Impact of the COVID-19 pandemic on children with and without affective dysregulation and their families.

Analyzing COVID-19-related stress in children with affective dysregulation (AD) seems especially interesting, as these children typically show heightened reactivity to potential stressors and an increased use of maladaptive emotion regulation strategies. Children in out-of-home care often show similar characteristics to those with AD. Since COVID-19 has led to interruptions in psychotherapy for children with mental health problems and to potentially reduced resources to implement treatment strategies in daily life in families or in out-of-home care, these children might show a particularly strong increase in stress levels. In this study, 512 families of children without AD and 269 families of children with AD reported on COVID-19-related stress. The sample comprised screened community, clinical, and out-of-home care samples. Sociodemographic factors, characteristics of child and caregiver before the pandemic, and perceived change in external conditions due to the pandemic were examined as potential risk or protective factors. Interestingly, only small differences emerged between families of children with and without AD or between subsamples: families of children with AD and families in out-of-home care were affected slightly more, but in few domains. Improvements and deteriorations in treatment-related effects balanced each other out. Overall, the most stable and strongest risk factor for COVID-19-related stress was perceived negative change in external conditions-particularly family conditions and leisure options. Additionally, caregiver characteristics emerged as risk factors across most models. Actions to support families during the pandemic should, therefore, facilitate external conditions and focus on caregiver characteristic to reduce familial COVID-19-related stress. Trial registration: German Clinical Trials Register (DRKS), ADOPT Online: DRKS00014963 registered 27 June 2018, ADOPT Treatment: DRKS00013317 registered 27 September 2018, ADOPT Institution: DRKS00014581 registered 04 July 2018.

[Desired place of death, living will and desired care at end of life: initial results of a survey of nursing home residents]. / Gewünschter Sterbeort, Patientenverfügungen und Versorgungswünsche am Lebensende: erste Ergebnisse einer Befragung von Pflegeheimbewohnern.

BACKGROUND AND PURPOSE: There is little information about the desired place of death of nursing home residents because they are usually not interviewed in population-based representative surveys. In preparation of support services for advance care planning the kind of care and support that nursing home residents desire needs to be systematically determined. METHOD: From October 2016 to January 2017 the residents of 5 nursing homes, municipally owned by Würzburg, were interviewed face-to-face. RESULTS: Of the residents 42.7% could not be interviewed due to cognitive limitations or dementia. The legal guardians of 63 residents declined participation in the study and 68 residents took part in the survey. Of the respondents 43 stated they wanted to pass away in the nursing home (63.2%). If interviewees had a person of trust or felt at home there, the number of those wanting to pass away in a nursing home was significantly higher. A total of 25 interviewees had either a living will, power of attorney for care, or a health care proxy (36.7%) and 55.3% had informed a person of trust in the nursing home about their desired care, usually a nurse (52.8%) or co-resident (36.1%). A total of 50.0% of respondents had informed their general practitioner and 23.5% had not spoken to anyone about their desired care. Especially nurses were specifically mentioned as the appropriate contact person to record desired care (70.4%). DISCUSSION: Residents view their nursing home as the place for dying in a much more positive light compared to frequent discussions contrasting population surveys and actual places of death. End of life prearrangements should be designed as a dynamic process that include persons of trust, nurses and general practitioners.

Intrathecal Baclofen therapy in Germany: Proceedings of the IAB-Interdisciplinary Working Group for Movement Disorders Consensus Meeting.

Continuous intrathecal Baclofen application (ITB) through an intracorporeal pump system is widely used in adults and children with spasticity of spinal and supraspinal origin. Currently, about 1200 new ITB pump systems are implanted in Germany each year. ITB is based on an interdisciplinary approach with neurologists, rehabilitation specialists, paediatricians and neurosurgeons. We are presenting the proceedings of a consensus meeting organised by IAB-Interdisciplinary Working Group for Movement Disorders. The ITB pump system consists of the implantable pump with its drug reservoir, the refill port, an additional side port and a flexible catheter. Non-programmable pumps drive the Baclofen flow by the reservoir pressure. Programmable pumps additionally contain a radiofrequency control unit, an electrical pump and a battery. They have major advantages during the dose-finding phase. ITB doses vary widely between 10 and 2000 µg/day. For spinal spasticity, they are typically in the order of 100-300 µg/day. Hereditary spastic paraplegia seems to require particularly low doses, while dystonia and brain injury require particularly high ones. Best effects are documented for tonic paraspasticity of spinal origin and the least effects for phasic muscle hyperactivity disorders of supraspinal origin. Oral antispastics are mainly effective in mild spasticity. Botulinum toxin is most effective in focal spasticity. Myotomies and denervation operations are restricted to selected cases of focal spasticity. Due to its wide-spread distribution within the cerebrospinal fluid, ITB can tackle wide-spread and severe spasticity.

Psychooncological provision in a general hospital: the Herford model.

Since October 1995 a Department of Psychooncology exists at the Herford Community Hospital. It was founded by a private foundation with the aim of supporting patients who suffer from cancer. The psychooncological section is an independent unit. This state of independence proved to be very useful and functional. The Herford Model is based on four compartments: psychosocial support for the patients; support for the patients' relations; the education of doctors and nurses; the evaluation of the activities of the team members, one music therapist and three psychologists. During the past 2.5 years 846 patients have had contact with the Department of Psychooncology. The mean age was about 62 years within a range from 15 to 92 years. Of the patients, 48% were men and 52% were women. The maximum number of meetings was 49: 29% of the patients had between four and eight therapeutical meetings, 12% had more than nine sessions. It is the aim of this report to show how the section is organized. The daily work and the rate of provision is shown and an outlook of the team's work in the future is given.

Clinical behavioral problems in day- and night-wetting children.

In this prospective, clinical study of 167 consecutive wetting children, the associations between specific forms of day and night wetting and clinical behavioral symptoms according to a parental questionnaire (Child Behavior Checklist; CBCL), as well as ICD-10 child psychiatric diagnoses are analyzed. For the entire group, the proportion of children with at least one ICD-10 diagnosis was 40.1% and for the CBCL total problems scale 28.2% - three times higher than in the general population. Expansive disorders (21%) were twice as common as emotional disorders (12%). A significantly higher (P<0. 05) proportion of day-wetting children had at least one diagnosis (52.6%) and emotional disorders (19.5%) compared with nocturnal enuretics (33.6% and 8.2%, respectively). Secondary nocturnal enuretics had significantly higher CBCL total problem scores (39.3% vs. 20.0%, P<0.05) as well as psychiatric ICD-10 diagnoses (75% vs. 19.5%, P<0.001) than primary enuretics. Children with primary monosymptomatic enuresis had the lowest rate of CBCL total behavioral symptoms (14.5%) and diagnoses (10%). Of the day-wetting children, those with voiding postponement had more expansive disorders (39.3% vs. 13.6%, P<0.05) and externalizing symptoms (37% vs. 19.%, NS) than those with urge incontinence. In summary, a third of wetting children showed clinically relevant behavioral problems with specific psychiatric comorbidity for the subtypes. A more-detailed differentiation into syndromes rather than into day/night and primary/secondary forms is needed.

Somatic correlates of functional enuresis.

Functional enuresis is a heterogeneous group of syndromes with different aetiology and pathophysiology. The aim was to identify specific somatic correlates of enuresis non-invasively in child psychiatric patients after exclusion of neurologic and structural forms of incontinence. One hundred sixty-seven consecutive children, aged 5 to 10 years with day and/or night wetting were examined prospectively with: urinalysis and bacteriology; ultrasonography, including bladder wall thickness and residual volume; uroflowmetry and pelvic-floor-EMG; EEG; and a complete paediatric-neurologic examination. Day wetting children had a significantly higher rate of previous antibiotic prophylaxis, larger residual volume, thicker bladder walls; the uroflow curves were significantly less bell- and more staccato-shaped, the EMG less relaxed. Voiding postponers showed a tendency towards more uroflow anomalies than urge incontinent children. Primary and secondary enuretics did not differ on most parameters, but primary nocturnal enuretics with micturition problems had significantly less relaxed EMGs than monosymptomatic enuretics. Although day wetters had more pathological EEGs and neurological signs, these differences did not reach significance. The overall rate of urogenital anomalies was 10%. In conclusion, enuresis has a high rate functional somatic correlates with clinical and theoretical, classificatory implications.

[Psycho-oncology in the Herford district clinic--the Herford model]. / Psychoonkologie im Klinikum Kreis Herford--Das Herforder Modell.

Following successful implementation of psychooncological support in a community hospital the focus has now been shifted to build up support for outpatients. This concentrates on cancer patients and their relatives during and following ambulatory cancer therapy. It is important to integrate these new structures into the preexisting support structures (self-help groups and counselling centres). Experiences of recent years have shown that information and psychosocial support should also be given to families and friends of cancer patients as well as to the involved clinical staff. Outpatient groups have been und will be offered in the psychooncological aftercare. Relaxation, imagination and creative therapy help to cope with the disease and enable a health-promoting life style.

[Possible pathophysiologic, diagnostic and therapeutic implications of new findings on leptin secretion within the scope of anorexia nervosa]. / Mögliche pathophysiologische, diagnostische und therapeutische Implikationen neuer Befunde zur Leptinsekretion im Rahmen der Anorexia nervosa.

OBJECTIVES: Leptin is a hormone synthesized in adipocytes and secreted into the bloodstream. It plays an important role in the regulation of body weight, the adaptation to semi-starvation and in reproductive function. Hence, clinical studies pertaining to anorexia nervosa can serve to further elucidate the functions of this hormone in light of the unique features of this disorder. METHODS: Circulating concentrations of leptin are exceedingly low during the acute stage of anorexia nervosa. Which symptoms result from these diminished concentrations must be clarified. Furthermore, research is required to evaluate whether or not a too rapid weight gain might induce a physiological counter-regulation which would predispose to renewed loss of weight. RESULTS: This review summarizes findings to date pertaining to leptin secretion in patients with anorexia nervosa. In addition, possible diagnostic, pathophysiological and therapeutic implications are discussed.

Anesthesia and pain management in pediatric burn patients.

Patients with severe burn injury are a challenge for the pediatric anesthesiologist. Today with adequate care many children survive their trauma and have a good chance for complete functional and psychological rehabilitation. The anesthesiologist has to provide excellent care even for patients in suboptimal or unstable condition to enable wound debridement and grafting, because only rapid skin closure will stabilize the patient. Adequate pain treatment during all phases of burn treatment is mandatory.

Extragenic and intragenic suppression of a transport mutation in the hemagglutinin gene of an influenza A virus as revealed by backcross and sequence determination.

Cooperation of viral proteins, or functional domains within a protein, can be studied by analyzing temperature-sensitive (ts) mutants and revertants carrying suppressor mutations. Accordingly, we have sequenced the hemagglutinin (HA) genes of a ts mutant of fowl plague virus (FPV), with a transport defect in the HA, and of five independent ts+ revertants (R1, R3, R4, R5, and R9). The amino acid replacement in position 480 from Thr to Ile, leading to the loss of a complex carbohydrate side chain, is responsible for the ts phenotype. R3, R4, and R5 are true revertants in that they have Thr in position 480, while R1 and R9 have kept Ile. The sequence of the HA of R1 is exactly the same as that of the ts mutant, while the R9 HA has two additional amino acid replacements in positions 91 (Lys-Thr) and 104 (Gly-Val). By doing a backcross with wild-type virus, it was shown that R1 carries an extragenic suppressor mutation, while R9 is intragenically suppressed. We conclude that the HA is transported from the site of its synthesis in the rough endoplasmic reticulum (RER) to the plasma membrane along with another viral gene product, which by mutation can complement the ts defect. An alternative interpretation is that the ts mutation results from a change in HA which allows an interacting protein to bind HA too soon, holding it back in the RER. The suppressor mutation may remove this premature interaction.