[Newborn hearing screening in Germany-results of the 2011/2012 and 2017/2018 evaluations]. / Neugeborenen-Hörscreening in Deutschland ­ Ergebnisse der Evaluationen 2011/2012 und 2017/2018.

BACKGROUND: Newborn hearing screening (NHS) was introduced nationwide by the Federal Joint Committee (Gemeinsamer Bundesausschuss, G­BA) in 2009. In this process, quality targets were also set in the pediatrics directive. In order to review the quality NHS in Germany, the G­BA commissioned a consortium to conduct an initial evaluation for the years 2011 and 2012 and a follow-up evaluation for 2017 and 2018. METHODS: The evaluations were based on NHS screening parameters (Sammelstatistiken) that must be documented by all obstetrics and neonatology departments as NHS providers and can also be compiled through cooperation with hearing screening centers (HSCs). Additional data were collected through questionnaires and interviews and routine data were used to evaluate the screening process. RESULTS: In 13 federal states, a total of 15 HSCs are involved in the screening process. Across Germany, an NHS screening rate of 86.1% was documented in 2018 (82.4% in 2012), but this differed significantly between the federal states. The specified quality targets could not yet be implemented everywhere. For example, only less than half of the obstetric departments achieved the specified screening rate of over 95%. A comparison of data from the follow-up evaluation and the first evaluation showed that the structural quality of NHS had improved, while the process quality remained the same or had deteriorated. The refer rate (children who were discharged without passing the screening) increased from 5.3% to 6.0%. DISCUSSION: To improve the quality of NHS, HSCs should be established nationwide and a second screening should be carried out more consistently before discharge in the case of a refer result in the initial screening.

Atopic diseases and airway-related symptoms in Bavarian pre-schoolers: determinants and association with immunization.

BACKGROUND: Atopic diseases are among the most common chronic conditions in childhood. Causes of allergies are manifold. The aim of this paper is to evaluate risk factors for atopic diseases and unremitting wheeze and to examine if there is an association between measles, mumps and rubella (MMR) vaccination and atopic dermatitis, asthma and unremitting wheeze in Bavarian pre-schoolers. METHODS: Parents filled out a questionnaire on children's health and environmental and socioeconomic factors. The questionnaire was administered within the Health Monitoring Units in a cross-sectional study in Bavaria, Germany (2014/2015). Data on vaccinations were obtained via the School Entrance Examination, a mandatory examination for pre-school children in Bavaria. Rates of influential factors of atopic diseases and wheeze, MMR and DTP (diphtheria, pertussis and tetanus) vaccination were calculated for all children stratified by health outcomes. To examine if there is an association between MMR vaccination and health outcomes, a multiple logistic regression analysis was performed. RESULTS: Data were available for 3237 individuals. Symptoms and diseases were more frequent in boys. Higher parental education was associated with a higher prevalence of atopic dermatitis. There were no significant associations between any of the health outcome groups and MMR vaccination in the multiple logistic regression models with adjustment for potential confounders. CONCLUSIONS: The present study is in line with the current state of research that MMR vaccination is not associated with atopic diseases.

Poststratification as a suitable approach to generalize findings of two cross-sectional studies along the Bavarian compulsory school entrance examination: An exemplary poststratified analysis for asthma, hay fever and wheezing.

BACKGROUND: A compulsory school entrance examination of pre-school children (SEU) is administered in the German state of Bavaria. Every second year since 2004, the examinations are expanded in six study regions using a cross-sectional survey design (GME). However, the extent to which the results of the GME surveys are generalizable to the SEU population is unknown. Therefore, this study carried out a poststratification of two different GME surveys. The aim was to observe the impact of poststratification on an exemplary analysis of influencing factors for three allergy and asthma related outcomes (hay fever, asthma, wheezing) and thus to better understand this important question. METHODS: First, poststratification was applied to correct for deviances of the GME sample in comparison to the SEU population. Logistic regression was used to determine the auxiliary variables for the poststratification. Following this, a composite variable as a linear combination was created to calculate weighting factors. Next, logistic regression analyses were applied to analyze possible influencing factors for three allergy and asthma related outcomes (hay fever, asthma and wheezing) in two GME surveys (2005/2006 and 2012/2013). Subsequently, the differences arising from poststratification were examined in more detail. RESULTS: This study supports the hypothesis that the GME sample deviates from the SEU population. Mother tongue other than German of at least one parent, complete vaccination status and conspicuous visuomotor test results were positively associated with participation in both GME surveys. The prevalence for hay fever, asthma and frequent wheeze did not change statistically significant from 2005/2006 to 2012/2013. In the twelve analyses before and after poststratification, male sex was statistically significant associated with the three allergy and asthma related outcomes (e.g. asthma 2005/2006 after poststratification, aOR: 2.06, 95%-CI: 1.56-2.71). A high body mass index was positively associated with asthma (e.g. 2005/2006 after poststratification, aOR: 1.12, 95%-CI: 1.05-1.20). Poststratification caused a significant change in the sample composition. CONCLUSIONS: It might be suggested that a poststratification should be performed for each GME survey. Poststratification tended to make results more comparable with previous research. In accordance with previous research, this study confirmed that male sex and high BMI are associated with asthma.

The Impact of Migration Background on the Health Outcomes of Preschool Children: Linking a Cross-Sectional Survey to the School Entrance Health Examination Database in Bavaria, Germany.

AIM OF THE STUDY: This study investigated the impact of migration background on the health outcomes of preschool children from families of various social status levels. METHODS: During the school entrance health examination (Schuleingangsuntersuchung (SEU)) from October 2012 to August 2013, the parents of 5052 preschool children (62% response rate) participated in a cross-sectional health survey within the framework of health-monitoring units (Gesundheits-Monitoring-Einheiten (GME)) in Bavaria, Germany. They were handed a self-administered questionnaire with questions relating to the language spoken at home and other socio-demographic characteristics. By applying the record linkage method, 3747 participants were correctly linked to the corresponding data of the SEU. Based on the merged dataset, 4 definitions of migration background were explored regarding demographic indicators, the parents' mother tongue, and the language spoken at home. The association between migration background and health outcomes of preschool children was analyzed using multivariable logistic regression models separately. The risk estimates were presented for the study population and stratified into high, medium, and low social status. The models were repeated for each of the 4 migration background variables. RESULTS: The results show significant associations between migration background and health outcomes of preschool children (except in pronunciation). A migration background had the strongest impact on the development of word/sentence formation disorder. Compared to non-migrant preschool children, migrant children had twice the chances for full vaccination coverage (OR [95% CI]: 2.4 [1.9-3.1]) but only half the chance to participate in all health examinations from U1 to U9 (0.5 [0.4-0.6]). These children were also at two-fold increased risk to be overweight/obese (2.2 [1.7-2.8]). Moreover, preschool children with double-sided migration from medium social status families faced the highest risk for word/sentence formation disorder (9.5 [5.6-16.1] with SEU definition and 23.3 [10.3-52.6] with GME definition of a migration background). CONCLUSIONS: Future prevention programs at the preschool level should focus on children with double-sided migration from medium social status families. With respect to social and cultural integration, the definition of migration background based on the language spoken at home should be appropriate for future SEUs.

[Epidemiological studies with environmental relevance in Germany]. / Epidemiologische Studien mit Umweltbezug in Deutschland.

Our environment is a major factor in determining health and well-being throughout life, from conception into old age. This overview illustrates the most important epidemiological studies and health monitoring systems in Germany, which investigate environmental influences in various population subgroups and estimate related health effects. Environmental factors examined in each study are described. The mentioned studies in children and adults build the basis for predictions and preventive measures. The number of the assessed environmental factors, the depth of the examinations as well as the (phenotypical) characterization of the study participants differ. Still, the obtained data build a base for important future research. However, for this, a permanent and Germany-wide assessment of environmental factors is necessary.The proportion of the European population living in urban areas is projected to increase in the future. Therefore, environmental factors such as air pollution, air temperature, and noise, but also social inequality, are likely to have a negative effect on health and quality of life of the population. The challenge of the aging population as well as potential adaptation processes to the diverse environmental stimuli requires multidisciplinary approaches. From an environmental epidemiology view, the collected data from the described studies are of immense value because only with this data can associations between environment and health be investigated and public health-relevant preventive measures be identified.The NAKO health study will be the largest resource of health data and should therefore be included in future activities related to the investigation of environmental health effects in Germany.