[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.

[Seroprevalence of SARS-CoV-2 among children and adolescents in Germany-an overview]. / SARS-CoV-2-Seroprävalenz bei Kindern und Jugendlichen in Deutschland ­ ein Überblick.

BACKGROUND: SARS-CoV­2 serologic studies complement and expand findings from confirmed COVID-19 cases through identification of undetected cases. OBJECTIVES: This article summarizes previous results on SARS-CoV­2 prevalence from seroepidemiological studies in Germany focusing on children and adolescents and complements the already existing overview on seroprevalence in adults from general population samples and especially blood donors in Germany. METHODS: The results are based on an ongoing systematic search in study registries, in literature databases, of preprint publications, and of media reports of seroepidemiological studies in Germany and their results. RESULTS: As of 17 September 2021, we are aware of 16 German seroepidemiological studies focusing on children and adolescents. Results are available for nine of these studies. For almost all settings studied, SARS-CoV­2 seroprevalence was well below 1% for preschool and elementary school children in the first COVID-19 wave and below 2% for adolescents. As the pandemic progressed, higher seroprevalences of up to 8% were found in elementary school children. DISCUSSION: Results of SARS-CoV­2 antibody studies in children and adolescents in Germany are scarce so far and are based on non-representative samples at local or regional level. In future studies, it is necessary on the one hand to estimate which proportion of children and adolescents has already either had an infection or has been vaccinated. On the other hand, it is important to investigate physical and mental health impairments that occur after an infection.

Frequent attenders in the German healthcare system: determinants of high utilization of primary care services. Results from the cross-sectional German health interview and examination survey for adults (DEGS).

BACKGROUND: In Germany, patients are consulting general practitioners increasingly frequently, resulting in a high burden on the healthcare system. This study aimed to identify factors associated with frequent primary care attendance in the German healthcare system. METHODS: The German Health Interview and Examination Survey for Adults (DEGS) is part of Germany's national health monitoring, and includes a large representative sample of the German population aged 18-79 years. We defined the 10% of participants with the highest number of general practitioner contacts in the preceding 12 months as frequent attenders of primary care services. Binary logistic regression models with average marginal effects were used to identify potential determinants for frequent use of primary care services. RESULTS: The sample comprised 7956 participants. Significant effects on frequent use of primary care were observed for low socioeconomic status, stressful life events, factors related to medical need for care such as medically diagnosed chronic conditions and for subjective health. In the full model, the number of non-communicable diseases and subjective health status had the strongest effect on frequent primary care use. We found an interaction effect suggesting that the association between subjective health status and frequent attendance vanishes with a higher number of non-communicable diseases. CONCLUSIONS: We observed strong associations between frequent primary care attendance and medical need for care as well as subjective health-related factors. These findings suggest that better coordination of care may be a preferred method to manage health services utilization and to avoid redundant examinations and uncoordinated clinical pathways. Further research is needed to clarify moderating and mediating factors contributing to high utilization of primary care services.

[Federal health reporting at the Robert Koch Institute-status quo and current developments]. / Gesundheitsberichterstattung des Bundes am Robert Koch-Institut ­ Status quo und aktuelle Entwicklungen.

Health reporting as an integral part of public health plays an important role in the development of strategies and concepts that aim to improve the health of all population groups. This article provides an overview of the definition and tasks of federal health reporting and describes important health reporting components in their current form. The publication format of the Journal of Health Monitoring, which was developed for different user groups of health monitoring, is presented. Examples of the uses and effects of health reporting are also presented. Health reporting is designed as a flexible system: changes in databases as well as forms of communication are taken into account in the further development of health reporting.The further development of health reporting requires close interdisciplinary cooperation between different actors in order to integrate current research results from various scientific disciplines into the processes of health reporting, as well as to further expand the scope and impact of health reporting. In addition, to further develop health reporting on a scientific level, the expansion of participatory elements and a stronger internationalization will be important future tasks.

[Regional differences in the development of hospitalizations : An effect of different demographic trends?] / Regionale Unterschiede der Entwicklung der Krankenhausbehandlungen : Effekt unterschiedlicher demografischer Trends?

Population aging and population decline in many regions of the Federal Republic of Germany are key elements of demographic change. In the regions concerned there is a rising number of older people and, simultaneously, a declining population. So far, the consequences of regional shrinkage and growth for inpatient care don't seem to have been analysed very well. This paper analyses the influence of population aging and declining/increasing population (demographic factors) as well as other, non-demographic factors on the number of hospitalizations in Germany and the Federal States since 2000.One result of the analysis is that there are major differences between the Federal States. The analysis shows, for example, an increase of hospitalizations in Berlin while in Saxony-Anhalt the number of hospitalizations declines. The increase in Berlin was the result of population aging and, to a lower extent, an increase in population. In Saxony-Anhalt the declining population resulted in a decreasing number of hospitalizations. Population aging and non-demographic factors were not able to compensate this trend.Overall, the effect of demographic factors on the number of hospitalizations remains constant over time. Short-term changes of hospitalizations are due to non-demographic factors, such as epidemiological trends, (for example trends of incidence or prevalence), or structural changes of health care service (for example patients shifting between different sectors of health care or the introduction of new reimbursement systems).

[Data on palliative care in Germany : Which data sources are available and what do they tell?] / Daten zur Palliativversorgung in Deutschland : Welche Datenquellen gibt es, und was sagen sie aus?

Palliative care is more and more in the focus of politics and the public. Although provision and utilization of palliative care have increased considerably in recent years, there is still a great need for palliative services and a comprehensive supply has not yet been achieved. Reliable and continually available data are indispensable to describe developments in Germany, to identify existing gaps in palliative care provision, and to assess the impact of relevant policies. In this article, we present a systematic outline of publicly available data sources on palliative care in Germany and point out their potentials and limitations. We show that mainly data on palliative care provision are available. Data on utilization are basically limited to inpatient and specialized outpatient palliative care ("spezialisierte ambulante Palliativversorgung", SAPV). Periodical analyses of routine data, e. g. from statutory health insurances or from the Association of Statutory Health Insurance Physicians, would be helpful to fill these data gaps. Monitoring the sociodemographic characteristics of users of palliative care could also be of major interest. Another important indicator is the place of death. The difference between the places where people die and where they wish to die indicates that there is a continuous need to strengthen outpatient structures of palliative care.

[Data on disability and participation in Germany : Requirements, analysis options and results]. / Daten zu Behinderung und Teilhabe in Deutschland : Anforderungen, Auswertungsmöglichkeiten und Ergebnisse.

As a basis for political decisions and to meet the statistical requirements of the CRPD, reliable data and reporting on the situation of people with disabilities are essential. Based on results of the preliminary study for a German participation survey, this article firstly defines data requirements and areas of participation. Secondly, data sources regarding participation and disability in Germany that were identified in a literature search are described in detail. Only sources providing population-based data that are collected on a regular basis and that could contribute to participation reporting were taken into account. This includes data from official statistics, (panel) studies or surveys, administrative data and reporting systems. Finally, we exemplarily present the main statistical findings of the 2012 European health and social integration survey (EHSIS), a survey that was specifically designed to investigate participation of persons with disabilities. In addition to the surveys identified in the preliminary study for a German participation survey that could be used or expanded for participation reporting, and the data sources used in the participation report published by the federal government in 2013, the research yielded further publicly available data sources with a high potential for a participation reporting system.

Correction: Starker et al. Intention for Screening Colonoscopy among Previous Non-Participants: Results of a Representative Cross-Sectional Study in Germany. Int. J. Environ. Res. Public Health 2021, 18, 4160.

In the published publication [...].

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.

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.

Limitations in activities of daily living and support needs - Analysis of GEDA 2019/2020-EHIS.

Being able to perform activities of daily living is an important component of a person's ability to function. If these activities are impaired, support is needed. Using data from GEDA 2019/2020-EHIS, we present how many people aged 55 and older living in private households in Germany experience limitations in activities of daily living. Severe limitations in basic (fundamental) activities (e.g. food intake) are reported by 5.8% of women and 3.7% of men. The proportion increases with age as 13.4% of women and 9.0% of men aged 80 and older experience limitations. Severe limitations of instrumental activities of daily living (e.g. grocery shopping) are rather rare in participants less than 80 years of age. But at age 80 and older the proportion rises to 35.9% of women and 21.0% of men. A total of 68.1% of afflicted women and 57.5% of men receive help and support related to limitations of basic activities. Women are also more likely to report a lack of support (48.8% vs. 43.2%). The situation is slightly better with regard to instrumental activities. The results of GEDA 2019/2020-EHIS show in which areas of daily life older and very old people are impaired, give an impression of who is affected particularly strongly and indicate where support services are insufficient. As such, these results provide clues as to where support can be provided to enable older people to keep living in their own homes for a long time.

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.

Non-utilisation of health care services during the COVID-19 pandemic: Results of the CoMoLo study.

Based on data from the CORONA-MONITORING lokal (CoMoLo) study conducted in four municipalities particularly affected by the COVID-19 pandemic, this article investigates the non-utilisation of health care services in the population aged 18 years and older (n=9,002) in relation to the period after the introduction of the containment measures in March 2020. The results show that about one third of the respondents (35.5%) gave up at least one of the surveyed health care services. The most frequent cancellations were dental (15.2%) and specialist check-ups (11.8%), followed by postponement of physiotherapy, ergotherapy or speech therapy (6.1%), cancellation of general practitioner (GP) check-ups (5.8%), postponement of psychotherapy (2.0%), postponement of planned hospital treatment (1.8%) and not going to an emergency room (0.7%). Almost 10% of the respondents reported not visiting a physician despite health complaints. Compared to respondents without such a waiver, these respondents were more often female and younger than 35 years, less often rated their health as very good or good, more often had a diagnosis of depression and more often used telemedical contacts as an alternative to visiting the practice during the pandemic. Further analyses of trends in utilisation behaviour and changes in health status over the course of the COVID-19 pandemic are important.

[Evidence syntheses in public health: An overview]. / Evidenzsynthesen in Public Health: ein Überblick.

BACKGROUND: Since the beginning of the COVID-19 pandemic, there has been a high demand for rapid evidence syntheses to answer urgent public health questions. This article provides an overview of different types of reviews for public health questions and a synthesis of existing recommendations for the preparation of reviews. The aim is to support the planning of one's own review and the critical evaluation of published reviews. METHODS: The basis of this summary is an extensive search for guidelines and recommendations for different review types. Furthermore, internal journal clubs were held to determine knowledge needs and to critically discuss the various review types. Relating to the dissemination of results, fact sheets were developed for the individual review types including the most important information, prerequisites and work steps, as well as a decision tree for identifying the appropriate review type for the respective question. RESULTS: Of the review types identified, Systematic, Rapid, Scoping, Umbrella, and Narrative Reviews were considered in more detail because they are particularly relevant to public health issues. Together with scoping and umbrella reviews, systematic reviews have the highest resource requirements due to the demands for extensive, systematic evidence synthesis and reproducibility. Rapid methods can accelerate the review process, for example by a very narrowly formulated question, a limited literature search, or the execution of certain steps by one instead of two persons. DISCUSSION: Systematic Reviews may be considered as the gold standard, but they were developed primarily for clinical questions relating to interventions. This article, however, focusses on review types that consider the diversity of questions as well as the predominant use of quantitative methods in the field of public health. The fact sheets developed and the decision tree should enable low-threshold access to reviews while linking the perspectives of research and resource planning. They complement existing guidelines and recommendations. CONCLUSION: To answer the diverse spectrum of public health questions, various types of reviews with various requirements and approaches are available. Given this diversity, a systematic introduction can be helpful for researchers planning or assessing a review.

Survey of sex/gender diversity in the GEDA 2019/2020-EHIS study - objectives, procedure and experiences.

Sex/gender diversity is increasingly recognised by society and should be taken into account more in population-representative studies, as they are important data sources for targeting health promotion, prevention and care. In 2019, the Robert Koch Institute started a population-representative health survey with the study Health in Germany Update (GEDA 2019/2020-EHIS) with a modified, two-stage measures of sex/gender. The survey covered sex registered at birth and gender identity with an open response option. This article describes the aims, the procedure and the experiences with the operationalisation of sex/gender and the results. Out of 23,001 respondents, 22,826 persons are classified as cisgender, 113 persons as transgender and 29 persons as gender-diverse. 33 respondents were counted as having missing values. A survey of interviewers showed that the two-stage measures of sex/gender had a high level of acceptance overall and that there were only a few interview drop-outs. On the basis of previous experience, the modified query can be used for further surveys, but should also be adapted in perspective. For this purpose, participatory studies are desirable that focus on how the acceptance of measures of sex/gender can be further improved and how hurtful experiences in the context of the questions asked can be avoided.

Nationally representative results on SARS-CoV-2 seroprevalence and testing in Germany at the end of 2020.

Pre-vaccine SARS-CoV-2 seroprevalence data from Germany are scarce outside hotspots, and socioeconomic disparities remained largely unexplored. The nationwide representative RKI-SOEP study (15,122 participants, 18-99 years, 54% women) investigated seroprevalence and testing in a supplementary wave of the Socio-Economic-Panel conducted predominantly in October-November 2020. Self-collected oral-nasal swabs were PCR-positive in 0.4% and Euroimmun anti-SARS-CoV-2-S1-IgG ELISA from dry-capillary-blood antibody-positive in 1.3% (95% CI 0.9-1.7%, population-weighted, corrected for sensitivity = 0.811, specificity = 0.997). Seroprevalence was 1.7% (95% CI 1.2-2.3%) when additionally correcting for antibody decay. Overall infection prevalence including self-reports was 2.1%. We estimate 45% (95% CI 21-60%) undetected cases and lower detection in socioeconomically deprived districts. Prior SARS-CoV-2 testing was reported by 18% from the lower educational group vs. 25% and 26% from the medium and high educational group (p < 0.001, global test over three categories). Symptom-triggered test frequency was similar across educational groups. Routine testing was more common in low-educated adults, whereas travel-related testing and testing after contact with infected persons was more common in highly educated groups. This countrywide very low pre-vaccine seroprevalence in Germany at the end of 2020 can serve to evaluate the containment strategy. Our findings on social disparities indicate improvement potential in pandemic planning for people in socially disadvantaged circumstances.

Intention for Screening Colonoscopy among Previous Non-Participants: Results of a Representative Cross-Sectional Study in Germany.

Early detection of colorectal cancer has the potential to reduce mortality at population level. Colonoscopy is the preferred modality for colon cancer screening and prevention, but attendance rates are low. To exploit colonoscopy's preventive potential, it is necessary to identify the factors influencing uptake, especially among previous non-participants. This analysis of cross-sectional data involved 936 non-participants in screening colonoscopy aged 55 years or older in Germany. Differences between non-participants with and without future participation intentions were investigated in terms of socio-demographic factors, health status, attitudes and beliefs, and medical counselling. Logistic regression models were fitted to estimate associations between intention to participate and selected factors. Intention to participate was lower among women than among men. For both genders, intention to participate was positively associated with younger age. For women, higher socioeconomic status and counselling were positively associated with intention to participate. Men showed a positive association with favouring joint decision-making. The results draw attention to starting points for improving acceptance of and participation in screening colonoscopy. This includes good medical counselling and successful physician-patient communication, for which the information and communication skills of both medical professions and the general public should be strengthened. Gender differences should be considered.

Utilisation of outpatient medical services in Germany - Results from GEDA 2019/2020-EHIS.

Outpatient health care provision plays an important role in the identification and treatment of health problems. Data are needed on the utilisation of health care services and their determinants to enable health policy decision-making and needs-based care provision. The analyses set out in this article are based on current data on the utilisation of outpatient health care services. The data stem from the German Health Update (GEDA 2019/2020-EHIS), a nationwide cross-sectional survey of the resident population in Germany that is undertaken as part of the health monitoring conducted at the Robert Koch Institute. Around 80% of the population aged 18 or over were treated at least once within twelve months by a general practitioner, 60% by a specialist, and 10% received psychiatric or psychotherapeutic treatment. Less than half of those eligible had had a stool test during the past two years, and just over half had had a colonoscopy in the past ten years. Around 80% of women and 70% of men had had their blood pressure checked within the last year, and 60% had had their blood cholesterol or blood sugar levels monitored. Over 50% reported that they had taken medically prescribed drugs in the past two weeks. In general, most of the indicators under study suggest that utilisation increases with age and that utilisation is higher among women than men, with the exception of psychiatric and psychotherapeutic services, among others.

Reasons for women aged 50 years and older to seek gynaecological advice and treatment.

Gynaecological care is generally perceived as focused on reproductive health. However, when women enter the non-reproductive life phase, other reasons to seek gynaecological care gain in importance. This paper presents findings on the reasons for women in the 50 years and older age group to seek gynaecological consultation and treatment. Our findings are based on data from the German Health Interview and Examination Survey for Adults (DEGS1, 2008-2011), conducted by the Robert Koch Institute (RKI), as well as the 2016 claims data from the Associations of Statutory Health Insurance Physicians (KVen), provided by the Central Research Institute of Ambulatory Health Care in Germany (Zi). At this age, cancer screening and menopausal complaints can become, as DEGS1 data shows, important reasons to seek gynaecological services. Around 65.0% of 50- to 79-year-old women took advantage of breast palpation examinations during the last twelve months, and 58.0% underwent cervical cell smear tests (pap smear). 47.2% of women had their last menstrual period at age 50 or later. KV data shows that with 45.3% and 33.1% of cases respectively, menopausal symptoms (International Statistical Classification of Diseases and Related Health Problems, 10th revision, ICD-10: N95) and screening for malignant neoplasms (ICD 10: Z12) were the most frequently billed services. The data clearly shows reasons for consultation and treatment of women aged 50 years and older and these should therefore be considered in treatment planning and design.