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Extramural langzeitbeatmete Kinder und Jugendliche sind trotz fortlaufender Steigerung der Pravalenz noch immer selten, und die Grunderkrankungen sind sehr vielseitig. Die groste Gruppe bilden neuromuskulare Erkrankungen. Fur diese Patienten ist die nichtinvasive oder invasive Beatmung in sich rehabilitativ, insbesondere wenn ein kompetentes Uberleitmanagement auf die optimale Teilhabe und Kommunikation abzielt sowie durch Schulung Sicherheit im Alltag und in Notfallen generiert. Durch fortlaufende Betreuung am Kompetenzzentrum sollte eine etwaige Moglichkeit fur ein Weaning bzw. eine Dekanulierung evaluiert und leitliniengerecht genutzt werden. Neben einer ambulanten rehabilitativen Betreuung besteht gerade bei komplexeren Krankheitsbildern und auch bei Palliativpatienten Bedarf an stationarer medizinischer Rehabilitation. Die Patienten sollten in einem stabilen Zustand sein, und die respiratorische Sicherheit sollte gegeben sein, oft unterstutzt durch eine gut geschulte, vertraute Begleitperson. Die Rehabilitationsziele sollten definiert und realistisch sein. Bei schwer erkrankten Patienten setzt die Erreichung nicht nur ein breit gefachertes biopsychosoziales Therapieangebot voraus, sondern ist auch eine Frage der personellen Ressourcen und Kompetenzen der Klinik und damit von Tagessatzen, die die hoheren Kosten decken.

Objective: Treatment of paediatric obesity focuses on changes of nutrition and eating behaviour and physical activity. The evaluation of the patient education programme by KgAS was utilised to analyse the association of changes of portion size, eating rate and dietary habits with BMI-SDS reductions. Methods: Patients (n = 297) were examined at the beginning and at the end of treatment and after 1-year follow-up at different out-patient centres. Their parents completed questionnaires including estimation of children's portion size, eating rate and frequency of food intake. Associations of 1- and 2-year changes in BMI-SDS and behaviour were calculated for patients with complete data in BMI-SDS, portion size, eating rate, frequency of green, yellow and red food intake (n = 131) by multiple linear regression models. Results: Significant changes were found in the desired direction for BMI-SDS, portion size, eating rate and the intake of unfavourable red food items both after 1 and 2 years as well as for the consumption of favourable green food items after 1 year. Significant positive associations with BMI-SDS reduction after 1 and 2 years were detected for portion size (Cohen's f2 0.13 and 0.09) and eating rate (Cohen's f2 0.20 and 0.10), respectively. Conclusion: Reduced portion sizes and eating rates are associated with BMI-SDS reduction after 1 and 2 years. These findings suggest to focus on appropriate portion sizes and reduced eating rates in patient education programmes.

The comparison of patient-bases, approaches, social support and results of pediatric long-term home ventilation (LTHV) requires the collection of detailed data and careful analysis. In 2016, Italian centers established a national network of hospitals that deal with LTHV. The central purpose was to describe the variation in indications, approaches, structures and policies between different places in Italy. A documentation tool, the Ve.Do. Piccolo database, was developed for children on LTHV. The inclusion criteria were pediatric age (0-18 years) and mechanical ventilation at home for at least three months and six hours per day. By 1.12.2018 the database included 436 patients from 12 Italian hospitals. The age at initiation of ventilation and at last data point was 6 (1-13) years and 12 (5,6-17,3) years respectively (median, IQR). The distribution of underlying diseases is shown in Figure 1. Details on the indication, interface, ventilatory modes, settings, duration, home and social support are presented. We have shown that multi-center data collection is feasible and informative. As a next step we aim to extend data collection to European centers outside of Italy. A large participating European network of LTHV centers could improve standardization and quality of care through benchmarking.

Zusammenfassung Hintergrund: Die Beobachtungsstudie zur Evaluation ambulanter und stationärer Versorgung zur Behandlung der Adipositas im Kindes- und Jugendalter in Deutschland (BZgA-Studie) zeigte in einer breiten Angebotspalette sehr heterogene Therapieadhärenz und Ergebnisse. Es soll gezeigt werden, welche Ergebnisse durch ein homogenes, leitliniengerechtes, ambulantes Programm der Konsensusgruppe Adipositasschulung für Kinder und Jugendliche e. V. (KgAS) in der multizentrischen Anwendung erzielt warden können. Methode: 8–16-jährige adipöse Patienten und ihre Familien wurden an 14 Standorten in Deutschland ein Jahr ambulant nach dem KgAS-Programm in einer Gruppenschulung behandelt. Neben einem Fragebogen zur Lebensqualität wurden zu Therapiebeginn (T0) und -ende (T1) sowie ein Jahr später (T2) BMI, Blutdruck und Adipositas-relevante Laborwerte von den Patienten erhoben. Die Analyse erfolgte sowohl für Fälle mit vollständigen Daten als auch mit Baseline observation carried foreward (BOCF)-Methode für Patienten mit fehlenden Daten. Ergebnisse: Der BMI der 297 Patienten lag zu T0 im Mittel bei 28,7 kg/m², bzw. +2,37 SDS, 13,2 % übergewichtig, 55,8 % adipös, 31,0 % extrem adipös. Das mittlere Alter betrug 11,7 Jahre, 52,1 % waren weiblich und einen Migrationshintergrund hatten 34,7 % der Patienten. Zu T1 konnten 97 % der Patienten untersucht werden, zu T2 59 %. Der BMI-SDS reduzierte sich bis T1 signifikant (für vollständige Daten von +2,32 auf +2,03 zu T1 und +2,07 zu T2 und BOCF +2,37 [T0], 2,14 [T1] und 2,22 [T2]). Die Hypertonieprävalenz verminderte sich kurz- und langfristig signifikant (für vollständige Daten N=103, p Schlussfolgerung: Die KgAS-Studie weist mit einem standardisierten Programm in der multizentrischen Durchführung für alle dargestellten Behandlungsziele signifikante Verbesserungen nach: Übergewichtsreduktion, Reduktion von kardiovaskulären Risikofaktoren sowie positive Veränderungen der Lebensqualität.

Background: Population-based data on pediatric patients on long-term respiratory support (LTRS) in Austria are lacking. This study aimed to record the pediatric departments active in this field, as well as number and characteristics of patients on LTRS. Methods: A national cross-sectional study was carried out by means of questionnaires sent to all pediatric departments in Austria. Results: All departments answered to the questionnaires. On June 1st, 2013, the reference day for this study, 12 of the 41 pediatric departments in Austria were active in the field. At this time, these centers were caring for 143 patients, 111 (77.6%) of them under 18 years, which corresponds to a prevalence of 7.4 per 100 000. The patients suffered from neuromuscular disorders (44%), other neurological disorders (18.9%), disorders of respiratory drive (9.1%), obstructive sleep apnea (8.4%), thoracal and spinal diseases (8.4%), pulmonary disorders (4.9%) and other diseases (6.3%). Continuous positive airway pressure was used in 6.3%, non-invasive ventilation in 60.1% and invasive ventilation in 33.6% of the patients, respectively. LTRS was performed at home in 92.3%. Conclusion: LTRS represents a common management strategy in children and adolescents with a variety of disorders. Census reports such as this one provide the basis for appropriate planning of resource allocation. The age distribution of our patients shows the need for structured transition into adult care.

There have been numerous reports on association between attention-deficit/hyperactivity disorder (ADHD) and overweight/obesity in children and adolescents; however, most studies adjusted only for a limited number of possible confounders. We analyzed the data of 11 159 six through seventeen-year-old participants in the German Health Interview and Examination Survey for Children and Adolescents. We determined weight status based on measured anthropometry and national reference data by International Obesity Task Force criteria. The parent-rated hyperactivity/inattention subscale of the Strengths and Difficulties Questionnaire (SDQ-HI) was used as a continuous measure of ADHD symptoms. We examined whether the putative confounders socioeconomic status, migrant status, parental body mass index (BMI) and parental smoking were associated with both SDQ-HI and overweight/obesity. Associations between SDQ-HI and overweight/obesity vs normal weight were analyzed by binary logistic regression analyses. In the first model, we adjusted for age and sex only and in the second model also for the parental confounders. SDQ-HI was associated with an increased risk for overweight/obesity in both sexes adjusting for age and sex. However, after adjusting for all confounders SDQ-HI was associated with an increased risk for overweight/obesity only in adolescent females. Socioeconomic status, parental BMI and parental smoking each were relevant confounders. Migrant status was also significantly associated with both SDQ-HI and overweight/obesity, thus qualifying as a confounder but contributed only weakly to the association. The association between ADHD symptoms and overweight/obesity is due to confounding by family background variables in all but adolescent girls. Possible reasons for the increased risk for overweight/obesity in this subgroup are discussed. We also propose possible mechanisms for confounding by parental socioeconomic status, BMI and smoking.

BACKGROUND The considerable increase of obesity in children and adolescents poses a major challenge to the health care system. METHODS In an observation study of the Bundeszentrale fur gesundheitliche Aufklarung (BZgA) somatic data of 1916 overweight and obese children and adolescents aged 8-17 years were compared to data of 7 451 normal weight children and adolescents (KiGGS). Age, sex, body weight, height, BMI-SDS, blood pressure, and lipids were analyzed. Body weight was assessed using the BMI categories of the Arbeitsgemeinschaft Adipositas im Kindes- und Jugendalter (AGA) guidelines. Blood pressure measurements were given as above 95 (th) percentile and categorized according to the classification of the European Society of Hypertension (ESH). In addition blood pressure in BZgA-patients were estimated as above 95 (th) percentile by age, sex and height in German normal weight children and adolescents. Lipid values were evaluated according to American Heart Association specifications. RESULTS Out of the participants of BZgA-study 14% were overweight, 48% obese, and 38% extremely obese. Blood pressure values were above the 95 (th) percentile (ESH) in 35%. The blood pressure in normal weight participants of the KiGGS-study were elevated in 5%. Total cholesterol of BZgA-patients was elevated in 13%, LDL-cholesterol was elevated in 13%, HDL-cholesterol was low in 7%, and triglycerides in the fasting state were elevated in 12%. CONCLUSIONS The rising prevalence of cardiovascular risk factors in children and adolescents with increasing BMI category requires effective strategies for prevention and treatment of obesity.

BACKGROUND: In recent years, the prevalence of overweight and obesity in children and adolescents has markedly increased. Even though numerous treatment options are available for patients, these are heterogeneously structured and insufficiently evaluated. PATIENTS: In this initial report of specific therapy under routine care circumstances, data from 1916 patients aged 8-16.9 years were analyzed. Patients were characterized based on cluster of therapy, sociodemographic, psychosocial and medical features. Furthermore, the quality of care procedures with regard to the diagnosis of comorbidities was analyzed. RESULTS: At initial medical examination mean patient BMI-SDS was +2.43 and mean age was 12.6 years. 43.3% of patients were male. The mean duration of treatment was 6.1 months (55% outpatient, 45% inpatient care setting). 14% of patients were overweight, 48% obese and 37% were extremely obese. In 51% of the patients we could find already comorbidities. Parental BMI was related to patient's BMI. Socioeconomic status was reduced compared to general population. CONCLUSION: In this nationwide, pioneer multicentre observational study initiated by Federal Centre for Health Education (BZgA) in Germany, different therapeutic approaches were compared by examining somatic and psychosocial variables. The short- and long-term effects of different weight reduction programs on BMI-SDS, nutritional- and physical activity habits as well as quality of life and comorbidity will be examined at the end of therapy. Two follow-up assessments are planned for one and two years after the intervention ended.

Although inpatient lifestyle treatment for obese children and adolescents can be highly effective in the short term, long-term results are unconvincing. One possible explanation might be that the treatment takes place far from parents' homes, limiting the possibility to incorporate the parents, who play a major role in establishing and maintaining a healthy lifestyle in childhood and adolescence. The main goal was to develop a brief behaviorally oriented parent training program that enhances 'obesity-specific' parenting skills in order to prevent relapse. We hypothesized that the inclusion of additional parent training would lead to an improved long-term weight course of obese children. Parents of obese children (n = 686; 7-13 years old) either participated in complementary cognitive-behavioral group sessions (n = 336) or received written information only (n = 350) during the inpatient stay. Children of both groups attended multidisciplinary inpatient rehabilitation. BMI-SDS as a primary outcome was evaluated at baseline, post-intervention and at 6- and 12-month follow-up. Intention-to-treat (ITT) as well as per-protocol analyses (PPA) were performed. A significant within-group decrease of 0.24 (95% CI 0.18 to 0.30) BMI-SDS points from the beginning of the inpatient stay through the first year was found, but no group difference at the one-year follow-up (mean difference 0.02; 95% CI -0.04 to 0.07). We also observed an increase in quality of life scores, intake of healthy food and exercise for both groups, without differences between groups (ITT and PPA). Thus, while the inpatient treatment proved highly effective, additional parent training did not lead to better results in long-term weight maintenance or to better psychosocial well-being compared to written psycho-educational material. Further research should focus on subgroups to answer the question of differential treatment effects.

Introduction Inpatient rehabilitation is an important contributor to the treatment of child and adolescent obesity with comorbidity in Germany. Thus far outpatient follow-up care has not been subject to research. The main goal of this study is the development and longer-term evaluation of a programme for structured outpatient follow-up care by primary care physicians after inpatient rehabilitation of obese children and adolescents. Methods This multicentre, randomized, parallel controlled clinical trial enrolled 521 children and adolescents aged 9 - 16 (avg. 13.3) years in 7 cooperating specialized rehabilitation facilities. The patients were randomized at the end of their multimodal inpatient treatment that lasted for 5.9 (+/- 1.2) weeks. The intervention consisted of 12 half-hour outpatient consultations by the primary care physicians utilizing a modular consultation guideline and an internet-based training programme. The control group received standard care. Outcome variables included anthropometric measures, questionnaires on eating behaviour, physical activity, quality of life, self-efficacy and subjective rating of the intervention. Measurements were performed at the beginning (t1) and end (t2) of inpatient rehabilitation as well as 6 (t3) and 12 (t4) months after discharge. Results There was a highly significant improvement of BMI-z-score (standard deviation score of the Body Mass Index), relevant behaviour, quality of life and self-efficacy between t1 and t4. On intention to treat analysis no differences were detected between intervention and control groups. The intervention was utilized by only 50 % of entitled. The BMI-z-score reached a minimum at t3 (6-month follow-up). Predictors of longer-term BMI-z-score decline were psychological suffering, poor eating behaviour, low physical activity and high socio-economic status. In multivariate linear regression improvement of eating behaviour and physical activity correlated with the improvement of BMI-z-score. Discussion This low-level outpatient intervention did not improve the demonstrated longer-term effectiveness of inpatient rehabilitation. An interdisciplinary outpatient follow-up care in groups with inclusion of the parents is recommended.

ZsuammenfassungIn den letzten Jahren sind von der Arbeitsgemeinschaft Adipositas im Kindes- und Jugendalter (AGA) der Deutschen Adipositas-Gesellschaft Leitlinien für Diagnostik, Therapie und Prävention der Adipositas im Kindes- und Jugendalter entwickelt worden. Zur Vervollständigung dieser Leitlinien im Bereich der Patientenschulung wurde die Konsensusgruppe Adipositasschulung (KGAS) gegründet. Über 20 Institutionen erarbeiteten konsensual den Rahmen für ein interdisziplinäres Trainingskonzept. Hauptziel der Schulung ist eine stabile Veränderung des Ess-, Ernährungs- und Bewegungsverhaltens, die es den Betroffenen langfristig erlaubt, ihr Übergewicht und Risiko für Folgeerkrankungen zu reduzieren. Die Schulung im ambulanten Setting (Zeitraum 12 Monate) umfasst ca. 36 Unterrichtseinheiten zu den Bereichen Medizin, Psychosoziales und Ernährung sowie ca. 50 Einheiten körperliche Aktivität und Sport. Wichtig sind handlungsrelevante Themen und praktische Übungen. Eine stationäre Schulung kann eine andere zeitliche Aufteilung haben. Zu jeder Einheit wurden Empfehlungen für anzustrebende Ziele, Methodik, Didaktik und Unterrichtsmaterial erarbeitet. Dieses Konzept soll multizentrisch evaluiert werden.