Role of dietary protein and exercise on biomarkers of immune activation in older patients during hospitalization.

The aim of this study was to examine the effect of short-term protein supplementation (aiming to consume 1.2 g protein/kg body weight per day) combined with moderate resistance training on 3 days of the week on tryptophan-kynurenine metabolism in 40 older patients with hip fracture. Secondary outcomes for physical recovery were hand-grip strength and chair-rise score. Older patients with hip fracture exhibited higher degrees of immune activation, detected by increased neopterin and kynurenine to tryptophan levels compared with reference values for healthy elderly with no significant differences between those who received the exercise-protein intervention compared to the control. Increasing dietary protein intake during hospitalization did not alleviate the Th1-type immune response in the elderly patient. On the other hand, muscularity per se may affect immune activation responses following injury, as improvements in maximum hand-grip strength with the intervention were related to decreases in neopterin levels.

Healthcare use and costs associated with children's behavior problems.

The objective of the study was to investigate associations between severity of behavior problems, specific symptom domains with healthcare use and costs in school-aged children. A cross-sectional study using data from the 10-year follow-up of two population-based birth cohorts was conducted on four rural and urban communities in Germany. There were 3,579 participants [1,834 boys (51%), 1,745 girls (49%)] on average aged 10.4 years. The severity levels (normal, at risk, abnormal) and symptom domains of behavioral problems were assessed by parent-reported strengths and difficulties questionnaire (SDQ).The outcomes were medical use categories (physicians, therapists, hospital, and rehabilitation), medical costs categories and total direct medical use and costs (calculated from parent-reported utilization of healthcare services during the last 12 months). Total direct medical costs showed a graded relationship with severity level (adjusted p < 0.0001). Average annual cost difference in total direct medical costs between at risk and normal total difficulties was Euro () 271 (SD 858), and 1,237 (SD 2,528) between abnormal and normal total difficulties. A significant increase in physician costs showed between children with normal and at risk total difficulties (1.30), and between normal and abnormal total difficulties (1.29; p < 0.0001). Between specific symptom domains, children with emotional symptoms showed highest costs for physicians, psychotherapist, and hospitalization as well as total direct medical costs. Children with hyperactivity/inattention showed highest costs for therapists and emergency room costs. Healthcare use and costs are related to the severity of child behavior problems. In general, children's costs for psychotherapy treatments have been low relative to general medical treatments which may indicate that some children with behavioral problems did not get appropriate care. To some degree, medical conditions may be attributable to some of the high hospitalization costs found in children with emotional symptom.

Association of atopic and non-atopic asthma with emotional symptoms in school children.

OBJECTIVE: To date, there is conflicting evidence whether the association between asthma and depression depends on the atopic or non-atopic asthma phenotype. This study investigates associations between emotional symptoms and atopic and non-atopic asthma in school-aged children. METHODS: Cross-sectional data on asthma and allergic diseases at the 10-year follow-up of two birth cohorts were collected by parent-reported physician diagnoses. Specific IgE levels including most common inhalant allergens (SX1) and food allergens (FX5) were measured by RAST-CAP FEIA. Atopic asthma was defined as asthma ever and positive specific IgE test, non-atopic asthma as asthma ever and no IgE sensitization. Emotional symptoms were assessed by parent-reported strength and difficulty questionnaire. Logistic regression modeling were applied to determine likelihood of emotional symptoms in children with atopic and non-atopic asthma controlling for socio-demographic factors, body mass index, atopic eczema, allergic rhinitis, and pubertal development. RESULTS: Non-atopic asthma was associated with about 3-fold higher likelihood of emotional symptoms compared to children with no asthma (ORadj = 2.90, CI95% = 1.46-5.73). Atopic asthma was not associated with emotional symptoms (ORadj = 1.35, CI95% = 0.81-2.26). CONCLUSIONS: Atopic and non-atopic asthma in children might have different etiologies, whereas for non-atopic asthma, emotional symptoms are relevant, this is not the case in atopic asthma. The relationship between the non-atopic asthma phenotype and emotional symptoms might be dependent on gender.

Is there a relationship between hyperactivity/inattention symptoms and poor oral health? Results from the GINIplus and LISAplus study.

OBJECTIVES: A few clinical observations reported that children with attention deficit hyperactivity disorder (ADHD) have poor oral health compared to children without ADHD. However, evidence is not conclusive. We assess the association between hyperactivity/inattention and oral health in a population-based study. MATERIAL AND METHODS: As part of the ongoing birth cohort studies German Infant Nutritional Intervention-plus (GINIplus) and Influences of lifestyle-related factors on the immune system and the development of allergies in childhood-plus (LISAplus), 1,126 children at age 10 years (±10.2) from Munich (Germany) were included in the present analysis. During the dental examination, oral hygiene, non-cavitated and cavitated caries lesions, dental trauma, and enamel hypomineralization (EH) in the permanent dentition (MIH/1) were recorded. Children with a Molar-Incisor-Hypomineralization were subcategorized into those with EH on at least one first permanent molar (MIH/1A), and on at least one first permanent molar and permanent incisor (MIH/1B). Data on children's hyperactivity/inattention symptoms were collected by parent-reported Strength and Difficulties Questionnaire. Logistic regressions and zero-inflated Poisson regression models were applied adjusted for gender, parental education, parental income, and methylphenidate or atomoxetine medication. RESULTS: Logistic regressions showed that non-cavitated caries lesions were positively related with the presence of hyperactivity/inattention (ORadj = 1.51,CI95% = 1.08-2.11). When adjusted for parental background, an association showed between hyperactivity/inattention symptoms and MIH/1A but did not reach statistical significance (ORadj = 1.59,CI95% = 1.00-2.53). CONCLUSIONS: Children with borderline and abnormal values of hyperactivity/inattention symptoms showed more non-cavitated caries lesions. Severe levels of hyperactivity/inattention may contribute to a higher risk for MIH/1A in school age. CLINICAL RELEVANCE: Adequate dental preventive care for children with hyperactivity/inattention, especially from a low social background, is of importance for optimal caries prevention.

Differences in perceived threat and trauma in children during the COVID-19 pandemic.

BACKGROUND: The past 2 years of the COVID-19 pandemic were stressful for most children and adolescents; some children may have experienced a high level of stress and trauma. To date, no study has examined self-reported stress and trauma levels due to COVID-19 in children. This study aimed to assess perceived threat, exposure and trauma symptoms in children aged 7-13 years. In addition, we explored whether parent-reported factors could predict a higher risk of COVID-19 vulnerability in their children. METHOD: Cross-sectional data were collected from 752 children to assess COVID-19 threat, exposure and trauma symptoms using the self- and parent-reported Child and Adolescent Trauma Screening Self-Report (CATS) Trauma questionnaire. We used exploratory analyses (factor analysis of mixed data and hierarchical clustering) to identify subgroups (i.e., clusters) of children sharing similar characteristics in the dataset. Linear regression modeling was applied to determine the likelihood of higher threat and vulnerability in children with parent-reported COVID-19 threat, exposure, CATS trauma symptoms, behaviors on the Child Behavior Checklist (CBCL), and posttraumatic growth (PTG). RESULTS: We identified a high-risk group of children reporting clinically relevant trauma symptoms and COVID-19-related fears. Parents' reports of trauma could be used to identify children at high risk. CONCLUSIONS: Approximately 25% of children reported moderate to clinically relevant levels of trauma symptom. It is especially important to offer adequate support to these children to ease the trauma and prevent their symptoms from developing into psychopathology.

Comparative study of children's mental health outcomes in Tyrol, Austria, and South Tyrol, Italy, during the COVID-19 pandemic.

PURPOSE: This study aimed to compare the mental health outcomes of children in North Tyrol, Austria, and South Tyrol, Italy, during the coronavirus disease 2019 (COVID-19) pandemic, considering the sociocultural and contextual differences between the two regions. METHODS: The Tyrolean COVID-19 Children's Study (TCCS: n = 401; June 2021 to July 2021) and the Corona and Psyche in South Tyrol 2021 Study (COP­S; n = 3402; May 2021 to June 2021) were used for data analyses. Both studies employed cross-sectional designs and collected data through online questionnaires completed by children aged 7-13 years and their parents. Various psychosocial assessment tools including the Child and Adolescent Trauma Screening, Children Anxiety Test, Child Behavior Check List, Screen for Child Anxiety Related Emotional Disorders, and Health Behaviour in School-Aged Children were used in the surveys. RESULTS: The comparison between North Tyrol and South Tyrol revealed no significant differences in perceived threats, trauma, or anxiety among children. Similarly, there were no substantial disparities in psychosomatic complaints, indicating similar manifestations of emotional distress across the two regions. CONCLUSION: The comparative analysis of children's mental health outcomes in North Tyrol and South Tyrol during the COVID-19 pandemic confirmed the analogous influence of sociocultural and contextual factors on their wellbeing. Despite presumable variations in pandemic events, management strategies, and healthcare systems, the study suggests comparable resilience among children and highlights the importance of sociocultural factors in shaping their wellbeing. The findings emphasize the need for comprehensive understanding and targeted interventions to support children's mental health during challenging times.

Food intake, diet quality and behavioral problems in children: results from the GINI-plus/LISA-plus studies.

BACKGROUND/AIMS: To assess the association between food intake and diet quality and behavioral problems at the 10-year follow-up of the two population-based birth cohorts of the studies German Infant Nutritional Intervention and 'Influences of lifestyle-related factors on the immune system and the development of allergies in childhood'. METHODS: Cross-sectional data on food intake over the past year were collected by a parent-reported food frequency questionnaire. Diet quality was based on reference values of food amounts of the optimized mixed diet. Behavioral problems were assessed by a parent-reported Strengths and Difficulties Questionnaire. Relationships between food category intake, diet quality and behavior problems were examined using multivariable regression modeling adjusted for gender, sociodemographic characteristics, body mass index, physical exercise, television viewing/PC use and total energy intake. A total of 3,361 children with complete data were analyzed. RESULTS: Children with increased intake of confectionery had increased odds of having emotional symptoms [adjusted odds ratio (OR(adj)) 1.19, 95% confidence interval (CI) 1.08-1.32] compared to children with low intake. A higher diet quality score was associated with lower likelihood of emotional symptoms (OR(adj) 0.89, 95% CI 0.80-0.98). The unadjusted significant relationship between diet quality and hyperactivity/inattention was attenuated by adjusting for several confounders to an OR(adj) of 0.92 (95% CI 0.82-1.03). CONCLUSIONS: Increased consumption of high-sugar products and lower diet quality are associated with a higher likelihood of emotional symptoms in children.

From childhood to adult age: 18-year longitudinal results and prediction of the course of mental disorders in the community.

OBJECTIVE: This prospective longitudinal study of a representative community sample of children and adolescents (N = 269) examined the long-term course and predictive power of psychiatric symptoms in childhood/adolescence for diagnostic outcome (ICD-10) 18 years later at adult age. METHOD: At both cross-sectional assessments, baseline (1980-1984) and the 18-year follow-up (2001-2004), psychiatric symptoms were assessed using the 'Standardized Psychiatric Interview' (Goldberg et al. in Br J Prev Soc Med 24:18-23, 1970). At follow-up, study participants were reassessed with the standardized M-CIDI (Wittchen and Pfister in Manual und Durchführungsbeschreibung des DIA-X-M-CIDI, Swets and Zeitlinger, Frankfurt, 1997) interview. RESULTS: The participation rate at 18-year follow-up was 82% of those alive. The frequency of clinically relevant depressive symptoms and symptoms of anxiety or phobia was considerably higher when the participants were younger (baseline assessment at childhood, adolescent age) as compared to their scores in adult age. Increased levels of somatic symptoms, fatigue, irritability, sleep disturbances, depression, anxiety and worry as well as phobic symptoms in childhood/adolescence were related to a higher risk of suffering from a psychiatric disorder in adulthood. Depressive symptoms predicted both mood disorders and substance use disorders in adulthood. Phobias predicted later anxiety disorders. CONCLUSION: These data spanning almost two decades add significant information to the existing literature on the course of mental disorders in the community during the transition from adolescence to adulthood.

The Upper Bavarian longitudinal community study 1975-2004. 2. Long-term course and outcome of depression. A controlled study.

OBJECTIVE: The study describes course and outcome over 25 years in depressed and non-depressed men and women from a large community study. Outcome measures covered psychopathology, disability, and impaired functioning. METHOD: A depressive syndrome (depressed mood and three additional depressive symptoms) was defined and compared to a control condition without depressive symptoms in the seven days preceding baseline assessment. Assessments focused on three time points: baseline survey, 5-year follow-up, and 25-year follow-up. Self-rating scales as well as expert-rating interviews yielded data on a wide range of social and psychopathological risk factors and outcome measures. RESULTS: Among participants of all three waves (N=838), the baseline prevalence for depressive syndrome was 18.1%. Depressive symptoms manifest at the first wave had substantial impact over the 25-year study. Subjects with a depressive syndrome were predisposed for later adverse mental health outcomes, more disability in social domains and reduced functionality. No long-term increase or decrease of the prevalence of the depressive syndrome was observed. CONCLUSION: There is a persistent and long lasting impact of depressive syndrome, irrespective of diagnostic status, in the general population. Our results underscore the importance of sub-syndromal depressive syndrome when estimating the risk of future mental disorders and functional impairment in the long-term.

The Upper Bavarian longitudinal community study on psychopathology 1975-2004: 1. Methods and first results.

OBJECTIVE: This paper presents background information on the methods and first results of the 25-years follow-up of the prospective longitudinal Upper Bavarian Study in the community. Longitudinal epidemiological studies which cover very long time spans require special methods. Issues concerning these requirements are discussed using design and experiences from the Upper Bavarian Study. METHOD: Assessments focused on three time points: baseline survey, five-year follow-up, and 25-year follow-up. Self-rating scales as well as expert-rating interviews yielded data on a wide range of social and psychopathological risk factors and outcome measures. RESULTS: Of the 1,342 study participants in the original sample, 390 had died during the 25-year follow-up period. Participation rate was 88% of those alive. At all three time points, a total of 838 participants were interviewed. Data on this unselected sample over a quarter century will be presented in forthcoming papers. Because of their mobility young individuals from our original sample were more difficult to follow up. We analyzed in detail data of subjects interviewed at t3 (and earlier time points) as compared to data from subjects not traced or reached, and subjects who refused to participate at wave t3. We found no evidence that the long-term outcome was biased by drop-out due to gender or earlier mental illness. CONCLUSION: Methodological possibilities and limitations concerning long-term epidemiological studies across decades are presented and discussed.

Prognosis of multifactorial outcome in lumbar discectomy: a prospective longitudinal study investigating patients with disc prolapse.

OBJECTIVES: Although previous research has shown that certain medical data and psychosocial factors predict postoperative pain, it remains unclear whether they also contribute to a more distinct outcome measure that is based on classification of self-reported outcome criteria. To assess the prognostic power of somatic, psychologic, and social predictors when evident outcome criteria of surgical treatment are investigated, this study used a prospective longitudinal design examining preoperative factors associated with outcome six months after lumbar discectomy. METHODS: Forty-eight out of 58 consecutive patients were included (60% male, 40% female, mean age 47 years). Preoperative data comprised of Lasegue sign (straight leg raising test), pain duration, paresis and radicular distribution, depression, pain disability, pain coping strategies, and qualitative descriptions of pain. Additionally, sociodemographic and occupational characteristics were observed. Six months' postoperative classification of outcome included pain intensity, pain locations, functional capacity, return to work, and health-related quality of life. RESULTS: From a surgical point of view, lumbar discectomy was successfully carried out on all patients. But, when subjective criteria of outcome were investigated, 56% of patients benefited from lumbar discectomy, whereas 44% of patients had poor results. Lasegue sign, depression, and sensory pain descriptions proved to be significant predictors, whereas pain cognition and pain coping strategies had no significant influence on evident outcome classification. DISCUSSION: Classification of patients regarding their individual outcome profiles showed that patients responded differently to lumbar disc-surgery. High risk factors for poor outcome of surgery are Laseque-sign and depression.

Effect of fatty acid status in cord blood serum on children's behavioral difficulties at 10 y of age: results from the LISAplus Study.

BACKGROUND: Little is known about the effect of fatty acid (FA) concentrations in cord blood on long-term behavioral outcomes. OBJECTIVE: We assessed the effect of FAs in cord blood serum on children's behavioral difficulties at the age of 10 y. DESIGN: A longitudinal study of 416 children from the population-based Influences of Lifestyle-Related Factors on the Immune System and the Development of Allergies in Childhood (LISAplus) birth cohort from Munich was conducted. Individual glycerophospholipid FAs in blood were analyzed in venous cord blood. Data on children's behavior were collected with a parent-reported Strength and Difficulties Questionnaire at 10 y of age. Zero-inflated Poisson regression models were applied and adjusted for sex, parental income, smoking during pregnancy, and dietary intake of arachidonic acid (AA) and DHA at 10 y. RESULTS: A 1% increase in DHA in cord blood serum was found to decrease total difficulties by (exp)ß(adj) = 0.93 (SE = 0.02, P < 0.0001) and hyperactivity or inattention by (exp)ß(adj) = 0.94 (SE = 0.03, P < 0.04). Higher long-chain (LC) PUFA concentrations in cord blood serum were associated with fewer emotional symptoms [(exp)ß(adj) = 0.95, SE = 0.03, P = 0.01], and similarly higher AA concentrations were associated with fewer emotional symptoms [(exp)ß(adj) = 0.94, SE = 0.03, P = 0.03]. CONCLUSION: Increased concentrations of DHA, LC-PUFAs, and AA in cord blood serum were associated with lower scores on a parent-completed behavioral screen. An appropriate FA supply to the developing fetus may be essential for optimal long-term behavioral outcomes in children.

Acting out and self-harm in children, adolescents and young adults and mental illness 18 years later: The Longitudinal Upper Bavarian Community Study

Background and Objectives: To assess the predictive impact of childhood/adolescent/young adult acting out and self-harm in a community sample of 224 participants on mental illness 18 years later. Methods: Assessments focusseded on a baseline in 1980-84 and the results at a 18-yearfollow-up from 2001-2004. Self-rating scales as well as expert-rating interviews yielded data on acting out, self-harm, psychiatric diagnoses and psycho-social outcome. Results: The participation rate at 18-year follow-up was 82% of those of the baseline sample. Regression analyses showed these results: Acting out and self-harm predicted later mood disorders. Self-harm predicted later psychiatric treatment in the year preceding 18-year follow-up, and impairment in social functioning. Conclusions: Our data contribute to a better and broader understanding of the impact of acting out and self-harm in childhood/adolescence/young adulthood on mental illness and its consequences in adult age and underscore the need for early and intensive intervention at many levels to prevent the accumulation of psychological problems in this age (AU)