Indicator-based public health monitoring in old age in OECD member countries: a scoping review.

BACKGROUND: The scoping review was conducted as part of the project "Improving Health Monitoring in Old Age" (IMOA) which aims at developing a conceptual framework with key indicators for a public health monitoring of the population aged 65 years and older in Germany. We systematically identified indicator-based monitoring systems that focus on health and wellbeing of older populations in member countries of the Organisation for Economic Co-operation and Development (OECD) and analysed them with regard to structure, development and content. METHODS: A systematic search strategy included searching the websites of national public health institutes, an additional internet search and a MEDLINE search via PubMed. Indicator systems were included if they presented data on a national level, if they were published or updated after 01/01/2007, if they relied on more than one data source and if they were available in English or German. Data on the structure and development of the indicator sets were extracted using a standardized documentation form, and a content analysis of the indicators was conducted using a pre-defined conceptual framework with three health areas and 11 health domains that is based on the Worlds Health Organization's "World Report on Ageing and Health" and on the International Classification of Functioning, Disability and Health (ICF). RESULTS: Ten indicator-based monitoring systems met our inclusion criteria. Of these, six systems focused exclusively on older populations, and four offer a specific subset of indicators for older age. The number of indicators varied between 22 and 53 (median 32.5). Four systems were directly related to national public health or healthy ageing strategies, and two systems had been developed in consensus processes involving multiple stakeholders. The highest numbers of indicators could be assigned to the domains "health care", "nursing and community care", "wealth and poverty" and "physical health". Overall, 47 different concepts could be identified in the monitoring systems. CONCLUSION: Among indicator-based monitoring systems of health in older age identified in member countries of the OECD, there is considerable variation with regard to structure, development and content. The results will inspire the development of a public health monitoring of the older population in Germany.

Does breastfeeding help to reduce the risk of childhood overweight and obesity? A propensity score analysis of data from the KiGGS study.

BACKGROUND: Current studies suggest that the beneficial effect of breastfeeding on overweight and obesity may have been largely overestimated. We examined the relationship between >4 months of full breastfeeding and overweight/obesity in children living in Germany. METHODS: We analyzed retrospectively collected data on breastfeeding from children aged 3-17 years who participated in the German Health Interview and Examination Survey for Children and Adolescents (KiGGS baseline study) between 2003 and 2006 (n = 13163). To minimize confounding, we applied propensity score matching and multivariate logistic regression analyses to estimate the effect of breastfeeding on childhood overweight and obesity. RESULTS: Adjusted analyses of the matched dataset (n = 8034) indicated that children who were breastfed for >4 months had a significant reduction in the odds of overweight (OR 0.81 [95% CI 0.71­0.92]) and obesity (OR 0.75 [95% CI 0.61­0.92]) compared to children who were not breastfed or who were breastfed for a shorter duration [corrected].Further analyses stratified by age group showed that the association was strongest in children aged 7-10 years (OR 0.67 [95% CI 0.53-0.84] for overweight and OR 0.56 [95% CI 0.39-0.81] for obesity), while no significant effect could be seen in other age groups. DISCUSSION: Our findings support the hypothesis that breastfeeding does have a beneficial effect on childhood overweight and obesity, although the effect seems to be strongest in children of primary school age.

Influence of acute complications on outcome 3 months after ischemic stroke.

BACKGROUND: Early medical complications are potentially modifiable factors influencing in-hospital outcome. We investigated the influence of acute complications on mortality and poor outcome 3 months after ischemic stroke. METHODS: Data were obtained from patients admitted to one of 13 stroke units of the Berlin Stroke Registry (BSR) who participated in a 3-months-follow up between June 2010 and September 2012. We examined the influence of the cumulative number of early in-hospital complications on mortality and poor outcome (death, disability or institutionalization) 3 months after stroke using multivariable logistic regression analyses and calculated attributable fractions to determine the impact of early complications on mortality and poor outcome. RESULTS: A total of 2349 ischemic stroke patients alive at discharge from acute care were included in the analysis. Older age, stroke severity, pre-stroke dependency and early complications were independent predictors of mortality 3 months after stroke. Poor outcome was independently associated with older age, stroke severity, pre-stroke dependency, previous stroke and early complications. More than 60% of deaths and poor outcomes were attributed to age, pre-stroke dependency and stroke severity and in-hospital complications contributed to 12.3% of deaths and 9.1% of poor outcomes 3 months after stroke. CONCLUSION: The majority of deaths and poor outcomes after stroke were attributed to non-modifiable factors. However, early in-hospital complications significantly affect outcome in patients who survived the acute phase after stroke, underlining the need to improve prevention and treatment of complications in hospital.

Association between socioeconomic status and functional impairment 3 months after ischemic stroke: the Berlin Stroke Register.

BACKGROUND AND PURPOSE: We aimed to analyze the association between patient socioeconomic status and functional impairment 3 months after ischemic stroke and to identify factors that influence this association. METHODS: Data were obtained from the Berlin Stroke Register, a network of 14 stroke units in Berlin. Ischemic stroke patients consecutively admitted to 1 of the hospitals in the Berlin Stroke Register between June 2010 and September 2011, were followed-up 3 months after the index event by postal or telephone interview. We used multivariable logistic regression to examine the association between highest education as marker of socioeconomic status and functional impairment after stroke defined by Barthel Index categories. We adjusted for age, sex, prestroke dependency, stroke severity, functional deficit after stroke onset, and comorbidities as possible confounding factors. RESULTS: A total of 1688 ischemic stroke patients who were alive at 3 months and completed the questionnaire were included in the analysis; 40% of the patients were female and 50% of the patients were 70 years or older. Age, prestroke dependency, stroke severity, and the absence of comorbidities were significantly associated with good functional outcome at 3 months. In multivariable analysis, a higher probability of good outcome was observed in patients with college or university degree (odds ratio, 2.18; 95% confidence interval, 1.39-3.42) compared with patients with no completed education. CONCLUSIONS: Patients with lower education have considerably lower rates of good functional outcome after stroke that cannot be fully explained by variations in the patients' clinical and demographic characteristics.