One year of general practice during the COVID-19 pandemic - presentation and evaluation of digital medical education.

Background and teaching situation: The SARS-CoV-2 pandemic had a substantial didactic impact on medical teaching. In Erlangen, the lecture "General Practice" was offered asynchronously and digitally in an inverted-classroom concept. Contents were available via a learning platform. The lecture was presented using annotated videos, consolidation materials and control questions. A forum encouraged for discussions and feedback and collected in-depth aspects for a case-based video consultation. The aim of this work is to evaluate and critically examine the digital teaching concept during the SARS-CoV-2 pandemic. Methodology: Two semester cohorts evaluated the lecture. Overall impression of the lecture, didactic elements, suitability and the desired future lecture format were surveyed quantitatively. Free text answers were evaluated by means of qualitative content synthesis. Results: In terms of overall impression, the students (N=199) rated the lecture on average as "very good" (M=1.41, SD=.57). Digital methods were perceived as suitable for supporting self-study, and digital usage was rated as unproblematically (M=1.18, SD=.50). Desired future teaching formats were blended learning concepts (79.4%). Organisation, structure and content presentation were highly appreciated. The time for completing the course was perceived critically. The students urged for more practical and consolidating lecture work. Discussion and implications: The results illustrate high acceptance of digital teaching and underline the demand for future blended learning concepts. It is particularly important to better consider the students' time investment and practical relevance of digital self-learning mechanisms.

Diagnosis and treatment of infraspinatus tendon-bursa ossification in a Eurasian Dog.

A 4-year-old male Eurasian Dog presented at our veterinary clinic with a history of perpetual forelimb lameness in both thoracic limbs. In the clinical exploration, direct pressure over the infraspinatus tendon of insertion caused pain in both thoracic forelimbs and a firm band-like structure was palpable. No improvement was observed after treatment with rest, non-steroidal anti-inflammatory drugs and an intralesional injection of a long-acting glucocorticoid. Radiographic examination, ultrasonographic exploration and computed tomography were performed, identifying ossified structures lateral to the proximal humerus and an irregular roughened periosteum at the insertion and tendon of the infraspinatus muscle on both sides. There were more distinct alterations on the right thoracic limb. The imaging results led to a diagnosis of an infraspinatus tendon-bursa ossification accompanied by a chronic tendinopathy/tendovaginitis, accentuated on the right side. The dog was subjected to physiotherapy and autologous conditioned plasma (ACP) was injected into the insertion of the infraspinatus muscle of both thoracic limbs. After 5 months of physiotherapy and two injections of ACP with an interval of one week in both forelimbs, the dog showed no signs of lameness. This case report describes the diagnosis and management of infraspinatus tendon-bursa ossification in a Eurasian Dog. To the authors' knowledge, this condition has previously not been described in this breed of dog.

Qualitative Reflections: CASA's Trauma and Attachment Group (TAG) Program for Youth who have Experienced Early Developmental Trauma.

OBJECTIVE: We demonstrated previously that the Trauma and Attachment Group (TAG) program for youth in middle childhood significantly improved caregiver/child attachment relationships, reduced children's symptoms of attachment trauma, and increased the caregiver's ability for self-reflection. Here we examine the perspectives of both those administering and those taking part in this intensive dyad-based group intervention. METHODS: Utilizing an ethnographic design we collected and analyzed qualitative data obtained through a focus group and interviews with program facilitators, as well as interviews with participating caregivers. Data were collected from six TAG facilitators through a formal focus group interview (n=4), and informal interviews with TAG facilitators unable to attend the focus group (n=2). Four interviews were also carried out with caregivers (three females and one male). Thematic analysis of the focus group and interview transcripts was conducted. RESULTS: Three key themes were identified in the focus group and interview data: Relationship as locus of change, Group process, and Psychoeducation-based content. That the TAG program provides psychoeducation about the effects of trauma to caregiver/child dyads in a group setting appears important in supporting the effectiveness of the program. Structured parent-child play and sensory activities together ("kit-time") were also highly valued. CONCLUSIONS: This qualitative study suggests that establishment of a healthy and focused caregiver/child relationship may be the key mechanism to promoting change in relationships that have been challenged by adverse effects of early developmental trauma. Further evaluation may help to identify other components that contribute to the success of the program.

OBJECTIF: Nous avons précédemment démontré que le programme du groupe sur le traumatisme et l'attachement (TAG) pour les jeunes de la phase intermédiaire de l'enfance améliorait significativement les relations d'attachement entre soignant et enfant, réduisait les symptômes du traumatisme d'attachement chez les enfants, et accroissait la capacité d'autoréflexion du soignant. Nous examinons ici les perspectives de ceux qui administrent cette intervention de groupe intensive sous forme de dyade et de ceux qui y prennent part. MÉTHODES: À l'aide d'un concept ethnographique, nous avons recueilli et analysé des données qualitatives obtenues grâce à un groupe de discussion et à des entrevues menées auprès des animateurs du programme, ainsi qu'à des entrevues avec les soignants participants. Les données ont été recueillies auprès de 6 animateurs du TAG lors d'une entrevue avec le groupe de discussion officiel (n = 4), et d'entrevues informelles avec les animateurs du TAG qui n'ont pas pu assister au groupe de discussion (n = 2). Quatre entrevues ont aussi été menées avec les soignants (3 femmes et 1 homme). Une analyse thématique du groupe de discussion et des transcriptions des entrevues a été menée. RÉSULTATS: Trois thèmes principaux se sont dégagés du groupe de discussion et des données d'entrevues: la relation en tant que centre du changement, le processus du groupe, et le contenu basé sur la psychoéducation. Il semble important que le programme TAG offre la psychoéducation sur les effets du traumatisme aux dyades soignant/enfant dans le cadre d'un groupe pour soutenir l'efficacité du programme. Le jeu structuré parent-enfant et les activités sensorielles faites ensemble (« kit-time ¼) étaient aussi très appréciés. CONCLUSIONS: Cette étude qualitative suggère que la formation d'une relation soignant/enfant saine et ciblée puisse être le principal mécanisme favorisant le changement dans les relations qui ont été affectées par les effets indésirables d'un traumatisme développemental précoce. Une évaluation additionnelle serait utile pour identifier d'autres éléments qui contribuent au succès du programme.

Clinical, radiographic, and magnetic resonance imaging findings of gastrocnemius musculotendinopathy in various dog breeds.

OBJECTIVES: To describe clinical, radiographic, and magnetic resonance imaging (MRI) findings in 16 dogs diagnosed with gastrocnemius musculotendinopathy. METHODS: Retrospective evaluation of medical records, radiographs, and MRI results, as well as follow-up completed by telephone questionnaire. RESULTS: Most dogs had chronic hindlimb lameness with no history of trauma or athletic activities. Clinical examination revealed signs of pain on palpation without stifle joint instability. Seven dogs had radiographic signs of osteophyte formation on the lateral fabella. Magnetic resonance imaging revealed T2 hyperintensity and uptake of contrast agent in the region of the origin of the gastrocnemius muscle. Changes were found in the lateral and medial heads of the gastrocnemius. Conservative treatment resulted in return to full function in 11 dogs. Two dogs showed partial restoration of normal function, one dog showed no improvement. Two dogs were lost to follow-up. CLINICAL SIGNIFICANCE: Gastrocnemius musculotendinopathy is a potential cause of chronic hindlimb lameness in medium to large breed dogs. A history of athletic activity must not necessarily be present. Magnetic resonance imaging shows signal changes and uptake of contrast agent in the region of the origin of the gastrocnemius muscle. A combination of T1 pre- and post-contrast administration and T2 weighted sequences completed by a fat-suppressed sequence in the sagittal plane are well-suited for diagnosis. Conservative treatment generally results in return to normal function.

The CASA Trauma and Attachment Group (TAG) Program for Children who have Attachment Issues Following Early Developmental Trauma.

OBJECTIVE: There is relatively little research about effective therapeutic approaches for children in middle childhood who have attachment related diagnoses as a result of experiencing significant, early developmental trauma. This study describes findings from an intensive, dyad-based intervention, aimed at stabilizing attachment relationships with primary caregivers, increasing caregiver reflective function skills, and reducing children's trauma-related behavioural sequelae. METHOD: We analyzed retrospective data from 51 caregiver/child dyads who participated in the Trauma and Attachment Group (TAG) Program from September 2011-December 2014. This data included pre- and post-intervention scores retrieved from the Parenting Relationship Questionnaire (PRQ), the Parent Report of Post-Traumatic Stress Symptoms (PROPS), and the Parental Reflective Functioning Questionnaire (PRFQ-1). RESULTS: The preliminary findings show statistically significant improvements in attachment, communication, discipline practices, involvement, and relational frustration. Additionally there were statistically significant improvements in parental reflective functioning, and a trend towards a reduction in symptoms typical of post-traumatic stress disorder. CONCLUSION: Poor quality or inconsistent interactions with early caregivers can lead to life-long impairments in physical and mental health. This intensive program shows potential as a way to improve longer-term outcomes for children exposed to early developmental trauma. Longer-term research is required to further substantiate outcomes, appraise cost analysis, as well as to consider evaluation with appropriate comparison groups.

OBJECTIF: Il y a relativement peu de recherches sur les approches thérapeutiques efficaces pour les enfants en phase intermédiaire de l'enfance qui ont des diagnostics liés à l'attachement pour avoir vécu des traumatismes développementaux précoces significatifs. Cette étude décrit les résultats d'une intervention intensive, dyadique, visant à stabiliser les relations d'attachement avec les soignants principaux, à accroître les capacités de la fonction réflexive, et à réduire les séquelles comportementales liées au traumatisme chez les enfants. MÉTHODE: Nous avons analysé les données rétrospectives de 51 dyades soignant/enfant qui ont participé au programme de groupe traumatisme et attachement (TAG) de septembre 2011­à décembre 2014. Ces données incluaient les scores d'avant et d'après intervention obtenus du Parenting Relationship Questionnaire (PRQ), du Parent Report of Post-Traumatic Stress Symptoms (PROPS), et du Parental Reflective Functioning Questionnaire (PRFQ-1). RÉSULTATS: Les résultats préliminaires révèlent des améliorations significatives de l'attachement, de la communication, des pratiques de discipline, de la participation, et de la frustration relationnelle. En outre, il y avait des améliorations statistiquement significatives du fonctionnement réflexif parental, et une tendance vers une réduction des symptômes typiques du trouble de stress post-traumatique. CONCLUSION: Des interactions de mauvaise qualité ou incohérentes avec les premiers soignants peuvent mener à des déficiences de durée de vie de la santé mentale et physique. Ce programme intensif présente un potentiel comme façon d'améliorer les résultats à long terme pour les enfants exposés à un traumatisme développemental précoce. Il faut une recherche à plus long terme pour étayer les résultats, estimer l'analyse des coûts et envisager l'évaluation avec des groupes de comparaison appropriés.

Glyoxalase-I mRNA expression and CCK-4 induced panic attacks.

RATIONALE: There is evidence that the anti-glycation enzyme glyoxalase-1 (GLO1) may play a role in anxiety-related behaviour. However, discordant findings between GLO1 expression and anxiety-related behaviour have been observed in animal models. Because no data are available on the relation between GLO1 mRNA expression and human anxiety so far, we investigated the expression of GLO1 mRNA in peripheral blood cells in relation to cholecystokinin-tetrapeptide (CCK-4) induced panic anxiety in healthy subjects as an established model of human anxiety in healthy volunteers. METHODS: Twenty-three healthy subjects underwent challenge with CCK-4. GLO1 mRNA expression was assessed by quantitative real-time polymerase chain reaction prior to CCK-4 injection. Baseline anxiety was assessed with the State-Trait-Anxiety-Inventory (STAI) and panic response was measured with the Panic Symptom Scale (PSS). RESULTS: CCK-4 elicited a marked anxiety response accompanied by a significant increase in heart rate. GLO1 mRNA expression did not correlate with state or trait anxiety nor with severity of CCK-4 induced anxiety. CONCLUSIONS: The lack of correlation between GLO1 mRNA expression and CCK-4 induced panic severity suggests that GLO1 is not involved into the acute panic response to CCK-4 in healthy volunteers. Therefore, further studies are needed to clarify the involvement of GLO1 in anxiety disorders at baseline and in anxiety challenge paradigms to resolve the apparent contradictions of preclinical studies concerning the relationship between GLO1 expression and anxiety.

Counting Child Domestic Servants in Latin America.

This paper summarizes trends in the use of child domestic servants in six Latin American countries using IPUMS-International census samples for 1960 to 2000. Child domestics are among the most vulnerable of child workers, and the most invisible. They may be treated kindly and allowed to attend school, or they may be secluded in their employers' home, overworked, verbally abused, beaten, and unable to leave or report their difficulties to kin. Estimates and imputations are based on labor force and relationship-to-head variables. We find that domestic service makes up a substantial fraction of girls' employment in some countries. We also analyze trends in live-in versus live-out status and school enrollment of child domestic servants. While all child workers are disadvantaged in enrollment relative to non-workers, domestics are sometimes better off than non-domestic workers. In some samples, live-ins are more likely to go to school than live-out child domestics. In others, they are substantially worse off.