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Physical therapy plays an important role in health care and is listed as a therapy in many clinical guidelines. Claims data gathered by statutory health insurers demonstrate that in Germany physical therapy accounts for more than 70% of the reimbursable costs of all non-medical treatments comprising physical therapy, logopaedics, occupational therapy and podiatry. In monetary terms, this equates to about EUR 4.4 billion annually. According to self-reports of the respondents of GEDA 2014/2015-EHIS on their utilization of physical therapy services 25.5% of women and 17.7% of men used physical therapy services within the 12 months that preceded the interview. This rate increases significantly with age, reaching its peak among the 50-to-59 year age group, at 30.7% among women and 20.1% among men. People with a high level of education and those with private health insurance use physical therapy services more frequently. Moreover, people living in the eastern part of Germany use physical therapy services more often than those living in the western federal states.

Sex/gender diversity is increasingly recognised by society and should be taken into account more in population-representative studies, as they are important data sources for targeting health promotion, prevention and care. In 2019, the Robert Koch Institute started a population-representative health survey with the study Health in Germany Update (GEDA 2019/2020-EHIS) with a modified, two-stage measures of sex/gender. The survey covered sex registered at birth and gender identity with an open response option. This article describes the aims, the procedure and the experiences with the operationalisation of sex/gender and the results. Out of 23,001 respondents, 22,826 persons are classified as cisgender, 113 persons as transgender and 29 persons as gender-diverse. 33 respondents were counted as having missing values. A survey of interviewers showed that the two-stage measures of sex/gender had a high level of acceptance overall and that there were only a few interview drop-outs. On the basis of previous experience, the modified query can be used for further surveys, but should also be adapted in perspective. For this purpose, participatory studies are desirable that focus on how the acceptance of measures of sex/gender can be further improved and how hurtful experiences in the context of the questions asked can be avoided., (© Robert Koch Institute. All rights reserved unless explicitly granted.)

Unwanted pregnancies and abortions are experiences shared by many women. In light of the fact that some general framework conditions are currently changing in Germany, and that the Corona pandemic represents a particular challenge for the care of women with unwanted pregnancies, current data from the statistics on terminations of pregnancy of the Federal Statistical Office are outlined. Compared to Europe, Germany has a low proportion of induced abortions. In 2021, 94,596 abortions were reported. The number of abortions as well as the abortion rate and the abortion ratio have decreased since 2001. 95.8% of abortions took place according to the so-called counselling provision. In more than half of the abortions (52.1%) vacuum aspiration was used, in 11.4% curettage, 32.3% were medical abortions using mifepristone. There are large regional differences in the method used., Competing Interests: Conflicts of interest The authors declared no conflicts of interest., (© Robert Koch Institute. All rights reserved unless explicitly granted.)

Sexual behaviour is an important aspect of sexual health. 18-year-old and older participants of the KiGGS cohort in KiGGS Wave 2 were asked about their sexual and contraceptive behaviour. Data from 2,966 women and 2,206 men were included in the analysis, which was adjusted to the age and sex distribution of the German population by means of weighting. More than half of the respondents report their first sexual intercourse before reaching the age of majority (women 61%, men 53%). Women report a lower age than men. With regard to the number of opposite-sex sexual partners in the last twelve months, almost 69% of women and 58% of men state that they have had contact. Three or more sexual partners were reported by 11% of women and 20% of men. 7.4% of women have same-sex and 1.4% have both same-sex and opposite-sex sexual contacts, among men the figures are 2.8% and 0.4%, respectively. When asked about the type of contraception used during the last sexual intercourse, about two thirds of the women and more than half of the men indicated the pill; a condom is used by about 44% of the women and about two thirds of the men. Almost one third of the women have already taken the morning-after pill. Overall, the results can help to support prevention and education campaigns on sexual and reproductive health., Competing Interests: Conflicts of interest The authors declared no conflicts of interest., (© Robert Koch Institute. All rights reserved unless explicitly granted.)

Being able to perform activities of daily living is an important component of a person's ability to function. If these activities are impaired, support is needed. Using data from GEDA 2019/2020-EHIS, we present how many people aged 55 and older living in private households in Germany experience limitations in activities of daily living. Severe limitations in basic (fundamental) activities (e.g. food intake) are reported by 5.8% of women and 3.7% of men. The proportion increases with age as 13.4% of women and 9.0% of men aged 80 and older experience limitations. Severe limitations of instrumental activities of daily living (e.g. grocery shopping) are rather rare in participants less than 80 years of age. But at age 80 and older the proportion rises to 35.9% of women and 21.0% of men. A total of 68.1% of afflicted women and 57.5% of men receive help and support related to limitations of basic activities. Women are also more likely to report a lack of support (48.8% vs. 43.2%). The situation is slightly better with regard to instrumental activities. The results of GEDA 2019/2020-EHIS show in which areas of daily life older and very old people are impaired, give an impression of who is affected particularly strongly and indicate where support services are insufficient. As such, these results provide clues as to where support can be provided to enable older people to keep living in their own homes for a long time., Competing Interests: Conflicts of interest The authors declared no conflicts of interest., (© Robert Koch Institute. All rights reserved unless explicitly granted.)

According to international studies, children and adolescents with disabilities have more tooth decay, brush their teeth less often twice a day and use preventive dental services less often than children and adolescents without disabilities. With data from the second follow-up to the German Health Interview and Examination Survey for Children and Adolescents (KiGGS Wave 2, 2014-2017), toothache, tooth brushing frequency and dental check-ups are examined in children and adolescents with and without disabilities. It was found that children and adolescents with disabilities had more toothache in the three months before the survey (23.5% and 15.9%, respectively) and brushed or got their teeth brushed twice a day less often (33.5% and 22.2%, respectively) than children and adolescents without disabilities. Differences in the utilisation of dental check-ups could not be determined. Overall, the results point to the importance of measures to promote tooth brushing frequency in order to improve the oral health of children and adolescents with disabilities. In addition, further opportunities should be created to collect data on the oral health of people with disabilities at the population level in health or participation studies., Competing Interests: Conflicts of interest The authors declared no conflicts of interest., (© Robert Koch Institute. All rights reserved unless explicitly granted.)

A large part of the population is affected by impairments and disabilities. Around 13% of people in Germany have an officially recognised disability, and an estimated 15.6% have an impairment. This article provides an overview of the health of people with impairments and disabilities on the basis of selected indicators. The analyses are based on data from 23,372 participating persons aged 18 and over (12,747 women, 10,625 men) in the GEDA 2014/2015-EHIS study of the Robert Koch Institute (RKI), a nationwide survey of the adult population in Germany. 21.5% of persons with impairments and disabilities rate their health as good or very good, in contrast to 76.0% of persons without impairments and disabilities. Depressive symptoms exist in 27.1% of persons with impairments and disabilities and 7.5% of persons without impairments and disabilities. In part, there were differences in health behaviour, for example, people with impairments and disabilities do less aerobic physical activities and consume alcohol in risky amounts less often. 97.0% of the persons with and 86.1% of the persons without impairments and disabilities make use of outpatient medical services within one year, the former also have a higher inpatient and home care utilisation. Overall, poorer health is found among women than among men with impairments and disabilities, as well as with increasing age. The analyses show the need for prevention, health promotion and health care. Further data is needed to describe the health situation of people with impairments and disabilities., Competing Interests: Conflicts of interest The authors declared no conflicts of interest., (© Robert Koch Institute. All rights reserved unless explicitly granted.)

Based on data from the CORONA-MONITORING lokal (CoMoLo) study conducted in four municipalities particularly affected by the COVID-19 pandemic, this article investigates the non-utilisation of health care services in the population aged 18 years and older (n=9,002) in relation to the period after the introduction of the containment measures in March 2020. The results show that about one third of the respondents (35.5%) gave up at least one of the surveyed health care services. The most frequent cancellations were dental (15.2%) and specialist check-ups (11.8%), followed by postponement of physiotherapy, ergotherapy or speech therapy (6.1%), cancellation of general practitioner (GP) check-ups (5.8%), postponement of psychotherapy (2.0%), postponement of planned hospital treatment (1.8%) and not going to an emergency room (0.7%). Almost 10% of the respondents reported not visiting a physician despite health complaints. Compared to respondents without such a waiver, these respondents were more often female and younger than 35 years, less often rated their health as very good or good, more often had a diagnosis of depression and more often used telemedical contacts as an alternative to visiting the practice during the pandemic. Further analyses of trends in utilisation behaviour and changes in health status over the course of the COVID-19 pandemic are important., Competing Interests: Conflicts of interest The authors declared no conflicts of interest., (© Robert Koch Institute. All rights reserved unless explicitly granted.)

Outpatient health care provision plays an important role in the identification and treatment of health problems. Data are needed on the utilisation of health care services and their determinants to enable health policy decision-making and needs-based care provision. The analyses set out in this article are based on current data on the utilisation of outpatient health care services. The data stem from the German Health Update (GEDA 2019/2020-EHIS), a nationwide cross-sectional survey of the resident population in Germany that is undertaken as part of the health monitoring conducted at the Robert Koch Institute. Around 80% of the population aged 18 or over were treated at least once within twelve months by a general practitioner, 60% by a specialist, and 10% received psychiatric or psychotherapeutic treatment. Less than half of those eligible had had a stool test during the past two years, and just over half had had a colonoscopy in the past ten years. Around 80% of women and 70% of men had had their blood pressure checked within the last year, and 60% had had their blood cholesterol or blood sugar levels monitored. Over 50% reported that they had taken medically prescribed drugs in the past two weeks. In general, most of the indicators under study suggest that utilisation increases with age and that utilisation is higher among women than men, with the exception of psychiatric and psychotherapeutic services, among others., Competing Interests: Conflicts of interest The authors declared no conflicts of interest., (© Robert Koch Institute. All rights reserved unless explicitly granted.)

[This corrects the article on p. 3-20 in vol. 5.]., (© Robert Koch Institute. All rights reserved unless explicitly granted.)

SARS-CoV-2, the novel coronavirus, has posed major challenges in Germany in 2020. It is unclear whether the pandemic and containment measures will have an impact on the health of the population beyond the point of infection. The German Health Update (GEDA 2019/2020-EHIS) is a nationwide survey of the population aged 15 years and older (n=23,001) that was conducted between April 2019 and September 2020. The focus of the analysis was on indicators for which pandemic-related changes could be expected. Based on regression models, adjusted proportions and mean values were estimated as trends over time. Any differences in the values found for the time period of containment measures in spring 2020 and the reference period 2019 were statistically tested. Since the implementation of containment measures, both body weight and body mass index (BMI) have increased. The utilisation of general and specialist medical services decreased temporarily. The number of tobacco smokers during the observation period also decreased, yet without revealing a clear link to the pandemic situation. No differences were found in the general population for depressive symptoms and household assistance received and provided. During the period of containment measures, changes to the health situation beyond the occurrence of infections can be observed. However, a more differentiated explanation of these findings will require further analyses., Competing Interests: Conflicts of interest The authors declared no conflicts of interest., (© Robert Koch Institute. All rights reserved unless explicitly granted.)

Since the beginning of the year 2020, the SARS-CoV-2 coronavirus has spread globally at a tremendous pace. Studies on the prevalence of SARS-CoV-2 antibodies in the population help estimate the number of people that have already been infected. They also allow an estimate of the number of undetected infections i.e. infections that do not appear in data on officially reported cases. The interpretation of study results needs to consider bias from selective sampling and the diagnostic test properties. To promote networking and co-operation between scientists, the Robert Koch Institute has compiled an overview of the seroepidemiological studies conducted in Germany on its website, which is regularly updated. The RKI conducts searches, for example of press releases, study registry entries or preprint server publications, and contacts the lead investigators of these studies. Of the 40 studies contacted so far, 24 have already provided information (as of 25.06.2020). We can differentiate between studies of the general population, of selected population groups such as healthcare workers, or of ongoing cohorts. This article provides an overview of such studies from Germany, but also of selected international studies. A special focus is set on studies of children and adolescents, which are now of particular interest due to the planned reopening of childcare facilities and schools., Competing Interests: Conflicts of interest The authors declared no conflicts of interest., (© Robert Koch Institute. All rights reserved unless explicitly granted.)

Considerable demographic differences characterise the Berlin, Brandenburg and Mecklenburg-Western Pomerania region (the north east region), for example, regarding settlement patterns and age structures. These differences are also observed among women in the age group 50 years and older. The most conspicuous difference is population density. While Berlin is one of the most densely populated cities in Germany, Brandenburg and Mecklenburg-Western Pomerania are the two most sparsely populated federal states. In these two states, the female population is on average older than in Berlin, a fact particularly true of rural areas. Continuing migration is a contributing factor not only to a rise in average age but also to further decreasing population density. An essential consideration for rural area health care provision are the distances people need to travel to reach services. Having (access to) a car is a key factor. Yet, as older women are less likely than men of the same age to have (access to) a car, public transport and other modern forms of mobility (dial-a-bus services, shared taxis) are gaining in importance., Competing Interests: Conflicts of interest The authors declared no conflicts of interest., (© Robert Koch Institute. All rights reserved unless explicitly granted.)

There are relatively few representative data on the utilisation of physician services in Germany and its influencing. Based on data from the German Health Interview and Examination Survey for Adults (DEGS1, 2008-2011), we analyse the utilisation of gynaecology and general practitioner (GP) services, with a focus on women aged 50 years and older. We compare these findings with data from the German National Health Interview and Examination Survey 1998 (GNHIES98) and, based on this and further data, discuss possible developments. Figures for seeking GP services (over 80%) are constantly high across the entire lifespan, whereas figures for gynaecology services drop with age. Around 60% of women aged 50 years and older go to a gynaecological practice at least once a year. Socioeconomic status and place of residence are important determinants for the utilisation of services. Around half of all women aged 50 years and older sought both gynaecology and GP services at least once over a one-year period. Under 10% had only been to a gynaecologist, and around one third sought GP services only. Compared to GNHIES98, figures for GP and gynaecology services were considerably higher in DEGS1, health insurance data, however, shows no increase in the use of gynaecology services between 2008 and 2018. The results highlight the need to increase awareness among GPs of the needs of middle-aged and older women for gynaecological consultation and treatment., Competing Interests: Conflicts of interest The authors declared no conflicts of interest., (© Robert Koch Institute. All rights reserved unless explicitly granted.)

For older and very old women in rural areas, the long distances involved and the limited availability of services can make accessing general practitioners and specialist physicians difficult. Based on data from the recent wave of the German Health Update (GEDA 2014/2015-EHIS), we have analysed the barriers to accessing health care for women in the age group 50 years and older in Germany. 21.0% of the women reported having had difficulties getting an appointment for an examination when it was needed during the twelve-month period before the interview. Fewer than 5% of the women reported distance as the reason for delayed medical examinations. Over the course of a one-year period, women in the large cities more frequently had to wait for an appointment for an examination than women in smaller towns. However, women in smaller towns reported more often that an examination had taken place late due to distance. The results are informative for the planning of health care services., Competing Interests: Conflicts of interest The authors declared no conflicts of interest., (© Robert Koch Institute. All rights reserved unless explicitly granted.)

Gynaecological care is generally perceived as focused on reproductive health. However, when women enter the non-reproductive life phase, other reasons to seek gynaecological care gain in importance. This paper presents findings on the reasons for women in the 50 years and older age group to seek gynaecological consultation and treatment. Our findings are based on data from the German Health Interview and Examination Survey for Adults (DEGS1, 2008-2011), conducted by the Robert Koch Institute (RKI), as well as the 2016 claims data from the Associations of Statutory Health Insurance Physicians (KVen), provided by the Central Research Institute of Ambulatory Health Care in Germany (Zi). At this age, cancer screening and menopausal complaints can become, as DEGS1 data shows, important reasons to seek gynaecological services. Around 65.0% of 50- to 79-year-old women took advantage of breast palpation examinations during the last twelve months, and 58.0% underwent cervical cell smear tests (pap smear). 47.2% of women had their last menstrual period at age 50 or later. KV data shows that with 45.3% and 33.1% of cases respectively, menopausal symptoms (International Statistical Classification of Diseases and Related Health Problems, 10th revision, ICD-10: N95) and screening for malignant neoplasms (ICD 10: Z12) were the most frequently billed services. The data clearly shows reasons for consultation and treatment of women aged 50 years and older and these should therefore be considered in treatment planning and design., Competing Interests: Conflict of interest The authors declared no conflicts of interest., (© Robert Koch Institute. All rights reserved unless explicitly granted.)

In Germany, specialists in paediatrics and general medicine in private practices provide the bulk of outpatient treatment. Data from the second wave of the German Health Interview and Examination Survey for Children and Adolescents (KiGGS Wave 2, 2014-2017) surveyed the ambulatory attendance of paediatric and general medical services for 0- to 17-year-old children and adolescents. During the last 12 months, 72.8% of girls and 72.7% of boys have made use of outpatient paediatric treatment and 25.9% of girls and 24.6% of boys have made use of outpatient general medical services. Attendance rates in paediatric practices decrease with age, whereas those of general medical practices increase. While no relevant differences between genders exist, rural areas evidence significantly lower paediatric practice and significantly higher general medical practice attendance rates. Compared to the data collected in the previous KiGGS studies, the trend over the last ten years approximately indicates an increase in the use of paediatric services and a decrease in the use of general medical services., Competing Interests: Conflicts of interest The authors declared no conflicts of interest., (© Robert Koch Institute. All rights reserved unless explicitly granted.)

Data from the German Health Interview and Examination Survey for Children and Adolescents (KiGGS) enable conclusions about the utilization of outpatient and inpatient medical services by children and adolescents accounting the family's socioeconomic status (SES). Results from the second follow-up to the KiGGS survey (KiGGS Wave 2), which covers the years 2014 to 2017, clearly demonstrate that children and adolescents from families with a low SES visit specialists in general medicine, gynaecologists and psychiatrists, as well as child and adolescent psychiatrists, psychotherapists and psychologists more frequently. In contrast, children and adolescents from families with a high SES visit paediatric, dermatological, dental and orthodontic practices more often. No statistically significant differences between the status groups with regard to the utilization of outpatient medical services in hospitals were identified. However, children and adolescents from the low status group received inpatient hospital treatment more frequently and, on average, spent more nights in hospital. These results reflect status-specific differences both in disease prevalence and care, as well as in patterns related to the utilization of medical services., Competing Interests: Conflicts of interest The authors declared no conflicts of interest., (© Robert Koch Institute. All rights reserved unless explicitly granted.)

For patients with considerable malfunctions, or where these could potentially develop, statutory health insurers completely cover the cost of correcting malpositionings of the teeth and jaws through orthodontic treatment in Germany. Based on the self-reported information from the second wave of the German Health Interview and Examination Survey for Children and Adolescents (KiGGS Wave 2, 2014-2017), the uptake of orthodontic treatment was analysed. A total of 25.8% of the girls and 21.1% of the boys aged 3 to 17 years are receiving regular orthodontic treatment. Uptake of treatment is very much dependent on age. The highest rates are found among 13-year-old girls (55.0%) and 14-year-old boys (50.8%). Compared to the data from previous KiGGS waves, the trend over approximately ten years has seen a significant increase of orthodontic treatment across all age groups. More health services research and a broader discourse on current treatment practices and their benefits are desirable., Competing Interests: Conflicts of interest The authors declared no conflicts of interest., (© Robert Koch Institute. All rights reserved unless explicitly granted.)

Maternal smoking during pregnancy poses a significant risk to the development of unborn children. Data from KiGGS Wave 2 shows that 10.9% of mothers of 0 to 6 year-old children smoked during pregnancy. Mothers who were under 25 when giving birth smoked about two to three times more often than older mothers. Furthermore, there is a distinct social gradient in maternal smoking: a higher socioeconomic status is associated with a lower proportion of children with a mother who smoked during pregnancy. A comparison with data from the KiGGS baseline study shows that the proportion of mothers who smoked during pregnancy fell from to 19.9% to 10.9% between the two study periods. Thus, the KiGGS results are in line with those from the perinatal survey, which also found that the proportion of pregnant women who smoke has declined significantly since the mid-1990s., Competing Interests: Conflicts of interest The authors declared no conflicts of interest., (© Robert Koch Institute. All rights reserved unless explicitly granted.)

In Germany, the provision of health services to people with mental disorders is an issue that is subject to controversial debate. On the one hand, regional differences exist in the distribution of psychotherapists in Germany. On the other hand, patients are often willing to accept the extra effort of having to travel further in order to access treatment even in case of a low supply. Thus, in addition to issues of access, an analysis of care provision also needs to take into account the actual level of services utilization. The present paper analyses the utilization of outpatient psychiatric and psychotherapeutic services and identifies individual and regional determinants. The German Health Update (GEDA) is a nationwide survey of the adult population that is conducted by the Robert Koch Institute in the context of its population-based health monitoring. The GEDA 2014/2015-EHIS study (n=24,016) is based on a two-stage stratified random sample drawn from the population registers of 301 local authorities in Germany. The main outcome is the utilization of psychotherapeutic or psychiatric services during the last 12 months. In addition to the consideration of individual factors, the survey data was combined with information describing the regional distribution of providers of outpatient psychotherapeutic and neurological care. The data was analysed using logistic multi-level regression. In Germany, 11.3% of women and 8.1% of men report that they have used psychotherapeutic or psychiatric treatment within the last 12 months. Among respondents with current depressive symptoms, these rates are 35.0% in women and 31.0% in men. This means that approximately two thirds of people with current depressive symptoms do not seek the services of these health professionals during this period. Apart from current depressive symptoms the utilization of psychiatric and psychotherapeutic services is associated with not living with a partner and with low levels of social support. Furthermore, in regions with a high density of care providers, the proportion of people with current depressive symptoms using such services is about 15 percentage points higher than in regions with a low density. The conditions for the utilization of the respective services should not only be improved by increasing the number of care providers, but also by implementing accompanying measures. Innovations in health care aiming at rapid and low-threshold access as well as approaches for a better cooperation between primary and specialist care should therefore be evaluated regarding their contribution to an improved early treatment., Competing Interests: Conflicts of interest The authors declared no conflicts of interest., (© Robert Koch Institute. All rights reserved unless explicitly granted.)

The use of medicines is an essential aspect of treating disease. In this field, surveys that map the population's use of medicines are of particular interest. The GEDA 2014/2015-EHIS study collected data on the use of medically prescribed and self-medicated drugs during the two weeks that preceded the survey. 58.9% of women and 52.0% of men reported that they had taken medically prescribed drugs during this period. 48.5% of women and 35.4% of men stated they had taken medication during this period that had not been prescribed by a doctor. The prevalence of the use of medically prescribed drugs and self-medication was higher among women than among men. Finally, the prevalence of the use of medically prescribed drugs increased significantly with age, whereas the prevalence of self-medication decreased with age., Competing Interests: Conflicts of interest The authors declared no conflicts of interest., (© Robert Koch Institute. All rights reserved unless explicitly granted.)

Inpatient care is an important pillar of the health care system. Data from health surveys enable to analyse the utilization of inpatient treatment from the patient's perspective, and to identify associations to social determinants and other influencing factors. As part of the GEDA 2014/2015-EHIS study, data was collected for the indicator 'utilization of inpatient medical care during the last 12 months'. The data analysis shows that 16.9% of women and 15.3% of men were admitted to hospital at least once during the last 12 months. The utilization of inpatient treatment depends on age: among people aged 65 or above, 25.9% of women and 25.8% of men were admitted to hospital during the last 12 months. Almost no significant differences in utilization were identified in regard to gender, with the exception of the 18-to-29 age group, where admittance to hospital was more common among women than men. In terms of education, people with the lowest level of education have a higher utilization of inpatient care, and this is particularly the case in middle age., Competing Interests: Conflicts of interest The authors declared no conflicts of interest., (© Robert Koch Institute. All rights reserved unless explicitly granted.)

Outpatient care in Germany is mainly provided in physicians' private practices. Data from health surveys enable to analyse the utilization of outpatient services from the patient's perspective, and to identify associations with social determinants and other influencing factors. As part of the GEDA 2014/2015-EHIS study, data was collected for the indicator 'utilization of outpatient medical care in the last 12 months'. The analysis found that 90.9% of women aged 18 years and over and 84.1% of men had used outpatient medical services within the last 12 months. The utilization of outpatient medical care increases with age: about 94% of people aged 65 or over were provided with outpatient medical treatment in the last 12 months. There were significant differences in utilization between younger men and women, which balance out with age. No differences were identified in relation to educational level or federal state., Competing Interests: Conflicts of interest The authors declared no conflicts of interest., (© Robert Koch Institute. All rights reserved unless explicitly granted.)

Joint symptoms and pain belong to the most common diseases worldwide that affect people in their usual activities and lead to loss of quality of life. 29.3% of women and 24.4% of men reported acute joint pain, which is defined as pain suffered during the past 24 hours. With age, these figures increase. Women report pain in 3.9 joints on average and men in 3.6. In both genders the joints most affected are the shoulders, knees and hips. Respondents suffering from joint pain significantly more often report medically diagnosed osteoarthritis or rheumatoid arthritis than respondents who were free of pain., Competing Interests: Conflicts of interest The authors declared no conflicts of interest., (© Robert Koch Institute. All rights reserved unless explicitly granted.)

A continuous breastfeeding monitoring is essential as it enables reports on changes in breastfeeding behaviour. The German Health Interview and Examination Survey for Children and Adolescents (KiGGS), which is conducted by the Robert Koch Institute, periodically collects data about the health of children and young people living in Germany, including data on breastfeeding. Moreover, KiGGS is mentioned within the approach developed by the National Breastfeeding Committee as a possible source of data for breastfeeding monitoring. The data from KiGGS can be used to develop retrospective indicators on breastfeeding for particular birth cohorts. The data demonstrate that the prevalence of children who were ever breastfed tended to rise between the 2001/2002 and 2007/2008 cohorts; however, no significant changes were identified for the 2001-2008 cohorts with respect to breastfeeding duration. Breastfeeding monitoring relies on reports about current trends in the field; due to the periodicity with which the KiGGS study waves are conducted, data on current birth cohorts cannot be provided. Therefore, data on breastfeeding needs to be collected throughout Germany in relation to direct environmental and other factors. This data should be collected during health screenings and regular check-ups so that it can be used as a further measure in breastfeeding monitoring., Competing Interests: Conflicts of interest The authors declared no conflicts of interest., (© Robert Koch Institute. All rights reserved unless explicitly granted.)