Utilization of early detection examinations by children in Germany. Results of the cross-sectional KiGGS Wave 2 study

Schmidtke, Claudia; Kuntz, Benjamin; Starker, Anne; Lampert, Thomas

doi:10.17886/rki-gbe-2018-100

Cited by 5 publications

(5 citation statements)

References 6 publications

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“…The fifth check-up (U5), which has to be undertaken between the sixth and seventh month of life, includes the explicit check for undescended testis [26]. As almost all of the children in Germany participate in the U5 [27], primary undescended testis should be detected up to the seventh months of life. Despite this early check-up numbers of procedures for orchidopexy, cryptorchism and abdominal testis were 10% in 2010 and went up to 12% in 2020.…”

Section: Discussionmentioning

confidence: 99%

Are we still too late? Timing of orchidopexy

Schmedding

Wasen²,

Lippert³

2023

Eur J Pediatr

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An undescended testis is the most common genitourinary disease in boys. The German guidelines, first published in 2009, proposed the timing of orchidopexy to be before 12 months of age. The aim of the study was to analyze the implementation of these guidelines 10 years after publication. The national cumulative statistics of hospital admissions, provided by the Institute for the Remuneration System in Hospitals (InEK), and the statistics concerning procedures performed in private pediatric surgical practices of the professional association of pediatric surgeons (BNKD) regarding the time of surgeries for the year 2019 were analyzed. Data from InEK included all German hospital admissions. Data from BNKD included data from 48 private pediatric surgical practices. The hospitals treated 6476 inpatients with undescended testis, and 3255 patients were operated in private practices. Regarding the age at treatment, 15% of the hospital patients and 5% of the private practice patients were younger than 1 year and fulfilled the guideline recommendations. Forty percent of the hospital patients and 29% of the private practice patients were 1 or 2 years of age. All other patients were 3 years of age or older at the time of orchidopexy. Conclusions: The rate of orchidopexy within the first 12 months of life is remarkably low even 10 years after the publication of the guidelines. Awareness of the existing guideline must be increased for both referring pediatric and general practitioners. What is Known:• In Germany, orchidopexy is performed by pediatric surgeons and urologists either in hospital settings or in private practices.• Most international guidelines set the age for surgical treatment of undescended testis between 12 and 18 months of age. The German guidelines, published in 2009, sets the time-limit at one year of age. Until five years after publication of the German guidelines, the number of patients treated before the first year of life was low; studies show an orchidopexy ratebetween 8% and 19% during this time. What is New:• This study the first to cover all administered hospital patients in Germany and a large group of patients treated in private practices. It contains the largest group of German patients with undescended testis.• Although almost all children participate in the routine check-up at the age of seven months, which includes investigation for undescended testis, adherence to the orchidopexy guidelines is still low. Only 15% of the hospital patients and 5% of the patients in private practice were treated before their first birthdays.

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Section: Discussionmentioning

confidence: 99%

Are we still too late? Timing of orchidopexy

Schmedding

Wasen²,

Lippert³

2023

Eur J Pediatr

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“…These results are unexpected; as several studies in the field of early detection and prevention have demonstrated that, inter alia, education and income, as well as the composite index of socio-economic status, have an influence on participation. For example, the baseline survey and the two follow-up surveys of the Study on the Health of Children and Adolescents in Germany (KiGGS) showed that children with a lower socio-economic status are significantly less likely to use preventive check-ups compared to children with a medium or high socio-economic status [ 12 , 25 , 30 ]. Most regional studies examining the relationship between uptake of preventive or screening examinations and education of the parents have also achieved the similar result [ 7 , 14 , 28 ].…”

Section: Discussionmentioning

confidence: 99%

“…U1-U9, J1) offered by the statutory health insurance. It has also been found that adolescents with a migration background participate in the early detection examination J1 (between 12 and 14 years) only half as often as adolescents without a migration background [ 6 , 7 , 25 , 30 , 32 ].…”

Section: Introductionmentioning

confidence: 99%

Determinants for participation in a prevention and early detection programme for children and adolescents in Germany: does social background play a role?

Krüger,

Lapstich,

Reber

et al. 2023

Arch Public Health

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Early detection examinations and prevention are particularly important in childhood and adolescence, as certain diseases are already developing and health-related attitudes and behaviour patterns are formed and implemented. Despite the importance of screening and prevention, not all families use the available services and programmes. The aim of this study is to identify factors associated with participation in an early detection and prevention programme for children and adolescents, as well as factors associated with actual uptake of an examination. The analyses are based on questionnaire data of an online survey of participants and non-participants. Descriptive analyses and logistic regression models are conducted on a defined sample (n = 1,289). The results show that both groups differ with regard to several factors: age, chronic diseases, federal state, living space, number of siblings, country of birth, migration background, language spoken at home, mother’s occupational status, household income, treatment duration, and trust in treating physician. Regression I shows that participation in the programme is significantly associated with higher age, language spoken at home, mother’s occupational status and greater trust in the treating physician. The latter demonstrates the highest predictive power. Regression II indicates that the actual uptake of an examination among participants is significantly affected by age, federal state and father’s occupational status. Overall, the results of this study show that social background partly plays a role in participation, but that factors such as trust in the treating physician also have a significant impact. For the future, further research on the factors influencing participation in screening and prevention services or programmes for children and adolescents is important in order to develop strategies to overcome existing barriers and thus reach groups that have not been reached yet. In this context, trust in the treating physician and his or her influence on decision-making should in particular be considered.

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“…Previous analyses of these early diagnosis examinations have mainly focused on participation rates and behaviour. Here, a social gradient is partly evident [ 11 – 15 ]. For this reason, it will also be investigated whether the generated results apply to all subgroups irrespective of education and income among other things.…”

Section: Introductionmentioning

confidence: 99%

The effectiveness of additional screening examinations for children and adolescents in Germany: a longitudinal retrospective cohort study

Krüger

Lapstich

Reber³

et al. 2023

BMC Pediatr

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Background Continuous medical care is particularly important in childhood and adolescence. Since there are gaps in regular care in Germany, various health insurance providers offer to cover additional examinations (e.g., U10, U11, J2) to ensure ongoing paediatrician visits. However, the question arises as to whether these examinations are effective. Thus, the main objective of this study is to determine whether participation in the U10, U11 or J2 examinations leads to more frequent and earlier diagnosis and treatment of age-specific diseases. Methods The analyses are based on administrative claims data from a statutory health insurance fund. For each examination, an intervention group (IG) is formed and matched with a corresponding control group (CG). Descriptive analyses include proportion with diagnosis and treatment, average age of diagnosis and treatment initiation. Hypothesis testing is performed using methods appropriate to each. In addition, subgroup analyses and binominal logistic regression models are conducted. Results More diagnoses are detected in IG, irrespective of subgroups. Additionally, diagnoses are made slightly earlier on average in IG. In the total samples, more therapies are initiated in IG, and slightly earlier. Considering only diagnosed cases, more therapies are initiated in CG but continue to be started earlier in IG. Regression models show that participation in the examinations has the highest predictive power for detecting a diagnosis. The presence of a chronic disease and sex - male at the U10 and U11 and female at the J2 - are also significantly associated. The models further show that nationality, unemployment of parents and region also have a significant influence in some cases, whereas school-leaving qualification, vocational qualification and income of parents do not. Considering the initiation of treatment in overall samples, the models show similar results, but here the presence of a chronic illness has the highest predictive power. Conclusion The results indicate that participation in the examinations leads to significantly more diagnoses and, in the overall samples, significantly more treatments. In addition, diagnoses were made somewhat earlier and therapies were initiated somewhat earlier. In the future, it would be useful to investigate the U10, U11 and J2 examinations over a longer time horizon to determine whether the statistically significant difference found is also clinically relevant, i.e., earlier diagnosis and initiation of therapy lead to prevention of manifestation or progression of the diagnosed diseases and to avoidance of secondary diseases. Trial registration German Clinical Trials Register (DRKS), DRKS-ID: DRKS00015280. Prospectively registered on 18 March 2019.

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Utilization of early detection examinations by children in Germany. Results of the cross-sectional KiGGS Wave 2 study

Cited by 5 publications

References 6 publications

Are we still too late? Timing of orchidopexy

Are we still too late? Timing of orchidopexy

Determinants for participation in a prevention and early detection programme for children and adolescents in Germany: does social background play a role?

The effectiveness of additional screening examinations for children and adolescents in Germany: a longitudinal retrospective cohort study

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