[Data Collection and Assessment of Costs for Prevention And Health Promotion Programs: Development of a Concept Illustrated with 'Promotion of Physical Activity']. / Erfassung und Bewertung der Kosten von Präventions- und Gesundheitsförderungsmaßnahmen ­ Entwicklung eines Konzepts am Beispiel 'Bewegungsförderung'.

It is a desirable medical as well as health economic objective to achieve the best possible health effects with given financial resources. Estimating the costs of intervention programs is complex and not always possible in advance. One possibility to obtain information on costs or cost effectiveness of certain interventions is to assess programs already in existence. The aim of this article was to develop a simple, easy to understand and practical possibility of documenting costs of prevention and health promotion programs. Based on the fundamentals necessary for cost assessment, a questionnaire and a module to document the consumed resources and the resultant costs were developed. These were applied and improved within a pre-test. The developed cost module is as follows: In the left column, 5 key cost categories are listed: personnel, rooms, equipment and process, management, other costs. The cost module is a compromise between different objectives that are difficult to reconcile. On the one hand, the costs should be documented as detailed as possible and on the other, the module must be very simple to implement, as otherwise it will not be used in practice. For this purpose, it might also be useful to develop a module for each stakeholder that is aligned as closely as possible to his or her special activities. All feedback and suggestions from the pre-test were incorporated. However, some of the feedback points were project specific. Here an attempt was made to find a compromise between detail and practicality. This was done by implementing more detailed descriptions and examples in the manual. The presented module is very general. This also is a great advantage because it can be used to document the costs of completely different stakeholders. Thus, the concept presented here for cost assessment provides a first and essential component for a detailed documentation of program costs and provides the potential to check comparability and transferability of those prevention programs.

Complementary and Alternative Medicine Use Among Chronically Ill Adolescents from 2 German Birth Cohorts.

BACKGROUND: Pediatric use of complementary and alternative medicine (CAM) is popular in Europe, and utilization may be even more prevalent in chronically ill children/adolescents. This study's aim is to assess CAM use among adolescents with chronic conditions. METHODS: Data on drug utilization (past 4 weeks) and consultation with CAM providers (past year) were collected using a self-administered questionnaire from 4,677 adolescents from the German GINIplus/LISAplus birth cohorts. All reported drugs were classified into therapeutic categories (conventional drugs, homeopathy, herbal drugs, etc.). Additionally, participants were asked to list any chronic diseases (that were parent-reported, physician-verified diagnoses such as allergies, atopic dermatitis, asthma, or other chronic diseases) that they had had over the previous 5 years. RESULTS: Compared with the total sample, drug utilization in general (60.1% vs. 41.1%), homeopathy use (11.1% vs. 8.1%), and consultation with CAM providers (16.9% vs. 10.9%) was significantly more prevalent among chronically ill adolescents. However, chronically ill adolescents used relatively (proportion of the defined therapeutic category among all drugs used) more conventional drugs than healthy adolescents. CONCLUSION: Compared with healthy adolescents, CAM use is more prevalent among adolescents with chronic conditions. Nevertheless, CAM may predominantly be used as a complementary treatment option rather than substituting conventional drugs.

Utilization of self-medication and prescription drugs among 15-year-old children from the German GINIplus birth cohort.

PURPOSE: The objective was to analyse paediatric drug utilization in relation to self-medication, prescription drugs, and the most reported therapeutic drug categories. METHODS: Data were collected for 3013 children on their utilization of drugs (4-week prevalence) from a German birth cohort study (GINIplus, 15-year follow-up) using a self-administered questionnaire. The drugs were grouped into over-the-counter drugs and prescription drugs, and were classified according to the anatomical therapeutic chemical classification system. Predictors were analysed using a logistic regression model with four independent variables (gender, study area, maternal education, and parental income). RESULTS: Some 69% of the reported 2489 drugs were over-the-counter drugs, and 31% were prescription drugs. The 4-week prevalence for using any type of drug was 41.0%. Drug categories with high prevalence rates of use were antiinflammatory drugs (10.3%), analgesics (7.1%), and antiallergics (5.0%). Factors associated with higher use of over-the-counter drugs were female gender (OR = 1.56, p < 0.0001) and higher maternal education (OR = 1.60, p = 0.0021; university degree vs. secondary high school). Maternal education was correlated with the use of prescribed or self-medicated antiallergics (positive association) and contraceptives (negative association). The use of antibiotics, methylphenidate, and drugs for thyroid therapy was associated with lower parental income. CONCLUSION: The use of over-the-counter drugs in 15-year-old children from the GINIplus birth cohort is very common and is predicted by socioeconomic factors such as maternal education. This has to be considered by health care managers when deciding about the exclusion of over-the-counter drugs (normally used for self-medication) from reimbursement or the deregulation of drug sales.

Utilization of complementary and alternative medicine (CAM) among children from a German birth cohort (GINIplus): patterns, costs, and trends of use.

BACKGROUND: The use of complementary and alternative medicine (CAM) is widespread among children in Germany and other European countries. Only a few studies are available on trends in pediatric CAM use over time. The study's objective was to present updated results for prevalence, predictors, and costs of CAM use among German children and a comparison with findings from a previous follow-up of the same birth cohort. METHODS: Data were collected for 3013 children on their utilization of medicinal products (during the last 4 weeks) and consultation with CAM providers (in the preceding year) from a German birth cohort study (GINIplus, 15-year follow-up) using a self-administered questionnaire. The reported medicinal CAMs were classified into six categories (homeopathy, herbal drugs, nutritionals, minerals and trace elements, microorganisms, further CAM). Drug prices were traced using pharmaceutical identification numbers (PZNs), or otherwise conservatively estimated. Finally, the results were compared with data obtained from the 10-year follow-up of the same birth cohort study by adopting the identical methodology. RESULTS: In all, 26% of the reported 2489 drugs were medicinal CAM. The 4-week prevalence for homeopathy and herbal drug use was 7.5% and 5.6%, respectively. Some 13.9% of the children used at least one type of medicinal CAM in the preceding 4 weeks. The 1-year prevalence for consultation with CAM providers was 10.8%. From the drugs identified as CAM, 53.7% were homeopathic remedies, and 30.8% were herbal drugs. Factors associated with higher medicinal CAM use were female gender, residing in Munich, and higher maternal education. A homeopathy user utilized on average homeopathic remedies worth EUR 15.28. The corresponding figure for herbal drug users was EUR 16.02, and EUR 18.72 for overall medicinal CAM users. Compared with the 10-year follow-up, the prevalence of homeopathy use was more than halved (-52%) and dropped substantially for herbal drug use (-36%) and overall CAM use (-38%) as well. CONCLUSION: CAM use among 15-year-old children in the GINIplus cohort is popular, but decreased noticeably compared with children from the same cohort at the age of 10 years. This is possibly mainly because German health legislation normally covers CAM for children younger than 12 years only.

Patterns of complementary and alternative medicine (CAM) use in children: a systematic review.

UNLABELLED: Utilization of complementary and alternative medicine (CAM) among children/adolescents is popular. This review summarizes the international findings for prevalence and predictors of CAM use among children/adolescents. We therefore systematically searched four electronic databases (PubMed, Embase, PsycINFO, AMED; last update in 07/2013) and reference lists of existing reviews and all included studies. Publications without language restriction reporting patterns of CAM utilization among children/adolescents without chronic conditions were selected for inclusion. The prevalence rates for overall CAM use, homeopathy, and herbal drug use were extracted with a focus on country and recall period (lifetime, 1 year, current use). As predictors, we extracted socioeconomic factors, child's age, and gender. The database search and citation tracking yielded 58 eligible studies from 19 countries. There was strong variation regarding study quality. Prevalence rates for overall CAM use ranged from 10.9-87.6 % for lifetime use and from 8-48.5 % for current use. The respective percentages for homeopathy (highest in Germany, United Kingdom, and Canada) ranged from 0.8-39 % (lifetime) and from 1-14.3 % (current). Herbal drug use (highest in Germany, Turkey, and Brazil) was reported for 0.8-85.5 % (lifetime) and 2.2-8.9 % (current) of the children/adolescents. Studies provided a relatively uniform picture of the predictors of overall CAM use (higher parental income and education, older children), but only a few studies analyzed predictors for single CAM modalities. CONCLUSION: CAM use is widespread among children/adolescents. Prevalence rates vary widely regarding CAM modality, country, and reported recall period.