Guideline Concordance of Treatment and Outcomes Among Adult Non-Hodgkin Lymphoma Patients in Sub-Saharan Africa: A Multinational, Population-Based Cohort.

BACKGROUND: Although non-Hodgkin lymphoma (NHL) is the 6th most common malignancy in Sub-Saharan Africa (SSA), little is known about its management and outcome. Herein, we examined treatment patterns and survival among NHL patients. METHODS: We obtained a random sample of adult patients diagnosed between 2011 and 2015 from 11 population-based cancer registries in 10 SSA countries. Descriptive statistics for lymphoma-directed therapy (LDT) and degree of concordance with National Comprehensive Cancer Network (NCCN) guidelines were calculated, and survival rates were estimated. FINDINGS: Of 516 patients included in the study, sub-classification was available for 42.1% (121 high-grade and 64 low-grade B-cell lymphoma, 15 T-cell lymphoma and 17 otherwise sub-classified NHL), whilst the remaining 57.9% were unclassified. Any LDT was identified for 195 of all patients (37.8%). NCCN guideline-recommended treatment was initiated in 21 patients. This corresponds to 4.1% of all 516 patients, and to 11.7% of 180 patients with sub-classified B-cell lymphoma and NCCN guidelines available. Deviations from guideline-recommended treatment were initiated in another 49 (9.5% of 516, 27.2% of 180). By registry, the proportion of all patients receiving guideline-concordant LDT ranged from 30.8% in Namibia to 0% in Maputo and Bamako. Concordance with treatment recommendations was not assessable in 75.1% of patients (records not traced (43.2%), traced but no sub-classification identified (27.8%), traced but no guidelines available (4.1%)). By registry, diagnostic work-up was in part importantly limited, thus impeding guideline evaluation significantly. Overall 1-year survival was 61.2% (95%CI 55.3%-67.1%). Poor ECOG performance status, advanced stage, less than 5 cycles and absence of chemo (immuno-) therapy were associated with unfavorable survival, while HIV status, age, and gender did not impact survival. In diffuse large B-cell lymphoma, initiation of guideline-concordant treatment was associated with favorable survival. INTERPRETATION: This study shows that a majority of NHL patients in SSA are untreated or undertreated, resulting in unfavorable survival. Investments in enhanced diagnostic services, provision of chemo(immuno-)therapy and supportive care will likely improve outcomes in the region.

Nitrate leaching potential from arable land in Germany: Identifying most relevant factors.

Diffuse nitrogen losses from agriculture in Germany continue to cause regionally increased nitrate concentrations in groundwater. Groundwater quality monitoring cannot be a timely indicator of the effects of mitigation measures being applied in agriculture, due to frequently long transport routes and high residence times of the leachate. Instead, nitrate leaching potential is often determined at field and farm scale by monitoring soil mineral nitrogen contents at 0-90 cm depth in autumn (SMNa), i.e. before the start of the annual leachate period. In this study, we developed an understanding of the controls on the soil mineral nitrogen content at the start of winter. In an on-farm approach, extensive data was collected from 48 farms in five nitrate-sensitive regions in Germany from 2017 to 2020. From this data set, 25 management and site factors were evaluated with regard to their significance for SMNa by means of a random forest model. With the random forest regression, we identified the role of the factors on SMNa with an acceptable model accuracy with R2 = 0.56. The results show that the cultivated crop is the most important factor influencing SMNa. Potatoes, oilseed rape and maize produced the highest SMNas, whereas SMNas were lowest after spring barley, sugar beet and winter barley. Among site factors, soil type and texture as well as precipitation in October were most decisive. The effects of N fertilisation parameters such as rate and timing were masked by these site factors. The results show that the reduction of nitrogen-intensive crops in crop sequences can be a promising measure for the reduction of nitrate loads. On the other hand, our analysis makes clear that soil-related factors controlling nitrogen release and risk of leaching, as well as weather, can significantly mask the effect of cultivation.

Are emotionally competent adults emotionally available parents? Examination of theoretical and empirical relationships in a video-recorded parent-child interaction clinical preschool-aged sample.

OBJECTIVE: Emotional competence (EC) describes one's general ability to perceive, express, process, and regulate their own emotions as well as those of others. In the clinical context of parent-child interactions, the specific ability to perceive, express and regulate a child's emotions is conceptually covered by the Emotional Availability Scales (EAS). We aim to examine theoretical and empirical overlaps between EC (Rindermann) and emotional availability (EA; Biringen) for theoretical, diagnostic, and therapeutic reasons. METHODS: Parents of a clinically referred sample of preschool-aged children (55 dyads) filled out a self-report questionnaire (ECQ), and certified and blinded raters applied the EAS via observations. In a novel approach, the EC was additionally estimated with independent ratings made by two further observers. All dyads were coded on 10-min video-recorded parent-child interactions during free play. RESULTS: In bivariate and multivariate analyses, EC scores from observational ratings were strongly associated with independently rated clinical emotional availability scores. EC scores from self-reports were moderately associated with emotional availability scores. A post hoc power analysis estimated ß error probabilities. CONCLUSIONS: EC may represent an important personal precondition to an emotionally available parent. As such, we discuss implications for early risk factor assessments for child development and highlight new prevention approaches, new diagnostic options, and refined treatment goals. Limitations included the sample size, assessment, and the influence of study design on results.

[Trends in Adolescents' Satisfaction with Their Inpatient Psychiatric Treatment: A Panel Analysis over 7 Years]. / Trends in der Zufriedenheit von Jugendlichen mit ihrer stationären psychiatrischen Behandlung: Eine Verlaufsanalyse über 7 Jahre.

Trends in Adolescents' Satisfaction with Their Inpatient Psychiatric Treatment: A Panel Analysis over 7 Years Abstract. Because the German legislature is increasingly enabling adolescents' participation in their psychiatric treatment, we traced changes in satisfaction of 6,893 patients at the end of their stay in 10 hospitals using BEST-J. The treatments resulted in a fair overall satisfaction without any improvement over the 7 years studied. In seven hospitals, we calculated deviation from the overall satisfaction based on annual surveys. Satisfaction with the psychotherapeutic relationship was good from the beginning, whereas the relationship with caregivers improved during the sample period. When new legal standards were introduced, we measured an improvement in some items concerning patient participation (coercive measures information, goals of treatment discussed). Patients were less satisfied with the information about their illness than with medication information. Initially poor satisfaction with leave regulations significantly improved over time. Respect for privacy also improved. Satisfaction with the environment and service organization scored substantially worse than the other items. Peer relations within the ward were rated close to overall satisfaction. The results point to benefits from training in psychotherapy and a growing awareness of closeness-distance issues and patients' rights. Nevertheless, psychoeducation and leave regulations require improvement. Furthermore, patients stated unmet needs for refurbishing and renovating buildings.

[Diagnostic of Parent-Child-Interaction andTheir Relationship: Results from a Multiprofessional and Task Specific Survey]. / Diagnostik der Eltern-Kind-Interaktion und -Beziehung: Ergebnisse einer multiprofessionellen und tätigkeitsspezifischen Umfrage und Vorschläge für eine standardisierte Dokumentation.

The assessment of parent-child interactions and relationships (PCIR) plays an important role for many diagnostic purposes in child and adolescent psychology and psychological health care. While child and adolescent psychology has been intensively researched, the field still faces a lack of knowledge about health care practice. To offer knowledge about practical routine needs and derived needs in these domains, we aimed to obtain information from professionals who routinely assess PCIR.We aimed to gain a basic description of task-specific diagnostic fields, professional staff and their education, their clients, key diagnostic questions, observational settings, guidelines used in assessing PCIR and professionals' personal understanding of PCIR. To gain information on how professionals assess PCIR, we used an online survey containing multiple choice questions and rating scales.We describe differences between task-specific diagnostic fields of inpatient and outpatient settings, consulting and officially appointed surveyors for court decision. Only responses from professionals performing PCIR are analyzed (N = 166). PCIR is regularly used for more than a half of children between 0-12 years of age and for more than a third of adolescents for answering a broad spectrum of diagnostical questions. We describe differences for nearly all facets of PCIR except for the content related domain. Based on these differences between task-specific fields, we give suggestions for standardized documentation of PCIR and how findings from this study can be used for scientific development.

Peptide microarray-based analysis of antibody responses to SARS-CoV-2 identifies unique epitopes with potential for diagnostic test development.

Humoral immunity to the Severe Adult Respiratory Syndrome (SARS) Coronavirus (CoV)-2 is not fully understood yet but is a crucial factor of immune protection. The possibility of antibody cross-reactivity between SARS-CoV-2 and other human coronaviruses (HCoVs) would have important implications for immune protection but also for the development of specific diagnostic ELISA tests. Using peptide microarrays, n = 24 patient samples and n = 12 control samples were screened for antibodies against the entire SARS-CoV-2 proteome as well as the Spike (S), Nucleocapsid (N), VME1 (V), R1ab, and Protein 3a (AP3A) of the HCoV strains SARS, MERS, OC43, and 229E. While widespread cross-reactivity was revealed across several immunodominant regions of S and N, IgG binding to several SARS-CoV-2-derived peptides provided statistically significant discrimination between COVID-19 patients and controls. Selected target peptides may serve as capture antigens for future, highly COVID-19-specific diagnostic antibody tests.

Urology on Display: Museum, Library and Archives of the DGU Duesseldorf-Berlin.

Within a modern changing academic society, it has become necessary and important for scientific collections and museums as decentralized infrastructures for research, teaching, and education, to define and redefine their missions, their goals, their functions, and their strategies to reflect the expectations of a changing society and the academic world, especially museums of scientific associations as possessing critical resources. For example, the dues of the members are on task for education and promotion of the specials values of these communities under aspects of historical marketing and corporate museums which promote heritage.

[The Emotional Competence of Mothers and the Clinical Quality of Mother-Child Relationship in a Preschool Psychiatric Population]. / Die emotionale Kompetenz der Mutter und die klinische Qualität der Mutter-Kind-Beziehung in einer vorschulpsychiatrischen Inanspruchnahmepopulation.

The Emotional Competence of Mothers and the Clinical Quality of Mother-Child Relationship in a Preschool Psychiatric Population The quality of mother-child interaction and relationship is an essential risk factor for the development of mental disorders at preschool age. We examine maternal emotional competence and maternal level of psychopathology as predictors for the quality of mother-child relationship. At the beginning of their treatment a clinical sample of mother-child-dyads at the Child Psychiatric Family Day Hospital in Münster was assessed concerning the emotional competence of mothers (EKF), the maternal psychopathology (SCL) and the mother-child relationship quality, the latter with three different instruments reflecting the mother's, the child's and the therapist's perspective (PIR-GAS, SKEI, M-PCR). The mothers showed decreased results in the EKF scales emotional regulation, recognition of emotions and in the EKF-overall-score and presented a higher level of maternal psychopathology compared to the normal population. There is a direct relation between emotional regulation and the M-PCR scales affective bond and functional-conflict. Besides the direct influence of the maternal psychopathology, the expected moderator effect of emotional expressiveness and the M-PCR scale functional-conflict, reported by mothers, was apparent. Certain aspects of the emotional competence of mothers and their psychopathology show an influence on mother-child relationship quality. The method and the perspective of assessment are crucial to the results.

Impaired predictability: enhanced fluctuations in the parenting behaviour of mothers of pre-school children with clinical diagnoses across three different play tasks.

Fluctuations in parenting behaviour are thought to be important for the development of child psychopathology. This study focusses on fluctuations in the parenting behaviour of mothers with 3-6-year-old children with a clinical diagnosis according to the International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10) (N = 39) and compared them with a control group of mothers with children without a clinical diagnosis (N = 41). In a laboratory setting, we compared the quality of mother-child interactions between both groups using three increasingly challenging co-operation tasks. At first, the mother and child interacted via a free play task. They then co-operated within a constructional play task and finally within a challenging problem-solving task. We analysed the mothers' parenting behaviour using the Laboratory Parenting Assessment Battery (LAB-PAB) and children's problem behaviours by means of their mothers' rating using the Child Behavior Checklist 1 ½-5 (CBCL). The results corroborated our hypotheses. Mothers of the group of children with clinical diagnoses had a lower parenting quality and higher fluctuations in parenting behaviour across situations compared with the non-clinical group. Further analysis revealed that specific fluctuations in maternal involvement and hostility uniquely predicted child psychopathology, measured with the CBCL, showing incremental validity of fluctuations in maternal involvement, when controlling for parenting quality and maternal difficulties in emotion regulation, measured with the Difficulties in Emotional Regulation scale. The results are discussed in terms of their implications for clinical interventions, as well as theoretical implications and future research.

CCSchool: a multicentre, prospective study on improving continuum of care in children and adolescents with mental health problems associated with school problems in Germany.

BACKGROUND: Most psychiatric disorders in childhood and adolescence cause impairment in academic performance. Early interventions in school are thought to reduce the burden of disorder and prevent chronicity of disorder, while a delay in reachable help may result in more severe symptoms upon first time presentation, often then causing upon first-time presentation immediate need of inpatient care. METHODS: The study aims at reducing hospitalization rates and increasing social participation and quality of life among children and adolescents by establishing collaborations between schools, mental health care services and youth welfare services. CCSchool offers children and adolescents, aged six to 18 years, who present with psychiatric problems associated to school problems, a standardized screening and diagnostic procedure as well as treatment in school if necessary. Students can participate in CCSchool in three federal states of Germany if they a) show symptoms vindicating a mental health diagnosis, b) present with confirmed school problems and c) have a level of general functioning below 70 on the children global assessment of Functioning (C-GAF). Intervention takes place in three steps: module A (expected n = 901, according to power calculation) with standardized diagnostic procedures; module B (expected n = 428) implies a school-based assessment followed by a first intervention; module C (expected n = 103) offering school-based interventions with either four to six sessions (basic, 80% of patients) or eight to 12 sessions (intensive, 20% of patients). Primary aim is to evaluate the effectiveness of CCSchool, in reducing the need of hospitalization in children with mental health problems. The analyses will be conducted by an independent institute using mainly data collected from patients and their caregivers during study participation. Additionally, claims data from statutory health insurances will be analysed. Relevant confounders will be controlled in all analyses. DISCUSSION: Evaluation may show if CCSchool can prevent hospitalizations, enhance social participation and improve quality of life of children and adolescents with mental health problems by providing early accessible interventions in the school setting. TRIAL REGISTRATION: Deutsches Register Klinischer Studien, Trial registration number: DRKS00014838 , registered on 6th of June 2018.

[The Multiperspective Parent-Child Relationship Questionnaire (M-PCR)]. / Der Multiperspektivische Fragebogen zur Eltern-Kind-Beziehung (MEK).

The Multiperspective Parent-Child Relationship Questionnaire (M-PCR) Parent-child relationship quality may considerably impact child mental health. Yet many instruments apply effortful behavioral observation methods. In this paper we aim to develop a multiperspective questionnaire of parent-child relationships. Several experts in the field of parent-child interaction treatment generated 18 items to assess aspects of the parent-child relationship. Mothers, therapists and assistant therapists rated 129 mother-child dyads that were treated at the Child Psychiatric Family Day Hospital for preschool children in Münster, Germany at the beginning and again at the end of treatment. For validity purposes, a global measure of relationship quality (PIRGAS) and measures of maternal psychopathology (SCL-90-R) and child behavior problems (CBCL/1.5-5; C-TRF/1.5-5) completed the assessment.Six principal component analyses and subsequent oblique rotation revealed a stable patternof two interpretable factors labeled as "Affective Bond" and "Functional-Conflict" with highinternal consistency and retest-reliability. Validity of the MEK scales was supported by significant correlations with the global rating of relationship quality PIRGAS by experts (therapistsand assistant therapists) and measures of maternal and child psychopathology, particularlyexternalizing problems, and therapy outcome. The MEK appears as a valid, reliable and user-friendly instrument for assessing the quality of parent-child relationship in clinical contextsfrom different perspectives.

Patient-reported adverse events after colonoscopy in Norway.

Background and aims Patient-reported outcome measures are increasingly important in healthcare. European guidelines have recommended inclusion of patient feedback to capture adverse events due to colonoscopy, but this is rarely implemented. Methods The Norwegian Quality Assurance network for endoscopy (Gastronet) collects patient-reported outcome for colonoscopies. Free-text comments on patient reports from January to December 2015 were characterized as positive or negative. All negative free-text comments were scrutinized for information that might suggest colonoscopy-related adverse events. We identified severe adverse events with and without admission to hospital. Results We included 16 552 outpatient colonoscopies performed at 21 hospitals. A total of 11 248 procedures (68 %) were accompanied by a patient feedback report, of which 2628 (23 %) had free-text comments (2196 [20 %] characterized as positive and 432 [3.8 %] as negative). These negative free texts on patient reports revealed 15 post-colonoscopy hospital admissions due to adverse events that had not been registered in the colonoscopy report. This increased the number of hospital admissions caused by adverse events from 3 (0.03 %) to 18 (0.16 %). In addition, there were 14 patient reports of severe events without hospital admission. Therefore, a total of 29 severe adverse events reported by patients were missed by conventional documentation in the colonoscopy form. Conclusion It is feasible to implement patient feedback as routine reporting to capture the full picture of colonoscopy-related adverse events. Some patients experience significant complications that are not recorded through any registries. Patient feedback forms should be tailored to capture adverse events after colonoscopy that are otherwise not easily disclosed.

[Clinical Validation of the Caregiver-Child Socioemotional and Relationship Rating Scale (SIRS) for Child Behavior in a Preschool-Age Sample]. / Klinische Validierung der Beurteilungsskala Caregiver-Child Socioemotional and Relationship Rating Scale (SIRS) für kindliches Interaktionsverhalten im Kleinkind- und Vorschulalter.

Clinical Validation of the Caregiver-Child Socioemotional and Relationship Rating Scale (SIRS) for Child Behavior in a Preschool-Age Sample The description of child behavior in mother-child-interaction is important in early detection and treatment of psychiatric disorders in preschool children. The Caregiver-Child Socioemotional and Relationship Rating Scale (SIRS) may serve this diagnostic purpose. We aim to examine interrater-reliability of SIRS and concurrent, convergent, and discriminant validity to maternal behavior by Play-PAB, and a measure of mother-child-relationsship by Parent-Infant-Global-Assessment-Scale (PIRGAS). Five raters assessed 47 ten-minute video sequences of parent-child-interaction recorded at the Family Day Hospital for Preschool Children with SIRS, Play-PAB, and PIRGAS. We report psychometric properties of SIRS, and present the association with Play-PAB and PIRGAS. SIRS shows a satisfying interrater-reliability for all items. Positive child behavior e. g. the SIRS' "child responsiveness" shows negative correlation to Play-PAB-scales' parental "hostility" and "intrusiveness", but independence of parental "involvement", "positive emotionality", and "discipline". Child and parental behavior show expected associations with the global relationship measure PIRGAS. The assessment of child behavior in parent-child-interaction with SIRS can be quickly learned and reliably applied without extensive training. SIRS shows meaningful relations to parental behavior and a clinical global measure of the caregiver-child-relationship. We recommend SIRS for clinical diagnostics to describe child behavior in mother-child-interaction.

[Validated Instruments for the Psychological Assessment of Unaccompanied Refugee Minors - a Systematic Review]. / Validierte Verfahren zur psychologischen Diagnostik unbegleiteter minderjähriger Flüchtlinge - eine systematische Übersicht.

The German care system faces a growing number of unaccompanied refugee minors (URM). URM show high levels of traumatization, a variety of psychological symptoms and lack important resilience factors. Therefore an early and valid psychological assessment is important for intervention and service planning. Yet, no systematic review on validated instruments for the assessment of this group exists. Literature search revealed one study about translators in the assessment of URM and five validated instruments for proxy and self-report. These instruments are available in several languages and showed good psychometric properties. It has to be critically stated that all instruments have been validated by a single work group within a single population. Especially with regards to changing definitions of Posttraumatic Stress Disorder within the new (and upcoming) classification systems ICD-11 and DSM-5, increased awareness for diagnostic procedures is necessary. Additionally, more validated instruments for specific psychological disorders in multiple languages are needed. Under an economic perspective the use of open access questionnaires that are available in different languages seems useful, even if they are not especially validated for URM.

Psychiatric treatment outcomes of preschool children in a family day hospital.

This study describes the treatment outcomes of preschoolers with severe mental health problems who were treated at the child psychiatric family day hospital for preschool children in Münster, Germany. The eclectic multi-modal treatment combines behavioral and psychodynamic techniques for both parents and children in various settings within an intermittent attendance structure provided by a multi-disciplinary team. This study evaluated 185 children with the Caregiver-Teacher Report Form (C-TRF/1.5-5), which was completed by therapists, and the Child Behavior Checklist (CBCL/1.5-5), which was completed by mothers, at admission and discharge. The mothers' ratings of their children were statistically adjusted for the distortion caused by their own psychopathology. After treatment, the patients showed significant improvement on the C-TRF/CBCL Total Problem score with an average Cohen's d = -0.50 based on therapists' ratings, d = -0.97 for the non-adjusted maternal ratings, and d = -0.68 for the adjusted maternal ratings. We conclude that specialized family day hospitals may successfully treat preschool psychiatric patients.

[Body dysmorphic disorder]. / Körperdysmorphe störung.

Body dysmorphic disorder (BDD) is a relatively common disorder with a point prevalence of 0.7-2.4 %. BDD is characterized by the patient's excessive concern with an imagined or slight defect in physical appearance. BDD usually begins in adolescence. Comorbidity rates and also suicidality rates are high. The course of BDD tends to be chronic. According to the present state of knowledge, cognitive-behavioral therapy and pharmacotherapy with selective serotonin reuptake inhibitors are valuable options in the therapy of BDD. The case report describes a recent case of BDD with typical clinical and therapy-related characteristics. The aim of this work is to strengthen the awareness of BDD in clinical practice of child and adolescent psychiatry, facilitating an adequate diagnosis and treatment of the affected individuals.

[International aspects of inclusion in schools]. / Internationale Aspekte der Verankerung inklusiver Unterrichtskonzepte.

The term inclusion (=admittance, involvement) is used almost synonymously for the concept of the joint schooling of children with and without intellectual disabilities, language disabilities, physical handicaps, or mental disorders. This article addresses the current state of inclusion in Germany as well as the international situation, such as the Salamanca Declaration of the UNESCO, the «Individuals with Disabilities Act¼ (IDEA) in the United States as well as European developments, particularly in Great Britain, Austria, and Russia. Even though, from a political perspective, the decision in favor of inclusion seems irreversible, there appears to be a lack an agreement on the modality and timeframe. Thus, the average percentage of students with special education needs in Germany amounts to only 28.2%. The reasons behind this situation are presently being analyzed and discussed. A question of key importance concerns the benefit for the persons concerned, since that should be the measure of the success of inclusion. This question will most likely be validly answered only for individual subgroups of disabilities. This field still requires extensive research.

[Evaluation of Treatment of Mothers at the Family Day Hospital in Münster, Germany]. / Evaluation einer tagesklinischen Mutter-Kind-Behandlung für belastete Mütter psychisch kranker Kinder.

Evaluation of Treatment of Mothers at the Family Day Hospital in Münster, Germany. Mothers of preschool children have limited access to mental health treatment services. The Family Day Hospital for Preschool Children at the University Hospital Münster, Germany, offers therefore a specialized treatment for mothers with their preschool children. The therapy outcome of mothers is evaluated in effectiveness study by a pre-post-design. For mothers, therapy was composed of individual session and couple sessions with the partner, video-based parent-child-interaction therapy, and parent group sessions. We evaluated the psychiatric symptom burden of N = 103 mothers at admission and discharge with the Symptom Checklist-90-Revised (SCL-90-R) above the clinical cut-off ≥ 0.57. After treatment the mothers showed significant improvement on the global severity index (GSI) with an average Cohen's d = 1.64 (p0.001). We identified the following positively associated moderator variables of maternal improvement by a multiple regression analysis: the initial symptom burden, the educational level of the mother, not restricted housing conditions, and the age of the child. We conclude that especially distressed parents benefit from the treatment in the Family Day Hospital for Preschool Children.

[Attachment Patterns and their Relation to the Development of Anxiety Symptoms in Childhood and Adolescence]. / Der Zusammenhang von Bindungsmustern und der Entwicklung von Angstsymptomen im Kindes- und Jugendalter.

From the perspective of attachment theory, insecure attachment can be seen as a key risk factor for the development of anxiety symptoms and anxiety disorders. This systematic review addresses the current state of empirical research on the relationship between attachment status and anxiety symptoms respective anxiety disorders in childhood and adolescence. 21 current international studies published between 2010 and 2014 were included in this systematic review. These studies were heterogeneous in target populations, methods and study design. The majority of studies supported the assumed correlation between insecure attachment and anxiety symptoms or anxiety disorders. These findings are more evident in studies with school-age children than with preschool children or adolescents. Furthermore, the disorganized-disoriented type of attachment seems to be a particular risk factor for the development of anxiety symptoms and anxiety disorders. Results were discussed in relation to attachment theory and with reference to the results of previous relevant reviews.

[Multiprofessional intermittent psychiatric treatment of children in preschool age and their parents in a family day clinic]. / Multiprofessionelle Intervallbehandlung psychisch kranker Kinder im Vorschulalter und ihrer Eltern in einer Familientagesklinik.

Psychiatric treatment of children in preschool age (0-6 years) and their parents is an expanding field of research due to its high clinical significance. Specific family psychiatric treatment programs have been developed to meet the demands of this young age group, but are little known. A multiprofessional intermittent treatment approach sensitive to developmental and family context has been established in the Preschool Family Day Hospital for Infants, Toddlers and Preschoolers and their Families at Münster University Hospital, Germany. Group and individual therapeutic interventions for both children and parents, video-based parent-child-interaction therapy, psychiatric and psychotherapeutic treatments of parents and family therapeutic interventions integrating siblings are supporting and enhancing each other in an innovative and integrated family psychiatric program. First results of evaluation studies are reported that show that this treatment is effective.