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Analyzing COVID-19-related stress in children with affective dysregulation (AD) seems especially interesting, as these children typically show heightened reactivity to potential stressors and an increased use of maladaptive emotion regulation strategies. Children in out-of-home care often show similar characteristics to those with AD. Since COVID-19 has led to interruptions in psychotherapy for children with mental health problems and to potentially reduced resources to implement treatment strategies in daily life in families or in out-of-home care, these children might show a particularly strong increase in stress levels. In this study, 512 families of children without AD and 269 families of children with AD reported on COVID-19-related stress. The sample comprised screened community, clinical, and out-of-home care samples. Sociodemographic factors, characteristics of child and caregiver before the pandemic, and perceived change in external conditions due to the pandemic were examined as potential risk or protective factors. Interestingly, only small differences emerged between families of children with and without AD or between subsamples: families of children with AD and families in out-of-home care were affected slightly more, but in few domains. Improvements and deteriorations in treatment-related effects balanced each other out. Overall, the most stable and strongest risk factor for COVID-19-related stress was perceived negative change in external conditions—particularly family conditions and leisure options. Additionally, caregiver characteristics emerged as risk factors across most models. Actions to support families during the pandemic should, therefore, facilitate external conditions and focus on caregiver characteristic to reduce familial COVID-19-related stress. Trial registration: German Clinical Trials Register (DRKS), ADOPT Online: DRKS00014963 registered 27 June 2018, ADOPT Treatment: DRKS00013317 registered 27 September 2018, ADOPT Institution: DRKS00014581 registered 04 July 2018.

The Patient-Reported Outcome Measurement Information System (PROMIS®) is a National Institutes of Health (NIH)-funded initiative to develop reliable, valid, and normed item banks to measure health. We describe the first large-scale translation and cross-cultural adaptation effort to German and Spanish of eight pediatric PROMIS item banks: Physical activity (PAC), subjective well-being (SWB), experiences of stress (EOS), and family relations (FAM). We utilized methods outlined in the International Society for Pharmacoeconomics and Outcomes Research (ISPOR) PRO Translation Task Force recommendations. Ten professional translators performed a translatability assessment and generated forward translations. Forward Translations were compared within a country and cross-culturally to identify problems and to produce a consensus-derived version, which was then back translated, evaluated, and revised where necessary. Reconciled versions were evaluated in cognitive interviews with 126 children before finalization. Eight resulting pediatric PROMIS® item banks were translated: Two PAC banks (22 total items), three SWB banks (125 total items), two EOS banks (45 total items), and one FAM bank (47 total items). Up to 92% of all items raised no or only minor translation difficulties, 0–5.6% were difficult to translate. Up to 20% item revisions were necessary to ensure conceptual equivalence and comprehensibility. Cognitive interviews indicated that 91–94% of the final items were appropriate for children (8–17 years). German and Spanish translations of eight PROMIS Pediatric item banks were created for clinical trials and routine pediatric health care. Initial translatability assessment and rigorous translation methodology helped to ensure conceptual equivalence and comprehensibility. Next steps include cross-cultural validation and adaptation studies.

We examined whether there are certain dysregulation profile trajectories in childhood that may predict an elevated risk for mental disorders in later adolescence. Participants (N = 554) were drawn from a representative community sample of German children, 7–11 years old, who were followed over four measurement points (baseline, 1, 2 and 6 years later). Dysregulation profile, derived from the parent report of the Strengths and Difficulties Questionnaire, was measured at the first three measurement points, while symptoms of attention deficit hyperactivity disorder (ADHD), anxiety and depression were assessed at the fourth measurement point. We used latent class growth analysis to investigate developmental trajectories in the development of the dysregulation profile. The predictive value of dysregulation profile trajectories for later ADHD, anxiety and depression was examined by linear regression. For descriptive comparison, the predictive value of a single measurement (baseline) was calculated. Dysregulation profile was a stable trait during childhood. Boys and girls had similar levels of dysregulation profile over time. Two developmental subgroups were identified, namely the low dysregulation profile and the high dysregulation profile trajectory. The group membership in the high dysregulation profile trajectory (n = 102) was best predictive of later ADHD, regardless of an individual’s gender and age. It explained 11% of the behavioural variance. For anxiety this was 8.7% and for depression 5.6%, including some gender effects. The single-point measurement was less predictive. An enduring high dysregulation profile in childhood showed some predictive value for psychological functioning 4 years later. Hence, it might be helpful in the preventive monitoring of children at risk.

Epilepsy in a child or adolescent can have severe psychosocial impact on the whole family and burdens them, especially the parents. As the familial background is essential for the child's coping and the progression of the epilepsy, parental burden should be considered within a comprehensive treatment approach. This study validated the applicability of the Impact on Family Scale (IOFS), a well-established instrument that assesses the strains of families with chronically ill or disabled children, in parents of children with epilepsy. In a sample of 219 parents, the psychometric properties of the original IOFS version (33 items) and two short forms (15 and 11 items, respectively) were examined. Both short forms revealed good reliability (Cronbach's alpha, test-retest reliability), and construct validity was verified by correlations with epilepsy-and burden-related variables. However, exploratory and confirmatory factor analyses indicated superior characteristics of the short form with 11 items (IOFS-11). In conclusion, the IOFS-11 as well as the IOFS-15 proved to be practicable, reliable, and valid tools to assess the impact of childhood epilepsy on family life in research and clinical practice. (C) 2014 Elsevier Inc. All rights reserved.

Die Epilepsie eines Kindes oder Jugendlichen kann zu starken psychosozialen Belastungen bei den Eltern fuhren. In der vorliegenden Studie wurde untersucht, ob eine Kurzfassung der deutschsprachigen Version der Impact-on-Family Scale [Familien-Belastungs-Fragebogen, FaBel] geeignet ist, diese Belastungen reliabel und valide zu erfassen. An einer Stichprobe von 219 Eltern mit epilepsiekranken Kindern [Mittelwert (M) = 8,7 Jahre; Standardabweichung (SD) ±5,0 Jahre] wurde eine Kurzform des FaBel mit 11 “items“ (FaBel-11) psychometrisch uberpruft und mit der Langversion des FaBel (33 Items) verglichen. Angaben zur Epilepsie des Kindes und zu spezifischen Beeintrachtigungen der Eltern wurden mit einem Elternfragenbogen erfasst („PESOS-Elternkurzfragebogen“). Die Kurzform FaBel-11 wies eine gute Reliabilitat (α = 0,91) und faktorielle Validitat (exploratorische und konfirmatorische Faktorenanalyse) auf. Die Konstruktvaliditat wurde durch erwartungskonforme signifikante Zusammenhange mit epilepsie-, krankheits- bzw. belastungsbezogenen Variablen (z. B. Anfallshaufigkeit, Schwerbehindertenausweis, Komorbiditat und Verhaltensauffalligkeiten des Kindes) nachgewiesen. Der FaBel-11 scheint geeignet, die Belastungen von Eltern mit epilepsiekranken Kindern zuverlassig zu erfassen.

Die randomisierte kontrollierte Studie (RCT) gilt als Goldstandard zur Gewinnung angemessener Evidenz für Therapieentscheidungen. Idealtypische Studien werden auch als Explanatory Trials bezeichnet, um sie von Studien unter Alltagsbedingungen (Pragmatic Trials) zu unterscheiden. Bei Einhaltung aller für die Durchführung dieser Studien geforderten Qualitätskriterien können die vier wesentlichen Formen systematischer Fehler (Selection Bias, Performance Bias, Attrition Bias und Detection Bias) vermieden und die interne Validität von Studien gewährleistet werden. Wenn die interne Validität einer Studie bestätigt wird, ist davon auszugehen, dass die innerhalb der Studie angestellten Vergleiche weitgehend frei von systematischen Fehlern sind. Die externe Validität besagt, dass in einer Studie di e Eigenschaften der Grundgesamtheit reflektiert werden, für welche die Ergebnisse der Studie gültig sein sollen. Da eine gute randomisierte Studie eine möglichst exakt definierte und homogene Population von Probanden enthält, kann sie per definitionem nahezu keine externe Validität, d. h. externe Gültigkeit, haben. Der Nachweis der externen Validität ist aber ebenso bedeutend wie der Nachweis der internen Validität, weil Erkenntnisse, die in randomisierten Studien gewonnen werden, nur wertvoll sind, wenn sie auch bei Patienten unter Alltagsbedingungen mit Erfolg angewandt werden können. Eine Verletzung dieser letztgenannten Forderung wird auch als Sampling Bias bezeichnet. Zur Gewährleitung der internen und externen Evidenz scheint ein Zwei-Schritt-Verfahren sinnvoll. Im ersten Schritt wir d die Wirkung eines Therapieprinzips idealtypisch in einem Explanatory Trial ohne Anspruch auf externe Validität nachgewiesen. Im zweiten Schritt wird der Nutzen für die untersuchten Patientengruppen unter Alltagsbedingungen (Pragmatic Trial) geprüft. Designs und etablierte Methoden zur Auswertung dieser Studien werden diskutiert. Das Zwei-Schritt-Verfahren bietet gegenüber den bisherigen Verfahren drei Vorteile: Das Risiko, die Ergebnisse von RCTs zu überinterpretieren, wird reduziert, weil Explanatory Trials lediglich die Wirkung unter Idealbedingungen nachweisen können. Der vom Gesetzgeber geforderte Nachweis des Nutzens kann durch Pragmatic Trials, welche die externe Validität berücksichtigen, erbracht werden. Möglicherweise lassen sich Fortschritte des Erkenntnisgewinns nur erzielen, wenn in kontrollierten pragmatischen Studien Methoden angewandt werden, bei denen der Einfluss der beabsichtigten Intervention (Therapie) mit jenem unbeabsichtigter Interventionen (Confounder) verglichen wird. Beispiele solcher Methoden sind das Propensity Score Matching und Strukturgleichungsmodelle. Die Entscheidung über die ideale Auswertungsmethode ist von den Bedingungen und den Variablen der Studie abhängig.

The first European Society of Cardiology (ESC) guidelines on atrial fibrillation (AF) developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS) were published in August 2016. These guidelines replace the revised guidelines from 2012 and contain some interesting new aspects. The topics range from the pathophysiology through diagnostics, therapy and stroke prevention up to special clinical situations, such as atrial fibrillation in cardiopathy, sport and pregnancy. Early screening, patient informed consent, individualized therapy and the modification of factors promoting atrial fibrillation are of particular importance. The guidelines recommend the establishment of AF heart teams, containing specialists from various disciplines. The guidelines also underline the importance of non-vitamin K‑dependent oral anticoagulants (NOAC) for stroke prevention compared to standard anticoagulants with vitamin K antagonists. For symptomatic and especially paroxysmal atrial fibrillation, the guidelines emphasize the importance of an antiarrhythmic treatment with catheter ablation and/or pharmaceutical antiarrhythmic therapy in addition to a frequency regulating therapy.

Human atrial electrophysiology exhibits high inter-subject variability in both sinus rhythm (SR) and chronic atrial fibrillation (cAF) patients. Variability is however rarely investigated in experimental and theoretical electrophysiological studies, thus hampering the understanding of its underlying causes but also its implications in explaining differences in the response to disease and treatment. In our study, we aim at investigating the ability of populations of human atrial cell models to capture the inter-subject variability in action potential (AP) recorded in 363 patients both under SR and cAF conditions.

ZusammenfassungDie Entstehung von Vorhofflimmern (VHF) ist eng verbunden mit Risikofaktoren wie Hyper-tonie und Herzinsuffizienz, ferner mit Diabetes mellitus, Herzinfarkt und Herzklappenerkrankungen. Diese Faktoren überlappen teilweise mit denjenigen, die für das Fort-schreiten des VHF und für Schlaganfälle verantwortlich sind. Für die Vorhersage einer Progression von paroxysmalem zu permanentem VHF ist der HATCH-Score (Herzinsuffizienz, Alter, TIA oder Schlaganfall in der Vorgeschichte, chronisch-obstruktive Lungenerkrankung und Hypertonie) vorgeschlagen worden. Der CHADS2-Score wurde in den Leitlinien der Europäischen Gesellschaft für Kardiologie von 2010 erweitert.Für die Blutungsbereitschaft spielen teilweise die gleichen Risikofaktoren eine Rolle, die zur Entstehung von VHF führen und das Risiko von Schlaganfällen und TIA bestimmen. Auch wenn die Punktesysteme zur Vorhersage von Ereignissen in größeren Populationen entwickelt worden sind, haben sie zunehmende Bedeutung zur Risikoabschätzung im Einzel-fall erlangt. Auf diese Weise stellen sie eine Hilfe auf dem Weg zu einer besseren Implementierung der oralen Antikoagulation und der Beeinflussung der zum VHF führenden Faktoren in der täglichen Praxis dar.

Frauen vor der Menopause sind seltener von kardiovaskularen Ereignissen betroffen als Manner. Die Unterschiede gehen aber nach der Menopause zunehmend verloren. In epidemiologischen Untersuchungen geht die Ostrogenbehandlung typischer Postmenopausenbeschwerden mit gunstigen Effekten auf die koronare Herzkrankheit (KHK) einher. Die Uberprufung in prospektiven, randomisierten Interventionsstudien ergibt jedoch keinen Hinweis auf Protektion gegenuber kardiovaskularen Ereignissen durch eine langfristige Ostrogentherapie. Stattdessen nimmt das Risiko fur KHK in Abhangigkeit vom Beginn der Therapie nach der Menopause sogar zu wie auch das Risiko fur Schlaganfall und Lungenembolien. Fur Phytoostrogene oder synthetische Steroide mit Ostrogenwirkung (z. B. Tibolon) sind keine praventiven Effekte nachgewiesen. Auch Raloxifen, ein selektiver Ostrogenrezeptormodulator (SERM), lasst keinen protektiven Effekt auf das KHK-Risiko erkennen. Eine Hormonersatztherapie (HET) zur Prophylaxe kardiovaskularer Ereignisse kann deshalb nicht empfohlen werden. Wegen des erhohten Mammakarzinomrisikos sollten Hormone in der Postmenopause nur zur Behandlung schwerer Menopausensymptome eingesetzt werden.

ObjetivosObtener una versión española del cuestionario KINDL transculturalmente equivalente a la versión original alemana, y evaluar sus propiedades psicométricas en una muestra de padres y de niños/adolescentes sanos de 8–16 añosDiseñoEstudio transversalEmplazamientoDos colegios públicos de EGB y ESO de la cuenca minera central de Asturias de similares condiciones sociodemográficasParticipantesUn total de 243 niños de 8-16 años y 153 padresMediciones principalesCalidad de vida relacionada con la salud (CVRS) valorada mediante la versión adaptada del cuestionario alemán KINDL. Adicionalmente, se realizó una valoración externa de la CVRS infantil a través de un grupo de padres de los alumnos. También se comprobaron las propiedades psicométricas de la versión española adaptadaResultadosSólo 6 ítems (6/24) necesitaron sucesivas traducciones y discusión conceptual durante la fase de adaptación idiomática. El análisis factorial confirmó la validez de construcción de las escalas, excepto en la dimensión “Escuela” de la versión 13–16 años. La consistencia interna, medida mediante el coeficiente α de Cronbach, fue buena para el total del cuestionario (> 0,70) y aceptable en la mayoría de las escalas (> 0,50). El sexo femenino y la mayor edad de los niños se correspondieron con peores puntuaciones de CVRS en la mayoría de las dimensiones investigadas (p < 0,01)ConclusionesLa versión española del KINDL presentó coeficientes de fiabilidad y validez aceptables. Se encontraron insuficiencias puntuales en este primer paso de la investigación en la escala “Escuela” entre adolescentes. Los resultados constituyen un importante punto de partida para disponer de un instrumento de medida de la CVRS infantil, en lengua españolaObjectivesTo obtain a first Spanish version of the KINDL questionnaire idiomatic and culturally equivalent to the German original version, and then to evaluate its psychometric properties in a sample of healthy children/adolescents 8-16 years old, and their parentsDesignCross-sectional studySetting2 public schools of Asturias of similar sociodemographic conditionsParticipants243 children 8–16 year-old, and 153 parents were investigatedMain measurementsHRQoL evaluated through the generic questionnaire KINDL. An external assessment through the parents was made as well. The psychometric properties of the Spanish version of the questionnaire were investigated and results on HRQoL are presented for different ages and gender in the Spanish sampleResults6 ítems (6/24) needed successive translations and conceptual discussion during the phase of idiomatic adaptation. The factorial analysis confirmed the validity of construction of the instrument for most scales. The internal consistency, measured by αCronbach coefficent, was good for the total of the questionnaire (>0.70) and acceptable in most of the scales (>0.50). Only the school scale for adolescents shows very poor reliability. Females and children with higher age scored lower in most of the investigated dimensions (P

In Public Health, an outlook developed emphasising the importance of assets and protective factors in addition to stress and risk factors. The study aimed at the development of a brief, multidimensional questionnaire to assess protective factors for the mental health of children and adolescents. This questionnaire was to be tested as a self-report survey instrument. In a random sample consisting of 883 children and adolescents aged 11 to 17 years scales already validated in empirical research as well as questions newly developed from aspects of protective factors identified in the literature were applied in a written questionnaire. Three dimensions, covering social, personal and family assets, could be identified from the items by factor analysis. The resulting scales for the assessment of protective factors were analysed for their psychometric characteristics. Mental health and health-related quality of life served as validation criteria. The protective factors proved to significantly influence these outcomes in regression analyses, showing a proportion of explained variance of up to 53 %. The child and adolescent self-report measure presented is apt to give a picture of protective factors for mental health representing the three dimensions of social, personal, and family assets.

Since 1971 routine child health check-ups allow the routine identification of dis-eases in children and adolescents. Paediatricians play a central role in health prevention in childhood and adolescence and are - on account of their acceptance and admission requirements - important actors in child protection. Thus, paediatric practitioners were actively involved in the invitation and reporting system for the routine child health check-ups (U6 and U7), which was introduced to increase participation rates and improve child protection in Hamburg.By means of a questionnaire survey, all paediatric practitioners practicing in Hamburg were asked a year after introduction of the invitation and reporting system to report on their practical experience, and to share their assessment and criticism of the system (response rate 73%).Out of 110 participating pediatricians (M=19.5 years practical experience), 81% evaluated the invitation and reporting system as very useful, useful or rather useful; 83% supported an expansion of the system for routine child health check-ups, and about 18% observed an increased utilisation of routine child health check-ups especially from families with a migrant background and by socially-disadvantaged families. Criticism was made concerning ineffective procedures.The invitation and reporting system for routine child health check-ups in Hamburg shows how pediatricians can be integrated into the network of prevention and child welfare. It also shows their support of this system. Paying more systematic attention and an interdisciplinary network connecting paediatricians may contribute to a more comprehensive prevention and child protection.

Child and adolescent mental health problems burden not only the individual, but also their families and their social environment and may, therefore, be regarded as a highly relevant public health issue. The data on mental health problems of children and adolescents from the KiGGS Wave 1 study (sample period 2009-2012) make it possible to report on both current prevalence rates and time trends over the 6-year period beginning with the KiGGS baseline survey (2003-2006). The assessment of emotional and behavioral problems in KiGGS Wave 1 was carried out with the symptoms questionnaire of the Strengths and Difficulties Questionnaire (SDQ) in a telephone interview with 10,353 guardians of children and adolescents aged 3-17 years. Moreover, using the SDQ impact supplement, the KIGGS Wave 1 data provide information on psychosocial impairment following child and adolescent mental health problems. Subjects with a borderline or abnormal SDQ score, according to German normative data, were considered at risk. A total of 20.2% (95% CI: 18.9-21.6%) of the study subjects were identified as being at risk for a mental health disorder, compared with 20.0% (19.1-20.9%) during the KiGGS baseline study (age-standardized based on population from 12 December 2010). Thus, no significant changes over time in the prevalence of mental health problems were detected. Also, there were no statistically significant differences in prevalence by sex, age group, or socioeconomic status between the KiGGS baseline survey and KiGGS Wave 1. The statistical comparison of the subscale mean values for both girls and boys showed higher values with respect to the subscales for emotional problems, behavioral problems, and prosocial behavior and lower mean values for the peer problems subscale in KiGGS Wave 1. These partly small temporal trends, however, may be due to possible mode effects (written questionnaire in the KiGGS baseline study versus telephone interview in KiGGS Wave 1). The hyperactivity subscale remained stable across the two sample periods. Regarding impairments following mental health problems at the second sample period, boys were more affected in the areas of chronicity, family burden, and impact score. The high and stable prevalence rates and magnitude of emotional and behavioral problems should prompt increased preventive efforts.

The members of the Task Force on Sudden Death dedicate this paper to the memory of our former friend and colleague, Professor Ronald W. F. Campbell. Ronnie spent his life working in the field of sudden cardiac death; he contributed much and helped many. But his own life fell victim to this very problem, sadly illustrating its unexpected nature. With Ronnie’s memory in mind the Task Force has worked diligently to describe the extent of our expanding knowledge in this field, hoping that our small contribution might help to appease his sad and sudden death.

The subjectively perceived health of children and adolescents has received little attention in Public Health research so far. In co-operation with school physicians of Hamburg, Eimsbuettel, 1,501 children and adolescents (grades 4 and 8, as well as their parents) were questioned with regard to health-related quality of life and health behaviour, using among others the short form of the KINDL Quality of Life Questionnaire and established psychosocial instruments. High values in the KINDL scale were found in 75% of the students, the mean value of the 0-100 transformed KINDL total scale was around 80. Adolescents--and in this group specifically the girls--reported significantly lower quality of life scores. Psychosocial strain, presence of disease and school absenteeism were negatively associated with quality of life ratings. Health-related behaviours in terms of resources in the area of food intake and risk behaviours in terms of addiction, obesity and stressors correlated with subjective health as expected. In multiple regressions these factors explained 20% of the KINDL-score variance in the total group. Taking into account indicators of functional status and life satisfaction, the percentage of explained variance increased to over 50%; here these predictors yielded a correct classification of high vs. low self-reported quality of life in 90% of the cases. The study shows that subjective health is a methodologically adequate and scientifically interesting indicator which in the public health area can be used in epidemiological research, in health reporting and in school physicians' practice to identify young persons with quality of life impairments in order to provide early and in-focus support to this group.

Background: Part of the therapy concept in atopic dermatitis in childhood is – depending on the severity – temporary application of topical or

While esthetic and functional outcomes of treatment have improved for patients with cleft lip and palate (CLP), a CLP remains a severe problem for patients and relatives. To date, psychological research has dealt with issues such as intelligence, self-consciousness or treatment satisfaction but the long-term impact of a CLP on a psychological construct such as quality of life has yet to be explored. From a pool of 156 patients with CLP, subgroups of varying sizes were examined with a set of standardized questionnaires (KINDL, SF-36, Social Support Survey). In all patients, primary operative treatment had been accomplished. Long-term impact of the CLP on family life was assessed by 112 of the patients' parents by filling in the Impact on Family Scale. A set of questionnaires, especially developed for patients with CLP, was administered as well. For all patients who have been being treated in an interdisciplinary cleft center for their entire life, the results presented indicate that quality of life is good and within a normal range. Social support appears to be within a normal range. Parents report only minor long-term impact of the CLP on family life and family planning. Treatment satisfaction is high in the CLP patients. The questionnaires especially aimed at CLP patients indicate more specific problems mainly concerning social acceptance, where patients think the CLP had a negative impact. The standardized questionnaires employed so far failed to capture these problems. The combination of the two types of questionnaires is a sufficiently sensitive assessment procedure.

A 22-year-old woman suffering from dyskeratosis follicularis Darier became pregnant 4 months after the last dose of etretinate (Tigason). The pregnancy was terminated in the 10th week because of teratogenic risk. The pathological examination of the fetus revealed severe malformation of the left leg with aplasia of tibia and fibula, as well as hypoplasia of the left femur. This observation emphasises the necessity of effective contraception even after discontinuation of etretinate therapy.

Based on a randomized controlled multicentre-design the effect of school-based life skills programmes was investigated in a sample of 102 classes of secondary schools (Hauptschulen) in northern Germany. Self-reports of 1,057 pupils showed positive effects of the programmes on the reduction of smoking. Pupils' life skills improved in the teachers' assessment. The social and the migration status did not moderate the results. Both pupils and teachers evaluated the programmes very positive.

With medical advances, acute -disease in childhood and adolescence could be substantially reduced, thus shifting the focus towards chronic and mental health problems. Currently there is a lack of studies on trends in health-related quality of life (HRQoL) and mental well-being and their determinants in the context of children's and adolescents' environment (e. g., family, school). The aim of this paper is to describe the trend in HRQoL in children and adolescents from 2006 to 2010 and to analyse factors associated with HRQoL and mental well-being of children and adolescents.Results are based on the German sample (11-, 13- and 15-year-old school children) of the international WHO Study from the 2006 (n=6 896) and 2010 (n=4 723) surveys. HRQoL was assessed by means of KIDSCREEN-10. The Strengths and Difficulties Questionnaire (SDQ), a screening instrument for mental health problems, was used as an indicator of mental health. Logistic regressions were performed to analyse the effects of covariates on HRQoL as well as on mental health problems.HRQoL remained fairly stable between 2006 and 2010 for both boys and girls. Approximately 85% of the school children report a high or normal HRQoL, whereby girls indicate a lower HRQoL than boys. Overall, 14,3% of the pupils show signs of mental health problems. The model results show that poor communication with parents, spending little time with friends, lack of perceived support from classmates and a negative attitude towards school are negatively associated with mental health.The majority of children and adolescents report a high HRQoL over time. The fact that every 7th 11- to 15-year-old shows signs of mental health problems raises concern and suggests that addressing mental health problems needs to gain more priority in public health measures.

The monitoring of health through the analysis of trends provides important information on the long-term development of key outcome parameters for health. Currently, Germany does not have any reliable data on trends in the health situation of young people.The presented results are based on the German trend data from the Health Behaviour in School-aged Children (HBSC) Study. Data were analysed for a representative sample of 11-, 13- and 15-year-old school children from 2002 (N=5 650), 2006 (N=7 274) and 2010 (N=5 005). First, a comparison between German and international HBSC trend data was conducted for subjective health, life satisfaction and health complaints in 2002, 2006 and 2010. Next, a logistic regression was calculated to further describe the trends for these outcomes in the German data set.Overall, children and adolescents in Germany report good health. The comparison with the international data further supports this finding. Detailed analyses of trends showed that the health level generally improved between 2002 and 2010 for German children. In particular, better subjective health and lower rates of multiple recurrent health complaints were reported. Irrespective of the survey year, girls and older adolescents reported the highest level of health impairment.Trend analyses contribute towards health politics not only by providing information on the health situation across time, but also by pointing out the long-term effects of measures at the macro level (such as national health programmes, interventions) on children's health.

For many years, the HBSC-Study has provided important insight and information on the health situation and health behaviours of young people 11- through 15 years of age living in Germany. The papers in this supplement take a first look at the trends in selected indicators of health and health behaviour of this group and draw important conclusions about the association between prevention and health promotion measures and individual health across time. This short report gives an overview on the key results and findings of the 10 papers in the supplement.

The aim of the HBSC-Study is to collect data on the physical and mental health and health behaviour of children and adolescents and to gain a deeper insight into their situation and the specific environment they grow up in. The HBSC-study is an international school-based cross-sectional survey conducted in collaboration with the World Health Organization (WHO). The survey takes place every 4 years since 1982 and is based on a standardised protocol. In Germany the survey was first conducted in 1994 as a pilot study in North Rhine-Westphalia. The German sample is based on a random sample of classes in all public schools in Germany. 11-, 13-, and 15-year-old pupils are surveyed by means of a paper and pencil questionnaire. The questionnaire comprises a broad selection of -topics, including sociodemographics, health and risk behaviours, family, school and peers. The reported trends in the supplement are based on the data from surveys in 2002 (N=5.650), 2006 (N=7.274) and 2010 (N=5.005). The representative samples for each of the survey years are defined as follows: in 2002 the data is based on information collected in 4 Federal States (Berlin, Hesse, North Rhine-Westphalia, Saxony); in 2006 5 states define the German data file (Berlin, Hamburg, Hesse, North Rhine-Westphalia, Saxony). The data from the 2010 survey comprises data from 15 Federal States. The HBSC-data contributes towards a better understanding of the relationship between health and living conditions of young people. The papers in this supplement deliver important insights into the living context of young people and in doing this they provide important information about their health and the long-term effectiveness of public-health-measures.

The considerable increase of obesity in children and adolescents poses a major challenge to the health care system.In an observation study of the Bundeszentrale für gesundheitliche Aufklärung (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.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%.The rising prevalence of cardiovascular risk factors in children and adolescents with increasing BMI category requires effective strategies for prevention and treatment of obesity.

Different providers of obesity treatment in children and adolescents in Germany were compared using the following criteria: outpatient/inpatient; with/without AGA certification; good/less good quality.A total of 1,916 patients (8-16.9 years) from 48 study centers were examined before (t0), after (t1), and at least 1 year after therapy (t2/3). Body mass index (BMI), blood pressure, blood lipids, and psychosocial data were measured.Patients from inpatient rehabilitation centers were older and more obese. Patients from AGA-certified centers were more obese, and the completeness of comorbidity screening was higher. There were no differences in short- or long-term BMI reduction. "Good" treatment centers (classified after the UKE study 2004) did not differ from those centers not rated as "good" in weight reduction. Patients treated in "good" centers were more obese, and screening for comorbidity was better. No differences in drop out and loss to follow-up were found.There were only small differences between the different groups. Pronounced differences were found between the individual treatment centers. In order to improve therapy processes and outcomes, benchmarking and quality management have to be extended.

This article analyzes emotional and behavioral problems in children and adolescents with chronic somatic disorders. Within the German Health Interview and Examination Survey for Children and Adolescents (Kinder- und Jugendgesundheitssurvey, KIGGS), chronic somatic conditions and obesity were assessed in 11,529 children and adolescents aged 7-17 years old. Special health care needs (CSHCN), emotional and behavioral problems (SDQ), as well as personal, familial, and social resources were surveyed. About 10.8% of the respondents displayed special health care needs and declared a chronic somatic disorder. Of these cases, 20.6% were classified as abnormal in the SDQ (non-somatic conditions: 6.4%). In a logistic regression analysis, male gender (OR=2.0), low socioeconomic status (Winkler index; OR=2.6), family structure (OR1), and deficits in familial (OR=2.4) and personal (OR=2.1) resources were found to be significantly associated with psychological comorbidity in chronic somatic conditions. The results confirmed previous findings. Especially socioeconomic, structural, and functional aspects of a family have to be considered in the development and prevention of psychological comorbidity in chronic somatic conditions in childhood and adolescence.

Numerous forms of therapy exist for the increasing number of obese children and adolescents in Germany, but these are heterogeneous and have not been evaluated. Access to health care, long- and short-term treatment outcome, as well as factors determining success of therapy were examined for the first time using standardized instruments to measure somatic and psychosocial variables. A total of 1,916 children aged 8-16 years from 48 (5 rehabilitation, 43 outpatient) institutions were examined. Data were collected for height, weight, blood pressure, and lipid status before treatment started (t0), at the end of treatment (t1), and 1 year after completion of treatment (t2). Furthermore, psychosocial variables were documented using questionnaires for parents and children. The mean BMI-SDS (body mass index standard deviation score) reduction at t1 was -0.27 and 1 year later at t2 was -0.23 (per protocol analysis; intention to treat: t1=-0.24; t2=-0.06). Psychological health and quality of life, which were markedly impaired at the beginning, improved. However, physical activity, media consumption, and nutrition remained basically unchanged. A reduction in weight is associated with an improvement in cardiovascular risk profiles, and long-term behavior changes are possible. However, the institutions differed considerably in the percentage of follow-up examinations and in the weight reduction accomplished.

Psychische Storungen im Kindes- und Jugendalter umfassen eine Vielzahl von Storungsbildern. Dabei konnen die Storungsbilder zum einen denen des Erwachsenenalters ahneln, z. B. treten schizophrene Erkrankungen auch bei Jugendlichen auf. Zum anderen lassen sich aber auch Storungen identifizieren, die bei Kindern und Jugendlichen spezifisch fur ein bestimmtes Alter sind, wie z. B. Futterstorungen, die uber den Zeitraum von der Geburt bis ins Kleinkindalter bestehen konnen.

Foscarnet (phosphonoformate) is a potent virustatic drug against herpes-like viruses and is widely used in the therapy of cytomegalovirus infections in immunosuppressed patients. To obtain data on its penetration across the blood-brain barrier, we determined concentrations of foscarnet in cerebrospinal fluid and in plasma specimens from 26 patients with human immunodeficiency virus (stages 2 to 6 by Walter Reed Army Institute of Research classification) after a single infusion of 90 mg of foscarnet per kg of body weight and at steady state by electrochemical detection by high-pressure liquid chromatography. Penetration coefficients were correlated with the integrity of the blood-brain barrier. After a single infusion of foscarnet, levels in plasma ranged from 297 to 1,775 micrograms/ml (990 to 5,920 mumol/liter), with a mean of 766 +/- 400 micrograms/ml. Corresponding levels in cerebrospinal fluid were 57 to 225 micrograms/ml (190 to 750 mumol/liter), with a mean of 131 +/- 52 micrograms/ml. The penetration coefficient was 0.05 to 0.72 (mean, 0.23 +/- 0.16). At steady state, mean foscarnet levels in plasma were 464 +/- 219 micrograms/ml (1,553 mumol/liter) and mean levels in cerebrospinal fluid were 308 +/- 155 micrograms/ml (1,023 mumol/liter). The penetration coefficient was 0.66 +/- 0.11. Although penetration coefficients were highly variable after a single administration and at steady state, the concentrations of foscarnet attained in cerebrospinal fluid are sufficient for complete inhibition of cytomegalovirus replication in vitro. In conclusion, we show that foscarnet seems to be the drug of choice for the treatment of cytomegalovirus encephalitis, because it penetrates the blood-brain barrier and is found in the cerebrospinal fluid in virustatic concentrations. Foscarnet might be considered for additive therapy for human immunodeficiency virus encephalitis in combination with zidovudine or dideoxyinosine.

The German Competence Network on Atrial Fibrillation (AFNET) is a national interdisciplinary research network funded by the Federal Ministry of Education and Research (BMBF). AFNET was initiated in 2003 and aims at improving treatment of atrial fibrillation (AF), the most frequent sustained cardiac arrhythmia. AFNET has established a nationwide patient registry on diagnostics, therapy, course and complications of AF in Germany. The data analyzed to date demonstrate that patients with AF are likely to have multiple co-morbidities, such as hypertension, valvular heart disease, coronary artery disease, diabetes mellitus and advanced age. Oral anticoagulation is provided to the majority of patients in accordance with the recommendations given by guidelines. Further areas of research deal with the optimal duration of antiarrhythmic therapy following electrical cardioversion of atrial fibrillation and the value of strategies to prevent arrhythmogenic changes, such as fibrosis in the atria, for prevention of further episodes of atrial fibrillation. Additional registry projects were established for patients with catheter-based interventional therapy of atrial fibrillation and surgical ablation to define success, complications and long term results of these recently developed procedures more clearly. Data and insights gathered from these projects were used to further develop standards of care in two international conferences.

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.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.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.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.

While aesthetic and functional outcomes of treatment have improved for patients with cleft lip and palate (CLP), a CLP remains a severe problem for patients and relatives. To date, psychological research has dealt with issues such as intelligence, self-consciousness or treatment satisfaction, but the long-term impact of a CLP on a pyschological construct such as quality of life has yet to be explored. From a pool of 156 patients with CLP, subgroups of varying sizes were examined with a set of standardized questionnaires (KINDL, SF-36, Social Support Survey). In all patients, primary operative treatment had been accomplished. Long-term impact of the CLP on family life was assessed in 112 of the patients’ parents by filling in the Impact of Family Scale. An additional questionnaire, specially developed for patients with CLP, was used to cross check the validity of the standardized questionnaires. For the patients who are treated by an interdisciplinary cleft center, the results presented indicate that quality of life was good and within a normal range of social acceptance. Parents reported only minor long-term impact of the CLP on family life and family planning. Treatment satisfaction was high in the CLP patients. The questionnaire specifically aimed at CLP patients indicated more specific problems relating to social acceptance of CLP, while the standardized questionnaires used failed to indicate these problems. The authors concluded that a combination of the two types of questionnaires will constitute a sufficiently sensitive assessment method for CLP. Henning Schliephake

This study compares item reduction analysis based on classical test theory (maximizing Cronbach's alpha - approach A), with analysis based on the Rasch Partial Credit Model item-fit (approach B), as applied to children and adolescents' health-related quality of life (HRQoL) items. The reliability and structural, cross-cultural and known-group validity of the measures were examined.Within the European KIDSCREEN project, 3019 children and adolescents (8-18 years) from seven European countries answered 19 HRQoL items of the Physical Well-being dimension of a preliminary KIDSCREEN instrument. The Cronbach's alpha and corrected item total correlation (approach A) were compared with infit mean squares and the Q-index item-fit derived according to a partial credit model (approach B). Cross-cultural differential item functioning (DIF ordinal logistic regression approach), structural validity (confirmatory factor analysis and residual correlation) and relative validity (RV) for socio-demographic and health-related factors were calculated for approaches (A) and (B).Approach (A) led to the retention of 13 items, compared with 11 items with approach (B). The item overlap was 69% for (A) and 78% for (B). The correlation coefficient of the summated ratings was 0.93. The Cronbach's alpha was similar for both versions [0.86 (A); 0.85 (B)]. Both approaches selected some items that are not strictly unidimensional and items displaying DIF. RV ratios favoured (A) with regard to socio-demographic aspects. Approach (B) was superior in RV with regard to health-related aspects.Both types of item reduction analysis should be accompanied by additional analyses. Neither of the two approaches was universally superior with regard to cultural, structural and known-group validity. However, the results support the usability of the Rasch method for developing new HRQoL measures for children and adolescents.