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1.
Artigo em Alemão | MEDLINE | ID: mdl-31529182

RESUMO

In KiGGS Wave 2, data from 3­ to 17-year-olds were collected from a total of 3462 persons using a standardized interview on the current use of AM/NEM in the last seven days. For trends analysis, data from 14,679 study participants in the same age group from the KiGGS baseline study were used.In KiGGS Wave 2, 36.4% (95% CI 34.1-38.8) of the 3­ to 17-year-olds had used at least one AM/NEM in the last seven days. The prevalence was highest at 46.5% in 14- to 17-year-olds and significantly different between girls and boys (56.4% vs. 37.3%). Only among girls were there significant differences by migrant background with a higher prevalence of use among girls without a migrant background.Most frequently, the preparations used were for treatment of the respiratory tract (girls: 14.2%, boys: 14.9%), followed by "Varia" (girls: 8.7%, boys: 9.3%) and preparations for the treatment of the musculoskeletal system (girls: 8.9%, boys: 5.8%). There was a significant decrease in the overall prevalence of medicine use compared to the KiGGS baseline study (46.4% vs. 36.4%). This decrease was mainly due to lower prevalences of use in the ATC main groups "N Nervous System" (7.5% vs. 5.4%), "J Systemic Anti-infectives" (2.5% vs. 1.4%) and "H Systemic Hormones, excl. Sexual Hormones and Insulins" (2.0% vs. 1.1%).The results describe key points in the use of AM/NEM, including self-medication for children and adolescents in Germany. They illustrate the use behaviour and represent a valuable supplement to prescription data.


Assuntos
Suplementos Nutricionais/estatística & dados numéricos , Automedicação/estatística & dados numéricos , Adolescente , Saúde do Adolescente , Criança , Saúde da Criança , Estudos Transversais , Feminino , Alemanha/epidemiologia , Inquéritos Epidemiológicos , Humanos , Masculino , Prevalência
2.
Artigo em Alemão | MEDLINE | ID: mdl-31187183

RESUMO

BACKGROUND: The benefit of medicines in the secondary prevention of coronary heart disease (CHD) has been demonstrated in women and men. However, gender-specific differences have been observed in the prescription of these medicines. Information on trends in prevalence use in women and men from population-based studies are still lacking. METHODS: Data of people aged 40-79 years with CHD from the national health interview and examination surveys for adults in Germany from 1997-1999 (GNHIES98, n = 411) and from 2008-2011 (DEGS1, n = 440) were analyzed. Trend analyses via multivariable regression models, taking into account relevant covariables, were used to calculate the prevalence of medicine use in secondary prevention of CHD between GNHIES98 and DEGS1. The following groups were considered: antiplatelet, statins, beta-receptor blockers, agents acting on the renin-angiotensin system (RAS blocker), calcium-channel blockers, and nitrate. RESULTS: In one decade, the prevalence had increased for antiplatelet (24.0% vs. 59.6%), statins (18.5% vs. 56.2%), beta-receptor blockers (24.7% vs. 65.5%), and RAS blockers (31.6% vs. 69.0%). The prevalence of calcium-channel blockers (33.3% vs. 20.5%) and nitrate (40.6% vs. 10.1%) had decreased. In GNHIES98, men were more likely to use RAS blockers. Significant gender differences were found in DEGS1 only for angiotensin-converting-enzyme (ACE) inhibitors. CONCLUSION: This study showed an improvement in the use of drugs for the secondary prevention of CHD in both sexes.


Assuntos
Doença das Coronárias/epidemiologia , Adulto , Idoso , Inibidores da Enzima Conversora de Angiotensina , Doença das Coronárias/prevenção & controle , Feminino , Alemanha/epidemiologia , Inquéritos Epidemiológicos , Humanos , Masculino , Pessoa de Meia-Idade , Prevenção Secundária
3.
PLoS One ; 14(1): e0210695, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30640945

RESUMO

BACKGROUND: Use of psychotropic drugs is common among older adults. Population-based studies on the associations of psychotropic drug use with mortality are sparse. OBJECTIVES: To investigate the associations between the use of specific psychotropic drug groups (opioids, antipsychotics, antidepressants and benzodiazepines) and all-cause mortality among community-dwelling older adults in Germany. METHODS: Participants of the German National Health Interview and Examination Survey 1998 were followed up for mortality from 1997 to 2011. Persons aged 60-79 years with complete data on psychotropic drug use at baseline and on mortality follow-up were considered as study population (N = 1,563). Associations between the use of opioids, antipsychotics, antidepressants and benzodiazepines and all-cause mortality were examined by Cox proportional hazards models adjusted for sociodemographics (sex, age, community size, region, socioeconomic status), life style (smoking, sports, risky alcohol drinking) and health conditions (obesity, disability, history of cardiovascular diseases, diabetes, hyperlipidemia, hypertension, any cancers, any mental disorders) at baseline. RESULTS: After a median follow-up of 11.4 years, 21, 18, 23 and 26 deaths were documented among those who used at baseline opioids (n = 39), antipsychotics (n = 30), antidepressants (n = 53) and benzodiazepines (n = 54) with an unadjusted mortality rate (MR) of 57.7, 59.1, 44.6 and 53.7 per 1000 person-years, respectively. Meanwhile, 400 deaths were documented among 1,406 nonusers of any of the above mentioned psychotropic drugs with a MR of 26.7 per 1000 person-years. The age and sex adjusted mortality rate ratios in comparison with nonusers were 2.20 (95% confidence intervals 1.42-3.41), 1.66(1.03-2.70), 1.56(1.06-2.28), and 1.57(1.07-2.31) for the use of opioids, antipsychotics, antidepressants and benzodiazepines, respectively. In the fully adjusted Cox models, use of opioids (hazardous ratio 2.04, 95% confidence intervals 1.07-3.89), antipsychotics (2.15, 1.11-4.15) and benzodiazepines (1.76, 1.09-2.82), but not antidepressants, were significantly associated with an increased risk of mortality. CONCLUSIONS: Use of opioids, antipsychotics, benzodiazepines is significantly associated with an increased risk of all-cause mortality among community-dwelling older adults in Germany. Clinicians should be careful in prescribing these psychotropic drugs to older adults while patients already under psychotropic therapy should well balance the risks and benefits of drug use. Further studies with a larger sample size and information on specific indications for psychotropic drug use and mental comorbidities are required to confirm the findings of the present study.


Assuntos
Psicotrópicos/efeitos adversos , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Transtornos Relacionados ao Uso de Substâncias/mortalidade , Idoso , Analgésicos Opioides/efeitos adversos , Antidepressivos/efeitos adversos , Antipsicóticos/efeitos adversos , Benzodiazepinas/efeitos adversos , Feminino , Alemanha/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Fatores Socioeconômicos , Inquéritos e Questionários
4.
J Clin Epidemiol ; 105: 112-124, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30253216

RESUMO

OBJECTIVES: On the basis of current treatment guidelines, we developed and validated a medication-based chronic disease score (medCDS) and tested its association with all-cause mortality of older outpatients. STUDY DESIGN AND SETTING: Considering the most prevalent chronic diseases in the elderly German population, we compiled a list of evidence-based medicines used to treat these disorders. Based on this list, a score (medCDS) was developed to predict mortality using data of a large longitudinal cohort of older outpatients (training sample; MultiCare Cohort Study). By assessing receiver-operating characteristics (ROC) curves, the performance of medCDS was then confirmed in independent cohorts (ESTHER, KORA-Age) of community-dwelling older patients and compared with already existing medication-based scores and a score using selected anatomical-therapeutic-chemical (ATC) codes. RESULTS: The final medCDS score had an ROC area under the curve (AUC) of 0.73 (95% CI 0.70-0.76). In the validation cohorts, its ROC AUCs were 0.79 (0.76-0.82, KORA-Age) and 0.74 (0.71-0.78, ESTHER), which were superior to already existing medication-based scores (RxRisk, CDS) and scores based on pharmacological ATC code subgroups (ATC3) or age and sex alone (Age&Sex). CONCLUSIONS: A new medCDS, which is based on actual treatment standards, predicts mortality of older outpatients significantly better than already existing scores.


Assuntos
Doença Crônica , Vida Independente/estatística & dados numéricos , Conduta do Tratamento Medicamentoso/estatística & dados numéricos , Medição de Risco/métodos , Idoso , Idoso de 80 Anos ou mais , Causas de Morte , Doença Crônica/epidemiologia , Doença Crônica/terapia , Feminino , Alemanha/epidemiologia , Humanos , Masculino , Mortalidade , Multimorbidade , Valor Preditivo dos Testes , Prognóstico , Curva ROC , Projetos de Pesquisa
5.
Pharmacy (Basel) ; 6(2)2018 Jun 07.
Artigo em Inglês | MEDLINE | ID: mdl-29880765

RESUMO

In order to assess the effects of prescription-only (Rx) to over-the-counter (OTC) drug switches and related policies, it is imperative to distinguish self-medication from OTC drug use. The objective of this study was to estimate the OTC drug use in the adult population in Germany, to identify its predictors and to highlight methodological differences when compared to the study of a self-medication prevalence. Seven-day prevalence of OTC drug use was calculated on the basis of information provided by 7091 participants of the German Health Interview and Examination Survey for Adults (DEGS1) conducted between 2008 to 2011. Logistic regression analysis was used to identify predictors of OTC drug use. Seven-day prevalence of OTC drug use was higher in women (47.16%) than in men (33.17%). Female gender, an age of more than 60 years, reduced health status, Rx drug use, and multi-morbidity were identified as predictors of OTC drug use. The levels of OTC drug use were higher than the self-medication prevalence found in the same data set probably because some OTC drugs are commonly prescribed by physicians. Drug utilization studies should, therefore, make a methodological distinction between self-medication and OTC drug use depending on whether the focus is on drug safety or the impact of regulatory decisions on the trade status.

6.
Artigo em Alemão | MEDLINE | ID: mdl-29138901

RESUMO

BACKGROUND: Recent studies demonstrate a relationship between the prescription of potentially inappropriate medications (PIM) for patients 65 years or older and an increased risk for adverse events, in particular hospitalisations. The RKI conducted DEGS1-Survey ("German health interview and examination survey for adults") provides a representative sample of the target population to identify determinants for PIM use. OBJECTIVE: The aim of this study was to determine characteristics of older persons in Germany, who currently use PIM, and if there are subpopulations among older persons with a particularly high PIM use. METHODS: Within the DEGS1-Survey a total of 175 variables regarding health and social aspects were documented from 1392 community-dwelling persons between 65 and 79 years of age, and medication intake during the last seven days was recorded. PIM drugs were identified according to the PRISCUS list. Associations between PIM use and variables recorded were evaluated by means of multivariate statistical models. RESULTS: Within seven days before the survey PIM drugs were used by 13.0% (95%-CI: 10.7-15.6) of the respondents. The following factors significantly increase the risk for receiving a PIM: number of drugs taken in the last seven days; number of visits to different physician specialists during the last 12 months; sleep disorders; psychiatric condition, and diseases affecting the musculoskeletal system. The majority of PIMs were antidepressants and anxiolytics/sedatives. Elderly women with depression, sleep disorders, and a need for analgesics are particularly affected by increased PIM use. They deserve special attention in this regard.


Assuntos
Prescrição Inadequada/estatística & dados numéricos , Idoso , Comorbidade , Feminino , Medicina Geral/estatística & dados numéricos , Alemanha , Inquéritos Epidemiológicos , Humanos , Masculino , Admissão do Paciente/estatística & dados numéricos , Polimedicação , Fatores de Risco , Índice de Gravidade de Doença
7.
PLoS One ; 12(8): e0182432, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28792521

RESUMO

PURPOSE: To investigate the association of psychotropic drug use with falls among older adults in Germany based on data from the National Health Interview and Examination Survey for Adults 2008-2011 (DEGS1). METHODS: DEGS1 collected data on drug use in the past 7 days and on falls occurred in the last 12 months. Study participants were older adults aged 65-79 years with complete data on drug use and falls (N = 1,833). Odds ratio (OR) and 95% confidence intervals (95% CI) were derived from logistic regression models adjusting for potential confounders including socio-demographic characteristics, health-related behaviors (alcohol drinking), body mass index and health conditions (frailty, vision impairment, disability, polypharmacy, blood pressure) as well as use of potential falls-risk-increasing drugs. SPSS complex sample methods were used for statistical analysis. RESULTS: Compared to people without falls, people with falls (n = 370) had a higher psychotropic drug use (33.1% vs. 20.7%, p < .001). After adjusting for potential confounders, use of psychotropic drugs overall was associated with a higher risk of falls (OR 1.64, 95% CI 1.14-2.37). This was particularly true for the use of synthetic psychotropic drugs (1.57, 1.08-2.28), antidepressants overall (2.88, 1.63-5.09) or synthetic antidepressants (2.66, 1.50-4.73), specifically, selective serotonin reuptake inhibitors (SSRIs) (6.22, 2.28-17.0). Similar results were found for recurrent falls. CONCLUSIONS: Use of psychotropic drugs overall, especially synthetic antidepressants like SSRIs, is associated with higher risks of falls and recurrent falls among community dwelling older adults aged 65-79 years in Germany.


Assuntos
Acidentes por Quedas/estatística & dados numéricos , Psicotrópicos/uso terapêutico , Idoso , Feminino , Alemanha/epidemiologia , Humanos , Entrevistas como Assunto , Modelos Logísticos , Masculino , Razão de Chances , Prevalência , Recidiva , Fatores de Risco , Inibidores de Captação de Serotonina/uso terapêutico , Fatores Socioeconômicos , Inquéritos e Questionários
8.
Z Evid Fortbild Qual Gesundhwes ; 122: 22-31, 2017 May.
Artigo em Alemão | MEDLINE | ID: mdl-28511896

RESUMO

BACKGROUND: Evidence-based guideline recommendations on lipid lowering drug treatment, in particular statin treatment, play an essential role in the management of dyslipidemias and in the prevention of cardiovascular disease events. In Germany, statutory health insurance data provide information on time trends in the prescription of lipid lowering drugs. However, population-based data regarding changes in user prevalence according to socio-demographic and health-related characteristics are lacking. Based on data from national health interview and examination surveys for adults in Germany 1997-1999 (GNHIES98) and 2008-2010 (DEGS1), the present analysis aims to close this information gap with a particular focus on the use of statins. METHODS: The study population consisted of 7,099 participants (GNHIES98) and 7,091 participants (DEGS1) aged 18 to 79 years at the time of the respective surveys. Primary data on medication use within 7 days prior to the survey were collected using standardized medication interviews and brown-bag drug review. Unique product identifiers on original drug containers were scanned and coded according to the latest version of the Anatomical Therapeutic Chemical (ATC) classification system. Medical history was obtained in computer-assisted personal interviews. A history of stroke or coronary heart disease (CHD) was assessed among persons aged 40 to 79 years only, and previous stroke or CHD were defined as cardiovascular disease. Obesity was defined as a body mass index (BMI) of ≥ 30kg/m2) based on calculation from standardized measures of body weight and height. Information on socio-demographic variables and type of health insurance was collected using standardized self-administered questionnaires. In cross-sectional descriptive analyses we calculated the prevalence of statin use (ATC codes: C10AA, C10BA, C10BX) by survey as well as the changes between surveys stratified according to relevant preexisting diseases and other co-variables. The association between survey period and statin use was analyzed in multivariable binary logistic regression models among persons aged 40 to 79 years. All results were weighted and standardized for the population of 2010. RESULTS: Between the two survey periods 1997-1999 and 2008-2011, the prevalence of statin use increased from 3.2 % to 8.8 %. The increase was most pronounced for the age group 65 to 79 years (7.2 % vs. 26.9 %) and among persons with relevant preexisting conditions, such as CHD (19.1 % vs. 54.9 %), stroke (17.1 % vs. 50.1 %), diabetes mellitus (10.5 % vs. 33.2 %), and dyslipidemia (12.6 % vs. 27.8 %). Among persons aged 40 to 79 years, the prevalence of statin use significantly increased between the two surveys, independent of co-variables (Odds Ratio: 3.70; 95 % confidence interval [CI]: 2.92 to 4.70). This applied to persons with cardiovascular disease (5.17; 3.50 to 7.64) and without cardiovascular disease (2.76; 2.07 to 3.67). CONCLUSION: The increase in the prevalence of statin use in Germany between the two national health surveys (1997-1999 and 2008-2011) reflects the implementation of current guideline recommendations without evidence for inequalities according to gender, education, type of health insurance or region of residence. These population-based data add to information on statin prescription obtained from statutory health insurance data. Limitations of survey-based information derive from potential misclassification and selection bias as well as large time gaps between the survey periods. Further studies are needed to examine why the observed prevalence of statin use among persons with cardiovascular morbidity lags behind current guideline recommendations for secondary cardiovascular prevention.


Assuntos
Uso de Medicamentos/tendências , Inquéritos Epidemiológicos , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Adolescente , Adulto , Idoso , Estudos Transversais , Feminino , Alemanha , Humanos , Masculino , Pessoa de Meia-Idade , Padrões de Prática Médica , Prevalência , Adulto Jovem
9.
BMC Psychiatry ; 17(1): 90, 2017 03 09.
Artigo em Inglês | MEDLINE | ID: mdl-28279159

RESUMO

BACKGROUND: Psychotropic drug use and alcohol consumption among older adults need to be monitored over time as their use or combined use bears risks of harms. Representative data on changes in prevalence, patterns and co-relates of substance use are lacking in Germany. METHODS: Participants were older adults (60-79 years) from two German National Health Surveys: 1997-99 (GNHIES98, N = 1,606) and 2008-11 (DEGS1, N = 2,501). Included were drugs acting on the nervous system used during the last 7 days. Alcohol consumption was measured by frequency (daily drinking) and quantity (risky drinking: ≥20/10 g/day alcohol for men/women). Changes in prevalence adjusted for potential socio-economic and health-related confounders were calculated by logistic regression models approximated by the SAS LSMEANS statement. RESULTS: The prevalence of overall psychotropic drug use (20.5% vs. 21.4%) remained constant between the two surveys. Significant changes were observed in the use of some psychotropics (all GNHIES98 vs. DEGS1): Synthetic antidepressants (3.9% vs. 6.9%), St. John's wort (2.9% vs. 1.1%), benzodiazepines (3.7% vs. 2.5%), benzodiazepine related drugs (0.2% vs. 0.8%), narcotic analgesics (3.0% vs. 4.1%), anti-dementia drugs (2.2% vs. 4.2%) and anti-epileptics (1.0% vs. 2.3%). Significant changes were also observed in long-term use of synthetic anti-depressants (3.2% vs. 5.9%), St. John's wort (2.0% vs. 0.6%) and opioid analgesics (1.0% vs. 2.2%). Further, we found significant changes in benzodiazepines use (3.3% vs. 1.4%) among men, opioids use (2.9% vs. 7.3%) among people with a lower social status, and overall psychotropics (26.8% vs. 32.5%) as well as opioids use (4.4% vs. 8.1%) among those with a worse health status. Moderate alcohol consumption increased significantly (58.0% vs. 66.9%). Risky drinking remained unchanged (16.6% vs. 17.0%). In spite of significant increases in daily alcohol drinking (13.2% vs. 18.4%) psychotropic drug use combined with daily drinking remained unchanged (1.8% vs. 2.7%). CONCLUSIONS: Although prevalence of overall psychotropic drug use remained stable, changes in the use of some psychotropic drug groups and alcohol consumption patterns have been observed. Further studies are required to investigate resulting health consequences and public health relevance of those outcomes.


Assuntos
Consumo de Bebidas Alcoólicas/epidemiologia , Consumo de Bebidas Alcoólicas/tendências , Inquéritos Epidemiológicos/tendências , Psicotrópicos/uso terapêutico , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Idoso , Feminino , Alemanha/epidemiologia , Inquéritos Epidemiológicos/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Vigilância da População/métodos , Prevalência , Meio Social , Transtornos Relacionados ao Uso de Substâncias/tratamento farmacológico
10.
Artigo em Alemão | MEDLINE | ID: mdl-28054117

RESUMO

BACKGROUND AND OBJECTIVES: Vitamins, minerals and food supplements (FSs) are often used without medical prescription. Valid data on the magnitude of use are rare in Germany. The aim of the present analysis is to describe the prevalence and trends of self-medication and the associations between health-related factors and self-medication with these substances. METHODS: The data base consisted of the results of nationwide health surveys (GNHIES98: 1997-1999 and DEGS1: 2008-2001) in which adults aged 18-79 years were interviewed on health-related themes and were examined. The use of drugs and FSs was recorded in standardized personal interviews. Data of 7099 (GNHIES98) and 7091 (DEGS1) individuals were available for analysis. The dependent variable was self-medication with vitamins, minerals and FS. Analysis was conducted in SPSS Version 20 with the complex sample method. Statistical significance was tested with 95% confidence intervals (95% CI) and verified via p-values. RESULTS: Of all DEGS1 participants, 18.1% (95% CI: 17.0-19.2%) consumed vitamins, minerals and FSs in self-medication. Significantly higher prevalence was found among women, older people (60-79 years), those with a higher social status, people living alone, ex- and non-smokers, and those doing more sports. In comparison to the GNHIES98 study the prevalence in DEGS1 has increased by about 6 percentage points (5.8 percentage points, 95% CI 4.1-7.5%, p < 0.001). This increase remained significant when socio-demographic and health-relevant factors were considered simultaneously (odds ratio (OR): 1.49, 95% CI 1.27-1.75). CONCLUSION: In Germany self-medication with vitamins, minerals or FSs shows a high user prevalence which has increased significantly over time. In light of potential interactions with prescribed medicines the results show the importance of ascertaining self-medication with vitamins, minerals and FSs in medical practice.


Assuntos
Suplementos Nutricionais , Inquéritos Epidemiológicos , Minerais , Automedicação/estatística & dados numéricos , Vitaminas , Administração Oral , Adolescente , Adulto , Distribuição por Idade , Idoso , Feminino , Alemanha/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Distribuição por Sexo , Fumar/epidemiologia , Fatores Socioeconômicos , Esportes/estatística & dados numéricos , Adulto Jovem
11.
BMJ Open ; 6(10): e012182, 2016 10 08.
Artigo em Inglês | MEDLINE | ID: mdl-27855095

RESUMO

OBJECTIVES: The use and combined use of psychotropic drugs and alcohol among older adults is a growing public health concern and should be constantly monitored. Relevant studies are scarce in Germany. Using data of the most recent national health survey, we analyse prevalence and correlates of psychotropic drug and alcohol use among this population. METHODS: Study participants were people aged 60-79 years (N=2508) of the German Health Interview and Examination Survey for Adults 2008-2011. Medicines used during the last 7 days were documented. Psychotropic drugs were defined as medicines acting on the nervous system (ATC code N00) excluding anaesthetics (N01), analgesics/antipyretics (N02B), but including opiate codeines used as antitussives (R05D). Alcohol consumption in the preceding 12 months was measured by frequency (drinking any alcohol-containing beverages at least once a week/a day) and quantity (alcohol consumed in grams/day; cut-offs: 10/20 g/day for women/men defining moderate and risky drinking). SPSS complex sample module was used for analysis. RESULTS: 21.4% of study participants use psychotropic medications, 66.9% consume alcohol moderately and 17.0% riskily, 51.0% drink alcohol at least once a week and 18.4% daily, 2.8% use psychotropic drugs combined with daily alcohol drinking. Among psychotropic drug users, 62.7% consume alcohol moderately, 14.2% riskily. The most frequently used psychotropic medications are antidepressants (7.9%) and antidementia (4.2%). Factors associated with a higher rate of psychotropic drug use are female sex, worse health status, certified disability and polypharmacy. Risky alcohol consumption is positively associated with male sex, smoking, upper social class, better health status, having no disability and not living alone. CONCLUSIONS: Despite the high risk of synergetic effects of psychotropic drugs and alcohol, a substantial part of older psychotropic drug users consume alcohol riskily and daily. Health professionals should talk about the additional health risks of alcohol consumption when prescribing psychotropic drugs to older adults.


Assuntos
Consumo de Bebidas Alcoólicas/epidemiologia , Psicotrópicos/efeitos adversos , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Adolescente , Adulto , Idoso , Consumo de Bebidas Alcoólicas/efeitos adversos , Consumo de Bebidas Alcoólicas/psicologia , Estudos Transversais , Feminino , Alemanha/epidemiologia , Conhecimentos, Atitudes e Prática em Saúde , Inquéritos Epidemiológicos , Humanos , Masculino , Pessoa de Meia-Idade , Vigilância da População , Prevalência , Fatores de Risco , Assunção de Riscos , Meio Social , Fatores Socioeconômicos , Transtornos Relacionados ao Uso de Substâncias/psicologia , Adulto Jovem
12.
Dtsch Arztebl Int ; 113(42): 712-719, 2016 Oct 21.
Artigo em Inglês | MEDLINE | ID: mdl-27866566

RESUMO

BACKGROUND: Data from three representative health examination surveys in Germany were analyzed to examine secular trends in the prevalence and magnitude of cardiometabolic risk factors. METHODS: The target variables were the following cardiometabolic risk factors: lack of exercise, smoking, obesity, systolic blood pressure, total cholesterol, serum glucose, self-reported high blood pressure, hyperlipidemia, and diabetes, and the use of antihypertensive, cholesterol-lowering, and antidiabetic drugs. 9347 data sets from men and 10 068 from women were analyzed. The calculated means and prevalences were standardized to the age structure of the German population as of 31 December 2010 and compared across the three time periods of the surveys: 1990-1992, 1997-1999, and 2008-11. RESULTS: Over the entire period of observation (1990-2011), the mean systolic blood pressure fell from 137 to 128 mmHg in men and from 132 to 120 mmHg in women; the mean serum glucose concentration fell from 5.6 to 5.3 mmol/L in men and from 5.4 to 5.0 mmol/l in women; and the mean total cholesterol level fell from 6.2 to 5.3 mmol/L in both sexes. In men, smoking and lack of exercise became less common. On the other hand, the prevalence of use of antidiabetic, cholesterol-lowering, and antihypertensive drugs rose over the same time period, as did that of self-reported diabetes. The first of the three surveys (1990-1992) revealed differences between persons residing in the former East and West Germany in most of the health variables studied; these differences became less marked over time, up to the last survey in 2008-2011. CONCLUSION: The cardiometabolic risk profile of the German adult population as a whole improved over a period of 20 years. Further in-depth analyses are now planned.


Assuntos
Glicemia , Pressão Sanguínea , Doenças Cardiovasculares/epidemiologia , Colesterol/sangue , Adulto , Idoso , Feminino , Alemanha , Humanos , Hipertensão , Masculino , Pessoa de Meia-Idade , Prevalência , Valores de Referência , Fatores de Risco
13.
Artigo em Inglês | MEDLINE | ID: mdl-27453723

RESUMO

BACKGROUND: The present study examined pain perception in children and adolescents with ADHD and the interaction between pain perception and the administration of methylphenidate (MPH) in order to generate hypotheses for further research that will help to clarify the association between ADHD diagnosis, MPH treatment and pain perception. METHODS: We included 260 children and adolescents of the "German Health Interview and Examination Survey for Children and Adolescents" (KiGGS) and analyzed parent's assessments of children's pain distribution and pain perception, as well as the influence of MPH administration on pain perception in affected children and adolescents. RESULTS: Pain perception was associated with ADHD and MPH administration, indicating that children and adolescents suffering from ADHD without MPH treatment were reported to have lower pain perception compared to both, healthy controls (HC) and ADHD patients medicated with MPH. CONCLUSION: We suggest that reduced pain perception in children and adolescents with ADHD not medicated with MPH may lead to higher risk tolerance by misjudgments of dangerous situations, expanding the importance of MPH administration in affected children and adolescents.

14.
BMC Public Health ; 16: 240, 2016 Mar 08.
Artigo em Inglês | MEDLINE | ID: mdl-26956524

RESUMO

BACKGROUND: Monitoring of serum lipid concentrations at the population level is an important public health tool to describe progress in cardiovascular disease risk control and prevention. Using data from two nationally representative health surveys of adults 18-79 years, this study identified changes in mean serum total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), and triglycerides (TG) in relation to changes in potential determinants of serum lipids between 1997-99 and 2008-11 in Germany. METHODS: Sex-specific multivariable linear regression analyses were performed with serum lipids as dependent variables and survey wave as independent variable and adjusted for the following covariables: age, fasting duration, educational status, lifestyle, and use of medication. RESULTS: Mean TC declined between the two survey periods by 13 % (5.97 mmol/l vs. 5.19 mmol/l) among men and by 12 % (6.03 mmol/l vs. 5.30 mmol/l) among women. Geometric mean TG decreased by 14 % (1.66 mmol/l vs. 1.42 mmol/l) among men and by 8 % (1.20 mmol/l vs. 1.10 mmol/l) among women. Mean HDL-C remained unchanged among men (1.29 mmol/l vs. 1.27 mmol/l), but decreased by 5 % among women (1.66 mmol/l vs. 1.58 mmol/l). Sports activity and coffee consumption increased, while smoking and high alcohol consumption decreased only in men. Processed food consumption increased and wholegrain bread consumption decreased in both sexes, and obesity increased among men. The use of lipid-lowering medication, in particular statins nearly doubled over time in both sexes. Among women, hormonal contraceptive use increased and postmenopausal hormone therapy halved over time. The changes in lipid levels between surveys remained significant after adjusting for covariables. CONCLUSION: Serum TC and TG considerably declined over one decade in Germany, which can be partly explained by increased use of lipid-lowering medication and improved lifestyle among men. The decline in serum lipids among women, however, remains unexplained.


Assuntos
Lipídeos/sangue , Adolescente , Adulto , Idoso , Doenças Cardiovasculares/prevenção & controle , Colesterol/sangue , HDL-Colesterol/sangue , Feminino , Alemanha , Inquéritos Epidemiológicos , Humanos , Estilo de Vida , Masculino , Pessoa de Meia-Idade , Fatores Sexuais , Triglicerídeos/sangue , Adulto Jovem
15.
J Atten Disord ; 20(6): 501-9, 2016 06.
Artigo em Inglês | MEDLINE | ID: mdl-24470540

RESUMO

OBJECTIVE: This study aims to ascertain once and for all whether children and adolescents affected by ADHD show a higher risk for accidents, as well as investigating a possible association between the administration of ADHD-specific medication and the occurrence of accidents. METHOD: Two exceptionally large sets of data were implemented in this analysis. Participants included children and adolescents representative of the entire German population. Data for Survey 1 was collected through extensive administration of questionnaires. Data for Survey 2 stemmed from the records of a leading German health insurance company. In terms of statistical analysis, chi-square tests as well as logistic regression analyses were applied and odds ratios (ORs) were determined. RESULTS: Innovative results are presented showing a significantly higher likelihood for ADHD-affected youngsters to be involved in accidents compared with their nonaffected counterparts (Survey 1: OR = 1.60; Survey 2: OR = 1.89) but lacking an overall significant influence of medication regarding the occurrence of accidents (Survey 1: OR = 1.28; Survey 2: OR = 0.97). Frequency of accidents could be predicted by ADHD, gender, and age in both samples. Medication intake served as a weak predictor only in Survey 2. CONCLUSION: It has been determined in two representative and independent German samples that youngsters with ADHD are at a significantly higher risk of being involved in accidents. In the future, this should always be considered when setting up a treatment plan to ensure a safer and healthier coming of age without relying solely on specific effects of medication. (J. of Att. Dis. 2016; 20(6) 501-509).


Assuntos
Propensão a Acidentes , Transtorno do Deficit de Atenção com Hiperatividade/psicologia , Acidentes/estatística & dados numéricos , Adolescente , Distribuição por Idade , Transtorno do Deficit de Atenção com Hiperatividade/tratamento farmacológico , Transtorno do Deficit de Atenção com Hiperatividade/epidemiologia , Criança , Métodos Epidemiológicos , Feminino , Alemanha/epidemiologia , Humanos , Masculino , Distribuição por Sexo
16.
Am J Hypertens ; 29(1): 104-13, 2016 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-25968124

RESUMO

BACKGROUND: Hypertension is a major risk factor for morbidity and mortality, therefore its control is of great importance. In this study we compare the use of antihypertensive medication among adults with hypertension in Germany 1998 and 2008-2011 and determine factors associated with use and control. METHODS: Data from German Health Examination Surveys (GNHIES98 1998, n = 7,124 and DEGS1 2008-2011 n = 7,988, age 18-79 years) including standardized blood pressure (BP) measurements and Anatomical Therapeutic Chemical (ATC) medication codes were analyzed. RESULTS: The use of antihypertensive medication among adults with hypertension in Germany increased from 54% to 72% in 1 decade. In 2008-2011, 67% of users were treated with polytherapy. The most commonly used antihypertensive class in 1998 was diuretics (43%) and in 2008-2011 beta-blockers (54%). Ramipril and metoprolol are currently the most commonly used monotherapy agents, while ramipril in combination with hydrochlorothiazide is the most frequent polytherapy. Being a woman, older age, having statutory health insurance, diabetes, coronary heart disease (CHD), stroke, and obesity were positively associated with antihypertensive use. The control rate among treated increased from 42% to 72%. Young women (18-54 years) had better control compared to older women or to men. Having CHD or stroke was positively associated with BP control. CONCLUSIONS: Increased and improved antihypertensive use might be a main contributor to the decrease in BP observed in Germany in the last decade. However, there are still socio-demographic and health disparities in hypertension treatment and control.


Assuntos
Anti-Hipertensivos/uso terapêutico , Pressão Sanguínea/efeitos dos fármacos , Inquéritos Epidemiológicos , Hipertensão/tratamento farmacológico , Adolescente , Antagonistas Adrenérgicos beta/uso terapêutico , Adulto , Idoso , Pressão Sanguínea/fisiologia , Bloqueadores dos Canais de Cálcio/uso terapêutico , Diuréticos/uso terapêutico , Quimioterapia Combinada , Feminino , Alemanha/epidemiologia , Humanos , Hipertensão/epidemiologia , Hipertensão/fisiopatologia , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Retrospectivos , Fatores de Tempo , Adulto Jovem
17.
J Asthma ; 53(1): 50-61, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-26512420

RESUMO

OBJECTIVES: In Germany, population-wide data on adherence to national asthma management guidelines are lacking, and performance measures (PM) for quality assurance in asthma care are systematically monitored for patients with German national asthma disease management program (DMP) enrollment only. We used national health survey data to assess variation in asthma care PM with respect to patient characteristics and care context, including DMP enrollment. METHODS: Among adults 18-79 years with self-reported physician-diagnosed asthma in the past 12 months identified from a recent German National Health Interview Survey (GEDA 2010: N = 1096) and the German National Health interview and Examination Survey 2008-2011 (DEGS1: N = 333), variation in asthma care PM was analyzed using logistic regression analysis. RESULTS: Overall, 38.4% (95% confidence interval: 32.5-44.6%) of adults with asthma were on current inhaled corticosteroid therapy. Regarding non-drug asthma management, low coverage was observed for inhaler technique monitoring (35.2%; 31.2-39.3%) and for provision of an asthma management plan (27.3%; 24.2-30.7%), particularly among those with low education. Specific PM were more complete among persons with than without asthma DMP enrollment (adjusted odds ratios ranging up to 10.19; 5.23-19.86), even if asthma patients were regularly followed in a different care context. CONCLUSIONS: Guideline adherence appears to be suboptimal, particularly with respect to PM related to patient counseling. Barriers to the translation of recommendations into practice need to be identified and continuous monitoring of asthma care PM at the population level needs to be established.


Assuntos
Asma/terapia , Adolescente , Corticosteroides/uso terapêutico , Adulto , Idoso , Antiasmáticos/uso terapêutico , Asma/tratamento farmacológico , Asma/fisiopatologia , Feminino , Alemanha , Inquéritos Epidemiológicos , Humanos , Masculino , Pessoa de Meia-Idade , Testes de Função Respiratória , Abandono do Hábito de Fumar , Adulto Jovem
18.
BMC Pharmacol Toxicol ; 16: 28, 2015 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-26428626

RESUMO

BACKGROUND: Despite the public health relevance of analgesic use, large-scale studies on this topic in Germany are lacking. This study describes the prevalence, trends, associations and patterns of use of prescription and over-the-counter (OTC) analgesics, focusing on five of the most common agents: aspirin, diclofenac, ibuprofen, naproxen and paracetamol. METHODS: Data from two representative population-based surveys: The German National Health Interview and Examination Survey 1998 (GNHIES98 n = 7099) and the German Health Interview and Examination Survey for Adults 2008-2011 (DEGS1 n = 7091) was investigated. Information on all medicines consumed in the previous 7 days was collected via computer-assisted personal interviews with adults aged 18-79 years. Associations between analgesic use and socio-demographic and health-behaviour factors were analysed using logistic regression models. RESULTS: Analgesic use has increased over the last decade from 19 to 21%. This was exclusively due to the rise in OTC analgesic use from 10.0 to 12.2%. Prescribed analgesic use remained constant (7.9%). Findings from DEGS1 indicate that ibuprofen is the most commonly used analgesic followed by aspirin and paracetamol. OTC analgesic use is higher among women and smokers, but lower among older adults (65-79 years). Prescribed analgesics use is higher among women, older adults, smokers and obese adults with medium or high socio- economic status. Adults performing more than 2 h/week of physical exercise use fewer analgesics. DISCUSSION: Among the adult population of Germany, the prevalence of OTC analgesic use has significantly increased over the last decade. We found differences between adults consuming OTC and prescribed analgesics (or both) concerning their health behaviour and health conditions. International direct comparison between prevalence rates of analgesic use was limited due to varying availability of analgesics between countries and to methodological differences. CONCLUSIONS: About one in five community dwelling adults aged 18-79 years in Germany use analgesics in a given week. Considering the potential harms of analgesic use, monitoring of prevalence, patterns and determinants of use at the population level are important steps to inform disease prevention and health promotion policies.


Assuntos
Analgésicos/uso terapêutico , Tratamento Farmacológico/estatística & dados numéricos , Medicamentos sem Prescrição/uso terapêutico , Dor/prevenção & controle , Acetaminofen/uso terapêutico , Adolescente , Adulto , Fatores Etários , Idoso , Aspirina/uso terapêutico , Diclofenaco/uso terapêutico , Tratamento Farmacológico/tendências , Feminino , Alemanha/epidemiologia , Inquéritos Epidemiológicos/métodos , Inquéritos Epidemiológicos/estatística & dados numéricos , Humanos , Ibuprofeno/uso terapêutico , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Naproxeno/uso terapêutico , Dor/epidemiologia , Prevalência , Fatores Sexuais , Classe Social , Adulto Jovem
19.
BMC Pharmacol Toxicol ; 15: 44, 2014 Aug 09.
Artigo em Inglês | MEDLINE | ID: mdl-25106446

RESUMO

BACKGROUND: Medicines to treat common colds (CC) and upper respiratory tract infections (URTI) are widely used among children, but there are only few data about treatments actually applied for these diseases. In the present study we analyze the prevalence and correlations of self-medicated and prescribed drug use for the treatment of CCs and URTIs among children and adolescents in Germany. METHODS: Medicine use during the week preceding the interview was recorded among 17,450 children (0-17 years) who participated in the drug interview of the 2003-2006 German Health Interview and Examination Survey for Children and Adolescents (KiGGS). The definition of CCs and URTIs in the present study included the WHO-ICD-10 codes J00, J01.0, J01.9, J02.0, J02.9, J03.0, J03.9, J04.0, J06.8, J06.9, J11.1, J11.8, R05 and R07.0. Using the complex sample method, the prevalence and associated socio-demographic factors of self-medication, prescribed medicines and antibiotics were defined. RESULTS: 13.8% of the participating girls and boys use drugs to treat a CC or an URTI. About 50% of this group use prescribed medications. Among the users of prescribed medication, 11.5% use antibiotics for the treatment of these diseases. Looking at all prescribed medicines we find associations with younger age, immigration background, and lower social status. Antibiotic use in particular is associated with female sex, higher age, residency in the former East Germany and immigration background. CONCLUSIONS: The use of medicines to treat CCs or URTIs is widespread among children and adolescents in Germany. Thus, longitudinal studies should investigate the risks associated with this drug use. Differences in socio-demographic variables regarding exposure to antibiotic use indicate that there could be an implausible prescribing behavior among physicians in Germany.


Assuntos
Resfriado Comum/epidemiologia , Infecções Respiratórias/epidemiologia , Adolescente , Criança , Pré-Escolar , Feminino , Alemanha , Humanos , Lactente , Recém-Nascido , Masculino
20.
BMC Complement Altern Med ; 14: 218, 2014 Jul 02.
Artigo em Inglês | MEDLINE | ID: mdl-24988878

RESUMO

BACKGROUND: Germany is a country with a high use of herbal medicinal products. Population-based data on the use of herbal medicinal products among children are lacking. The aim of this study is to investigate the prevalence, patterns and determinants of herbal medicine use among children and adolescents in Germany. METHODS: As data base served the German Health Interview and Examination Survey for Children and Adolescents (KiGGS), a representative population based survey conducted 2003-2006 by the Robert Koch Institute. 17,450 boys and girls aged 0-17 years provided information on drug use in the preceding seven days. Herbal medicinal products were defined according to the European and German drug laws. SPSS Complex Sample method was used to estimate prevalence rates and factors associated with herbal medicine use. RESULTS: The prevalence rate of herbal medicinal product use amounts to 5.8% (95% confidence interval 5.3-6.3%). Use of herbal medicine declines along with increasing age and shows no difference between boys and girls in younger age groups. Teenage girls are more likely to use herbal medicines than teenage boys. Two thirds of herbal medicines are used for the treatment of coughs and colds; nearly half of herbal medicines are prescribed by medical doctors. Determinants of herbal medicinal product use are younger age, residing in South Germany, having a poor health status, having no immigration background and coming from a higher social class family. Children's and parents-related health behavior is not found to be associated with herbal medicine use after adjusting for social class. CONCLUSIONS: Use of herbal medicinal products among children and adolescents between the ages of 0 and 17 years in Germany is widely spread and shows relatively higher rates compared to international data. This study provides a reference on the use of herbal medicinal products for policy-makers, health professionals and parents. Further studies are needed to investigate the effectiveness and safety of specific herbal medicinal products, potential effects of long term use as well as possible interactions of herbal medicinal products with concomitantly used conventional medicines.


Assuntos
Fitoterapia/estatística & dados numéricos , Extratos Vegetais/administração & dosagem , Adolescente , Fatores Etários , Criança , Pré-Escolar , Estudos Transversais , Feminino , Alemanha , Inquéritos Epidemiológicos , Humanos , Lactente , Masculino , Prevalência , Fatores Socioeconômicos
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