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In the contribution at hand, a new material modelling approach is introduced. This formulation is based upon the Principle of Multiscale Virtual Power and consideration of micromechanically motivated assumptions. Consequently, the evolution of dissipative phenomena depends on the chosen microstructure. Therefore, a strong anisotropy, which is induced by damage, is represented even with isotropic material formulations. This phenomenon is present in concrete. Furthermore, the modelling approach is validated by different material tests. Tensile-tensile and compression-tensile tests are used for validation of the proposed description. Some material tests are taken from the existing literature, while others are presented in the contribution at hand. Furthermore, the capabilities of the proposed formulation to capture different amounts of textile reinforcement in concrete are shown by additional experiments from the literature. Subsequently, the consistent linearisation of the proposed model is verified based on numerical analyses. • Consistent formulation of a multiscale analysis applied to concrete. • Novel microlayer framework for concrete. • Validation for concrete. • Application to concrete under biaxial loads. [ABSTRACT FROM AUTHOR]

Civil engineering structures are exposed to complex loading scenarios leading to multiaxial fracture and activation of stress transfer mechanisms along cracks controlled by combined deformations in two independent spatial directions (crack opening and crack sliding). Such multi-degree of freedom conditions cannot be properly investigated by state-of-the-art testing procedures. That is why – based on a thorough review of existing experimental procedures – this paper presents a novel testing methodology that applies shear via torsional loading and can simultaneously load specimens in axial direction (TorAx) to explore the material behavior before, during, and after macro-cracking. Independent control of both degrees of freedom allows the generation of arbitrary biaxial load or deformation paths. To prove the technical feasibility of the proposed testing method, several tests on thin-walled concrete tubes have been conducted. The obtained results proved uniformity of strain distribution along the tested ligament which guarantees several advantages (e.g., elimination of size/boundary effects and reduced scatter) over existing testing methods. With low costs (material/time) TorAx will serve as a benchmark for future studies under monotonic, cyclic, and fatigue loading. By experimentally quantifying all stress transfer mechanisms in one unifying test setup, an unbiased comparison of the individual mechanisms is possible, which is the first necessary step towards accelerated yet economical and reliable mechanical and numerical models. • Characterization of multiaxial stress transfer in plain and reinforced concrete. • Review of existing setups for testing cohesive and non-cohesive behavior. • Identification of five major shortcomings of existing test setups. • Performance of aggregate interlock tests in a combined axial-torsion test setup. • Presentation of a newly developed multiaxial testing machine. [ABSTRACT FROM AUTHOR]

Abstract: Anchorage behavior of textile reinforcement in thin concrete components The safe and reasonable anchorage of textile reinforcement in concrete is relevant for both researchers and users of the innovative composite material carbon reinforced concrete. In research, major questions of bond and anchorage remain unsolved. To date, there is no design model for anchorage or overlap which incorporates the currently available range of textile reinforcement with soft to stiff impregnation materials. The different failure mechanisms of bond, which result from the material characteristics, are rarely distinguished. This article illustrates the results of form closure on the bond behavior of textile reinforcement with stiff impregnation. Results of new experimental investigations are discussed considering previous research. A modified test setup for single fiber strand pull‐out is presented, which allows for investigation of the anchorage behavior for projects in research and practice as well as for quality control during production. [ABSTRACT FROM AUTHOR]

• Fabrication of lightweight, carbon textile reinforced concrete components using extrusion. • Extrusion of high-performance carbon textile reinforced concrete with tensile strength up to 4000 MPa. • Development of sustainable concrete structures with u to 80 % concrete saving. This paper describes the concept, form finding, fabrication and experimental testing of prototype innovative concrete components made of extruded and transformed carbon textile reinforced concrete (TRC). The components consist of two thin-walled concrete facings that are connected by an internally nested lattice structure made of carbon TRC. Through an innovative process, thin carbon TRC stripes with a width of 10 mm were extruded with 2 textile grids and then shaped into a counter arched structure following a sinusoidal wave. The components with internally nested lattice structure represent a lightweight structural system with a drastic saving of dead load compared to conventional steel reinforced concrete (SRC) components. The design process as well as the manufacturing process, concrete mixing, material and experimental testing are presented. The results indicate that sandwich wall components with up to 76 % less use of materials in comparison to steel reinforced constructions can be realized. In addition, an outlook for the production of further components from extruded TRC components is given, which are suitable for use as ribbed ceilings and which show up to 30 % less emissions in Global Warming Potential (kg CO 2 e/(service life)) than a comparable component with steel reinforcement based on the Life Cycle Assessment (3cradle-to-gate) with up to 77 % concrete saving. [ABSTRACT FROM AUTHOR]

In spite of an extensive research in the past few decades, design of beams without shear reinforcement is still considered to be a challenging task. With the goal of developing realistic and simple engineering models, many researchers have contributed to the development of analytical and numerical approaches that have improved the understanding of the mechanical background of shear fracture. Still, some assumptions in these approaches, such as the rigid body kinematics which relies on the assumption of a uniquely identifiable center of rotation, have raised critical questions in the scientific community that need further consideration. In this paper, an automated crack detection scheme based on DIC-controlled modeling of damage localization is developed and presented. This scheme enables an automatic evaluation of opening and sliding profiles along the crack ligament, the center of rotation between two neighboring concrete teeth, and the moment–rotation curve directly from the DIC measurements of the surface displacement. To demonstrate the feasibility and the features of the developed scheme, verification studies are performed using tests performed on longitudinally reinforced concrete beams. The description of the mathematical concepts behind the developed crack detection scheme is accompanied with the explanation of the implementation method using modern Python packages for scientific computing, providing code snippets that show a straightforward translation of the mathematics into an executable code. Furthermore, a publicly available implementation of the developed scheme is provided in the form of an interactive Jupyter notebook. • Model and implementation concept for automated crack detection in RC shear zones. • Immediate evaluation of the opening and sliding profiles along crack ligaments. • Identification of the center of rotation between two neighboring concrete teeth. • Evaluation of rotational kinematics assumption of analytical models for shear zones. [ABSTRACT FROM AUTHOR]

Background: Transition to adult health services is a vulnerable phase in young persons with chronic disease. We describe how young persons with inflammatory bowel disease in Germany and Austria experience care during the transitional age, focusing on differences by type of provider (pediatric vs. adult specialist, no specialist). Methods: This was a follow up survey in patients previously registered with a pediatric IBD registry. Patients aged 15 to 25 received a postal questionnaire, including a measure of health care experience and satisfaction. Descriptive analyses were stratified by age. Sub-analyses in the 18–20 year age group compared health care experience by type of provider. Determinants of early or late transfer were examined using multinomial logistic regression. Results: 619 patients responded to the survey; 605 questionnaires were available for analysis. Usual age of completing transition was 18. Earlier transfer was more common with low parental SES (OR 1.8, 95% CI 0.7 to 4.6), and less common with advanced schooling (OR 0.5, 95% CI 0.2 to 1.2). Structured transition was uncommon. 48% of the respondents had not received any preceding transition advice. Overall satisfaction with IBD care was high, especially with respect to interpersonal aspects, but less so in aspects of continuity of care. Conclusions: Despite high overall patient satisfaction, relevant deficiencies in transitional care were documented. Some of these were associated with lower parental social status. Differences in health care satisfaction by type of provider (adult vs. pediatric) were small. [ABSTRACT FROM AUTHOR]

The punching shear design of flat slabs and column bases was revised with the introduction of Eurocode 2. While in many former codes the punching shear resistance was determined regardless of the type of member, in Eurocode 2 two different design equations for flat slabs and column bases were introduced. Additionally, different control sections for flat slabs and column bases were defined. The differentiation between flat slabs and column bases and especially the iterative design procedure for the determination of the punching shear resistance of column bases require great effort in daily practice. Based on the punching shear provisions according to Eurocode 2, a new Uniform Design Method (UDM) for flat slabs and column bases is developed. The derivation of the design method is described in detail. To verify the changes in the current design provisions, the new design method is evaluated using large databanks for flat slabs and column bases without and with shear reinforcement as well as systematic test series. [ABSTRACT FROM AUTHOR]

[Display omitted] • Printability (3D) of beams of two recycled materials was evaluated experimentally. • Flexural (bending) tests showed excellent performance of the composite beams. • Composite beams with plastic showed higher loads than beams with timber. • We quantified to what extent and which material can provide flexural strength. • The infill density was found to be effective in bending capacity. The abundance of the waste materials of wood and plastic inspired the authors to explore the possibility of 3D printing the recycled materials as composite beams. This paper addresses the design, fabrication, and structural testing of 3D printed composite beams under 3-point bending. The authors believe that 3D printing of beams from timber waste and Polylactic Acid (PLA) is a state-of-the-art and has excellent potential to be transformed to state-of-the-practice in the construction industry. Beams with different compositions of materials and printing densities were designed, printed and tested to failure. This paper elaborates details of the design and printing of the beams, which then will be followed by detailed discussions as to how each beam reacts under flexural loading in terms of deformability, stiffness, strength-to-mass ratio, failure, and load-carrying capacity. General deformations of the specimens implied that the design of the specimens was quite successful in avoiding any premature failure. Large deflections of all specimens indicated that the shear strengthening performed effectively as the shear-vulnerable areas were not affected by the shear failure. The infill density affects the flexural capacity, which is obviously due to the amount of material present against loading. The capacity of the specimens with PLA at the top and bottom sections of the beams was higher than the equivalent beams with timber flanges. Overall, very promising results were obtained with a view to extending the idea into more advanced elements and techniques to develop various 3D printed structural elements towards the ongoing discussion on automation in the construction and prefabrication. [ABSTRACT FROM AUTHOR]

Background: Abdominal pain is a common and often debilitating issue for children and adolescents. In many cases, it is not caused by a specific somatic condition but rather emerges from a complex interplay of bio-psycho-social factors, leading to functional abdominal pain (FAP). Given the complex nature of FAP, understanding its origins and how to effectively manage this condition is crucial. Until now, however, no questionnaire exists that targets knowledge in this specific domain. To address this, the Abdominal Pain Knowledge Questionnaire (A-PKQ) was developed., Methods: Two versions were created (one for children and one for parents) and tested in four gastroenterology clinics and one specialized pain clinic in Germany between November 2021 and February 2024. Children between 8 and 17 years of age ( N = 128) and their accompanying parents ( N = 131) participated in the study. Rasch analysis was used to test the performance of both versions of the questionnaire., Results: The original questionnaires exhibited good model and item fit. Subsequently, both questionnaires were refined to improve usability, resulting in final versions containing 10 items each. These final versions also demonstrated good model and item fit, with items assessing a variety of relevant domains., Conclusion: The A-PKQ is an important contribution to improving assessment in clinical trials focused on pediatric functional abdominal pain.

Crigler-Najjar Syndrome (CNS) with residual activity of UDP-glucuronosyltransferase 1A1 ( UGT1A1 ) and no need for daily phototherapy is called mild Crigler-Najjar Syndrome. Most of these patients need medical treatment for enzyme induction (phenobarbital) to lower blood levels of unconjugated bilirubin (UCB). Apart from this, no long-term problems have been described so far. The phenotype of patients with the homozygous pathogenic variant c.115C>G p.(His39Asp) in UGT1A1 is described as variable. Clinical observations of our patients led to the assumption that patients with variant c.115C>G have a mild CNS phenotype while having a high risk of developing progressive liver disease. For mild CNS disease, progressive liver disease has not been described so far. Therefore, we conducted a retrospective multicenter analysis of 14 patients with this particular variant, aiming for better characterization of this variant. We could confirm that patients with variant c.115C>G have a high risk of progressive liver disease (seven of fourteen), which increases with age despite having a very mild CNS phenotype. Earlier predictors and causes for an unfavorable disease course are not detectable, but close follow-up could identify patients with progressive liver disease at the beginning. In conclusion, these patients need close and specialized follow-up. Our study questions whether fibrosis in the CNS is really driven by high amounts of UCB or phototherapy.

Functional Constipation and Nonretentive Fecal Incontinence in Children and Adolescents: Clinical Guideline for Assessment and Treatment Abstract. Objective: Constipation and fecal incontinence are common disorders in children and adolescents and are associated with incapacitation and a high rate of comorbid psychological disorders. Functional constipation and nonretentive fecal incontinence can be differentiated according to the current Rome-IV classification systems. This interdisciplinary guideline aims to summarize the current state of knowledge regarding somatic and psychiatric assessment and treatment. It formulates consensus-based, practical recommendations. Methods: The members of the Guideline Commission consisted of 11 professional associations and a parental organization. The guideline was based on current literature searches, several online surveys, and consensus conferences based on standard procedures. Results: Functional constipation is much more common than nonretentive fecal incontinence. Constipation requires a detailed medical assessment to exclude somatic causes, especially in young children. Red flags are useful indicators of organic causes to be considered. Most cases of constipation are functional (approximately 95 %). Counseling, toilet training, disimpaction, and long-term oral laxatives, combined with cognitive-behavioral interventions, are most effective. The assessment and treatment of nonretentive fecal incontinence are similar. The rate of somatic factors is much lower (approximately 1 %). Laxatives can worsen outcomes and should be avoided. Comorbid psychological disorders are common (approximately 30 % to 50 %). They should be assessed and treated additionally according to evidence-based guidelines. Conclusions: The recommendations of this guideline were approved with a high consensus. Interdisciplinary cooperation is especially important, as somatic factors and comorbid psychological disorders and symptoms need to be considered. More research is required, especially regarding nonretentive fecal incontinence.

Background: According to a population-based study, approximately 6.8% of children and adolescents in Germany suffer from acute or chronic constipation. It can be of organic or functional origin and may be associated with comorbid disturbances, particularly fecal incontinence., Methods: We selectively searched the PubMed and Google Scholar databases for articles with the keywords "constipation," "children and adolescents," and "incontinence". Recommendations are based on the AWMF guideline on constipation and fecal incontinence and on international guidelines and reviews., Results: More than 90% of cases of chronic constipation are of functional origin. Organic causes vary with age and call for targeted differential diagnosis. Invasive tests are only rarely necessary. Functional constipation may be associated with fecal and urinary incontinence, and the relative risk of urinary tract infections is 2.2 to 6.5. There may be associated psychological symptoms and mental disorders in 30-50% of cases. The cornerstone of treatment is patient and parent education, along with laxative medication and toilet training. Instructional programs have been found effective in otherwise refractory cases., Conclusion: The treatment of constipation in childhood should begin as soon as the differential diagnostic evaluation is completed. The education of parents, follow-up at close intervals, and drug treatment and behavioral therapy that are adapted to the symptoms can improve quality of life.

Introduction: Children and adolescents with chronic gastrointestinal, pancreatic and liver diseases need age-appropriate and qualified treatment. A representative survey is used to analyse the structural and personnel-related outpatient and inpatient care of children with chronic gastrointestinal, pancreatic and liver diseases in Germany., Methodology: 319 paediatric and adolescent medicine clinics and 50 paediatric gastroenterology practices in Germany were invited to participate in the anonymous online survey via EFS Survey. The structure of the facilities, further training authorisations, cooperations, treatment and care data and an assessment of the need for care were systematically recorded and descriptively evaluated., Results: 81 clinics and 10 practices participated in the survey. Almost two thirds of the clinics (n=52) provide outpatient paediatric gastroenterology services. Mostly up to 10 (25.4%) or 20 hours/week (33.8%). A quarter of the clinics do not offer consultation hours. Outpatient care needs cannot be met by two-thirds of the institutions. Half of all clinics stated that inpatient paediatric gastroenterology care needs can be met. However, one third cannot cover this and only rarely are there unused capacities. 35 clinics (43.2%) have a further training authorisation according to the state medical association (n=33) and/or are a further training centre of the Society for Paediatric Gastroenterology and Nutrition (GPGE) (n=18)., Conclusion: There is a deficit in both outpatient and inpatient care in paediatric and adolescent gastroenterology. This results, among other things, from the economic framework conditions and a lack of personnel. Well-trained specialists with specialisation in paediatric and adolescent gastroenterology are still needed to provide qualified care throughout the country. Future studies should also include the need for paediatric gastroenterological care from the perspective of other groups, such as affected patients, internal gastroenterologists and paediatricians in private practice., Competing Interests: Die Autoren geben an, dass keine finanziellen Interessenkonflikte bestehen. AK, SB, RM, SS, SD, MC und CP sind Mitglieder der Gesellschaft für Pädiatrische Gastroenterologie und Ernährung (GPGE) e.V.; AK, SB, SS, SD, MC und CP waren zum Zeitpunkt der Umfrage im Vorstand und Beirat der GPGE ehrenamtlich tätig; SH ist bei der GPGE angestellt. CP ist Mitglied der Deutschen Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselkrankeiten (DGVS) und RM beim Bund niedergelassener Gastroenterologen (BNG)., (The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).)

Background and Aims: In recent years, biological agents, such as anti-TNF-α blockers, have been introduced and have shown efficacy in pediatric patients with inflammatory bowel disease (IBD). Here, the prescription mode differentiated into a first/second line application, and efficacy and side effects are evaluated beginning from 2004 until today., Methods: Statistical analyses of the prospective and ongoing CEDATA multicenter registry data from the Society of Pediatric Gastroenterology and Nutrition (GPGE) were performed for patients receiving a biological agent at least once during the period from June 2004 until November 2020 ( n = 487). The analyzed parameters were patient demographics, disease extent and behavior, prior or concurrent therapies, duration and outcome of biological therapy, disease-associated complications, drug-related complications, laboratory parameters and treatment response as determined by the Physician's Global Assessment., Results: Crohn's disease (CD) was present in 71.5% of patients, and 52% were boys. Patients showed high disease activity when receiving a first-line TNF-α blocker. After 2016, patients who failed to respond to anti-TNF-α induction therapy were treated with off-label biologics (vedolizumab 4.3% and ustekinumab 2.1%). Propensity score matching indicated that patients with CD and higher disease activity benefitted significantly more from early anti-TNF-α therapy. This assessment was based on a clinical evaluation and lab parameters related to inflammation compared to delayed second-line treatment. Additionally, first-line treatment resulted in less treatment failure and fewer extraintestinal manifestations during TNF-α blockade., Conclusion: First-line treatment with anti-TNF-α drugs is effective and safe. An earlier start significantly reduces the risk of treatment failure and is associated with fewer extraintestinal manifestations during longitudinal follow-up., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Claßen, de Laffolie, Claßen, Schnell, Sohrabi and Hoerning.)

Objective: Among patients with inflammatory bowel disease (IBD), the risk of thromboembolism (TE) is increased, representing a relevant cause of morbidity and mortality. In contrast to other extraintestinal IBD manifestations, TE receives much less attention because of its low incidence, estimated at merely 0.4-0.9% in hospitalised children with IBD., Methods: Cases with TE, as documented in the German-Austrian Paediatric IBD registry gesellschaft für pädiatrische gastroenterologie und ernährung - large paediatric patient registry (CEDATA-GPGE), were analyzed retrospectively. For all patients with signs of TE, a questionnaire was filled in by the treating paediatric gastroenterologist., Results: Over 10 years, 4,153 paediatric patients with IBD (0-18 years) were registered in the registry, and 12 of them identified with TE. Eight patients were diagnosed with ulcerative colitis (UC), three with Crohn's disease (CD), and one with IBD-unclassified. The median age at IBD diagnosis was 10 years and at the manifestation of TE 13 years, respectively, with a median latency to TE of 2 years. Prevalence of TE was 0.3%, with a significantly higher risk for patients with UC than CD (OR 5.9, CI 1.56-22.33, p = 0.008). More girls than boys were affected (f:m = 7:5) without reaching significance. Approximately 90% of patients experienced TE during active disease, with relevant cerebral and limb involvement in 6/12 patients. Various risk factors, e.g., hospitalisation, coagulopathy, or anaemia were identified. TE management included intensive care and surgery. Among the 12 patients, 11 recovered fully, in which one patient has focal epilepsy as a sequela., Conclusion: Paediatric patients with IBD have a substantially increased risk for TE. Risk factors, such as those identified should be considered when managing paediatric IBD and preventive measures for those hospitalised taken routinely. Initiating pharmacological thromboprophylaxis is challenging for the lack of published trials on efficacy and safety in paediatric IBD but should be considered carefully in each case., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 De Laffolie, Ballauff, Wirth, Blueml, Rommel, Claßen, Laaß, Lang, Hauer and the CEDATA-GPGE Study Group.)

Not available., (© Dustri-Verlag Dr. K. Feistle.)

Background: Despite the introduction of vaccination against rotavirus, and even though it can often be treated on an outpatient basis, acute infectious gastroenteritis is nevertheless the second most common non-traumatic cause of emergency hospitaliza - tion in children aged 1 to 5 years, accounting for approximately 9% of cases (39 410 cases in 2017). The most common path - ogens are viruses (47% rotavirus, 29% norovirus, and 14% adenovirus)., Methods: This review is based on publications retrieved by a selective search in PubMed employing the terms "acute gastro - enteritis children" AND "dehydration" OR "rehydration" OR "prevention," and by manual searching (based, for example, on reference lists and expert knowledge), with subsequent evaluation including consideration of the relevant guidelines., Results: The degree of dehydration can be judged from weight loss and other clinical findings. In 17 randomized controlled trials conducted on a total of 1811 children with mild or moderate dehydration, oral rehydration with oral rehydration solution was just as effective as intravenous rehydration with respect to weight gain, duration of diarrhea, and fluid administration, and was associated with shorter hospital stays (weighted mean difference, -1.2 days; 95% confidence interval [-2.38; -0.02]). Oral rehydration therapy failed in 4% of patients [1; 7]. In children who are vomiting or who refuse oral rehydration solution, continuous nasogastric application is just as effective as intravenous rehydration and is the treatment of first choice., Conclusion: In Germany, children with mild or moderate dehydration are often hospitalized for intravenous rehydration therapy, despite the good evidence supporting ambulatory oral rehydration. Obstacles to intersectoral care, the nursing shortage, and inadequate reimbursement must all be overcome in order to reduce unnecessary hospitalizations and thereby lessen the risk of nosocomial infection.

Epidemiological an clinical observations as well as results from animal studies indicate that nutrition can play a role in the development of inflammatory bowel disease (IBD). Exclusive enteral nutrition therapy represents an example for modulating inflammatory responses solely through diet modification. Therefore, caretakers, patients, families, doctors and nutritionists seek for more dietary options to control IBD. These options include partial enteral nutrition therapy as for example the socalled Crohn's disease exclusion diet. The following statement summarizes existing data and provides recommendations for the current management of enteral nutrition therapy in pediatric Crohn's disease., Competing Interests: PD Dr. med. Jan de Laffolie: Beratertätigkeit für Abbvie, Shire, Autorentätigkeit für Falk, Vortragstätigkeit Nutricia, pharmacosmosDr. med. Martin Claßen: Beratertätigkeit für Nutricia, Milupa, Abbvie, Autorentätigkeit FalkPD Dr. med. Carsten Posovszky: Beratertätigkeit für Nestle, Shire, Abbvie, Vortragstätigkeit Nutricia, Falk, pharmacosmos, Dr. SchärPD Dr. med. Tobias Schwerd: Vortragstätigkeit NutriciaPD Dr. med. Anjona Schmidt-Choudhury: kein COI mit Bezug zum ProjektDr. med Ilse Broekaert: keine COI mit Bezug zum ProjektDipl. oec. troph. Annette Simon: Vortragstätigkeit NutriciaM.sc. Ernährung Maren Pauli: keine COI mit Bezug zum Projekt, (© Georg Thieme Verlag KG Stuttgart · New York.)

Competing Interests: Erklärungen siehe Tabelle.

Objective: We describe school performance and experience in children with inflammatory bowel disease (IBD) across Germany and Austria. Predictors of compromised performance and satisfaction were evaluated to identify subgroups of increased risk., Design: This cross-sectional analysis was based on a postal survey in children aged 10-15 with Crohn's disease, ulcerative colitis or unclassified IBD and their families. Multivariate regression analysis was used to assess influential factors on parental satisfaction with school, attending advanced secondary education (ASE), having good marks and having to repeat a class. Satisfaction was assessed based on the Child Healthcare-Satisfaction, Utilisation and Needs instrument (possible range 1.00-5.00)., Results: Of 1367 families contacted, 675 participated in the study (49.4%). Sixty-eight participants (10.2%) had repeated a year, 312 (46.2%) attended ASE. The median school satisfaction score was 2.67 (IQR 2.00-3.33). High socioeconomic status (SES) and region within Germany were predictive for ASE (OR high SES 8.2, 95% CI 4.7 to 14.2). SES, female sex and region of residence predicted good marks. Grade retention was associated with an active disease course (OR 2.7, 95% CI 1.4 to 5.3) and prolonged periods off school due to IBD (OR 3.9, 95% CI 1.8 to 8.6)., Conclusions: A severe disease course impacted on the risk of grade retention, but not on type of school attended and school marks. Low satisfaction of parents of chronically ill children with the school situation underlines the need for a more interdisciplinary approach in health services and health services research in young people., Competing Interests: Competing interests: None declared.

Purpose: Patient satisfaction is frequently used as a health care quality measure despite methodological challenges. By the example of pediatric inflammatory bowel disease (IBD), we assessed factors associated with low satisfaction and examined differences by type of provider., Patients and Methods: In a cross-sectional design, a 32-item questionnaire and global questioning were used to assess satisfaction in patients aged 15-25 years. Determinants of low satisfaction were identified by logistic regression (OR with 95% CI). Separate models were calculated for patient-related variables such as age, socioeconomic status (SES), health status (emotional, somatic, quality of life) or region of residence (step 1), and impact of provider (pediatric specialist, adult specialist, no specialist) (step 2). As secondary analysis, we studied the effect of additional indicators such as waiting time, consultation time, and an IBD Management Quality Index (IMQI) on effect estimates (step 3)., Results: A total of 567 cases were available for analysis (response 48.2%). The strongest predictors of low satisfaction were anxiety symptoms (OR 2.49, CI 1.14 to 5.45). In step 2, not being seen by a specialist (1.89, 1.16 to 3.10) and having been with the new provider for less than 12 months (1.71, 1.03 to 2.83) were associated with low satisfaction. Satisfaction with adult care provider was similar to pediatric care if adjusted for anxiety, health status, and time with provider (0.95, 0.59 to 1.51). Presence of other quality indicators (step 3), waiting time >30 minutes, consultation time <15 minutes, and low IMQI were all associated with low satisfaction. Age, SES, and region of residence were not found to affect satisfaction in any of the models., Conclusion: Anxiety symptoms were most strongly associated with low patient satisfaction. The relevance of recent provider change and not being seen by a specialist underlines the importance of well-planned transition in this age group., Competing Interests: Disclosure The authors report no conflicts of interest in this work.

Objective: There are inconsistent reports on age-related differences in inflammatory bowel disease (IBD). On the basis of patient information, we describe the clinical presentation and therapy in relation to age at diagnosis in longstanding pediatric IBD., Patients and Methods: Two surveys were conducted in children and young adults (age: 10-25 years) by pretested postal questionnaires. The main analyses are descriptive, showing proportions and distributions per grouped age of diagnosis. Exploratory logistic regression was used to identify sociodemographic and disease-related factors associated with prognosis. Recent disease course, use of biological therapy, and resecting surgery were chosen as indicators of disease severity. Patients with a diagnosis in infancy (<2 years of age) are presented as a case series., Results: Information of 1280 cases was available [804 Crohn's disease (CD), 382 ulcerative colitis (UC), 94 IBD not specified] (response: 44.6 and 49.6%). Stable remission during the preceding year was reported by 675 (56.7%) patients; 825 (60.9%) patients reported feeling currenty well. Anti-tumor necrosis factor therapy was reported by 33% of CD patients and 9.3% of UC patients, immunomodulation in 82.1 and 63.2%, and corticosteroids by 78.4 and 76.1%, respectively (ever use). Age at diagnosis was not associated with indicators of severe disease. Diagnosis in infancy was reported by 37 patients., Conclusion: Our data do not support age at diagnosis-related differences in prognosis in pediatric-onset IBD.

Background: The incidence of inflammatory bowel disease (IBD) in childhood and adolescence is 5-11 cases per 100 000 persons per year, corresponding to a new diagnosis of IBD in 800-1470 patients in Germany each year., Methods: This review is based on pertinent publications retrieved by a selective search in PubMed, including guidelines from Germany and abroad., Results: Children and adolescents with IBD often have extensive involvement and an aggressive course of disease. Nonetheless, infliximab and adalimumab are the only biological agents that have been approved for this group of patients. In Crohn's disease, exclusive enteral nutrition is the treatment of first choice for inducing a remission. Patients with (peri-)anal fistulae are treated primarily with infliximab. Corticosteroids and aminosalicylates should be used with caution. In contrast, children and adolescents with ulcerative colitis are treated with either aminosalicylates or prednisolone to induce a remission. As a rule, maintenance pharmacotherapy with thiopurines in Crohn's disease and severe ulcerative colitis, or with aminosalicylates in mild to moderate ulcerative colitis, is indicated for several years, at least until the end of puberty. Patients with refractory disease courses are treated with methylprednisolone, anti-TNF-α-antibodies, and/or calcineurin inhibitors. The spectrum of surgical interventions is the same as for adults. Specific aspects of the treatment of children and adolescents with IBD include adverse drug effects, the areas of nutrition, growth, and development, and the structured transition to adult medicine., Conclusion: Children and adolescents with IBD or suspected IBD should be cared for by pediatric gastroenterologists in a center where such care is provided. Individualized treatment with multidisciplinary, family-oriented longterm care is particularly important. Drug trials in children and adolescents are needed so that the off-label use of drugs to patients in this age group can be reduced.

Background and Study Aims: The goal of this study was to analyze the bowel cleansing methods currently used for pediatric colonoscopy in terms of effectiveness, tolerance and safety., Patients and Methods: Data from 768 colonoscopies reported by 28 centers were registered in an online database for further analysis. Binary logistic regression was used to determine how preparation methods affected the cleaning effect (Aronchick score) and the rate of adverse events (Aes) and complications., Results: The most frequently reported cleansing agents were sodium picosulphate (54.2 %) and polyethylene-glycol (41.3 %) in various combinations. The cleaning effect was good to excellent in 72.6 % of patients. AEs during the preparation period occurred in 21.5 % of patients. Complications during endoscopy were reported in 12.1 % and were mostly mild. The different agents had no influence on the cleaning effect. In contrast the risk of AEs during preparation was significantly increased when polyethylene-glycol was used (odds ratio (OR) 2.112, P = 0.002) but reduced with the use of sodium picosulphate (OR 0.380, P < 0.001). In particular, the risk of needing a nasogastric tube to complete clean-out was about 10-fold higher when polyethylene-glycol was used., Conclusions: A large variety of regimens are used for bowel preparation in children. We found a good overall cleaning result independent of the agents used. Cleansing agents, on the other hand, had a significant influence on tolerance and safety.