[Evalutation of health monitoring in Bavaria by computer-assisted telephone interviews (CATI) in comparison to the German National Health Examination Survey conducted in 1998 by the Robert Koch Institute]

Between June 1999 and May 2000, 2051 residents of Bavaria were interviewed on health and health-related behaviour. The objective of the study was to assess the representativeness and validity of data acquired by computer-assisted telephone interviewing (CATI) as compared to results of the German National Health Examination Survey 1998. The following variables showed excellent agreement: subjective health status, lifetime disease prevalences, such as myocardial infarction, stroke, cancer, asthma, diabetes, hypertension, hypercholesterolaemia, utilisation of medical services, and smoking habits (prevalence of present and former smoking, average cigarette consumption per day). Minor differences were found with respect to the frequency of consulting naturopathic doctors. Self-reported anthropometric data from the present study differed considerably from the results of the objective measurements during the German Health Survey. We conclude that, in terms of data quality, CATI compares well with traditional methods such as face-to-face interviewing or mailed questionnaires. In view of several practical advantages of the method, we recommend CATI as a future basic methodology of a German health surveillance system consisting of different coordinated health data collections.

Quality of life in children and adolescents: a European public health perspective

OBJECTIVES

The measurement of health-related quality of life (HRQOL) is increasingly important as a means of monitoring population health status over time, of detecting sub-groups within the general population with poor HRQOL, and of assessing the impact of public health interventions within a given population. At present, no standardised instrument exists which can be applied with equal relevance in pediatric populations in different European populations. The collaborative European KIDSCREEN project aims to develop a standardised screening instrument for children's quality of life which will be used in representative national and European health surveys. Participants of the project are centres from Austria, France, Germany, Netherlands, Spain, Switzerland, and United Kingdom. By including the instrument in health services research and health reporting, it also aims at identifying children at risk in terms of their subjective health, thereby allowing the possibility of early intervention.

METHODS

Instrument development will be based on constructing a psychometrically sound HRQOL instrument taking into account the existing state of the art. Development will centre on literature searches, expert consultation (Delphi Methods) and focus groups with children and adolescents (8-17 years). According to international guidelines, items will be translated into the languages of the seven participating countries for a pilot test with 2,100 children and their parents in Europe. The final instrument will be used in representative mail and telephone surveys of HRQOL in 1,800 children and their parents per country (total n = 25,200) and normative data will be produced. The potential for implementing the measurement tool in health services and health reporting will also be evaluated in several different research and public health settings. The final analysis will involve national and cross cultural-analysis of the instrument.

RESULTS

The international, collaborative nature of the KIDSCREEN project means it is likely to provide many challenges in terms of producing an instrument which is conceptually and linguistically appropriate for use in many different countries, but it will also provide the opportunity to develop, test and implement the first truly cross-national HRQOL instrument developed for use in children and adolescents. This will help to contribute to a better understanding of perceived health in children and adolescents and to identify populations at risk.

[German Health survey 1997/98: immune status against poliomyelitis]

BACKGROUND

One of the goals of the WHO is the worldwide eradication of poliomyelitis in the next years. A high level of population immunity protects against imported wild viruses from endemic areas.

PATIENTS AND METHODS

The first German Health Survey, a representative study of the health status of the population (aged between 17 and 79 years) in unified Germany, was started in 1997. In order to study the serological status against poliomyelitis, a representative serum panel was investigated (n = 2564). Furthermore, 881 sera from persons aged less than 18 years were included in the study. The microneutralization test was used to demonstrate antibodies against the three poliovirus types. For the first time, the results were expressed in International Units. The threshold values 0.075 IU, 0.180 IU, 0.080 IU were calculated for Polio 1, 2, 3 respectively.

RESULTS

Overall, neutralizing antibodies against poliovirus type 1, 2 and 3 were detected in 96.2%; 96.8% and 89.6% of samples, respectively. 85% of test persons had antibodies against all three virus types.

CONCLUSIONS

The seroprevalence of antibodies against all three types of polioviruses indicates a very high population immunity. It must be kept after the switch of immunization strategy from attenuated to inactivated vaccine in Germany (OPV to IPV).

[The SF-36 in the Federal Health Survey--possibilities and requirements for application at the population level]

The SF-36 Questionnaire is an internationally accepted instrument for measuring therapeutic success by subjective assessment of health-related quality of life, done by patient groups. It remains to be seen to what extent this instrument is suitable for measuring the subjective health status of population groups or changes thereof. The answers to the SF-36 Questionnaire in the German National Health Examination and Interview Survey together with information about other health parameters allow deeper evaluation of the features of this instrument. A new approach to establishing a model revesling the association between age, social status, morbidity and the SF-36 Scales is discussed.

[The Federal Health Survey: response, composition of participants and non-responder analysis]

The first German Health Survey was carried out from October 1997 to March 1999. In the survey, 7,124 subjects of a representative sample of the residential population aged between 18 and 79 years were interviewed and medically examined. The response rate was 61.4%; 0.4% of the sample participated only partly in the study. Moreover, 16.0% of the non-respondents filled in a short questionnaire. This results in (although partly limited) information from 77.8% of the sample. The sample also comprises aliens living in Germany. More than 15% of the non-respondents could not be addressed to participate in the study because they were never reached personally. According to the statements in the short questionnaire, non-respondents and respondents differ in particular items such as e.g. education. The differences between the individual answers concerning the important question of the general health status can be classified as negligible. Weighting factors were calculated to arrive at representative information on the 18 to 79 year-old population.

[The SF-36 in the Federal Health Survey--description of a current normal sample]

The German National Health Interview and Examination Survey 1998 included the Short Form 36-Questionnaire as an instrument for measuring health-related quality of life. As a result of the subjective assessment by 6964 survey participants aged between 18 and 80 years a description of a new German normative population sample is given. Using the same statistical parameters as in the description of the normative German sample from 1994 a time comparison can be made.

[The German Health Survey. 1997/98]

The first German Health Survey, a representative study of the health status of the population in unified Germany, was started in October 1997. In this project which is being carried out by the Robert Koch Institute on behalf of the Federal Ministry of Health about 7,200 study participants aged between 18 and 79 are going through a medical check-up and are interviewed as to health-relevant issues. The German National Health Survey consists of a core survey and supplementary modules. These modules are, for the most part, carried out in subsamples of the study population. They partially have been designed and co-financed by cooperating institutions of the RKI. This time, the opportunity given to the individual Länder to increase the size of the sample was realized by Bavaria. This practised principle of a modular structure and co-financing may be regarded as a model and serve as an example for the cost effective implementation of such extensive health surveys. As a result, the German National Health Examination Survey will yield information enabling the RKI to deliver relevant health reports on a federal level and, therefore, to support decisions in health policy. The demand for representative population-based data will be met by supply of survey data as a file for public use.

Predictors of early retirement and rehabilitation for use in a screening to detect workers in need of rehabilitation

In the German pension insurance sector a screening is being suggested to ensure the participation in rehabilitation measures of workers at risk of health-related early retirement. Screening presupposes empirical indicators of rehabilitation needs. A study is presented that determined predictors of early retirement and rehabilitation from longitudinal data for use in a screening for the selection of workers likely to be in need of rehabilitation. We gathered longitudinal data by conducting a second survey with a cohort for which the first survey had delivered clinical findings, lab. values, medical diagnoses and self reports regarding morbidity, medication, health-related behavior, family- and occupational-related strains, and sociodemographic information (first survey T0: 1975/76, n = 3.968; second survey T1: 1992/93, n = 28.463). The survey of T1 also comprised inquiries of the pension insurance institutions concerning the retirement and rehabilitation status for pension-insured study subjects (n = 1.794). Based on these subjects, using multi- and bivariate regression analysis, we determined those T0 variables which were significantly related to the events of early retirement (98 cases/357 controls), rehabilitation (127 cases/200 controls) and early retirement or rehabilitation (185 cases/270 controls) in the period T0-T1. The significant T0 variables were subsequently used for the definition of a selection index which measured rehabilitation need by a simple sum score (number of significant T0 variables present). We tested the discriminative power of this index for a subsample of the cohort (cases who retired early or underwent rehabilitation and controls). The index classified 68% of the cases correctly. The sensitivity reached 57% and the specificity 76%. In connection with this result, the long prognostic time interval (up to 17 years) has to be considered. In the case of screening the preselection of workers via the index would occur at the same time as the medical assessment of the actual need for rehabilitation. An earlier study showed that this would raise sensitivity and specificity of an index based on predictors of early retirement substantially.

Intensity, duration, and frequency of physical activity and coronary risk factors

Relationships between coronary risk factors and intensity, duration, and frequency of leisure activity were studied in 5943 men and 6039 women, ages 25-69. Age, smoking, socioeconomics, season, body mass index (BMI), urbanization, occupational activity, and liquid, alcohol, and saturated/total fat intake were adjusted using multivariate regressions. Among men each 100 kcal.kg-1.wk-1 spent on vigorous activities (7.5-9.0 MET) was associated with: significant (P < 0.01) average differences of -0.36 mmol.L-1 total cholesterol, +0.17 mmol.L-1 HDL cholesterol (P < 0.001), +0.05 HDL/total cholesterol (P < 0.001), -0.33 mmol.L-1 triglycerides, -3 mm Hg diastolic blood pressure, -10 beats.min-1 heart rate (P < 0.001), +30 L.min-1 peak flow, and -1.1 kg.m-2 BMI. Among women it was associated with: -7 mm Hg systolic blood pressure, -6 beats.min-1 heart rate (P < 0.001), +50 L.min-1 peak flow (P < 0.001), and -1.4 kg.m-2 BMI (P < 0.05). Moderate activity (either 3.0-4.5 MET or 5.0-7.0 MET) was significantly (P < 0.05) associated with HDL cholesterol, BMI, and, for men, heart rate; for women, it was associated with HDL/total cholesterol, triglycerides, diastolic blood pressure, and peak flow. With duration and intensity constant, increasing frequency by one time per wk was significantly (P < 0.05) associated with -0.014 mmol.L-1 total cholesterol, +0.001 HDL/total cholesterol, -0.36 beats.min-1 heart rate, -0.093 kg.m-2 BMI among men, and +0.009 mmol.L-1 HDL cholesterol, +0.001 HDL/total cholesterol, -0.014 mmol.L-1 triglycerides, -0.31 beats.min-1 heart rate, and -0.098 kg.m-2 BMI among women. Serum lipids and BMI showed stronger associations with frequency than with intensity or duration.