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This article defines the term twice-exceptional as being gifted (highly able) and having challenges with learning or physical disabilities. The focus is on understanding these children, who are brilliant in one way but at the same time in some situations are at risk. The biggest challenges they face are misunderstanding and misdiagnosis. This article will assist those involved in the life and education of twice-exceptional children to help light the way towards better understanding them, focusing on their strengths and supporting them individually to change their life in an optimal direction. One million of our nation's most promising, innovative thinkers--children who learn differently, not "deficiently"--constitute a neglected national resource.

Background: Nature-based therapeutic approaches have largely centered on the significance of nature, as a unique setting. This article focuses on an additional perspective, that of nature as actively influencing the therapeutic process, providing significant content. Purpose: The main objective of this study was to shed light on how practitioners experience, perceive, and work with nature to serve therapeutic goals. Methodology/Approach: Grounded theory inquiry was implemented. Data included in-depth interviews conducted with 26 nature-based practitioners with different professional backgrounds from five countries and field observations of six nature-based workshops. Findings/Conclusions: Four major categories emerged--(a) A basic belief among practitioners that nature is actively influencing the therapeutic process, providing significant and relevant personal information; (b) the practitioners' relationship with nature and its role in the therapeutic process; (c) the practice of working with nature so nature's input is acknowledged and integrated intentionally; (d) creating the conditions for the clients' engagement with nature as a resource via five themes. Implications: This study expands on common notions of nature-based facilitation, illuminating the possibilities and potential of integrating nature's input as beneficial and relevant to the therapeutic process by working with nature. The operational and practical steps for working with nature are delineated.

Introduction: Digital mental health interventions are on the rise; yet people with intellectual disabilities are not generally seen as their potential users. This study aims to explore the accessibility of two mainstream online mood-management programmes. Methods: Using a qualitative study design, 12 adults with intellectual disabilities were interviewed while accessing moodgym and iFightDepression®. Thematic analysis was used to explore the programs' accessibility according to the technology acceptance model. Results: The programs' ease-of-use was considered in terms of visual appeal, support needs, and essential skills for independent program use. Perceived usefulness concerned participants' understanding of the purpose and expected personal benefits associated with the interventions. Finally, intention to use and motivation to interact with the interventions were key aspects of participants' attitudes toward them. Conclusion: Improving intervention accessibility is a first important step to ensure people with intellectual disabilities can understand the purpose and content of digital mental health interventions.

Regardless of their limited evidence and potential adverse effects, use of complementary and alternative medicine is common in children with autism spectrum disorder. Nevertheless, data on complementary and alternative medicine use in children with autism spectrum disorder in Germany are lacking. Therefore, a questionnaire survey on the use of complementary and alternative medicine was distributed to parents of children with autism spectrum disorder from three academic autism spectrum disorder outpatient clinics in Germany. Of 211 respondents, 46% stated that their child currently used or had ever used some form of complementary and alternative medicine in their life. The complementary and alternative medicine modalities most frequently used were manipulative and body-based methods (e.g. craniosacral therapy). And 18% of caregivers expressed willingness to try complementary and alternative medicine treatments for their child with autism spectrum disorder in the future, with mind-body interventions predominating. Health professionals should be aware of the considerable complementary and alternative medicine use prevalence among children with autism spectrum disorder and offer parents information about its effectiveness and potential side effects.

The authors suggest the possibility of using concepts and practices drawn from peace education to assist in the treatment and education of refugees suffering from post-traumatic stress. They introduce four basic principles of peace education, which permit students/clients to work through memory and present conflicts, and calls on therapists/teachers to be flexible in their approaches. Three case studies are offered: Bosnian youth in a community center in Chicago, adult male Bosnian refugees in Berlin participating in a social integration project and recently arrived Syrian and Afghani youth living in a transitional setting in Leipzig. There is potential for work undertaken with refugees using principles of peace education to resolve ongoing internal conflicts, while helping to prevent the creation of new social conflicts in the process of integration.

For this study we examined collaborative assessment in counseling 820 German students who were going abroad and who were exposed to the Test to Measure Intercultural Competence (TMIC). A randomized pretest-posttest control group design was used. The control group did not get any test feedback. The remaining groups received written feedback or written plus oral collaborative test feedback. Repeated measures linear mixed effects modeling showed that collaborative test feedback positively influenced students' self-appraisal of their intercultural competence (TMIC-SA); their values on three stages of change; as well as their self-understanding, self-confidence, and perceived benefit from test participation. It is concluded that collaborative assessment and feedback can enhance self-appraised intercultural competence, thereby showing its potential in intercultural training.

Lexicon Pirate was originally developed as a strategy intervention programme to treat lexical disorders of pre-school children. To evaluate the therapy's effectiveness for school-age students, a randomized controlled trial (RCT, N = 157) was conducted. Based on a pre--post-test design, the programme's impacts were compared with a control group (CG) that did not receive the strategy training. Potential long-term impacts were analysed with a follow-up test (four months after the intervention was completed). Therapeutic success is interpreted by an improved performance in standardized tests compared to the CG. The experimental group (EG) made significant to highly significant progress on both lexical and syntactical levels. The improvements of the EG are statistically significantly higher compared to the control group's performance (exception: Subtest 1, P-ITPA). Consequently, the trial proves the advantages of this strategy therapy compared to the CG, finding that the Lexicon Pirate is an effective approach for treating lexical disorders of school-age students.

From the 1970s on, case studies reported the effectiveness of therapeutic mirroring in movement with children with autism spectrum disorder. In this feasibility study, we tested a dance movement therapy intervention based on mirroring in movement in a population of 31 young adults with autism spectrum disorder (mainly high-functioning and Asperger's syndrome) with the aim to increase body awareness, social skills, self-other distinction, empathy, and well-being. We employed a manualized dance movement therapy intervention implemented in hourly sessions once a week for 7 weeks. The treatment group (n = 16) and the no-intervention control group (n = 15) were matched by sex, age, and symptom severity. Participants did not participate in any other therapies for the duration of the study. After the treatment, participants in the intervention group reported improved well-being, improved body awareness, improved self-other distinction, and increased social skills. The dance movement therapy-based mirroring approach seemed to address more primary developmental aspects of autism than the presently prevailing theory-of-mind approach. Results suggest that dance movement therapy can be an effective and feasible therapy approach for autism spectrum disorder, while future randomized control trials with bigger samples are needed.

Early interventions aim at promoting a good mother-child relationship as basis for a good socio-emotional development, especially in high-risk populations, and at correcting already unfavorable patterns of interaction and are common today. Insecure attachment, both of the child and of the mother, has been identified as a risk factor for early regulation disorders and further child development. Based on accumulating evidence of effectiveness of animal-assisted interventions, we implemented an Equine-Assisted Intervention (EAI) as an early intervention approach for mother-child-dyads and investigated its effects in comparison to a conventional play-based early intervention (PBI) in a randomized controlled trial. Both interventions took place once a week for 45 minutes over a period of 8 weeks and aimed at improving maternal caregiving and security in the mother-child relationship. Twenty mother-child dyads (children aged 12 to 24 months) from a high-risk background, in some of which the child already displayed dysregulation symptoms, were investigated. Attachment of mother and child, maternal caregiving, and interaction within the dyad were assessed before and after the intervention. There was not statistically significant difference (p < 0.05) between intervention groups with regard to changes from insecure to secure attachment or from disorganized to organized attachment, assessed via the Ainsworth Strange Situation Test. The only significant group-difference with regard to self-reported caregiving, was found for proximity maintenance in mothers without previous therapy experience (n = 8), those in the EAI reaching higher scores (p = 0.064). Play interaction, assessed via the CARE-Index, showed that mothers and children in PBI improved significantly more in their interaction behavior on several scales, while child's difficultness only significantly improved in EAI.

Objective: The intent of this manuscript was to review all published studies on slow cortical potentials (SCP) neurofeedback for the treatment of ADHD, with emphasis on neurophysiological rationale, study design, protocol, outcomes, and limitations. Method: For review, PubMed, MEDLINE, ERIC, and Google Scholar searches identified six studies and six subsequent publications. In addition to five studies focusing on children with "Diagnostic and Statistical Manual of Mental Disorders" (4th ed.; "DSM-IV")--diagnosed ADHD, one study reports on adults. Results: SCP protocols utilize unipolar-electrode placement at Cz, randomized bidirectional signal regulation, feedback/transfer trials, and discrete feedback/rewards. Results demonstrated learning of SCP self-regulation, moderate to large within group effect sizes for core ADHD symptom reduction, and enhancement of event-related potentials/electroencephalogram components. Neurophysiological and session variables were predictive of treatment outcome, but open questions of specific and nonspecific effects remain. Study limitations and future directions are discussed. Conclusion: SCP is an efficacious and standardized neurofeedback protocol that addresses behavioral and neurophysiological deficits in ADHD. (Contains 4 tables and 1 figure.)

The most common interventions for children with lexical disorders are forms and combinations of interventions focusing on phonological and semantic elaboration and retrieval. Systematic reviews of intervention studies on children with lexical disorders show that a significant generalization of therapeutic effects to untrained vocabulary was rarely achieved. The aim of this study was to investigate whether preschool children with lexical deficits profit from an intervention approach that focuses on implementing lexical learning strategies. A randomized controlled trial was conducted. The control group consisted of 25 children, who received language support in their kindergarten. The 26 children in the experimental group additionally received 15 intervention sessions of the lexical strategy intervention "lexicon pirate". Intervention effects were measured using a standardized expressive vocabulary assessment one year after the intervention. All children significantly improved on the expressive vocabulary measure. In addition, the gain in expressive vocabulary size was higher for children in the experimental group than for the participants in the control group. Further analysis revealed that "lexicon pirate" was as effective for children with qualitative (word-finding) lexical deficits as for those with quantitative (vocabulary) lexical deficits. The gain in expressive vocabulary size was independent of nonverbal IQ, deficits in phonological working memory or other possible influencing factors. (Contains 3 tables and 3 figures.)

The construct of psychological flexibility (PF) is a central concept in acceptance and commitment therapy. It is defined as the process of contacting the present moment fully as a conscious human being and persisting in or changing behavior in the service of chosen values. PF is hypothesized to be an important aspect of healthy psychological functioning. Despite its potential importance, the distinctness of PF from other constructs has not been adequately demonstrated, and psychometric evaluations of measures designed to assess it are limited. This study aimed at extending current knowledge about PF by examining the construct in 2 help-seeking samples, including panic disorder with agoraphobia (n = 368), clinically relevant social phobia (n = 209), and 2 nonclinical samples including students (n = 495) and individuals visiting an employment office (n = 95). Results across all samples indicate that PF, as measured by the Acceptance and Action Questionnaire (2nd version; AAQ-II), is a unitary construct with a 1 factor model. PF correlated with other variables largely consistent with predictions, differentiated patients from healthy controls, and showed preliminary indications of treatment sensitivity. Incremental validity was partially demonstrated, especially for indices of functioning. Surprisingly, PF also explained unique variance above more established measures for some indices of symptomatology. Results suggest that PF adds some incremental clinical validity, yet further and more stringent tests are required to fully elucidate its strengths and limitations. (Contains 4 tables.)

Objective: Cognitive-behavioral therapy (CBT) is a first-line treatment for panic disorder with agoraphobia (PD/AG). Nevertheless, an understanding of its mechanisms and particularly the role of therapist-guided exposure is lacking. This study was aimed to evaluate whether therapist-guided exposure in situ is associated with more pervasive and long-lasting effects than therapist-prescribed exposure in situ. Method: A multicenter randomized controlled trial, in which 369 PD/AG patients were treated and followed up for 6 months. Patients were randomized to 2 manual-based variants of CBT (T+/T-) or a wait-list control group (WL; n = 68) and were treated twice weekly for 12 sessions. CBT variants were identical in content, structure, and length, except for implementation of exposure in situ: In the T+ variant (n = 163), therapists planned and supervised exposure in situ exercises outside the therapy room; in the T− group (n = 138), therapists planned and discussed patients' in situ exposure exercises but did not accompany them. Primary outcome measures were (a) Hamilton Anxiety Scale, (b) Clinical Global Impression, (c) number of panic attacks, and (d) agoraphobic avoidance (Mobility Inventory). Results: For T+ and T- compared with WL, all outcome measures improved significantly with large effect sizes from baseline to post (range = -0.5 to -2.5) and from post to follow-up (range = -0.02 to -1.0). T+ improved more than T- on the Clinical Global Impression and Mobility Inventory at post and follow-up and had greater reduction in panic attacks during the follow-up period. Reduction in agoraphobic avoidance accelerated after exposure was introduced. A dose-response relation was found for Time x Frequency of Exposure and reduction in agoraphobic avoidance. Conclusions: Therapist-guided exposure is more effective for agoraphobic avoidance, overall functioning, and panic attacks in the follow-up period than is CBT without therapist-guided exposure. Therapist-guided exposure promotes additional therapeutic improvement--possibly mediated by increased physical engagement in feared situations--beyond the effects of a CBT treatment in which exposure is simply instructed. (Contains 3 footnotes, 2 tables, and 3 figures.)

Numerous services in the field of social, emotional and behavioural difficulties (SEBD) are active, with different qualities and outcomes in their work. Different professions are also involved in this field between regular and special schools, the children and young people welfare system, the psychiatric ward, the police, therapeutically services and the like--and all too often they fail because of an institutional mismanagement. This case study has two objectives: specifying the situation of children and young people with SEBD in Germany and clarifying the need of an attachment oriented pedagogy in contrast to the latest hype of "facts and figures" based programmes. (Contains 8 notes and 3 figures.)

This study interviewed 29 women from various countries and spiritual backgrounds, between the ages of 16 and 67, seeking to better understand how dance/creative movement supports women during difficult life struggles such as trauma from abuse, relationship breakups, community violence and loss of self, and how it acts as a connection to the sacred. Results yielded three overarching themes of empowerment, healing, and a connection to Spirit. The results also give rise to a unique healing element for women through dance. It appears as if dance provides these women with a resiliency to not only survive very difficult circumstances, but to move past them to a place of healing. (Contains 1 table.)

The Kentucky Inventory of Mindfulness Skills (KIMS) is a well-validated multidimensional questionnaire measuring dimensions of mindfulness on four scales: Observing, Describing, Act With Awareness, and Accept Without Judgment. Even though the KIMS has been used in several clinical studies no information is available about the psychometric properties in different clinical samples. The present study includes two clinical samples: a German sample of people diagnosed with borderline personality disorder, posttraumatic stress disorder, or major depression and an English sample of people diagnosed with recurrent depression. Results of confirmatory factor analysis offer good support for the hypothesized model of four correlated factors, whereas the model of one general underlying mindfulness factor as a second order construct was not confirmed. Furthermore, our analyses revealed that the KIMS scales show high internal consistency and that all KIMS scales are sensitive to change in a subsample of participants taking part in Mindfulness-Based Cognitive Therapy. (Contains 3 tables and 1 figure.)

Introduction: The present study reports cross-cultural comparisons of body mass index (BMI) and growth in Prader-Willi syndrome, a neurodevelopmental disorder associated with obesity, growth restriction and mild learning disability. Our objectives were to: (1) compare rates of obesity in adults with Prader-Willi syndrome (PWS) in France, with data available from Belgium, the UK and the USA; (2) compare growth of French children with PWS with their counterparts in Germany and the USA; and (3) evaluate the contribution of genetic, medical and social parameters to obesity outcome in French children and adults with PWS. Method: (1) Cross-sectional comparison of BMI of 40 French adults, 38 Belgian adults, 46 British adults and 292 North American adults; (2) Construction of growth curves for French children aged 2-20 years from longitudinal data for 150 individuals with PWS, and comparison with published growth curves from Germany and the USA; and (3) Longitudinal regression analysis of 141 French children and adults to determine the factors contributing to obesity outcome. Results: A total of 82.5% French adults with PWS have BMI greater than 30 compared with 65.8% in Belgium (n.s.), 58.2% in the USA (P less than 0.005), and 54.3% in the UK (P less than 0.01). Higher rates of obesity in females vs. males were found in the USA sample (P less than 0.001) but not in the other samples. In contrast to adults, growth curves for French children with PWS show similar rates of growth compared with children with PWS in Germany and the USA. The principal determining factors of BMI status in the French PWS population are age (P less than 0.0001), cohort (born within the last 15 years vs. born over 15 years ago, P less than 0.0002) and growth hormone replacement therapy (P less than 0.0002). Significant subsidiary effects include domestic situation (P less than 0.0001), genetic diagnosis (P less than 0.0001) and age of diagnosis (P less than 0.0001). Conclusions: French adults withPWS have significantly higher rates of obesity than adults in the UK and the USA, but growth in French children with PWS is similar to the USA and Germany. Clinical management has a greater impact on obesity outcome in PWS than cultural factors.

Presents psychoanalytic view based on author's 21 years of experience as an expert witness for approximately 750 individuals who committed sex crimes, and on author's clinical psychiatric experience in treating 170 sex offenders released from prison. Describes treatment program theoretically based on these experiences. (Author/NB)

Reviews methods of treatment used with sex offenders, each based on the erroneous belief that sex offenders constitute a relatively homogeneous taxonomic class. Asserts that sex offenders are people with a sad personal history, in which their deviant sexual behavior represents an effort to banish the pain they experienced during their developing years. (Author/NB)

The aim of the study was two-fold: first, to collect data on the use of antibiotics in Germany for dogs and cats and, second, their owners' experiences and opinions. Using an anonymous online survey, dog and cat owners were asked about the last antibiotic administration in their pet. The inclusion criterion was any antibiotic administration within the last year. A total of 708 questionnaires from 463 dogs and 245 cats could be evaluated. Diarrhea was reported as the most common reason for antibiotic administration in dogs (18.4%). Wound infection/abscess/bite injury was the second most common reason in dogs (16.0%). In cats wound infection/abscess/bite injury was the most common reason (23.3%), followed by dental treatment (21.2%) and upper respiratory tract infections (16.7%). The most common antibiotics used systemically in both species were amoxicillin/clavulanic acid (32.5%), amoxicillin (14.8%), metronidazole (6.9%), and doxycycline (6.8%). While efficacy (99.9%) and tolerability (94.8%) were rated as most important for the choice of antibiotics, costs (51.6%) were cited as predominantly unimportant. First-line antibiotics were used significantly more often than critically important antibiotics. The majority of animal owners show awareness for avoidance of antibiotic resistance and the use of critically important antibiotics. [ABSTRACT FROM AUTHOR]

Chronic noncancer pain (CNCP) is a widespread disease pattern in Germany that severely affects the quality of life of those affected and also burdens the national economy. Frequently, comorbidities such as depression and medication abuse occur. Treatment of CNCP requires individualized,multimodal pain management that includes both drug and nondrug interventions. Opioids are the most effective single intervention for CNCP, but their use must be guideline-driven to ensure safety and efficacy. The german S3 guideline on long-term opioid therapy for chronic noncancer pain (LONTS) provides a helpful resource to improve treatment decisions for CNCP. It is important to communicate realistic prognosis and treatment goals and to clearly state the risks of opioid therapy. When opioids are used incorrectly, the risk to patients is high. Prevention and discontinuation strategies are therefore of great importance. [ABSTRACT FROM AUTHOR]

Background: Cervical cancer (CC) screening is generally recommended until age 65. The incidence of CC could be underestimated, particularly in older women, due to a lack of hysterectomy correction. Furthermore, elderly women (≥65 years) are more often diagnosed with late‐stage disease and have worse outcomes than younger patients. This study aims to provide an in‐depth overview of CC in Germany. Methods: Incidence rates of CC (ICD‐10 C53) were determined using data from the German Centre of Cancer Registry data (ZfKD) of six federal state registries. Incidence was corrected by using hysterectomy prevalence values from a real‐world study. The distribution of treatment modalities (surgery, chemotherapy, radiation therapy) was assessed. Relative survival was calculated using the period approach (2011–2015). Survival was stratified by tumor (T) stage and histological type. Results: In total, 14,528 CC cases were included, 27.6% of which occurred in elderly women. Cumulative (2001–2015) age‐standardized incidence rates were 12.5 per 100,000 women without hysterectomy correction and 15.5 per 100,000 women after hysterectomy correction (+24% relative change). A lower proportion of elderly women were treated, especially in advanced tumor stages. Younger women (20–64 years) had a higher 5‐year relative survival compared to elderly women: 76.7% versus 46.9%, respectively. Survival was worse with increasing stage and for glandular histological subgroups, particularly among elderly women. Conclusions: CC incidence in elderly women is underestimated and survival is lower compared to younger women in Germany. Due to the high disease burden in elderly women, screening and treatment strategies need to be improved. [ABSTRACT FROM AUTHOR]

Phonological developmental speech sound disorders (pDSSD) in childhood are often associated with later difficulties in literacy acquisition. The present study is a follow-up of the randomized controlled trial (RCT) on the effectiveness of PhonoSens, a treatment for pDSSD that focuses on improving auditory self-monitoring skills and categorial perception of phoneme contrasts, which could have a positive impact on later spelling development. Our study examines the spelling abilities of 26 German-speaking children (15 girls, 11 boys; mean age 10.1 years, range 9.3–11.2 years) 3–6 years after their successful completion of the PhonoSens treatment. Spelling assessment revealed that only 3 out of 26 participants developed a spelling disorder. In the overall population of fourth-graders, one in five children showed a spelling deficit; in another study of elementary school children, with resolved pDSSD, 18 of 32 children had a spelling deficit. Thus, the applied pDSSD treatment method appears to be associated with positive spelling development. Multiple regression analysis revealed that among the potentially predictive factors for German-speaking children with resolved pDSSD to develop later spelling difficulties, parental educational level and family risk for developmental language disorder (DLD) had an impact on children's spelling abilities; gender and the child's phonological memory had not. [ABSTRACT FROM AUTHOR]

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Objective: The aim of this study was to assess the common practices of dental implant maintenance among dental hygiene professionals (DHP) in Israel (IL) and Germany (GE). Methods: An online questionnaire was developed by the Periodontology Departments of Tel Aviv (IL) and Frankfurt University (GE) to address demographics, training, prevention and treatment of peri‐implant diseases. The questionnaire was distributed by DHP associations via social media. Results: The responses of 376 DHPs (IL: 169; GE: 207) were analysed. Most participants were female (IL: 168/99%; GE: 203/98%), had received education (IL: 179/97%; GE: 207/97%) and were working in their home countries (IL: 182/99%; GE: 211/99%). Peri‐implant probing was not performed by 22% of DHPs in IL and 5% in GE. Of the DHPs who used probes, 49% used metal probes in IL, while 40% used plastic probes in GE (p < 0.001). A majority of DHPs performed peri‐implant instrumentation (IL: 168/99%; GE: 190/92%). Most DHPs from IL did not use devices other than hand and/or sonic/ultrasonic instruments for peri‐implant cleaning (IL: 130/77%; GE 5/2%); in GE, the use of airflow (IL: 31/18%; GE: 199/96%) is popular (p < 0.001). Conclusions: Most DHPs in IL and GE perform peri‐implant probing and debridement. However, there are some distinct differences between the two countries regarding the choice of instruments and treatment regimens. [ABSTRACT FROM AUTHOR]

Background: The effectiveness of virtual reality exposure (VRE) in the treatment of anxiety disorders is well established. Several psychological mechanisms of VRE have been identified, whereby both emotional processing and the sense of presence play a key role. However, there are only few studies that contribute to our knowledge of examples of implementation in the case of VRE for claustrophobia based on patients' experiences and the perspective of therapists. Objective: This study asks for key elements of a VRE app that are necessary for effective exposure for people with claustrophobic symptoms. Methods: A mixed methods design was applied in which patients (n=15) and therapeutic experts (n=15) tested a VRE intervention of an elevator ride at 5 intensity levels. Intensity was varied by elevator size, duration of the elevator ride, and presence of virtual humans. Quantitative measures examined self-reported presence with the Igroup Presence Questionnaire (IPQ) ranging from 0 to 6 and 15 Likert-scaled evaluation items that had been developed for the purpose of this study, ranging from 1 to 5. In both measures, higher scores indicate higher levels of presence or agreement. Think-aloud protocols of the patients and semistructured interviews posttreatment of all participants were conducted to gain in-depth perspectives on emotional processes. Results: The intervention induced a feeling of presence in patients and experts, posttreatment scores showed a high IPQ presence score (mean 3.84, SD 0.88), with its subscores IPQ spatial presence (mean 4.53, SD 1.06), IPQ involvement (mean 3.83, SD 1.22), and IPQ experienced realism (mean 2.75, SD 1.02). Patients preferred a setting in the presence of a therapist (mean 4.13, SD 0.83) more than the experts did (mean 3.33, SD 1.54). Think-aloud protocols of the patients revealed that presence and anxiety both were achieved. Qualitative interviews of patients and experts uncovered 8 topics: feelings and emotions, personal story, telepresence, potential therapeutic effects, barriers, conditions and requirements, future prospects, and realization. The intensity levels were felt to appropriately increase in challenge, with ambivalent results regarding the final level. Virtual humans contributed to feelings of fear. Conclusions: Key elements of a VRE app for claustrophobic symptoms should include variation of intensity by adding challenging cues in order to evoke presence and anxiety. Virtual humans are a suitable possibility to make the intervention realistic and to provide a sense of closeness; however, some of the fears might then be related to symptoms of social phobia or agoraphobia. Patients may need the physical presence of a therapist, though not all of them share this view. A higher degree of sophistication in the intensity levels is needed to deliver targeted help for specific symptoms of anxiety. [ABSTRACT FROM AUTHOR]

Background: Ferroptosis is an iron-dependent mode of cell death that could be induced by erastin and exert antitumor effects. However, the clinical and biological roles of ferroptosis-related gene (FRG) signature and the therapeutic value of erastin in multiple myeloma (MM) remained unknown. Methods: Clinical and gene expression data of MM subjects were extracted from the Gene Expression Omnibus (GEO) public database. Univariable cox analysis was applied to determine FRGs related to survival and the least absolute shrinkage and selection operator (LASSO) regression analysis was used to develop a prognostic model. Prediction accuracy of the model was estimated by receiver operating characteristic (ROC) curves. Functional pathway enrichments and infiltrating immune status were also analyzed. We conducted in vitro experiments to investigate the combination therapy of erastin and doxorubicin. Results: 17 FRGs were strongly associated with patient survival and 11 genes were identified to construct the prognostic model. ROC curves indicated great predictive sensitivity and specificity of the model in all cohorts. Patients were divided into low- and high-risk groups by median risk score in each cohort and the survival of the low-risk group was significantly superior than that of the high-risk group. We also observed a close relevance between functional pathways and immune infiltration with risk scores. Moreover, we combined erastin and doxorubicin in our in vitro experiments and found synergetic antitumor effects of the two agents, and the underlying mechanism is the overgeneration of intracellular Reactive Oxygen Species (ROS). Conclusions: We demonstrated the important value of ferroptosis in patient prognosis and as a potential antitumor target for MM. [ABSTRACT FROM AUTHOR]

Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a severe, chronic multisystemic disease which, depending on its severity, can lead to considerable physical and cognitive impairment, loss of ability to work and the need for nursing care including artificial nutrition and, in very severe cases, even death.The aim of this D-A-CH (Germany, Austria, Switzerland) consensus statement is 1) to summarize the current state of knowledge on ME/CFS, 2) to highlight the Canadian Consensus Criteria (CCC) as clinical criteria for diagnostics with a focus on the leading symptom post-exertional malaise (PEM) and 3) to provide an overview of current options and possible future developments, particularly with regard to diagnostics and therapy. The D-A-CH consensus statement is intended to support physicians, therapists and valuer in diagnosing patients with suspected ME/CFS by means of adequate anamnesis and clinical-physical examinations as well as the recommended clinical CCC, using the questionnaires and other examination methods presented. The overview of the two pillars of therapy for ME/CFS, pacing and symptom-relieving therapy options, is intended not only to provide orientation for physicians and therapists, but also to support decision-makers from healthcare policy and insurance companies in determining which therapy options should already be reimbursable by them at this point in time for the indication ME/CFS., (© 2024. The Author(s).)

The S3 Guideline on the Treatment of Language Development Disorders: Summary of Recommendations Abstract: The German S3 Guidelines on the Treatment of Developmental Speech and Language Disorders (AWMF: No. 049-015) were published on the AWMF homepage at the end of 2022. The German Society for Phoniatrics and Paedaudiologie coordinated the work and developed the guideline text together with linguists and speech and language therapists. Many scientific medical societies consented to the respective recommendations. For the first time in the German-speaking area, the guideline group reviewed international research results on the treatment of various speech and language disorders and formulated evidence- or consensus-based recommendations for clinical care. The present article summarizes these recommendations and evaluates the guidelines from the perspective of child and adolescent psychiatry and psychotherapy.

The following article describes the perceptions and practices of Japanese Buddhism in Germany, focusing on Zen and its local converts. We will give a short overview of the early reception of Buddhism in Germany, which shaped the foundation of its further development there. The article will then examine the relationship between the German reception of Japanese Buddhism and National Socialism and introduce Eugen Herrigel, who wrote the bestseller Zen in der Kunst des Bogenschießens , which led to increased interest in Buddhist practices. We will trace how institutionalization manifested in the Buddhist landscape in Germany, utilizing Deshimaru Taisen as an example. We will then briefly discuss the influence of Japanese Buddhism on philosophy, psychology, and popular culture. The conclusion will draw attention to the lack of attention to specific themes in previous discussions on Japanese Buddhism, especially on women's activities in the field. [ABSTRACT FROM AUTHOR]

The escalating worldwide prevalence of Crohn's disease (CD) among children and adolescents, coupled with a trend toward earlier onset, presents significant challenges for healthcare systems. Moreover, the chronicity of this condition imposes substantial individual burdens. Consequently, the principal objective of CD treatment revolves around rapid inducing remission. This study scrutinizes the impact of age, gender, initial disease localization, and therapy on the duration to achieve disease activity amelioration. Data from the Saxon Pediatric IBD Registry in Germany were analyzed over a period of 15 years. In addition to descriptive methods, logistic and linear regression analyses were conducted to identify correlations. Furthermore, survival analyses and Cox regressions were utilized to identify factors influencing the time to improvement in disease activity. These effects were expressed as Hazard Ratios (HR) with 95% confidence intervals. Data on the clinical course of 338 children and adolescents with CD were available in the registry. The analyses showed a significant correlation between a young age of onset and the severity of disease activity. It was evident that treatment with anti-TNF (Infliximab) was associated with a more favorable prognosis in terms of the time required for improvement in disease activity. Similarly, favorable outcomes were observed with the combination therapies of infliximab with enteral nutrition therapy and Infliximab with immunosuppressants.Conclusion: Our analysis of data from the Saxon Pediatric IBD Registry revealed that the timeframe for improvement of disease activity in pediatric Crohn's disease is influenced by several factors. Specifically, patient age, treatment modality, and initial site of inflammation were found to be significant factors. The study provides important findings that underline the need for individualized treatment., (© 2024. The Author(s).)

Background: Clinical cancer registries are intended to reflect the reality of care through differentiated data analysis and, if necessary, to offer approaches for improving care., Methods: For the years 2000-2018, the data of the Clinical Epidemiological Cancer Registry Brandenburg-Berlin were examined separately for adenocarcinoma and squamous cell carcinoma with respect to epidemiology and health care reality., Results: Between 2000 and 2018 a total of 3207 esophageal cancers were documented in the cancer registry, of which 2182 were squamous cell carcinomas (ESCC), 843 adenocarcinomas (EAC) and 182 various others or missing histology. During the observation period there was a clear dominance of ESCC but with a significant increase in EAC in both sexes. Overall, the rate of new cases was 5 times higher for men than for women. The relative 5‑year survival probability of all esophageal cancers was 17.4% in men and 22.5% in women. Patients with EAC survived significantly longer than those with ESCC. Radiotherapy and chemotherapy, individually or in combination, were mainly used as treatment methods. Surgery was performed on 19% of ESCC and 42% of EAC., Conclusion: The proportion of ESCC in Brandenburg is still significantly higher than EAC, with a significant increase for the latter, especially in men. Although locally advanced tumors have been significantly more common, modern neoadjuvant concepts have rarely been documented, and although the quality of the surgery is comparable to the international standard, surgery is carried out in relatively few patients., (© 2024. The Author(s).)

The S2k guideline on hidradenitis suppurativa/acne inversa (HS/AI) aims to provide an accepted decision aid for the selection/implementation of appropriate/sufficient therapy. HS/AI is a chronic recurrent, inflammatory, potentially mutilating skin disease of the terminal hair follicle-glandular apparatus, with painful, inflammatory lesions in the apocrine gland-rich regions of the body. Its point prevalence in Germany is 0.3%, it is diagnosed with a delay of 10.0 ± 9.6 years. Abnormal differentiation of the keratinocytes of the hair follicle-gland apparatus and accompanying inflammation form the central pathogenetic basis. Primary HS/AI lesions are inflammatory nodules, abscesses and draining tunnels. Recurrences in the last 6 months with at least 2 lesions at the predilection sites point to HS/AI with a 97% accuracy. HS/AI patients suffer from a significant reduction in quality of life. For correct treatment decisions, classification and activity assessment should be done with a validated tool, such as the International Hidradenitis Suppurativa Severity Scoring System (IHS4). HS/AI is classified into two forms according to the degree of detectable inflammation: active, inflammatory (mild, moderate, and severe according to IHS4) and predominantly inactive, non-inflammatory (Hurley grade I, II and III) HS/AI. Oral tetracyclines or 5-day intravenous therapy with clindamycin are equal to the effectiveness of clindamycin/rifampicin. Subcutaneously administered adalimumab, secukinumab and bimekizumab are approved for the therapy of HS/AI. Various surgical procedures are available for the predominantly non-inflammatory disease form. Drug/surgical combinations are considered a holistic therapy method., (© 2024 Deutsche Dermatologische Gesellschaft (DDG).)

Background: Diagnostic and therapeutic options for asthma have improved with asthma control and remission being of central importance. The RELEVANT study aimed for a nationwide snapshot of current asthma diagnosis and treatment in general practice and specialty care for identification of further aspects for optimization., Method: RELEVANT is a nationwide cross-sectional study using a structured questionnaire. This comprised 14 questions on asthma-related topics covering diagnostics and therapy. Participants were general practitioners/internal medicine specialists and pulmonologists., Results: A total of 1,558 persons took part in the survey. Regarding relevant specific diagnostic procedures for asthma, GPs/internists almost exclusively mentioned pulse oximetry. Among the pulmonologists, fractional exhaled nitric oxide (FeNO) measurement was mentioned, among others. FeNO and blood eosinophils were only mentioned by the pulmonologists as diagnostic and treatment-relevant markers. A total of more than 60% of the GPs/internists surveyed stated that only around 25% or fewer of their patients would voluntarily report restrictions in their everyday lives. Regarding drug treatment, the majority stated that they recognized differences between various ICS/LABA combination therapies., Conclusions: The results indicate a need for optimization, particularly regarding asthma control. This involves both a better assessment by patients' everyday life restrictions and modern ways of assessing asthma control in cooperation between GPs/internal medicine specialists and pulmonologists. One fifth of respondents do not see any differences between various ICS/LABA combinations in daily practice, although there are pharmacodynamic and pharmacokinetic differences., (© 2024. Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

Background: Dentists (Ds) and dental assistants (DAs) have a high lifetime prevalence of musculoskeletal disorders (MSDs). In this context, it is assumed that they have an increased intake of substances such as pain medication. Currently, there exist no data on the use of medication among Ds and DAs with MSDs in Germany. Methods: The online questionnaire (i.e., the Nordic Questionnaire) analysed the medical therapies used by 389 Ds (240 f/149 m) and 406 DAs (401 f/5 m) to treat their MSDs. Results: Ds (28.3–11.5%) and DAs (29.4–10.3%) with MSDs took medication depending on the affected body region. A trend between the Ds and DAs in the intake of drug therapy and the frequency was found for the neck region (Ds: 21.1%, DAs: 28.7%). A single medication was taken most frequently (Ds: 60.0–33.3%, DAs: 71.4–27.3%). The frequency of use varied greatly for both occupational groups depending on the region affected. Conclusion: Ds and DAs perceived the need for medical therapies because of their MSDs. Painkillers such as ibuprofen and systemic diclofenac were the medications most frequently taken by both occupational groups. The intake of pain killers, most notably for the neck, should prevent sick leave. [ABSTRACT FROM AUTHOR]

Background: Spinal muscular atrophy (SMA) is a rare, severely debilitating neuromuscular disease characterized by a wide spectrum of progressive muscular atrophy and weakness., Objectives: The objective of this pilot study was to estimate self-assessed health-related quality of life (HRQoL) of children with SMA., Methods: Children with SMA were recruited via the German national TREAT-NMD SMA patient registry and asked to self-complete the following rating-scales: KIDSCREEN-27, KINDL, the PedsQL 3.0 Neuromuscular Module (PedsQL 3.0 NMM), EQ-5D-5L, and the Health Utilities Index (HUI). Estimates were stratified by current best motor function of the lower limb and trunk (i.e., non-sitter, sitter, and walker) and SMA type (i.e., type I, II, and III)., Results: In total, 17 children with SMA (mean age: 9.88 years, SD: 4.33 years, range: 5-16 years; 59% female) participated in the study. Across examined strata, the mean KIDSCREEN-27 total score was estimated at between 48.24 and 83.81; the mean KINDL total score at between 60.42 and 76.73; the mean PedsQL 3.0 NMM total score at between 58.00 and 83.83; the mean EQ-5D-5L utility at between 0.31 and 0.99; and the mean HUI-derived utility at between -0.02 and 0.96., Conclusions: The results from this pilot study show that German children with SMA, despite significant physical disability, have surprisingly good HRQoL as assessed using KIDSCREEN-27. Yet, many reside in health states associated with low utility. The disease burden was generally higher among non-sitters compared with walkers, and SMA type I compared with type III, but more research is needed to further delineate this variability. Our preliminary findings contribute to the understanding of HRQoL in pediatric patients with SMA and should be helpful to inform the design of future studies of this patient population.

In Germany, access to outpatient treatment services devoted to the prevention of (further) sexual offenses against minors and child sexual exploitation material (CSEM) offenses is often limited. The therapy project "Prevention of Sexual Abuse" tries to fill this gap by providing treatment to patients with a self-reported sexual interest in children and adolescents, irrespective of whether or not they are pedophilic or prosecuted by the legal justice system. Within the project, a treatment manual was developed which specifically addresses dynamic risk-factors in child sexual abusers and CSEM offenders. The treatment manual was conceived to reduce recidivism risk and to contribute to the enhancement of the patients' personal well-being. In this paper, results of the accompanying scientific research are presented: offense-supportive attitudes (N = 23), self-reported CSEM use (N = 10), emotional distress (N = 24), and participants' subjective risk perception of committing (further) sexual offenses (N = 25) reduced during the course of treatment. A reduction of offense-supportive attitudes was further observed from pre-intervention to 1-year follow-up (N = 8). Changes with regard to self-efficacy, quality of life, participants' self-perceived ability to control sexual impulses toward children and adolescents permanently, and several measures assessing different kinds of sexual recidivism did not, however, reach any level of significance. During an average observation period of 2.4 years, six patients confessed to have conducted new sexual exploitation material offenses, while no further sexual abuse cases were reported (N = 19). Due to the used research design and small sample sizes, treatment effects cannot be inferred and external validity is limited. This notwithstanding, results provide first evidence for a relationship between treatment participation and self-reported recidivism and psychological well-being. [ABSTRACT FROM AUTHOR]

Objectives: Depression is highly prevalent worldwide and generates significant economic burden. Despite this, there is still insufficient information on hospitalisation costs related to depression. Therefore, this paper presents a comparison of costs of inpatient care of depression among patients hospitalised in 2014 in Kiel (Germany) and in Poznan (Poland). Methods: The retrospective study was conducted from October 2015 to May 2017 in Kiel and in Poznan and concerned all patients (n = 548 and eventually included n = 444; 334 in Kiel and 110 in Poznan) hospitalised in these centres. Results: The annual cost of inpatient care of patients hospitalised due to depression in 2014 was EUR x ¯ = EUR 9397.21 (total EUR 313,8667.2) in Kiel and EUR x ¯ = EUR 2962.90 (total EUR 325,919.38) in Poznan. In Kiel, the most frequently prescribed medicine was mirtazapine while in Poznan it was venlafaxine. Conclusions: The 3-fold difference in average costs of hospitalisation might result from differences in funding of mental health care which in Poland needs urgent amendment. Besides, mental health care was underfunded in Poznan. In general, treatment was comprehensive in both centres. Non-pharmacological treatment, however, was more comprehensive in Kiel. The cost of inpatient care of depression was very high both in Kiel and Poznan. Inpatient care of depression is long-lasting, but a reduction in the length of hospital stay seems to be possible. Hospital stay is the main part of costs of inpatient care of depression. Treatment of depression should be comprehensive, but differences e.g. in pharmacotherapy used are possible between hospitals and/or countries. [ABSTRACT FROM AUTHOR]