Evaluation of frailty in geriatric patients undergoing cardiac rehabilitation after cardiac procedure: results of a prospective, cross-sectional study.

BACKGROUND: Frailty is an indicator of a decline in quality of life and functional capacity in cardiac rehabilitation (CR) patients. Currently, there is no standardized assessment tool for frailty used in CR. The aim of this study was to determine if the Clinical Frailty Scale (CFS) is feasible for assessing frailty in CR. METHODS: Prospective, cross-sectional study within the framework of the ongoing multicenter prehabilitation study "PRECOVERY". Patients ≥75 years undergoing CR after cardiac procedure (n=122) were recruited in four German inpatient CR facilities. Assessments included: CFS, Katz-Index, hand grip strength (HGS), Short Physical Performance Battery (SPPB) and six-minute-walk test (6MWT). Outcomes were frailty (CFS≥4) and the correlation of frailty with assessments of functional capacity, activities of daily living and clinical parameters. Statistical analysis included descriptive statistics and correlations, using the spearman correlation coefficient and chi-square test to test for significance. RESULTS: Data from 101 patients (79.9±4.0 years; 63% male) were analyzed. The mean CFS score was 3.2±1.4; 41.6% were defined as frail (CFS≥4). The mean time required to assess the CFS was 0.20 minutes. The findings show that CFS correlates significantly (p<0.001) with the following factors: Katz-Index, HGS, SPPB-Score and 6MWT (r≤-0.575). In addition, CFS correlated with small to moderate effects with co-morbidities (r=0.250), as-needed medications and need for nursing assistance (r≤0.248). CONCLUSIONS: The CFS assessment can be performed in under one minute and it correlates significantly with assessments of functional capacity, activities of daily living and clinical parameters in the CR setting. TRIAL REGISTRATION: German Clinical Trials Register (DRKS; http:// www. drks. de; DRKS00032256). Retrospectively registered on 13 July 2023.

Prevalence of gestational diabetes mellitus in Germany: Temporal trend and differences by regional socioeconomic deprivation.

Background: Gestational diabetes mellitus (GDM) increases the risk for adverse pregnancy outcomes. In 2012, a general screening for GDM was introduced in Germany. Methods: The analysis is based on data from the external inpatient quality assurance for obstetrics from the years 2013 to 2021. Women with pregestational diabetes were excluded. GDM was defined either by documentation in the maternity record or by ICD diagnosis O24.4 during hospitalisation. We reported the prevalence stratified by year, maternal age and regional socioeconomic deprivation. Results: The age-standardized prevalence of GDM continuously rose from 4.7 % in 2013 to 8.5 % in 2021. The increase was observed in all age groups. In 2021, this corresponded to 63,563 women with GDM. The prevalence was higher in highly deprived regions than in low deprived regions. Conclusion: A steady increase in GDM prevalence and evidence of health inequalities emphasise the need for primary prevention strategies for GDM.

The prevalence and impact of sarcopenia in older cardiac patients undergoing inpatient cardiac rehabilitation - results from a prospective, observational cohort pre-study.

BACKGROUND: The prevalence of sarcopenia and its impact in older patients undergoing inpatient cardiac rehabilitation (iCR) after cardiac procedure has been insufficiently studied. The main aim of this study was to evaluate the prevalence of sarcopenia and quantify the functional capacity of older sarcopenic and non-sarcopenic patients participating in iCR. METHODS: Prospective, observational cohort study within the framework of the ongoing multicenter prehabilitation study "PRECOVERY". A sample of 122 patients ≥75 years undergoing iCR after cardiac procedure were recruited in four German iCR facilities and followed up 3 months later by telephone. At iCR (baseline), the Strength, Assistance with walking, Rise from a chair, Climb stairs and Falls (SARC-F) questionnaire was used to identify sarcopenic patients. In addition, Katz-Index, Clinical Frailty Scale (CFS), handgrip strength (HGS), Short Physical Performance Battery (SPPB) and 6-minute walk distance (6MWD) measured functional capacity and frailty at baseline. Outcomes were prevalence of sarcopenia and the correlation of sarcopenia to functional capacity and frailty at baseline as well as the SARC-F score at follow-up. The Wilcoxon test was applied for pre-post-test analysis. Correlation between sarcopenia and 6MWD, SPPB score and HGS was tested with the eta coefficient with one-way ANOVA. RESULTS: Complete assessments were collected from 101 patients (79.9 ± 4.0 years; 63% male). At baseline, the mean SARC-F score was 2.7 ± 2.1; 35% with sarcopenia. Other baseline results were Katz-Index 5.7 ± 0.9, CFS 3.2 ± 1.4, HGS 24.9 ± 9.9 kg, SPPB score 7.5 ± 3.3 and 6MWD 288.8 ± 136.5 m. Compared to baseline, fewer patients were sarcopenic (23% versus 35%) at follow-up. In the subgroup of sarcopenic patients at baseline (n = 35), pre-post comparison resulted in a significant SARC-F improvement (p = 0.017). There was a significant correlation between sarcopenia measured by SARC-F and poor results in the assessments of functional capacity (p < 0.001; r > 0.546). CONCLUSIONS: The prevalence of sarcopenia in older patients at iCR after cardiac procedure is high (35%) and remains high at follow-up (23%). Sarcopenia screening is important since the diagnosis of sarcopenia in these patients correlates significantly with poor functional capacity. The results indicate that these patients may benefit from prehabilitation aimed at improving perioperative outcomes, increasing functional capacity and mitigating adverse effects. TRIAL REGISTRATION: German Clinical Trials Register (DRKS; http://www.drks.de ; DRKS00032256). Retrospectively registered on 13 July 2023.

[Reference evaluations for estimating prevalence, incidence, and mortality of public health relevant diseases based on routine data]. / Referenzauswertungen für die Schätzung von Prävalenz, Inzidenz und Mortalität Public-Health-relevanter Erkrankungen auf Basis von Routinedaten.

The routine data of all statutorily insured persons according to the Data Transparency Regulation (DaTraV data) represent a promising data source for the recurrent and timely surveillance of non-communicable diseases (NCDs) in Germany. Thereby, it has become apparent that there is a high demand for reference evaluations that enable quick and regularly repeatable analyses on important NCDs. Against this background, ReFern-01 was initiated, a joint project of the Robert Koch Institute (RKI) and the Federal Institute for Drugs and Medical Devices (BfArM). In collaboration with experts from the field of secondary data analysis and healthcare research, reference evaluations for estimating prevalence, incidence, and mortality for important public health-relevant diseases were developed. First, 11 central NCDs were selected by means of an online survey, and initial case definitions were created in conjunction with a literature review. These were then discussed and agreed upon in a virtual workshop. The created reference evaluations (analysis scripts) allow a standardized estimation of the mentioned epidemiological figures, which are comparable over time and regionally. In addition to providing the results, the scripts will be available at the BfArM for further analysis. Provided that remote access to the analysis of the DaTraV data is available in the future, the results of the ReFern project can strengthen the surveillance of NCDs and support public health actors, for example, in the planning and implementation of health promotion and prevention measures at the federal, state, county, and local levels.

Cross-seeding by prion protein inactivates TDP-43.

A common pathological denominator of various neurodegenerative diseases is the accumulation of protein aggregates. Neurotoxic effects are caused by a loss of the physiological activity of the aggregating protein and/or a gain of toxic function of the misfolded protein conformers. In transmissible spongiform encephalopathies or prion diseases, neurodegeneration is caused by aberrantly folded isoforms of the prion protein (PrP). However, it is poorly understood how pathogenic PrP conformers interfere with neuronal viability. Employing in vitro approaches, cell culture, animal models and patients' brain samples, we show that misfolded PrP can induce aggregation and inactivation of TAR DNA-binding protein-43 (TDP-43). Purified PrP aggregates interact with TDP-43 in vitro and in cells and induce the conversion of soluble TDP-43 into non-dynamic protein assemblies. Similarly, mislocalized PrP conformers in the cytosol bind to and sequester TDP-43 in cytosolic aggregates. As a consequence, TDP-43-dependent splicing activity in the nucleus is significantly decreased, leading to altered protein expression in cells with cytosolic PrP aggregates. Finally, we present evidence for cytosolic TDP-43 aggregates in neurons of transgenic flies expressing mammalian PrP and Creutzfeldt-Jakob disease patients. Our study identified a novel mechanism of how aberrant PrP conformers impair physiological pathways by cross-seeding.

Chewing ability and associated factors in older adults in Germany. Results from GEDA 2019/2020-EHIS.

BACKGROUND: Oral well-being is an important component of general well-being and quality of life, as it is greatly influenced by the ability to chew and speak, and thus by central factors of social interaction. Because quality of life and participation are important factors for health in older age, the aim of this article was to examine the chewing ability, including associated factors, for the older population in Germany on the basis of a nationally representative sample. METHODS: Database is the German Health Update (GEDA 2019/2020-EHIS), a population based cross-sectional survey of the Robert Koch Institute. In the telephone interview, participants aged 55 years and older were asked: "Do you have difficulty biting and chewing on hard foods such as a firm apple? Would you say 'no difficulty', 'some difficulty', 'a lot of difficulty' or 'cannot do at all/ unable to do'?" Prevalences and multivariate prevalence ratios (PR) were calculated with 95% confidence intervals (95% CI) from log-Poisson regressions. Sociodemographic, health-, behavioral- and care-related characteristics were investigated as associated factors. RESULTS: The analyses were based on data from 12,944 participants (7,079 women, 5,865 men). The proportion of people with reduced chewing ability was 20.0%; 14.5% had minor difficulty, 5.5% had major difficulty. There were no differences between women and men. The most important associated factors for reduced chewing ability were old age (PR 1.8, 95% CI 1.5-2.1), low socioeconomic status (PR 2.0, 95% CI 1.7-2.5), limitations to usual activities due to health problems (PR 1.9, 1.6-2.2), depressive symptoms (PR 1.7, 1.5-2.1), daily smoking (PR 1.6, 95% CI 1.3-1.8), low dental utilization (PR 1.6, 95% CI 1.4-1.9), and perceived unmet needs for dental care (PR 1.7, 95% CI 1.5-2.1). CONCLUSIONS: One fifth of adults from 55 years of age reported reduced chewing ability. Thus, this is a very common functional limitation in older age. Reduced chewing ability was associated with almost all investigated characteristics. Therefore, its prevention requires a holistic view in the living environment and health care context of older people. Given that chewing ability influences quality of life and social participation, maintaining or improving chewing ability is important for healthy aging.

NEMO reshapes the α-Synuclein aggregate interface and acts as an autophagy adapter by co-condensation with p62.

NEMO is a ubiquitin-binding protein which regulates canonical NF-κB pathway activation in innate immune signaling, cell death regulation and host-pathogen interactions. Here we identify an NF-κB-independent function of NEMO in proteostasis regulation by promoting autophagosomal clearance of protein aggregates. NEMO-deficient cells accumulate misfolded proteins upon proteotoxic stress and are vulnerable to proteostasis challenges. Moreover, a patient with a mutation in the NEMO-encoding IKBKG gene resulting in defective binding of NEMO to linear ubiquitin chains, developed a widespread mixed brain proteinopathy, including α-synuclein, tau and TDP-43 pathology. NEMO amplifies linear ubiquitylation at α-synuclein aggregates and promotes the local concentration of p62 into foci. In vitro, NEMO lowers the threshold concentrations required for ubiquitin-dependent phase transition of p62. In summary, NEMO reshapes the aggregate surface for efficient autophagosomal clearance by providing a mobile phase at the aggregate interphase favoring co-condensation with p62.

[Utilization of dental care by adults with and without impairments and disabilities-results of the GEDA 2014/2015-EHIS study]. / Inanspruchnahme zahnmedizinischer Versorgung von Erwachsenen mit und ohne Beeinträchtigungen und Behinderungen ­ Ergebnisse der Studie GEDA 2014/2015-EHIS.

BACKGROUND: Impairments and disabilities can have a negative impact on oral health. However, studies on the oral health of people with impairments and disabilities are rare. This article examines the 12-month prevalence of dental utilization among adults with and without impairments and disabilities in Germany. METHODS: Analyses are based on data from 23,372 persons aged 18 years and older with permanent residency in Germany from the GEDA 2014/2015-EHIS study. Participants were asked when they last visited a dentist or orthodontist on their own behalf - "less than 6 months ago," "6 to less than 12 months ago," "12 months ago or longer," or "never." For the analyses, the first two and the last two response options were combined, giving the 12-month prevalence of dental utilization. RESULTS: Adults with impairments and disabilities were slightly more likely not to have visited a dental practice in the year prior to the survey than adults without impairments and disabilities (21.5% and 18.4%, respectively; p = 0.002). However, the association between the presence of impairments and disabilities and lower dental utilization did not persist after controlling for age, gender, partnership, and socioeconomic status. DISCUSSION: There are hardly any differences in the dental utilization between persons with and without impairments and disabilities. However, due to their poorer oral health on average, it is necessary to consider how the dental care of this very heterogeneous group can be further improved. The analyses point to the need for care and prevention potentials.

Linear ubiquitination induces NEMO phase separation to activate NF-κB signaling.

The NF-κB essential modulator NEMO is the core regulatory component of the inhibitor of κB kinase complex, which is a critical checkpoint in canonical NF-κB signaling downstream of innate and adaptive immune receptors. In response to various stimuli, such as TNF or IL-1ß, NEMO binds to linear or M1-linked ubiquitin chains generated by LUBAC, promoting its oligomerization and subsequent activation of the associated kinases. Here we show that M1-ubiquitin chains induce phase separation of NEMO and the formation of NEMO assemblies in cells after exposure to IL-1ß. Phase separation is promoted by both binding of NEMO to linear ubiquitin chains and covalent linkage of M1-ubiquitin to NEMO and is essential but not sufficient for its phase separation. Supporting the functional relevance of NEMO phase separation in signaling, a pathogenic NEMO mutant, which is impaired in both binding and linkage to linear ubiquitin chains, does not undergo phase separation and is defective in mediating IL-1ß-induced NF-κB activation.

Physical Activity and Recurrent Pain in Children and Adolescents in Germany-Results from the MoMo Study.

Recurrent pain can be a significant disruption in the activities of daily life, and is not only a health problem in adults but also in children and adolescents. This study analyzed the prevalence of recurrent pain in the current sample (n = 1516; 11-17 years (meanage = 14.4 ± 2.0 years); 50.8% female) of a nationwide study in Germany, evaluated the association of participants' device-based physical activity (PA) with the prevalence of recurrent pain, and assessed whether children and adolescents who reported pain for the last three months accumulated less PA than those who did not. A higher prevalence was found in girls for recurrent headaches (42.2% vs. 28.7%), abdominal pain (28.2% vs. 20.1%), and back pain (26.9% vs. 19.5%). We found higher odds for recurrent headaches in girls (OR = 1.54) and in participants that did not reach at least 60 min of moderate to vigorous PA (MVPA) per day (OR = 2.06). Girls who reported recurrent headaches accumulated 4.7 min less MVPA per day than those without. The prevalence of pain remains at a high level in the German youth and underscores the need for interventions to improve the health situations of children and adolescents.

Abortions in Germany - Current data from the statistics on terminations of pregnancy.

Unwanted pregnancies and abortions are experiences shared by many women. In light of the fact that some general framework conditions are currently changing in Germany, and that the Corona pandemic represents a particular challenge for the care of women with unwanted pregnancies, current data from the statistics on terminations of pregnancy of the Federal Statistical Office are outlined. Compared to Europe, Germany has a low proportion of induced abortions. In 2021, 94,596 abortions were reported. The number of abortions as well as the abortion rate and the abortion ratio have decreased since 2001. 95.8% of abortions took place according to the so-called counselling provision. In more than half of the abortions (52.1%) vacuum aspiration was used, in 11.4% curettage, 32.3% were medical abortions using mifepristone. There are large regional differences in the method used.

Sexual and contraceptive behaviour of young adults in Germany - Results from KiGGS Wave 2.

Sexual behaviour is an important aspect of sexual health. 18-year-old and older participants of the KiGGS cohort in KiGGS Wave 2 were asked about their sexual and contraceptive behaviour. Data from 2,966 women and 2,206 men were included in the analysis, which was adjusted to the age and sex distribution of the German population by means of weighting. More than half of the respondents report their first sexual intercourse before reaching the age of majority (women 61%, men 53%). Women report a lower age than men. With regard to the number of opposite-sex sexual partners in the last twelve months, almost 69% of women and 58% of men state that they have had contact. Three or more sexual partners were reported by 11% of women and 20% of men. 7.4% of women have same-sex and 1.4% have both same-sex and opposite-sex sexual contacts, among men the figures are 2.8% and 0.4%, respectively. When asked about the type of contraception used during the last sexual intercourse, about two thirds of the women and more than half of the men indicated the pill; a condom is used by about 44% of the women and about two thirds of the men. Almost one third of the women have already taken the morning-after pill. Overall, the results can help to support prevention and education campaigns on sexual and reproductive health.

The Role of Ubiquitin in Regulating Stress Granule Dynamics.

Stress granules (SGs) are dynamic, reversible biomolecular condensates, which assemble in the cytoplasm of eukaryotic cells under various stress conditions. Formation of SGs typically occurs upon stress-induced translational arrest and polysome disassembly. The increase in cytoplasmic mRNAs triggers the formation of a protein-RNA network that undergoes liquid-liquid phase separation when a critical interaction threshold has been reached. This adaptive stress response allows a transient shutdown of several cellular processes until the stress is removed. During the recovery from stress, SGs disassemble to re-establish cellular activities. Persistent stress and disease-related mutations in SG components favor the formation of aberrant SGs that are impaired in disassembly and prone to aggregation. Recently, posttranslational modifications of SG components have been identified as major regulators of SG dynamics. Here, we summarize new insights into the role of ubiquitination in affecting SG dynamics and clearance and discuss implications for neurodegenerative diseases linked to aberrant SG formation.

Toothache, tooth brushing frequency and dental check-ups in children and adolescents with and without disabilities.

According to international studies, children and adolescents with disabilities have more tooth decay, brush their teeth less often twice a day and use preventive dental services less often than children and adolescents without disabilities. With data from the second follow-up to the German Health Interview and Examination Survey for Children and Adolescents (KiGGS Wave 2, 2014-2017), toothache, tooth brushing frequency and dental check-ups are examined in children and adolescents with and without disabilities. It was found that children and adolescents with disabilities had more toothache in the three months before the survey (23.5% and 15.9%, respectively) and brushed or got their teeth brushed twice a day less often (33.5% and 22.2%, respectively) than children and adolescents without disabilities. Differences in the utilisation of dental check-ups could not be determined. Overall, the results point to the importance of measures to promote tooth brushing frequency in order to improve the oral health of children and adolescents with disabilities. In addition, further opportunities should be created to collect data on the oral health of people with disabilities at the population level in health or participation studies.

Health of people with impairments and disabilities in Germany - Selected indicators from GEDA 2014/2015-EHIS.

A large part of the population is affected by impairments and disabilities. Around 13% of people in Germany have an officially recognised disability, and an estimated 15.6% have an impairment. This article provides an overview of the health of people with impairments and disabilities on the basis of selected indicators. The analyses are based on data from 23,372 participating persons aged 18 and over (12,747 women, 10,625 men) in the GEDA 2014/2015-EHIS study of the Robert Koch Institute (RKI), a nationwide survey of the adult population in Germany. 21.5% of persons with impairments and disabilities rate their health as good or very good, in contrast to 76.0% of persons without impairments and disabilities. Depressive symptoms exist in 27.1% of persons with impairments and disabilities and 7.5% of persons without impairments and disabilities. In part, there were differences in health behaviour, for example, people with impairments and disabilities do less aerobic physical activities and consume alcohol in risky amounts less often. 97.0% of the persons with and 86.1% of the persons without impairments and disabilities make use of outpatient medical services within one year, the former also have a higher inpatient and home care utilisation. Overall, poorer health is found among women than among men with impairments and disabilities, as well as with increasing age. The analyses show the need for prevention, health promotion and health care. Further data is needed to describe the health situation of people with impairments and disabilities.

[Self-perceived oral health and associated factors among adults in Germany. Results from GEDA 2019/2020-EHIS]. / Selbstwahrgenommene Mundgesundheit und assoziierte Faktoren bei Erwachsenen in Deutschland. Ergebnisse aus GEDA 2019/2020-EHIS.

BACKGROUND AND AIM OF THE WORK: Information on the oral health of the population is important for the assessment of (preventable) disease burden, for the estimation and planning of health resources and costs, and for the evaluation of health inequalities. The aim of this work is to investigate for the first time self-perceived oral health, including associated factors, based on data from a nationally representative sample for the adult population in Germany. MATERIAL AND METHODS: The data basis is the nationwide German Health Update study (GEDA 2019/2020-EHIS, n = 22,708 aged 18 years and older). In the telephone interview, the participants were asked how they would describe the state of their teeth and gums - "very good," "good," "fair," "bad," or "very bad." Sociodemographic, behavioral, and dental characteristics are examined as associated factors. Prevalences and results of multivariate binary logistic regressions (odds ratios, OR) are reported. RESULTS AND DISCUSSION: Of the participants, 71.4% perceived their oral health as very good or good, 28.6% as fair to very bad. Difficulty in chewing and biting on hard foods (OR 4.0), unmet dental care needs (OR 2.3), male gender (OR 1.5), and not consuming fruits and vegetables daily (OR 1.2) were the most important associated factors for fair to very bad self-perceived oral health; for men, low education (OR 2,1), daily smoking (OR 1.6) and not receiving dental care annually (OR 1.4) were also important. From the results, starting points for promoting oral health can be derived.

Effect of various weight loss interventions on serum NT-proBNP concentration in severe obese subjects without clinical manifest heart failure.

Obesity is associated with a "natriuretic handicap" indicated by reduced N-terminal fragment of proBNP (NT-proBNP) concentration. While gastric bypass surgery improves the natriuretic handicap, it is presently unclear if sleeve gastrectomy exhibits similar effects. We examined NT-proBNP serum concentration in n = 72 obese participants without heart failure before and 6 months after sleeve gastrectomy (n = 28), gastric bypass surgery (n = 19), and 3-month 800 kcal/day very-low calorie diet (n = 25). A significant weight loss was observed in all intervention groups. Within 6 months, NT-proBNP concentration tended to increase by a median of 44.3 pg/mL in the sleeve gastrectomy group (p = 0.07), while it remained unchanged in the other groups (all p ≥ 0.50). To gain insights into potential effectors, we additionally analyzed NT-proBNP serum concentration in n = 387 individuals with different metabolic phenotypes. Here, higher NT-proBNP levels were associated with lower nutritional fat and protein but not with carbohydrate intake. Of interest, NT-proBNP serum concentrations were inversely correlated with fasting glucose concentration in euglycemic individuals but not in individuals with prediabetes or type 2 diabetes. In conclusion, sleeve gastrectomy tended to increase NT-proBNP levels in obese individuals and might improve the obesity-associated "natriuretic handicap". Thereby, nutritional fat and protein intake and the individual glucose homeostasis might be metabolic determinants of NT-proBNP serum concentration.

Prevalence of back and neck pain in Germany. Results from the BURDEN 2020 Burden of Disease Study.

Back and neck pain are widespread and can significantly reduce quality of life. A cross-sectional telephone survey (N=5,009) was carried out between October 2019 and March 2020 to gain a valid estimate of the prevalence of back and neck pain among adults in Germany. In addition to the frequency and intensity of back and neck pain, the study collected information about quality of life and comorbidity. The findings showed that 61.3% of respondents reported back pain in the last twelve months. Lower back pain was reported about twice as often as upper back pain, with 15.5% of respondents stating that they experienced chronic back pain. 45.7% reported neck pain, and 15.6% of respondents have experienced lower and upper back pain in addition to neck pain in the past year. Women are affected by all types of pain more often than men. About half of the respondents categorise their back or neck pain as moderate; older respondents report significantly more pain episodes per month than younger respondents. The results described here provide a comprehensive picture of the population-related limitations associated with back and neck pain and are used within the framework of the BURDEN 2020 study to quantify key indicators of burden of disease calculation.

Individual trajectories of asthma, obesity and ADHD during the transition from childhood and adolescence to young adulthood.

The German Health Interview and Examination Survey for Children and Adolescents (KiGGS) provides comprehensive and reliable data on the health situation of the upcoming generation. The KiGGS cohort accompanies participants from the KiGGS baseline study (2003-2006) into adulthood. Until now, two follow-up surveys of the cohort have been implemented with KiGGS Wave 1 (2009-2012) and KiGGS Wave 2 (2014-2017). In KiGGS Wave 2, the cohort was supplemented by the in-depth study 'Family and care-specific factors influencing the development, trajectories and effects of mental disorders (especially ADHD), obesity and allergic diseases (especially asthma)'. One aim of the study was to identify individual trajectories of these health disorders. For this purpose, probabilities for typical transitions from the KiGGS baseline study to KiGGS Wave 2 were calculated. An important result is that many participants who had asthma, obesity or ADHD at KiGGS baseline still had the disease more than ten years later: Over a third still had asthma (35%) or ADHD (37%), and almost half were still affected by obesity (47%). The results point to the need for early preventive measures to stop these potentially chronic diseases from developing in childhood and adolescence.