[Adverse Childhood Experiences in Mothers and Intergenerational Family Violence]. / Negative Kindheitserfahrungen von Müttern und generationenübergreifende familiäre Gewalt.

For children, own adverse experiences, as well as their exposure to intimate partner violence poses a severe risk for health and development. In order to answer the question of intergenerational transmission of family violence, adverse childhood experiences in mothers are considered to be a significant risk factor for the occurrence of child maltreatment and intimate partner violence in families, which, however, has been little studied in Germany. Therefore, this paper uses cross-sectional data of 5.646 mothers that was taken fromthe representative study "Kinder in Deutschland - KiD 0-3". Multiple binary-logical regression models were calculated in order to examine the influence ofmaternal adverse childhood experiences on various forms of family violence. As a result, 823 mothers (9,3 %) reported adverse childhood experiences; 157 (2,8 %) admitted that their child had already been exposed to physical harm or harsh punishment, and 168 (3,0%) reported intimate partner violence since the birth of their child, respectively 493 (8,7 %) since any past relationship. Taking demographic and socioeconomic factors into account, the occurrence of all three forms of violence becamemore likely inmothers with adverse childhood experiences: physical harm of the child (OR = 2,78, p ≤ 0,001), current intimate partner violence of themother (OR = 3,76, p ≤ 0,001), as well as her lifetime experiences in general (OR = 3,67, p ≤ 0,001). Therefore, the support and guidance of families (e.g., by early childhood interventions) should take into account the connection between negative maternal childhood experiences, as well as familial forms of violence, and, if applicable, make generous preventative offers. In case of signs for familial violence, additional protective steps should be applied.

A Short Form of the Child/Youth Health Care Questionnaire on Satisfaction, Utilization, and Needs in Children and Adolescents with a Chronic Condition (CHC-SUN-SF/YHC-SUN-SF).

We decided to develop a short-form of the CHC-SUN/YHC-SUN, a questionnaire aiming at assessing health care satisfaction of children and adolescents with chronic health conditions. Data analysis was based on samples from three different studies. Item selection involved statistical analysis and expert consensus. For independent validation purposes, we calculated descriptive statistics on single-item and composite-scale levels and applied classic test theory, confirmatory factor analyses, and correlation analysis to investigate the psychometric properties of the final short-form by different types of reliability and validity. Internal consistency (Cronbach's Alpha) reached values of a = 0.89 (self-report) and a = 0.92 (parents report), split-half reliability values reached 0.85 (self-report) and 0.91 (parents report). Confirmatory factor analysis indicated no sufficient fit for the single factor solution, whereas the solution with three factors and one higher order factor indicated the best overall fit amongst three competing models. Validity of the short-form measure can be assumed, e.g., as indicated by its association with a single-item measure on general health care satisfaction. The short-form measures of the CHC-SUN for parents (CHC-SUN-SF) and the YHC-SUN self-report version for adolescents (YHC-SUN-SF) feature excellent psychometric performances, provide economical assessments, and are easy-to-administer questionnaires. They should be used whenever brief measures are needed for economic reasons.

[How are Effects of Patient Education Programs Influenced by Psychosocial Risk Factors in Pediatrics?] / Wie beeinflussen psychosoziale Risiken den Erfolg von Patientenschulungen in der Pädiatrie?

BACKGROUND: Modular patient education programs are effective in children with chronic conditions and their families. Little is known about the influence of socioeconomic status (SES), migration background (MB) and children's mental-health problems on the programs' effects. OBJECTIVES: Do SES, MB or mental-health problems influence the success of education programs (disease-specific knowledge, children's health-related quality of life (HRQoL) and life satisfaction and parents' condition-specific burden)? MATERIALS AND METHODS: Children with different chronic conditions and their parents participated in modular patient education programs. Before and 6 weeks after the participation SES, MB, children's mental-health problems, parents' und children's disease-specific knowledge, children's HRQoL and life satisfaction and parents' condition-specific burden were assessed by standardized questionnaires. The influence on the programs' effects of SoS, MH and mental-health problems were examined with variance and correlation analyses. RESULTS: 398 children (mean age 10.2 yrs) and their parents participated. Irrespective of SoS, MH and mental-health problems the programs were associated with improved disease-specific knowledge, children's HRQoL and life satisfaction and parents' disease-specific burden. At follow-up SoS, MH and mental-health problems were associated with reduced knowledge, reduced children's' HRQoL and life satisfaction and increased parents' disease-specific burden. CONCLUSIONS: Disadvantaged families and children with mental-health problems benefit from education programs, but have an increased need of education due to special challenges.

Development and evaluation of a generic education program for chronic diseases in childhood.

OBJECTIVE: To support families with a chronically ill child, a modular curriculum and new healthcare structures (trainer education, quality management) for a group self-management program (ModuS) were developed. ModuS focuses on common psychosocial aspects of chronic conditions and comprises generic and disease-specific modules. A pilot test was conducted for asthma by comparing ModuS with an established asthma-specific education program (CAE). METHODS: Under routine care conditions, 491 children (6-17 years) with asthma and their parents participated in a multi-center prospective study (265 ModuS; 226 CAE). Families' program satisfaction, disease-specific knowledge, health-related quality of life (HRQoL), life satisfaction, and burden of disease were assessed before, directly following and six weeks after participation. RESULTS: The families were highly satisfied with the program. CAE and ModuS were associated with improved disease-specific knowledge, childrens HRQoL and life satisfaction and decreased the families' burden. This demonstrates comparability of existing care with the modular approach. CONCLUSION: The ModuS approach offers a structure for effective patient education programs aiming to improve self-management. As it focused on the similarities of chronic conditions, it provides the opportunity to establish education programs for a wide range of chronic childhood diseases. PRACTICE IMPLICATIONS: ModuS facilitates the development of new patient education programs.

Subjective health, school victimization, and protective factors in a high-risk school sample.

OBJECTIVE: School victimization has adverse effects on mental and physical health. However, little is known about the influence of protective factors, socioeconomic status (SES), or a migration background (MB) on this association. The authors analyzed data from a multicenter longitudinal school study with a high proportion of pupils with a low SES and an MB. Victimization was defined as bullying or the experiences of interpersonal violence. METHODS: In a cross-sectional design, 2483 pupils of secondary schools in northern Germany completed standardized questionnaires measuring families' SES, MB, school victimization, psychosomatic complaints, life satisfaction, health-related quality of life (HRQoL), and social and personal protective factors. The authors tested the association between victimization, low protective factors, low SES and MB, and subjective health parameters using linear regression models. RESULTS: A total of 39% of the pupils reported being bullied, and 16% had experienced interpersonal violence. Victimized children reported twice as many psychosomatic problems, lower life satisfaction, and reduced HRQoL (p < .001) compared with children without victimization experiences. Regression models confirmed this association; in addition to victimization, low social and especially low personal protective factors increased the risk for low subjective health parameters. The SES and MB had no influence on the outcomes. CONCLUSION: The results underscore the strong association between school victimization and low subjective health factors. Strengthening pupils' self-efficacy and a supportive school climate can diminish the health consequences of victimization.