Hommer is spot-on in calling otitis media in adolescents a rarity. The data of the KiGGS study are based on surveys of patients and their parents (1). The study is not based on any doctors’ documentation or accounting data, and incorrect coding (by general practitioners) is therefore not possible. When surveying a 14-year-old, for example, what is captured is whether a certain diagnosis was made in the preceding 14 years, but not at which particular point in time it was made. In view of how common otitis media is in infants and toddlers (2), the claim that at the age of 14, more than half of those surveyed have had a minimum of one episode of otitis media in their lives is not at all surprising and correlates well with routine experience in clinical practice. The reported frequency is therefore not a comorbidity at the time when the J1 is executed. If we did not characterize these data on frequencies of diseases as “cumulative” variables unanimously enough, we apologize to our readers and are grateful for this opportunity to clarify this.
One would certainly have to agree with Lüder that the “wrong people” attend screening examinations. Especially adolescents with particular risk factors, such as smoking or misuse of illegal drugs are not that likely to participate in the J1. An understanding of the benefit of preventive measures and a health-conscious lifestyle are likely to exist in a reverse proportional relation. It has already been noted elsewhere that children and adolescents from families with a low socioeconomic status or migration background participate less commonly in the screening examinations U3–U9 (3). The parents’ formative influence is a particularly contributing factor in this setting. It is therefore even more important for doctors to point out the benefits of the J1, in order to examine as many adolescents as possible and capture the hidden health problems that were uncovered in the article. It would be absolutely fatal if obstacles for conducting the J1 arose from the medical side. We wholeheartedly support Lüder’s idea to offer screening to 15–16-year-olds. The newly introduced J2 (from age 16) sets a positive new trend, albeit one that has been implemented by far too few statutory health insurers.
This further screening measure will hopefully be included in the standard services offered by all statutory health insurers at the very earliest opportunity. The KiGGS data do not provide any answers to questions about medical fees and practice organization; we did not report on these ourselves. Accordingly, our article does not provide a discussion base for this topic.
Dr. phil. Bernd Hagen
Zentralinstitut für die Kassenärztliche Versorgung, Köln
Dr. med. Stefan Strauch
Conflict of interest statement
Dr Hagen declares that no conflict of interest exists.
Dr Strauch has received honoraria for acting as an adviser and travel and hotel expenses from Wyeth Pharma. Furthermore he has received honoraria for conducting vaccination studies from Wyeth and GSK.
|1.||Kurth BM: Der Kinder- und Jugendgesundheitssurvey (KiGGS): Ein Überblick über Planung, Durchführung und Ergebnisse unter Berücksichtigung von Aspekten eines Qualitätsmanagements. Bundesgesundheitsbl, Gesundheitsforsch, Gesundheitsschutz 2007; 50(5/6): 533–46. CrossRef MEDLINE|
|2.|| Schnabel E, Sausenthaler S, Brockow I, et al. for the LISA Study Group: Burden of otitis media and pneumonia in children up to 6 |
years of age: Results of the LISA birth cohort. Eur J Pediatr 2009; 168(10): 1251–7. CrossRef MEDLINE
|3.||Kamtsiuris P, Bergmann E, Rattay P, Schlaud M: Inanspruchnahme medizinischer Leistungen. Ergebnisse des Kinder- und Jugendgesundheitssurveys (KiGGS). Bundesgesundheitsbl, Gesundheitsforsch, Gesundheitsschutz 2007; 50(5/6): 836–50. CrossRef MEDLINE|
|4.||Hagen B, Strauch S: The J1 adolescent health check-up:analysis of data from the German KiGGS survey. Dtsch Arztebl Int 2011; 108(11): 180–6.|