Meilen- und Grenzsteine der Entwicklung : Was Kinderärztinnen und Kinderärzte wissen müssen

Zusammenfassung Umfassende Kenntnisse über Meilen- und Grenzsteine der kindlichen Entwicklung sind für Kinderärztinnen und Kinderärzte unerlässlich. Ein Meilenstein definiert den Zeitpunkt, an dem ein bestimmter Entwicklungsschritt zum ersten Mal von einem Kind vollzogen wurde. Von diesem individuellen Meilenstein abzugrenzen ist der Grenzstein: Er kennzeichnet denjenigen Zeitpunkt, an dem fast alle Kinder (z. B. 90 %) einen bestimmten Entwicklungsschritt erreicht haben. Grenzsteine stellen – ebenso wie Meilensteine – keine qualitativen Aspekte der Entwicklung dar; sie beschreiben nicht die individuellen Entwicklungswege und Entwicklungsvarianten der Kinder, sondern definieren ein bestimmtes Alter, in dem die Mehrheit der Kinder ein vorgegebenes Entwicklungsziel erreicht hat. Grenzsteine sind eine Art Frühwarnsystem und geben Hinweise darauf, dass eine weitere diagnostische Abklärung erfolgen sollte. Abstract Knowledge about milestones and red flags in children’s development is essential for pediatricians. A milestone defines the point in time at which a developmental step occurs for the first time in a child. An individual milestone must be distinguished from a cut-off point (red flag), the point at which 90% of all children have reached a developmental step. Milestones and cut-offs do not represent qualitative aspects of children’s development; they do not describe children’s individual developmental trajectories and developmental variations, but define the age at which the majority of children have reached a given developmental goal. Milestones can be considered as cut-off points and provide some indications that further diagnostic work-up should take place

Starting the Debate: Rethinking Well-Child Care in Europe

Preventive care of children and adolescents is a cornerstone of pediatrics and is provided by the healthcare systems of most European countries

Пересмотр системы профилактических мероприятий для детей в Европе: открываем дискуссию

Preventive care of children and adolescents is a cornerstone of pediatrics and is provided by the healthcare systems of most European countries.Краеугольным камнем педиатрии считаются профилактические мероприятия для детей и подростков, обеспечение которых лежит на системах здравоохранения большинства европейских стран

The LifeStories project: Empowering voices and avoiding harm-Ethics protocol of a long-term follow-up study of individuals placed in infant care institutions in Switzerland

Little empirical data exist to guide ethical decisions when conducting research with vulnerable populations. The current study assesses a protocol designed to mitigate risks in a population-based cohort of 246 individuals placed in care institutions as infants in a non-selective 60-year follow-up. In total, 116 (47%) individuals chose to participate, of whom 53 (55%) reported positive effects of participation such as the opportunity to fill some gaps in their life stories, to better deal with their past, and to understand previous family dynamics. Only three individuals (2.5%) explicitly reported negative short-term consequences such as feeling upset as a result of thinking about stressful times, but they nonetheless rated the usefulness of the study as high. For six participants (5%), psychological counseling sessions were initiated as a support measure. Our findings suggest that risk of harm can be managed with a rigorous ethics protocol when conducting research with a vulnerable cohort and therefore enable the voices of survivors to be heard. A step wise approach in which increasing amounts of information were presented at each step, clearly operationalized passive decline, and direct and consistent contact with highly trained staff were considered key to mitigating distress. Keywords: deprivation; ethics; institutionalization; long-term follow-up; vulnerable cohor

Sleep and Health-Related Characteristics among Adolescents during COVID-19: An Update

Two opposing effects on adolescents' health during COVID-19 lockdown have been described: A beneficial one due to longer sleep times during school closures and a detrimental one of psychological distress. This study investigated how sleep and health changed in the course of the pandemic when schools were open again. Overall, 12,238 adolescents in Switzerland participated in three cross-sectional online surveys: In 2017 under regular conditions (control group), during pandemic school closures in 2020 (closure group), and in 2021 still under pandemic conditions, but schools were open again (postclosure group). Sleep behavior and health-related characteristics (health-related quality of life; caffeine, alcohol, and nicotine use) in all three groups and depressive symptoms in the closure and postclosure groups were assessed. The sleep period on school days was longer in the closure group (median 9.00 h, interquartile range 8.25-9.75) and similar in the postclosure (7.92, 7.00-8.50) compared to the control group (7.75, 7.08-8.33). Health-related characteristics were better during school closures and similar to worse in the postclosure compared to the control group. Depressive symptom levels were higher in the postclosure than in the closure group. Therefore, beneficial effects were specific to school closures and adolescents' psychological distress increased over the course of the pandemic

Comparing neuromotor functions in 45- and 65-year-old adults with 18-year-old adolescents

AimThis cross-sectional analysis investigates how neuromotor functions of two independent cohorts of approximately 45- and 65-year-old individuals are different from 18-year-old adolescents using the Zurich Neuromotor Assessment-2 (ZNA-2).MethodsA total of 186 individuals of the Zurich Longitudinal Studies (ZLS) born in the 1950s (mean age 65.1 years, SD = 1.2 year, range of ages 59.0–67.5 years, n = 151, 82 males) and 1970s (mean age 43.6 years, SD = 1.3 year, range of ages 40.8–46.6 years, n = 35, 16 males) were tested with the ZNA-2 on 14 motor tasks combined in 5 motor components: fine motor, pure motor, balance, gross motor, and associated movements. Motor performance measures were converted into standard deviation scores (SDSs) using the normative data for 18-year-old individuals as reference.ResultsThe motor performance of the 45-year-old individuals was remarkably similar to that of the 18-year-olds (SDS from −0.22 to 0.25) apart from associated movements (−0.49 SDS). The 65-year-olds showed lower performance than the 18-year-olds in all components of the ZNA-2, with the smallest difference observed for associated movements (−0.67 SDS) and the largest for gross motor skills (−2.29 SDS). Higher body mass index (BMI) was associated with better performance on gross motor skills for 45-year-olds but with worse performance for 65-year-olds. More educational years had positive effects on gross motor skills for both ages.InterpretationWith the exception of associated movements, neuromotor functions as measured with the ZNA-2 are very similar in 45- and 18-year-olds. In contrast, at age 65 years, all neuromotor components show significantly lower function than the norm population at 18 years. Some evidence was found for the last-in-first-out hypothesis: the functions that developed later during adolescence, associated movements and gross motor skills, were the most vulnerable to age-related decline

Teachers' preference for later school start times

Early morning school start times conflict with biologically determined sleep phase preference and thus contribute to common sleep deficits. This conflict is most pronounced in adolescents, and numerous studies have confirmed that later school start times are beneficial for their sleep and health. However, the conflict continues to exist beyond adolescence and, accordingly, also teachers might benefit from later school start times, but this has gained little attention so far. Importantly, teachers' resistance to delay school start time is one of the key barriers for a successful implementation and, therefore, teachers' school start time preferences and influencing factors are important to consider. To this end, we conducted an online survey. Teachers (n = 694, 56.1% female) from 17 high schools in Zurich, Switzerland, participated in the study. They indicated their school start time preference. In addition, four predictor blocks were assessed: sociodemographic, school-/work-related, and sleep characteristics, as well as teachers' perception of students in the first morning lesson. Mixed models were applied to predict the preference. The majority (51%) endorsed later school start times (median preferred delay 25.2 min). School start time, sleep characteristics and perception of students in the first morning lesson were significant predictors for the preference. Thus, teachers with more misaligned sleep and higher awareness for students' issues in the early morning were more likely to report a preference. This suggests psychoeducation about sleep biology throughout life span to be an effective measure to increase teachers' support to delay school start time, especially because also they themselves are likely to benefit from later school start times

Adolescents' preference for later school start times

As the chronotype delays progressively throughout puberty, early morning school start times (SSTs) contradict the sleep biology of adolescents. Various studies have demonstrated beneficial effects of later SSTs on sleep and health; however, adolescents' preferences for SSTs have to date never been investigated in detail. The present online survey study aimed to fill this gap and explored influencing factors. A total of 17 high schools in the Canton of Zurich, Switzerland, circulated the survey among their students. Participants were included if they reported their sex, age, and school (n = 5,308). Students indicated whether they preferred later SSTs. Additionally, five predictor blocks were assessed: sociodemographic, school-related, sleep, leisure-time, and health-related characteristics. We applied multivariate logistic regression models with fixed and random effects to predict the preference. The mean (SD) age of the students was 16.09 (1.76) years (65.1% female). The majority (63.2%) endorsed later SSTs with a preferred delay of 55 min (interquartile range 25-75 min). In the multilevel analysis (n = 2,627), sex, mother tongue, sleep characteristics, mobile device use at bedtime, caffeine consumption, and health-related quality of life were significant predictors for the preference. Hence, the majority of adolescents preferred later SSTs, and especially those with sleep or health-related problems. These characteristics have been consistently shown to improve after delaying SSTs. Thus, also from adolescents' view, later SSTs should be considered to improve the adolescents' health

EEG Sleep Slow-Wave Activity as a Mirror of Cortical Maturation

Deep (slow wave) sleep shows extensive maturational changes from childhood through adolescence, which is reflected in a decrease of sleep depth measured as the activity of electroencephalographic (EEG) slow waves. This decrease in sleep depth is paralleled by massive synaptic remodeling during adolescence as observed in anatomical studies, which supports the notion that adolescence represents a sensitive period for cortical maturation. To assess the relationship between slow-wave activity (SWA) and cortical maturation, we acquired sleep EEG and magnetic resonance imaging data in children and adolescents between 8 and 19 years. We observed a tight relationship between sleep SWA and a variety of indexes of cortical maturation derived from magnetic resonance (MR) images. Specifically, gray matter volumes in regions correlating positively with the activity of slow waves largely overlapped with brain areas exhibiting an age-dependent decrease in gray matter. The positive relationship between SWA and cortical gray matter was present also for power in other frequency ranges (theta, alpha, sigma, and beta) and other vigilance states (theta during rapid eye movement sleep). Our findings indicate a strong relationship between sleep EEG activity and cortical maturation. We propose that in particular, sleep SWA represents a good marker for structural changes in neuronal networks reflecting cortical maturation during adolescenc

Comparing neuromotor functions in 45- and 65-year-old adults with 18-year-old adolescents

Aim: This cross-sectional analysis investigates how neuromotor functions of two independent cohorts of approximately 45- and 65-year-old individuals are different from 18-year-old adolescents using the Zurich Neuromotor Assessment-2 (ZNA-2). Methods: A total of 186 individuals of the Zurich Longitudinal Studies (ZLS) born in the 1950s (mean age 65.1 years, SD = 1.2 year, range of ages 59.0–67.5 years, n = 151, 82 males) and 1970s (mean age 43.6 years, SD = 1.3 year, range of ages 40.8–46.6 years, n = 35, 16 males) were tested with the ZNA-2 on 14 motor tasks combined in 5 motor components: fine motor, pure motor, balance, gross motor, and associated movements. Motor performance measures were converted into standard deviation scores (SDSs) using the normative data for 18-year-old individuals as reference. Results: The motor performance of the 45-year-old individuals was remarkably similar to that of the 18-year-olds (SDS from −0.22 to 0.25) apart from associated movements (−0.49 SDS). The 65-year-olds showed lower performance than the 18-year-olds in all components of the ZNA-2, with the smallest difference observed for associated movements (−0.67 SDS) and the largest for gross motor skills (−2.29 SDS). Higher body mass index (BMI) was associated with better performance on gross motor skills for 45-year-olds but with worse performance for 65-year-olds. More educational years had positive effects on gross motor skills for both ages. Interpretation: With the exception of associated movements, neuromotor functions as measured with the ZNA-2 are very similar in 45- and 18-year-olds. In contrast, at age 65 years, all neuromotor components show significantly lower function than the norm population at 18 years. Some evidence was found for the last-in-first-out hypothesis: the functions that developed later during adolescence, associated movements and gross motor skills, were the most vulnerable to age-related decline