Externe Qualitätssicherung im Kinder- und Jugendgesundheitssurvey (KiGGS)

The results of the German Health Interview and Examination Survey for Children and Adolescents (KiGGS) of the Robert Koch Institute (RKI) will be of great importance for health policy and research. Therefore, in this study internal quality assurance was supplemented by an external quality assurance which was carried out by the institute of epidemiology at the GSF National Research Center for Environment and Health. The subjects were the interviewer training, sampling and response, field work and data management. External quality assurance was defined as 'an audit of internal quality assurance measures and systematic observation and spot checks to ensure quality requirements were fulfilled'. The requirements followed the manual of operation and the recognized epidemiologic standards and guidelines. For the different subjects, tests and detailed check-lists were developed and used. The quality requirements were fulfilled: The field work was performed with high quality and remarkable engagement over the whole time from May 2003 to May 2006, which resulted in high response and data quality. An extensive, efficient quality management system was in place for the data management

Five-Year Changes in Population Blood Pressure and Hypertension Prevalence. Results from the MONICA Augsburg Surveys 1984/85 and 1989/90.

Two cardiovascular risk factor surveys were carried out in 1984/85 and 1989/90 in the Augsburg study region of the international World Health Organization (WHO) Monitoring Trends and Determinants of Cardiovascular Disease (MONICA) project. Independent random samples of the 25- to 64-year- old population were examined at each survey. Five-year changes in blood pressure (BP) and hypertension parameters were monitored in a population not targeted by any formal intervention program. Response rates in both surveys ranged close to 80%. Evaluation of selected quality indicators confirmed comparability of the two surveys in terms of BP measurement quality. Small but consistent decreases in mean systolic and diastolic BP were observed, particularly for women 35 years and older, whereas BP changes in men were less pronounced and inconsistent. Likewise, downward shifts of the 10th, 50th, and 90th percentiles of systolic and diastolic BP occurred in women and their slopes of BP rise with age decreased while such changes were less clear in men. The age-standardized prevalence of men and women with hypertensive BP (HBP; ≥ 160/95 mm Hg) decreased slightly. This contrasted with rises in the prevalence of actual hypertension (those with HBP plus those taking antihypertensive drugs) for 45- to 64-year-old men, which originated from changes in hypertension management involving a more frequent drug treatment of borderline-hypertensive men (140 to 159/90 to 94 mm Hg) in 1989/90. There were notable overall increases in the awareness, treatment, and control of men and women with hypertension. In summary, based on a monitoring of the Augsburg population, prevention efforts in Germany between 1984/85 and 1989/90 appear to have been particularly successful for high-risk hypertensive individuals from both sexes. In the male population, no clear changes of BP distribution parameters could be detected while changes observed in women above 35 years old may be cautiously interpreted to indicate the onset of a downward shift of the entire BP distribution independent from antihypertensive medication use

Escalating topotecan in combination with treosulfan has acceptable toxicity in advanced pediatric sarcomas.

Patients with advanced pediatric sarcomas have a poor prognosis and novel combination therapies are needed to improve the response rates. Hematological and organ related toxicities have been observed when administering topotecan in combination with, e. g., high dose thiotepa. This study evaluates the toxicity of escalating doses of topotecan alone or in combination with thiotepa or treosulfan. We compared the toxicity including death of complication (DOC) of topotecan alone or in combination with thiotepa or treosulfan in advanced pediatric sarcomas (n = 12). Ten of 12 patients (0.83) suffered from advanced tumors of the Ewing family (i.e., bone or marrow metastases or relapse <24 month after diagnosis, including one neuroepithelial tumor of the kidney) and two from alveolar rhabdomyosarcoma stage IV (0.17). Median age was 15 years (range 5-28). Ratio of female to male was 1:1. Two patients received topotecan alone (1.25 mg/m(2) q 5d and 1.5 mg/m(2) q 5d), three patients received four courses of topotecan (2 mg/m(2) q d 1-5) in combination with thiotepa (100 mg/m(2) q d 1-5), and seven patients received topotecan (2 mg/m(2) q d 1-5) in combination with treosulfan (10g/m(2) q d 3-5). Overall toxicity was not different between all three groups; mean scores were 1.6, 1.8, and 1.7 according to WHO grading (Scale 0-4). Organ related toxicity ranged between 0 and 4 and was not different as well. DOC was 0/2, 1/3, and 0/7 patients respectively. Escalating therapy with topotecan in combination with treosulfan has acceptable toxicity and warrants further investigation in advanced pediatric sarcomas

Kinder-Umwelt-Survey—das Umweltmodul im KiGGS

Seit Mai 2003 läuft bundesweit die Feldarbeit des Kinder-Umwelt-Surveys (KUS) als ein Modul des Kinder- und Jugendgesundheitssurveys (KiGGS). In diesem Umweltmodul werden 1.800 Kinder, die zufällig aus der Stichprobe der ca. 18.000 Kinder und Jugendlichen des KiGGS ausgewählt wurden, hinsichtlich gesundheitsrelevanter Umweltbelastungen untersucht. Im Vorfeld sind in einer Pilotphase (Pretest) die Durchführbarkeit und Praktikabilität der eingesetzten Erhebungs- und Untersuchungsinstrumente erfolgreich geprüft worden. Es wurden dabei praktische Erfahrungen zur Optimierung der Feldarbeit im Hauptsurvey gesammelt. Die Feldarbeit des KUS wird im Wesentlichen von den Umweltinterviewern der im KiGGS eingesetzten 3 Teams durchgeführt. Die Vorbereitung, Organisation und Begleitung dieser Arbeit erfolgt über das Koordinationszentrum am Robert Koch-Institut, das diesen Umwelt-Survey im Auftrag des Umweltbundesamtes und gefördert vom Bundesministerium für Umwelt, Naturschutz und Reaktorsicherheit sowie dem Bundesministerium für Bildung und Forschung durchführt. Sowohl der Kinder- und Jugendgesundheitssurvey als auch das Umweltmodul werden über die gesamte Laufzeit (Mai 2003–Mai 2006) durch eine interne und externe Qualitätskontrolle hinsichtlich der Struktur-, Prozess- und Ergebnisqualität evaluiert. Die bisherigen Einschätzungen ergaben, dass die eingesetzten Teams den Anforderungen im Feld voll gerecht werden und die Koordination dieser Arbeit über das Robert Koch-Institut gut funktioniert. Bis Juli 2004 nahmen 722 Kinder am Kinder-Umwelt-Survey teil.The field work of the German Environmental Survey for Children (GerES IV) was started nationwide in May 2003. The survey is a module of the National Health Interview and Examination Survey for Children and Adolescents (KiGGS). This environmental survey includes a representative subsample of 1800 children from the 18,000 participants of the KiGGS who are being examined regarding health-relevant environmental exposure. The investigational programme of the survey was tested successfully in a pilot study (pretest) the results of which contributed to the optimisation of the main study. The field work is essentially done by the environmental interviewer of the three teams of the KiGGS. Preparation, organization and accompaniment of the work is done by the coordination centre of the Robert Koch Institute on Federal Environmental Agency (UBA) instructions. Funding agencies are the Federal Ministry of Education and Research (BMBF) and the Federal Ministry for the Environment, Nature Conservation and Nuclear Safety (BMU). Both the KiGGS and the environmental module are evaluated by internal and external quality assurance during the whole study period (May 2003–May 2006). Up to now the established teams have done their field work very well and the coordination of the overall project by the Robert Koch Institute works well, too. A total of 722 subjects had taken part in the GerES IV by July 2004

No reason to change the current guidelines on allergy prevention.

no Abstrac

Full breastfeeding and allergies from infancy until adolescence in the GINIplus cohort.

Breastfeeding has major benefits on infant health outcomes and their physical and mental development, but the effect on allergic disease risk remains controversial (1-3). We used the large GINIplus cohort (4) to study short and long term effects of full breastfeeding during the first 4 months compared to formula or mixed feeding on the occurrence of eczema, allergic rhinitis and asthma from birth up to age of 15 years