Prävalenz und Charakteristika von Kindern und Jugendlichen mit speziellem Versorgungsbedarf im Kinder- und Jugendgesundheitssurvey (KiGGS) in Deutschland

Um zu bevölkerungsrepräsentativen Einschätzungen der Prävalenz und der Charakteristika von Kindern und Jugendlichen mit gesundheitsbedingtem Versorgungsbedarf zu gelangen, sind Screening-Instrumente entwickelt worden. Diese zielen auf eine Erfassung von Konsequenzen körperlicher, seelischer und verhaltensbedingter Störungen ab, unabhängig von den zugrunde liegenden medizinischen Diagnosen. Eines der bestuntersuchten und unter Machbarkeitsaspekten bewährtesten Instrumente, der CSHCN-(Children with Special Health Care Needs)Screener, wurde in den Elternfragebogen des Kinder- und Jugendgesundheitssurveys (KiGGS) in Deutschland integriert. Die gewichtete Gesamtprävalenz von Kindern und Jugendlichen mit speziellem Versorgungsbedarf betrug 16,0% für Jungen und 11,4% für Mädchen. Bei Kindern im Vorschul- und Schulalter lag nach den Befragungsergebnissen ein spezieller Versorgungsbedarf 2- bis 3-mal häufiger vor als bei Kleinkindern. Bis zu einem Alter von 14 Jahren war ein deutlich höherer Versorgungsbedarf bei Jungen als bei Mädchen für alle Altersgruppen ersichtlich. Am deutlichsten ausgeprägt war der Geschlechtsunterschied bei den 3- bis 10-Jährigen. Kinder und Jugendliche mit Migrationshintergrund wiesen einen signifikant niedrigeren Versorgungsbedarf auf als Kinder ohne Migrationshintergrund. Dies traf insbesondere auf die Jungen (8,0% vs. 17,1%) zu. Signifikante Unterschiede im Versorgungsbedarf nach Sozialstatus, Größe des Wohnortes oder Zugehörigkeit des Wohnortes zu den alten oder neuen Ländern wurden nicht beobachtet. Mit Ausnahme eines fehlenden Zusammenhangs zwischen Versorgungsbedarf und sozioökonomischem Status zeigen die hier berichteten Ergebnisse gute Übereinstimmung mit Beobachtungen im US-amerikanischen National Survey of CSHCN.In order to arrive at population-based estimates on the prevalence and characteristics of children and adolescents with specific health care needs (CSHCN), screening instruments focussing on the consequences of physical, mental and behavioral problems rather than on medical diagnoses have been developed. One of the most feasible and widely tested instruments, the CSHCN screener was added to the self-administered questionnaire for parents of children participating in the German Health Interview and Examination Survey for Children and Adolescents (KiGGS). The overall weighted prevalence of CSHCN was 16.0% among boys and 11.4% among girls. Children at kindergarten or school age were more than 2-3 times more likely to screen positive compared to toddlers. Up to 14 years, the sex difference persisted through all age groups and was most pronounced between the ages of 3 and 10 years. Children with a migrant background had significantly lower rates of CSHCN compared to non-migrants. This was particularly true for boys (8.0% vs. 17.1%). CSHCN status was not related to social status, urbanization or residence in former West vs. former East Germany. Except for the lack of association with social status, these results are in good accordance with observations from the US National Survey of CSHCN

Effectiveness and safety of opicapone in Parkinson's disease patients with motor fluctuations: The OPTIPARK open-label study

BACKGROUND: The efficacy and safety of opicapone, a once-daily catechol-O-methyltransferase inhibitor, have been established in two large randomized, placebo-controlled, multinational pivotal trials. Still, clinical evidence from routine practice is needed to complement the data from the pivotal trials. METHODS: OPTIPARK (NCT02847442) was a prospective, open-label, single-arm trial conducted in Germany and the UK under clinical practice conditions. Patients with Parkinson’s disease and motor fluctuations were treated with opicapone 50 mg for 3 (Germany) or 6 (UK) months in addition to their current levodopa and other antiparkinsonian treatments. The primary endpoint was the Clinician’s Global Impression of Change (CGI-C) after 3 months. Secondary assessments included Patient Global Impressions of Change (PGI-C), the Unified Parkinson’s Disease Rating Scale (UPDRS), Parkinson’s Disease Questionnaire (PDQ-8), and the Non-Motor Symptoms Scale (NMSS). Safety assessments included evaluation of treatment-emergent adverse events (TEAEs) and serious adverse events (SAEs). RESULTS: Of the 506 patients enrolled, 495 (97.8%) took at least one dose of opicapone. Of these, 393 (79.4%) patients completed 3 months of treatment. Overall, 71.3 and 76.9% of patients experienced any improvement on CGI-C and PGI-C after 3 months, respectively (full analysis set). At 6 months, for UK subgroup only (n = 95), 85.3% of patients were judged by investigators as improved since commencing treatment. UPDRS scores at 3 months showed statistically significant improvements in activities of daily living during OFF (mean ± SD change from baseline: − 3.0 ± 4.6, p < 0.0001) and motor scores during ON (− 4.6 ± 8.1, p < 0.0001). The mean ± SD improvements of − 3.4 ± 12.8 points for PDQ-8 and -6.8 ± 19.7 points for NMSS were statistically significant versus baseline (both p < 0.0001). Most of TEAEs (94.8% of events) were of mild or moderate intensity. TEAEs considered to be at least possibly related to opicapone were reported for 45.1% of patients, with dyskinesia (11.5%) and dry mouth (6.5%) being the most frequently reported. Serious TEAEs considered at least possibly related to opicapone were reported for 1.4% of patients. CONCLUSIONS: Opicapone 50 mg was effective and generally well-tolerated in PD patients with motor fluctuations treated in clinical practice. TRIAL REGISTRATION: Registered in July 2016 at clinicaltrials.gov (NCT02847442)

Measuring local autonomy: A decision-making approach

In studies on central-local relations it is common to assess local autonomy in a deductive way. The extent of local autonomy is determined by measuring the central legal and financial competence, after which the remaining room for local decision-making is determined. The outcome of this indirect method is that the autonomy of local government tends to be systematically underestimated. As an alternative this paper introduces a decision-making approach in which local decisions are systematically weighed on three dimensions: Agenda setting, freedom in choices, and dependency. Using Dutch data, the authors come to the conclusion that a locally oriented perspective leads to a more accurate and positive judgement of the autonomy of local government. © 2006 Taylor & Francis

Peanut‐induced anaphylaxis in children and adolescents: Data from the European Anaphylaxis Registry

Background Peanut allergy has a rising prevalence in high-income countries, affecting 0.5%-1.4% of children. This study aimed to better understand peanut anaphylaxis in comparison to anaphylaxis to other food triggers in European children and adolescents. Methods Data was sourced from the European Anaphylaxis Registry via an online questionnaire, after in-depth review of food-induced anaphylaxis cases in a tertiary paediatric allergy centre. Results 3514 cases of food anaphylaxis were reported between July 2007 - March 2018, 56% in patients younger than 18 years. Peanut anaphylaxis was recorded in 459 children and adolescents (85% of all peanut anaphylaxis cases). Previous reactions (42% vs. 38%; p = .001), asthma comorbidity (47% vs. 35%; p < .001), relevant cofactors (29% vs. 22%; p = .004) and biphasic reactions (10% vs. 4%; p = .001) were more commonly reported in peanut anaphylaxis. Most cases were labelled as severe anaphylaxis (Ring&Messmer grade III 65% vs. 56% and grade IV 1.1% vs. 0.9%; p = .001). Self-administration of intramuscular adrenaline was low (17% vs. 15%), professional adrenaline administration was higher in non-peanut food anaphylaxis (34% vs. 26%; p = .003). Hospitalization was higher for peanut anaphylaxis (67% vs. 54%; p = .004). Conclusions The European Anaphylaxis Registry data confirmed peanut as one of the major causes of severe, potentially life-threatening allergic reactions in European children, with some characteristic features e.g., presence of asthma comorbidity and increased rate of biphasic reactions. Usage of intramuscular adrenaline as first-line treatment is low and needs to be improved. The Registry, designed as the largest database on anaphylaxis, allows continuous assessment of this condition

An interdisciplinary approach to characterize peanut-allergic patients - first data from the FOOD@ consortium

BACKGROUND: Peanut allergy is a frequent cause of food allergy and potentially life-threatening. Within this interdisciplinary research approach, we aim to unravel the complex mechanisms of peanut allergy. As a first step were applied in an exploratory manner the analysis of peanut allergic versus non-allergic controls. METHODS: Biosamples were studied regarding DNA methylation signatures, gut microbiome, adaptive and innate immune cell populations, soluble signaling molecules and allergen-reactive antibody specificities. We applied a scalable systems medicine computational workflow to the assembled data. RESULTS: We identified combined cellular and soluble biomarker signatures that stratify donors into peanut-allergic and non-allergic with high specificity. DNA methylation profiling revealed various genes of interest and stool microbiota differences in bacteria abundances. CONCLUSION: By extending our findings to a larger set of patients (e.g., children vs. adults), we will establish predictors for food allergy and tolerance and translate these as for example, indicators for interventional studies