[Cohort studies in child and adolescent psychiatry]. / Kohortenstudien in der Kinder- und Jugendpsychiatrie.

BACKGROUND: Longitudinal cohort studies with early start and life span perspectives are increasingly recognized as being crucial to uncover developmental trajectories as well as risk and resilience factors of psychiatric disorders. OBJECTIVE: The importance of longitudinal studies is presented and the main findings of the Mannheim study of children at risk (MARS), the adolescent brain cognitive development (ABCD), the pediatric and adolescent health survey (Kinder- und Jugendgesundheitssurvey, KiGGS) and the AIMS longitudinal European autism project (LEAP) cohort studies are described. MATERIAL AND METHODS: A literature search was carried out in MEDLINE. RESULTS: The MARS followed participants with psychosocial and organic risks over more than 30 years starting from birth and showed the importance of early risk factors (prenatal period up to early childhood) for neuropsychosocial development. The ABCD cohort study (start 9-10 years old) underlined the developmental significance of early socioemotional and prenatal risks as well as toxin exposure. The KiGGS cohort followed children and adolescents from age 0-17 years up to the ages of 10-28 years. Main findings underline the importance of the socioeconomic status and gender-specific effects with respect to sensitive periods for the onset and trajectories of psychiatric disorders. The AIMS cohort followed patients with and without autism spectrum disorders aged between 6 and 30 years and first results revealed small effects regarding group differences. Further, cohort studies starting prenatally along with deep phenotyping are warranted to uncover the complex etiology of mental disorders. CONCLUSION: Existing cohort studies on early mental development have shown specific focal points. To identify general and specific risk and resilience factors for psychiatric disorders and to model trajectories, there is a need for multimodal integration of data sets.

Ambulant health care utilisation among children of childhood cancer survivors in Germany.

PURPOSE: Within the framework of a questionnaire-based health survey in Germany, we examined ambulant health care utilisation among childhood cancer survivors' offspring compared to utilisation among children of the general population. METHODS: In total, 1299 former patients received a questionnaire for every known biological child in two cross-sectional surveys, 2013/14 (n = 393) and 2015/16 (n = 906). For investigation of health care utilisation, questions on frequencies and kind of ambulant medical services were chosen for bivariate and multivariate analyses. Correlations between utilisation and anxiety, diagnosis of the parent, pain or preterm birth of the child and social indicators were conducted. For comparison with the general population, data of 17,640 children and adolescents aged 0 to 17 years were used for matched-pair analysis. These data were available from the KIGGS baseline study on the health of children and adolescents in Germany, conducted by the Robert Koch Institute. RESULTS: Overall, 852 (65.6%) of the contacted 1299 survivors completed 1340 questionnaires on their children's health. Childhood cancer survivors' offspring showed a similar attendance of ambulant primary health care compared to the general population (paediatricians 83.1% vs. 82.1%). However, the majority of specialist physicians was visited significantly more often (e.g. dermatologist 10.5% vs. 6.2%) by childhood cancer survivors' offspring compared to children from the general population. Logistic regression showed that parental diagnosis and anxiety on children's health significantly influenced health care utilisation. CONCLUSIONS: Further improvement of after-care for childhood cancer survivors by including topics on offspring seems necessary. Offspring's paediatricians should implement counselling and providing of information considering the special family anamnesis.

Health-Related Behaviour Among Children of Childhood Cancer Survivors in Germany.

Purpose: Childhood cancer survivors fear that previous therapy could not only impair their own but also their children's health. We examined whether health-related behaviour in children of childhood cancer survivors differs from the general population. Methods: Our first nationwide survey wave (2013-2014) surveyed offspring health in 396 German childhood cancer survivors known to have a child of their own. Answers about health behaviour were analysed using descriptive statistics. Data were collected for 418 offspring and 394 could be integrated for matched-pair analyses with data from the German general population (KIGGS, n=17 641). Results: Teeth-cleaning routine, body-mass-index or subjective body image evaluation by parents were no different from children in the general population. Parents who included a cancer survivor smoked less in the presence of their children (p=0.01). During pregnancy, mothers in cancer survivor parent pairs abstained from drinking alcohol more often (p=0.01) and smoked less (p=0.05). While the calculated effect sizes (Phi) were generally low (0.135-0.247), children from cancer survivors played less outdoors than peers did (p=0.01). Boys participated in sports outside a club more often (p=0.05) and watched less TV on weekdays (p=0.01) and girls spent more time on the computer during weekdays than peers did (p=0.01). Conclusions: This study provides the first data for health-related behaviour in cancer survivors' offspring and sheds light on differences to parenting in the general population. Multivariate analyses in a larger study population are needed to relate these differences to fear issues in cancer survivors.

[Utilization of Physiotherapy Services by Children and Adolescents - Results of the KiGGS- Baseline Survey]. / Inanspruchnahme von Physiotherapie im Kindes- und Jugendalter ­ Ergebnisse aus der KiGGS-Basiserhebung.

Aim of the study: The use of physical therapy in German children and adolescents has so far solely been analyzed on the basis of health insurance data, which can neither consider case history nor social factors. Using the KiGGS-baseline survey it is possible to examine the use of physical therapy on the basis of parental reported health problems and social factors. Methodology: Identifiable determinants for the use of physical therapy in the last 12 months in the KiGGS-baseline survey were examined bivariate and multivariate in logistic regression models with mutual adjustment. The following determinants were considered: social factors, somatic disorders and psychological abnormalities. The proportion of the use of physical therapy, which can be explained by these determinants, was estimated using population-attributable risk fraction. Results: The frequency of the use of physical therapy in the last 12 months in the 0 to 17-year-olds in the KiGGS-baseline survey was 6,4% with higher use during infancy and adolescence. The socio-economic status of parents was not associated with the use of physical therapy. A migration background decreased the probability of the use of physical therapy, for example, among children aged 0 to 2 years (ORadjusted: 0,5 [95% CI: 0,2-1,0]). In those with scoliosis, the use of physical therapy was almost twice as frequent in infancy as in adolescence (58,4 vs. 34,4%). A maximum of 15% of all children and adolescents with back pain reported the use of physical therapy. When ADHD was diagnosed at preschool age, the probability of using physical therapy was increased (ORadjusted: 5,1 [95% CI: 1,4-18,6]). The health problems, which were assessed in the KiGGS-baseline survey and considered for this analysis could explain 37% of the use of physical therapy in the 0 to 2-year-olds. In the other age groups, 59 to 62% could be explained. Conclusion: Comparison of the KiGGS-baseline survey with health insurance data shows similar frequencies and patterns of the use of physical therapy and can therefore be used for the analysis of healthcare questions on the use of physical therapy. The data point to potential deficits in treatment in population segments and for some conditions. An examination of these hypotheses based on analyses of health insurance data seems to be reasonable.

Mental Health Care Use in Children of Parents with Mental Health Problems: Results of the BELLA Study.

Whether parental mental health problems facilitate or hinder the use of mental health care of the parents´ children is still unclear. The present cross sectional study examined mental health care use and potential predictors in a population based sample. Children of parents with mental health problems (CPM) were nearly 5 times more likely to use mental health care compared to children of parents without mental health problems. A multiple regression analysis revealed that the most important predictors of mental health care use for CPM were active family life (OR = 2.67) and children´s own mental health problems (OR = 1.18 self-report, 1.17 parent-report). Additionally, parental strain showed a tendency to predict mental health care use (OR = 2.45). This study demonstrates that parental mental health problems are associated with mental health care use in their children and that improving certain family factors may support children´s mental health care use.

[Implementation of the German S3 guidelines on dementia in clinical practice: wish or reality?] / Umsetzung der S3-Leitlinie "Demenzen" im klinischen Alltag: Wunsch oder Wirklichkeit?

BACKGROUND: Published in 2009, the German S3 guidelines on dementia define a milestone in quality improvement of the diagnostics and treatment of dementia. In clinical practice patients suffering from dementia are primarily treated by physicians in private practice; therefore, this study examined how the guidelines are implemented in outpatient clinical settings. Furthermore, it aimed at the identification of behavioral determinants that govern the actual diagnostic and therapeutic approach in clinical practice. METHODS: Physicians involved in the primary care of dementia patients were asked to participate in a nationwide internet survey. The questionnaire covered aspects on the diagnostic and therapeutic care of dementia patients as recommended by the S3 guidelines. Behavioral determinants of the implementation of the guidelines (e. g. treatment decisions) were derived from an established psychological prediction model. RESULTS: Out of a total of 2755 physicians contacted, the data of 225 participants could be used in this study. The diagnostic recommendations of the S3 guidelines were implemented in satisfactory measures (e.g. combined cognitive screening in at least 68%, cerebral neuroimaging in at least 93% and specific laboratory diagnostics in at least 27% of cases); however, only two thirds of the patients with indications for a guideline-conform therapy were treated in accordance with the S3 guidelines. There was a substantial prescription of non-recommended drugs and a notable long-term use of antipsychotic drugs (prescription by at least 14% of non-neurological medical specialists and by 8% of neurologists and psychiatrists). When considering the behavioral determinants in the implementation of the guidelines, normative assumptions ("my colleagues and patients expect me to comply with the guidelines") surprisingly had the highest impact, which was then followed by attitudes towards the behavior ("utilization of the guidelines improves diagnostics and therapy"). CONCLUSION: The German S3 guidelines on dementia were satisfactorily implemented in outpatient clinical practice; however, deficits existed in the frequency of the pharmaceutical treatment of patients with indications for therapy, the prescription of non-recommended drugs and the relatively common use of permanent neuroleptic medications. Interestingly, the motivation for implementation of the guidelines was not primarily influenced by the physicians' personal convictions but mainly stimulated by the expectations of others.

[Method for the quality assessment of data collection processes in epidemiological studies]. / Methode zur Qualitätsbewertung von Datenerhebungsprozessen in epidemiologischen Studien.

CONTEXT: For a quantitative evaluation of primary data collection processes in epidemiological surveys based on accompaniments and observations (in the field), there is no description of test criteria and methodologies in relevant literature and thus no known application in practice. Therefore, methods need to be developed and existing procedures adapted. OBJECTIVE: The aim was to identify quality-relevant developments within quality dimensions by means of inspection points (quality indicators) during the process of data collection. As a result we seek to implement and establish a methodology for the assessment of overall survey quality supplementary to standardized data analyses. METHOD/CONCEPT: Monitors detect deviations from standard primary data collection during site visits by applying standardized checklists. Quantitative results - overall and for each dimension - are obtained by numerical calculation of quality indicators. Score results are categorized and color coded. This visual prioritization indicates necessity for intervention. RESULT: The results obtained give clues regarding the current quality of data collection. This allows for the identification of such sections where interventions for quality improvement are needed. In addition, process quality development can be shown over time on an intercomparable basis. DISCUSSION: This methodology for the evaluation of data collection quality can identify deviations from norms, focalize quality analyses and help trace causes for significant deviations.

[Utilization of Occupational Therapy in Children - Results from the KiGGS Basis Survey]. / Inanspruchnahme von Ergotherapie im Kindesalter - Ergebnisse aus der KiGGS-Basiserhebung.

BACKGROUND: A population-based analysis on use of occupational therapy by child's parentally reported health restrictions and socio-demographic determinants is missing. PATIENTS AND METHODS: The basis KiGGS survey (2003 to 2006) reports on health in 17 641 children aged 0 to 17 years. The use of occupational therapy in the last 12 months could be ticked as other therapies with a free text field to name occupational therapy or others. Health restrictions potentially relevant for the use of occupational therapy and sociodemographic factors were assessed. The proportion of use of occupational therapy explained by the health restrictions was estimated by the population attributable risk fraction. RESULTS: The average use of occupational therapy for 3 to 13-year-olds was 2.4%. There was no association with the socioeconomic status; Children with immigration background used occupational therapy less often (e. g. age group 3 to 6 years: ORadjusted 0.2 [95-% KI: 0.1-1.0]). The proportion of occupational therapy explainable by the health restrictions considered ranged from 45% (3 to 6 years) to 65% (11 to 13 years). DISCUSSION: The lower use of occupational therapy in the KiGGS survey compared to health insurance reports may be explained by the ascertainment method. A lower use of occupational therapy related to immigration background matches lower use for physician visits. CONCLUSION: The causes for the low proportion of explained occupational therapy in young children and the lower use in children with immigration background warrant further research.

[Mental health in adolescents in Germany: A comparison with regard to migration background and country of origin]. / Psychische Gesundheit von Jugendlichen in Deutschland : Ein Vergleich nach Migrationshintergrund und Herkunftsland.

Many children and adolescents in Germany grow up in families with a migration background. Different cultural, religious, and linguistic backgrounds have an influence on their behavior in various ways. Health status can be affected both negatively and positively by a migration background. The aim of this study was to analyze associations between migration background and self-reported psychological problems. In addition, it was tested whether country of origin had a differential effect on the associations found. Because of its migration-specific approach, the baseline survey (2003-2006) of the nationwide German Health Interview and Examination Survey for Children and Adolescents (KiGGS) offers a solid basis for migrant-specific analyses. Self-reported mental health problems were assessed using the Strengths and Difficulties Questionnaire (SDQ), which was completed by 6,719 adolescents aged 11-17 years. Adolescents with a two-sided migration background (i.e., both parents) reported higher SDQ total difficulties scores compared with adolescents without a migration background (16.9 vs 11.5%) or those with a one-sided migration background (16.9 vs 11.3%). Adolescents with a Turkish background had higher odds (boys: OR 2.0; 95%CI 1.3-3.2; girls: OR 2.0; 95%CI 1.2-3.4) of reporting mental health problems than adolescents without a migration background. Also, girls with a migration background from Western Europe, the USA or Canada had higher odds (OR 2.2; 95%CI 1.3-3.6). In some cases, adjusting for socioeconomic status led to insignificant associations with regard to the country of origin. The findings underline the importance of migrant-specific and culture-sensitive prevention, which also takes the environment and culture-specific characteristics into account.

[Has the prevalence of parent-reported diagnosis of attention deficit hyperactivity disorder (ADHD) in Germany increased between 2003-2006 and 2009-2012? Results of the KiGGS-study: first follow-up (KiGGS Wave 1)]. / Hat die Häufigkeit elternberichteter Diagnosen einer Aufmerksamkeitsdefizit-/Hyperaktivitätsstörung (ADHS) in Deutschland zwischen 2003-2006 und 2009-2012 zugenommen? : Ergebnisse der KiGGS-Studie - Erste Folgebefragung (KiGGS Welle 1).

Recent international studies have reported a considerable increase in the diagnosis of attention deficit hyperactivity disorder (ADHD). Data from German statutory health insurance companies suggest a comparable trend for Germany. Based on data from the nationally representative study KiGGS Wave 1 (2009-2012) it was the aim of this study to report on the prevalence rates of parent-reported ADHD diagnoses in children and adolescents aged 3-17 years as well as to report on time trends in comparison with the KiGGS baseline study (2003-2006). ADHD caseness was met if a parent reported that a physician or a psychologist diagnosed their child with ADHD. Participants without a reported ADHD diagnosis but who scored ≥ 7 (clinical range) on the parent-rated hyperactivity subscale of the Strengths and Difficulties Questionnaire (SDQ) were considered as potential ADHD cases. The prevalence of diagnosed ADHD was 5.0% (prevalence of potential ADHD cases 6.0%). An ADHD diagnosis was more than four and a half times more likely to be reported among boys than girls. Children from families with low socioeconomic status (SES) were more than two and a half times more likely to be diagnosed with ADHD than children from families with high SES. Among potential cases, boys were twice as common as girls, and children from families with low SES were approximately three times more common compared with those from high SES families. The proportion of lifetime ADHD diagnoses increased with age and was highest in 11- to 17-year-olds. In every fifth child with ADHD the initial diagnosis was made by the age of 6 years and in 1 out of 11 children with ADHD the initial diagnosis was made by the age of 5 years. In total, we observed no significant changes regarding the frequency of ADHD diagnosis compared to the KiGGS baseline study. Increases reported using data from German statuary health insurance companies were not reflected in the KiGGS data.

[Psychopathological problems and psychosocial impairment in children and adolescents aged 3-17 years in the German population: prevalence and time trends at two measurement points (2003-2006 and 2009-2012): results of the KiGGS study: first follow-up (KiGGS Wave 1)]. / Psychische Auffälligkeiten und psychosoziale Beeinträchtigungen bei Kindern und Jugendlichen im Alter von 3 bis 17 Jahren in Deutschland - Prävalenz und zeitliche Trends zu 2 Erhebungszeitpunkten (2003-2006 und 2009-2012) : Ergebnisse der KiGGS-Studie - Erste Folgebefragung (KiGGS Welle 1).

Child and adolescent mental health problems burden not only the individual, but also their families and their social environment and may, therefore, be regarded as a highly relevant public health issue. The data on mental health problems of children and adolescents from the KiGGS Wave 1 study (sample period 2009-2012) make it possible to report on both current prevalence rates and time trends over the 6-year period beginning with the KiGGS baseline survey (2003-2006). The assessment of emotional and behavioral problems in KiGGS Wave 1 was carried out with the symptoms questionnaire of the Strengths and Difficulties Questionnaire (SDQ) in a telephone interview with 10,353 guardians of children and adolescents aged 3-17 years. Moreover, using the SDQ impact supplement, the KIGGS Wave 1 data provide information on psychosocial impairment following child and adolescent mental health problems. Subjects with a borderline or abnormal SDQ score, according to German normative data, were considered at risk. A total of 20.2% (95% CI: 18.9-21.6%) of the study subjects were identified as being at risk for a mental health disorder, compared with 20.0% (19.1-20.9%) during the KiGGS baseline study (age-standardized based on population from 12 December 2010). Thus, no significant changes over time in the prevalence of mental health problems were detected. Also, there were no statistically significant differences in prevalence by sex, age group, or socioeconomic status between the KiGGS baseline survey and KiGGS Wave 1. The statistical comparison of the subscale mean values for both girls and boys showed higher values with respect to the subscales for emotional problems, behavioral problems, and prosocial behavior and lower mean values for the peer problems subscale in KiGGS Wave 1. These partly small temporal trends, however, may be due to possible mode effects (written questionnaire in the KiGGS baseline study versus telephone interview in KiGGS Wave 1). The hyperactivity subscale remained stable across the two sample periods. Regarding impairments following mental health problems at the second sample period, boys were more affected in the areas of chronicity, family burden, and impact score. The high and stable prevalence rates and magnitude of emotional and behavioral problems should prompt increased preventive efforts.

Age- and sex-dependent disparity in physical fitness between obese and normal weight children and adolescents.

AIM: Aim of the present study was to determine whether the association between obesity and physical fitness in children and adolescents is age- and sex-specific. METHODS: A total of 4519 children and adolescents aged 4-17 years grouped by age (4-5, 6-10, 11-13 and 14-17 years), sex and BMI (normal-weight: BMI≤90th percentile; overweight: BMI>90th percentile; adipose: BMI>97th percentile) participated in this large-scale representative cross-sectional study. Endurance, strength, flexibility and fine and gross motor coordination was measured using the following physical fitness tests: PWC170, push-ups test, standing long-jumps, side-to-side jumps, one-minute single leg stance on the dominant leg, balancing backwards on three beams of different width, lowest point reached by the fingertips while standing on a box with legs extended, reaction to colour changes of traffic light, tracing lines without touching the rim and sorting 25 pens. RESULTS: Overweight and obese boys and girls had lower physical fitness values describing endurance, strength and gross motor coordination than normal-weight boys and girls, respectively (P<0.001 for all; boys: -12% and -19%, respectively; girls: -9% and -19%, respectively). Differences in physical fitness between weight groups were greater in older groups (P<0.001). Fine motor skills and flexibility values did not differ between weight groups. CONCLUSION: The disparity in physical fitness, in particular in endurance, strength and gross motor coordination, between obese and normalweight is greater in adolescents than in children. Physical fitness programs are warranted for all overweight and obese children and adolescents but especially for overweight and obese adolescents.

[The first wave of the German Health Interview and Examination Survey for Adults (DEGS1): participant recruitment, fieldwork, and quality management]. / Die erste Welle der Studie zur Gesundheit Erwachsener in Deutschland (DEGS1): Gewinnung von Studienteilnehmenden, Durchführung der Feldarbeit und Qualitätsmanagement.

The purpose of the German Health Interview and Examination Survey for Adults (DEGS) is to repeatedly obtain representative nationwide health data for adults aged 18-79 years living in Germany. The first wave (DEGS1) was carried out by the Robert Koch Institute (RKI) from November 2008 to December 2011. The study has a mixed design, which permits both cross-sectional and longitudinal analysis. It was carried out on an up-to-date sample from the population registration office and on participants from the 1998 German National Health Interview and Examination Survey (GNHIES98), who were invited to take part again. All newly selected individuals, and those GNHIES98 participants living in the same locations as in 1998, were asked to undergo an interview and examination. GNHIES98 participants who had moved to a different location were asked to take part in a survey based on self-completion questionnaires and telephone interviews. This article describes the practicalities of recruiting participants, planning and carrying out fieldwork, managing data, and taking measures to ensure the quality of the process and data. An English full-text version of this article is available at SpringerLink as supplemental.

[Physical and psychological violence perpetration and violent victimisation in the German adult population: results of the German Health Interview and Examination Survey for Adults (DEGS1)]. / Körperliche und psychische Gewalterfahrungen in der deutschen Erwachsenenbevölkerung: Ergebnisse der Studie zur Gesundheit von Erwachsenen in Deutschland (DEGS1).

Violence is of considerable relevance to Public Health. It was the aim of the violence screening implemented as part of the"German Health Interview and Examination Survey for Adults" (DEGS1) to assess data on physical and psychological violence in various social environments (partnership, family, workplace, public space). For the first time as part of a nationally representative health survey, the data was collected from the perspective of victim and perpetrator both among women and men. The study population was comprised of 5939 participants aged between 18 and 64 years. Approximately every 20th participant reported being the victim of physical violence in the preceding 12 months, men significantly more frequently than women. With regard to the frequency of being the perpetrator of physical violence (overall prevalence 3.7 %) there were no significant differences between the sexes. Psychological victimisation was reported by every fifth participant and overall perpetrating psychological violence was reported by every tenth. Women tended to be more frequent the victims but they were also significantly more frequently the perpetrators of both physical and psychological violence in the domestic area (partnership, family). In contrast, men more frequently report being both the perpetrator and the victim of violence in the workplace and in the public space. Young adults between 18 and 29 years as well as persons of low socioeconomic status were consistently more frequently affected by violence although there were exceptions with regard to psychological violent victimisation. More than three-quarters of the victims of physical violence reported being greatly or extremely affected in their well-being by the violence and in the case of psychological violence the rate was about approximately 60%. Overall, the traumatic experience as a consequence of experiencing physical and psychological violence was considerably higher, especially in the case of domestic violence (partnership, family). Overall, women reported a greater sense of wrongdoing following violence perpetration than men; as to the perpetration of violence towards a partner, however, there was no difference between the sexes in this regard. An English full-text version of this article is available at SpringerLink as supplemental.

[Physical and cognitive capabilities among persons aged 65-79 years in Germany: results of the German Health Interview and Examination Survey for Adults (DEGS1)]. / Körperliche und geistige Funktionsfähigkeit bei Personen im Alter von 65 bis 79 Jahren in Deutschland: Ergebnisse der Studie zur Gesundheit Erwachsener in Deutschland (DEGS1).

In older age, physical and cognitive capabilities play an important role for independent living. For this reason, the German Health Interview and Examination Survey for Adults (DEGS1) included the Timed Up and Go test (TUG) and a chair-rise test, balance tests, a measurement of hand grip strength and the Digit Symbol Substitution Test (DSST) in order to representatively describe physical and cognitive performance of older people in Germany. Among 1,853 persons 65-79 years of age who came to the study centre more than 90 % participated in the performance tests. The average time needed to complete the TUG and chair-rise tests were 10.7 and 11.8 s, respectively. On average, participants reached 3.9 of a maximum of 5 points in the balance tests (FICSIT4 protocol). Mean maximum grip strength was 32.3 kg. The mean number of correctly assigned symbols in the DSST was 43.8. In all functional capacity areas tested, performance declined with increasing age. There were differences by sex in the chair-rise test, hand grip strength and DSST. The objective measurement of physical and cognitive capabilities in DEGS1 contributes to describe the health status of older people with implications for health promotion and prevention. An English full-text version of this article is available at SpringerLink as supplemental.

[Measurement of cardiorespiratory fitness in the German Health Interview and Examination Survey for Adults (DEGS1)]. / Messung der kardiorespiratorischen Fitness in der Studie zur Gesundheit Erwachsener in Deutschland (DEGS1).

A state of good fitness is related to a better health state and a lower mortality risk. In the German Health Interview and Examination Survey for Adults (DEGS1), aerobic fitness was measured among adults between 18 and 64 years old using a submaximal cycle ergometry test. The total sample comprised 5,263 persons, amongst those 3,111 were categorized as being test-qualified according to the Physical Activity Readiness-Questionnaire. There were 3,030 persons who absolved a submaximal exercise test according to the exercise protocol of the WHO (25/25/2). The test-participation rate was 57.2 % in relation to the total sample and 97.4 % among test-qualified persons. Apart from the continuous heart-rate monitoring, capillary blood was taken prior to starting the test and at the end of each workload stage for performing blood lactate analyses. The test ended when 85 % of the age-predicted maximal heart rate was exceeded. In all 11.9 % of the tests were terminated earlier, the mean exercise duration was 10.8 min, and the anticipated submaximal exertion in the highest workload stage was on average achieved with a mean of 15 on the 20-point RPE scale. The nationwide data can now be used for the national health monitoring system, epidemiological research and for the calculation of reference values. An English full-text version of this article is available at SpringerLink as supplemental.

[The KiGGS study. Nationwide representative longitudinal and cross-sectional study on the health of children and adolescents within the framework of health monitoring at the Robert Koch Institute]. / Die KiGGS-Studie. Bundesweit repräsentative Längs- und Querschnittstudie zur Gesundheit von Kindern und Jugendlichen im Rahmen des Gesundheitsmonitorings am Robert Koch-Institut.

From 2003 to 2006 the KiGGS Baseline Study was conducted, including a clustered random sample of 167 sample points and 17,641 children and adolescents from 0 to 17 years, as well as their parents in 167 sample points. The children and adolescents were medically and physically examined, and their parents answered questions about physical, psychological and social aspects of their children's health, as did, from 11 years on, the children and adolescents themselves. Within the framework of the nationwide health monitoring at the Robert Koch Institute, the KiGGS study is being continued as a prospective cohort study with an interval of approximately 5 years between follow-ups. The study sample will be cross-sectionally refilled with younger age groups at each time of measurement. The assessment of the KiGGS core study follows a core indicator concept, which is modularly complemented by external scientific cooperation partners. The field work of the first wave (KiGGS Wave 1), a telephone survey, will continue until June 2012. The second follow-up (KiGGS Wave 2) will again combine examinations and interviews, starting in 2013. On the basis of the nationally representative KiGGS data, important questions about health policy can be answered, such as trends and trajectories of health. Important results are expected, among others concerning trends in overweight and obesity, the incidence of atopic diseases, and the persistency or remission of psychopathological symptoms and disorders.

[Which implications for obesity prevention can be offered by the KiGGS follow-up study?]. / Welche Ansatzpunkte zur Adipositasprävention bietet die KiGGS-Kohorte?

From 2003-2006, the health status of 17,641 girls and boys was comprehensively assessed by interview and medical examinations in the nationwide German Health Interview and Examination Survey for Children and Adolescents (KiGGS). Therewith, data exists for a broad spectrum of health relevant questions in childhood and adolescence, including indicators, determinants and consequences of obesity. As part of the health monitoring system of the Robert Koch Institute, KiGGS is being continued as a longitudinal study. This enables the observation of health development of children and adolescents up to adulthood as well as the detection of changes in behavior and circumstances within this population. This offers many new perspectives for analyses, whose findings may be helpful for the prevention of obesity. Current insights and future perspectives are discussed.

[Monitoring and quality assurance of prevention and health promotion at the federal level]. / Monitoring und Qualitätssicherung von Prävention und Gesundheitsförderung auf Bundesebene.

Monitoring and quality assurance are gaining in importance for the identification of needs and the effectiveness of prevention and health promotion activities. This paper presents examples of activities of monitoring and quality assurance at the federal level, carried out by the Federal Centre for Health Education and the Robert Koch Institute. Examples include the prevention issues "HIV/AIDS", "nutrition and physical activity" and "child health". They illustrate the roles of epidemiological surveillance, health monitoring, evaluation, and intervention reporting. The Robert Koch Institute and the Federal Centre for Health Education provide complementary information on health and intervention reporting at the federal level. With their reports, they provide essential information for health policy to formulate, to implement and to evaluate evidence-based national health goals and action plans.

[Self-assessment of BMI data : verification of the practicability of a correction formula on a sample of 11- to 13-year-old girls]. / BMI-Selbstauskünfte : Überprüfung der Praktikabilität einer Korrekturformel an einer Stichprobe elf- bis 13-jähriger Mädchen.

The decision to measure or to ask about data concerning height and weight in order to calculate body mass index (BMI) has an influence on the economy and validity of the measurements. Although self-reported information is less expensive, this information may possibly have a bias on the determined prevalences of different weight groups. Using representative data from the KiGGS study with a comparison of directly measured and self-reported BMI data, Kurth and Ellert (2010) developed two correction formulas for prevalences resulting from self-reported information. The aim of the study was to examine the practicability of the proposed correction formulas on our own data concerning self-reported BMI data of 11- to 13-year-old girls (n=1,271) and to assess the plausibility of the corrected measurements. As a result, the prevalences of our own data changed in the expected direction both for underweight and for overweight. Both formulas were found to be practicable, the consideration of the subjective weight status (formula 2) resulted in a greater change in prevalences compared to the first correction formula.