RESUMEN
BACKGROUND: We analyzed data from the Robert Koch Institute's KiGGS survey regarding the J1 adolescent health check-up in order to determine what information this check-up provides. METHODS: Descriptive statistical analysis of J1 participation with respect to social, demographic, medical and psychological factors, with logistic regression analysis of the risk associated with non-participation. RESULTS: 32.9% of all adolescents in Germany aged 14 to 17 had a J1 check-up. Thus, the J1 participation rate has remained low since the introduction of the J1 in Germany. The main conditions that were more commonly found in adolescents who had a J1 check-up were thyroid disorders (4.1% vs. 2.9%), and scoliosis (14.8% vs. 10.5%). Adolescents were only half as likely to have a J1 check-up if they were under the care of a general practitioner, rather than a pediatrician (odds ratio [OR] 0.46, 95% confidence interval [CI] 0.36-0.60). Foreign adolescents were only half as likely to have a J1 check-up as German ones (OR 0.51, 95% CI 0.31-0.84). CONCLUSION: There is compelling evidence that scoliosis and thyroid disorders, in particular, are underdiagnosed if a J1 check-up is not performed. Thus, elevating the J1 participation rate should be a priority. If a J1-check up were performed in the nearly two-thirds of all adolescents who currently do not undergo one, many latent health problems could be recognized and treated in timely fashion.
Asunto(s)
Tamizaje Masivo/estadística & datos numéricos , Examen Físico/estadística & datos numéricos , Escoliosis/diagnóstico , Escoliosis/epidemiología , Enfermedades de la Tiroides/diagnóstico , Enfermedades de la Tiroides/epidemiología , Adolescente , Comorbilidad , Recolección de Datos , Femenino , Alemania/epidemiología , Humanos , Masculino , Prevalencia , Medición de Riesgo , Factores de Riesgo , Adulto JovenRESUMEN
BACKGROUND: Esophageal perforations remain a life-threatening event requiring rapid diagnosis and treatment. Surgical repair and interventional endoscopic or conservative treatment are the common treatment methods. METHODS: From 1998 to 2006, the authors retrospectively analyzed 62 patients treated for esophageal perforation. Data were evaluated for cause of perforation, symptoms, therapeutic regimen, complications, and mortality. RESULTS: The causes of perforation were iatrogenic or suicidal (n = 33) or spontaneous (n = 29). In the first group, the causes were dilation of stenosis (n = 16), endoscopy (n = 7), transesophageal echography (n = 4), ingestion of acid or leach (n = 2), intubation (n = 2), ingestion of a foreign body (n = 1), and migration of a screw after osteosynthesis (n = 1). The spontaneous perforations were caused by tumors (n = 19), Boerhaave syndrome (n = 6), unknown origin (n = 3), and Barrett's ulcer (n = 1). The most frequent symptoms were dysphagia (n = 50), pain (n = 35), fever (n = 24), and vomiting (n = 18). At the time of perforation, 28 patients presented with cancer. Of these 28 patients, 18 had esophageal cancer. The treatment included surgery (n = 32), which consisted of double-layer suture (n = 26) or esophageal resection (n = 6). A total of 30 patients were treated interventionally with a stent (n = 21), clips (n = 1), or without further measures (n = 8). The patients in the surgery group presented with severe primary and postoperative general conditions including renal failure (25%), respiratory insufficiency (65.5%), and need for catecholamines (62.5%). This multiorgan involvement was found only occasionally in the conservative group. The overall hospital mortality rate was 14.5%, involving 9 patients (5 in the surgery group and 4 in the conservative group). Early treatment led to better survival than late treatment with a delay exceeding 24 h. CONCLUSION: The treatment method still must be chosen on an individual basis. It appears that surgical treatment is necessary in cases of severe general conditions. The data from this study show that surgical repair and conservative treatment may be used successfully. The best outcome was obtained after immediate treatment.