Nicht-suizidales selbstverletzendes Verhalten bei stationär behandelten Kindern und Jugendlichen mit Essstörung: Lebenszeitprävalenz, Methoden, klinische Korrelate und Suizidalität

This dissertation adresses nonsuicidal self-injury (NSSI) in youth inpatients with eating disorders (EDs). Even though EDs and NSSI both represent self-harming behaviors that are associated with an increased risk of mortality and suicide, epidemiological data on NSSI have been lacking for this vulnerable patient population. The present work first provides an overview of relevant clinical concepts and the current state of research on NSSI in EDs. An empirical study is then presented that was conducted as part of this dissertation to address an existing research gap by providing data on lifetime prevalence, methods used, clinical correlates, and suicidality associated with NSSI in youth inpatients with EDs. This empirical study is a retrospective chart review, which analyzed data from patients ≤ 18 years consecutively admitted between 1990–2015 to the Child and Adolescent Psychiatry Unit of the Charité University Hospital in Berlin, Germany, with a diagnosis of anorexia nervosa, restrictive type (AN-R), anorexia nervosa, binge-purge type (AN-BP), or bulimia nervosa (BN), according to the International Statistical Classification of Diseases and Related Health Problems. The sample consisted of 382 patients, was predominantly female (97.1%), and had a median age of 15.6 years (age range 9–18 years). Overall, a high lifetime prevalence of NSSI was found, with 47.6% in BN, 39.3% in AN-BP, and 8.3% in AN-R. Cutting was the most common NSSI method, followed by scratching, hitting, and burning. Multivariable regression analyses showed that NSSI independently correlated with a significantly higher number of psychiatric comorbidities in each ED subgroup and, in addition, with a lower weight gain during hospitalization in AN-R and with a longer duration of treatment in BN. Furthermore, NSSI was associated with more suicidal ideation in all ED subgroups, and additionally with more suicide attempts in AN-BP. In this dissertation, the obtained empirical findings are discussed against the background of the current state of research on NSSI in EDs, and implications for clinical practice and future research are derived. Overall, the empirical evidence gathered in this dissertation underscores the importance of early prevention programs and treatment specialization to identify at-risk individuals on time, provide help, and enable a full recovery. The association between NSSI and increased suicidality highlights the need for suicide prevention efforts in youth seeking inpatient care for an ED and engaging in NSSI.Die vorliegende Dissertation thematisiert nicht-suizidales selbstverletzendes Verhalten (NSSV) bei stationär-psychiatrisch behandelten Kindern und Jugendlichen mit Essstörungen. Für diese vulnerable PatientInnenpopulation mangelte es bisher an epidemiologischen Daten zu NSSV, obwohl Essstörungen und NSSV beide selbstschädigende Verhaltensweisen darstellen, die mit einem erhöhten Mortalitäts- und Suizidrisiko einhergehen. Die vorliegende Arbeit gibt zunächst einen Überblick über relevante klinische Konzepte und den Forschungsstand zu NSSV bei Essstörungen. Anschließend wird eine empirische Studie vorgestellt, die im Rahmen der Dissertation durchgeführt wurde. Diese empirische Studie zielte darauf ab vorhandene Forschungslücken zu adressieren, indem Daten zu Lebenszeitprävalenz, Selbstverletzungsmethoden, klinischen Korrelaten und Suizidalität im Zusammenhang mit NSSV bei stationär behandelten Kindern und Jugendlichen mit Essstörung erhoben wurden. Bei dieser Studie handelt es sich um eine retrospektive Aktenanalyse, die PatientInnen ≤ 18 Jahren einschloss, die zwischen 1990 und 2015 in der Kinder- und Jugendpsychiatrie der Charité – Universitätsmedizin Berlin aufgrund der Diagnose restriktive Anorexia nervosa (AN-R), binge-purge AN (AN-BP) oder Bulimia nervosa (BN) entsprechend der internationalen statistischen Klassifikation der Krankheiten und verwandter Gesundheitsprobleme aufgenommen wurden. Die Stichprobe umfasste 382 PatientInnen, war überwiegend weiblich (97,1%), und hatte einen Altersmedian von 15,6 Jahren (Altersbereich 9–18 Jahre). Insgesamt wurde eine hohe Lebenszeitprävalenz von NSSV gefunden mit 47,6% bei BN, 39,3% bei AN-BP und 8,3% bei AN-R. Sich selbst schneiden stellte die häufigste Selbstverletzungsmethode dar, gefolgt von Kratzen, Schlagen und Verbrennen. Multivariable Regressionsanalysen zeigten, dass NSSV in allen Essstörungsgruppen mit einer signifikant erhöhten Anzahl psychiatrischer Komorbiditäten unabhängig korrelierte und zusätzlich mit einer geringeren Gewichtszunahme während des Klinikaufenthaltes bei AN-R und mit einer längeren Behandlungsdauer bei BN. Zudem ging NSSV in allen Essstörungsgruppen mit mehr Suizidgedanken einher, und bei AN-BP zusätzlich mit mehr Suizidversuchen. In der vorliegenden Dissertation werden diese empirischen Befunde vor dem Hintergrund des aktuellen Forschungsstandes zu NSSV bei Essstörungen diskutiert und Implikationen für klinische Praxis und zukünftige Forschung abgeleitet. Insgesamt unterstreichen die im Rahmen dieser Dissertation gewonnen empirischen Befunde die Relevanz von Früherkennungsprogrammen und Behandlungsspezialisierung, um gefährdete Individuen rechtzeitig zu identifizieren, Hilfe anbieten und vollständige Genesung ermöglichen zu können. Der gefundene Zusammenhang zwischen NSSV und erhöhter Suizidalität weist auf die Notwendigkeit einer gesonderten Suizidprävention in der PatientInnenpopulation von stationär behandelten Kindern und Jugendlichen mit Essstörung und NSSV hin

Determinants Of Drug Utilisation During Childhood

Paediatric pharmacology is a neglected area in terms of rational use of drugs. Wide differences have been observed in children’s exposure to drugs between and within countries and regions. The aim of the current thesis is to investigate the determinants of drug prescription in paediatrics. Pharmacoepidemiology and the use of administrative databases can be a useful tool for this scope. Data collected in regional and multiregional administrative prescription databases were analysed. Prevalence data by sex and age were calculated by dividing the number of drug users by the total number of male and female residents in each age group. Univariable and multivariable analyses were performed with the aim to identify the determinants of drug prescriptions. The studies showed quantitative and qualitative differences in drug prescription to children and adolescents among Italian regions and within regions. The prescription of a great number of different, redundant, active substances, even among experienced paediatricians, was found. A North-South trend was found in antiasthmatic and antibiotic prevalence, with an important association with average income at the area level. A confirmation of the high prevalence of these drugs and poor qualitative profile was also found. Large heterogeneity was found in psychotropic drug prevalence among different Italian regions. Psychotropic drugs were scantly prescribed and some of the most used drugs were prescribed off-label. The analyses of the prescription of generic antibiotics showed that generic formulations are scantly prescribed by Italian paediatricians, and the lowest prescription rate of generic drugs was found in paediatricians who prescribe more antibiotics. Some quality indicators for antibiotic prescribing were developed at the paediatrician level. The youngest paediatricians and those who were not exposed to educational interventions showed a significantly worse quality of prescribing. The thesis provide some useful data for policy makers in order to improve the rational drug use in children

Pharmacokinetics of Extended vs Intermittent Intravenous Infusion of Meropenem in Critically Ill Patients Receiving Continuous Veno-Venous Haemofiltration

peer reviewe

Which extended paramedic skills are making an impact in emergency care and can be related to the UK paramedic system? A systematic review of the literature

BACKGROUND: Increasing demand on the UK emergency services is creating interest in reviewing the structure and content of ambulance services. Only 10% of emergency calls have been seen to be life-threatening and, thus, paramedics, as many patients’ first contact with the health service, have the potential to use their skills to reduce the demand on Emergency Departments. This systematic literature review aimed to identify evidence of paramedics trained with extra skills and the impact of this on patient care and interrelating services such as General Practices or Emergency Departments. METHODS: International literature from Medline, Embase, Cumulative Index of Nursing and Allied Health Literature (CINAHL), ProQuest, Scopus and grey literature from 1990 were included. Articles about any prehospital emergency care provider trained with extra skill(s) beyond their baseline competencies and evaluated in practice were included. Specific procedures for certain conditions and the extensively evaluated UK Emergency Care Practitioner role were excluded. RESULTS: 8724 articles were identified, of which 19 met the inclusion criteria. 14 articles considered paramedic patient assessment and management skills, two articles considered paramedic safeguarding skills, two health education and learning sharing and one health information. There is valuable evidence for paramedic assessing and managing patients autonomously to reduce Emergency Department conveyance which is acceptable to patients and carers. Evidence for other paramedic skills is less robust, reflecting a difficulty with rigorous research in prehospital emergency care. CONCLUSIONS: This review identifies many viable extra skills for paramedics but the evidence is not strong enough to guide policy. The findings should be used to guide future research, particularly into paramedic care for elderly people

Chronic Fatigue Syndrome/Myalgic Encephalomyelitis

This Special Issue on CFS/ME collects 18 papers with an interdisciplinary view on the current demographic and epidemiological data and immunological characteristics of CFS/ME and examines the different pathogenic hypotheses, as well as giving information about the latest knowledge on diagnostic investigations, pharmacological, integrative, physical, cognitive-behavioral and psychological curative approaches