[Challenges in the Analysis of Health Care Inequalities in Pediatric Rehabilitation]. / Herausforderungen in der Analyse von Versorgungsungleichheiten in der Kinderrehabilitation.

BACKGROUND: Social inequalities on access and utilization of inpatient rehabilitation among adolescents have rarely been studied. METHODS: Parents of children with chronic health conditions (age of 7-17) were interviewed about access and utilization of inpatient rehabilitation. Parents were recruited through pediatricians as well as rehabilitation centers in Central Germany. RESULTS: Despite of numerous recruitment measures the participation by pediatricians was low. Also expanding the sample did not remedial. Furthermore, fewer adolescents with need of rehabilitation were achieved than expected. The analysis is subject to these restrictions, nevertheless, they still allow explorative statements about access and utilization of pediatric rehabilitation. CONCLUSION: Despite major challenges in recruitment, pediatricians should be considered into analysis of inequalities in rehabilitation because of their gatekeeper function.

Multiple complications and frequent severe hypoglycaemia in 'elderly' and 'old' patients with Type 1 diabetes.

AIM: Elderly and old patients with Type 1 diabetes represent a growing population that requires thorough diabetes care. The increasing relevance of this subgroup, however, plays only a minor role in the literature. Here, we describe elderly patients with Type 1 diabetes on the basis of a large multi-centre database in order to point out special features of this population. METHOD: Data of 64609 patients with Type 1 diabetes treated by 350 qualified diabetes treatment centres were assessed and analysed by age group. RESULTS: Compared with the age group ≤ 60 years, patients aged >60 years (n=3610 61-80 years and n=377 >80 years old) were characterized by a longer diabetes duration (27.7 vs. 7.7 years), an almost double risk for severe hypoglycaemia (40.1 vs. 24.3/100 patient-years), a lower level of HbA(1c) [60 vs. 67 mmol/mol (7.6 vs. 8.3%)] and higher percentages of microalbuminuria (34.5 vs. 15.6%), diabetic retinopathy (45.2 vs. 8.3%), myocardial infarction (9.0 vs. 0.4%) or stroke (6.8 vs. 0.3%). Elderly patients used insulin pumps less frequently (12.2 vs. 23.8%), but more often used conventional premixed insulin treatment (10.8 vs. 3.8%). Differences between elderly and younger patient groups were significant, respectively. CONCLUSION: Diabetes care of elderly patients with Type 1 diabetes involves individualized treatment concepts. Increased hypoglycaemia risk and functional impairment attributable to diabetes-associated and/or age-related disorders must be taken into account.