Wirksamkeit von schulbasierten Interventionen zur Prävention und/oder Reduktion psychosozialer Probleme bei Kindern und Jugendlichen: Ein Review von Reviews

OBJECTIVE: To summarize the current evidence on the effectiveness of school-based interventions for the maintenance of mental health and the prevention of psychosocial problems among pupils. METHODS: A systematic literature search of reviews published between 2007 and 2015 was carried out. Databases searched included Medline, PsycINFO, Campbell Library, Cochrane Library, NICE, ERIC, and Web of Science. Study selection, data extraction, and quality assessment (using AMSTAR criteria) were performed by 2 independent reviewers. RESULTS: 6 reviews covering 331 primary studies were included in this review of reviews. Findings of three reviews with a focus on the maintenance and/or promotion of mental health and general well-being suggested that interventions aimed at changes in the social and the school environment were more effective than those that only targeted individual behavior change among pupils. Interventions for the reduction of mobbing/bullying were most effective if they comprised organizational changes at schools, such as playground and schoolyard supervision, and disciplinary measures. One review suggested strong evidence for the effectiveness of classroom management to reduce violent behavior among pupils. CONCLUSIONS: Participation in interventions promoting changes in the school environment, in addition to individual behavior change, appears to be associated with improved mental health among pupils and reductions in mobbing/bullying and violent behavior at schools.ZIEL DER STUDIE: Zusammenfassung der aktuellen Evidenz zur Wirksamkeit von schulbasierten Interventionen zur Aufrechterhaltung von psychischer Gesundheit und zur Prävention psychosozialer Probleme. METHODIK: Eine systematische Literaturrecherche zu zwischen 2007 und 2015 publizierten Übersichtsarbeiten wurde in den Datenbanken Medline, PsycINFO, Campbell Library, Cochrane Library, NICE, ERIC und Web of Science durchgeführt. Die Studienauswahl, Datenextraktion und Qualitätsbewertung (nach AMSTAR-Kriterien) erfolgte durch 2 unabhängige Reviewerinnen. ERGEBNISSE: 6 Übersichtsarbeiten zu insgesamt 331 Primärstudien wurden in dieses Review von Reviews eingeschlossen. Bei Interventionen zur Förderung der psychischen Gesundheit bzw. des allgemeinen Wohlbefindens erzielten diejenigen, die die soziale Umgebung und Schulumwelt einbezogen, eine größere Wirkung als Interventionen, die nur auf Änderungen im individuellen Verhalten abzielten. Bei Interventionen zur Reduktion von Mobbing/Bullying erwiesen sich organisationale Änderungen, wie die Einführung einer Pausenaufsicht oder Disziplinarmaßnahmen, als wirksam. Zur Reduktion von Gewalt in Schulen zeigte eine Übersichtsarbeit starke Evidenz für die Wirksamkeit von Klassenraummanagement. SCHLUSSFOLGERUNG: Interventionen, die über das Individualverhalten hinaus auch Aspekte der Schulumwelt adressieren, scheinen zur Förderung von psychischer Gesundheit bei Schülern/-innen beizutragen und Mobbing/Bullying sowie Gewalt an Schulen zu reduzieren

Ca 2+ and innate immune pathways are activated and differentially expressed in childhood asthma phenotypes

Background Asthma is the most common chronic disease in children. Underlying immunologic mechanisms—in particular of different phenotypes—are still just partly understood. The objective of the study was the identification of distinct cellular pathways in allergic asthmatics (AA) and nonallergic asthmatics (NA) vs healthy controls (HC). Methods Peripheral blood mononuclear cells (PBMCs) of steroid‐naïve children (n(AA/NA/HC) = 35/13/34)) from the CLARA study (n = 275) were stimulated (anti‐CD3/CD28, LpA) or kept unstimulated. Gene expression was investigated by transcriptomics and quantitative RT‐PCR. Differentially regulated pathways between phenotypes were assessed after adjustment for sex and age (KEGG pathways). Networks based on correlations of gene expression were built using force‐directed graph drawing. Results Allergic asthmatics vs NA and asthmatics overall vs HC showed significantly different expression of Ca2+ and innate immunity‐associated pathways. PCR analysis confirmed significantly increased Ca2+‐associated gene regulation (ORMDL3 and ATP2A3) in asthmatics vs HC, most prominent in AA. Innate immunity receptors (LY75, TLR7), relevant for virus infection, were also upregulated in AA and NA compared to HC. AA and NA could be differentiated by increased ATP2A3 and FPR2 in AA, decreased CLEC4E in AA, and increased IFIH1 expression in NA following anti‐CD3/28 stimulation vs unstimulated (fold change). Conclusions Ca2+ regulation and innate immunity response pattern to viruses were activated in PBMCs of asthmatics. Asthma phenotypes were differentially characterized by distinct regulation of ATP2A3 and expression of innate immune receptors (FPR2, CLEC4E, IFIH1). These genes may present promising targets for future in‐depth investigation with the long‐term goal of more phenotype‐specific therapeutic interventions in asthmatics