilot project underline the need for a national mortality register. Until this is established the approach used in the pilot study can be used and, working together with the state and national data protection authorities and with the highest national health authorities, can be further optimized in order to avoid losing data and to use resources efficiently.