Impact of a family-oriented rehabilitation programme on behavioural and emotional problems in healthy siblings of chronically ill children

Objective: To evaluate the impact of a family-oriented inpatient rehabilitation programme on behavioural and emotional problems in healthy siblings of chronically ill children and to assess the association between these problems and quality of life. Methods: A total of 259 healthy children (4–16 years,M = 8.6 years, SD = 3.3) with a chronically ill sibling were enrolled in the study. Parents filled in the Strengths and Difficulties Questionnaire, while the children answered a self-report quality of life instrument (LQ-KID) at the time of admission and discharge from the clinic and at a 6-month follow-up. Comparisons were performed with a matched control group from the German general population (n = 777). Results: Significant behavioural or emotional symptoms were found in 30.5% of the healthy siblings, the relative risk of having elevated scores being 2.2 compared with the control group. Symptoms were inversely correlated with quality of life (r = -0.42). During the inpatient rehabilitation, symptoms decreased significantly to a normal level. Similarly, quality of life significantly improved, except in the dimension family relations. Conclusions: Family-oriented inpatient rehabilitation is a promising approach to improve the mental health of children with a chronically ill sibling

Individual trajectories of asthma, obesity and ADHD during the transition from childhood and adolescence to young adulthood

The German Health Interview and Examination Survey for Children and Adolescents (KiGGS) provides comprehensive and reliable data on the health situation of the upcoming generation. The KiGGS cohort accompanies participants from the KiGGS baseline study (2003–2006) into adulthood. Until now, two follow-up surveys of the cohort have been implemented with KiGGS Wave 1 (2009–2012) and KiGGS Wave 2 (2014–2017). In KiGGS Wave 2, the cohort was supplemented by the in-depth study ‘Family and care-specific factors influencing the development, trajectories and effects of mental disorders (especially ADHD), obesity and allergic diseases (especially asthma)’. One aim of the study was to identify individual trajectories of these health disorders. For this purpose, probabilities for typical transitions from the KiGGS baseline study to KiGGS Wave 2 were calculated. An important result is that many participants who had asthma, obesity or ADHD at KiGGS baseline still had the disease more than ten years later: Over a third still had asthma (35%) or ADHD (37%), and almost half were still affected by obesity (47%). The results point to the need for early preventive measures to stop these potentially chronic diseases from developing in childhood and adolescence. ASTHMA · OBESITY · ADHD · TRANSITION · YOUNG ADULTHOOD · KIGG

Gender and Age Differences in ADHD Symptoms and Co‑occurring Depression and Anxiety Symptoms Among Children and Adolescents in the BELLA Study

Attention-deficit/hyperactivity disorder (ADHD) is one of the most diagnosed neurodevelopmental disorders of childhood. Current studies addressing gender and age differences in ADHD are lacking. The present study aims to fill this research gap by dimensionally evaluating gender and age differences in ADHD symptoms, as measured by a DSM-5-based parent rating scale, in children and adolescents who participated in the two-year follow-up of the community-based BELLA study (n = 1326). Associations between ADHD symptoms and depression symptoms and anxiety symptoms were also examined. Multiple linear regressions revealed significant associations between gender and all ADHD symptoms. Age was significantly associated with hyperactive/impulsive symptoms. Additional multiple linear regressions demonstrated significant positive associations between depression and anxiety symptoms and ADHD symptoms. Further, female gender was found to be posi- tively associated with both depression and anxiety symptoms. These findings may suggest a need for more gender-specific approaches to ADHD diagnosis and treatment, as well as more research into the intersections of ADHD and depression and anxiety symptoms in children and adolescents.Peer Reviewe

Die KiGGS-Studie

Von 2003 bis 2006 wurde die KiGGS-Basiserhebung (Baseline) in insgesamt 167 Städten und Gemeinden in Deutschland mit einer geclusterten Zufallsstichprobe von 17.641 Kindern und Jugendlichen im Alter von 0 bis 17 Jahren und ihren Eltern durchgeführt. Dabei wurden die Kinder und Jugendlichen medizinisch-physikalisch untersucht und getestet sowie die Eltern, ab elf Jahren auch die Kinder und Jugendlichen selbst, zu körperlichen, psychischen und sozialen Aspekten ihrer Gesundheit befragt. Im Rahmen des bundesweiten Gesundheitsmonitorings am Robert Koch-Institut (RKI) wird die Studie als prospektive Kohortenstudie mit einem Abstand von etwa fünf Jahren zwischen zwei Messzeitpunkten weitergeführt, wobei die Stichprobe durch die Einbeziehung jüngerer Jahrgänge zu jedem Messzeitpunkt querschnittlich ergänzt wird. Die Erhebung in der Kernstudie basiert auf einem Eckwertekonzept zu wesentlichen Indikatoren der körperlichen, psychischen und sozialen Gesundheit, das durch vertiefende Erhebungen beziehungsweise Untersuchungen an Teilstichproben im Rahmen von Kooperationen mit externen wissenschaftlichen Einrichtungen modular ergänzt wird. Derzeit befindet sich die erste Wiederholungsbefragung (KiGGS Welle 1) als telefonischer Befragungssurvey noch bis Juni 2012 im Feld. Die Feldphase der zweiten Folgeerhebung (KiGGS Welle 2), die wieder ein Untersuchungs- und Befragungssurvey sein wird, beginnt noch 2013. Mit den bundesweit repräsentativen Daten lassen sich wichtige gesundheitspolitische Fragestellungen beantworten, sowohl mit Blick auf gesundheitliche Trends als auch mit Blick auf längsschnittliche Gesundheitsverläufe. Wichtige Aussagen werden unter anderem in Bezug auf Trends in der Prävalenz von Übergewicht und Adipositas, der Inzidenz von atopischen Erkrankungen oder der Persistenz beziehungsweise Remission von psychischen Auffälligkeiten und Störungen erwartet.From 2003 to 2006 the KiGGS Baseline Study was conducted, including a clustered random sample of 167 sample points and 17,641 children and adolescents from 0 to 17 years, as well as their parents in 167 sample points. The children and adolescents were medically and physically examined, and their parents answered questions about physical, psychological and social aspects of their children’s health, as did, from 11 years on, the children and adolescents themselves. Within the framework of the nationwide health monitoring at the Robert Koch Institute, the KiGGS study is being continued as a prospective cohort study with an interval of approximately 5 years between follow-ups. The study sample will be cross-sectionally refilled with younger age groups at each time of measurement. The assessment of the KiGGS core study follows a core indicator concept, which is modularly complemented by external scientific cooperation partners. The field work of the first wave (KiGGS Wave 1), a telephone survey, will continue until June 2012. The second follow-up (KiGGS Wave 2) will again combine examinations and interviews, starting in 2013. On the basis of the nationally representative KiGGS data, important questions about health policy can be answered, such as trends and trajectories of health. Important results are expected, among others concerning trends in overweight and obesity, the incidence of atopic diseases, and the persistency or remission of psychopathological symptoms and disorders

Veränderungen der psychischen Gesundheit in der Kinder- und Jugendbevölkerung in Deutschland während der COVID-19- Pandemie – Ergebnisse eines Rapid Reviews

Hintergrund: Dieser Rapid Review untersucht Veränderungen der psychischen Gesundheit von Kindern und Jugendlichen in der Allgemeinbevölkerung in Deutschland während der COVID-19-Pandemie. Methode: Grundlage sind 39 Publikationen, die mittels systematischer Literaturrecherche (Stand 19.11.2021) und Handrecherche identifiziert wurden. Die Datengrundlagen der eingeschlossenen Publikationen wurden bezüglich ihrer Repräsentativität für die Allgemeinbevölkerung systematisiert, die verwendeten Indikatoren hinsichtlich der abgebildeten Konstrukte und ihrer Verlässlichkeit kategorisiert. Ergebnisse: Die große Mehrzahl der Studien bezog sich auf den Pandemiebeginn bis zum Sommerplateau 2020. Aus repräsentativen Studien wurde überwiegend ein hohes Ausmaß an pandemiebezogenen Belastungen, Zunahmen psychischer Auffälligkeiten und Beeinträchtigungen der Lebensqualität berichtet. Nichtrepräsentative Studien zeigten gemischte Ergebnisse. Vulnerable Gruppen ließen sich nur eingeschränkt identifizieren. Routine- und versorgungsbezogene Daten wiesen Rückgänge der ambulanten und stationären Inanspruchnahme während der Pandemiewellen mit Nachholeffekten aus. Kinder und Jugendliche erweisen sich in der Pandemie als vulnerabler im Vergleich zu Erwachsenen. Ihre Belastung variierte jedoch mit den Pandemiewellen und den assoziierten Eindämmungsmaßnahmen. Schlussfolgerungen: Ein zukünftiges vorausschauendes Krisen- und Pandemiemanagement erfordert eine engmaschige und kontinuierliche Surveillance der psychischen Kindergesundheit sowie eine bessere Identifikation von Risikogruppen

Esophageal sphincter device for gastroesophageal reflux disease

BACKGROUND Patients with gastroesophageal reflux disease who have a partial response to proton-pump inhibitors often seek alternative therapy. We evaluated the safety and effectiveness of a new magnetic device to augment the lower esophageal sphincter. METHODS We prospectively assessed 100 patients with gastroesophageal reflux disease before and after sphincter augmentation. The study did not include a concurrent control group. The primary outcome measure was normalization of esophageal acid exposure or a 50% or greater reduction in exposure at 1 year. Secondary outcomes were 50% or greater improvement in quality of life related to gastroesophageal reflux disease and a 50% or greater reduction in the use of proton-pump inhibitors at 1 year. For each outcome, the prespecified definition of successful treatment was achievement of the outcome in at least 60% of the patients. The 3-year results of a 5-year study are reported. RESULTS The primary outcome was achieved in 64% of patients (95% confidence interval [CI], 54 to 73). For the secondary outcomes, a reduction of 50% or more in the use of proton-pump inhibitors occurred in 93% of patients, and there was improvement of 50% or more in quality-of-life scores in 92%, as compared with scores for patients assessed at baseline while they were not taking proton-pump inhibitors. The most frequent adverse event was dysphagia (in 68% of patients postoperatively, in 11% at 1 year, and in 4% at 3 years). Serious adverse events occurred in six patients, and in six patients the device was removed. CONCLUSIONS In this single-group evaluation of 100 patients before and after sphincter augmentation with a magnetic device, exposure to esophageal acid decreased, reflux symptoms improved, and use of proton-pump inhibitors decreased. Follow-up studies are needed to assess long-term safety. (Funded by Torax Medical; ClinicalTrials.gov number, NCT00776997.

RANK-Dependent Autosomal Recessive Osteopetrosis: Characterization of Five New Cases With Novel Mutations

Autosomal recessive osteopetrosis (ARO) is a genetically heterogeneous disorder attributed to reduced bone resorption by osteoclasts. Most human AROs are classified as osteoclast rich, but recently two subsets of osteoclast-poor ARO have been recognized as caused by defects in either TNFSF11 or TNFRSF11A genes, coding the RANKL and RANK proteins, respectively. The RANKL/RANK axis drives osteoclast differentiation and also plays a role in the immune system. In fact, we have recently reported that mutations in the TNFRSF11A gene lead to osteoclast-poor osteopetrosis associated with hypogammaglobulinemia. Here we present the characterization of five additional unpublished patients from four unrelated families in which we found five novel mutations in the TNFRSF11A gene, including two missense and two nonsense mutations and a single-nucleotide insertion. Immunological investigation in three of them showed that the previously described defect in the B cell compartment was present only in some patients and that its severity seemed to increase with age and the progression of the disease. HSCT performed in all five patients almost completely cured the disease even when carried out in late infancy. Hypercalcemia was the most important posttransplant complication. Overall, our results further underline the heterogeneity of human ARO also deriving from the interplay between bone and the immune system, and highlight the prognostic and therapeutic implications of the molecular diagnosis. © 2012 American Society for Bone and Mineral Researc

Associations between preschool attendance and developmental impairments in pre-school children in a six-year retrospective survey

BACKGROUND: Many school-aged children suffer physical and mental impairments which can adversely affect their development and result in significant morbidity. A high proportion of children in western countries attend pre-school, and it is likely that the preschool environment influences the prevalence and severity of these impairments. Currently there is insufficient data available on the prevalence of these impairments and their causal associations. The influence that location of a pre-school and the duration of preschool attendance have on the prevalence of these impairments is not known. METHODS: In a retrospective survey spanning six years (1997–2002) we reviewed the records of 6,230 preschool children who had undergone routine school entry assessments. These children had been assessed utilising a modified manual of the "Bavarian Model" for school entry examinations. This model outlines specific criteria for impairments of motor, cognitive, behavioural and psychosocial functioning. Prevalence rates for physical and behavioural impairments were based on the results of these assessments. The relationship between the prevalence of impairments and the duration of preschool attendance and the location of the preschool attended was estimated utilizing logistic regression models. RESULTS: We found that 20.7% of children met the criteria for at least one type of impairment. Highest prevalence rates (11.5%) were seen for speech impairments and lowest (3.5%) for arithmetic impairments. Boys were disproportionately over represented, with 25.5% meeting the criteria for impairment, compared to 13.0% for girls. Children who had attended preschool for less than one year demonstrated higher rates of impairment (up to 19.1% for difficulties with memory, concentration or perseverance) compared to those who had attended for a longer duration (up to 11.6% for difficulties with pronouncation). Children attending preschool in an urban location had slightly elevated rates of impairment (up to 12.7%), compared to their rural counterparts (up to 11.1%). CONCLUSION: Our results demonstrate that there are high prevalence rates for physical and mental impairments among preschool children. Furthermore, children without preschool experience are a risk group for struggling with educational successes. The associations between the duration of preschool attendance and location of preschool attended and rates of impairment need replication and further exploration. Larger prospective studies are needed to examine if these relationships are causal and may therefore lend themselves to specific intervention strategies

Is Acceleration Used for Ocular Pursuit and Spatial Estimation during Prediction Motion?

Here we examined ocular pursuit and spatial estimation in a linear prediction motion task that emphasized extrapolation of occluded accelerative object motion. Results from the ocular response up to occlusion showed that there was evidence in the eye position, velocity and acceleration data that participants were attempting to pursue the moving object in accord with the veridical motion properties. They then attempted to maintain ocular pursuit of the randomly-ordered accelerative object motion during occlusion but this was not ideal, and resulted in undershoot of eye position and velocity at the moment of object reappearance. In spatial estimation there was a general bias, with participants less likely to report object reappearance being behind than ahead of the expected position. In addition, participants’ spatial estimation did not take into account the effects of object acceleration. Logistic regression indicated that spatial estimation was best predicted for the majority of participants by the difference between actual object reappearance position and an extrapolation based on pre-occlusion velocity. In combination, and in light of previous work, we interpret these findings as showing that eye movements are scaled in accord with the effects of object acceleration but do not directly specify information for accurate spatial estimation in prediction motion

The challenge of comprehensively mapping children's health in a nation-wide health survey: Design of the German KiGGS-Study

<p>Abstract</p> <p>Background</p> <p>From May 2003 to May 2006, the Robert Koch Institute conducted the German Health Interview and Examination Survey for Children and Adolescents (KiGGS). Aim of this first nationwide interview and examination survey was to collect comprehensive data on the health status of children and adolescents aged 0 to 17 years.</p> <p>Methods/Design</p> <p>Participants were enrolled in two steps: first, 167 study locations (sample points) were chosen; second, subjects were randomly selected from the official registers of local residents. The survey involved questionnaires filled in by parents and parallel questionnaires for children aged 11 years and older, physical examinations and tests, and a computer assisted personal interview performed by study physicians. A wide range of blood and urine testing was carried out at central laboratories. A total of 17 641 children and adolescents were surveyed – 8985 boys and 8656 girls. The proportion of sample neutral drop-outs was 5.3%. The response rate was 66.6%.</p> <p>Discussion</p> <p>The response rate showed little variation between age groups and sexes, but marked variation between resident aliens and Germans, between inhabitants of cities with a population of 100 000 or more and sample points with fewer inhabitants, as well as between the old West German states and the former East German states. By analysing the short non-responder questionnaires it was proven that the collected data give comprehensive and nationally representative evidence on the health status of children and adolescents aged 0 to 17 years.</p