[Erratum to: Application of medicines and nutritional supplements in childhood and adolescence in Germany]. / Erratum zu: Anwendung von Arznei- und Nahrungsergänzungsmitteln im Kindes- und Jugendalter in Deutschland.

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: 14.5%, boys: 15.1%), followed by "Varia" (girls: 8.7%, boys: 9.3%) and preparations for the treatment of the musculoskeletal system (girls: 9.0%, boys: 5.9%). 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.

[Application of medicines and nutritional supplements in childhood and adolescence in Germany : Results from KiGGS Wave 2]. / Anwendung von Arznei- und Nahrungsergänzungsmitteln im Kindes- und Jugendalter in Deutschland : Ergebnisse aus KiGGS Welle 2.

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.

[Secondary prevention of coronary heart disease in women and men in Germany from 1997-1999 and from 2008-2011-Trend analysis with two national health population surveys]. / Medikamentöse Sekundärprävention bei Frauen und Männern mit koronarer Herzkrankheit in Deutschland zwischen 1997­1999 und 2008­2011 ­ Trendanalyse mit Daten zweier bundesweiter Gesundheitssurveys.

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.

[Which factors are associated with the use of potentially inadequate medications (PIM) in the elderly? : Results from the German health interview and examination survey (DEGS1)]. / Welche Faktoren begünstigen die Anwendung potenziell ungeeigneter Medikamente bei älteren Menschen? : Ergebnisse aus der Studie zur Gesundheit Erwachsener in Deutschland (DEGS1).

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.

Changes in prevalence of psychotropic drug use and alcohol consumption among the elderly in Germany: results of two National Health Interview and Examination Surveys 1997-99 and 2008-11.

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.

[Self-medication with vitamins, minerals and food supplements in Germany : Results of nationwide health surveys]. / Selbstmedikation mit Vitaminen, Mineralstoffen und Nahrungsergänzungsmitteln in Deutschland : Ergebnisse bundesweiter Gesundheitssurveys.

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.

Asthma management practices in adults--findings from the German Health Update (GEDA) 2010 and the German National Health Interview and Examination Survey (DEGS1) 2008-2011.

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.

Changes in mean serum lipids among adults in Germany: results from National Health Surveys 1997-99 and 2008-11.

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.

Use of herbal medicinal products among children and adolescents in Germany.

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.

Off-label medicine use in children and adolescents: results of a population-based study in Germany.

BACKGROUND: Population-based self-reported data on off-label medicine use independent from health care provisions are lacking. The purpose of this study is to investigate off-label medicine use in children and adolescents in Germany in a non-clinical setting and to identify prevalence, determinants and spectrum of off-label medicine use. METHODS: Data were obtained from the German Health Interview and Examination Survey for Children and Adolescents (KiGGS) conducted by the Robert Koch Institute (2003-2006). 17,450 randomly selected children aged 0-17 years took part in the drug interviews. Of those, 8,899 took at least one medicine during the 7 days preceding the interview. Off-label medicine use was defined as the discrepancy between actual use and the intended use described in the summary of product characteristics. Off-label medicine use was stratified into off-label indication, off-label age, off-label over-dosing, and off-label under-dosing. RESULTS: The prevalence rate of off-label medicine use among those who used medicines amount of is 40.2%. The prevalence rate is significantly higher in boys (41.4%), in children aged 3 to 6 years (48.7%), without migration background (40.9%), with high social status (42.5%), living in small (42.0%) and medium sized cities (41.6%), and with a poor parents rated health status (41.7%). 12,667 preparations (attributable in respect to off-label use) were taken by 8,899 children. 30% of the medicines have been used off-label. Off-label medicine use was highest in preparations of the ATC-class "C00 Cardiovascular System". In all origins of medicine, all age groups and all ATC-classes under-dosing was the most frequent reason for off-label medicine use. CONCLUSIONS: There is a considerable level of self-reported off-label medicines use in the general paediatric population. Further investigations are needed to examine in how far off-label medicine use is based on lack of knowledge or on empiricism in paediatric pharmacotherapy. Attention also needs to be paid to under-dosing which potentially exposes drug users to risks of side effects without the benefit of a therapeutic effect. Clinical trials for licensing of paediatric medicines, education of health care professionals, but also of parents and carers are needed to ensure the rational use of medicines.

German health interview and examination survey for adults (DEGS) - design, objectives and implementation of the first data collection wave.

BACKGROUND: The German Health Interview and Examination Survey for Adults (DEGS) is part of the recently established national health monitoring conducted by the Robert Koch Institute. DEGS combines a nationally representative periodic health survey and a longitudinal study based on follow-up of survey participants. Funding is provided by the German Ministry of Health and supplemented for specific research topics from other sources. METHODS/DESIGN: The first DEGS wave of data collection (DEGS1) extended from November 2008 to December 2011. Overall, 8152 men and women participated. Of these, 3959 persons already participated in the German National Health Interview and Examination Survey 1998 (GNHIES98) at which time they were 18-79 years of age. Another 4193 persons 18-79 years of age were recruited for DEGS1 in 2008-2011 based on two-stage stratified random sampling from local population registries. Health data and context variables were collected using standardized computer assisted personal interviews, self-administered questionnaires, and standardized measurements and tests. In order to keep survey results representative for the population aged 18-79 years, results will be weighted by survey-specific weighting factors considering sampling and drop-out probabilities as well as deviations between the design-weighted net sample and German population statistics 2010. DISCUSSION: DEGS aims to establish a nationally representative data base on health of adults in Germany. This health data platform will be used for continuous health reporting and health care research. The results will help to support health policy planning and evaluation. Repeated cross-sectional surveys will permit analyses of time trends in morbidity, functional capacity levels, disability, and health risks and resources. Follow-up of study participants will provide the opportunity to study trajectories of health and disability. A special focus lies on chronic diseases including asthma, allergies, cardiovascular conditions, diabetes mellitus, and musculoskeletal diseases. Other core topics include vaccine-preventable diseases and immunization status, nutritional deficiencies, health in older age, and the association between health-related behavior and mental health.

Juvenile obesity and its association with utilisation and costs of pharmaceuticals--results from the KiGGS study.

BACKGROUND: According to a national reference, 15% of German children and adolescents are overweight (including obese) and 6.3% are obese. An earlier study analysed the impact of childhood overweight and obesity on different components of direct medical costs (physician, hospital and therapists). To complement the existing literature for Germany, this study aims to explore the association of body mass index (BMI) with utilisation of pharmaceuticals and related costs in German children and adolescents. METHODS: Based on data from 14, 836 respondents aged 3-17 years in the German Interview and Examination Survey for Children and Adolescents (KiGGS), drug intake and associated costs were estimated using a bottom-up approach. To investigate the association of BMI with utilisation and costs, univariate analyses and multivariate generalised mixed models were conducted. RESULTS: There was no significant difference between BMI groups regarding the probability of drug utilisation. However, the number of pharmaceuticals used was significantly higher (14%) for obese children than for normal weight children. Furthermore, there was a trend for more physician-prescribed medication in obese children and adolescents. Among children with pharmaceutical intake, estimated costs were 24% higher for obese children compared with the normal weight group. CONCLUSIONS: This is the first study to estimate excess drug costs for obesity based on a representative cross-sectional sample of the child and adolescent population in Germany. The results suggest that obese children should be classified as a priority group for prevention. This study complements the existing literature and provides important information concerning the relevance of childhood obesity as a health problem.

Operationalizing multimorbidity and autonomy for health services research in aging populations--the OMAHA study.

BACKGROUND: As part of a Berlin-based research consortium on health in old age, the OMAHA (Operationalizing Multimorbidity and Autonomy for Health Services Research in Aging Populations) study aims to develop a conceptual framework and a set of standardized instruments and indicators for continuous monitoring of multimorbidity and associated health care needs in the population 65 years and older. METHODS/DESIGN: OMAHA is a longitudinal epidemiological study including a comprehensive assessment at baseline and at 12-month follow-up as well as brief intermediate telephone interviews at 6 and 18 months. In order to evaluate different sampling procedures and modes of data collection, the study is conducted in two different population-based samples of men and women aged 65 years and older. A geographically defined sample was recruited from an age and sex stratified random sample from the register of residents in Berlin-Mitte (Berlin OMAHA study cohort, n = 299) for assessment by face-to-face interview and examination. A larger nationwide sample (German OMAHA study cohort, n = 730) was recruited for assessment by telephone interview among participants in previous German Telephone Health Surveys. In both cohorts, we successfully applied a multi-dimensional set of instruments to assess multimorbidity, functional disability in daily life, autonomy, quality of life (QoL), health care services utilization, personal and social resources as well as socio-demographic and biographical context variables. Response rates considerably varied between the Berlin and German OMAHA study cohorts (22.8% vs. 59.7%), whereas completeness of follow-up at month 12 was comparably high in both cohorts (82.9% vs. 81.2%). DISCUSSION: The OMAHA study offers a wide spectrum of data concerning health, functioning, social involvement, psychological well-being, and cognitive capacity in community-dwelling older people in Germany. Results from the study will add to methodological and content-specific discourses on human resources for maintaining quality of life and autonomy throughout old age, even in the face of multiple health complaints.

Perceived adverse drug reactions among non-institutionalized children and adolescents in Germany.

WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT: Drug safety in paediatric medication is a public health concern. According to previous studies, the incidence of adverse drug reactions (ADRs) varies greatly from 0.7% to 2.7% among paediatric outpatients and from 2.6% to 18.1% among paediatric inpatients. Little has been reported on the risks of drug use in the general child population. WHAT THIS STUDY ADDS: Our study showed that the prevalence of perceived ADRs in Germany was 0.9% among non-institutionalized children in general and 1.7% among children who had used at least one medicine within the 7 days before the medical interview. Perceived ADRs in the general child population were clustered with gastrointestinal disorders and subcutaneous tissue disorders. They appeared to be mild and at the lower limits of the range reported in other studies. Health surveys covering the use of a diverse range of drugs might be suitable for computing ADR prevalence and for identifying risk factors among non-institutionalized children. They should be taken into account together with other pharmacovigilance systems. AIMS: Little has been reported on the risks of drug use in the general child population. This study investigated perceived adverse drug reactions (ADRs) among non-institutionalized children in Germany. METHODS: All medicines used in the last 7 days before the medical interview were recorded among the 17 450 children aged 0-17 years who participated in the 2003-06 German Health Interview and Examination Survey for Children and Adolescents (KiGGS). Perceived ADRs were reported by the children's parents and confirmed by trained medical professionals during the medical interview. RESULTS: One hundred and fifty-seven medicines were involved in the occurrence of 198 perceived ADRs in 153 patients. This corresponded to 1.1% of total used drugs, 0.9% (95% confidence intervals 0.7, 1.1%) of all children, and 1.7% (1.4, 2.1%) of children treated with medications. About 40% of all perceived ADRs involved gastrointestinal disorders and 16% involved skin tissue disorders. Perceived ADRs were most frequently reported in relation to drugs acting on the nervous system (25.8%), followed by systemic anti-infectives (18.7%) and drugs acting on the respiratory system (16.2%). Risk factors for perceived ADRs included older age groups, polypharmacy (>or=2) and a poor health status. CONCLUSION: Perceived ADRs in the general child population were clustered with gastrointestinal disorders and subcutaneous tissue disorders. They appeared to be mild and at the lower limits of the range reported in other studies. Health surveys covering the use of a diverse range of drugs might be suitable for computing ADR prevalence and identifying risk factors among non-institutionalized children. They should be taken into account together with other pharmacovigilance systems.

Self-medication among children and adolescents in Germany: results of the National Health Survey for Children and Adolescents (KiGGS).

AIMS: Despite the widespread use of self-medication among the child population and the potential harm it can do, up-to-date epidemiological data on self-medication are sparse worldwide. The aim was to investigate the prevalence and correlates of self-medication use among non-institutionalized children in Germany, focusing on the paediatric self-medications that are most frequently used. METHODS: All cases of last-week medicine use were recorded among 17 450 children aged 0-17 years who participated in the 2003-2006 German Health Interview and Examination Survey for Children and Adolescents. Self-medication was defined as the use of medicines that had either been bought over the counter or obtained from other sources (OS). The complex sample method was used to estimate the prevalence of, and factors associated with self-medication use. RESULTS: During the previous week 25.2% of participants had used self-medication (17.0% used over-the-counter drugs and 9.9% other-sources drugs). Self-medication accounted for 38.5% of total medicine use and included all medication classes. These clustered among drugs acting on the respiratory system (32.1%), alimentary tract and metabolism (21.6%), skin (14.2%) and nervous system (11.3%), as well as homoeopathic preparations (8.6%). Vitamin preparations were most frequently used with a weighted user prevalence of 4.7% (5.2% vs. 4.1%, P < 0.001, boys vs. girls), followed by cough and cold medicines (CCMs) 4.4% (4.3 vs. 4.5, P > 0.05) and analgesics 3.7% (3.0% vs. 4.4%, P < 0.001, both boys vs. girls). Overall use of aspirin among children <12 years old was 0.3%; use of CCMs was substantial (4.4%), particularly among children <6 years old. Use of self-medication was closely related to older adolescent ages of between 14 and 17 years (odds ratio 1.16; 95% confidence interval 1.00, 1.33), children with a poor health status (1.29; 1.10, 1.52), with no immigration background (1.55; 1.33, 1.80), from families with a higher household income (1.23; 1.06, 1.42) and with mothers with a higher educational level (1.37; 1.19, 1.57). CONCLUSIONS: Self-medication use is highly prevalent in Germany, particularly among children and adolescents from families with a higher socioeconomic status. Self-medication in younger children using such drugs as CCMs and aspirin suggested inappropriate drug use and potential risks. This should be closely monitored and warrants an education programme for parents in Germany.

Paediatric homoeopathy in Germany: results of the German Health Interview and Examination Survey for Children and Adolescents (KiGGS).

PURPOSE: Despite growing pressure against homoeopathy, an unexpected resurgence in the use of homoeopathy has been reported. It is of interest to examine the use of homoeopathy and user profiles among children in Germany. METHODS: Last-week homoeopathy use was recorded among 17,450 children aged 0-17 years who participated in the 2003-2006 German Health Interview and Examination Survey for Children and Adolescents (KiGGS). The complex sample method was used to estimate the prevalence of, and factors associated with, homoeopathy use. RESULTS: Nine hundred and fifty-one homoeopathic preparations were used by 718 children (weighted prevalence 4.6%). Nearly half of the homoeopathic preparations were obtained by prescriptions from medical doctors or Heilpraktiker (non-medical practitioners) and used most often to treat certain self-limiting conditions. About 60% of homoeopathy users concomitantly received conventional medicines. Homoeopathy use was closely related to socioeconomic factors, with a significantly higher prevalence rate found in the 0-6 year age group [prevalence 6.2%, odds ratio 2.2, 95% confidence intervals (CIs) 1.7-2.9], among children residing in the former West Germany [5.1%, 2.2(1.5-3.2)] or the south of Germany [6.6%, 1.7(1.3-2.4)], among children with a poor health status [6.8%, 3.0(2.2-4.2)], with no immigration background [5.3%, 3.7(2.2-6.1)], who received breast-feeding >6 months [7.6%, 2.1(1.6-2.9)], were from upper social-class families [7.4%, 1.8(1.1-2.8)] and whose children's mothers were college educated [7.2%, 1.6(1.2-2.2)]. CONCLUSIONS: Paediatric homoeopathy is quite popular in Germany, particularly among children from families with a higher socioeconomic status. The high level of paediatric homoeopathy use in Germany warrants a critical review to determine whether it is evidence based and cost-effective.

Associations between the use of specific psychotropic drugs and all-cause mortality among older adults in Germany: Results of the mortality follow-up of the German National Health Interview and Examination Survey 1998.

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.

A novel superior medication-based chronic disease score predicted all-cause mortality in independent geriatric cohorts.

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.

Over-The-Counter (OTC) Drug Consumption among Adults Living in Germany: Results from the German Health Interview and Examination Survey for Adults 2008⁻2011 (DEGS1).

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.

Oral health behaviour of children and adolescents in Germany. Results of the cross-sectional KiGGS Wave 2 study and trends.

Oral health behaviour plays a key role in the prevention of caries and periodontitis. This article describes the prevalence, determinants and trends of tooth brushing frequency and utilization of dental check-ups. The analyses are based on the data from the second wave of the German Health Interview and Examination Survey for Children and Adolescents (KiGGS Wave 2, 2014-2017). The results show that around 80% of children and adolescents meet the recommended tooth brushing frequency and utilization of dental check-ups. Around one fifth of children and adolescents do not meet the recommendations. 14- to 17-year-old adolescents, as well as those with low socioeconomic status and a migration background are groups which are particularly at risk. Compared to the KiGGS baseline study (2003-2006), tooth brushing frequency and utilization of dental check-ups has improved. While this positive development is apparent for nearly all the population groups analysed, the same risk groups that were identified by the baseline study are also evident in the KiGGS Wave 2 results. Targeted measures directed at specific target groups to promote oral health behaviour at younger ages should therefore be maintained and expanded, respectively.