[Circumstances of injury in childhood and adolescence. Data and epidemiology]

The population-related aspects of injuries in children and adolescents in Germany using data from different sources were compiled and analyzed. In contrast to clinical case studies, our focus was on risk groups, injury mechanisms, and context of injury. Sources of information used for this study included the following: Causes of Death Statistics, Hospital Diagnosis Statistics, Child and Adolescent Health Survey, Injury Database. Data for the period 1998 to 2008 on unintentional injuries, violence, and suicide were assessed by age group and gender and study results on sociodemographic risk factors were included. The analysis revealed that injuries display an age-specific dynamic: infants carry a high risk for fatal domestic injuries as well as for injuries due to violence, whereas in adolescents the majority of injuries result from fatal traffic injuries and from suicide. In addition, social factors were found to be related to specific mechanisms of injury (e.g., scalds) and intention (e.g., violence) only. Migration status has an age- and gender-related influence on injury rates.

[Child abuse and violence as reasons for injuries in childhood: results of a monitoring of children and adolescents in South Brandenburg (Germany)]

BACKGROUND

During childhood injuries are one of the most common reasons for a consultation, second only to infectious diseases. Not as rare as aspected these injuries are caused by maltreatment. The aim of this study is to show the frequency of non-accidental injuries (NAI) in the patient group from a pediatric hospital in East Germany.

MATERIAL AND METHODS

Over a 12-month period all cases of injured children who needed to be hospitalized for treatment were registered. In a computer based questionnaire various parameters, such as age, sex, social status, and accident details were documented.

RESULTS

A total of 573 injured children and adolescents needed inpatient treatment. In 86.7% of the cases injuries resulted from an accident. In 8.6% of all cases a connection to violence could be found mostly in the form of head and soft tissue injuries.

CONCLUSION

The findings show the importance of a detailed and specific anamnesis and physical exploration of children with trauma. Recognition of maltreated children does not only apply to pediatricians, but also to physicians of several specializations.

[The Brandenburg social index: a tool for health and social reporting at regional and communal levels in the analysis of data of school beginners]

A social index derived from examinations of prospective first graders is used for health reporting in the Federal State of Brandenburg. The Brandenburg social index consists of data from the medical examinations, which contain social anamnesis questions. Based on parents' education and employment, the social index is computed for each child and finally each child is assigned to a group of lower, middle or higher socioeconomic status. The simply made social index is not only used for analysing health and social inequalities but also for analysing the social situation and trends of young families. Social index data for prospective first graders have ben collected since 1994. Thus, the social index is part of the social reporting in Brandenburg. The present article illustrates with examples how the index is used. Finally, it is mentioned that the Brandenburg government uses the social index to control finances in the language promotion for kindergarteners in day-care centres.

Verletzungen bei Kindern und Jugendlichen (1–17 Jahre) und Umsetzung von persönlichen Schutzmaßnahmen

Parent interviews with regard to their children's accidents and to accident protective measures in the Health Interview and Examination Survey for Children and Adolescents (KiGGS) aimed at extending our knowledge of age- and gender-specific injuries and to identify risk groups and risk factors for injury prevention. The parents of 16,706 children (aged 1-17 years) were asked about their children's injuries within the last 12 months which were medically treated, and about accident mechanisms, consequences of injuries, and ambulatory and hospital treatment. In addition, parents and children aged 11 to 17 years (n = 6813) were asked to give information on protective measures. According to the parents 15.9 % of the children had at least one injury within the last 12 months, 15.2 % because of an accident and 0.8 % because of assault. In the age group 1-17 boys have been injured significantly more often than girls (17.9 % vs. 14,0 %). Overall, 13.3 % of 2,410 injured children and adolescents were hospitalized. Two thirds of the accidents among toddlers were domestic accidents (60 %) whereas leisure and sport accidents were most prevalent in children and adolescents aged 5-14 years and 15-17 years (32.1 % and 38.9 %). The proportion of accidents in child care facilities and educational institutions tripled from infancy to school age (age 5-14 years) (10.9-28.7 %), as did traffic accidents (5.6-16.7 %). The three most frequent injury mechanisms in the age range 1-17 years were falls on level ground (35.2 %), falls from heights (25.2 %) and collisions with objects or persons (20.6 %). Falls from heights showed the highest risk in toddlers (35.8 %). Contusions, sprains and strains increased to a highest level of 50.9 % in adolescents; likewise, bone fractures increased from 10.7 % in toddlers to 21.8 % in adolescents aged 15-17 years. An influence of socioeconomic status on injuries overall and on consequences of injuries was not seen. For traffic accidents in children aged 1-17 years boys (p = 0.019) and girls (p = 0.047) from families with lower socioeconomic status showed higher rates of accidents than children from families with higher socioeconomic status. The application of protective measures was lowest in the age group 14-17 years. While according to the parents about 90 % of children aged 3-4 years wear a helmet when riding a bicycle or when skating, this quote was lower in the age group 5-14 (60 %) and dropped to about 15 % in the age group 14-17 (about 15 %). Also the rate for using protective clothes was lowest in age group 14-17 (boys 41.8 %; girls 52.2 %). In children and adolescents the rate of self-reported helmet use is lower than estimated by their parents. In all age groups migration background and low socioeconomic status were associated with lower use of protective measures (helmets and protective clothes). The age related data analysis should be the starting point in prevention measures for specific risk groups considering migration and socioeconomic status. Prevention activities in traffic should focus on families with low social status. Adolescents should be specifically and adequately addressed regarding the benefits of certain safety measures when riding a bicycle and when skating.

Epidemiologische Analyse von Unfällen bei Kindern unter 15 Jahren in Deutschland - Ausgangspunkt für die Unfallprävention

OBJECTIVE

The epidemiological analysis of injury circumstances can play an important role in implementing targeted injury prevention measures. The data available in Germany are being compiled in order to define risk groups, risk factors and the main accident causes.

METHOD

A descriptive epidemiological analysis of injuries among children according to severity (fatality or hospitalization rate), frequency, age group, location, product involvement, ethnic background and social risk factors was carried out. The following data sources were drawn upon for the epidemiological analysis: official statistics, surveys on home and leisure accidents, social status data from school beginners' medical examinations in the federal states of Brandenburg and Schleswig-Holstein as well as population-based injury monitoring in the city of Delmenhorst (1998 - 2002).

RESULTS

Since 1990, total injury mortality among children under 15 years has declined by more than two-thirds in Germany (from 10.2 to 3.0 per 100,000 during the period 1990 - 2004). This is true both for road traffic accidents and for home and leisure accidents. There is an age-specific distribution in terms of fatal accident causes: suffocation, drowning, falls and burns are the most common among the under 5-year-olds, while in school-age children road traffic accidents and drowning predominate. For several years, infants and toddlers have been the groups most at risk and hospitalisation figures for these groups are still sharply increasing. In the under 5-year-old group, accidents happen mainly in and around the home, whereas among school children (5 - 14 years) they occur most frequently at school, at home and during leisure activities, and on the roads. Accidents are often environment- and product-related. Children from ethnic minorities and low status families are the groups most at risk in terms of road traffic accidents and scalds.

CONCLUSION

The epidemiological analysis of childrens' injuries should be the starting point for age- and environment-specific and product-related interventions. Intervention strategies should take into account parents' ethnic background as well as potential language barriers.

[Survey on awareness of violence against children and the use of the guide "violence against children and young people" by paediatricians in Brandenburg]

Following the lead of other German Federal States, Brandenburg has developed a guide entitled "Violence Against Children and Young People" for use by paediatricians. This guide has two objectives: to help doctors detect violence against children at an early stage, and to improve interdisciplinary case management. In order to assess whether the guide has proved its worth in practice, the Public Health Institute of Brandenburg conducted a survey among users. In addition, paediatricians treating the victims were interviewed to obtain estimates of the incidence rate of such acts of violence against children.

METHODOLOGY

In 2002/03, the guide was provided free of charge to all paediatricians engaged in the treatment of in- and outpatients, and a structured questionnaire was used to interview a total of 285 such doctors and child and youth psychiatrists on the following topics: estimated incidence rate of acts of violence (proven and suspected cases), case management in practice (cooperation with other agencies, provision of care, support needs) as well as assessment of the guide's content and design in terms of the practical utility of the information provided. After the questionnaires had been sent out a second time, the response rate was 33.3 % (92 out of a total of 285).

RESULTS

82 (89.1 %) of the paediatricians questioned had dealt with at least one case of violence against children in 2003; only three doctors had seen no case at all. A total of 904 proven and 945 suspected cases were registered. One striking result of the survey was the great variation in the number of cases registered by individual doctors: between 0 and 179 proven cases, and between 0 and 120 suspected cases. 12 doctors (13 %) stated that they had treated proven or suspected cases in all four categories (physical abuse, physical neglect, emotional abuse, sexual abuse). Other doctors registered no proven, only suspected cases. 80 doctors (87 %) questioned said that they worked together with other agencies, but 19 (20.6 %) were dissatisfied with this cooperation. 59 (64.1 %) reported a need for case-related support, particularly from the following institutions: 1. Youth Welfare Office, 2. Child and Youth Psychiatry, 3. Public Health Office. 19 (30.4 %) doctors regarded the local provision of care as insufficient. Results of the guide's evaluation: 44 out of a total of 49 doctors (88.8 %) considered the guide's design and contents "good" or "very good". 19 doctors (38.8 %) stated that the guide had led to changes in the way they work and that they were now able to deal with the problem of violence against children more confidently.

CONCLUSION

Paediatricians in Brandenburg testify to cases of violence against children. The guide "Violence Against Children and Young People" offers useful information on the practical handling of such cases. The alliance "Growing up Healthy in Brandenburg" tackless the need for support by developing a catalogue of measures to be implemented. These include conducting specialised further training for paediatricians as well as cross-disciplinary furthertraining measures, and setting up regional working groups to improve basic networking in practice.

Impfpr�vention im Kindes- und Jugendalter

This article identifies successful vaccination strategies, obstacles to such strategies and the role that schools can play in terms of health education by analysing vaccination rates among children in the Federal State of Brandenburg. The analysis is based on the vaccination status of Brandenburg's children at day care centres and schools in relation to the social status of their parents, the extent to which preventive examinations (U up to J1) is taken advantage of and regional location. Furthermore, an evaluation is rendered of the vaccination awareness campaign which has been carried out in sixth grade students since 2002 to assess the impact of health promotion at schools. In the Federal State of Brandenburg vaccination coverage among infants and toddlers is good, with approximately 94% having received complete basic vaccination in 2003. By contrast, there are marked deficits among tenth grade schoolchildren in terms of refresher vaccinations, basic hepatitis B vaccinations and the second measles, mumps and rubella (MMR) vaccinations. Vaccination status is strongly dependent on the social status of parents and the extent to which preventive medical examinations and regional medical health-care provision are utilized. Systematic checking of vaccination documents by the public health services promotes vaccination awareness. Prevention by vaccination is most effective when combined with preventive medical examinations, effective local vaccination management and interdisciplinary interventions: education at schools, systematic tracking of vaccination documents combined with the provision of vaccinations in doctors' surgeries and additionally by the public health services.

[Social status and health of young people in the German Federal State of Brandenburg]

In the German Federal State of Brandenburg, reporting on health and social issues is closely linked. This also applies to the present article, which attempts to describe the social and health situation of young people in Brandenburg. The aim is to define future priorities in health prevention.

METHODS

In addition to data from official statistics (on demographic trends, employment and social security) and from surveys conducted among young adults, the results from serial medical and dental examinations of 10th-grade pupils are presented.

RESULTS

The number of young citizens in Brandenburg aged 16-25 will rise until the middle of the decade but then fall sharply. This will apply in particular to the rural areas far from Berlin. Sociological studies show that "work and family" enjoy the highest priority among people. However, less educated young people are increasingly doubtful about their ability to live their lives according to these priorities. According to medical statistics, every tenth young person suffers from allergies (especially allergic rhinitis). The same applies with regard to orthopaedic data. Approx. 5% of young people are obese, pupils of special schools more frequently than grammar school pupils.

DISCUSSION

Healthy schooling, healthy professional training and good opportunities on the labour market are the key pillars of health policy in Brandenburg. The social and health situation of young people in Brandenburg is a complex issue and can only be improved by networking and cooperation among of all parties concerned.

International comparisons of child injuries and prevention programs: recommendations for an improved prevention program in Germany

OBJECTIVES

To compare child injury mortality in Germany with that of four neighboring countries, and to examine injury prevention models in these countries with a view to improving prevention programs in Germany.

METHODS

Based on official cause of death certificates, child injury mortality rates in Germany are compared with those of Austria, The Netherlands, Sweden, and Switzerland. The main structures and funding of injury prevention programs in these countries are described.

RESULTS

In all five countries, mortality is highest among children aged 1-4 years for home and leisure accidents and drownings. Transport accidents are the main cause of death in the 5-14 age group. Mortality in both age groups has fallen significantly since 1980, most markedly in Sweden and The Netherlands.

CONCLUSION

Drawing on the injury mortality data and experience of the comparison countries, the following recommendations are proposed to further reduce home and leisure injuries among children in Germany: (1) establish a soundly funded, central institution responsible for child injury surveillance, research, and the coordination of injury prevention activities, (2) improve product control legislation, and (3) disseminate specific safety information to target groups and the general public.

[Health of school beginners]

Since 1994, the results of medical examinations carried out on school beginners in the Federal state of Brandenburg have been documented according to a uniform standard, and a standardised procedure has been used for questioning parents about their child's medical history, accidents, and the relevant environmental and social anamnesis. To this extent, information is available on each child's health and social characteristics. In order to analyse the connection between a child's health and the social status of the family, a combined social and education-related variable was established. The social status of the families in question was defined in terms of three groups (low, medium and high social status) and related to the child's health characteristics. The results of the 1994 study of 23,462 families (response: 72.8%) are considered in detail and include comprehensive data on the families' social situation. The results of the 1995 study (n = 14,568) confirm the effects of social status on a child's health and prove the reliability of the model of calculation.

[The Charlottenburg Allergy Prevention Program 90. Early detection and prevention of allergic diseases by modifying mass screening of 3d grade students]

On the one hand, the Charlottenburg allergy prevention programme showed the spread of allergic diseases among the pupils of the third form of public schools, and on the other hand it familiarized parents, teachers and pupils with health promotion schemes under the slogan These who are informed well in time will suffer less. For the first time within the area of Berlin, the Charlottenburg district developed a quality standard in respect of screening and health promotion connected with allergy. This new focal point of attention was set up by means of mass screenings of pupils while at the same time critically reviewing previous routine methods, weeding out unnecessary procedures and emphasizing the essential. The difficult tasks confronting Public Health services in this regard could not be managed without outside help. This was forthcoming from partners recruited from the university, the sickness insurance bodies and self-help groups. The cooperation that developed in this manner was exemplary and might serve as a model for future on-target health prevention programmes.