[Injury prevention in young children]. / Prävention von Verletzungen bei kleinen Kindern.

Epidemiological studies in Germany show that infants and toddlers are at most risk of injury and in need of protection. Of all children under the age of 15 years, they have the highest rates of fatal and severe injuries. Therefore, this article aims to show which injury prevention measures have been proven successful for this age group. International specialist recommendations are described and evidence-based knowledge of interventions is presented from the Cochrane Reviews. For the four most frequent child injury mechanisms (drowning, poisoning, burning, and falling), the World Health Organization recommends a set of measures covering legislation, regulations, changes of environment, education, and emergency medical care. Meta-analyses on the effectiveness of interventions related to safety at home conclude that informing parents personally (face-to-face) and in combination with free safety equipment (e.g., safety gates, smoke alarms) increased parents' safety practices significantly. This included advice on not using baby walkers. Multifaceted education programs for parents (e.g., visiting programs at home or in pediatric clinics) proved to have the highest effect in reducing home accidents to children. The prevention of injuries in young children should be driven by a multifaceted and data-based approach. Postnatal interventions (Frühe Hilfen) at the community level are especially useful to integrate accident prevention at home, because they are connected with family visiting programs.

[Vaccination among students in grades 6-10, 2011 - a comparison of German states: need for action for a targeted nationwide immunisation strategy]. / Impfstatus bei Schülern in den 6.-10. Klassen 2011 - ein Ländervergleich. Handlungsbedarf für eine zielgerichtete nationale Impfstrategie.

OBJECTIVE: In Germany, surveillance of the population's immunisation is only mandatory for school beginners, not for adolescents. Therefore, no current data are available from the public health service related to the immunisation of adolescents. Also lacking are nationwide monitoring data regarding HPV vaccination among girls aged 12-18 years and the meningococcal C vaccination, both recently introduced by the German Standing Committee on Vaccination (STIKO) in 2009 and 2006, respectively. The present research and analysis therefore aims to determine which German states perform a monitoring of the vaccination status of adolescents, how immunisation rates differ across German states and what need for action, in terms of a nationwide immunisation strategy, can be derived. METHOD: A systematic survey of vaccination coverage among students in grades 6-10 (age group 12-16 years) for the school year 2010/11 was undertaken. The defined documentation standard is based on the standard vaccinations for children and adolescents according to STIKO, requiring complete primary immunization (PI) and the number of booster vaccinations. In the analysis, 8 of 16 states were included, due to lack of data for the remaining states. RESULTS: In total, the public health service -examined 157,599 school children in 8 German states and checked 103,250 vaccination certificates (on average 68.1%, range 54.9-85.2%). The implementation of the booster vaccination among students in grades 6-10 proved to be insufficient. The 2-dose measles vaccination, required by the WHO for 95% of the population, was only nearly achieved by 2 of 8 German states -(Saxony-Anhalt, Brandenburg). The effects of insufficient immunisation coverage are shown by, for example, a higher measles incidence rate in children under 15 years and a persisting peak of pertussis incidence in 10- to 15-year-olds. The meningococcal C vaccination, introduced in 2006, was insufficiently taken up by students and very differently implemented among the 8 -German states (Saxony 73.9% vs. Bavaria 29.1%). HPV vaccination in girls has not yet been established (Brandenburg maximum 39.8%). CONCLUSION: Findings of this study show that the primary health care system is insufficient in reaching adolescents. Systematic checks of vaccination certificates in schools need to be extended, in cooperation with the public health service in order to identify gaps in vaccination. Through counselling and referrals to general practitioners or paediatricians there is the chance to catch up on missing vaccinations. It is necessary to promote catch-up programmes for newly indroduced vaccinations as well as for missed and booster vaccinations and to implement them in the health care system.

[Status quo of children's preventative medicine programmes--results of the first German nationwide workshop 2011 in Frankfurt am Main]. / Zum aktuellen stand der kindervorsorgeprogramme--ergebnisse des ersten bundesweiten arbeitstreff ens 2011 in Frankfurt am Main.

10 of the 13 federal states presented their structures, implementation methods and results as part of the nationwide workshop for children's preventative medicine and early recognition projects for Germany on 9th September 2011 in Frankfurt am Main. This was the first time a full overview of all programmes of this kind in Germany has been possible. The programmes and data from these 10 presentations were analysed and compared. Despite the many differences between the legal frameworks and structural implementation, the programmes also displayed similarities in the implementation and in the problems which arise. Significantly improved participation rates for early recognition check-ups have been achieved in the context of the programmes. Previously, only a few detailed evaluations for the detection of risks to children's welfare and other effects such as vaccination rates and improvements in children's health through more advice and care were available.

[Child health check-ups as an instrument in child welfare. First results of compulsory check-up systems in German federal states]. / Früherkennungsuntersuchungen als Instrument im Kinderschutz. Erste Erfahrungen der Länder bei der Implementation appellativer Verfahren.

Routine well-child visits, implemented as a means of secondary prevention and covered by health insurance, lead to early identification of disorders and abnormalities in child development."Guiding principles for children" (by the G-BA) have determined the content of the eleven examinations, ranging from U1 immediately after birth to J1 in adolescence; eight of them take place within the first four years of age. Since cases of child maltreatment, neglect, or abuse became public in 2007, almost all German federal states have established mandatory examination and notification processes in the new child welfare surveillance programs. First results in the German federal states (six of which are exemplarily illustrated) point out that mandatory requirements have collectively increased the frequency of medical check-ups in children, especially starting from four years of age and most significantly in families with social disadvantages (young/single parents, immigrant background, uneducated or socially disadvantaged families), which have so far been difficult to reach. Subsequently, provision of primary prevention (vaccinations and health promotion advice) by pediatricians has also increased. As a sole instrument for the complete identification of threats for children's welfare, however, systems inviting and reminding parents about check-ups are only of limited benefit.

[Circumstances of injury in childhood and adolescence. Data and epidemiology]. / Verletzungsgeschehen im Kindes- und Jugendalter. Datenlage und Epidemiologie.

The population-related aspects of injuries in children and adolescents in Germany using data from different sources were compiled and analyzed. In contrast to clinical case studies, our focus was on risk groups, injury mechanisms, and context of injury. Sources of information used for this study included the following: Causes of Death Statistics, Hospital Diagnosis Statistics, Child and Adolescent Health Survey, Injury Database. Data for the period 1998 to 2008 on unintentional injuries, violence, and suicide were assessed by age group and gender and study results on sociodemographic risk factors were included. The analysis revealed that injuries display an age-specific dynamic: infants carry a high risk for fatal domestic injuries as well as for injuries due to violence, whereas in adolescents the majority of injuries result from fatal traffic injuries and from suicide. In addition, social factors were found to be related to specific mechanisms of injury (e.g., scalds) and intention (e.g., violence) only. Migration status has an age- and gender-related influence on injury rates.

[Child abuse and violence as reasons for injuries in childhood: results of a monitoring of children and adolescents in South Brandenburg (Germany)]. / Misshandlungen und Gewalt als Verletzungsursachen im Kindesalter: Ergebnisse eines Unfallmonitorings bei Kindern und Jugendlichen in Südbrandenburg (Deutschland).

BACKGROUND: During childhood injuries are one of the most common reasons for a consultation, second only to infectious diseases. Not as rare as aspected these injuries are caused by maltreatment. The aim of this study is to show the frequency of non-accidental injuries (NAI) in the patient group from a pediatric hospital in East Germany. MATERIAL AND METHODS: Over a 12-month period all cases of injured children who needed to be hospitalized for treatment were registered. In a computer based questionnaire various parameters, such as age, sex, social status, and accident details were documented. RESULTS: A total of 573 injured children and adolescents needed inpatient treatment. In 86.7% of the cases injuries resulted from an accident. In 8.6% of all cases a connection to violence could be found mostly in the form of head and soft tissue injuries. CONCLUSION: The findings show the importance of a detailed and specific anamnesis and physical exploration of children with trauma. Recognition of maltreated children does not only apply to pediatricians, but also to physicians of several specializations.

[The Brandenburg social index: a tool for health and social reporting at regional and communal levels in the analysis of data of school beginners]. / Der Brandenburger Sozialindex: ein Werkzeug für die Gesundheits- und Sozialberichterstattung auf Landes- und kommunaler Ebene bei der Analyse von Einschülerdaten.

A social index derived from examinations of prospective first graders is used for health reporting in the Federal State of Brandenburg. The Brandenburg social index consists of data from the medical examinations, which contain social anamnesis questions. Based on parents' education and employment, the social index is computed for each child and finally each child is assigned to a group of lower, middle or higher socioeconomic status. The simply made social index is not only used for analysing health and social inequalities but also for analysing the social situation and trends of young families. Social index data for prospective first graders have ben collected since 1994. Thus, the social index is part of the social reporting in Brandenburg. The present article illustrates with examples how the index is used. Finally, it is mentioned that the Brandenburg government uses the social index to control finances in the language promotion for kindergarteners in day-care centres.

[Migration-sensitive data collection for public health surveillance]. / Migrationssensible Datenerhebung für die Gesundheitsberichterstattung. Arbeitsgruppe Gesundheitsberichterstattung des Arbeitskreises "Migration und öffentliche Gesundheit".

Despite the many potential sources of stress and strain that accompany a migration situation, there are very few data in official statistics with regard to the health and social situation of migrants in Germany. The fact that this information is not available for public health reporting could lead to problems of improper, lacking or excessive health care. A working group within the Arbeitskreis Migration und Offentliche Gesundheit has been addressing this problem since 2003. In this article, a systematic overview of the most important data sources for public health reporting and of the indicators for migration background and social status that each one contains will be given. After that we will present examples of good practice in migration-sensitive data collection at the local and national level. Finally suggestions for improving the data situation with regard to the health of migrants based on the recommendation for recording the migration status in epidemiological studies will be made.

[Injuries among children and adolescents (1-17 years) and implementation of safety measures. Results of the nationwide German Health Interview and Examination Survey for Children and Adolescents (KiGGS)]. / Verletzungen bei Kindern und Jugendlichen (1-17 Jahre) und Umsetzung von persönlichen Schutzmassnahmen. Ergebnisse des bundesweiten Kinder- und Jugendgesundheitssurveys (KiGGS).

Parent interviews with regard to their children's accidents and to accident protective measures in the Health Interview and Examination Survey for Children and Adolescents (KiGGS) aimed at extending our knowledge of age- and gender-specific injuries and to identify risk groups and risk factors for injury prevention. The parents of 16,706 children (aged 1-17 years) were asked about their children's injuries within the last 12 months which were medically treated, and about accident mechanisms, consequences of injuries, and ambulatory and hospital treatment. In addition, parents and children aged 11 to 17 years (n = 6813) were asked to give information on protective measures. According to the parents 15.9 % of the children had at least one injury within the last 12 months, 15.2 % because of an accident and 0.8 % because of assault. In the age group 1-17 boys have been injured significantly more often than girls (17.9 % vs. 14,0 %). Overall, 13.3 % of 2,410 injured children and adolescents were hospitalized. Two thirds of the accidents among toddlers were domestic accidents (60 %) whereas leisure and sport accidents were most prevalent in children and adolescents aged 5-14 years and 15-17 years (32.1 % and 38.9 %). The proportion of accidents in child care facilities and educational institutions tripled from infancy to school age (age 5-14 years) (10.9-28.7 %), as did traffic accidents (5.6-16.7 %). The three most frequent injury mechanisms in the age range 1-17 years were falls on level ground (35.2 %), falls from heights (25.2 %) and collisions with objects or persons (20.6 %). Falls from heights showed the highest risk in toddlers (35.8 %). Contusions, sprains and strains increased to a highest level of 50.9 % in adolescents; likewise, bone fractures increased from 10.7 % in toddlers to 21.8 % in adolescents aged 15-17 years. An influence of socioeconomic status on injuries overall and on consequences of injuries was not seen. For traffic accidents in children aged 1-17 years boys (p = 0.019) and girls (p = 0.047) from families with lower socioeconomic status showed higher rates of accidents than children from families with higher socioeconomic status. The application of protective measures was lowest in the age group 14-17 years. While according to the parents about 90 % of children aged 3-4 years wear a helmet when riding a bicycle or when skating, this quote was lower in the age group 5-14 (60 %) and dropped to about 15 % in the age group 14-17 (about 15 %). Also the rate for using protective clothes was lowest in age group 14-17 (boys 41.8 %; girls 52.2 %). In children and adolescents the rate of self-reported helmet use is lower than estimated by their parents. In all age groups migration background and low socioeconomic status were associated with lower use of protective measures (helmets and protective clothes). The age related data analysis should be the starting point in prevention measures for specific risk groups considering migration and socioeconomic status. Prevention activities in traffic should focus on families with low social status. Adolescents should be specifically and adequately addressed regarding the benefits of certain safety measures when riding a bicycle and when skating.

[Epidemiological Analysis of Injuries Among Children under 15 Years of Age in Germany--The Starting Point for Injury Prevention]. / Epidemiologische Analyse von Unfällen bei Kindern unter 15 Jahren in Deutschland--Ausgangspunkt für die Unfallprävention.

OBJECTIVE: The epidemiological analysis of injury circumstances can play an important role in implementing targeted injury prevention measures. The data available in Germany are being compiled in order to define risk groups, risk factors and the main accident causes. METHOD: A descriptive epidemiological analysis of injuries among children according to severity (fatality or hospitalization rate), frequency, age group, location, product involvement, ethnic background and social risk factors was carried out. The following data sources were drawn upon for the epidemiological analysis: official statistics, surveys on home and leisure accidents, social status data from school beginners' medical examinations in the federal states of Brandenburg and Schleswig-Holstein as well as population-based injury monitoring in the city of Delmenhorst (1998 - 2002). RESULTS: Since 1990, total injury mortality among children under 15 years has declined by more than two-thirds in Germany (from 10.2 to 3.0 per 100,000 during the period 1990 - 2004). This is true both for road traffic accidents and for home and leisure accidents. There is an age-specific distribution in terms of fatal accident causes: suffocation, drowning, falls and burns are the most common among the under 5-year-olds, while in school-age children road traffic accidents and drowning predominate. For several years, infants and toddlers have been the groups most at risk and hospitalisation figures for these groups are still sharply increasing. In the under 5-year-old group, accidents happen mainly in and around the home, whereas among school children (5 - 14 years) they occur most frequently at school, at home and during leisure activities, and on the roads. Accidents are often environment- and product-related. Children from ethnic minorities and low status families are the groups most at risk in terms of road traffic accidents and scalds. CONCLUSION: The epidemiological analysis of childrens' injuries should be the starting point for age- and environment-specific and product-related interventions. Intervention strategies should take into account parents' ethnic background as well as potential language barriers.

[Survey on awareness of violence against children and the use of the guide "violence against children and young people" by paediatricians in Brandenburg]. / Befragung zur Wahrnehmung von Gewalt gegen Kinder und zur Nutzung des Leitfadens "Gewalt gegen Kinder und Jugendliche" durch Brandenburger Kinder- und Jugendärzte.

UNLABELLED: Following the lead of other German Federal States, Brandenburg has developed a guide entitled "Violence Against Children and Young People" for use by paediatricians. This guide has two objectives: to help doctors detect violence against children at an early stage, and to improve interdisciplinary case management. In order to assess whether the guide has proved its worth in practice, the Public Health Institute of Brandenburg conducted a survey among users. In addition, paediatricians treating the victims were interviewed to obtain estimates of the incidence rate of such acts of violence against children. METHODOLOGY: In 2002/03, the guide was provided free of charge to all paediatricians engaged in the treatment of in- and outpatients, and a structured questionnaire was used to interview a total of 285 such doctors and child and youth psychiatrists on the following topics: estimated incidence rate of acts of violence (proven and suspected cases), case management in practice (cooperation with other agencies, provision of care, support needs) as well as assessment of the guide's content and design in terms of the practical utility of the information provided. After the questionnaires had been sent out a second time, the response rate was 33.3 % (92 out of a total of 285). RESULTS: 82 (89.1 %) of the paediatricians questioned had dealt with at least one case of violence against children in 2003; only three doctors had seen no case at all. A total of 904 proven and 945 suspected cases were registered. One striking result of the survey was the great variation in the number of cases registered by individual doctors: between 0 and 179 proven cases, and between 0 and 120 suspected cases. 12 doctors (13 %) stated that they had treated proven or suspected cases in all four categories (physical abuse, physical neglect, emotional abuse, sexual abuse). Other doctors registered no proven, only suspected cases. 80 doctors (87 %) questioned said that they worked together with other agencies, but 19 (20.6 %) were dissatisfied with this cooperation. 59 (64.1 %) reported a need for case-related support, particularly from the following institutions: 1. Youth Welfare Office, 2. Child and Youth Psychiatry, 3. Public Health Office. 19 (30.4 %) doctors regarded the local provision of care as insufficient. Results of the guide's evaluation: 44 out of a total of 49 doctors (88.8 %) considered the guide's design and contents "good" or "very good". 19 doctors (38.8 %) stated that the guide had led to changes in the way they work and that they were now able to deal with the problem of violence against children more confidently. CONCLUSION: Paediatricians in Brandenburg testify to cases of violence against children. The guide "Violence Against Children and Young People" offers useful information on the practical handling of such cases. The alliance "Growing up Healthy in Brandenburg" tackless the need for support by developing a catalogue of measures to be implemented. These include conducting specialised further training for paediatricians as well as cross-disciplinary furthertraining measures, and setting up regional working groups to improve basic networking in practice.

[Prevention by vaccination of children and young people. Obstacles and examples of effective measures in the Federal State of Brandenburg]. / Impfprävention im Kindes- und Jugendalter. Hindernisse und Beispiele wirksamer Massnahmen im Land Brandenburg.

This article identifies successful vaccination strategies, obstacles to such strategies and the role that schools can play in terms of health education by analysing vaccination rates among children in the Federal State of Brandenburg. The analysis is based on the vaccination status of Brandenburg's children at day care centres and schools in relation to the social status of their parents, the extent to which preventive examinations (U up to J1) is taken advantage of and regional location. Furthermore, an evaluation is rendered of the vaccination awareness campaign which has been carried out in sixth grade students since 2002 to assess the impact of health promotion at schools. In the Federal State of Brandenburg vaccination coverage among infants and toddlers is good, with approximately 94% having received complete basic vaccination in 2003. By contrast, there are marked deficits among tenth grade schoolchildren in terms of refresher vaccinations, basic hepatitis B vaccinations and the second measles, mumps and rubella (MMR) vaccinations. Vaccination status is strongly dependent on the social status of parents and the extent to which preventive medical examinations and regional medical health-care provision are utilized. Systematic checking of vaccination documents by the public health services promotes vaccination awareness. Prevention by vaccination is most effective when combined with preventive medical examinations, effective local vaccination management and interdisciplinary interventions: education at schools, systematic tracking of vaccination documents combined with the provision of vaccinations in doctors' surgeries and additionally by the public health services.

[Social status and health of young people in the German Federal State of Brandenburg]. / Soziale Lage und Gesundheit von jungen Menschen im Land Brandenburg.

UNLABELLED: In the German Federal State of Brandenburg, reporting on health and social issues is closely linked. This also applies to the present article, which attempts to describe the social and health situation of young people in Brandenburg. The aim is to define future priorities in health prevention. METHODS: In addition to data from official statistics (on demographic trends, employment and social security) and from surveys conducted among young adults, the results from serial medical and dental examinations of 10th-grade pupils are presented. RESULTS: The number of young citizens in Brandenburg aged 16-25 will rise until the middle of the decade but then fall sharply. This will apply in particular to the rural areas far from Berlin. Sociological studies show that "work and family" enjoy the highest priority among people. However, less educated young people are increasingly doubtful about their ability to live their lives according to these priorities. According to medical statistics, every tenth young person suffers from allergies (especially allergic rhinitis). The same applies with regard to orthopaedic data. Approx. 5% of young people are obese, pupils of special schools more frequently than grammar school pupils. DISCUSSION: Healthy schooling, healthy professional training and good opportunities on the labour market are the key pillars of health policy in Brandenburg. The social and health situation of young people in Brandenburg is a complex issue and can only be improved by networking and cooperation among of all parties concerned.

[Not Available]. / Epidemiologische Analyse von Sturzunfällen im Kindesalter (<15 Jahre) Konsequenzen für die Prävention : Konsequenzen für die Prävention.

UNLABELLED: In Germany, the database on falls among children (<15 years) is insufficient because there is no systematic, population-based monitoring of injuries according to location, type and mechanism. This analysis will compile relevant data on fall injuries among children in Germany and define risk groups, risk factors and typical accident mechanisms according to the frequency and severity of fall injuries. RESULTS: In 1998, 31 children (<15 years) (N=655) died through falls, in most cases by falling from a building (n=8). Around 700,000 children are estimated to have required medical treatment for falls, approx. 120,000 of them being hospitalized. Fall injuries show an age- and environment-specific accident pattern. Most of the falls among infants and toddlers are from changing tables, children's beds, high chairs and stairs. Among school-age children, falls occur most frequently at school (during break and physical education lessons) and during leisure activities (skating, cycling). These facts should form the basis for prevention measures targeting behaviour and health conditions.

International comparisons of child injuries and prevention programs: recommendations for an improved prevention program in Germany.

OBJECTIVES: To compare child injury mortality in Germany with that of four neighboring countries, and to examine injury prevention models in these countries with a view to improving prevention programs in Germany. METHODS: Based on official cause of death certificates, child injury mortality rates in Germany are compared with those of Austria, The Netherlands, Sweden, and Switzerland. The main structures and funding of injury prevention programs in these countries are described. RESULTS: In all five countries, mortality is highest among children aged 1-4 years for home and leisure accidents and drownings. Transport accidents are the main cause of death in the 5-14 age group. Mortality in both age groups has fallen significantly since 1980, most markedly in Sweden and The Netherlands. CONCLUSION: Drawing on the injury mortality data and experience of the comparison countries, the following recommendations are proposed to further reduce home and leisure injuries among children in Germany: (1) establish a soundly funded, central institution responsible for child injury surveillance, research, and the coordination of injury prevention activities, (2) improve product control legislation, and (3) disseminate specific safety information to target groups and the general public.

[Health of school beginners]. / Gesundheit von Schulanfängern: Auswirkung sozialer Benachteiligung am Beispiel der Brandenburger Schulanfängeruntersuchungen 1994 und 1995.

Since 1994, the results of medical examinations carried out on school beginners in the Federal state of Brandenburg have been documented according to a uniform standard, and a standardised procedure has been used for questioning parents about their child's medical history, accidents, and the relevant environmental and social anamnesis. To this extent, information is available on each child's health and social characteristics. In order to analyse the connection between a child's health and the social status of the family, a combined social and education-related variable was established. The social status of the families in question was defined in terms of three groups (low, medium and high social status) and related to the child's health characteristics. The results of the 1994 study of 23,462 families (response: 72.8%) are considered in detail and include comprehensive data on the families' social situation. The results of the 1995 study (n = 14,568) confirm the effects of social status on a child's health and prove the reliability of the model of calculation.

[The Charlottenburg Allergy Prevention Program 90. Early detection and prevention of allergic diseases by modifying mass screening of 3d grade students]. / Charlottenburger Allergievorsorgeprogramm 90. Früherkennung und Prophylaxe allergischer Krankheiten durch Modifizierung der Reihenuntersuchung der 3. Klassen.

On the one hand, the Charlottenburg allergy prevention programme showed the spread of allergic diseases among the pupils of the third form of public schools, and on the other hand it familiarized parents, teachers and pupils with health promotion schemes under the slogan These who are informed well in time will suffer less. For the first time within the area of Berlin, the Charlottenburg district developed a quality standard in respect of screening and health promotion connected with allergy. This new focal point of attention was set up by means of mass screenings of pupils while at the same time critically reviewing previous routine methods, weeding out unnecessary procedures and emphasizing the essential. The difficult tasks confronting Public Health services in this regard could not be managed without outside help. This was forthcoming from partners recruited from the university, the sickness insurance bodies and self-help groups. The cooperation that developed in this manner was exemplary and might serve as a model for future on-target health prevention programmes.