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In the context of national collaborative efforts to increase the prevalence of active learning strategies in undergraduate precalculus and calculus classrooms, we discuss the context, strategy, and processes used at one university to create change within a mathematics department. We highlight the use of a unified active learning approach and the importance of collaborative practices as leverage for departmental change. We conclude with lessons learned from the first year of implementation. [ABSTRACT FROM AUTHOR]

Psychologists and mathematics educators have long viewed flexibility as critical to students' mathematical development. In this paper, we focused on the multidimensional nature of flexibility to better understand how preference, knowledge, and use of effective methods for solving algebra problems are related. In Study 1, we identified research-based aspects of flexibility with algebra and assessed students on them following a two-step equations unit. Results indicated that certain aspects of flexibility develop prior to others and that prior knowledge of algebra plays a significant role in that development. Study 2 confirmed and elaborated on these results using a larger sample size. Implications for theory and for supporting flexibility in classrooms are discussed. [ABSTRACT FROM AUTHOR]

Abstract Background and aims Lipid disorders are often detected very late, particularly in affected young children. We evaluated the feasibility of a screening for LDL-hypercholesterolemia (highLDL) among toddlers and preschoolers. Methods Population-based screening has been offered to all children (2–6 years) living in the State of Lower Saxony, Germany, with capillary blood sampling for detection of elevated LDL-cholesterol (LDL-C ≥ 135 mg/dL). Positive results were confirmed by a second measurement. Follow-up in specialized centers, including disease specific counselling and extended diagnostics, as well as evaluation of psychological distress of the parents, is carried out longitudinally. Results Up to March 2018, 5656 children have participated in the screening program. 5069/5656 children have completed the screening for highLDL (52.0% boys; median age: 4.0 years [Interquartile range, IQR 3.0–5.1]; mother age: 35 years [IQR 31–38]; father's age: 37 years; [IQR 33–42]). HighLDL was identified in 112 children (2.2%; 40.2% boys; LDL-C 157.6 ± 29.5 mg/dL, mean ± SD). In the total cohort, parents stated in 40.9% of the cases a positive family history for hyperlipidemia and in 29.9% a premature cardiovascular event. Children with highLDL had more often both risk factors in their family history; however, in 37% of them none of these factors were reported. Conclusions The first results of the screening program showed its feasibility and revealed high prevalence of highLDL in the general population. Furthermore, a large proportion of families of affected children were not aware about their lipid disorders. Graphical abstract Image 1 Highlights • Combined early screening for hypercholesterolemia and type 1 diabetes is feasible. • Fr1dolin offers capillary blood sampling to all children aged 2–6 years. • Results show a 5-fold higher prevalence for LDL-hypercholesterolemia than expected in the general population. • Fr1dolin provides a comprehensive counselling and follow-up plan for affected families. [ABSTRACT FROM AUTHOR]

The article focuses on International Society for Pediatric and Adolescent Diabetes (ISPAD) guidelines on diabetes education in children and adolescents. It mentions effective educational interventions which include involving the continuing responsibility of parents and other carers throughout adolescence; making use of cognitive behavioral techniques most often related to problem solving; and utilizing new technologies in diabetes care as one of the vehicles for educational motivation.

Laccase production and pellet formation of transformants of Coprinopsis cinerea strain FA2222 of C. cinerea laccase gene lcc1 subcloned behind the gpdII-promoter from Agaricus bisporus were compared with a control transformant carrying no extra laccase gene. At the optimum growth temperature of 37 °C, maximal laccase yields of 2.9 U/ml were obtained by the best lcc1 transformant pYSK7-26 in liquid shake flask cultures. Reduction in temperature to 25 °C increased laccase yields up to 9.2 U/ml. The control transformant had no laccase activities at 37 °C but native activity at 25 °C (3.5 U/ml). Changing the temperature had severe effects on the morphology of the mycelial pellets formed during cultivation, but links of distinct pellet morphologies to native or recombinant laccase production could not be established. Automated image analysis was used to characterise pellet formation and morphological parameters (pellet area, diameter, convexity and mycelial structure). Cross sections of selected pellets showed that they differentiated in an outer rind and an inner medulla of loosened hyphae. Pellets at 25 °C had a small and dense outer zone and adopted with time a smooth surface. Pellets at 37 °C had a broader outer zone and a fringy surface due to generation of more and larger protuberances in the rind that when released can serve for production of further pellets. [ABSTRACT FROM AUTHOR]

Objective: The reason for center differences in metabolic control of childhood diabetes is still unknown. We sought to determine to what extent the targets, expectations, and goals that diabetes care professionals have for their patients is a determinant of center differences in metabolic outcomes. Research Design and Methods: Children, under the age of 11 with type 1 diabetes and their parents treated at the study centers participated. Clinical, medical, and demographic data were obtained, along with blood sample for centralized assay. Parents and all members of the diabetes care team completed questionnaires on treatment targets for hemoglobin A1c (HbA1c) and recommended frequency of blood glucose monitoring. Results: Totally 1113 (53% male) children (mean age 8.0 ± 2.1 years) from 18 centers in 17 countries, along with parents and 113 health‐care professionals, participated. There were substantial differences in mean HbA1c between centers ranging from 7.3 ± 0.8% (53 mmol/mol ± 8.7) to 8.9 ± 1.1% (74 mmol/mol ± 12.0). Centers with lower mean HbA1c had (1) parents who reported lower targets for their children, (2) health‐care professionals that reported lower targets and more frequent testing, and (3) teams with less disagreement about recommended targets. Multiple regression analysis indicated that teams reporting higher HbA1c targets and more target disagreement had parents reporting higher treatment targets. This seemed to partially account for center differences in Hb1Ac. Conclusions: The diabetes care teams’ cohesiveness and perspectives on treatment targets, expectations, and recommendations have an influence on parental targets, contributing to the differences in pediatric diabetes center outcomes. [ABSTRACT FROM AUTHOR]

Background: Few diabetes‐specific quality of life (QOL) tools are available for young children. Objectives: To design and evaluate, a new age‐specific QOL questionnaire and its associations with treatment regimens and metabolic control. Methods: Clinical, demographic data and centrally analyzed HbA1c were collected on 1133 children <11 years (girls 48%; mean ± SD age 8.0 ± 2.1 years; diabetes duration ≥1 year) from 18 centers (Europe, Japan, North America and Australia). Children completed the 10‐item Smiley Faces QOL questionnaire constructed for the study, and children ≥7 years also completed the KIDSCREEN‐10 Index. Results: In total, 1035 children completed the new Smiley Faces questionnaire which was well understood by 993 (70% ≥4 years and 96% ≥5 years, respectively). Internal consistency and reliability were good (Cronbach's α = .73). Inter‐item correlation ranged r = 0.047 to 0.451 indicating each item measures separate aspects of children's satisfaction construct. Convergent validity assessed by comparison to the HrQOL KIDSCREEN‐10 Index showed moderate correlation coefficient 0.501. Factor analysis revealed 3 factors explaining 51% of the variance. Children reported good QOL with most items positive, mean values between 1 and 2 on a 5‐point scale (lower scores indicating greater QOL). Diabetes satisfaction was unrelated to age, diabetes duration, HbA1c, or severe hypoglycemia. Girls were more satisfied than boys. Children on intensive regimens reported better QOL (P < .02). Main dissatisfaction related to insulin injections and blood sugar testing. Conclusions: The Smiley Faces questionnaire enables QOL assessment in young children and identification of areas of dissatisfaction and other clinically relevant items relating to diabetes management. [ABSTRACT FROM AUTHOR]

Aim: To assess the psychological well-being and social integration of adults with craniopharyngioma diagnosed in childhood.Method: A cross-sectional study of a nationwide cohort of young adults with craniopharyngioma in Germany was performed. A structured questionnaire covered the sociodemographic, clinical data, and subjective effects of the condition on social integration. Psychological well-being was assessed using the Hospital Anxiety and Depression Scale (HADS). Results were compared to young adults with type 1 diabetes mellitus (T1DM).Results: The study included 59 participants (29 females, 30 males; mean age 25y 2mo [SD 5y 10mo]), mean age at first surgery 10y 2mo [SD 3y 7mo]. Compared to the T1DM group, significantly more young people with craniopharyngioma aged 25 to 35 years lived at their parents' homes (craniopharyngioma 43.34%; T1DM 13.7%; χ2 =4.14, p=0.049), and fewer lived in a relationship (craniopharyngioma 8.69%; T1DM 54.7%; χ2 =15.74, p<0.001). The HADS revealed a score for depression above the cut-off in 20.69 per cent of young adults with craniopharyngioma and in 6 per cent of young adults with T1DM (χ2 =13.42, p<0.001).Interpretation: Young adults with craniopharyngioma reported subjective disadvantages in professional and social integration. Further, they presented with reduced well-being and increased depression rates. Better psychosocial support and self-management education might reduce the long-term burden of the disease. [ABSTRACT FROM AUTHOR]

The article discusses the benefits of using worked examples and self-explanation prompts in mathematics and how it relates to the U.S. Common Core State Standards for Mathematics (CCSSM). These benefits include increased algebra learning, require less teacher assistance, and enable the students to focus on important mathematical principles. Also provided is an instruction on how middle school mathematics teachers could create worked-samples and self-explanation problems for their students.

Background: This study analyzed the prevalence of and association between symptoms of eating disorders and depression in female and male emerging adults with early-onset, long-duration type 1 diabetes and investigated how these symptoms are associated with metabolic control. Methods: In a nationwide population-based survey, 211 type 1 diabetes patients aged 18-21 years completed standardized questionnaires, including the SCOFF questionnaire for eating disorder symptoms and the Patient Health Questionnaire (PHQ-9) for symptoms of depression and severity of depressive symptoms (PHQ-9 score). Multiple linear and logistic regression models were used to analyze the association between eating disorder and depressive symptoms and their associations with HbA1c. Results: A total of 30.2% of the women and 9.5% of the men were screening positive for eating disorders. The mean PHQ-9 score (standard deviation) was 5.3 (4.4) among women and 3.9 (3.6) among men. Screening positive for an eating disorder was associated with more severe depressive symptoms among women (βwomen 3.8, p<0.001). However, neither eating disorder symptoms nor severity of depressive symptoms were associated with HbA1c among women, while HbA1c increased with the severity of depressive symptoms among men (βmen 0.14, p=0.006). Conclusions: Because of the high prevalence of eating disorder and depressive symptoms, their interrelationship, and their associations with metabolic control, particularly among men, regular mental health screening is recommended for young adults with type 1 diabetes. [ABSTRACT FROM AUTHOR]

Summary Objective This study sought to evaluate the associations between metabolic control and each DSM-5 (Diagnostic and Statistical Manual, fifth edition) symptom of depression among young women and men with early-onset long-duration type 1 diabetes. Methods The data of 202 18–21-year-old patients with type 1 diabetes from a population-based, nationwide survey (40.1% male) with a mean age of 19.4 (standard deviation 0.9) years, a mean HbA1c level of 8.3% (1.6%) (i.e., 67 [17.5] mmol/mol), and a mean diabetes duration of 15.7 (1.0) years were included. The German version of the Patient Health Questionnaire (PHQ-9) was used to assess depression symptoms. For each PHQ-9 depressive symptom, the mean HbA1c values of screening-positive and screening-negative patients were compared via t -test. The associations between HbA1c levels and depressive symptoms were analyzed using multiple linear regression analyses and stepwise adjustments for individual, socioeconomic and health-related covariates. Results Exactly 43.0% and 33.3% of female and male participants reported at least one depressive symptom, and 5.0% and 2.5% met the DSM-5 criteria for major depressive syndrome. HbA1c levels increased with psychomotor agitation/retardation (women), overeating/poor appetite (men/women), lethargy (men), and sleep difficulty (men). Overeating/poor appetite, lethargy, and total PHQ-9 score (per score increase by one) were associated with increased HbA1c levels of 1.10, 0.96 and 0.09 units (%), respectively. Conclusions The associations between depressive symptoms and HbA1c levels vary by symptom and sex. Differentiating the symptoms of depression and targeted interventions might help to improve metabolic outcomes in young adults with early-onset type 1 diabetes and depression. [ABSTRACT FROM AUTHOR]

Use of continuous subcutaneous insulin infusion (CSII) therapy improves glycemic control, reduces hypoglycemia and increases treatment satisfaction in individuals with diabetes. As a number of patient- and clinician-related factors can hinder the effectiveness and optimal usage of CSII therapy, new approaches are needed to address these obstacles. Ceriello and colleagues recently proposed a model of care that incorporates the collaborative use of structured SMBG into a formal approach to personalized diabetes management within all diabetes populations. We adapted this model for use in CSII-treated patients in order to enable the implementation of a workflow structure that enhances patient-physician communication and supports patients' diabetes self-management skills. We recognize that time constraints and current reimbursement policies pose significant challenges to healthcare providers integrating the Personalised Diabetes Management (PDM) process into clinical practice. We believe, however, that the time invested in modifying practice workflow and learning to apply the various steps of the PDM process will be offset by improved workflow and more effective patient consultations. This article describes how to implement PDM into clinical practice as a systematic, standardized process that can optimize CSII therapy. [ABSTRACT FROM AUTHOR]

The article presents a chapter of the guidelines on pediatric diabetes in the International Society for Pediatric and Adolescent Diabetes (ISPAD) Clinical Practice Consensus Guidelines 2014 Compedium. It highlights the recommendations for content and delivery of structured education for children and adolescents with diabetes. It compares the grading system used in the ISPAD guidelines with that of the American Diabetes Association.

The article discusses how the combination of the strategy of providing worked example problems and self-explanation can influence students' learning positively in both traditional and computer-based classrooms. Particular focus is given to the unique and powerful aspect of using worked examples in the classroom. It also discusses the use of correct and incorrect examples in a classroom setting through a computer program, and in traditional classroom through student homework.

Objective: To evaluate mental health problems and associations between mental health problems and health-related quality of life in adolescents with type 1 diabetes in comparison with the general population. Method: A total of 629 11- to 17-year-olds with early-onset and long-lasting type 1 diabetes and their parents completed comprehensive questionnaires. Mental health was assessed using the parent- and self-report versions of the Strengths and Difficulties Questionnaire (SDQ). The Revised Children's Quality of Life Questionnaire (KINDL-R) was used to measure quality of life. The comparison group (n = 6,813) was a representative sample from the German KiGGS study. Results: The proportion of youths with mental health problems (defined as abnormal SDQ total difficulties score) was, based on self-reports, 4.4% in the patient group and 2.9% in the general population (adjusted OR = 1.61, p = 0.044); and based on proxy reports, 7.9% in the patient group and 7.2% in the general population (OR = 1.05, p = 0.788). Youths with type 1 diabetes and self-reported mental health problems scored worse in the KINDL-R subscales of physical well-being (adjusted average difference β = −16.74, p<0.001) and family (β = −11.09, p = 0.017), and in the KINDL-R total score (β = −8.09, p<0.001), than peers with self-reported mental health problems. The quality of life of diabetic adolescents and proxy-reported mental health problems did not differ from peers with proxy-reported mental health problems adjusted for confounders. Conclusions: Compared with the general population with mental health problems, the quality of life of adolescents with type 1 diabetes who report mental health problems is more severely impaired. This observation calls for early prevention and intervention as part of pediatric diabetes long-term care. [ABSTRACT FROM AUTHOR]

Objective To investigate whether center differences in glycemic control are present in prepubertal children <11 yr with type 1 diabetes mellitus. Research Design and Methods This cross-sectional study involved 18 pediatric centers worldwide. All children, <11 y with a diabetes duration ≥12 months were invited to participate. Case Record Forms included information on clinical characteristics, insulin regimens, diabetic ketoacidosis ( DKA), severe hypoglycemia, language difficulties, and comorbidities. Hemoglobin A1c ( HbA1c) was measured centrally by liquid chromatography ( DCCT aligned, range: 4.4-6.3%; IFFC: 25-45 mmol/mol). Results A total of 1133 children participated (mean age: 8.0 ± 2.1 y; females: 47.5%, mean diabetes duration: 3.8 ± 2.1 y). HbA1c (overall mean: 8.0 ± 1.0%; range: 7.3-8.9%) and severe hypoglycemia frequency (mean 21.7 events per 100 patient-years), but not DKA, differed significantly between centers (p < 0.001 resp. p = 0.179). Language difficulties showed a negative relationship with HbA1c (8.3 ± 1.2% vs. 8.0 ± 1.0%; p = 0.036). Frequency of blood glucose monitoring demonstrated a significant but weak association with HbA1c (r = −0.17; p < 0.0001). Although significant different HbA1c levels were obtained with diverse insulin regimens (range: 7.3-8.5%; p < 0.001), center differences remained after adjusting for insulin regimen (p < 0.001). Differences between insulin regimens were no longer significant after adjusting for center effect (p = 0.199). Conclusions Center differences in metabolic outcomes are present in children <11 yr, irrespective of diabetes duration, age, or gender. The incidence of severe hypoglycemia is lower than in adolescents despite achieving better glycemic control. Insulin regimens show a significant relationship with HbA1c but do not explain center differences. Each center's effectiveness in using specific treatment strategies remains the key factor for outcome. [ABSTRACT FROM AUTHOR]

Abstract: In a series of two in vivo experiments, we examine whether correct and incorrect examples with prompts for self-explanation can be effective for improving students’ conceptual understanding and procedural skill in Algebra when combined with guided practice. In Experiment 1, students working with the Algebra I Cognitive Tutor were randomly assigned to complete their unit on solving two-step linear equations with the traditional Tutor program (control) or one of three versions which incorporated examples; results indicate that explaining worked examples during guided practice leads to improved conceptual understanding compared with guided practice alone. In Experiment 2, a more comprehensive battery of conceptual and procedural tests was used to determine which type of examples is most beneficial for improving different facets of student learning. Results suggest that incorrect examples, either alone or in combination with correct examples, may be especially beneficial for fostering conceptual understanding. [Copyright &y& Elsevier]

Education is the keystone of diabetes care, and structured self-management education is the key to a successful outcome. Existing guidelines provide comprehensive guidance on the various aspects of education and offer general and organizational principles of education, detailed curricula at different ages and stages of diabetes, and recommendations on models, methods, and tools to attain educative objectives. The International Society for Pediatric and Adolescent Diabetes guidelines give the most elaborate and detailed descriptions and recommendations on the practice of education, which other national guidelines address on specific aspects of education and care. The aim of the work package on education developed by Better Control in Paediatric and Adolescent Diabetes in the European Union: Working to Create Centers of Reference ( SWEET) project was not to generate new guidelines but to evaluate how the existing guidelines were implemented in some pediatric diabetes reference centers. The SWEET members have completed a questionnaire that elaborates on the many aspects of delivery of education. This survey highlights a profound diversity of practices across centers in Europe, in terms of organization as well as the practices and the content of initial and continuing education. A toolbox is being developed within SWEET to facilitate exchanges on all aspects of education and to establish a process of validation of materials, tools, written structured age-adjusted programs, and evaluation procedures for the education of children and adolescents with diabetes. [ABSTRACT FROM AUTHOR]

Introduction ISPAD guidelines recommend age appropriate diabetes education concepts for young patients and their families as well as tools for nutritional management, psychosocial assessment, and psychological advice but their implementation in Europe is presently unknown. Methods On the basis of a structured survey among the European SWEET members information on established tools and programs in national languages were analyzed using an extensive literature and desk search. These were differentiated according to five age-groups and five target groups (young people with diabetes, parents, and other close relations, carers in school and nursery, and healthcare professionals). Results Responses and original tools were received from 11 SWEET countries reflecting the European status in 2011. More or less structured information for parents, close relations, and carers in school or nursery are available in all 11 participating countries. However, only two countries followed the recommendations of having published a structured, curriculum lead, and evaluated program for different age-groups and carers. One of these was evaluated nationwide and funded by the respective National Health Care System after accreditation. In addition a huge variety of creative tools, e.g., booklets, leaflets, games, videos, and material for educating children of different age-groups and their parents are available - but most of them are not linked to a structured education program. Conclusions Harmonizing and integrating these materials into quality assured structured holistic national education programs will be an important future task for the ongoing SWEET project. A comprehensive European diabetes educational toolbox is aimed to be published and continuously updated on the SWEET website. [ABSTRACT FROM AUTHOR]

Education is the keystone of diabetes care, and structured self-management education is the key to a successful outcome. Existing guidelines provide comprehensive guidance on the various aspects of education and offer general and organizational principles of education, detailed curricula at different ages and stages of diabetes, and recommendations on models, methods, and tools to attain educative objectives. The International Society for Pediatric and Adolescent Diabetes guidelines give the most elaborate and detailed descriptions and recommendations on the practice of education, which other national guidelines address on specific aspects of education and care. The aim of the work package on education developed by Better Control in Paediatric and Adolescent Diabetes in the European Union: Working to Create Centers of Reference ( SWEET) project was not to generate new guidelines but to evaluate how the existing guidelines were implemented in some pediatric diabetes reference centers. The SWEET members have completed a questionnaire that elaborates on the many aspects of delivery of education. This survey highlights a profound diversity of practices across centers in Europe, in terms of organization as well as the practices and the content of initial and continuing education. A toolbox is being developed within SWEET to facilitate exchanges on all aspects of education and to establish a process of validation of materials, tools, written structured age-adjusted programs, and evaluation procedures for the education of children and adolescents with diabetes. [ABSTRACT FROM AUTHOR]

The article presents advice by the authors related to the need for diabetic people to be given adequate care in schools. According to the authors, children as well as young people who have diabetes should be given proper guidance and they should be allowed to have education and the right to participate in all kinds of activities. They add that the patients should not suffer discrimination because of their disease.

There is a reluctance within humanist chaplaincy to critically reflect on power dynamics during conversations. This reluctance stems from the idea that every person is capable of finding meaning in equal contacts and that chaplains do not have aims or direct the conversation. A study was conducted to gain insight into power dynamics in conversations between chaplains and patients, and how these power dynamics influence the co-creation of meaning. Power in a conversation is dynamic because of changing positions of power between conversation partners and depends on their initiative and response in a conversation. Based on feminist relational theories, power is conceptualized as both dominating and transformative, and within transformative power a distinction is made between agential and receptive forms of power. A secondary analysis was performed on qualitative interview data of six humanist chaplains. Dominating strategies taken from the Initiative-Response theory and verbal responses from chaplaincy literature have been used to map the power dynamics between chaplain and client. The results showed that both chaplain and patient use dominating strategies, and that transformative power is necessary to foster the co-creation of meaning. This transformative power can take both agential forms, such as direct leading by questions and focusing, and receptive forms, e.g., listening and affirming. The receptive forms were still the dominant strategies used by chaplains, but the results made clear that agential forms have taken ground within humanist chaplaincy, although some strategies may need to be developed further in training, such as focusing and self-disclosure by the chaplain. [ABSTRACT FROM AUTHOR]

The increased availability of continuous glucose sensors is likely to have a significant impact on pediatric diabetes therapy and education in the future. While a recent meta-analysis of retrospective first-generation Holter-type sensors was not able to show advantages compared to self-monitoring of blood glucose levels, this review focuses on current real-time sensors. Our own experience with 23 children aged 10 (3–15) years with sensor-augmented pump therapy showed high ratings for overall satisfaction and ease of use of the system (5.8 on a 7 point Likert scale). The results of our ongoing international pediatric ONSET trial will show the impact of this technology on learning to live with diabetes by having the biofeedback of glucose excursions from the onset of diabetes. Families previously relying on self-monitoring of blood glucose need to understand the difference between estimating the absolute blood glucose value (point accuracy) and the change in blood glucose (rate accuracy), and how to take into consideration the inherent interstitial time lag. Selection of patients capable and motivated to use continuous sensors accompanied with proper age-appropriate education remain key factors for the long-term success of these new technological advances in diabetes therapy as long as closed loop systems are not available. Copyright © 2008 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

The article focuses on the new developments in treating type 1 diabetes among children. The developments suggest the efforts of diabetes teams implementing new approaches in pediatric diabetes care is successful. It is noted that the treatment of diabetes in infants and toddlers are linked with additional, unique challenges related to the physiological and developmental characteristics of children. It is suggested that the clinical significance of increased insulin antibody formation and changes in lung function parameters should be clarified. It is also recommended that there should be an effort in investigating the long-term benefits of these developments.

Continuous diabetes education for children, adolescents and their parents are widely accepted as an integral part of every type 1 diabetes therapy. Especially in paediatric diabetes care age-appropriate, demand-oriented and individualized practical information and skills training are mandatory for achieving good metabolic control and psychosocial well-being. A paediatric multidisciplinary diabetes team experienced in an intensified insulin therapy with a differential substitution of prandial and basal insulin needs (MDI or CSII) and in child psychology is required to initiate and maintain lifelong diabetes self-management. In Germany an education programme for children aged 6–12 years and another programme for adolescents and young adults have previously been evaluated in multicenter studies. Programmes were considered with respect to applicability, acceptance by target groups and efficacy (knowledge, competence, quality of life and glycaemic control). Furthermore, a programme specifically designed for parents of children affected was evaluated. Contents, modular structures, developmental psychological background and didactic concepts of all above mentioned programmes are presented in detail. Apart from teaching insulin therapy according to current guidelines special emphasis is laid on translating this knowledge into everyday self-management behaviour. In addition, emotional coping with the chronic disease and its psychosocial consequences is supported. In the context of the Disease-Management–Program for Type 1 Diabetes in Germany these programmes for young people were certified and reimbursed nationwide by health insurances. [ABSTRACT FROM AUTHOR]

Anaplastic large-cell lymphoma (ALCL) comprises approximately 25% of all non-Hodgkin lymphomas (NHL) in children and young adults, and up to 15% of high-grade NHL in older patients. Over 50% of these tumours carry the translocation t(2;5)(p23;q35). The result of this translocation is the fusion of the nucleophosmin (NPM) gene to the anaplastic lymphoma kinase (ALK) gene. The resulting hybrid protein contains the ALK catalytic domain that consequently confers transforming potential, which contributes to the pathogenesis of ALCL. To further analyse the transforming activity in an animal model, a cDNA encoding the protein product, NPM–ALK, was inserted into the retrovirus vector pLXSN and transduced into mouse bone marrow progenitors. These cells were subsequently used in a bone marrow transplant with the aim of reconstituting the haematopoietic compartments of lethally irradiated recipients. IL-9 transgenic mice were chosen as the animal model system, because dysregulated expression of the IL-9 gene in transgenic mice results in the sporadic development of spontaneous thymic lymphomas. Moreover, IL-9 is known to be expressed in cases of human ALCL. We used 15 IL-9 transgenic mice and eight corresponding wild-type mice (FVB/N) and transplanted them with NPM/ALK infected bone marrow cells. Eight IL-9 transgenic mice, serving as a control group, received pLXSN (vector only)-infected marrow. Reconstituted mice developed NPM–ALK-positive lymphomas, including lymphoblastic lymphomas of T-cell type (T-LB), mature and immature plasmacytoma (PC), and plasmoblastic/anaplastic diffuse large-B-cell lymphoma after about 19–20 weeks. The combined overexpression of NPM–ALK and IL-9 led to the transformation of murine lymphoid cells with accelerated and enhanced development of T-LB in 46% of the mice, which only very rarely occurs in IL-9 transgenic mice only. Of the 15 animals, five (33%) developed plasmacytic/plasmoblastic neoplasms, of which the... [ABSTRACT FROM AUTHOR]

Describes human anaplastic large cell lymphoma (ALCL) cell line tumorigenic in mice. Morphologic features of ALCL; Rearrangement of T-cell receptor locus; Similarities between xenograft and ALCL tumor.

Aims With the exception of the coronavirus pandemic, video consultations have not been a part of the standard care for children with diabetes in Germany. The "Virtual Diabetes Outpatient Clinic for Children and Adolescents 2.0" (VIDIKI 2.0) study investigated the effect of monthly and supplementary video consultations on standard care over one year. The qualitative substudy investigated the experiences of families with a child newly diagnosed with type 1 diabetes mellitus (T1DM) who received at least four weekly supplementary video consultations. Methods Guideline-based qualitative interviews were conducted with seven families with children under the age of eight and T1DM onset shortly before study entry. The answers were analyzed using a qualitative content analysis approach, particularly inductive category formation. Results Families of patients with T1DM onset have questions, almost daily, concerning various aspects of insulin therapy. The offer of high-frequency video consultations can reduce the number of trips to the diabetes team, facilitate the organization of daily life and increase the sense of security. Conclusion Video consultations as a supplementary offer of health care, especially after diabetes onset, were considered very helpful by the affected families. High-frequency video consultations may provide a tool to overcome existing deficiencies in specialized diabetes care. [ABSTRACT FROM AUTHOR]

Background. Only 2% of all extranodal primary lymphomas affect the female genital tract. Involvement of the fallopian tubes by primary lymphoma is extremely rare.Case. A 34-year-old patient presented with the symptoms of salpingitis. Laparoscopy with salpingectomy was performed. Salpingitis caused by Acinetobacter species was diagnosed and antibiotic treatment was administered. Histologic examination of the fallopian tube revealed primary extranodal marginal zone B-cell lymphoma (MALT-type lymphoma) of the fallopian tube. After 12 months no tumoral recurrence occurred.Conclusion. Although the female genital tract is rich in mucosa and the existence of mucosa-associated lymphoid tissue (MALT) has been demonstrated previously, extranodal marginal zone B-cell lymphoma of the fallopian tube is exceptional. To our knowledge only two cases with extranodal marginal zone B-cell lymphoma of the fallopian tube have been previously reported. Existence of inflammation close to the tumor is interesting to emphasize. [Copyright &y& Elsevier]

Children with Type 1 diabetes (T1D) and their parent-caregivers often experience diabetes distress due to the daily demands of diabetes management. Regular screening for diabetes distress is needed to prevent the deterioration of metabolic control and the development of mental health disorders. The aim of this analysis was to examine the psychometric properties of the German versions of the Problem Areas in Diabetes Scale for Children (PAID-C) and for caregiver burden in Parents (P-PAID-C). Data were collected from 136 children aged 7–12 years (46.7% females) and 304 parents (Mage = 42.9 (SD 6.1) years; 78% mothers) by using linguistically translated questionnaires in a multicenter study. Confirmatory factor analysis and correlational analyses were conducted. Results confirmed the two-factor model for the PAID-C and the four-factor model for the P-PAID-C with a slight modification. Cronbach's αs for children and parents were 0.88 and 0.92, respectively. The PAID-C and P-PAID-C scores had small positive associations with HbA1c (rs =.220 and.139, respectively, all p <.05) and strong inverse association with the KIDSCREEN-10 index (r = −.643 and −.520, respectively, all p <.001). P-PAID-C scores increased with increasing depressive symptoms measured in nine-item Patient Health Questionnaire among parents (rs =.534, p <.001). The scores produced by the German PAID-C and P-PAID-C were reliable and valid in measuring diabetes burdens. These German versions of PAID can be utilized to assess diabetes-specific distress and to design interventions for children and their parents experiencing high levels of diabetes distress. Public Significance Statement: Diabetes distress is associated with poor health outcomes; thus, regular screening is recommended as part of a holistic diabetes care model. This analysis confirms that linguistically translated German versions of the Problem Area in Diabetes Scale for Children and Parents are suitable tools for assessing diabetes-specific distress in both groups. These instruments can be of particular value to health care providers, enabling early detection of diabetes distress and tailoring interventions. [ABSTRACT FROM AUTHOR]

This document provides comprehensive information on glucose monitoring and control testing for individuals with Type 1 or Type 2 diabetes. It discusses the importance of regular glucose measurements for monitoring therapy and assessing long-term risks. The document covers different methods of glucose measurement, including self-measurement of capillary blood glucose concentration (SMBG) and continuous glucose monitoring (CGM). It emphasizes the need for proper training and supervision in using CGM systems and highlights the benefits of CGM for children with Type 1 diabetes. The document also provides recommendations on using SMBG for different diabetes types and therapies. Additionally, it discusses the frequency of blood glucose measurements for different types of diabetes and therapy approaches. The document addresses the importance of self-measurement of capillary blood glucose concentration (SMBG) in patients with type 1 or insulin-dependent type 2 diabetes, even if a continuous glucose monitoring (CGM) system is used. The frequency of measurements varies depending on the type of diabetes and therapy approach. The document also provides information on self-measurement of blood glucose (SMBG) and continuous glucose monitoring (CGM) for individuals with diabetes. It emphasizes the importance of regular glucose measurements for proper diabetes management and discusses the different measurement methods, available systems, and specifications for measurement quality. The document also addresses the costs and refund of expenses for SMBG systems, as well as safety issues and practical implementation of the measurement. It highlights the use of CGM systems and the goals and indications for their use [Extracted from the article]

This document is a summary of an article from the journal Experimental & Clinical Endocrinology & Diabetes titled "Diagnosis, Therapy and Follow-Up of Diabetes Mellitus in Children and Adolescents." The article provides comprehensive information on the diagnosis, therapy, and follow-up of diabetes in this age group. It covers topics such as epidemiology, types of diabetes, risk factors, prevention, and early detection. The article emphasizes the importance of immediate insulin therapy after diagnosis and recommends specialized care for children with diabetes. It also discusses the psychosocial aspects of long-term care, the importance of a multi-professional team, and the treatment of acute and long-term complications. The document provides guidelines for the diagnosis and treatment of various types of diabetes in children and adolescents, including associated autoimmune diseases. It was prepared by the German Diabetes Society with input from experts in the field. [Extracted from the article]

Information about the spring general assembly of the Federation of Veterinarians of Europe (FVE) that was held on May 23-24, 2014 in Great Britain is presented. It discusses the forthcoming animal health legislation, corporate practice and antimicrobial resistance. It featured Torsten Jakobsson, president of the Swedish Veterinary Association, discussing the corporate veterinary practice.

Information about the general assembly of the Federation of Veterinarians of Europe (FVE) that was held in Amsterdam, Netherlands is presented. It featured Ludo Hellebrekers, president of the Royal Dutch Veterinary Society, stating that developments to the legislation on veterinary medicines in the Netherland have strengthened the role of the veterinarian. Meanwhile, FVE deputy executive director Nancy De Briyne presented the results of an online survey on veterinary prescription habits.

The article discusses the highlights of a food chain crisis management meeting held in Brussels, Belgium on May 19 and 20, 2011. Several case studies were examined such as the European Union's (EU) response to the avian flu outbreaks in 2005. Delegates like Michael Scannell, director of the Food and Veterinary Office in DG SANCO, emphasized on the importance of leadership in crisis management while Declan O'Brien of the International Federation of Animal Health Europe called for increased empowerment of the Committee of Veterinary Medicinal Products.

Information about several topics discussed at the general assembly of the Federation of Veterinary Europe (FVE) held in Brussels, Belgium on November 13 and 14, 2009 is presented. The topics being discussed has been the significance of animal welfare. The assembly featured several veterinarians including Laurence Bonados, Linda Keeling and Christopher Buhot.

Information about the World Organisation for Animal Health (OIE) global conference with the theme "Evolving veterinary education for a safer world" held in Paris, France in October 2009 is presented. The primary purpose of the conference was to develop further policies for the enhancement of temporary and continuing veterinary education worldwide. The conference featured 39 speakers including Katinka De Balogh, Brian Evans and Arnon Shimshony.

Information on several topics discussed at the general assemblies of the Union of European Veterinary Practitioners (UEVP) and the Federation of Veterinarians of Europe (FVE) held in Stockholm, Sweden in May 2009 is presented. Topics include antimicrobial resistance, pet insurance, and equine veterinary medicines. The general assemblies featured several veterinary professionals including Henk Vaarkamp, Christina Greko, and Tjeerd Jorna.

Information about topics discussed at the meeting of the Union of European Veterinary Practitioners (UEVP) and the general assembly of the Federation of Veterinarians of Europe (FVE) held in Hannover, Germany. Topics include animal health and welfare, stunning at slaughter, welfare labeling of food, animal welfare training in the Balkans, and veterinary education in Europe. Speakers of the meetings include Marcel Wanner, Walter Winding and Catherine Roy. INSETS: Successful week;FVE and WVA working together.

Information about the meeting of the first European Veterinary Week in Hannover, Germany on November 14, 2008 is presented. The meeting explored international trends and perspectives related to food animal practice. It also discussed issues on bluetongue, the Community Animal Health Strategy of the European Union (EU) and zoonoses.

Objective The COVID-19 pandemic had an impact on everyday life and in general, reduced the health-related quality of life (HRQoL) of adolescents. In this study, we assess the HRQoL of adolescents with type 1 diabetes (T1D) in Germany since the second wave of the COVID-19 pandemic by using self-report and parent-proxy reports, to identify risk factors, to compare to peers and to examine the agreement of HRQoL between parents and their children. Methods A total of 445 adolescents (12-18 years) and 413 parents participated in an anonymous cross- sectional survey conducted at three German diabetes centres from January 2021 to June 2022. Inclusion criteria were diabetes duration ≥1 year and German-speaking. Teen HRQoL was assessed by using self-report and parentproxy report versions of the KIDSCREEN-10 index. Results The majority of adolescents reported average (75.5%) HRQoL. Approximately 11.3% of teens reported high and 13.2% low HRQoL. Teen's female gender, older age, higher diabetes burden and parental depression symptoms contributed to lower self-reported HRQoL among teens. For parent-proxy reports, increasing diabetes burdens, parental depression symptoms, non-migrant status, high education and ketoacidosis contributed to lower scores on teen HRQoL. The mean scores of the KIDSCREEN-10 index for adolescents did not differ from the German norm. In comparison to healthy peers during the first wave of the pandemic, adolescents in the current study reported higher HRQoL. The overall teen-parent agreement was fair although parents reported significantly lower teen HRQoL than adolescents did. Conclusions HRQoL of most adolescents with T1D during the COVID-19 pandemic was average with parents reporting significantly lower scores. Self-reported and parent-proxy-reported HRQoL and the level of agreement due to different perspectives can provide important information for clinical care and intervention planning. [ABSTRACT FROM AUTHOR]

While socioeconomic inequalities in the prevalence and management of type 2 diabetes (T2D) are well established, little is known about whether inequalities exist in the prevalence and the temporal development of T2D comorbidities. Previous research points towards expansion of morbidity in T2D as depicted mainly by a rising trend of T2D comorbidities. Against this background, and using German claims data, this study aims to examine whether socioeconomic status (SES) inequalities exist in the rates and the temporal development of T2D comorbidities. Since previous research indicates varying risk levels for T2D prevalence in the population subgroups: working individuals, nonworking spouses and pensioners, the analyses are stratified by these three population subgroups. The study is done on a large population of statutory insured individuals with T2D in three time-periods between 2005 and 2017. Predicted probabilities of three comorbidity groups and the number of comorbidities were estimated using logistic and ordinal regression analyses among different income, education and occupation groups. Interaction analyses were applied to examine whether potential SES inequalities changed over time. The study showed that neither the cross-sectional existence, nor the temporal development of T2D comorbidities differed significantly among SES groups, ruling out SES inequalities in the prevalence and the temporal development of T2D comorbidities in Germany. In men and women of all examined population subgroups, predicted probabilities for less severe cardiovascular (CVD) comorbidities, other vascular diseases and the number of comorbidities per individual rose significantly over time regardless of SES, but little if any change took place for more severe CVD comorbidities. Another important finding is that the population subgroup of nonworking spouses had markedly higher predicted probabilities for most of the examined outcomes compared to working individuals. The study indicates that the expansion of morbidity in T2D in Germany does not appear to be SES-dependent, and applies equally to different population subgroups. Yet, the study highlights that nonworking spouses are a susceptible population subgroup that needs to be focused upon when planning and implementing T2D management interventions. [ABSTRACT FROM AUTHOR]

The negative impact of psychosocial burden in connection with the treatment of Type 1 diabetes (T1D) indicates the need for regular screening of diabetes distress in adolescents with T1D and their parents. Psychometric properties of the German versions of Problem Areas in Diabetes scale–Teen (PAID-T) and Parent (P-PAID-T) are examined in order to provide a clinical screening tool. Linguistically translated questionnaires were used in a multicenter study with 459 families. Confirmatory factor analysis, validity, and reliability were examined. Teens (42.8% female) had a mean age of 14.7 years. Most parent–caregivers were mothers (74.4%) and were born in Germany (83.1%). Results corroborate the three-factor model for the PAID-T with acceptable model fit, and convergent and discriminant validity was observed. The four-factor model for parents was also supported but had inadequate discriminant validity in this study. Teen and parent scores showed excellent Cronbach's α = 0.91 and 0.93, respectively. The PAID-T and P-PAID-T scores were positively correlated with HbA1c (rs =.343 and.252, respectively, p <.001) and negatively correlated with treatment satisfaction (Diabetes Treatment Satisfaction Questionnaire) and KIDSCREEN-10 index (teens: rs = −.545 and −.575; parents: rs = −.563 and −.489, respectively, all p <.001). The P-PAID-T correlated positively with depressive symptoms measured in Patient Health Questionnaire –9 (rs =.537, p <.001). The German versions of PAID-T and P-PAID-T produced scores that demonstrated good reliability and validity. Like the original English versions, the German versions are useful to detect diabetes-specific distress in families and to tailor interventions for affected teenagers and their parents. Public Significance Statement: Diabetes distress is linked to poor health outcomes; therefore, regular screening is recommended as part of a holistic diabetes care model. This investigation confirms that translated German versions of the PAID for teens and parents are suitable for routine screening of diabetes-specific distress in clinical settings. They can be of particular value to health care providers in the early detection of diabetes distress and tailoring interventions, and to investigators in enhancing communication across cultures and languages. [ABSTRACT FROM AUTHOR]

Objective To evaluate the impact of self-reported chronic-generic and condition-specific quality of life (QoL) on glycemic control among adolescents and emerging adults with long-duration type 1 diabetes (T1D) in a longitudinal design. Methods The database used was a nationwide cohort study of patients with ≥10 years T1D duration at baseline in Germany. The baseline questionnaire survey was conducted in 2009-2010, the follow-up survey in 2012-2013; additional clinical data of routine care procedures were linked. QoL was assessed by the DISABKIDS chronic generic module (DCGM-12) and diabetes module (DM) with treatment and impact scales. Regression analyses were conducted for the outcome hemoglobin A1c (HbA1c) at follow up with baseline DISABKIDS scores as predictors and sociodemographic and health-related covariates. Results At baseline, the included 560 patients had a mean age of 15.9 (SD 2.3) years, a diabetes duration of 13.0 (2.0) years, and an HbA1c of 67 (14.2) mmol/mol. Mean follow-up time was 3.0 (0.6) years. Univariate analyses indicated associations between baseline QoL scores and HbA1c at follow-up (β[DCGM-12] = −0.174 (SE 0.038), β[DM treatment] = −0.100 (0.022), β[DM impact] = −0.177 (0.030), p < .001). The associations remained significant after adjustment for sociodemographic and illness-related factors, but dissolved (p > .60) when additionally adjusting for baseline HbA1c. In patients with poor baseline HbA1c (>75 mmol/mol), significant associations were observed between DCGM-12 and DM impact scores and follow-up HbA1c (β[DCGM-12] = −0.144 (0.062), p = .021; β[DM impact] = −0.139 (0.048), p = .004). Conclusions QoL was inversely associated with HbA1c after 3 years in the course of T1D only in patients poorly controlled at baseline. [ABSTRACT FROM AUTHOR]

Hand hygiene in wound care by health care providers (HCPs) is a key principle in treating hospitalized patients with diabetic foot infections. This study aimed to estimate the extent to which patients with type-2-diabetes (T2D) intend to speak up for HCPs' hand hygiene during inpatient foot treatment, test whether this motivation increases given the hospital would invite patients to speak up, and identify associations with socio-demographics, knowledge of hand hygiene requirements, and diabetes-related factors. A questionnaire-survey was conducted in eight diabetes outpatient centres in Lower Saxony/Germany. Intentions to speak up (without and with institutional encouragement) and knowledge about hand hygiene during foot-care were assessed. Analyses of variance were conducted, partly as repeated measures-models with intention-items as within-subject factor. N = 473 patients participated (response = 77.4%). N = 177 (41%) strongly intended to speak up. Institutional encouragement was associated with an increased rate of strong (54% vs. 41%; p < .001) and higher mean intention (M = 3.9 vs. 3.4 with vs. without encouragement [5-point-scales]; F(1, 434) = 41.5, p < .001). In patients without diabetic foot syndrome, this effect was limited to those with at least medium school education (F(2, 292) = 4.4, p = .013) and knowledge on HCPs' hand hygiene (F(2, 294) = 3.1, p = .047). In conclusion, a majority of T2D-patients in diabetes outpatient centres intend to speak for HCPs' hand hygiene in inpatient foot treatment, and are receptive to institutional encouragement. However, this presupposes at least medium education and knowledge about hand hygiene, emphasizing that patient empowerment begins with knowledge. [ABSTRACT FROM AUTHOR]

Objective: To support families with a chronically ill child, a modular curriculum and new healthcare structures (trainer education, quality management) for a group self-management program (ModuS) were developed. ModuS focuses on common psychosocial aspects of chronic conditions and comprises generic and disease-specific modules. A pilot test was conducted for asthma by comparing ModuS with an established asthma-specific education program (CAE).Methods: Under routine care conditions, 491 children (6-17 years) with asthma and their parents participated in a multi-center prospective study (265 ModuS; 226 CAE). Families' program satisfaction, disease-specific knowledge, health-related quality of life (HRQoL), life satisfaction, and burden of disease were assessed before, directly following and six weeks after participation.Results: The families were highly satisfied with the program. CAE and ModuS were associated with improved disease-specific knowledge, childreńs HRQoL and life satisfaction and decreased the families' burden. This demonstrates comparability of existing care with the modular approach.Conclusion: The ModuS approach offers a structure for effective patient education programs aiming to improve self-management. As it focused on the similarities of chronic conditions, it provides the opportunity to establish education programs for a wide range of chronic childhood diseases.Practice Implications: ModuS facilitates the development of new patient education programs. [ABSTRACT FROM AUTHOR]

Background: This study estimates life expectancy with and without type 2 diabetes for individuals in Lower Saxony, Germany in order to detect a trend in population health. Methods: Morbidity and mortality data derived from German administrative claims data (statutory health insurance, AOK Niedersachsen, N = 2,900,065) were used covering 10 years from 2005 to 2014. Life table analysis was applied for calculating life expectancy, life expectancy free of type 2 diabetes, life expectancy with type 2 diabetes, and the proportion of life expectancy free of diabetes to total life expectancy using the Sullivan method. Results: The total life expectancy increase is stronger in men than in women: At the age of 20, total life expectancy was 55.0 years in 2005 and 56.3 years in 2014 for men, whereas it was 61.7 years in 2005 and 62.5 years in 2014 for women. Decreases in life expectancy without type 2 diabetes were more pronounced in women than in men. Accordingly, life expectancy with type 2 diabetes increased in both women and in men. The proportion of life expectancy without diabetes to total life expectancy decreased, indicating a similar development in both. For example, at the age of 60, the proportion of life expectancy without diabetes to total life expectancy decreased from 0.75 in 2005 to 0.66 in 2014 for men, while it decreased from 0.77 in 2005 to 0.70 in 2014 for women. Conclusions: Against the background of increasing total life expectancy, the time spent in morbidity increased for the case of type 2 diabetes in Lower Saxony, Germany. [ABSTRACT FROM AUTHOR]

Background: Diabetes distress is increasingly considered one of the most important psychosocial issues in the care of people with type 1 diabetes (T1D). We analyse whether diabetes distress and depression screening results of emerging adults are associated with the age at T1D onset. Methods: Data were taken from two cohort studies conducted at the German Diabetes Center, Düsseldorf, Germany. The 18–30-year-old participants had an age at onset either before the age of 5 years (childhood-onset long-term T1D study group, N = 749) or during adulthood (adult-onset short-term T1D study group from the German Diabetes Study (GDS), N = 163). Diabetes distress and depression screening were analysed by means of the 20-item Problem Areas in Diabetes (PAID-20) scale and the nine-item depression module from the Patient Health Questionnaire (PHQ-9). The average causal effect of age at onset was estimated by a doubly robust causal inference method. Results: The PAID-20 total scores were increased in the adult-onset study group [potential outcome mean (POM) 32.1 (95% confidence interval 28.0; 36.1) points] compared to the childhood-onset study group [POM 21.0 (19.6; 22.4) points, difference 11.1 (6.9; 15.3) points, p<0.001] adjusted for age, sex and haemoglobin A1c (HbA1c) levels. Moreover, more participants in the adult-onset group [POM 34.5 (24.9; 44.2) %] than in the childhood-onset group [POM 16.3 (13.3; 19.2) %] screened positive for diabetes distress [adjusted difference 18.3 (8.3; 28.2) %, p<0.001]. The PHQ-9 total score [difference 0.3 (-1.1; 1.7) points, p=0.660] and the proportion of participants with a positive screening result for depression [difference 0.0 (-12.7; 12.8) %, p=0.994] did not differ between the groups in the adjusted analyses. Conclusions: Emerging adults with short-term type 1 diabetes screened positive for diabetes distress more often than adults with type 1 diabetes onset during early childhood when age, sex and HbA1c values were considered confounding factors. Accounting for age at onset or the duration of diabetes may help explain the heterogeneity in the data when psychological factors are examined. [ABSTRACT FROM AUTHOR]

Screening In the general medical setting, an eating disorder should be considered for the following risk factors: Young women with low body weight Female patients who present with weight worries, but are not overweight Women with cycle disorders or amenorrhea Patients who appear malnourished Patients with gastrointestinal symptoms Patients with repeated vomiting For the early detection of eating disorders in a general medical setting, the following two questions should be considered first: "Do you have eating issues?" The treatment of eating disorder patients with type 1 diabetes should therefore be carried out according to the current S3 guideline "Diagnosis and treatment of eating disorders". Therapy of alcohol-related diseases Because of the increased health risks associated with addiction and its negative impact on diabetes treatment, treating addiction is of particular importance for patients with diabetes. Therapy The following measures are available for the treatment of depression: Active watchful waiting, psychotherapy, psychopharmacotherapy, combination treatment, light therapy, waking therapy, electroconvulsive therapy, sports and exercise therapy, occupational therapy or creative therapies supplement these procedures (see info box "Therapy steps for depression"). [Extracted from the article]

Aims. To investigate (1) daily, emotional, and physical caregiving burdens in parents of children with type 1 diabetes, (2) the sociodemographic and clinical predictors of three burdens, and (3) support measures that parents wish to receive. Methods. The study was a multicenter cross-sectional survey conducted in nine German pediatric diabetes centers. A questionnaire assessing three types of burdens and wishes for support was distributed to parents with a child with type 1 diabetes visiting one of the pediatric centers for a routine check-up. Results. Data from 1,107 parents (83% mothers) were analyzed. Parents reported significantly higher emotional burdens compared to daily and physical burdens (p < 0.0001). Mothers felt more burdened than fathers did. Parents of younger children reported higher daily and physical burdens compared to the parents of older children, and similarly, parents of technology users reported higher daily and physical burdens compared to the parents of nontechnology users. However, emotional burdens did not differ in both comparisons. Other demographic factors (i.e., parent's age, migration status, and single-parent family status) predicted high levels of daily or physical burdens, but only HbA1c level and the parent's gender (mother) predicted a high emotional burden. Independent of the level of burden, 78% of parents wanted additional diabetes training. Conclusion. Despite parents reporting high emotional burdens in connection with diabetes care, HbA1c and the gender of the reporting parent were the only risk factors. As the child gets older, parents' daily and physical distress decrease but not the emotional burden. Diabetes training including regularly offered booster sessions as well as low-threshold interventions for mental health issues and practical self-care skills is recommended to provide continuous support for parents. [ABSTRACT FROM AUTHOR]