Externe Qualitätssicherung epidemiologischer Gesundheitsstudien

Eine zuverlässig hohe Qualität ist eine wesentliche Grundlage für das Vertrauen in epidemiologische Studien. Die „Leitlinien und Empfehlungen zur Sicherung von Guter Epidemiologischer Praxis (GEP)“ der Deutschen Gesellschaft für Epidemiologie (DGEpi) enthalten daher Anforderungen an die Qualitätssicherung epidemiologischer Studien. Für die Umsetzung einer externen Qualitätssicherung gibt es jedoch bislang keinen national oder international konsentierten Standard. Das Handbuch „Externe Qualitätssicherung epidemiologischer Gesundheitsstudien – Ein Handbuch für die praktische Umsetzung“ wurde erstellt, um zu diesem Thema eine adäquate Literatur anzubieten und der Weiterentwicklung einer standardisierten externen Qualitätssicherung epidemiologischer Studien einen Anstoß zu geben. Im Kontext epidemiologischer Studien werden in dem Handbuch grundlegende Qualitätsbegriffe (wie „Qualität“, „Qualitätsmanagement“, „Qualitätssicherung“) definiert, relevante Inhalte aus DIN-Normen aufgeführt sowie die Planung, Anforderungen an Teammitglieder, Aufgaben und Werkzeuge einer externen Qualitätssicherung beschrieben

Impact of a family-oriented rehabilitation programme on behavioural and emotional problems in healthy siblings of chronically ill children

Objective: To evaluate the impact of a family-oriented inpatient rehabilitation programme on behavioural and emotional problems in healthy siblings of chronically ill children and to assess the association between these problems and quality of life. Methods: A total of 259 healthy children (4–16 years,M = 8.6 years, SD = 3.3) with a chronically ill sibling were enrolled in the study. Parents filled in the Strengths and Difficulties Questionnaire, while the children answered a self-report quality of life instrument (LQ-KID) at the time of admission and discharge from the clinic and at a 6-month follow-up. Comparisons were performed with a matched control group from the German general population (n = 777). Results: Significant behavioural or emotional symptoms were found in 30.5% of the healthy siblings, the relative risk of having elevated scores being 2.2 compared with the control group. Symptoms were inversely correlated with quality of life (r = -0.42). During the inpatient rehabilitation, symptoms decreased significantly to a normal level. Similarly, quality of life significantly improved, except in the dimension family relations. Conclusions: Family-oriented inpatient rehabilitation is a promising approach to improve the mental health of children with a chronically ill sibling

Associations between Parenting Style and Mental Health in Children and Adolescents Aged 11–17 Years: Results of the KiGGS Cohort Study (Second Follow-Up)

Few studies from Germany have investigated the associations between parenting style and children’s and adolescents’ health. Little attention has been directed to whether these associations vary with familial socioeconomic or migration status. The aim of this analysis was to investigate the association between parenting style and the mental health of children and adolescents aged 11–17 years using data from the KiGGS cohort study (second follow-up). We calculated mean Strengths and Difficulties Questionnaire (SDQ) total difficulties scores stratified by parenting style (authoritative, permissive, demanding–controlling, emotional distancing). Linear regression analyses adjusted for age, gender, socioeconomic status, migration status, and family status were performed. We also analyzed moderating effects of socioeconomic and migrations status on associations between parenting style and SDQ scores. There were only small differences between the permissive and the authoritative parenting styles. Significantly higher mean scores were observed for the demanding–controlling and emotional distancing styles for both the mother and father. These associations persisted after full adjustment and did not vary by socioeconomic or migration status. Parenting behavior is an important predictor of children’s and adolescents’ mental health. The promotion of good relationships within families and improving parenting skills offer promising approaches for health promotion in young people.Peer Reviewe

Support- and meaning-focused coping as key factors for maintaining adult quality of life during the COVID-19 pandemic in Germany

Introduction: During the COVID-19 pandemic, questions about both consequences and helpful strategies to maintain quality of life (QoL) have become increasingly important. Thus, the aim of this study was to investigate the distribution of coping factors during the COVID-19 pandemic, their associations with QoL and the moderating role of certain sociodemographic characteristics. Methods: Analyses were based on cross-sectional self-reports from German adult participants (N = 2,137, 18–84 years, 52.1% female) of the CORONA HEALTH APP Study from July 2020 to July 2021. Multivariate regression analyses were used to predict (a) coping factors assessed with the Brief COPE and (b) QoL assessed with the WHOQOL-BREF while taking measurement time, central sociodemographic, and health characteristics into account. Results: During the COVID-19 pandemic, German adults mostly pursued problem- and meaning-focused coping factors and showed a relatively good QoL [Mean values (M) from 57.2 to 73.6, standard deviations (SD) = 16.3−22.6], except for the social domain (M = 57.2, SD = 22.6), and with a decreasing trend over time (β from −0.06 to −0.11, ps < 0.01). Whereas, escape-avoidance coping was negatively related to all QoL domains (β = −0.35, p < 0.001 for psychological, β = −0.22, p < 0.001 for physical, β = −0.13, p = 0.045 for social, β = −0.49, p < 0.001 for environmental QoL), support- and meaning-focused coping showed positive associations with various QoL domains (β from 0.19 to 0.45, ps < 0.01). The results also suggested differences in the pursuit of coping factors as well as in the strength of associations with QoL by sociodemographic characteristics. Escape-avoidance-focused coping was negatively associated with QoL levels in older and less educated adults (simple slopes differed at ps < 0.001), in particular. Conclusions: The results demonstrated what types of coping may be helpful to avoid QoL deterioration (i.e., support- and meaning-focused coping) and provide implications for future universal or targeted health promotion (i.e., older or less educated adults who lack social or instrumental support) and preparedness in the face of unknown challenging societal situations similar to that of the COVID-19 pandemic. Cross-sectional trends of enhanced use of escape-avoidance-focused coping and QoL deterioration point toward a need for increased attention from public health and policy

Mental health of the adult population in Germany during the COVID-19 pandemic. Rapid Review

This rapid review examines how the mental health of adults in the general population in Germany changed during the COVID-19 pandemic. We conducted a systematic literature search and included 68 publications as of July 30 2021. The underlying studies were classified according to their suitability for representative statements for the general population and for estimating changes in mental health over time. In addition, the observation period and operationalisation of outcomes were considered. The first wave of infection and the summer plateau were mapped by 65% of the studies. Studies that were particularly suitable for representative statements due to their research design showed mixed results, which tend to indicate a largely resilient adult population with a proportion of vulnerable individuals. A predominantly negative development of mental health was described by results from more bias-prone study designs. Routine data analyses showed decreases in outpatient and especially inpatient care, increased use of a crisis service, mixed results for outpatient diagnoses, incapacity to work and mortality as well as indications of shifts in the spectrum of diagnoses. As the current evidence is ambiguous, generalised statements should be reflected in favour of a differentiated view. There is a need for research on the further course of the pandemic, specific risk groups and the prevalence of mental disorders

Reduced pain perception in children and adolescents with ADHD is normalized by methylphenidate

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

Health‐relatedquality of life of children born to childhood cancer survivors in Germany

Objective: Rising childhood cancer survival rates have increased the importance of health-related quality of life (HRQL) assessment. While survivors show comparable HRQL to peers, concerns that cancer treatment could impact the health of prospective children were reported. No previous publications address HRQL of childhood cancer survivor offspring. Methods: We assessed survivor offspring HRQL using the parental KINDL questionnaire. Matched-pair analysis was conducted with data from the general population (KiGGS study) using age, gender and education (1:1, n = 1206 cases). Multivariate analyses were conducted to detect the influence of parental diagnose and treatment on offspring HRQL. Results: Overall, within KINDL dimensions, survivors reported comparable to higher HRQL for their children than the general population. Survivor parents reported significantly (p < 0.001) higher psychological (86.7% vs. 83.0%, Cohen's d = 0.3) and self-esteem (79.1% vs. 73.3%, Cohen's d = 0.5) well-being scores for younger children (3–6-year-olds). As time since diagnosis increased, parents reported higher well-being scores. Accordingly, recently diagnosed survivors reported significantly lower psychological well-being scores (p = 0.28; OR = 0.457; 95% CI = 0.228–0.918) for their children. With increasing age, average HRQL scores decreased in both cohorts; yet, this drop was less pronounced for survivor offspring. The biggest difference between age groups (7–10- vs. 14–17-year-olds) was found for school-specific well-being (6.2-point drop in survivor offspring vs. 18.2-point drop in KiGGS offspring). Conclusion: Comparable to higher parentally assessed HRQL was reported for survivor offspring compared to peers. These findings are reassuring and consistent with self-reported HRQL in childhood cancer survivors. Type of parental cancer diagnosis and treatment showed no negative impact on offspring HRQL.Peer Reviewe

Health‐related quality of life of children born to childhood cancer survivors in Germany

Objective: Rising childhood cancer survival rates have increased the importance of health-related quality of life (HRQL) assessment. While survivors show comparable HRQL to peers, concerns that cancer treatment could impact the health of prospective children were reported. No previous publications address HRQL of childhood cancer survivor offspring. Methods: We assessed survivor offspring HRQL using the parental KINDL questionnaire. Matched-pair analysis was conducted with data from the general population (KiGGS study) using age, gender and education (1:1, n = 1206 cases). Multivariate analyses were conducted to detect the influence of parental diagnose and treatment on offspring HRQL. Results: Overall, within KINDL dimensions, survivors reported comparable to higher HRQL for their children than the general population. Survivor parents reported significantly (p < 0.001) higher psychological (86.7% vs. 83.0%, Cohen's d = 0.3) and self-esteem (79.1% vs. 73.3%, Cohen's d = 0.5) well-being scores for younger children (3-6-year-olds). As time since diagnosis increased, parents reported higher well-being scores. Accordingly, recently diagnosed survivors reported significantly lower psychological well-being scores (p = 0.28; OR = 0.457; 95% CI = 0.228-0.918) for their children. With increasing age, average HRQL scores decreased in both cohorts; yet, this drop was less pronounced for survivor offspring. The biggest difference between age groups (7-10- vs. 14-17-year-olds) was found for school-specific well-being (6.2-point drop in survivor offspring vs. 18.2-point drop in KiGGS offspring). Conclusion: Comparable to higher parentally assessed HRQL was reported for survivor offspring compared to peers. These findings are reassuring and consistent with self-reported HRQL in childhood cancer survivors. Type of parental cancer diagnosis and treatment showed no negative impact on offspring HRQL

Mental health and well-being from childhood to adulthood: design, methods and results of the 11-year follow-up of the BELLA study

Mental health and well-being are of great interest in health policy and research. Longitudinal surveys are needed to provide solid population-based data. We describe the design and methods of an 11-year follow-up of the German BELLA study in children, adolescents and young adults, and we report on age- and gender-specific courses of general health and well-being, long-term health-related outcomes of mental health problems, and mental health care use. The BELLA study is the module on mental health and well-being within the German Health Interview and Examination Survey for Children and Adolescents (KiGGS). Standardised measures were used at each of the five measurement points of the BELLA study. In the 11-year follow-up, young people aged 7–31 years participated (n = 3492). Individual growth modelling, linear regression and descriptive analyses were conducted. Self-reported general health and well-being were both better in younger (vs. older) and in male (vs. female) participants according to the data from all five measurement points. Mental health problems in childhood and adolescence (measured at baseline) predicted impaired health outcomes at 6-year and 11-year follow-ups. Approximately one out of four children with a diagnosed mental disorder was not undergoing mental health treatment. With its 11-year follow-up, the prospective longitudinal BELLA study provides new and solid data on mental health and well-being from childhood to adulthood in Germany, and these data are important for health promotion and prevention practices. These results are consistent with previous findings. Promising future analyses are planned.Peer Reviewe

Psychische und körperliche Gewalterfahrungen in den vergangenen 12 Monaten in der Allgemeinbevölkerung

Gewalterfahrungen können erhebliche psychosoziale und gesundheitliche Auswirkungen haben. In der bevölkerungsrepräsentativen Studie zur Gesundheit Erwachsener in Deutschland (DEGS1) wurde ein Instrument zur Erfassung körperlicher und psychischer Gewalterfahrung (sowohl aus der Opfer- und als auch aus der Täterperspektive) implementiert. Dieses Instrument wurde in der Altersgruppe 18–64 Jahre (n = 5939) eingesetzt. Ziel der vorliegenden Publikation ist es, den Anteil von Personen, denen innerhalb der letzten 12 Monate mehrfach Gewalt widerfuhr oder die infolge der Gewalterfahrung stark beeinträchtigt waren, zu berichten, sowie den Anteil der Personen, die mehrfach Gewalt ausgeübt haben. Des Weiteren werden die Konfliktpartner von Gewaltopfern bzw. Tätern beschrieben und besondere Konstellationen von Gewalterfahrungen in Bezug auf die gesundheitsbezogene Lebensqualität dargestellt. Abschließend wird der Zusammenhang zwischen ausgewählten Einflussfaktoren und dem Risiko, Gewaltopfer zu werden oder Gewalt auszuüben, untersucht. 2,7 % der Frauen und 4,3 % der Männer berichten von mehrfachen Erfahrungen körperlicher Gewalt in den letzten 12 Monaten oder erlebten sich durch diese Erfahrung stark beeinträchtigt; von psychischer Gewalt berichteten 18,9 % der Frauen und 15,4 % der Männer. Frauen sind häufiger als Männer sowohl Opfer als auch Täterin von Gewalt in der Familie. Männer berichten dagegen häufiger von Opfer- und Tätererfahrungen außerhalb des engeren familiären Umfelds. Unabhängig davon, ob sie Opfer oder Täter körperlicher oder psychischer Gewalt waren, ist das psychische Wohlbefinden von Personen mit Gewalterfahrungen signifikant schlechter als das von Personen ohne Gewalterfahrung. Erfahrungen von Gewalt in der Kindheit und Jugend erhöhen das Risiko, später Gewaltopfer oder Gewalttäter zu werden. Die vorliegenden Ergebnisse beschreiben psychische und körperliche Gewalterfahrungen als einen Teil von Gewalthandlungen in der Allgemeinbevölkerung näher und geben so Hinweise auf mögliche Präventionspotenziale.Experiences of violence may have considerable psychosocial and health implications. A violence screening tool was implemented in the German Health Interview and Examination Survey for Adults (DEGS1) to depict the perpetrators’ and victims’ point of view. The study participants were between 18 and 64 years old (n = 5939). The aim of this article is to assess the percentage of people who experienced physical and psychological violence in the last 12 months or who suffered negative effects on their quality of life as a consequence or who were perpetrators of multiple acts of violence. The characteristics of victims, offenders, and their conflict partners are described. Furthermore, specific constellations of violence experience with regard to health-related quality of life are described. Finally, the association between being a victim of violence and different factors is estimated. In total, 2.7 % of women and 4.3 % of men reported multiple experiences of physical violence in the last 12 months or having their lives negatively impacted as a consequence of violence. Experience of psychological violence was reported by 18.9 % of women and 15.4 % of men. Women are more likely than men to be both perpetrator and victim within the family. Men are more likely than women to be both the perpetrator and victim outside of the family environment. Regardless of whether they are the victim or perpetrator of violence, the psychological well-being is significantly worse than those of people who did not experience violence. Experience of violence in childhood and adolescence increases the risk of becoming victim or perpetrator of violence later on in life. The findings presented here describe the psychological and physical experience of violence as one part of violence committed in the whole population. Some prevention advice is also presented