Ute Ellert

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.

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.

[Health-related quality of life of children and adolescents in Germany. Norm data from the German Health Interview and Examination Survey (KiGGS)].

ZusammenfassungIn der vorliegenden Arbeit wird die gesundheitsbezogene Lebensqualität von Kindern und Jugendlichen in Deutschland unter Verwendung des international zur Anwendung kommenden Fragebogeninstrumentes KINDL-R zur Erfassung der gesundheitsbezogenen Lebensqualität von Kindern und Jugendlichen untersucht. Im Rahmen des Kinder- und Jugendgesundheitssurveys (KiGGS) beantworteten die Eltern von 14.836 Kindern und Jugendlichen im Alter von 3–17 Jahren sowie 6813 Kinder und Jugendliche (11 bis 17 Jahre) den KINDL-R. Die Reliabilität (Cronbachs alpha = 0,85) und Validität der Messung durch den KINDL-R wurde bestätigt. Die theoretisch zu erwartenden Unterschiede in der gesundheitsbezogenen Lebensqualität zwischen Kindern und Jugendlichen aus unterschiedlichen sozialen Lagen und Kindern und Jugendlichen mit unterschiedlichen Gesundheitszuständen konnten in den KINDL-R-Testwerten nachgewiesen werden (Effektgröße „d“ bis 1,52). Die Mittelwerte und Perzentile wurden für die Gesamtstichprobe sowie stratifiziert für Altersgruppen, Geschlecht, Region (Ost/West), Migrationstatus und sozioökonomischen Status berechnet. Die Ergebnisse dieser Studie können als repräsentative Normdaten für die Population der Kinder und Jugendlichen in Deutschland allgemein sowie stratifiziert für soziodemographische und sozioökonomische Subpopulationen zur Interpretation von Testwerten zur gesundheitsbezogenen Lebensqualität (KINDL-R) genutzt werden.AbstractThis study investigates the health-related quality of life of children and adolescents in Germany, using the internationally employed KINDL-R questionnaire for measuring the health-related quality of life of children and adolescents. In the National Health Interview and Examination Survey for Children and Adolescents (KiGGS) the parents of 14,836 children and adolescents aged 3–17 years completed the KINDL-R, as well as 6,813 children and adolescents (11–17 years old). The reliability (Cronbachs alpha = 0.85) and validity of the measurements using the KINDL-R were confirmed. The differences in health-related quality of life of children and adolescents from different social backgrounds and with different health statuses, which were to be expected on theoretical grounds, were demonstrated by the KINDL-R scores (size of effect “d” up to 1.52). The means and percentiles were calculated for the total sample as well as stratified by age group, sex, geographical region (East/West), migratory status and socio-economic status. The results of this study can be used as representative, normative data for the population of children and adolescents in Germany in general, as well as stratified for sociodemographic and socio-economic subpopulations, in order to interpret test scores on health-related quality of life (KINDL-R).

Epidemiologie des Schmerzes – Ergebnisse des Bundes- Gesundheitssurveys 1998

ZusammenfassungSchmerz hat als weit verbreitete Gesundheitsstörung nicht nur Konsequenzen für die Lebensqualität des einzelnen akut oder chronisch Schmerzkranken, sondern stellt darüber hinaus Anforderungen an das Gesundheitssystem. Die Daten des Bundes-Gesundheitssurveys ermöglichen erstmalig für die gesamte Bundesrepublik Deutschland repräsentative Aussagen zur Auftretenshäufigkeit von Schmerz, dessen Lokalisation und Intensität. Zudem ermöglicht die Datenlage eine Differenzierung nach Alter, Geschlecht und Schichtzugehörigkeit. Welch große Bedeutung der Schmerz für das Wohlbefinden des Menschen hat, wird mit Hilfe des SF-36 als Messinstrument für gesundheitlich bedingte Lebensqualität überzeugend belegt. Die Zusammenhänge zwischen bestimmten Krankheitsbildern und dem Auftreten von Schmerzen in unterschiedlicher Intensität, werden hier nur ansatzweise und exemplarisch für Migräne und Arthrose untersucht. Weitere komplexe Auswertungen der schmerzepidemiologischen Daten sind geplant.SummaryPain is a widely occurring disturbance of well-being and has serious consequences for the quality of life of patients suffering from acute or chronic pain. Thus, pain makes high demands on the health system. For the first time in the Federal Republic of Germany the National Health Interview and Examination Survey allows to make representative statements concerning the prevalence of pain, its intensity, frequency, duration and localisation. Furthermore, the results enable to differentiate according to age, gender, and social classes. The SF-36, used as an instrument to measure health related quality of life, has been employed to demonstrate the overwhelming significance of pain for the well-being of the population. In this publication the connection between certain disease syndromes like migraine and arthrosis and the prevalence of different qualities of pain is investigated. Additional more complex evaluation of the epidemiological data on pain are in preparation.

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)

Measuring adolescents' HRQoL via self reports and parent proxy reports: an evaluation of the psychometric properties of both versions of the KINDL-R instrument.

BackgroundSeveral instruments are available to assess childrens health-related quality of life (HRQoL) based on self reports as well as proxy reports from parents. Previous studies have found only low-to-moderate agreement between self and proxy reports, but few studies have explicitly compared the psychometric qualities of both. This study compares the reliability, factorial validity and convergent and known group validity of the self-report and parent-report versions of the HRQoL KINDL-R questionnaire for children and adolescents.MethodsWithin the nationally representative cross-sectional German Health Interview and Examination Survey for Children and Adolescents (KiGGS), 6,813 children and adolescents aged 11 to 17 years completed the KINDL-R generic HRQoL instrument while their parents answered the KINDL proxy version (both in paper-and-pencil versions). Cronbachs alpha and confirmatory factor-analysis models (linear structural equation model) were obtained. Convergent and discriminant validity were assessed by calculating the Pearsons correlation coefficient for the Strengths and Difficulties Questionnaire. Known-groups differences were examined (ANOVA) for obese children and children with a lower familial socio-economic status.ResultsThe parent reports achieved slightly higher Cronbachs alpha values for the total score (0.86 vs. 0.83) and most sub-scores. Confirmatory factor analysis revealed an acceptable fit of the six-dimensional measurement model of the KINDL for the parent (RMSEA = 0.07) and child reports (RMSEA = 0.06). Factorial invariance across the two versions did not hold with regards to the pattern of loadings, the item errors and the covariation between latent concepts. However the magnitude of the differences was rather small. The parent report version achieved slightly higher convergent validity (r = 0.44 – 0.63 vs. r = 0.33 – 0.59) in the Strengths and Difficulties Questionnaire. No clear differences were observed for known-groups validity.ConclusionOur study showed that parent proxy reports and child self reports on the childs HRQoL slightly differ with regards to how the perceptions, evaluations and possibly the affective resonance of each group are structured and internally consistent. Overall, the parent reports achieved slightly higher reliability and thus are favoured for the examination of small samples. No version was universally superior with regards to the validity of the measurements. Whenever possible, childrens HRQoL should be measured via both sources of information.

Jodversorgung in Deutschland

ZusammenfassungJod ist ein essenzielles Spurenelement, das in Deutschland in zu geringen Mengen im Boden vorkommt. Dem daraus resultierenden Jodmangel beim Menschen wird durch eine Jodprophylaxe begegnet, die im Wesentlichen aus der Jodierung von Speisesalz sowie der Jodierung von Futtermitteln in der Landwirtschaft besteht. Im Jodmonitoring des Kinder- und Jugendgesundheitssurvey (KiGGS) wurden die Schilddrüsenvolumina aller Kinder und Jugendlichen ab 6 Jahren sonografisch ermittelt. Um die Jodversorgung auf Bevölkerungsebene zu beurteilen, wurde zusätzlich die Jodausscheidung im Urin gemessen. Die Jodurie betrug im Median 117 μg/l und lag damit am unteren Ende der von der Weltgesundheitsorganisation (WHO) empfohlenen Spanne von 100–200 μg/l. Aus diesen Ergebnissen kann man schließen, dass die Jodprophylaxe erfolgreich war und sich die Jodversorgung im Vergleich zu früher verbessert hat. Gemäß den Empfehlungen der WHO herrscht zwar in Deutschland kein Jodmangel mehr, die Jodversorgung der Bevölkerung befindet sich dabei aber auf einem relativ niedrigen Niveau. Das Erreichte gilt es zumindest zu erhalten, sodass die Maßnahmen zur Verbesserung der Jodversorgung nicht nachlassen dürfen.AbstractIodine is an essential trace element which is found in too low quantities in the soil in Germany. The resulting iodine deficiency in human beings is countered by iodine prophylaxis, essentially consisting of iodised table salt and the iodisation of agricultural animal feed. In iodine monitoring during the German Health Interview and Examination Survey for Children and Adolescents (KiGGS), the thyroid volumes of all children and adolescents from six years of age were determined using sonography. To assess iodine intake among the population, iodine excretion in the urine was also measured. The median ioduria value was 117 μg/l, putting it at the lower end of the scale of 100–200 μg/l recommended by the World Health Organisation. It can be concluded from these results that the iodine prophylaxis has been successful and that iodine intake has improved compared with the past. In accordance with the WHO recommendations there is no iodine deficiency in Germany any more; however, at the same time the populations iodine intake is at a relatively low level. The aim is at least to keep up what has been achieved, meaning that measures to improve iodine intake must not be allowed to slacken.