Welche Rolle spielen Kinder in Schulen und Kindertagesstätten bei der Übertragung von SARS-CoV-2? – Eine evidenzbasierte Perspektive

Are children and adolescents relevant disease vectors when it comes to the transmission of SARS-CoV-2? Moreover, do they play a role as relevant disease vectors in a~school or kindergarten setting? These questions could not be sufficiently answered at the beginning of the pandemic. Consequently, schools and childcare facilities were closed to stop the spread of SARS-CoV\hbox-2. Over the past few months, researchers have gained a~more detailed understanding of the overall pandemic situation. The SARS-CoV\hbox-2 infection rate in children below 10~years of age in 2020 has been substantially lower than in adults. In addition, it showed that children had a~milder course of disease.Although a~majority of the analyses performed in schools and childcare facilities revealed that the virus is transmitted in these facilities, these transmissions did not, however, have a~considerable influence on the overall rate of new infections. Despite these findings, German politicians continue to advocate for the closure of childcare facilities, including schools, to fight the pandemic, whereas many specialist societies such as the German Society for Pediatric Infectious Diseases (DGPI) have emphasized that such closures should be the measure of last resort in combating the pandemic. The same message is also conveyed by a~German evidence-based S3~guideline established by an interdisciplinary expert group that had already put forward clear recommendations for high incidences in the general population at the beginning of February 2021, indicating that school closures were only required in exceptional cases.In this article, we would like to outline the situation based on the currently available data, try to predict the future, and discuss the circumstances necessary to realize normal classroom teaching without accepting the risk of an uncontrolled spread of SARS-CoV\hbox-2. ZUSAMMENFASSUNG Sind Kinder und Jugendliche relevante Vektoren für die Übertragung von SARS-CoV-2? Und welche Rolle spielt es, wenn sie eine Schule oder Kindertagesstätte besuchen? Diese Fragen konnten zu Beginn der Pandemie nur unzureichend beantwortet werden. So wurden weltweit Schulen und Kinderbetreuungseinrichtungen geschlossen, um die Verbreitung von SARS-CoV\hbox-2 einzudämmen. Inzwischen ist die Rolle von Kindern im Gesamtgeschehen der Pandemie jedoch klarer. Die Rate von SARS-CoV-2-Infektionen bei Kindern unter 10~Jahren war im Jahr 2020 deutlich niedriger als die bei Erwachsenen. Zudem zeigte sich bei Kindern ein deutlich milderer Verlauf der Erkrankung.Analysen zu Ausbrüchen an Schulen und Kinderbetreuungseinrichtungen kamen mehrheitlich zu dem Ergebnis, dass die Weitergabe des Virus in den Einrichtungen zwar stattfindet, jedoch das Infektionsgeschehen insgesamt nicht maßgeblich beeinflusst. Trotz dieser Erkenntnisse hält die deutsche Politik Schulschließungen weiterhin für einen integralen Baustein der Pandemiebekämpfung, wohingegen viele Fachgesellschaften, wie die Deutsche Gesellschaft für Pädiatrische Infektiologie e. V. (DGPI), betonen, dass es sich um das letzte Mittel in der Bekämpfung der Pandemie handeln sollte. Diese Botschaft hat auch eine evidenzbasierte und auf interdisziplinärem Expertenkonsens aufgebaute S3-Leitlinie, die bereits Anfang Februar 2021 klare Empfehlungen für Zeiten hoher Inzidenzen in der Gesamtbevölkerung ausgesprochen hat, die Schulschließungen nur noch in Ausnahmefällen für notwendig erachten.In diesem Artikel möchten wir die Datenlage mit Stand Juni 2021 zu diesem Thema darlegen, einen Blick in die Zukunft wagen und diskutieren, unter welchen Umständen ein regulärer Präsenzunterricht gelingen kann, ohne das Risiko einer unkontrollierten Ausbreitung von SARS-CoV\hbox-2 in Kauf nehmen zu müssen

Death from Failed Protection? An Evolutionary-Developmental Theory of Sudden Infant Death Syndrome

Sudden infant death syndrome (SIDS) has been mainly described from a risk perspective, with a focus on endogenous, exogenous, and temporal risk factors that can interact to facilitate lethal outcomes. Here we discuss the limitations that this risk-based paradigm may have, using two of the major risk factors for SIDS, prone sleep position and bed-sharing, as examples. Based on a multipronged theoretical model encompassing evolutionary theory, developmental biology, and cultural mismatch theory, we conceptualize the vulnerability to SIDS as an imbalance between current physiologic-regulatory demands and current protective abilities on the part of the infant. From this understanding, SIDS appears as a developmental condition in which competencies relevant to self-protection fail to develop appropriately in the future victims. Since all of the protective resources in question are bound to emerge during normal infant development, we contend that SIDS may reflect an evolutionary mismatch situation—a constellation in which certain modern developmental influences may overextend the child’s adaptive (evolutionary) repertoire. We thus argue that SIDS may be better understood if the focus on risk factors is complemented by a deeper appreciation of the protective resources that human infants acquire during their normal development. We extensively analyze this evolutionary-developmental theory against the body of epidemiological and experimental evidence in SIDS research and thereby also address the as-of-yet unresolved question of why breastfeeding may be protective against SIDS

One-year follow-up of young people with ME/CFS following infectious mononucleosis by Epstein-Barr virus

BackgroundInfectious mononucleosis after primary infection with Epstein-Barr virus (EBV-IM) has been linked to the development of myalgic encephalomyelitis/chronic fatigue-syndrome (ME/CFS) in children, adolescents, and young adults. Here, we present clinical phenotypes and follow-up data from a first German cohort of young people with ME/CFS following EBV-IM.Methods12 adolescents and 13 young adults were diagnosed with IM-triggered ME/CFS at our specialized tertiary outpatient service by clinical criteria requiring post-exertional malaise (PEM) and a history of confirmed EBV primary infection as triggering event. Demographic information, laboratory findings, frequency and severity of symptoms, physical functioning, and health-related quality of life (HRQoL) were assessed and re-evaluated 6 and 12 months later.ResultsYoung adults displayed more severe symptoms as well as worsening of fatigue, physical and mental functioning, and HRQoL throughout the study, compared to adolescents. After one year, 6/12 (54%) adolescents no longer met the diagnostic criteria for ME/CFS while all young adults continued to fulfill the Canadian consensus criteria. Improvement in adolescents was evident in physical functioning, symptom frequency and severity, and HRQoL, while young adults showed little improvement. EBV serology and EBV DNA load did not correlate with distinct clinical features of ME/CFS, and clinical chemistry showed no evidence of inflammation. Remarkably, the median time from symptom onset to ME/CFS diagnosis was 13.8 (IQR: 9.1–34.9) months.ConclusionsME/CFS following EBV-IM is a severely debilitating disease often diagnosed late and with limited responses to conventional medical care, especially in adults. Although adolescents may have a better prognosis, their condition can fluctuate and significantly impact their HRQoL. Our data emphasize that biomarkers and effective therapeutic options are also urgently needed to improve medical care and pave the way to recovery

A participatory parent-focused intervention promoting physical activity in preschools: design of a cluster-randomized trial

<p>Abstract</p> <p>Background</p> <p>With rates of childhood obesity increasing, physical activity (PA) promotion especially in young children has assumed greater importance. Given the limited effectiveness of most interventions to date, new approaches are needed. The General Systems theory suggests that involving parents as intervention targets may be effective in fostering healthier life styles in children. We describe the development of a parent-focused participatory intervention and the procedures used to evaluate its effectiveness in increasing daily PA in preschoolers.</p> <p>Methods/Design</p> <p>Thirty-seven South German preschools were identified for this study and agreed to participate. Using a two-armed, controlled cluster-randomized trial design we test a participatory intervention with parents as the primary target group and potential agents of behavioural change. Specifically, the intervention is designed to engage parents in the development, refinement and selection of project ideas to promote PA and in incorporating these ideas into daily routines within the preschool community, consisting of children, teachers and parents. Our study is embedded within an existing state-sponsored programme providing structured gym lessons to preschool children. Thus, child-based PA outcomes from the study arm with the parent-focused intervention and the state-sponsored programme are compared with those from the study arm with the state-sponsored programme alone. The evaluation entails baseline measurements of study outcomes as well as follow-up measurements at 6 and 12 months. Accelerometry measures PA intensity over a period of six days, with the mean over six days used as the primary outcome measure. Secondary outcomes include childrens' BMI, a sum of averaged skin fold thickness measurements across multiple sites, and PA behaviour. Longitudinal multilevel models are used to assess within-subject change and between-group differences in study outcomes, adjusted for covariates at the preschool and individual levels. Teacher qualitative interviews monitor the intervention implementation process.</p> <p>Discussion</p> <p>Participatory approaches that actively involve parents have the potential to promote PA in ways that might be better tailored to local needs and more sustainable. Our mixed methods approach to assess the intervention efficacy and implementation employing both quantitative and qualitative measures within a cluster-randomized controlled trial may serve as a framework for evaluating public health interventions in preschool settings.</p> <p>Trial Registration</p> <p><b>clinicaltrials.gov No: NCT00987532</b></p

Broken Connections: The Evidence for Neuroglial Failure in ME/CFS

In spite of decades of research, the pathobiology of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) is still poorly understood. Several pathomechanisms have been identified, yet, it remains unclear how they are related and which of them may be upstream or downstream.. In this paper, we present a theoretical strategy that may help clarify the causal chain of pathophysiological events in ME/CFS. We propose to focus on the common final histological pathway of ME/CFS and suggest to ask: Which cellular compartment may explain the pathological processes and clinical manifestations observed in ME/CFS? Any functional unit consistently identified through this search may then be a plausible candidate for further exploration. For this "histological" approach we have compiled a list of 22 undisputed clinical and pathophysiological features of ME/CFS that need to be plausibly and most directly explained by the dysfunctional cellular unit in question. For each feature we have searched the literature for pathophysiological explanations and analyzed if they may point to the same functional cellular unit. Through this search we have identified the CNS neuroglia - microglia and astroglia - as the one functional unit in the human body which may best explain all and any of the clinical and pathological features, dysfunctions and observations described for ME/CFS. While this points to neuroinflammation as the central hub in ME/CFS, it also points to a novel understanding of the neuroimmune basis of ME/CFS. After all, the neuroglial cells are now understood as the functional matrix of the human brain connectome which operates beyond and above specific brain centers, receptor units or neurotransmitter systems and integrates innate immune functions with CNS regulatory functions pertaining to autonomous regulation, cellular metabolism and the stress response

Herbert Renz-Polster's Quick Files

The Quick Files feature was discontinued and it’s files were migrated into this Project on March 11, 2022. The file URL’s will still resolve properly, and the Quick Files logs are available in the Project’s Recent Activity

Praktik kedokteran di negara berkembang/ Edit. : Michael Krawinkel

x, 1037 hal. : ill.; 21 cm

Praktik kedokteran di negara berkembang/ Edit. : Michael Krawinkel

x, 1037 hal. : ill.; 21 cm