Estimated and measured BMI and self-perceived body image of adolescents in Germany: part 1 - general implications for correcting prevalence estimations of overweight and obesity

OBJECTIVE

This study examines the degree of divergence between BMI calculated from subjective assessments and BMI calculated from measured height and weight as a function of gender and body image.

METHODS

In the German National Health Interview and Examination Survey for Children and Adolescents (KiGGS) the height and weight of 17,641 children and adolescents aged 0-18 years were measured. Participants were also questioned about their subjective body image (whether they considered themselves much too thin, a bit too thin, exactly the right weight, too fat or much too fat). A representative subsample of adolescents between 11 and 17 years old (N = 3,436: 1,663 boys and 1,773 girls) was asked additionally to self-report their body weight and height before being measured.

RESULTS

The bias in the self-reported BMI yielded an underestimation of overweight and obesity prevalence. Girls who considered themselves much too fat or too fat and boys who considered themselves as much too fat underestimated their BMI. This was taken into account using a correction procedure for prevalence estimates of overweight and obesity based on the concept of conditional probabilities.

CONCLUSION

The proposed correction formula using data from the KiGGS study can be applied to other German studies of adolescents in which weight, height and body image are only determined by self-report. Furthermore the correction procedure in principle can be transferred to other studies in other countries as long as a parallel validation study has been conducted to assess both subjective and objective BMI and body image.

Changes of menopausal hormone therapy use pattern since 2000: results of the Berlin Spandau Longitudinal Health Study

BACKGROUND

There are virtually no prospective cohort studies in Germany regarding the changes of menopausal hormone therapy (HT) use pattern and factors associated with HT discontinuation after the release of the Women's Health Initiative (WHI) trial results.

METHODS

We assessed HT prevalence and use pattern as well as factors associated with HT discontinuation in a cohort of 903 women 40 years of age and older, who participated in two consecutive follow-up visits in a 20-year prospective health study from July 2000 to February and from August 2002 to December 2004.

RESULTS

Overall, the prevalence of HT users in the cohort declined significantly from 35.4% in 2000-2002 to 22.5% in 2002-2004. Adjusting for aging of the population, a statistically significant decrease in HT user prevalence was consistently observed across subgroups of HT users defined by type and duration of HT use. The decline was most pronounced with respect to women using combined estrogen-progestin regimens (-10.5%), higher-dose estrogens (-11.6%), oral preparations (-11.1%), as well as long-term HT users (-8.4%). The prevalence of women indicating HT use for climacteric symptoms decreased significantly (-12.4%), whereas the prevalence of women reporting use of HT for the prevention of osteoporosis increased (+1.8%) significantly. Irrespective of hysterectomy status, half of the women who continued HT changed their HT preparations and switched to lower estrogen doses (11.5%), topical estrogens (8.2%), or phytohormones (3.8%). We did not observe any significant differences between women who continued and discontinued HT regarding health-related characteristics of the study population as of 2000-2002. However, women seeing a gynecologist in the 12 months preceding the 2002-2004 visit were significantly less likely to discontinue HT use in bivariate and multivariate analyses.

CONCLUSIONS

Substantial declines in HT user prevalence as well as changes in HT use patterns to lower-dose estrogen preparations and non-oral routes of administration are likely to reflect effects of the publication of the WHI results. Consulting a gynecologist appeared to be relevant for a woman's decision to continue HT.

The role of the inflammatory markers ferritin, transferrin and fibrinogen in the relationship between major depression and cardiovascular disorders - The German Health Interview and Examination Survey

OBJECTIVE

To determine levels of inflammation (ferritin, transferrin and fibrinogen) in major depression (MDD) and comorbid cardiovascular disease (CVD) in an adult population.

METHOD

In 4181 participants of the German Health Interview and Examination Survey MDD was assessed through the Composite International Diagnostic Interview (CIDI). Coronary heart disease, stroke, and hypertension were diagnosed by a computer-assisted physician interview. Analyses were performed using anova models stratified for gender.

RESULTS

Ferritin, transferrin and fibrinogen levels showed opposing patterns in individuals with either CVD or MDD alone. In comorbidity analyses, male participants with MDD plus comorbid CHD or hypertension had lower levels of ferritin and lower fibrinogen levels in hypertension compared to men without MDD, while in women, results were inconsistent.

CONCLUSION

Opposing patterns of inflammatory markers in CVD or MDD alone were reversed when both conditions were present. MDD reduced levels of ferritin, transferrin and fibrinogen in CVD in a gender-specific way.

A community-based survey of abdominal pain prevalence, characteristics, and health care use among children

BACKGROUND & AIMS

Abdominal pain is a common clinical problem among children and adolescents and an important public health problem. The German Health Interview and Examination Survey for Children and Adolescents was performed to assess children's health and living conditions in a representative population sample. By using data collected from this survey, we evaluated the prevalence and characteristics of abdominal pain and assessed health care use.

METHODS

The community-based survey was carried out from May 2003 to May 2006 among children and adolescents living in Germany. Questionnaires were given to adolescents (age, 11-17 y; n = 7697) and parents of children (age, 3-10 y; n = 7544).

RESULTS

Abdominal pain causes the greatest impairment to children (32.9%). The 3-month prevalence rates decreased with age (39.8% in children, 41.8% [corrected] in adolescents; P < .001), girls reported abdominal pain significantly more often than boys (children: 71.5% vs 67.1%; P = .002; adolescents: 65.3% vs 53.2%; P < .001). Migrant adolescents were affected significantly more often by abdominal pain than locals (66.9% vs 58.0%; P < .001). More than half (51.6%) of the children and 38.5% of the adolescents visited a doctor because of abdominal pain; 22.6% and 39.2%, respectively, used medication for abdominal pain. Pain characteristics were influenced by age, sex, and socioeconomic status in a complex fashion.

CONCLUSIONS

High levels of prevalence and health care use reveal that abdominal pain is an important public health problem in children and adolescents. Abdominal pain in children is influenced by a variety of biopsychosocial factors.

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

BACKGROUND

Several instruments are available to assess children's 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.

METHODS

Within 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). Cronbach's alpha and confirmatory factor-analysis models (linear structural equation model) were obtained. Convergent and discriminant validity were assessed by calculating the Pearson's 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.

RESULTS

The parent reports achieved slightly higher Cronbach's 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.

CONCLUSION

Our study showed that parent proxy reports and child self reports on the child's 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, children's HRQoL should be measured via both sources of information.

Vaccination coverage against measles in German-born and foreign-born children and identification of unvaccinated subgroups in Germany

Data from the representative German Health Interview and Examination Survey for Children and Adolescents were used to identify unvaccinated subgroups that should be targeted by vaccination programmes in order to interrupt measles transmission. Measles vaccination coverage was low among children below the age of 3, having > or =3 siblings and in foreign-born migrants. Multivariate analyses show that vaccination coverage was strongly related to the place of birth in migrants: foreign-born children have a three-fold odds of being unvaccinated. Odds were also higher in children living in former West Germany, having > or =3 siblings, and it was especially high in children with parents reporting reservations against vaccinations.

[Health care needs of children and adolescents with chronic conditions]

Using data from the German Health Interview and Examination Survey for Children and Adolescents (KiGGS), we studied the association between chronic health conditions and specific health care needs among children and adolescents in Germany. A chronic health condition was defined based on standardized parent questionnaires and computer-assisted parent interviews regarding any lasting illness or health problem, congenital malformation or officially recognized disability. As part of the parent questionnaire, the validated German version of the Children with Special Health Care Needs (CSHCN) screener was used to assess special health care needs. Overall, 38.7% of the study population had at least one chronic health condition, as compared to 73.0% of children and adolescents who were identified as having specific health care needs. Only 25.8% of children and adolescents with chronic health conditions were found to have any special health care needs. However, this proportion varied considerably according to the type of health condition. Overall 3.7% of study participants screened positive for special health care needs, while no specific chronic health condition was reported by their parents. In multiple logistic regression analyses, factors independently associated with the absence of perceived health care needs among children and adolescents with chronic health conditions included female gender, migration background, a lower socioeconomic status, residence in former West Germany, a lower number of concomitant health problems, and the absence of behavioural problems. The identification of special health care needs among children and adolescents without any reported chronic health condition was determined by male gender, having no migration background, and evidence of behavioural problems. Further analyses are necessary to elucidate the relationship between chronic health conditions and health care needs among children and adolescents. These need to focus on specific health conditions and should include additional information on health-related quality of life, health care services use, and psychosocial resources.

Perceived or true obesity: which causes more suffering in adolescents? Findings of the German Health Interview and Examination Survey for Children and Adolescents (KiGGS)

INTRODUCTION

The consequences of perceived obesity on quality of life are compared with those of genuine obesity in adolescents.

METHODS

Within the framework of the German Health Interview and Examination Survey for Children and Adolescents (KiGGS), the height and weight of the participants were measured. Children over 11 years of age were asked whether they thought of themselves as underweight, normal, or overweight. As a measure of their health-related quality of life they completed the internationally employed KINDL-R generic questionnaire.

RESULTS

While 74.8% of 11- to 17-year-old girls and boys are of normal weight, only 40.4% believe that they are "just the right weight." Only 60.9% of obese girls and 32.2% of obese boys think of themselves as overweight. The data showed that genuinely obese adolescents, as classified by body mass index, have a better quality of life than those who only perceive themselves as being overweight.

DISCUSSION

A realistic body image on the part of obese adolescents is a prerequisite for their acceptance of interventions. The marked deterioration in quality of life resulting from perceived obesity, even for young people of normal weight, illustrates the complexity of the struggle against obesity.

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

Background

From 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/Design

Participants 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%.

Discussion

The 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.

[Prevalence and characteristics of children and youth with special health care needs (CSHCN) in the German Health Interview and Examination Survey for Children and Adolescents (KiGGS)]

In order to arrive at population-based estimates on the prevalence and characteristics of children and adolescents with specific health care needs (CSHCN), screening instruments focussing on the consequences of physical, mental and behavioral problems rather than on medical diagnoses have been developed. One of the most feasible and widely tested instruments, the CSHCN screener was added to the self-administered questionnaire for parents of children participating in the German Health Interview and Examination Survey for Children and Adolescents (KiGGS). The overall weighted prevalence of CSHCN was 16.0% among boys and 11.4% among girls. Children at kindergarten or school age were more than 2-3 times more likely to screen positive compared to toddlers. Up to 14 years, the sex difference persisted through all age groups and was most pronounced between the ages of 3 and 10 years. Children with a migrant background had significantly lower rates of CSHCN compared to non-migrants. This was particularly true for boys (8.0% vs. 17.1%). CSHCN status was not related to social status, urbanization or residence in former West vs. former East Germany. Except for the lack of association with social status, these results are in good accordance with observations from the US National Survey of CSHCN.

[Prevalence of somatic diseases in German children and adolescents. Results of the German Health Interview and Examination Survey for Children and Adolescents (KiGGS)]

In the German Health Interview and Examination Survey for Children and Adolescents (KiGGS), which was conducted from 2003 to 2006, data on acute/infectious and chronic diseases were collected from a population-based sample of 17,641 subjects aged 0 to 17 years. The annual prevalence rates among acute diseases vary widely. Children and adolescents are most frequently affected by acute (infectious) respiratory conditions. 88.5 % of the surveyed children and adolescents experienced at least one episode of common cold within the last 12 months. Among the other acute respiratory infections, bronchitis and tonsillitis were the most frequently encountered conditions with 19.9 % and 18.5 %, respectively. The 12-month prevalence of otitis media and pseudocroup was 11 % and 6.6 %, respectively. 1.5 % of the children and adolescents experienced an episode of pneumonia. Apart from respiratory infections, gastrointestinal infections were very frequently stated as reasons for acute illness. Furthermore, 12.8 % of the children and adolescents experienced a herpetic infection, 7.8 % a conjunctivitis and 4.8 % a urinary tract infection. Lifetime prevalence rates of infectious diseases were as follows: pertussis 8.7 %, measles 7.4 %, mumps 4.0 %, rubella 8.5 %, varicella 70.6 %, scarlet fever 23.5 %. The various chronic somatic diseases in children and adolescents had different lifetime prevalence rates. Most frequently, children and adolescents were affected by obstructive bronchitis (13.3 %), neurodermatitis/atopic eczema (13.2 %) and hay fever (10.7 %). Scoliosis and asthma had been diagnosed by a doctor in 5.2 % and 4.7 % of subjects aged 0-17 years, respectively. The lifetime prevalence rates of the remaining diseases varied between 0.14 % for diabetes mellitus and 3.6 % for convulsions/epileptic fits. For the first time ever, these survey results provide nationwide representative information on the prevalence rates of acute/infectious and chronic diseases in children and adolescents which is based on a population-representative sample.

[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)]

As 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)]

This 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 (Cronbach's 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).

[Iodine intake in Germany. Results of iodine monitoring in the German Health Interview and Examination Survey for Children and Adolescents (KiGGS)]

Iodine 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 microg/l, putting it at the lower end of the scale of 100-200 microg/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 population's 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.

Kinder und Jugendliche mit Migrationshintergrund in Deutschland

A migration-specific approach was used in the German Health Interview and Examination Survey for Children and Adolescents (KiGGS) and thus it was possible for the first time to include children with a migration background in a nationwide health survey in Germany in a number corresponding to their percentage of the population. This article presents the migration-specific approach used in KiGGS as well as a definition of the term "migrant" and its operationalisation. In addition, we analyse the representativity of the migrant subsample and present data on its composition. Altogether 2,590 children and adolescents with a migration background (both parents) took part in the study; in the weighted sample they account for 17.1% of all children and adolescents. Another 8.3% of the children and adolescents have one parent with a migration background. The two largest groups among the migrant children are Germans from Russia (29.9%) and children and adolescents of Turkish origin (28.2%). There are differences between migrants and non-migrants related to socio-economic status and place of living (rural/urban and East/West). Analyses of the representativity of the migrant sample show that children and adolescents with a lower level of education are under-represented, whereas there were no differences with regard to sex, the fathers' occupation or the mothers' smoking status. Non-respondents rate their children's health better than respondents. Since the successful integration of children and adolescents with a migration background into the KiGGS study brings with it a sufficiently large number of cases and since KiGGS covers a wide range of health-related topics, comprehensive migration-specific analyses can be performed. Thus, KiGGS will contribute to filling some of the current gaps in our knowledge of migrant children's health.

Perinatale Einflussfaktoren auf die spätere Gesundheit

KIGGS is a health survey on 17,641 children and adolescents in 167 communities representative for Germany, conducted between May 2003 and May 2006. Of the perinatal indicators, only a small proportion of data important for long-term outcomes was available for statistical analysis, and is presented here. In the past 20 years the mean weight gain during pregnancy has increased significantly by 2 kg, the mean birth weight has increased significantly by an average of 50 g, there has been no significant time trend for smoking and alcohol consumption in pregnancy. Birth weight and pregnancy weight gain of the mother correlate significantly. Pregnancy weight gain explains 5% of the birth weight in first-born infants. 17-18% of the mothers smoked during pregnancy, 4 times as many in the lower than the upper social class. 14% of the mothers consumed alcohol in pregnancy, but only 1% regularly. Only 5% of the migrants, but 3 times as many of the non-migrants consumed alcohol in pregnancy, and 2 1/2 times as many of the upper class compared to the lower class. With respect to smoking and alcohol consumption during pregnancy there seems to be an urgent need for political action.

Factors contributing to conductance and outcome of specific immunotherapy: data from the German National Health Interview and Examination Survey 1998

BACKGROUND

Allergies are an increasingly relevant public health problem. Specific immunotherapy (sIT) is presently the only causal treatment option. This study aimed to assess the frequency and determinants of sIT use and factors associated with treatment outcome.

METHODS

A cross-sectional analysis based on data from the German National Health Interview and Examination Survey 1998.

RESULTS

2727 (39.2%) of study participants reported physician-diagnosed allergic disease. Among these, 16.5% (n = 296) stated to have undergone sIT. In this subset 43.4% (n = 129) reported improvement of symptoms, 21.9% (n = 65) had not changed, and 34.6% (n = 102) had discontinued treatment. The majority of patients treated with sIT showed multiple allergic symptoms and sensitisations. Factors significantly correlated with sIT treatment in multivariable analyses included rhinitis, asthma, several sensitisations, higher social status and residence in larger cities. Rhinitis and neurodermatitis were positively, and food allergy was negatively associated with the completion of sIT. No factors predicting improvement due to sIT could retrospectively be identified.

CONCLUSION

Treatment with sIT under 'real life' conditions does not exactly follow current clinical guideline recommendations. In addition, patients may be selected for IT by socio-demographic factors. Whether this contributes to considerable discontinuation rates and limited effectiveness as observed here, needs further investigation.

Urban-rural disparities in smoking behaviour in Germany

Background

It is currently not clear whether individuals living in metropolitan areas differ from individuals living in rural and urban areas with respect to smoking behaviours. Therefore, we sought to explore the relation between residential area and smoking behaviours in Germany.

Methods

We used a nationwide German census representative for the general population of Germany. A number of 181,324 subjects aged 10 years or older were included. Information on the average daily usage of cigarettes that have or had been smoked formerly or currently was available in subjects who have ever smoked. A daily consumption of more than 20 cigarettes was considered heavy smoking. Logistic regression analyses were performed sex-stratified and adjusted for relevant confounders.

Results

Analyses revealed inhabitants of metropolitan areas to be more likely current smokers than inhabitants of rural areas (odds ratio 1.56, 95%-confidence interval 1.51; 1.62). Among current and former smokers those who lived in urban communities had also increased odds for being heavy smokers than those who lived in rural communities.

Conclusion

We conclude that living in an urban and particularly living in a metropolitan area is a determinant of both smoking and severity of current smoking. Tobacco control programs should recognize the difference in living conditions between rural and urban areas.

Messung der gesundheitsbezogenen Lebensqualität mit dem SF-8

The SF-8, a relatively new instrument for measuring health-related quality of life, was used in the German National Telephone Health Survey 2003. The SF-8 provides results which are comparable to those of the SF-36, the instrument most commonly used internationally. The German National Telephone Health Survey provides nationally representative data for the residential population in Germany aged 18 and older. In addition to the measurement of health-related quality of life, comprehensive information on chronic illnesses and complaints, health care needs, utilisation of health care, risk factors, risk behaviour and social status is also collected, making differentiated analyses possible. According to the data collected, men rate their quality of life in all dimensions higher than women. With increasing age, quality of life for both men and women decreases in the physical dimensions, while increasing in the mental health dimensions. Apart from chronic disease and pain having a negative impact on health-related quality of life, social differences are also observable, in that worse health-related quality of life is reported by respondents with lower socioeconomic status.

Chronische Rückenschmerzen in der Allgemeinbevölkerung in Deutschland 2002/2003: Prävalenz und besonders betroffene Bevölkerungsgruppen

Back pain is one of the most common complaints in the general population and chronic back pain is a major Public Health burden. However, the prevalence of chronic back pain in Germany is not known. The aim of our study was to determine the prevalence of chronic back pain in the general adult population in Germany and to identify highly affected population groups. A nation-wide computer-assisted telephone interview (CATI) survey was conducted with 8,318 men and women aged 18 years and older residing in German households. Participants were selected using the Gabler-Häder telephone sampling method and the next-birthday method. The one-year prevalence of chronic back pain defined as daily or almost daily back pain over a period of three months was 16 % in men and 22 % in women, the lifetime prevalence 24 % in men and 30 % in women. The 12-months prevalence of any back pain was 66 % in women and 58 % in men. Back pain on the day preceding the interview was reported by 18 % of men and 27 % of women and had a median intensity on a 1 - 10 point scale of 5 in women and 4 in men. Factors independently associated with chronic back pain in the past 12 months were age, female sex, a history of arthritis, self-reported depression, lower educational level, current unemployment, overweight or obesity, no sports, smoking and living with a partner. In conclusion, chronic back pain is a highly prevalent complaint in the general population in Germany. The association not only with bone and joint diseases but also with depression, a lower level of education and with certain lifestyle behaviours emphasises that back pain should not be viewed only in the context of the spine.

Methodische Betrachtungen zu den Summenscores des SF-36 anhand der erwachsenen bundesdeutschen Bev�lkerung

The SF-36 is a widely used instrument to measure health-related quality of life that provides a profile of eight scales [Physical Functioning (PF), Role-Physical (RP), Bodily Pain (BP), General Health (GH), Vitality (VT), Social Functioning (SF), Role-Emotional (RE) and Mental Health (MH)]. To reduce the dimension of the profile, a principal component analysis with the data of the US SF-36 Survey was undertaken. As a result, the Physical Component Summary (PCS) and the Mental Component Summary (MCS) were gained by weighting and summing up of the original scales of the SF-36. The weights were assumed to be country specific. Comparing the weights from the representative samples of nine European countries with those from the USA it has been suggested that the weights gained from the US sample could be applied to all datasets for purposes of comparability and simplicity. In this paper, for a new representative German population sample completed in 1998, the calculation results are compared with those for the older German population sample from 1994. PCS and MCS are calculated using the weights from the new German population sample as well as using the American weights. In this paper, the calculations for the 1998 representative population sample were repeated based on the US weights developed in 1994. The German weights were also calculated based on the 1998 sample. The results were compared and the pro and cons of using the American weights are discussed. In essence, the American weights continue to be acceptable for international comparisons. The separate evaluation of physical and mental health for men and women allows additional insight into gender-specific changes. In this paper, the summary scales for the 1998 German normative population are calculated gender specific. The weights to be used in future studies are also published. With respect to gender mainstreaming, this approach should be taken into consideration in quality of life research. Regarding the methodological and factorial difficulties, the questions arise if the summary scales should be applied instead of the original scales of the SF-36 questionnaire.

[Assessing health-related quality of life data of building trade workers by means of the SF-36 questionnaire]

The Lower Saxony statutory medical service of the building trade, the building trade association in Hanover and the statutory health insurance body of Lower Saxony have co-operated in the "ArGO" model project. The objective was to focus on the main areas of work-dependent health hazards and disorders. The SF-36 questionnaire was employed to ascertain how far the results obtained concerning health-related quality of life were suitable for this purpose. Hence, the data from industrial medical check-ups were compared with the additional findings for 4,334 building trade workers. Additional unfitness for work and medication data were available from the health insurance schemes for about one half of the group. The analyses revealed clear relationships between the subjectively experienced disorders on the one hand, and the stress and illness data on the other. In addition to age and the conventional stresses, e. g. strenuous physical work, the influence of psychosocial stress was also reflected in the assessment of the quality of life. The results obtained confirm the value of the SF-36 questionnaire for preventive medicine at an industrial level. It is suitable for identifying focal points of stress and can be employed for assessing preventative measures.

The SF-36 questionnaire and its usefulness in population studies: results of the German Health Interview and Examination Survey 1998

OBJECTIVES

To describe the distribution and the relationships of the SF-36 scales in a representative sample of the German population.

METHODS

The German National Health Interview and Examination Survey 1998 comprised 7,124 participants aged 18 to 79 years and included the Short Form 36 Questionnaire (SF-36). The 1998 findings are compared to those of the first normative German SF-36 sample from 1994.

RESULTS

Older people (> or = 65 years) in particular have increased the mean scale values for quality-of-life assessment during the four years. The average of all SF-36 scales increases with the social status of the individual in all age categories. The representative sample shows a more positive subjective assessment of their quality-of-life by East Germans in nearly all scales of SF-36, although they do not have a correspondingly better health status. The intensity of pain and the number of diseases during the preceding year are shown to decrease the life quality scales. Furthermore the General Health scale of SF-36 is correlated with the physicians' consultation.

CONCLUSION

The instrument to assess quality-of-life can generate useful information for a wide variety of variables. However, future health-related quality-of-life measurements in healthy population should be more sensitive and more differentiating than the SF-36 instruments.

[The "Spandau Public Health" test--description of study]

In 2002 the "Spandauer Gesundheitstest" ("Spandau Public Health" Test), a prospective cohort study of the Robert Koch-Institute in Berlin has been successfully going on for two decades. Ten waves of follow-up of this study are now available, in which approximately 7 000 adults were interviewed and examined. Approximately 770 participants have taken part in all ten follow-up waves. The "Spandauer Gesundheitstest" is carried out to provide information on changes in health state at the individual level over time. The main epidemiological aim of the study is to follow up the development and course of chronic disease together with changes in health care needs and utilisation. A questionnaire, blood and urine examinations and a medical interview are parts of the study design in every wave. Since the beginning of this study more than 900 participants died. A mortality follow-up is carried out regularly to investigate the cause of death of the participants. The data are available for analysis.

[Assessment of pain in The Child and Adolescent Health Survey]

Until now, there have been no nation-wide studies allowing a reliable estimation of the prevalence of pain in children and adolescents in Germany. In addition, data regarding the limitations and use of health care measures were also not available for children and adolescents, as well as data on influential factors that might provide valuable information on the occurrence and persistence of pain in the same epidemiological group. In the part of the survey entitled "Pain", the prevalence of pain generally as well as the features of persistent and/or recurring pain will be studied. An important result of this study shall be the first nation-wide representative figures on the prevalence of pain in general, as well as combinations of various types of pain in children and adolescents. In this way it should provide an up-to-date and representative data source to answer the following questions: How frequent is pain in children and adolescents? To what extent does pain in afflicted individuals lead to limitations? What kinds of health care measure does the individual who suffers such pain seek (medical consultation, medication)? According to the children (or their parents) or adolescents, what factors are involved in causing pain and allowing it to persist?

[Social class and health]

This publication deals with the German social class and their interactions with health or illness. The analysis uses the data of the German National Health Interview and Examination Survey 1998. The results are as follows: During the last decade the proportion of inhabitants of lower social class has decreased in favour of the proportions of middle and upper social classes. The formerly observed differences between the eastern part (former GDR) and the western part of Germany have diminished or have even levelled to zero. Even today men in Germany belong more often to the upper social class than women. For the risk factors smoking, massive obesity and inactivity in sports a distinct gradient concerning the social class can be observed. Those belonging to lower social class are more often smokers, have significantly more often massive obesity and show more seldom activities in sports. Hypertension and hypercholesterolemia are more often observed in men of the upper social class than in those belonging to lower class while for women both mentioned risk factors are more often seen in the lower social class. With respect to morbidity different patterns can be observed. NIDDM, chronic bronchitis and gastric and duodenal ulcer are examples for higher prevalence data in the lower social class while allergic rhinitis can be observed more often in the higher class. The level of complaints is higher in the lower class than in the upper class. By differentiating according to the eastern or western part clear differences emerge concerning social class especially in the 'old Bundesländer' (western part). Members of the upper class estimates their health status clearly to be better than those study participants belonging to the lower class. This perhaps can be explained by their lower level of complaints. The contentedness concerning live and health-status is higher in the upper than in the lower class. Respecting the highest level of education, class-specific differences concerning drug utilization are observed doubly frequent in the 'old Bundesländer' compared to the 'new Bundesländer'. According to the level of complaints and the prevalence of diseases most drug groups are used more often in the lower than in the upper class whereas drugs with presumed preventive potential are clearly more often consumed in the upper class.

[Satisfaction with living conditions and health]

In the present publication, contentment with different life areas like work, housing, financial situation, health, familial situation and with life in general is described. The analysis is based on data of the German National Health Interview and Examination Survey 1998, in which a representative sample of the German residential population between 18 and 79 years of age participated in a standardized interview with regard to health relevant topics as well as in a medical examination. In general, women are more content with their life than men. In all age classes, contentment with life is higher in the West than in the East. Highest contentment is observed with family (over 70%) and housing, and lowest with financial situation. The East German residents show the highest degree of dissatisfaction in the age-group of 20 to 29 years regarding their financial situation (20%). In comparison to 1991, contentment with life is reduced negligibly in the East, and in the West it approximately remained the same. Men and women in both parts of Germany are more content with their health today than ten years ago. In contrast, contentment with the financial situation as well as the work situation is lower than ten years ago.

[The SF-36 in the Federal Health Survey--description of a current normal sample]

The German National Health Interview and Examination Survey 1998 included the Short Form 36-Questionnaire as an instrument for measuring health-related quality of life. As a result of the subjective assessment by 6964 survey participants aged between 18 and 80 years a description of a new German normative population sample is given. Using the same statistical parameters as in the description of the normative German sample from 1994 a time comparison can be made.