A social index derived from examinations of prospective first graders is used for health reporting in the Federal State of Brandenburg. The Brandenburg social index consists of data from the medical examinations, which contain social anamnesis questions. Based on parents' education and employment, the social index is computed for each child and finally each child is assigned to a group of lower, middle or higher socioeconomic status. The simply made social index is not only used for analysing health and social inequalities but also for analysing the social situation and trends of young families. Social index data for prospective first graders have ben collected since 1994. Thus, the social index is part of the social reporting in Brandenburg. The present article illustrates with examples how the index is used. Finally, it is mentioned that the Brandenburg government uses the social index to control finances in the language promotion for kindergarteners in day-care centres.
The epidemiological analysis of childrens' injuries should be the starting point for age- and environment-specific and product-related interventions. Intervention strategies should take into account parents' ethnic background as well as potential language barriers.
In 1998, 31 children (<15 years) (N=655) died through falls, in most cases by falling from a building (n=8). Around 700,000 children are estimated to have required medical treatment for falls, approx. 120,000 of them being hospitalized. Fall injuries show an age- and environment-specific accident pattern. Most of the falls among infants and toddlers are from changing tables, children's beds, high chairs and stairs. Among school-age children, falls occur most frequently at school (during break and physical education lessons) and during leisure activities (skating, cycling). These facts should form the basis for prevention measures targeting behaviour and health conditions.
Routine well-child visits, implemented as a means of secondary prevention and covered by health insurance, lead to early identification of disorders and abnormalities in child development."Guiding principles for children" (by the G-BA) have determined the content of the eleven examinations, ranging from U1 immediately after birth to J1 in adolescence; eight of them take place within the first four years of age. Since cases of child maltreatment, neglect, or abuse became public in 2007, almost all German federal states have established mandatory examination and notification processes in the new child welfare surveillance programs. First results in the German federal states (six of which are exemplarily illustrated) point out that mandatory requirements have collectively increased the frequency of medical check-ups in children, especially starting from four years of age and most significantly in families with social disadvantages (young/single parents, immigrant background, uneducated or socially disadvantaged families), which have so far been difficult to reach. Subsequently, provision of primary prevention (vaccinations and health promotion advice) by pediatricians has also increased. As a sole instrument for the complete identification of threats for children's welfare, however, systems inviting and reminding parents about check-ups are only of limited benefit.
Epidemiological studies in Germany show that infants and toddlers are at most risk of injury and in need of protection. Of all children under the age of 15 years, they have the highest rates of fatal and severe injuries. Therefore, this article aims to show which injury prevention measures have been proven successful for this age group. International specialist recommendations are described and evidence-based knowledge of interventions is presented from the Cochrane Reviews. For the four most frequent child injury mechanisms (drowning, poisoning, burning, and falling), the World Health Organization recommends a set of measures covering legislation, regulations, changes of environment, education, and emergency medical care. Meta-analyses on the effectiveness of interventions related to safety at home conclude that informing parents personally (face-to-face) and in combination with free safety equipment (e.g., safety gates, smoke alarms) increased parents' safety practices significantly. This included advice on not using baby walkers. Multifaceted education programs for parents (e.g., visiting programs at home or in pediatric clinics) proved to have the highest effect in reducing home accidents to children. The prevention of injuries in young children should be driven by a multifaceted and data-based approach. Postnatal interventions (Frühe Hilfen) at the community level are especially useful to integrate accident prevention at home, because they are connected with family visiting programs.
Paediatricians in Brandenburg testify to cases of violence against children. The guide "Violence Against Children and Young People" offers useful information on the practical handling of such cases. The alliance "Growing up Healthy in Brandenburg" tackless the need for support by developing a catalogue of measures to be implemented. These include conducting specialised further training for paediatricians as well as cross-disciplinary furthertraining measures, and setting up regional working groups to improve basic networking in practice.
Despite the many potential sources of stress and strain that accompany a migration situation, there are very few data in official statistics with regard to the health and social situation of migrants in Germany. The fact that this information is not available for public health reporting could lead to problems of improper, lacking or excessive health care. A working group within the Arbeitskreis Migration und Offentliche Gesundheit has been addressing this problem since 2003. In this article, a systematic overview of the most important data sources for public health reporting and of the indicators for migration background and social status that each one contains will be given. After that we will present examples of good practice in migration-sensitive data collection at the local and national level. Finally suggestions for improving the data situation with regard to the health of migrants based on the recommendation for recording the migration status in epidemiological studies will be made.
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