Content uploaded by B-M Kurth
Author content
All content in this area was uploaded by B-M Kurth on Nov 03, 2015
Content may be subject to copyright.
A preview of the PDF is not available
Personale, famili??re und soziale Schutzfaktoren und gesundheitsbezogene Lebensqualit??t chronisch kranker Kinder und Jugendlicher
Abstract
Die vorliegende Arbeit beschreibt auf der Grundlage der bundesweit repräsentativen Daten des Kinder- und Jugendgesundheitssurvey (KiGGS) die chronischen Gesundheitsstörungen Asthma, Adipositas und ADHS bei Kindern und Jugendlichen im Kontext personaler, familiärer und sozialer Schutzfaktoren (Ressourcen) und gesundheitsbezogener Lebensqualität. Die Auswahl dieser hoch prävalenten chronischen Krankheiten erfolgte unter Berücksichtigung ihrer unterschiedlichen Ätiologie und Genese unter der Annahme, dass diese Krankheiten in besonderem Maße mit Defiziten im Bereich der Schutzfaktoren und Einschränkungen der Lebensqualität einhergehen. Insgesamt wurden die Daten von 6813 Kindern und Jugendlichen im Alter von 11–17 Jahren in die Analyse einbezogen. Angaben zu den Diagnosen der chronischen Krankheiten stammen aus dem ärztlichen Interview (CAPI) mit den begleitenden Elternteilen bzw. aus dem Elternfragebogen. Für die Einschätzung von personalen, familiären und sozialen Ressourcen und Lebensqualität wurden die schriftlichen Selbsturteile der Kinder und Jugendlichen herangezogen. Die Befragung zu Ressourcen erfolgte mit mehreren psychometrischen Messinstrumenten, wie z. B. der Social Support Scale zur Erfassung der sozialen Ressourcen oder der Familienklimaskala, die den familiären Zusammenhalt untersucht. Zur Erfassung der gesundheitsbezogenen Lebensqualität wurde der KINDL–R herangezogen. Asthmakranke Kinder und Jugendliche geben kaum Defizite im Bereich der Schutzfaktoren und der gesundheitsbezogenen Lebensqualität an. Einschränkungen berichten hier vor allem die Mädchen. Damit unterscheiden sie sich wesentlich von den Kindern und Jugendlichen mit Adipositas oder ADHS, von denen durchgängig Defizite in beiden Bereichen berichtet wurden. Dabei waren die differenziellen Effekte bei ADHS am stärksten. Im Ergebnis zeigen sich gravierende Unterschiede bezüglich Schutzfaktorausprägungen und selbsteingeschätzter Lebensqualität der ausgewählten chronischen Gesundheitsprobleme in Abhängigkeit vom Krankheitsbild und Krankheitsverlauf. Es ist anzunehmen, dass Asthma als chronische Krankheit, die sich vornehmlich somatisch manifestiert und effizienteren Behandlungsmöglichkeiten unterliegt, seine einschneidende Belastung verloren und kaum noch einen Einfluss auf die selbst wahrgenommene Lebensqualität hat. Bei ADHS und Adipositas als Erkrankungen mit sozial stark stigmatisierenden, isolierenden, demotivierenden Komponenten zeigen sich deutlichere Zusammenhänge mit geringeren Ausprägungen der Schutzfaktor- und Lebensqualitätsskalen. Daher erscheint es besonders bedeutsam, diesen Kindern und Jugendlichen über das Maß medizinischer und/oder psychologischer Hilfe hinaus Unterstützung anzubieten, die ihnen bei der Bewältigung ihrer krankheitsbezogenen Probleme helfen. Die Ergebnisse machen auch deutlich, dass, bei einer ganzheitlichen Betrachtung von „chronischem Kranksein“, neben den unmittelbaren Auswirkungen der Erkrankung auf die Betroffenen und ihr familiäres und soziales Umfeld vorhandene Ressourcen zur Belastungsbewältigung (z. B. Copingstrategien) zukünftig noch mehr in die Untersuchungen einbezogen werden müssen. The present publication describes chronic conditions of children and adolescents (asthma, ADHD, obesity) in relation to personal, familial and social resources and to health-related quality of life (HRQOL). A database of these investigations is the German health interview and examination survey of children and adolescents (KiGGS), which is representative for 0 to 17 year-olds. The above mentioned chronic conditions occur frequently in this age group and are assumed to have an influence on quality of life and to be related to a lower level of protective factors. Methods The investigations used the data of 6813 children and adolescents within the age group of 11 to 17 who participated in the KiGGS study. Information about diagnosed chronic conditions was given by the parents within the framework of the computerassisted medical interview (CAPI) and by completing questionnaires. The personal, familial and social protection factors as well as the quality of life were assessed by the questionnaires, filled in by the adolescents themselves. Instruments used were the Social Support Scale, the Family Climate Scale and KINDL-R. Results Children and adolescents with asthma seem to have no deficits in the health-related quality of life and in the field of protective factors. This differs from the situation of the obese children as well as from the children with ADHD. Both groups show significant deficits in the health-related quality of life and protection factors. Discussion The chronic conditions investigated show remarkable differences in the scale values for measuring protective factors and health-related quality of life. Possible explanations are: For asthma as a chronic disease with somatic manifestation effective treatments and therapies exist, so that it has nearly no influence on the self-assessed quality of life. ADHD and obesity result in a decrease of quality of life and in the field of protective factors, possibly caused by social stigmatisation, isolation and demotivation of the concerned children and adolescents. Therefore it is important to support those children and adolescents to cope with their disease-related problems. The results illustrate that in addition to the immediate effects of chronic conditions on the concerned children and their families, it is the quality of life and the familial and social environment that should be specifically addressed in further studies.
... The German Health Interview and Examination Survey for Children and Adolescents (KiGGS) provides data on the physical and mental health of children and adolescents, which are also comprehensively analysed for their relationship with social status [4,5,12,13]. As a supplementary evaluation, this paper intends to examine the relationship between social status, mental health issues and personal, social and family resources, in particular the extent to which children from socially disadvantaged families benefit from corresponding resources. ...
... Psychosocial resources were surveyed using various items and can be divided into personal, family and social resources [13,16]. The corresponding data and results are based exclusively on self-reported data from the 11-to 17-year-old children and adolescents. ...
... Overall, 19.4% of 11 to 17-year-olds from the low status group present mental health issues compared to 15.9% from the medium and 9.9% from the high-status group. The the categories of 'inconspicuous or normal', 'below average or borderline' and 'significant deficits' [13,20]. Dummies were created for the binary logistic regressions (see 2.3 Statistical analyses). ...
Mental health burdens are among the most common health issues in childhood and adolescence. Psychosocial resources can act as protective factors and can help in preventing the development and reduce the symptoms of mental health issues. This article discusses this relationship and the availability of these resources within the three different social status groups among 11- to 17-year-olds. The database is the second wave of the German Health Interview and Examination Survey for Children and Adolescents (KiGGS Wave 2, 2014-2017). Mental health issues were assessed via the Strengths and Difficulties Questionnaires; psychosocial resources via self-reported personal, family and social resources; social status was ascertained through a multidimensional index based on the information provided by parents on education, occupational status and income. The analyses show that 11- to 17-year-olds who have psychosocial resources are less likely to show mental health issues (independent of their social status) and that, compared to high social status, mental health issues are more frequently associated with low social status. Children from (socially) worse-off families have less access to resources. The results consequently highlight the importance of prevention and health promotion measures directed at strengthening resources. Focusing such measures on the needs of disadvantaged population groups should contribute to health equity.
... За последние два десятилетия глобальная распространенность этого состояния среди пожилых людей показала тенденцию к росту. Будучи одной из основных проблем общественного здравоохранения, она стала особенно значимой в старшей возрастной группе, поскольку ухудшает здоровье, увеличивает инвалидизацию и смертность, усложняет лечение и реабилитацию и повышает риск развития осложнений у пожилых людей [5,6]. ...
Increasing life expectancy and, as a consequence, a large number of comorbidities lead to a multitude of medications prescribed by physicians of different specialties. Patients with obesity and carbohydrate metabolism disorders, especially with type 2 diabetes mellitus (DM2), are at particular risk of polypragmasy, which is associated with the use of potentially nonrecommended medications. Prescribing errors can cause significant harm to the patient’s health and increase the risk of rehospitalization and healthcare costs. Identification of probably not recommended drugs in this category of patients will improve understanding of prevalence and risk factors of their use, develop strategies to prevent and limit the burden of taking inappropriate drugs and promote development of personalized and patient-oriented treatment options. Tools exist to assess potentially inappropriate therapy (PIT) in the elderly and new tools and criteria are often created. However, they are not specifically aimed at people with obesity and carbohydrate metabolism disorders. Thus, these criteria usually include only a few items related to DM2. Consequently, there is a clear need for a modern tool that can be used to address PIT specifically in older adults with obesity and carbohydrate metabolism disorders.
... International surveys revealed a decreased HrQoL in children and adolescents with chronic conditions and mental health problems [60][61][62][63]. The German KIGGS study highlighted youths with neuro-dermatitis, obesity, and mental health problems as at-risk groups for deteriorated HrQoL and as target populations for prevention programs [42]. ...
Chronic physical health conditions (CPHC) are on the rise in younger age groups and might have a negative impact on children and adolescents. In a representative sample of Austrian adolescents aged 10–18 years, internalizing, externalizing, and behavioral problems were assessed cross-sectionally using the Youth Self-Report and health-related quality of life (HrQoL) using the KIDSCREEN questionnaire. Sociodemographic variables, life events, and chronic illness specific parameters were considered as associated variables with mental health problems in individuals with CPHC. Of 3469 adolescents, 9.4% of girls and 7.1% of boys suffered from a chronic pediatric illness. Of these individuals, 31.7% and 11.9% had clinically relevant levels of internalizing and externalizing mental health problems, respectively, compared to 16.3% and 7.1% adolescents without a CPHC. Anxiety, depression, and social problems were twice as high in this population. Medication intake due to CPHC and any traumatic life-event were related to mental health problems. All HrQoL domains were deteriorated in adolescents with a double burden of mental and CPHC, whereas adolescents with a CPHC without mental health problems did not differ significantly from adolescents without a chronic illness. Targeted prevention programs for adolescents with a CPHC are urgently needed to prevent mental health problems in the long term.
... As such, the SDQ does not enable valid conclusions about specific psychological disorders or whether mental health problems require treatment. However, in light of the reduced quality of life and increased medical costs linked to children and adolescents with mental health problems [2,20], it is crucial that young people and their families are informed about the opportunities available for Since 2006, the so called "U10" and "U11" medical checkups for children between 7 and 10 years of age include a specific assessment of behavioural problems. Problems that are identified during check-ups can be discussed with the physician. ...
Mental health problems in children and adolescents are associated with individual and family-related constraints as well as social costs. 20.0% of children and adolescents showed mental health problems at the KiGGS baseline study (2003-2006). This study investigates the current prevalence for KiGGS Wave 2 (2014-2017) as well as time trends in comparison with the KiGGS baseline study. Mental health problems were assessed for 3- to 17-year-old children and adolescents by using the parent-based version of the Strengths and Difficulties Questionnaire (SDQ). For KiGGS Wave 2, the prevalence of mental health problems was 16.9%. A decreasing trend is pronounced particularly among boys between 9 and 17 years of age. Mental health problems are displayed more frequently by girls and boys from families with a low socioeconomic status compared to their peers from families with a medium or high socioeconomic status. These findings are discussed in the light of various measures and actions in health promotion and health care.
... For the KiGGS baseline study, comorbid mental disorders are oppositional defiant disorder (ODD), conduct disorder (CD), depression, anxiety, and learning disabilities [7,12]. Furthermore, the symptoms of ADHD among children and adolescents are associated with a reduced subjective health-related quality of life [13,14], increased accident-proneness [15], decreased educational attainment [16], increased disruption of family functioning [17], conflict-ridden relationships with peers [16], and social stigmatisation [18]. Moreover, alongside the significant functional impairment and the broad impact of ADHD on individuals and families, it is likely to incur a high level of health-care related costs [19,20]. ...
Attention deficit/hyperactivity disorder (ADHD) is one of the most common mental disorders in childhood and adolescence and is associated with functional, psychosocial and cognitive impairment. As part of the second wave of the German Health Interview and Examination Survey for Children and Adolescents (2014-2017), parents of children and adolescents aged between 3 and 17 years reported whether their child was diagnosed with ADHD by a physician or psychologist. Overall, 4.4% of children and adolescents have been diagnosed with ADHD in Germany. In comparison, the KiGGS baseline study (2003-2006) showed a reduction of lifetime ADHD diagnoses of almost one percentage point over a period of ten years. The reduction of parent-reported ADHD diagnoses primarily occurred among 3- to 8-year old children and boys. The results are discussed in terms of health promotion and the introduction of health care measures.
... Research shows that adolescents' quality of life is more likely to be negatively affected by mental health issues than by physical illness (Hölling et al., 2008). It has been documented that adolescent mental health problems run a higher risk of chronification resulting in higher levels of functional impairment. ...
Background
Adolescence represents a vulnerable period to experience personal crises or mental health problems. However, many concerns stay unnoticed due to the hesitance of young people to seek help and the unavailability and inaccessibility of appropriate help services. Contemporary interventions have been developed incorporating with target group specific needs and preferred modes of communication. krisenchat (German for “crisis chat”) is a German low-threshold chat-based psychosocial crisis counselling service that is available around-the-clock. Despite the growing number of online support services, there is a dearth of research regarding the acceptability, usability, and feasibility.
Methods
The present cross-sectional study analyzed retrospective anonymous data on sociodemographic variables, utilization behavior, and user satisfaction of all krisenchat users between May 2020 and July 2021. Predictors of user satisfaction were identified using exploratory multiple regression analysis. Subgroup analyses were conducted using chi-square-tests to identify differences in user satisfaction.
Results
Data of N = 6962 users was included in the analysis. More than 50% of those reported not having contacted the professional health care system before. The mean user of krisenchat was 17 years old (M = 16.6, SD = 3.5), female (female: 83.4%, male: 14.7%, diverse: 1.8%), and first approached the service at 4 PM (M = 4:03 PM, SD = 5:44 h). More than 60% of the users contacted the service between 4 PM and 12 AM, 10% even between 12 AM and 8 AM. The most frequent chat topics were concerns regarding psychiatric symptoms (60.1%), psychosocial (34.0%) or emotional distress (30.2%). The majority of the users (64.7%) reported high levels of satisfaction and 88.3% a high likelihood (60% or more) of recommending krisenchat to others. Also, the results indicate that the number of messages and their respective length differed between users and counsellors, with users writing several, but shorter messages and counsellors replying with fewer, but longer messages.
Conclusion
The results of the present study imply a high acceptability and feasibility of krisenchat. Overall, there is a high need for a 24/7 messenger-based chat counselling service in crises for children and young adults. Currently, there is no other online service for youth that is available after 7 PM or at weekends, which indicates the great importance of krisenchat and its function to bridge a current gap in the mental health care system. A need for further research emerges e.g., for subgroup differences regarding utilization patterns and also for further insights regarding help-seeking behavior via social media in youth.
Study registration
DRKS00026671.
Epidemiological studies are necessary to focus on any disease process but in this case perhaps more so because of the conceptual and therapeutic inaccuracies often related to obesity. This chapter primarily analyses the evolution of prevalence in the general population and points out how the results are inevitably delayed due to the complexity of data collection and subsequent processing. The growth in the prevalence of pediatric overweight and obesity is analyzed in more detail and with truly representative data that started in the twenty-first century in high-income countries. The studies carried out in the westernized world have been fundamental because of the design and the way they have been carried out, usually inspired by global institutions. At this point we cannot forget how the WHO, in the heat of the debate on malnutrition and double burden (i.e., under and overnutrition), provided the first epidemiological data of obesity in low- or middle-income countries. We also highlight the importance of the creation of state agencies in high-income countries to monitor prevalence and provide reliable information to the population. Finally, we analyze the growth in prevalence in hot areas such as the countries bordering the Mediterranean Sea, where strategies against overweight should be reviewed and compared with those of other colder areas. A strong recommendation is made for the use of international definitions of overweight and obesity.KeywordsAdition of obesityPediatric overweightPedioatric obesityPrevalenceNon-communicable diseaseSocioeconomic factorEnvironmental and geographic factorsDouble burdenSurveys
ZUSAMMENFASSUNG
Kinder und Jugendliche mit chronischen rheumatischen Erkrankungen erleben oft vielfältige Belastungen, wie Schmerzen, Funktionsstörungen, Nebenwirkungen von Medikamenten, und sind nicht selten durch zeitintensive Therapien und Arztbesuche in ihrem sozialen Leben beeinträchtigt. So kann – trotz immer besserer Therapiemöglichkeiten – auch die psychische Gesundheit leiden. Verschiedene Forschungsverbünde (z. B. COACH) und Studien (z. B. KickCOVID) widmen sich zurzeit mittels spezifischer Fragebögen psychischen Symptomen von Kindern und Jugendlichen mit verschiedenen chronischen Erkrankungen (z. B. Mukoviszidose, juvenile idiopathische Arthritis, Typ-1-Diabetes). Psychische Komorbiditäten können im Kontext einer chronischen Erkrankung zu einer schlechteren Lebensqualität sowie zu einer geringeren Therapieadhärenz führen, welche wiederum das Outcome der Grunderkrankung beeinträchtigt. Eine umfassende Versorgung chronisch kranker junger Menschen sollte daher ein standardisiertes Screening auf psychische Komorbiditäten im Rahmen routinemäßiger Verlaufskontrollen beinhalten.
Background: Adolescence and young adulthood present particularly challenging periods for individuals affected by attention-deficit hyperactivity disorder (ADHD) symptoms. However, unlike childhood ADHD, ADHD among adolescents and young adults has been studied less frequently. A concept that can be used to characterize the experiences of individuals with ADHD symptoms is health-related quality of life (HRQoL), which encompasses well-being in various dimensions. Aims: The present study used a school-based sample in the German-speaking part of Switzerland to investigate the association between ADHD symptoms and HRQoL of adolescents and young adults. Method: A total of 907 individuals aged 14–24 years (M = 17.69; SD = 1.66; 58.9% female) were surveyed regarding ADHD symptoms and HRQoL. Results: Multiple hierarchical regression analyses disclosed that ADHD symptoms were negatively related to all subdimensions of HRQoL. Moreover, adolescents with clinically significant or subclinical ADHD symptoms showed lower values in all examined dimensions – physical, emotional, self-esteem, family, friends/peers, and school/education – than adolescents with unremarkable ADHD symptoms. An exception was the well-being concerning friends/peers. Limitations: The present study used a cross-sectional design and a selective sample of school classes.
ADHD symptoms were assessed using self-reports without any diagnostic judgment. Conclusion: The results illustrate the comprehensive effects of ADHD symptoms on well-being during adolescence and young adulthood. They highlight the importance of focusing more on ADHD during these stages of age, also considering individuals with symptoms in the subclinical range.
This article describes a scale measuring dispositional optimism, defined in terms of generalized outcome expectancies. Two preliminary studies assessed the scale’s psychometric properties and its relationships with several other instruments. The scale was then used in a longitudinal study of symptom reporting among a group of undergraduates. Specifically, respondents were asked to complete three questionnaires 4 weeks before the end of a semester. Included in the questionnaire battery was the measure of optimism, a measure of private self-consciousness, and a 39-item physical symptom checklist. Subjects completed the same set of questionnaires again on the last day of class. Consistent with predictions, subjects who initially reported being highly optimistic were subsequently less likely to report being bothered by symptoms (even after correcting for initial symptom-report levels) than were subjects who initially reported being less optimistic. This effect tended to be stronger among persons high in private self-consciousness than among those lower in private self-consciousness. Discussion centers on other health related applications of the optimism scale, and the relationships between our theoretical orientation and several related theories.
Two theoretical approaches are discussed in greater detail: one with a cognitive emphasis, the other an emotionally based approach. Consistent with these theories indicators of well-being are suggested. To operationalise these indicators, existing anglo-american questionnaires were used. In addition, several new items were constructed for this German language questionnaire.
In the analysis of a first sample (N=294) it was demonstrated that subjective well-being is comprised of two separate dimensions of satisfaction and ill-being. The components of satisfaction are: Positive attitude towards life, self-value, (lack of) depressive mood, and joy in living. Ill-being comprises problem-awareness and somatic complaints and reactions. The structure of subjective well-being was replicated in a large sample (N=1901) of Swiss adolescents aged between 14 and 20 years. The Bern subjective well-being questionnaire (BFW) meets psychometric standards with respect to reliability, stability, and validity.
Aufgrund des Fehlens einheitlicher Definitionen, der Unzulänglichkeit der diagnostischen Methoden im Säuglings-und Kleinkindalter und der häufig uncharakteristischen Symptomatik in den ersten Lebensjahren schwanken die Angaben über die Häufigkeit des Asthma bronchiale erheblich. Einige bernerkenswerte Besonderheiten in der Verteilung des Asthma bronchiale sind dennoch offensichtlich. So deutet manches darauf hin, daß Asthma und allergische Erkrankungen in ländlichen Gebieten und in Entwicklungsländern kaum vorkommen. In Papua-Neuguinea z. B. war Asthma vor Einführung westlicher Lebensgewohnheiten bei Kindern und Jugendlichen kaum zu finden (Anderson 1974). In Südafrika betrug die Prävalenz der bronchialen Hyperreaktivität nach Laufbelastung bei schwarzen, in der Stadt lebenden Schulkindern 3,2%, wohingegen in der ländlichen Transkei nur ein einziger Proband unter 671 untersuchten Kindern einen signifikanten Abfall des FEV1 aufwies (van Niekerk et al. 1979). Ähnliches wurde von Zimbabwe berichtet (Keeley et al. 1991), wo in den wohlhabenderen Regionen der Hauptstadt Harare 5,9% der untersuchten Schulkinder auf eine Laufprovokation reagierten, im ländlichen Bereich von Wheezda Communal Land hingegen nur ein einziges Kind aus einer Stichprobe von über 600 Kindern eine bronchiale Hyperreaktivität aufwies.
