[Aftercare Following Inpatient Rehabilitation of Patients with Obesity: Feasibility of the KgAS-Concept]. / Ambulante Nachsorge nach stationärer Adipositasrehabilitation: Machbarkeit des KgAS-Nachsorgekonzeptes.

Even though the inpatient rehabilitation of children and adolescents with obesity shows beneficial effects in short term, the relapse rate afterwards is high. Previous attempts to implement successful aftercare programs that are open to all patients were either not successful or have been cancelled. Therefore, a new program was developed and evaluated in terms of feasibility. In a cooperation of a rehabilitation clinic with aftercare specialists, 25 families were enabled to participate. During the inpatient treatment a case management was established to accompany and transfer the patients to the ambulatory care afterwards. The process and the aftercare were evaluated by questionnaires (children/adolescents, parents, aftercare specialists) as well as one-on-one interviews and a focus group with the aftercare specialists that were also analyzed. Results show the feasibility of the program and good satisfaction rates among all participating groups (children/adolescents, parents, aftercare specialists, inpatient rehabilitation center). Thus, the program might be eligible in the treatment process. However, the evaluation of the effectiveness in a randomized controlled study is recommended.

[Behavioral problems of somatic chronically ill adolescents: parent-child-agreement and differences]. / Verhaltensauffälligkeiten bei körperlich chronisch kranken Jugendlichen: Übereinstimmungen und Unterschiede im Selbst- und Elternurteil.

BACKGROUND: Adolescents with a chronic somatic disease often show comorbid mental health problems which interfere with adherence and disease management. As adolescents often pass their rehabilitation treatment without their parents and therapists frequently lack resources necessary for assessing information from both the patients and their parents, the question arises what conclusions can be drawn on the basis of self report data only and how general agreement between parent and adolescents can be rated. METHODS: Parent-child-agreement of chronically ill adolescents and their families are analyzed using intra-class-correlation (ICC). Data of 367 adolescents with obesity, chronic respiratory disease, skin disease and diabetes between the age of 12.0 and 16.11 years were collected at the beginning of rehabilitation treatment. Parents received their questionnaire via post. Psychological symptoms were identified using the German version of the Strength and Difficulties Questionnaire (SDQ-Deu). RESULTS: There was medium to high agreement between parent and child ratings regarding "emotional problems", "peer relationship problems" and "total difficulty score" for all diagnoses. CONCLUSIONS: Therapists of chronically ill adolescents can act on the assumption that parent-child-agreement is medium to high. Consequently, self-ratings appear a useful diagnostic indicator for rehabilitation treatment.

[Certification of therapy institutions, obesity trainers, and obesity trainer academies by the German Working Group on Obesity in Children and Adolescents (AGA)]. / Was hat die Arbeitsgemeinschaft Adipositas im Kindes- und Jugendalter durch die Zertifizierung von Behandlungseinrichtungen, Adipositas-Trainern und Adipositas-Trainer-Akademien erreicht?

There is a vast choice of behavioral therapy for obesity in children and adolescents, with wide differences in quality. In order to provide orientation for families, physicians, and health insurance companies, the German Working Group on Obesity in Children and Adolescents (AGA), which is affiliated with the German Obesity Society (DAG) and the German Pediatric Society (DGKJ), offers to certify institutions providing patient education programs for obese children and adolescents, obesity trainers, and academies for obesity trainers. Currently, 60 institutions offer obesity care, while 81 obesity trainers and 8 trainer academies are certified. This article summarizes requirements for certification and preliminary experience.

[Medical inpatient rehabilitation influences on self-esteem and self-efficacy of chronically ill adolescents]. / Einflüsse der medizinischen stationären Rehabilitation auf den Selbstwert und die Selbstwirksamkeit von chronisch kranken Jugendlichen.

BACKGROUND: In this article the development of self-esteem and self-efficacy in adolescents with chronic physical illness with and without psychological symptoms is measured over one year, following a medical inpatient rehabilitation treatment of four to six weeks. Gender- and diagnosis-related differences are analyzed. MATERIALS AND METHODS: 243 chronically ill adolescents were interviewed at the beginning of their rehabilitation treatment. After one year data of 99 chronically ill adolescents are available (age: M=14.6; SD=1.70), 50 boys. Self-esteem was measured using the revised Rosenberg Self-Esteem Scale. The revised Allgemeine Selbstwirksamkeitsskala was chosen for assessing self-efficacy at school and other social contexts. At the beginning of rehabilitation, psychological symptoms were identified using the German version of the Strengths and Difficulties Questionnaire. RESULTS: Therapy of chronically ill adolescents in medical rehabilitation affects their self-esteem positively, with differences in self-esteem found between adolescents who show clinically relevant psychological symptoms and those who do not. Only minor changes are however noticed in ratings of self-efficacy at school and other social contexts. Gender- and diagnosis-related differences have not been found.

[Self management in chronically ill adolescents: development of a short questionnaire]. / Entwicklung eines Kurz-Fragebogens zum Krankheitsmanagement chronisch kranker Jugendlicher.

PURPOSE: Behavioural interventions in chronically ill adolescents aim to improve disease-related self-management. The study presents a short questionnaire for examining the self-management strategies in paediatric patients with obesity, asthma, type I diabetes or atopic eczema. METHODS: For each indication, six favourable disease management strategies were identified: adherence to the subjective body perception, avoidance of trigger factors, adequate control of one's own behaviour, appropriate emergency treatment, and regular prolonged treatment including, depending on the disease at hand, adherence to alimentation. For each indication a "disease management" scale with six items was constructed. Psychometric properties (item statistics, reliability) were examined among 416 adolescents. Participants were diagnosed at least with one chronic illness and took part in an inpatient rehabilitation programme in a German rehabilitation clinic. RESULTS: For the scale obesity (KM-KJ-Adi) (n=192) difficulty of the items was 0.30-0.43, discrimination was 0.32-0.57 and Cronbach's alpha was 0.72. For the scale asthma (KM KJ AB) (n=164) difficulty of the items was 0.43-0.65, discrimination was 0.29-0.52 and Cronbach's alpha was 0.70. For the scale diabetes (KM-KJ-DM1) (n=78) difficulty of the items was of 0.42-0.74, discrimination was of 0.25-0.87 and Cronbach's alpha was 0.68. For the scale atopic eczema (KM-KJ-AE) (n=125) difficulty of the items was 0.31-0.71, discrimination was of 0.24-0.51 and Cronbach's alpha was 0.64. DISCUSSION: Up to now, no economic, indication-specific and reliable questionnaire exists for assessing the competences of adolescents in their disease self-management. The presented questionnaire fills this gap, the indication-specific scales with only a few items show satisfactory psychometric results. CONCLUSIONS: This questionnaire can be used as an instrument for self-management strategies in chronically ill adolescents. The responsiveness (change score) and validity have to be further investigated.