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Background: People with disabilities and chronic diseases represent a population group in vulnerable circumstances, and often have difficulty finding, understanding, assessing, and applying health information. The aim of this study was to examine the health literacy of people doubly burdened with both disabilities and chronic diseases in comparison to two other groups, namely people with either disabilities or chronic diseases and people without impairment., Material and Methods: Our data is based on the representative survey "German Health Update" 2014/2015-EHIS. The sample consists of n=21,647 people, including 2,875 (13.3%) people with disabilities and chronic diseases, 7,598 people (35.1%) with disability or chronic diseases and 11,174 (51.6%) people without impairment. Health literacy was measured using the short form of the questionnaire of the European Health Literacy Survey (HLS-EU-Q16). Uni, bi- and multivariate analyses were conducted., Results: 43.7% of respondents with both disabilities and chronic diseases had quite a lot difficulties in dealing with health information in comparison to people with disabilities or chronic diseases (37.7%) or those with no impairment (33.0%). People with double burdens had a 1.22-fold (CI: 1.10-1.35; p<0.001) and people with a single burden had a 1.08-fold (CI: 1.01-1.16; p=0.031) increased likelihood to find it difficult or very difficult to find, understand, evaluate and apply health-related information compared to people without impairment., Conclusion: The results show a gradient to the disadvantage of people with disabilities and/or chronic diseases. Health literacy among people with disabilities and/or chronic diseases should be adequately promoted in order to support their health, their participation as well as the quality and efficiency of and the reduction of barriers to access health care., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

Objectives:  The main aim of this study was to evaluate the feasibility of minimally invasive stabilization with polyaxial screws-rod using neuronavigation and to assess accuracy and safety of percutaneous drilling of screw corridors using neuronavigation in thoracolumbar spine and compare it between an experienced and a novice surgeon., Study Design:  Feasibility of minimally invasive polyaxial screws-rod fixation using neuronavigation was first performed in the thoracolumbar spine of two dogs. Accuracy and safety of drilling screw corridors percutaneously by two surgeons from T8 to L7 in a large breed dog using neuronavigation were established by comparing entry and exit points coordinates deviations on multiplanar reconstructions between preoperative and postoperative datasets and using a vertebral cortical breach grading scheme., Results:  Feasibility of minimally invasive stabilization was demonstrated. For the experienced surgeon, safety was 100% and mean (standard deviation) entry point deviations were 0.3 mm (0.8 mm) lateral, 1.3 mm (0.8 mm) ventral and 0.7 mm (1.8 mm) caudal. The exit points deviations were 0.8 mm (1.9 mm) lateral, 0.02 mm (0.9 mm) dorsal and 0.7 mm (2.0 mm) caudal. Significant difference in accuracy between surgeons was found in the thoracic region but not in the lumbar region. Accuracy and safety improvement are noted for the thoracic region when procedures were repeated by the novice., Conclusion:  This proof of concept demonstrates that using neuronavigation, minimally invasive stabilization with polyaxial screws-rod is feasible and safe in a large breed dog model., Competing Interests: None declared., (Thieme. All rights reserved.)

Objective:  The aim of this study was to validate an imaging technique for evaluation of spinal surgery accuracy and to establish accuracy and safety of freehand technique in the thoracolumbar spine of large breed dogs., Study Design:  After thoracolumbar spine computed tomography (CT), 26 drilling corridors were planned then drilled to receive 3.2 mm positive profile pins using a freehand technique. After pin removal, CT was repeated. All entry points, exit points and angles of the preoperative planned trajectories were compared with postoperative ones using an image registration and fusion technique by three observers. Corridor coordinates for entry and exit points were evaluated in three dimensions and angles were measured in one plane. Intraclass correlation coefficient (ICC) was used to establish the imaging technique reliability and descriptive statistics were used to report on the freehand technique accuracy. Safety was evaluated using a vertebral cortical breach grading scheme., Results:  Intraclass correlation coefficient for the entry points, exit points and angle were 0.79, 0.96 and 0.92 respectively. Mean deviations for the entry points, exit points and angle were 3.1 mm, 6.3 mm and 7.6 degrees respectively. Maximum deviations were 6.3 mm, 11.0 mm and 16.4 degrees. Most deviations were lateral and caudal. All corridors were judged as safe., Conclusion:  The imaging technique reliability was good to excellent to study spinal surgery accuracy. Implant deviations should be anticipated when planning stabilization surgery in large breed dogs using the freehand-guided technique., Competing Interests: None declared., (Thieme. All rights reserved.)

Background and Objective: Children and adolescents with disabilities and health-related impairment belong to a vulnerable population group. There are only few German findings on mental health that distinguish between children and adolescents with and without disabilities and health-related impairment., Materials and Methods: Data were used from the German KiGGS Wave 2 of the Robert Koch-Institute from 2014-2017. A total of 11,830 children and adolescents aged 3-17 years were included using the parent perspective and 5,222 children and adolescents between 11-17 years using their self-assessments. Mental health outcomes were mental health problems (SDQ, parental assessment) and health-related quality of life (kidscreen, self-assessment). Univariate and bivariate analyses were conducted using cross-tables with Chi square tests and multivariate analyses using binary logistic regression models., Results: In 16.5% of children aged 3-17 years, parents reported mental health problems; 48.4% of the interviewed children and adolescents aged 11-17 years reported a low health-related quality of life. Children with disabilities and health-related impairment had a significantly higher probability of mental health problems (OR: 5.11) and a low health-related quality of life (OR: 1.50)., Conclusion: The findings suggest a need for action to strengthen mental health in children and adolescents with disabilities and/or health-related impairment. In this context, the educational settings of kindergarten and school are of great importance., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

Background: The role of personality traits in self-rated health and well-being of adolescents has barely been studied in Germany so far. The aim of this study was to analyze the association between the Big Five personality traits and self-reported health as well as life satisfaction of adolescents in Germany., Methods: The study data are based on the National Educational Panel Study (NEPS), starting cohort 3 (wave 3, 2012). This sample includes (n=5,440) 7 th grade adolescents in regular schools. Personality traits were measured by the Big Five-Inventory (BFI-10): Extraversion, Agreeableness, Conscientiousness, Neuroticism, Openness. Statistical analyses were carried out using bivariate methods and binary-logistic multilevel models, taking into account individuals nested in school classes and schools., Results: Adolescents with pronounced neuroticism had a higher risk of both poor self-rated health (OR: 1.33) and low life satisfaction (OR: 1.46). In contrast, adolescents with high levels of conscientiousness had a reduced risk of poor health (OR: 0.72) and low life satisfaction (OR: 0.59). High levels of extraversion (OR: 0.78) and agreeableness (OR: 0.72) also correlated with higher life satisfaction, but not with better self-reported health. The characteristic of openness was not associated with either self-reported health or the life satisfaction of adolescents., Conclusion: The results suggest that certain personality traits, namely the Big Five can be important indicators of health and life satisfaction of adolescents in early adolescence. However, further studies are needed to assess the link between the Big Five and its generalizability to other age groups., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

Aim of the Study: Self-rated health is an important indicator of current and future health. However, panel data-based findings are lacking that take into consideration the background features of differentiated development of self-reported adolescent health. This paper examines the development of self- rated health through secondary education from grade 5-12 in Germany, analyzing differences according to indicators of socio-economic position and other background characteristics such as gender and family structure., Methodology: 5 th to 10 th grade data from the "Class 5" cohort and 9 th to 12 th grade data from the "9 th grade" cohort of the National Education Panel were combined. Growth curve models based on multi-level analysis were used to examine the level and course of self-rated health and to examine differences according to type of school, parenting, household income, gender and family structure. The final model contains 28,987 observations from 11,290 individuals over 8 time points., Results: Self-reported health declines slightly from 5 th to 12 th grade. Adolescents attending high school, living in higher-income households or parents with higher education status reported better health. Boys and adolescents growing up in nuclear families showed a more favorable course of self-rated health through secondary education., Conclusion: This study provides a comprehensive overview of the development of self-rated health of adolescents in secondary education. In addition to the static differences according to background characteristics, girls and adolescents who do not live in nuclear families also had a worse prognosis for the development of self-rated health over the school career., Competing Interests: Die Autoren erklären, dass keine Interessenkonflikte bestehen., (Thieme. All rights reserved.)

The aim of this study is to examine the impact of social determinants on subjective health, life satisfaction and absence from school due to illness among adolescents in secondary schools, by using data from the German National Educational Panel Study (NEPS).Data was obtained from the National Educational Panel Study (NEPS). The sample included (n=5 790) 6 th grade pupils in regular schools in 2011 (Starting Cohort 3, Wave 2). The socioeconomic background of adolescents was measured by pupils' school type as well as household income and parental education level. Family structure and gender were considered as additional social determinants in the analyses. Bivariate and multiple logistic regression techniques were applied.The results show that type of school and low household income were related to poor subjective health among students. Life satisfaction varied by family structure and school type. For absence from school due to illness, we found a weak association with students in low track schools.The results indicate that especially the school type had the most important impact on subjective health, life satisfaction and absence from school due to illness. Health promotion and preventive strategies should particularly focus on pupils in low track schools and in relation to socially unequal distribution of educational opportunities also on young people from households with low socioeconomic status., Competing Interests: Die Autoren geben an, dass kein Interessenkonflikt besteht., (© Georg Thieme Verlag KG Stuttgart · New York.)

Objectives: The aim of this study was to examine the associations between features of class climate and school wellbeing, based on self-rated health and reports of absence from school due to illness among adolescents in secondary schools, by using data from the German National Educational Panel Study (NEPS)., Methods: Data was obtained from the National Educational Panel Study (NEPS). The sample includes (n=7,348) seventh grade students in regular schools (Starting Cohort 3, Wave 3, 2012). Measures of class climate comprise indicators about demands, control and orientation, autonomy and interaction among students as well as teaching quality in German language class. School wellbeing was measured by satisfaction with school and helplessness in main school subjects. Bivariate and logistic multilevel logistic regression techniques are applied, by controlling for student age, gender and school type attended., Results: Multilevel results showed that particularly among students with higher school satisfaction, there was a higher likelihood of self-rated health and less school absence due to illness. In contrast, perceived helplessness in major subjects and learning orientation were negatively associated with both outcomes. Further, students attending low track schools had a higher risk of school absence than students in high track schools., Conclusion: The results highlight the fact that particularly students' school wellbeing in terms of school satisfaction and perceived helplessness in the subjects German and mathematics are associated with self-rated poorer health and school absence due to illness. Therefore, health promotion initiatives should particularly focus on students' school wellbeing as well as on students attending low track schools., Competing Interests: Die Autoren geben an, dass kein Interessenkonflikt besteht., (© Georg Thieme Verlag KG Stuttgart · New York.)

In all highly developed countries, the overall health status of the population has significantly improved within the past 30 years. The most important reason for this is the increase in economic prosperity. Economic wealth, however, today is much more unequally distributed than it was 3 decades ago. Countries with relatively small disparities in the availability of material resources between socioeconomic groups, such as the Scandinavian countries, have better health outcomes on the population level. Health inequalities, however, have also reached a higher level than 30 years ago. As of today, we do not have convincing explanations for the interrelation of economic and health inequality. This paper gives an overview of existing research on a comparative basis. The research results are ambivalent. They show the puzzling result that the Scandinavian countries with their highly distributive welfare policy manage to achieve the comparatively highest level of economic, but not health, equity. Based on these results, we develop proposals for future research approaches. A central assumption is that in rich societies no longer only material, but more and more immaterial determinants are crucial for the formation of health inequality. The promotion of "salutogenic" self-management capabilities in socially disadvantaged groups is considered to be the central element in effective intervention strategies., (© Georg Thieme Verlag KG Stuttgart · New York.)

Objectives: Children and adolescents in Germany are generally considered to be healthy if health is measured with "classic" indicators of health. However, health impairments increasingly emerge in terms of psychosocial health. The present study addresses the question whether and what aspects of psychosocial health are associated with age, gender and socioeconomic status., Methods: Data were obtained from the North Rhine-Westphalian sample of the "Health Behaviour in School-aged Children (HBSC)" study in 2006. Overall, 4 324 students aged 11-15 years were interviewed with a standardised questionnaire. Descriptive methods were used to analyse the association between age, gender and socioeconomic status and the four measures of psychosocial health. The socioeconomic status of the adolescents was measured by type of school., Results: About 20% of the adolescents suffer from impairments in their psychosocial health. In general, girls report worse psychosocial health than boys. Student's perceived rating of psychosocial health decreases with increasing age. Independently of gender, pupils from general school rate their health worse than pupils from grammar school., Conclusions: The results underline that there are manifold health problems in adolescence, which can lead to severe diseases in later life such as chronic diseases. The findings suggest that preventive strategies should be directed toward girls and pupils from general schools., (Georg Thieme Verlag KG Stuttgart, New York.)