[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)]

[Social situation, health, and health behavior of children and adolescents in one-parent households at the end of the COVID-19 pandemic: Results of the KIDA study 2022-2023]

INTRODUCTION

During the COVID-19 pandemic, single parents and their children were particularly exposed to stress due to the containment measures and to limited resources. We analyzed differences in the social and health situation of children and adolescents in one-parent households and two-parent households at the end of the pandemic.

METHODS

The analysis is based on data from the KIDA study, in which parents of 3‑ to 15-year-old children as well as 16- to 17-year-old adolescents were surveyed in 2022/2023 (telephone: n = 6992; online: n = 2896). Prevalences stratified by family type were calculated for the indicators psychosocial stress, social support, health, and health behavior. Poisson regressions were adjusted for gender, age, level of education, and household income.

RESULTS

Children and adolescents from one-parent households are more likely to be burdened by financial restrictions, family conflicts, and poor living conditions and receive less school support than peers from two-parent households. They are more likely to have impairments in health as well as increased healthcare needs, and they use psychosocial services more frequently. Furthermore, they are less likely to be active in sports clubs, but they take part in sporting activities at schools as often as minors from two-parent households. The differences are also evident when controlling for income and education.

DISCUSSION

Children and adolescents from one-parent households can be reached well through exercise programs in a school setting. Low-threshold offers in daycare centers, schools, and the community should therefore be further expanded. Furthermore, interventions are needed to improve the socioeconomic situation of single parents and their children.

Teachers reported that children with special health care needs displayed more attention problems

AIM

Children with special health care needs (SHCN) perform more poorly at school compared to their classmates. Specific causal pathways have not yet been extensively studied. Therefore, we investigated teacher-rated global attention, an important prerequisite for educational attainment, in children with SHCN.

METHODS

Data of a population-based prospective cohort study, which recruited preschool children from the Mainz-Bingen area, Germany, were analysed. Children with SHCN were identified by the Children with Special Health Care Needs screening tool. In 2016, global attention was reported by teachers at the end of first grade (mean age: 7.3 years) on a 5-point rating scale ranging from -2 through +2. Associations between SHCN consequences and teacher-rated attention were estimated by linear mixed models, adjusted for confounding variables.

RESULTS

We included 1921 children (51% males); of these, 14% had SHCN. Compared to their classmates, children with SHCN had poorer teacher-rated attention scores (adjusted mean difference: -0.35, 95% CI: -0.52 to -0.17). The effect was strongest among children with treatment or counselling for mental health problems or functional limitations. The effect remained after excluding children with attention deficit hyperactivity disorder from the analysis.

CONCLUSION

Children with SHCN showed more teacher-rated attention problems, which could explain their lower educational attainment.

School absenteeism in children with special health care needs. Results from the prospective cohort study ikidS

OBJECTIVE

Children with special health care needs (SHCN) due to a chronic health condition perform more poorly at school compared to their classmates. There is still little knowledge on the causal pathways and which factors could be targeted by interventions. We, therefore, investigated school absenteeism in children with SHCN compared to their peers.

METHODS

This study was based on data from the German population-based prospective cohort study ikidS (German for: I will start school). Children with SHCN were identified by the Children with Special Health Care Needs screener that captures five consequences of physical or mental chronic health conditions: (1) use or need of prescription medication, (2) above average use or need of medical, mental health, or educational services, (3) functional limitations compared with others of the same age, (4) use or need of specialized therapies, and (5) treatment or counseling for emotional, behavioral, or developmental problems. School absenteeism was defined as days absent from school due to illness during first grade and was reported by classroom teachers. Associations between SHCN consequences and school absenteeism were investigated by negative binomial regression models. Effect estimates were adjusted for confounding variables identified by a causal framework and directed acyclic graphs.

RESULTS

1,921 children (mean age at follow-up 7.3 years, standard deviation 0.3; 49% females) were included; of these, 14% had SHCN. Compared to their classmates, children with SHCN had more days absent (adjusted rate ratio: 1.37; 95% confidence interval 1.16, 1.62). The effect was strongest among children with i) functional limitations, ii) treatment or counseling for emotional, behavioral, or developmental problems, and iii) those who experienced two or more SHCN consequences.

CONCLUSIONS

Children with SHCN have higher school absenteeism, which could-at least partly-explain their poorer school performance and lower educational attainment. SHCN-specific targeted interventions may reduce the adverse effects of SHCN on educational outcomes in children.

Lost in Transition – Eine explorative qualitative Studie zur Transition von Jugendlichen aus der pädiatrischen Physiotherapie in die Erwachsenenphysiotherapie

Hintergrund In der Kinderphysiotherapie werden Kinder mit komplexer Beeinträchtigung oder chronischer Erkrankung und ihre Familien über Jahre begleitet. Während der Transition eines Jugendlichen in das Erwachsenenleben stellt sich oft die Frage: Wie kann sichergestellt werden, dass die Transition eines Jugendlichen von der pädiatrischen Physiotherapie in die Erwachsenenphysiotherapie als fließender Prozess ablaufen kann?

Ziel Evaluation von fördernden und hemmenden Faktoren für eine fließende Transition in der Physiotherapie sowie das Erstellen eines Leitfadens, um den Transitionsprozess fließender zu gestalten.

Methode In der qualitativen Studie wurden Beteiligte (Jugendliche, Eltern, Physiotherapeut*innen) mit leitfadengestützten Interviews befragt. Die Interviews wurden mittels der inhaltlich strukturierenden Inhaltsanalyse analysiert. Fördernde und hemmende Faktoren wurden abgeleitet.

Ergebnisse Es wurden 3 Hauptkategorien mit je 2 Subkategorien herausgearbeitet: 1. Eine vertrauensvolle und langjährige Beziehung zwischen allen Beteiligten spielt eine zentrale Rolle, 2. Um die Besonderheiten von Jugendlichen aufzuzeigen, sind medizinische und persönliche Informationen unerlässlich, 3. Das fachliche Wissen der Physiotherapeut*innen kann auf Erfahrung beruhen, aber genauso wichtig sind die Freude und das Interesse, sich weiterzubilden. Allen Beteiligten ist klar, dass eine optimale Übergabe eine zeitaufwändige und intensive Arbeit ist. Die Beziehung zwischen den verschiedenen Personen ist dabei das Kernelement.

Schlussfolgerung Für den Übergang von einer kindzentrierten zu einer erwachsenenorientierten Physiotherapie ist es wichtig, alle Beteiligten für das Thema zu sensibilisieren und alle wichtigen Teilschritte, die dieser Prozess beinhaltet, zu berücksichtigen. Ein Leitfaden zur Transition sollte den Prozess erleichtern.

[Chronically ill at School - School Performance in Children with Special Health Care Needs. Results of the Child Health Study ikidS]

BACKGROUND

The association between health status in childhood and later educational achievement is unknown. We describe the association between a chronic health condition (CHC) and school performance at the end of first grade.

PATIENTS

As part of the child health survey ikidS, 2,003 preschoolers from the Mainz-Bingen area (Rhineland-Palatinate; Germany) were recruited.

METHOD

In a prospective cohort study, children with CHC were identified by the children with special health care needs screener. At the end of first grade, classroom teachers evaluated the child's school performance on a rating scale ranging from - 2 through+2 in 5 domains: numeracy, science, reading, writing, and social competencies. Associations between special health care needs (SHCN) and each domain were assessed by linear mixed regression models adjusted for potential confounders.

RESULTS

1,463 children (51% males) were analyzed. Of these, 15% had SHCN. Compared to their classmates, children with SHCN performed poorer in numeracy (adjusted mean difference: - 0.40; 95% CI[- 0.57; - 0.23]) and writing (- 0.22; 95% CI[- 0.39; - 0.05]).

DISCUSSION

For the first time in a German sample, we found an indication which educational competencies might be negatively impacted by SHCN early in school. This could have long-lasting effects on educational attainment and later socio-economic status.

CONCLUSION

Our results question the uptake and/or effectiveness of existing medical care as well as educational support concepts for children with a CHC.

Health care transition from pediatric to adult care: an evidence-based guideline

For consistent quality of treatment of young people with chronic health care needs, a structured health care transition (HCT) from pediatric medicine to adult medical care is essential. Currently, most countries have no guidelines on HCT based on systematic evidence research. To close this gap, guidance to support HCT was developed in Germany. Twenty-two experts in the management of adolescents and young adults with different chronic conditions and three patient representatives were invited to take part in the guideline group. Based on a systematic literature search recommendations for HCT were drafted. Where evidence was lacking, recommendations were developed using collective expert consensus. The consensus process was independently moderated using a Delphi approach. The final draft was reviewed and endorsed by all major German medical societies. The clinical recommendations provide guidance for all chronic somatic diseases. After assessment of HCT readiness, an individualized plan for HCT should be drawn up. Key elements here are a responsible coordinator, age-adapted patient education, involvement of caregivers, web-based interventions, joint visits, and a structured summary for the receiving physician. The aim is the gradual transfer of responsibility for disease management to the young person themselves.    Conclusion: As only a few randomized controlled studies on HCT are available, evidence-based statements are possible for some but not all areas of HCT. However, this guideline may help to develop globally accepted standards. These standards should be established and implemented. The aim should be a reimbursement by individual national health systems to allow appropriate support for young people. What is Known: • Health care transition from pediatric to adult care is primarily organized in local settings, partly based on disease-specific guidelines. •There have been no national guidelines in Germany until now. What is New: • Here we present the general evidence-based guidelines of the German Association of Scientific Medical Societies for health care transition. • These might serve as a blueprint for further national or international health care transition guidelines.

Mental health and health-related quality of life in preschool-aged childhood cancer survivors. Results of the prospective cohort study ikidS-OEVA

OBJECTIVES

Long-term survivors of childhood cancer are at increased risk for sequelae such as poor mental health (MH) or impaired health-related quality of life (HrQoL). We aimed to evaluate early adverse effects on MH and HrQoL in young childhood cancer survivors (YCCS) before school entry.

METHODS

In a nationwide prospective cohort study, children with cancer other than brain tumors diagnosed at preschool age and completed cancer treatments were identified from the German Childhood Cancer Registry. The comparison group was children of the same age without a cancer diagnosis who participated in the prospective population-based health survey ikidS. MH problems and HrQoL were assessed by parental versions of the Strengths and Difficulties Questionnaire (SDQ) and the questionnaire for health-related quality of life in children (KINDL), respectively. Associations between cancer and MH as well as HrQoL were analyzed by multivariable linear regression.

RESULTS

Of 382 YCCS contacted, 145 were enrolled (mean age 6.6 years) and 124 analyzed. Compared to children without a cancer diagnosis (3683 contacted, 2003 enrolled, 1422 analyzed), YCCS had more MH problems (13% vs. 3%) and slightly worse HrQoL (median 78.7 vs. 80.2 points). In the adjusted analysis, YCCS had higher SDQ scores (2.2 points, 95% confidence interval [CI] 1.3, 3.0) and lower KINDL scores (-2.4 points, 95% CI -3.7, -1.1) compared to children without cancer diagnosis.

CONCLUSION

Already at preschool age, YCCS may be at increased risk of MH problems and impaired HrQoL. This could have impacts on subsequent school performance and educational attainment. Follow-up health care for YCCS may include early screening for MH problems and reasons for HrQoL deficits.

[Effect of a One-Week Health Program on the Mental Health of Caregiving Parents: A Controlled Panel Study]

OBJECTIVES

Parents of children in need of care and home care are a vulnerable group. The aim of this study was to determine the effect of a legally funded, one-week health program of the Social Insurance for Agriculture, Forestry and Horticulture (SVLFG) on the well-being of the participating caregiving. Methods In a controlled panel study (intervention group IG n=23, comparison group n=33, allocation not randomized), the WHO-5 index was collected at several time points of measurement. Evaluation was performed by fixed effects panel regression under control of time-varying characteristics (external conditions, period effects).

RESULTS

At the start of the intervention, 70% of the IG were at the threshold of clinically relevant depressiveness. After a very clear initial effect, the level remained above the baseline level for up to 15 weeks (under stable conditions). However, a sinking below the initial level was prevented until at least 26 weeks even with significantly increasing stress.

CONCLUSION

Considering the high initial burden, the effect of the prevention-oriented intervention is persistent over a considerable period of time. The intervention is unique for the social insurance system. The design allows a causal interpretation despite the small number of cases.

[Chronic somatic disorders-The way to adulthood medicine structures]

Transition is the structured crossing over of an adolescent patient from treatment by a pediatrician to that by an adult doctor. The transition falls in a difficult phase of life that includes the end of puberty, finding a job, obtaining training, gaining increasing autonomy, and "cutting off" from parents and the parents' home. In this article, problems with transition are explained with a focus on patients with chronic inflammatory bowel diseases. Structured transition programs are presented.There are different groups of patients who transfer to the adult care system: adolescents with diseases that are well known (1) or unknown (2) in adult medicine and adolescents with disabilities who are treated in social pediatric centers (SPZ) (3). For the final group there are currently no adequate treatment structures in the adult care. Medical centers for adults with intellectual and multiple disabilities (MZEB) are currently being established. In all groups transition is understood as a dynamic process in which the patient, the parents, as well as the pediatric, adolescent and adult caregivers/physicians are involved. This generally runs over a long period of time and does not rely solely on a passive handover or transfer. Cancellation of therapy with subsequent problems is very common in this phase and sometimes very harmful for the affected patient. Structured cross-sector and cross-indication transition programs with case management elements, such as the Berlin Transition Program (BTP), offer support of patients in this phase of life and can prevent the consequences of inadequate adherence to therapy. The German Society for Pediatric and Adolescent Medicine (DGKJ), the German Society for Internal Medicine (DGIM), and the German Society for Neurology (DGN) have established a transition working group that supports the BTP.

[Coping with life for children with chronic illness: necessary services in the healthcare system]

BACKGROUND

Children and adolescents with chronic diseases are a very heterogeneous group of patients with age-specific characteristics and a broad spectrum of underlying diseases. These patients require not only good medical care but also comprehensive support in order to achieve the greatest possible participation in social life.

OBJECTIVE

In this review, the problems faced by children and adolescents with chronic diseases, as well as by their families, and the requirements for the best possible life management, are presented. The framework conditions of the healthcare system and the necessary supplementary social benefits are presented and necessary steps for further development are discussed.

CONCLUSION

There are numerous services for children and adolescents with chronic diseases, as well as for their families. However due to the often-confusing access paths and a lack of coordination, these services are not seized to the extent necessary. Current efforts to improve coordination of social legislation and developing one-stop services represent a further step towards improving care.

Prenatal Alcohol Exposure and the Associated Risk of Elevated Blood Pressure: A Cross-sectional Analysis of 3- to 17-Year-Olds in Germany

BACKGROUND

As the prevalence of obesity and high blood pressure increases among the population, early action is needed to reduce blood pressure. Certain lifestyles during pregnancy have negative effects resulting in high blood pressure for children and adolescents. Using data from the "German Health Interview and Examination Survey for Children and Adolescents" (KiGGS), this study analyzed: (i) the association between low-to-moderate prenatal alcohol exposure (PAE) and the risk of increased systolic and diastolic blood pressure and (ii) whether associations were modified by socioeconomic status (SES), prenatal smoke exposure (PSE), and body mass index (BMI) of the children and adolescents.

METHODS

We applied multivariate logistic regression analyses and stratified analyses by SES, PSE, and BMI with cross-sectional data from the KiGGS study (N = 14,253) to examine the association between PAE and prehypertension or hypertension in 3- to 17-year-olds.

RESULTS

Of the surveyed children and adolescents, 13.7% had a systolic prehypertension and 11.5% had a diastolic prehypertension. A further 7.5% were identified as having systolic hypertension and 6.0% diastolic hypertension. In the regression analyses, PAE resulted in a decreased risk of systolic prehypertension (odds ratio [OR]: 0.83, 95% confidence interval [CI]: 0.70, 0.99) and diastolic prehypertension (OR: 0.82, 95% CI: 0.68, 0.98). Risk reductions were not significant in surveyed children and adolescents with hypertension. Interactions between PAE and SES, PSE, and offspring BMI were not significant.

CONCLUSIONS

Contrary to our initial hypothesis, PAE reduces the risk of prehypertension. Animal studies suggest that vasodilation is induced by nitric oxide in small quantities of PAE.

[Effects of poverty for health and health behavior of children and adolescents : Results from KiGGS Wave 2]

INTRODUCTION

Differences in the health status and health behavior of children and adolescents are analyzed, taking the income situation of the family into account.

METHOD

The data is based on the second wave of the German Health Interview and Examination Survey for Children and Adolescents (KiGGS Wave 2, 2014-2017). Health outcomes are the subjective health, chronic health limitations, mental disorders, ADHD, consumption of fresh fruit, consumption of sugary soft drinks, physical activity, sports activity during leisure time, overweight, and obesity. The income situation is recorded using the equivalized household income.

RESULTS

Poor children and adolescents are more likely to have health problems than their peers from the middle- and, especially, the high-income group; their health behavior is less favorable. The biggest relative income-related differences are found in subjective health. With statistical control for parental education and occupational status, income-related differences in health status remain consistent while being significantly reduced for health behavior.

DISCUSSION

The results confirm that low family income has a significant impact on the health of children and adolescents. Partly, this also applies to their health behavior, whereby the observed differences between the income groups can be attributed mainly to parental education and occupational status. This shows once again that children and adolescents growing up in poverty should be a key target group for prevention and health promotion.

Chronic health conditions and school performance in first graders: A prospective cohort study

Objective

Children with chronic health conditions may perform poorer at school. Associations may be confounded by numerous social factors. We aimed to estimate the effects of a chronic health condition on overall school performance in first graders with an emphasis on rigorous adjustment for potential confounders.

Methods

A population-based cohort study was performed in the area of Mainz-Bingen (Germany). In 2015 all preschoolers were approached and the presence of a chronic health condition was assessed by parental questionnaires and preschool health examination data. The identification of a chronic health condition was based on special health care needs and presence of a doctor’s diagnosis out of 24 school-relevant diseases. At the end of the first school year, overall school performance was assessed by teachers and rated on a 5-item scale ranging from -10 to +10.

Results

Of 3683 children approached, 2003 were enrolled. Overall school performance was available for 1462 children (51% boys). Of these, 52% suffered from a chronic health condition. Compared to children without a chronic health condition, children with special health care needs (15%) performed worse at school (adjusted mean difference: -0.95, 95% CI: [-1.55; -0.35], P = 0.002). Children with a doctor’s diagnosis but without special health care needs (37%) did not perform worse at school. The effect was further analysed considering the extent of special health care needed.

Conclusions

Chronic health conditions affect overall school performance early in primary school. To identify academically at-risk children, a chronic health condition identification based on special health care needs may be used.

[Chronic and vaccine-preventable diseases in children and adolescents in Germany: results of the KiGGS study: first follow up (KiGGS wave 1)]

The German Health Interview and Examination Survey for Children and Adolescents (KiGGS) 2003-2006 is the first nationwide comprehensive study on the health of children and adolescents living in Germany. The KiGGS first interview follow-up is a telephone interview study that collected, among other things, data on a number of chronic and vaccine-preventable diseases in 2009-2012 and is a combined cross-sectional and longitudinal study based on a population registry sample from the 167 KiGGS study points. The analysis is based on 12,368 respondents (7913 KiGGS follow-up participants aged 7-17 years, response 72 % and 4455 newly recruited 0- to 6-year-olds, response 42 %). Based on parent reports the lifetime prevalence of both chickenpox and pertussis has decreased in the population targeted by recently changed vaccination recommendations. For measles the prevalence remained unsatisfactorily high in each investigated age group. Of the children and adolescents aged 0-17 years 16 % (95 % confidence interval CI 15.2-17.0 %) had a long-standing chronic health condition according to the parents. Of these, however, only one in five was affected in their routine daily activities. The lifetime prevalence in 7- to 17-year-olds was 1.2 % (0.9-1.6) for epilepsy (0.4 % for the past 12 months), 5.0 % (4.4-5.7) for migraine, 0.2 % (0.1-0.3) for diabetes and in 0 to 6-year-olds 2.0 % (1.5-2.6) for heart conditions and 3.1 % (2.5-3.8) for febrile seizures with a -prevalence in 0 to 2-year-olds which are most affected of 1.0 % (0.6-1.6) in the past 12 months. The vast majority of children and adolescents in Germany are in good or very good health as suggested by other results reported in this issue; however, chronic conditions are not rare and need continuous monitoring. These results confirm that implementation of the vaccination recommendations of the German Standing Committee on Vaccination (STIKO) can lead to effective prevention of infectious diseases in Germany.

Taking stock of the CSHCN screener: a review of common questions and current reflections

Since 2000, the Children with Special Health Care Needs (CSHCN) Screener (CS) has been widely used nationally, by states, and locally as a standardized and brief survey-based method to identify populations of children who experience chronic physical, mental, behavioral, or other conditions and who also require types and amounts of health and related services beyond those routinely used by children. Common questions about the CS include those related to its development and uses; its conceptual framework and potential for under- or overidentification; its ability to stratify CSHCN by complexity of service needs and daily life impacts; and its potential application in clinical settings and comparisons with other identification approaches. This review recaps the development, design, and findings from the use of the CS and synthesizes findings from studies conducted over the past 13 years as well as updated findings on the CS to briefly address the 12 most common questions asked about this tool through technical assistance provided regarding the CS since 2001. Across a range of analyses, the CS consistently identifies a subset of children with chronic conditions who need or use more than a routine type or amount of medical- and health-related services and who share common needs for health care, including care coordination, access to specialized and community-based services, and enhanced family engagement. Scoring algorithms exist to stratify CSHCN by complexity of needs and higher costs of care. Combining CS data with clinical diagnostic code algorithms may enhance capacity to further identify meaningful subgroups. Clinical application is most suited for identifying and characterizing populations of patients and assessing quality and system improvement impacts for children with a broad range of chronic conditions. Other clinical applications require further implementation research. Use of the CS in clinical settings is limited because integration of standardized patient-reported health information is not yet common practice in most settings or in electronic health records. The CS continues to demonstrate validity as a non-condition-specific, population-based tool that addresses many of the limits of condition or diagnosis checklists, including the relatively low prevalence of many individual conditions and substantial within-diagnosis variations and across-diagnoses similarities in health service needs, functioning, and quality of care.

Determinants of agreement between self-reported and parent-assessed quality of life for children in Germany-results of the German Health Interview and Examination Survey for Children and Adolescents (KiGGS)

Background

The aim of this study is to quantify the level of agreement between self-reporting and proxy-assessment of children's health-related quality of life using KINDL-R in a large population based study in Germany and to identify factors which are associated with agreement.

Methods

The German Health Interview and Examination Survey for Children and Adolescents included the KINDL-R questionnaire on health-related quality of life. 6388 children and adolescents filled in the questionnaire while their parents answered the proxy version. Means and standard deviation for the self- and proxy ratings, and also the Pearson und Intra-Class correlation coefficients for the absolute agreement were calculated. The relationship between other variables and parent-child agreement were determined by means of logistic regression.

Results

In the 'Physical', 'Self-esteem' and 'School' dimension and for the 'Total' score, the parents significantly overestimated the quality of life of their child. In contrast, the quality of life of the children in the dimensions 'Psychological well-being' and 'Family' were considerably underestimated by the parents. The proportion of parent-child ratings in agreement (difference < 0.5 standard deviations) ranges from 34.9% for the 'Self-esteem' scale to 51.9% in the 'Psychological' scale. The most important factor explaining parents rating was the level of the child's self-assessment followed by the parent's assessment of the subjective health, or reported emotional abnormalities.

Conclusions

Our study shows that parental reports cannot adequately replace self-assessment for 11-17 year olds. In view of the different underlying perspectives, the parental assessments should where possible only be regarded as providing supplementary information.

[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.

[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.

Der Kinder- und Jugendgesundheitssurvey (KiGGS): Ein Überblick über Planung, Durchführung und Ergebnisse unter Berücksichtigung von Aspekten eines Qualitätsmanagements

The aim of the German Health Interview and Examination Survey for Children and Adolescents (KiGGS) was to improve the information available on the health of the up-and- coming generation in Germany and to fill gaps in knowledge. This was to be done using a nationwide representative investigation and survey of children and adolescents aged 0 to 17. From May 2003 to May 2006, 17,641 girls and boys took part in the study at 167 locations in Germany; along with their parents' input they provided a unique pool of information. From the point of view of quality management, there is a description of the planning, structures, efficient use of funding, implementation and planned evaluation of the German Health Interview and Examination Survey for Children and Adolescents (KiGGS). In this description, the quality achieved is evaluated by comparing what was actually achieved with the targets set. In this manner, a comprehensive overview can be provided of the German Health Interview and Examination Survey for Children and Adolescents (KiGGS): what it concerns, its modular structure, the co-operation partners involved, institutions financing it, regulatory processes accompanying it and strategies for evaluation. At the same time, it is shown how the individual publications in the journal for public health, health research and health protection (Bundesgesundheitsblatt) special issue no. 5/6 2007 connect to one another and to the issue as a whole.