[Effectiveness of School-Based Life Skills Programmes on Secondary Schoolchildren in a High Risk Sample]. / Überprüfung der Effektivität schulischer Gesundheitsprogramme bei Schülerinnen und Schülern der Sekundarstufe I mit besonderen sozialen Belastungen.

Based on a randomized controlled multicentre-design the effect of school-based life skills programmes was investigated in a sample of 102 classes of secondary schools (Hauptschulen) in northern Germany. Self-reports of 1,057 pupils showed positive effects of the programmes on the reduction of smoking. Pupils' life skills improved in the teachers' assessment. The social and the migration status did not moderate the results. Both pupils and teachers evaluated the programmes very positive.

Investigation of quality of life and family burden issues during insulin pump therapy in children with Type 1 diabetes mellitus--a large-scale multicentre pilot study.

AIMS: To investigate psychosocial aspects of continuous subcutaneous insulin infusion (CSII) therapy in children with Type 1 diabetes and to identify relevant and sensitive measures. METHODS: We performed a multi-centre prospective pre-/post-study with children (53 girls, 64 boys, age 10.5 +/- 3.7 years, mean +/- sd) with Type 1 diabetes and their main carer from 18 German diabetic centres. Twenty-five children aged 8-11 years and 63 adolescents aged 12-16 years and their parents, plus 29 parents of children aged 4-7 years completed standardized questionnaires on generic and diabetes-specific quality of life (QOL), generic parenting stress, mealtime behaviour, fear of hypoglycaemia and family conflict immediately before and 6 months after transition to CSII. RESULTS: After transition to CSII, diabetes-specific QOL of children increased significantly (P < 0.001) in all age groups, with moderate to large effect sizes (children aged 4-7 years: Cohen's effect sized = 1.3; 8-11 years: d = 0.9, adolescents 12-16 years: d = 0.6). Parents reported reduced frequency (P < 0.01, d = 0.4-0.7) and difficulty (P < 0.01, d = 0.3-0.6) of overall parenting stress and decreased worries about hypoglycaemia (P < 0.01, d = 0.4-0.6). Parents of younger children (4-7 years) reported reduced problems with nutrition management (frequency: P < 0.001, d = 1.1; difficulty: P < 0.05, d = 0.7). CONCLUSIONS: CSII may have substantial psychosocial benefits. Controlled studies are needed.

FLIP&FLAP-a training programme for children and adolescents with epilepsy, and their parents.

OBJECTIVE: The objective of this article is to present the development, contents and efficacy of the FLIP&FLAP programme for children and adolescents with epilepsy, and their parents. INTERVENTION: The programme is mainly directed at age-appropriately developed children and adolescents between 6 and 16 who take antiepileptic drugs. It is conducted as a 2.5-day group training programme; children and parents are grouped separately. The main focuses are: EVALUATION STUDY: We performed a multi-centre non-randomised two-group pre-/post-trial using a waiting-list control group design. 10 German epilepsy centres participated. The intervention group, IG (21 children 8-11 years, 44 adolescents 12-16 years, 72 parents) completed standardised questionnaires immediately before the FLIP&FLAP course and 6 months later; the waiting control group, WCG (31 children, 39 adolescents, 72 parents) 6 months before and immediately before the course. Compared to the WCG, the children and parents of the IG showed significantly improved knowledge of epilepsy, with medium to large effect sizes (univariate analysis of variance with repeated measurements, d=0.6-1.4). Parents of the IG reported improved self-management skills (d=0.7) and communication skills (d=0.8) of their child and fewer epilepsy-related worries (d=0.5). Children and adolescents of the IG reported improved HRQOL in the Social Exclusion dimension (d=0.3). CONCLUSION: FLIP&FLAP is an effective child- and family-centred programme. It is currently being established in Northern Germany to test its usefulness in routine care.

Self-reported health-related quality of life in children and adolescents with myelomeningocele.

The aim of the study was to investigate self-reported health-related quality of life (HRQOL) in children and adolescents with myelomeningocele (MMC) and to examine the impact of clinical impairments and limitations in activities of daily living (ADL). Fifty patients (28 females, 22 males) between 8 and 16 years of age (mean age 12y 1mo [SD 2y 4mo]) with MMC from three German paediatric centres and their mothers completed standardized measures on HRQOL (KINDL-R) and limitations in ADL (Childhood Health Assessment Questionnaire). Lesion level was thoracic in nine, sacral in 25, and lumbosacral in 11 patients. Twenty-one patients were community walkers, 17 were able to walk in the home, and seven used a wheelchair. Two-thirds had health problems related to the central nervous system causing current difficulties (eight patients had a shunt, six had hydrocephalus, and 10 had a tethered cord). Patients in the study group reported diminished overall HRQOL compared with norm data, specifically in the dimensions of emotional well-being, self-esteem, and peer relations. Adolescents reported diminished HRQOL in the dimension of peer relations. Most medical parameters as well as limitations in ADL were not significantly associated with HRQOL. Our findings confirm the results of studies which dispute a linear inverse association between condition severity and HRQOL and emphasize the importance of peer relations in young patients with MMC.

[Health-related quality of life in children and adolescents with juvenile idiopathic arthritis: which role do age, sex and medical parameters play?]. / Gesundheitsbezogene Lebensqualität von Kindern und Jugendlichen mit juveniler idiopathischer Arthritis: Welche Rolle spielen Alter, Geschlecht und medizinische Parameter?

BACKGROUND: The assessment of health-related quality of life gains increasing importance in pediatric practice. In the field of rheumatic health conditions in young people only a few studies about this topic are available. Within a European study health-related quality of life of children and adolescents with idiopathic arthritis was assessed. The results of the German sample will be presented. PATIENTS: A total of N=88 children and adolescents with juvenile idiopathic arthritis (57% female) between 8 und 16 years were included in the study. METHOD: Children and adolescents filled in a questionnaire. Health-related quality of life was assessed with the DISABKIDS instrument. RESULTS: No age or gender effects on health-related quality of life were detected. The variable "limitation of mobility" as well as the item "pain" showed the strongest relationship with the health-related quality of life dimensions. CONCLUSIONS: Health-related quality of life is decisively influenced by the consequences of the health condition. For clinical practice the study showed that patients with mobility limitations and/or pain need heightened attention which should especially concentrate on the social and mental dimensions of health-related quality of life.

Mobile diabetes education and care: intervention for children and young people with Type 1 diabetes in rural areas of northern Germany.

AIMS: To improve the quality of care in children with Type 1 diabetes who have limited access to specialized diabetes care in rural areas, by providing a mobile diabetes education and care team, affiliated with a University hospital paediatric diabetes centre. METHODS: A cohort of 107 children and their families from eight rural hospitals was followed between July 2000 and July 2002. Parameters on quality of metabolic control (HbA(1c), hospitalization rate and number of episodes of severe hypoglycaemia), diabetes knowledge and quality of life at baseline (t(0)), 6 weeks (t(1)) and 6 months (t(2)) after the interventions were measured. RESULTS: Mean HbA(1c) was 7.9 +/- 1.4% at t(0). The proportion of HbA(1c) values < 6.8% increased significantly (P < 0.05) and of values > 8.0% decreased significantly (P < 0.01) at t(1) and t(2). The rate of hospitalization fell significantly by 9.4%, from 16.2% at baseline to 6.8% at t(2) (P < 0.05). The children reported significantly better diabetes-specific quality of life (P < 0.05) and higher self-esteem (P < 0.01) after the intervention. Theoretical diabetes knowledge was increased both in the short and long term (P < 0.05). CONCLUSIONS: The intervention improved metabolic control, diabetes knowledge and diabetes-specific quality of life. We conclude that high-quality diabetes care in a rural area can be provided by a mobile diabetes education and care team.

[Quality of life and psychosocial adaptation in children and adolescents with juvenile idiopathic arthritis and reactive arthritis]. / Lebensqualität und psychosoziale Anpassung bei Kindern und Jugendlichen mit juveniler idiopathischer Arthritis und reaktiven Arthritiden.

OBJECTIVE: We sought to measure self-reported health related quality of life (HRQOL) and psychosocial adaptation in children and adolescents with juvenile idiopathic arthritis (JIA) and reactive arthritis and to determine factors associated with these outcomes. METHODS: We interviewed 72 children and adolescents with chronic arthritis, age 8-16, about HRQOL (KINDL-R-Questionnaire) and functional ability in activities of daily living (Childhood Health Assessment Questionnaire-CHAQ). Mothers reported behavior problems (Child Behavior Checklist-CBCL). RESULTS: Children and adolescents with juvenile idiopathic arthritis and reactive arthritis reported lower HRQOL compared to normative data in several areas. Children reported lower QOL in the dimensions self-esteem; adolescents reported lower QOL in the dimensions physical well being and total QOL. Almost 20% of the sample appeared to have serious behavior problems, mostly social isolation and depression/anxiety. Functional limitations affected HRQOL and behavior problems. Inpatient children and adolescents and those with shorter disease duration reported lower QOL than outpatient children and adolescents and those with longer disease duration. Best predictors for impaired HRQOL were functional limitations, social isolation and depression/anxiety. CONCLUSIONS: Self-reported HRQOL and behavior problems may be relevant outcome measures in children and adolescents with chronic arthritis and useful to monitor psychosocial support in this population.