[Early childhood intervention and children's health development : Exemplary findings and methodological challenges in the use of the school entry examination]. / Angebote Früher Hilfen und gesundheitliche Entwicklung von Kindern : Exemplarische Befunde und methodische Herausforderungen bei der Nutzung der Schuleingangsuntersuchung.

BACKGROUND: Early childhood intervention is intended to systematically network and customise support services, particularly for socio-economically disadvantaged families. The programmes are universal or selective, but the evidence on their effectiveness is limited. AIMS: The aims of this study were to exemplary analyse whether participants in early childhood intervention services had better development than non-participants using the school entry examination (SEE) as well as to discuss to what extent the SEE can be used to assess the impact of early childhood intervention services. METHODS: We analysed three typical offers of early childhood intervention services (family education; Zukunft für Kinder (ZfK); Kita-U) in relation to full vaccination coverage and age-appropriate development at U9. Data from 4579 Düsseldorf first graders were included. Propensity score matching was used to calculate percentage differences (average treatment effect on the treated; ATT) in terms of immunisation coverage and development between comparable intervention and control groups. RESULTS: All programmes are associated with a slightly increased probability of full vaccination protection (ATT 2.1 for family education; 2.5 for ZfK; 5.3 for Kita-U). Family education is also associated with a slightly higher probability of age-appropriate development (ATT 1.6), while the probability of age-appropriate development is lower for participants in ZfK (-10.1) and Kita­U (-4.5). DISCUSSION: The evaluation of early childhood intervention, especially selective services, is a methodological challenge due to confounding and suitable comparison groups. However, the SEE could be a framework for impact analyses under specific conditions.

[Does Vocational Reintegration After Medical Rehabilitation Differ in Terms of Social Status and Type of Rehabilitative Care?] / Unterscheidet sich die berufliche Wiedereingliederung nach medizinscher Rehabilitation bezüglich Sozialstatus und Art der rehabilitativen Versorgung?

BACKGROUND: Employees in a low socio-economic position (SEP) are more likely to leave the labour market after medical rehabilitation for health reasons than those in a better social position. So far, almost nothing is known about whether certain types of rehabilitative care can reduce this inequality in rehabilitation success. This paper examines whether certain types of care modify the SEP's influence on return-to-work (RTW). METHOD: The study is based on administrative data from the German statutory pension insurance on 266,413 medical rehabilitations of 253,311 persons fully integrated into working life. Poisson regression analyses were used to check whether there was a correlation between SEP (income, education, occupational position) and the probability of RTW in the year following the measure, and whether this correlation was lower in follow-up treatment (AHB), inpatient treatment or treatment with subsequent graded RTW compared to rehabilitation that did not meet these characteristics. RESULTS: People with a low income, education or occupational position were at increased risk of incomplete return to work after medical rehabilitation. This correlation was comparatively lower for all 3 SEP indicators when the return to work was gradual. In the case of AHB and inpatient rehabilitation, this only applied to income. CONCLUSION: Socio-economically disadvantaged population groups are comparatively more likely not to return fully to work after medical rehabilitation. These inequalities are less pronounced for certain types of rehabilitative care. This tends to be the case with an active structuring role of the care system. However, there is a need for further research on the modification of effects by the type of treatment. This should be further investigated using data collected for this purpose to exclude selection effects.

Neighbourhood deprivation and obesity among 5656 pre-school children-findings from mandatory school enrollment examinations.

The risk of child obesity is strongly related to socioeconomic factors such as individual socioeconomic position (SEP) and neighbourhood deprivation. The present study analyses whether the relationship between neighbourhood deprivation and child obesity differs by child's individual SEP. Data from 5656 children (5-7 years) from the mandatory school enrollment examinations of the pre-school cohorts 2017/2018 in Düsseldorf were analysed. Obesity was determined by the age- and gender-specific body mass index (BMI); neighbourhood deprivation by using the socio-spatial degree of deprivation of the children's residential addresses; and individual SEP by the level of parental education. Using Poisson regression, we estimated prevalence ratios (PR with 95% confidence interval (CI)) of child obesity by neighbourhood deprivation and parental education. Interactions between neighbourhood deprivation and parental education were tested. The prevalence of child obesity increases with the degree of neighbourhood deprivation. Compared to children living in low deprivation neighbourhoods, the proportion of obese children was twice as high in high deprivation neighbourhoods (PR=2.02; CI=1.46-2.78). Likewise, children from families with medium and low education have twice the risk for obesity compared to children with high parental education (PR=2.05; CI=1.46-2.78). The relationship between neighbourhood deprivation and child obesity was significantly moderated by parental education; it was stronger for higher parental education than for medium and low parental education (p<.001).Conclusion: Our findings suggest that children from deprived neighbourhoods and families with lower education have a higher risk for child obesity. The identification of particularly deprived neighbourhoods with structural interventions in combination with the strengthening of parental health literacy seems reasonable. What is Known: • Studies show that children from disadvantaged neighbourhoods are more frequently obese. What is New: • The relationship between neighbourhood deprivation and child obesity is significantly moderated by parental education. It is stronger for children with higher parental education than for children with medium and low parental education.

Reminder system for health screening in early childhood - an analysis regarding different social circumstances.

BACKGROUND: Children with a low socio-economic position (SEP) participate in prevention and health examinations less often. In order to increase participation, reminder systems have been implemented in Germany since 2009. The aim of the study is to investigate whether this implementation is associated with an increased participation in health examination in early childhood for children in disadvantaged social circumstances. METHODS: We used data from the school enrolment examination from 2002 to 2017 from the city of Duesseldorf (n = 64,883 children). With a trend analysis we observed health examination over time and we compared rates of children after implementation of the reminder system (2010 or later) to those who were not exposed to the programme (earlier than 2010). Health examination was measured by participation in the last examination before school entry ("U9") documented by paediatricians. Social circumstances included neighbourhood deprivation (very high to very low), migration background (foreign first language vs. German) and family status (one-parent vs. two-parent families). Poisson regression estimated adjusted Prevalence Ratios (PR) with a 95% confidence interval (CI) of U9 participation by reminder system exposure, both for the total population and within groups of social circumstances. Based on that, we calculated adjusted participation rates (predictive margins) by reminder system exposure for the different social circumstances. RESULTS: Participation rates increased slightly, but gradually over time. The probability of U9 participation for children exposed to the reminder system is 1.04-fold (1.03-1.04 CI) compared to children who were not exposed to it. The association of the reminder system and U9 participation differs according to social circumstances. Adjusted prevalences increased the most in the group of children from very deprived neighbourhoods, ranging from 84.3 to 91.4% (PR = 1.07; 1.03-1.10 CI); in all language groups; more in children from one-parent families ranging from 82.4 to 88.9% (PR = 1.07; 1.05-1.09 CI). CONCLUSION: Our results suggest that reminder systems have a moderate impact on the participation in health examinations in early childhood in the general population. In vulnerable groups, however, they could make a difference. Reminder systems should be combined with further activities of tailored prevention.

Social inequalities in medical rehabilitation outcomes-a registry-based study on 219 584 insured persons in Germany.

BACKGROUND: Given limited knowledge on the extent of social inequalities in longer-term work ability of people with a chronic disease, this study analyzes social inequalities of three consecutive indicators of work ability following medical rehabilitation in a large sample of insured employees. METHODS: Based on data from the German statutory pension insurance, a representative 20% random sample of all employed persons undergoing medical rehabilitation between 2006 and 2008 was included in a longitudinal analysis (n=219 584 persons). Three measures of consecutive work-related outcomes (physicians' assessment of work ability at discharge; return to work in the year thereafter; disability pension during follow-up) and socioeconomic position (SEP) (education, occupational position and income) were assessed. Adjusted relative risks (RRs) for each outcome were calculated according to SEP, applying Poisson regression analysis. RESULTS: The measures of SEP were associated with all three outcomes of work ability in the fully adjusted models. Relatively strongest relationships were observed for education as SEP measure, and they were particularly pronounced for 'low work ability' (RR=2.38 for lower secondary education compared to tertiary education; 95% CI: 2.26-2.51). Based on average marginal effects, absolute differences of work ability by SEP indicate a socially graded pattern, with only few exceptions. CONCLUSIONS: Despite Germany's universal access to medical and vocational rehabilitation social inequalities in longer-term work ability following chronic disease persist, thus calling for targeted programmes of prevention and occupational health promotion.

[Social inequality in reduced earning capacity among older employees : An analysis of routine data of the German statutory pension insurance]. / Soziale Ungleichheiten der Erwerbsminderung bei älteren Arbeitnehmern : Eine Analyse von Routinedaten der Deutschen Rentenversicherung.

BACKGROUND: The efforts to extend working lives are accompanied by the question of whether it is possible for all employees to work longer for health reasons. Existing studies show for example that particularly workers in a lower socioeconomic position have a comparatively higher risk to prematurely retire. It is therefore likely that an increase of the state pension age puts particular pressure on such workers; however, studies on socioeconomic differences of disability retirement focusing on older workers in Germany are missing. OBJECTIVE: The aim of this study was to investigate whether social inequality exists for reduced earning capacity also for older workers. MATERIAL AND METHODS: The study relied on administrative data of the German pension insurance (DRV). Detailed information on the course of insurance was available for a random sample of all insured persons born in the years 1947 and 1961 (aged 59 and 45 years respectively at the beginning of the observational period; n = 160,688). Using Cox regressions (adjusted for working hours, national citizenship and location of workplace) associations between three socioeconomic features (education, occupation and income) and the risk of disability retirement in the observational period were investigated. The analysis was carried out separately for both cohorts (born 1947 and 1961) of younger and older employees and separately for men and women. RESULTS AND CONCLUSION: The results showed an increased risk of reduction in earning capacity even for older workers with a low socioeconomic position compared to those in a higher position. For men this is true for all three socioeconomic features investigated and both cohorts. For women the association was also observed with the exception of education and occupational position for those born in 1947. In the efforts to extend working lives, special attention should be paid to persons in lower socioeconomic positions in order to protect them from new disadvantages.

Age differences in the association between stressful work and sickness absence among full-time employed workers: evidence from the German socio-economic panel.

PURPOSE: We aim to extend current knowledge on associations between stressful work and sickness absence, first, by studying associations between ERI and sickness absence among full-time employees from various occupations, and second, by investigating if associations vary by age. METHODS: We use data from four waves of the German socio-economic panel (GSOEP), collected among men and women between 2006 and 2012, with 9418 observations. Stressful work is measured with a short form of the ERI questionnaire. We investigate an imbalance between effort and reward (ER ratio) as well as the two main components ("high effort" and "low reward"). Sickness absence is measured by self-reported number of sickness days (assessed the following year). After descriptive analyses, we estimate a series of multivariable regressions, including tests for interactions between age and work stress. RESULTS: Each of the three indicators of stressful work is related to higher number of sickness days, with except of "high effort" in case of men. Findings remain significant after adjusting for social position (income, education and occupational class) and health. In addition, for both men and women, associations were slightly higher among older workers, though interactions did not reach statistical significance. CONCLUSION: Our findings support that stressful work is linked to sickness absence across a wide spectrum of jobs with varying incomes and educational levels, and also that associations are slightly more pronounced among older workers.

Applicability of stroke volume variation in patients of a general intensive care unit: a longitudinal observational study.

Sinus rhythm (SR) and controlled mechanical ventilation (CV) are mandatory for the applicability of respiratory changes of the arterial curve such as stroke volume variation (SVV) to predict fluid-responsiveness. Furthermore, several secondary limitations including tidal volumes <8 mL/kg and SVV-values within the "gray zone" of 9-13% impair prediction of fluid-responsiveness by SVV. Therefore, we investigated the prevalence of these four conditions in general ICU-patients. This longitudinal observational study analyzed a prospectively maintained haemodynamic database including 4801 transpulmonary thermodilution and pulse contour analysis measurements of 278 patients (APACHE-II 21.0 ± 7.4). The main underlying diseases were cirrhosis (32%), sepsis (28%), and ARDS (17%). The prevalence of SR and CV was only 19.4% (54/278) in the first measurements (primary endpoint), 18.8% (902/4801) in all measurements and 26.5% (9/34) in measurements with MAP < 65 mmHg and CI < 2.5 L/min/m2 and vasopressor therapy. In 69.1% (192/278) of the first measurements and in 65.9% (3165/4801) of all measurements the patients had SR but did not have CV. In 1.8% (5/278) of the first measurements and in 2.5% (119/4801) of all measurements the patients had CV but lacked SR. In 9.7% (27/278) of the first measurements and in 12.8% (615/4801) of all measurements the patients did neither have SR nor CV. Only 20 of 278 (7.2%) of the first measurements and 8.2% of all measurements fulfilled both major criteria (CV, SR) and both minor criteria for the applicability of SVV. The applicability of SVV in ICU-patients is limited due to the absence of mandatory criteria during the majority of measurements.

A systematic database-derived approach to improve indexation of transpulmonary thermodilution-derived global end-diastolic volume.

Global end-diastolic volume (GEDV) has been indexed to body surface area (BSA). However, data validating this indexation of GEDV are scarce. Furthermore, it has been suggested to index GEDV to "predicted BSA" based on predicted body weight. Therefore, we aimed to identify biometric parameters independently associated with GEDV. We analyzed a database including 3812 TPTD measurements in 234 patients treated in the ICU of a German university hospital. GEDVI indexed to actual BSA was significantly lower than GEDVI indexed to predicted BSA (748 ± 179 vs. 804 ± 190 mL/m2; p < 0.001). GEDV was independently associated with older age, male sex, height, and actual body weight. In a regression model for the estimation of GEDV, age and height were the most important parameters: Each year in age and each cm in height increased GEDV by 9 and 15 mL, respectively. In addition to height and weight also age and sex should be considered for indexation of GEDV.

Does the Association between Preschool Media Use and Language Difficulties at School Entry Vary by First Language of the Child and Parental Education?

BACKGROUND: Both media use and social background affect children's language development. The aim of this study was to explore the association between media use and different aspects of language difficulties (grammar, auditory memory, articulation) and social background (first language (FL), parental education (PE)) in more detail. METHODS: We analyzed data from 4015 children from the 2013/14 school entry examination in a Western German city. Media use, FL, and PE were assessed by social history, and language difficulties by sociopediatric screening. We calculated Prevalence Ratios with a 95% Confidence Interval for language difficulties by media use and FL/PE; compared models with and without interaction terms; and estimated the predicted prevalence of language difficulties by media use and FL/PE. RESULTS: Children with non-German FL/low PE had a higher media use and more language difficulties. However, the gradual association between media use and grammatical abilities/recommendation of training was more pronounced in children with German FL and medium/high PE. e.g., especially in the preposition subtest. CONCLUSIONS: The association between media use and language difficulties varies regarding different aspects of social background and language difficulties. Still, extensive media use is linked with language difficulties for all children. The media competence of young families remains crucial in times of digitalization.

Is the Level of Motor Development at School Entry Related to the Use of Municipal Exercise Programs? A Social-Differential Analysis.

Children's motor development is socially unevenly distributed despite many municipal exercise programs (EXP). It has not been sufficiently investigated whether and how they appeal to children from different social backgrounds. This study investigates the use of municipal EXP in preschool age and the association between participation and motor development considering social circumstances. In school entry health examinations, parents were asked about participating in various EXP (response = 65.5%; n = 6480). Motor development, i.e., body coordination and visual-motor coordination, were assessed by a social pediatric development screening, and social circumstances by migration background (MB) and parental education (PE). Poisson regression estimated adjusted Incidence Rate Ratios (IRR; 95% confidence interval, 95%-CI) for relationships between social circumstances and participation in programs and participation and body coordination/visual-motor coordination. Children with MB (IRR 0.73; 95%-CI 0.71-0.75) and low PE (IRR 0.45; 95%-CI 0.40-0.50) used EXP less often. Children participating less often have a finding in body- (IRR 0.76; 95%-CI 0.63-0.90) and visual-motor coordination (IRR 0.47; 95%-CI 0.35-0.62). Significant effects were found for children with and without MB and higher PE. Municipalities should make EXP more attractive for families with MB and low PE.

Radiation Dose Reduction in CT Torsion Measurement of the Lower Limb: Introduction of a New Ultra-Low Dose Protocol.

This study analyzed the radiation exposure of a new ultra-low dose (ULD) protocol compared to a high-quality (HQ) protocol for CT-torsion measurement of the lower limb. The analyzed patients (n = 60) were examined in the period March to October 2019. In total, 30 consecutive patients were examined with the HQ and 30 consecutive patients with the new ULD protocol comprising automatic tube voltage selection, automatic exposure control, and iterative image reconstruction algorithms. Radiation dose parameters as well as the contrast-to-noise ratio (CNR) and diagnostic confidence (DC; rated by two radiologists) were analyzed and potential predictor variables, such as body mass index and body volume, were assessed. The new ULD protocol resulted in significantly lower radiation dose parameters, with a reduction of the median total dose equivalent to 0.17 mSv in the ULD protocol compared to 4.37 mSv in the HQ protocol (p < 0.001). Both groups showed no significant differences in regard to other parameters (p = 0.344-0.923). CNR was 12.2% lower using the new ULD protocol (p = 0.033). DC was rated best by both readers in every HQ CT and in every ULD CT. The new ULD protocol for CT-torsion measurement of the lower limb resulted in a 96% decrease of radiation exposure down to the level of a single pelvic radiograph while maintaining good image quality.

Indexation of cardiac output to biometric parameters in critically ill patients: A systematic analysis of a transpulmonary thermodilution-derived database.

PURPOSE: Cardiac output (CO) (liters per minute) is usually normalized (ie, indexed) to the patient's body surface area (BSA) resulting in the hemodynamic variable cardiac index (CI) (liters per minute per square meter). We aimed (1) to evaluate the impact of different body weight-based CO indexations on the resulting CI values and (2) to identify biometric parameters independently associated with CO in critically ill patients. MATERIALS AND METHODS: The study is an analysis of a database containing transpulmonary thermodilution-derived hemodynamic variables of 234 medical intensive care unit patients. RESULTS: Cardiac index indexed to actual BSA was statistically significantly lower compared with CI indexed to predicted BSA in the totality of patients and in the subgroups of patients with body mass index greater than or equal to 25 kg/m(2) but less than 30 kg/m(2) and body mass index greater than or equal to 30 kg/m(2) (with a statistically significant difference in the proportion of low and high CI measurements). Multivariate analysis of the first CO measurement of each patient demonstrated that CO was independently associated with age (P < .001), height (P = .001), and actual body weight (BWact) (P = .030). Multivariate analysis of the mean of the patients' CO measurements confirmed age (P < .001), height (P = .001), and BWact (P < .001) as biometric factors independently associated with CO. Age was identified as the most important factor with each year of age decreasing CO by 66 mL/min (95% confidence interval, 47-86 mL/min). CONCLUSIONS: The indexation of CO to BSA is highly dependent on the body weight estimation formula used to calculate BSA. Cardiac output is independently associated with the biometric factors age, height, and BWact. These factors might be considered for indexation of CO.

Typical dreams: stability and gender differences.

Although the variability of dream content is large, typical dream themes that occur quite often and are reported by many people can be identified (e.g., being chased, falling, flying, failing an examination, being unable to find a toilet or restroom). The present study is an investigation of the stability of the rank order of the dream themes and of gender differences in the content of dreams. The authors administered A. L. Zadra and T. A. Nielsen's (1997) Typical Dream Questionnaire to 444 participants. The findings indicated that most of the 55 dream themes occurred at least once in most of the participants' lifetimes. In addition, the correlation coefficients for the rank order of the themes were very high; that is, the relative frequencies were stable. The gender differences in the present study were in line with content analytic findings; for example, men reported dreams about physical aggression more often than did women. Overall, previous research and the present data indicate that available research results of the measurement of typical dream themes are reliable and valid. The question of the meaning of these themes or the relationship between typical dream contents and waking life experiences, however, has not yet been answered and is open to future research.

Extravascular lung water and its association with weight, height, age, and gender: a study in intensive care unit patients.

PURPOSE: With regard to large inter-individual variability of height, body weight (BW), and age, several hemodynamic parameters are adjusted for biometric data. This also applies to extravascular lung water (EVLW), which traditionally was indexed to actual BW (BW-act) resulting in EVLW-index (EVLWI; i.e., EVLWI-act). Since indexation to BW-act might inappropriately diminish EVLWI-act in obese patients, the indexation has been changed to predicted BW (BW-pred) resulting in EVLWI-pred. BW-pred is a weight estimation formula calculated from height and gender that has not been derived from population-based data. The aim of the study was to investigate the independent association of biometric data with EVLW. METHODS: We analyzed a hemodynamic monitoring database including 3,691 transpulmonary thermodilution-derived EVLW measurements (234 consecutive patients; intensive care unit of a university hospital). We performed univariate and multivariate analyses regarding the association of biometric data with the first EVLW measurement and the mean EVLW value of each patient. RESULTS: In univariate analysis, the first EVLW significantly correlated with height (r = 0.254; p < 0.001), but neither with age nor BW-act. Similar findings were made in the analysis of the patients' EVLW means of all measurements ("one point per patient"). In multivariate analysis (primary endpoint), including BW-act, height, age, and gender, only height was independently associated with EVLW, with each centimeter of height increasing the first measurement of EVLW by 6.882 mL (p < 0.001) and mean EVLW by 6.727 mL (p < 0.001). CONCLUSIONS: Height is the only biometric parameter independently associated with the first and mean EVLW. In adult patients, EVLW should be indexed to height.

Factors of home dream recall: a structural equation model.

Previous research has indicated that personality factors such as openness to experience, creativity, visual memory, attitude toward dreams, and sleep behavior is related to home dream recall frequency (DRF). However, a study investigating all areas simultaneously within one sample in order to determine the percentage of variance explained by all variables and to take intercorrelations between the influencing factors into account has not been performed till now. The present study with 444 participants fills this gap. Using several indicators for each of the variables mentioned above, a structural equation model was tested. Although the model fit was satisfying, the four factors which were significantly related to DRF: personality (openness to experience, thin boundaries, absorption), creativity, nocturnal awakenings, and attitude toward dreams, explained only 8.4% of the total variance. As this value is considerably lower than those of studies investigating a single influencing factor and using similar measurement instruments in similar samples, one might speculate about possible expectancy effects in these previous studies, an effect which has been demonstrated for DRF in the laboratory setting. In addition, the small percentage of explained variance of each single factors (<3%) may indicate that other, in this study unmeasured, variables such as sleep duration (state aspect), introspection, and cognitive functioning immediately upon awakening (sleep inertia) show substantial covariance with the interindividual differences in DRF. Future studies should focus on longitudinal aspects in order to differentiate between state versus trait factors (although methodologic issues, e.g. the effect of the measurement technique on DRF itself, have to be clarified) and investigate additional variables which might be associated with DRF (see above).