Reductions in Bone Mineral Density Are Apparent Early in Children With Prevalent Osteonecrosis Lesions Following Leukemia Therapy

Osteonecrosis (ON) is a serious complication of childhood acute lymphoblastic leukemia. We determined the prevalence of osteonecrotic lesions in our patient population by a one-time multisite magnetic resonance imaging (MRI) more than 1 year following leukemia therapy. MRI findings were evaluated in relationship to clinical factors (including longitudinal changes in bone mineral density [BMD]). Eighty-six children enrolled in the Steroid Associated Osteoporosis in the Pediatric Population (STOPP) study were evaluated for ON at 3.1 ± 1.3 years following therapy. Thirty children had a total of 150 confirmed ON lesions (35%). Lumbar spine (LS) BMD Z-scores (mean ± SD) were low at diagnosis and similar between patients with and without ON (-1.09 ± 1.53 versus -1.27 ± 1.25, p = 0.549). LS BMD Z-scores declined from baseline to 12 months in children with ON (-0.31 ± 1.02) but not in those without (0.13 ± 0.82, p = 0.035); the hip BMD Z-scores from baseline to 24 months declined in both groups, but to a greater extent in those with ON (-1.77 ± 1.22) compared to those without (-1.03 ± 1.07, p = 0.045). At the time of the MRI, mean total hip and total body (TB) BMD Z-scores were lower in children with ON (hip -0.98 ± 0.95 versus -0.28 ± 1.06, p = 0.010; TB -1.36 ± 1.10 versus -0.48 ± 1.50, p = 0.018). Pain occurred in 11/30 (37%) with ON versus 20/56 (36%) without, p = 0.841. In multivariable models, older age at diagnosis (odds ratio [OR] 1.57; 95% confidence interval [CI], 1.15-2.13; p = 0.004), and hip BMD Z-score at MRI (OR 2.23; 95% CI, 1.02-4.87; p = 0.046) were independently associated with ON. Overall, one-third of children demonstrated ON after leukemia therapy. Those with ON had greater reductions in spine and hip BMD Z-scores in the first 1 and 2 years of therapy, respectively. Older age and lower hip BMD Z-scores at MRI were significantly associated with prevalent, off-therapy ON. These data assist in identifying children at risk of ON. © 2023 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).

Changes in mental health in the German child and adolescent population during the COVID-19 pandemic - Results of a rapid review

Background

This rapid review examines changes in the mental health of the German child and adolescent population during the COVID-19 pandemic.

Methods

The basis are 39 publications, which were identified by means of systematic literature search (until 19.11.2021) and manual search. The databases of the included publications were systematized with regard to their representativeness for the general population, and the indicators used were categorized with regard to the depicted constructs and their reliability.

Results

The large majority of the studies took place at the beginning of the pandemic until the summer plateau 2020. Representative studies mainly reported high levels of pandemic-related stress, increases in mental health problems, and negative impacts on the quality of life. Non-representative studies showed mixed results. Vulnerable groups could only be identified to a limited extent. Both routine and care-related data showed declines in the outpatient and inpatient service utilisation during the various waves of the pandemic followed by catch-up effects. Children and adolescents turned out to be more vulnerable during the pandemic compared to adults, but their stress levels varied with the waves of the pandemic and the related containment measures.

Conclusions

A future forward-looking crisis and pandemic management requires a close-knit and continuous surveillance of the mental health of children as well as an improved identification of risk groups.

Subjective health and well-being of children and adolescents in Germany - Cross-sectional results of the 2017/18 HBSC study

Subjective health is understood as a multidimensional construct that encompasses the physical, mental and social dimensions of a person's well-being. Promoting the subjective health and well-being of children and adolescents has strong public health relevance because health impairments in childhood and adolescence are often associated with long-term health problems in adulthood. Therefore, it is very important to gain information about potential risk and resource factors involved. This article presents current prevalences for subjective health, life satisfaction and psychosomatic health complaints among children and adolescents in Germany aged 11, 13 and 15 years from the 2017/18 Health Behaviour in School-Aged Children (HBSC) study (N=4,347, 53.0% girls). It also examines the sociodemographic and psychosocial factors that influence subjective well-being. Most children and adolescents provided positive ratings of their health and life satisfaction. Nevertheless, about one third of girls and one fifth of boys were affected by multiple psychosomatic health complaints. Impairments in subjective well-being were particularly evident in girls, older adolescents, young people with low levels of family affluence and those under a lot of pressure at school. In contrast, high family support was associated with better subjective well-being. These results illustrate the need for target group-specific prevention and health promotion measures aimed at improving the subjective health and well-being of children and adolescents.

Alcohol, tobacco and cannabis use in adolescence - Cross-sectional results of the 2017/18 HBSC study

Tobacco, alcohol and cannabis are psychoactive substances that is often tried for the first time during adolescence and further continued in later life. Regular tobacco and cannabis use as well as alcohol abuse are associated with serious health consequences. According to the importance of health reporting, this article describes current prevalence of adolescent substance use and the associations between psychoactive substance use and specific social determinants. Representative data for Germany from the 2017/18 Health Behaviour in School-Aged Children (HBSC) study among schoolchildren aged 11, 13 and 15 years are used. The article analyses both, the lifetime and 30-day prevalence of tobacco, alcohol and cannabis use (in the latter case, data were only available for 15-year-olds) among adolescents as well as their experiences of alcohol-related misuse (binge drinking). Tobacco and alcohol are used comparatively rarely by 11- and 13-year-olds. However, the prevalence increases significantly among 15-year-olds. In addition, cannabis use is also quite common among this age group. Schoolchildren who do not attend grammar schools are at greater risk of smoking and those with high family affluence are at a greater risk of alcohol use, this applies particularly to girls. Finally, adolescents with a migration background are less at risk of regular alcohol use or binge drinking, but face an increased risk of cannabis use (girls with one-sided migration background). The results indicate that prevention measures should start early, as the prevalence of substance use is significantly higher among older schoolchildren. Depending on the substance, different risk groups can be identified that require particular consideration when drawing up preventive measures.

Influencing factors of obesity in school-age children and adolescents - A systematic review of the literature in the context of obesity monitoring

Around 15% of children and adolescents in Germany are overweight or obese. To support the planning, implementation and evaluation of preventive activities, the Robert Koch Institute (RKI) has developed a population-wide monitoring of influencing factors relevant to the development of obesity during childhood (AdiMon). AdiMon is a web-based indicator system providing population-wide meaningful and regularly updated data on factors that influence obesity in kindergarten-age girls and boys (0- to 6-years-old). Towards the end of 2020, the RKI will expand the indicator system to also cover the 7- to 17-year-old age group. To this end, a systematic review of the literature was conducted, a process which served to identify over 80 relevant factors that influence the development of obesity. These factors have been attributed to the categories behaviour, environment, biology, pre- and postnatal, psychosocial factors and context. Compared to a previous literature review for kindergarten-age children, around one tenth of the influencing factors now identified are new, including 'peer group influences' and 'bullying'. As the results highlight, an array of influencing factors must be considered when expanding the monitoring system, ranging from individual health behaviour to the social framework conditions and environmental factors.

Results of the cross-sectional KiGGS Wave 2 study and trends

For patients with considerable malfunctions, or where these could potentially develop, statutory health insurers completely cover the cost of correcting malpositionings of the teeth and jaws through orthodontic treatment in Germany. Based on the self-reported information from the second wave of the German Health Interview and Examination Survey for Children and Adolescents (KiGGS Wave 2, 2014-2017), the uptake of orthodontic treatment was analysed. A total of 25.8% of the girls and 21.1% of the boys aged 3 to 17 years are receiving regular orthodontic treatment. Uptake of treatment is very much dependent on age. The highest rates are found among 13-year-old girls (55.0%) and 14-year-old boys (50.8%). Compared to the data from previous KiGGS waves, the trend over approximately ten years has seen a significant increase of orthodontic treatment across all age groups. More health services research and a broader discourse on current treatment practices and their benefits are desirable.

Results of the cross-sectional KiGGS Wave 2 study and trends

Oral health behaviour plays a key role in the prevention of caries and periodontitis. This article describes the prevalence, determinants and trends of tooth brushing frequency and utilization of dental check-ups. The analyses are based on the data from the second wave of the German Health Interview and Examination Survey for Children and Adolescents (KiGGS Wave 2, 2014-2017). The results show that around 80% of children and adolescents meet the recommended tooth brushing frequency and utilization of dental check-ups. Around one fifth of children and adolescents do not meet the recommendations. 14- to 17-year-old adolescents, as well as those with low socioeconomic status and a migration background are groups which are particularly at risk. Compared to the KiGGS baseline study (2003-2006), tooth brushing frequency and utilization of dental check-ups has improved. While this positive development is apparent for nearly all the population groups analysed, the same risk groups that were identified by the baseline study are also evident in the KiGGS Wave 2 results. Targeted measures directed at specific target groups to promote oral health behaviour at younger ages should therefore be maintained and expanded, respectively.

Utilization of early detection examinations by children in Germany. Results of the cross-sectional KiGGS Wave 2 study

Examinations for early detection of diseases (called U-Untersuchungen in Germany) are among the most important prevention measures at childhood age. According to KiGGS Wave 2 data, participation rates are over 95% for most of these examinations. 99.7% and 99.6% of children, respectively, who had reached the recommended age for these examinations participated in the U1 and U2 examinations, 98.0% and 98.1%, respectively, the U8 and U9 examinations. Participation rates for children from families with low socioeconomic status and those with a two-sided migration background are slightly lower. A comparison with previous KiGGS waves shows that the utilization of early detection examinations has increased significantly over the last ten years. During this time, social differences which were previously pronounced have decreased.

Results of the cross-sectional KiGGS Wave 2 study and trends

In Germany, specialists in paediatrics and general medicine in private practices provide the bulk of outpatient treatment. Data from the second wave of the German Health Interview and Examination Survey for Children and Adolescents (KiGGS Wave 2, 2014-2017) surveyed the ambulatory attendance of paediatric and general medical services for 0- to 17-year-old children and adolescents. During the last 12 months, 72.8% of girls and 72.7% of boys have made use of outpatient paediatric treatment and 25.9% of girls and 24.6% of boys have made use of outpatient general medical services. Attendance rates in paediatric practices decrease with age, whereas those of general medical practices increase. While no relevant differences between genders exist, rural areas evidence significantly lower paediatric practice and significantly higher general medical practice attendance rates. Compared to the data collected in the previous KiGGS studies, the trend over the last ten years approximately indicates an increase in the use of paediatric services and a decrease in the use of general medical services.

Results of the cross-sectional KiGGS Wave 2 study and trends

For children and adolescents, accidents represent an important health risk. Despite decreasing mortality rates, accidental (unintended) injuries remain the most common cause of death for children over the age of one in Germany. Accident injuries can cause considerable and lasting damage on health and development. The possible major implications as well as the potential to prevent accident injuries underline the importance of accident prevention. The German Health Interview and Examination Survey for Children and Adolescents (KiGGS) collects data on unintentional child injuries at regular intervals. Results of the second follow-up survey (KiGGS Wave 2, 2014-2017) show that during the past twelve months 16.5% of children and adolescents aged between 1 and 17 received medical treatment following an accident. Boys suffer injuries from accidents significantly more often than girls (18.6% vs. 14.3%). While the prevalences for older children and adolescents tend to be higher, age generally has little impact on accident rates. Compared to the two previous waves of KiGGS, the prevalences of accident injuries have remained stable.

Results of the cross-sectional KiGGS Wave 2 study and trends

Mental health problems in children and adolescents are associated with individual and family-related constraints as well as social costs. 20.0% of children and adolescents showed mental health problems at the KiGGS baseline study (2003-2006). This study investigates the current prevalence for KiGGS Wave 2 (2014-2017) as well as time trends in comparison with the KiGGS baseline study. Mental health problems were assessed for 3- to 17-year-old children and adolescents by using the parent-based version of the Strengths and Difficulties Questionnaire (SDQ). For KiGGS Wave 2, the prevalence of mental health problems was 16.9%. A decreasing trend is pronounced particularly among boys between 9 and 17 years of age. Mental health problems are displayed more frequently by girls and boys from families with a low socioeconomic status compared to their peers from families with a medium or high socioeconomic status. These findings are discussed in the light of various measures and actions in health promotion and health care.

Results of the cross-sectional KiGGS Wave 2 study and trends

Self-reported data from wave 2 of the German Health Interview and Examination Survey for Children and Adolescents (KiGGS Wave 2, 2014-2017) provides the basis for assessing whether the levels of physical activity of children and adolescents in Germany meet the levels recommended by the World Health Organization (WHO). Merely 22.4% of girls and 29.4% of boys in the 3-17 age group are physically active for at least 60 minutes per day and therefore meet the WHO recommendations. Prevalence of recommended levels of physical activity decreases continuously with age, both for girls and boys. In KiGGS Wave 2, girls in the 3-10 age group met the levels of physical activity recommended by the World Health Organization significantly less often than in KiGGS Wave 1. Low levels of physical activity were highest amongst adolescent age girls, as well as among boys and girls of low socioeconomic status. The results indicate a great potential to promote physical activity.

Results of the cross-sectional KiGGS Wave 2 study and trends

Consuming large amounts of sugary beverages has been related to developing obesity, diabetes mellitus type II and other chronic diseases. KiGGS Wave 2 (2014-2017) provides data on the consumption of sugary soft drinks in the 3-17 year age group in Germany. Overall, 13.7% of girls and 17.6% of boys consume one to three times a day sugary soft drinks and 3.3% of girls and 4.7% of boys four or more times. Consumption frequency increases with age and is higher among children and adolescents with low socioeconomic status (SES) than for those of the same age with high SES. The share of adolescents who drink sugary soft drinks daily has decreased since the KiGGS baseline study (2003-2006).

Results of the cross-sectional KiGGS Wave 2 study and trends

Data from KiGGS Wave 2 show that 95.7% of parents who participated in the survey rated the overall health of their 3 to 17 year-old children as very good or good. This proportion is higher than the figures identified by the KiGGS baseline study across all age groups. The proportion of children rated as in very good health is highest among 3 to 6 year-olds and decreases with age. Among 14 to 17 year-olds, the proportion of girls in very good health is well below the level found among boys. A pronounced social gradient is still clear from the data: the proportion of parents who assess the overall health of their children as very good or good rises with increasing social status. This highlights the need for strategies to reduce health inequalities that involve society as a whole, and the need for target group-specific measures in prevention and health promotion.

KiGGS Wave 2 longitudinal component - data collection design and developments in the numbers of participants in the KiGGS cohort

The German Health Interview and Examination Survey for Children and Adolescents (KiGGS) is conducted within the health monitoring framework that has been established at the Robert Koch Institute (RKI). In addition to regular cross-sectional studies of the current health of children and adolescents living in Germany, KiGGS also includes a longitudinal component - the KiGGS cohort. The longitudinal data, which can be linked individually throughout the various waves of the study, enables developments in health and their associated influencing factors to be analysed during the life course. Participants from the KiGGS baseline study form the baseline of the KiGGS cohort. The baseline study was carried out between 2003 and 2006 as a nationwide interview and examination survey of children and adolescents aged between 0 and 17 years. The KiGGS cohort comprises the 17,641 participants who, after taking part in the baseline study, also agreed to participate in recurring follow-ups that are to continue through adolescence into adulthood. Until now, two follow-up studies have been conducted: KiGGS Wave 1 (2009-2012, n=11,992) and KiGGS Wave 2 (2014-2017), which, in line with the baseline study, was conducted as an interview and examination survey. A total of 10,853 repeat participants were interviewed for KiGGS Wave 2; 6,465 people also took part in an examination. As such, 61.3% of the people who originally participated in the baseline study also provided data from interviews for KiGGS Wave 2. In addition, 50.8% have provided various forms of data for all three of the survey's waves. This data pool can help answer numerous questions from the epidemiological life course discipline regarding the population living in Germany; at the time of the baseline study, these participants were children and adolescents. In order to exploit the full potential of the study for life course research and to be able to trace the health and social development of different generations in the future, the concepts on which the study is based are to be further developed, and innovative strategies for participant retention are to be drawn up.

KiGGS Wave 2 cross-sectional study - participant acquisition, response rates and representativeness

For the third time, wave 2 of the German Health Interview and Examination Survey for Children and Adolescents (KiGGS), which is conducted in the context of health monitoring at the Robert Koch Institute, now provides representative cross-sectional data for Germany. Completed in 2017, data for the cross-sectional component of KiGGS Wave 2 was collected in the form of an interview and examination survey. Interview survey data was collected from 15,023 participants, meaning that the required number of participants has been reached. A randomly selected subgroup of 3,567 participants was also examined. The overall response rate was 40.1%. Differences in response rates were registered regarding certain sociodemographic characteristics. Weighting was applied to compensate for differences in willingness to participate related to age, gender, geographic region, nationality and education factors. Weighting ensures that assessments of the health of children and adolescents in Germany are representative for the population. The data serves to estimate prevalence rates and, through comparison with the results from previous survey waves, to analyse trends. A set of measures were taken to recruit a sufficiently large group of participants and ensure that the net sample reflects the composition of the overall population to the highest degree. For future surveys, further measures ought to be taken in order to improve the integration of hard-to-reach subgroups.

Follow-up of children and adolescents with special health care needs: Results from the KiGGS study 2003-2012

The incidence of chronic diseases in children has risen sharply throughout the world. Regardless of the particular diagnosis, chronically ill children and their families are faced with particular challenges. The transition to adulthood leads to changes in the conditions in which care is provided and the responsibilities that are associated with it. In this paper we used KiGGS cohort data to investigate the odds that chronically ill children and adolescents have of no longer feeling chronically ill or facing health impairments in young adulthood. Furthermore, it investigates the factors that are associated with an unfavourable transition from childhood into young adulthood. The analysis employs a data subgroup sourced from the first two waves of the KiGGS cohort - the longitudinal component of the German Health Interview and Examination Survey for Children and Adolescents (KiGGS) conducted by the Robert Koch Institute. The population-based KiGGS baseline survey was carried out between 2003 and 2006 as an examination and interview survey of 17,641 children and adolescents aged between 0 and 17. KiGGS Wave 1 - its first follow-up - was conducted between 2009 and 2012 via telephone. The KiGGS baseline survey used the German translation of the Children with Special Health Care Needs (CSHCN) screener as part of the written questionnaire provided to parents. This formed part of a generic approach towards identifying chronically ill children that applies irrespective of the diagnosis in question. KiGGS Wave 1 used a generic query to gather data on chronic illnesses using two questions taken from the Minimal European Health Module (MEHM); by this stage, the participants had reached adulthood. The information provided by 3,243 KiGGS cohort participants (who were aged between 18 and 24 at the time of KiGGS Wave 1) was analysed for indications of the presence or absence of a chronic disease among children and adolescents aged between 12 and 17. This was done using data gathered using the CSHCN screener between 2003 and 2006. Six years after the KiGGS baseline survey, half of the 509 participants who had screened positive (50.6%; 95% CI 44.4-56.8) stated that they were still chronically ill or faced health impairments. In contrast, one fifth of the participants who had provided no evidence of a chronic illness at the time of the KiGGS baseline survey (21.1%; 18.9-23.4) stated that they were now chronically ill or faced health impairments. Adolescents with a chronic illness reported being chronically ill in young adulthood more frequently than younger children (OR 1.8; 1.02-3.3). Bronchial asthma among 12- to 17-year-olds who had screened positive is associated with a reporting of chronic illness or health restrictions in later life (OR 3.5; 1.6-7.6). Regardless of age, obesity, the presence of asthma or an ADHD diagnosis, chronically ill boys who report pain, and chronically ill children from families with a low socio-economic status and few personal resources (personal protective factors), are at particular risk of a chronic illness in young adulthood.

New data for action. Data collection for KiGGS Wave 2 has been completed

The fieldwork of the second follow-up to the German Health Interview and Examination Survey for Children and Adolescents (KiGGS) was completed in August 2017. KiGGS is part of the Robert Koch Institute's Federal Health Monitoring. The study consists of the KiGGS cross-sectional component (a nationally representative, periodic cross-sectional survey of children and adolescents aged between 0 and 17) and the KiGGS cohort (the follow-up into adulthood of participants who took part in the KiGGS baseline study). KiGGS collects data on health status, health-related behaviour, psychosocial risk and protective factors, health care and the living conditions of children and adolescents in Germany. The first interview and examination survey (the KiGGS baseline study; undertaken between 2003 and 2006; n=17,641; age range: 0-17) was carried out in a total of 167 sample points in Germany. Physical examinations, laboratory analyses of blood and urine samples and various physical tests were conducted with the participants and, in addition, all parents and participants aged 11 or above were interviewed. The first follow-up was conducted via telephone-based interviews (KiGGS Wave 1 2009-2012; n=11,992; age range: 6-24) and an additional sample was included (n=4,455; age range: 0-6). KiGGS Wave 2 (2014-2017) was conducted as an interview and examination survey and consisted of a new, nationwide, representative cross-sectional sample of 0- to 17-year-old children and adolescents in Germany, and the second KiGGS cohort follow-up. The completion of the cross-sectional component of KiGGS Wave 2 means that the health of children and adolescents in Germany can now be assessed using representative data gained from three study waves. Trends can therefore be analysed over a period stretching to over ten years now. As the data collected from participants of the KiGGS cohort can be individually linked across the various surveys, in-depth analyses can be conducted for a period ranging from childhood to young adulthood and developmental processes associated with physical and mental health and the associated risk and protective factors can be explored. As such, KiGGS Wave 2 expands the resources available to health reporting, as well as policy planning and research, with regard to assessing the health of children and adolescents in Germany.