[A comparison of perceived maternal love and parentification in children of single-mothers and two-parent families]. / Wahrgenommene mütterliche Liebe und Rollenumkehr im Vergleich zwischen Kindern Alleinerziehender und Kindern aus Zweielternfamilien.

Objectives: About 20 % of children in Germany grow up with a single mother - this is often associated with multiple strain for the mothers and may have adverse effects on the child-parent relationship. Methods: In two retrospective internet surveys (wave 1 born in 1960s, wave 2 born in 1990s) perceived maternal love and role reversal were assessed in children of single mothers and children grown up in two parent families. Results: In both waves high values of maternal love were reported. For children raised by single mothers, strong effects for age and occupational status were observed. Contrary to literature, no gender specific effects on role reversal were observed in this sample. Discussion: High occupational strain in a single mother was associated with less perceived love in the child.Multiple strain in singlemothers should findmore social and political attention. Regarding role reversal support should address daughters and sons similarly.

Novel hereditary angioedema linked with a heparan sulfate 3-O-sulfotransferase 6 gene mutation.

BACKGROUND: Hereditary angioedema (HAE) is a potentially fatal disorder resulting in recurrent attacks of severe swelling. It may be associated with a genetic deficiency of functional C1 inhibitor or with normal C1 inhibitor (HAEnCI). In families with HAEnCI, HAE-linked mutations in the F12, PLG, KNG1, ANGPT1, or MYOF genes have been identified. In many families with HAEnCI the genetic cause of the disease is currently unknown. OBJECTIVE: The aim of this study was to identify a novel disease-linked mutation for HAEnCI. METHODS: The study methods comprised whole exome sequencing, Sanger sequencing analysis, pedigree analysis, bioinformatic analysis of the mutation, and biochemical analysis of parameters of the kallikrein-kinin (contact) system. RESULTS: By performing whole exome sequencing on a multigenerational family with HAEnCI we were able to identify the heparan sulfate (HS)-glucosamine 3-O-sulfotransferase 6 (HS3ST6) mutation c.430A>T (p.Thr144Ser) in all 3 affected family members who were sequenced. This gene encodes HS-glucosamine 3-O-sulfotransferase 6 (3-OST-6), which is involved in the last step of HS biosynthesis. The p.Thr144Ser mutation is likely to affect the interaction between 2 ß-sheets stabilizing the active center of the 3-OST-6 protein. CONCLUSIONS: We conclude that mutant 3-OST-6 fails to transfer sulfo groups to the 3-OH position of HS, resulting in incomplete HS biosynthesis. This likely affects cell surface interactions of key players in angioedema formation and is a novel mechanism for disease development.

Estimating person parameters via item response model and simple sum score in small samples with few polytomous items: A simulation study.

BACKGROUND: The Item Response Theory (IRT) is becoming increasingly popular for item analysis. Theoretical considerations and simulation studies suggest that parameter estimates will become precise only by utilizing many items in large samples. METHOD: A simulation study focusing on a single scale was performed on data with (a) n = 40, 60, 80, 120, 200, 300, 500, and 900 cases utilizing (b) 4, 8, 16, or 32 items. The items were (c) symmetrically distributed vs. skew (skewness 0, 1, and 2). Item loadings were (d) homogeneous vs. heterogeneous. Item loadings were (e) low vs. high. Half of the items had (f) a correlated error or not. The number of answering categories (g) was four vs. five. A total of 10% of each item had missing values. The ability-estimates from the IRT model and the simple sum score served as criteria for evaluating the results. RESULTS: The ability-estimate from the IRT model outperformed the sum score when there were many items, skewed distributed items, and the item loadings were heterogeneous and high. The sum score outperformed the ability-estimate when there were few items, nonskewed items, and homogeneous and low item loadings. However, convergence rates were partly low in small samples. Correlated errors affected, both negatively, the ability-estimate and the sum score. CONCLUSION: With skew item distributions and heterogeneous item loadings, utilizing an IRT model is recommended. However, with few items, many cases are required, conversely, with few cases many items. With few items and few cases, the sum score performs better.

[Therapy of Chronic Back Pain Considering Psychosocial Aspects]. / Therapie des chronischen Rückenschmerzes unter Berücksichtigung psychosozialer Faktoren.

Chronic pain and especially back pain rank among the most meaningful medical conditions worldwide. This leads to extensive costs in medical care systems. In about 80-85% of cases there is no morphologic evidence for a possible pain etiology, hence such forms are called "non-specific back pain". Therapies with a pure focus on symptomatic aspects are not effective to treat non-specific pain. The origin of chronic back pain can be best explained via a multi causal mechanism with a combination of bio-psycho-social, biographical, neurobiological, genetic, and cognitive factors. Since various aspects of the pain genesis have to be considered, multidisciplinary treatment shows much better results.

[The role of childhood stress in symptoms of social phobia and agoraphobia in adulthood]. / Kindheitsbelastungen und Symptome der Sozialen Phobie und Agoraphobie im Erwachsenenalter.

The role of childhood stress in symptoms of social phobia and agoraphobia in adulthood Objectives: Anxiety disorders are among themost prevalent mental disorders inmodern times. Childhood stress constitutes a risk factor for their occurrence in adulthood. METHODS: In a sample of 1000 Polish and German probands recruited via the internet, we studied the associations of nine childhood stress factors (physical abuse, periodic harsh physical punishment, threat of physical violence, sexual abuse, neglect, long-term absence of a parent, violence between parents, arguments between parents and financial hardship) with later agoraphobic and sociophobic symptoms. RESULTS: Especially neglect showed a strong association to both forms of phobic symptoms. Threat of physical violence aswell as periodic harsh physical punishment and threat of physical violence also showed an association to both forms of phobic symptoms. CONCLUSIONS: The study revealed plausible associations for both forms of anxiety and various childhood adversities, though the amounts of explained variances were generally small.

Peer attachment, specific patterns of internet use and problematic internet use in male and female adolescents.

Problematic internet use may lead to serious psychosocial dysfunction. Recent studies have found comparable prevalence in both male and female adolescents. We pursue the neglected questions how male and female adolescents differ regarding their patterns of internet use and how gender, peer attachment and patterns of use are related to pathological internet use. In 2410 adolescents (1307 girls and 1103 boys) aged 12-18 years from different types of school we assessed peer attachment, frequency and use of eight specific applications and indicators of pathological internet use. Three patterns of internet use, 'social'; 'sex and games" and 'functional' were identified and connections between variables were modeled by ordered sequences of regression. We found that problematic internet use-sex and games as well as social usage-was more prevalent in boys. Insecure peer attachment predicted problematic internet use in both sexes. Also, excessive usage of internet games and sex mediated the influence of peer attachment insecurity on problematic internet use, but only for boys. Our study identified that adolescents with insecure peer attachment are at higher risk for problematic internet use. With regard to specific types of internet use, the consumption of online games and sex was identified as risk factor in boys with increasing age. Further studies are needed to understand and possibly subgroup problematic internet use behavior in girls. Our findings suggest that increasing the quality of peer relationships may be promising approach in the prevention and treatment of problematic internet use.

A new questionnaire for measuring quality of life - the Stark QoL.

OBJECTIVE: The Stark questionnaire measures health-related quality of life (QoL) using pictures almost exclusively. It is supplemented by a minimum of words. It comprises a mental and a physical health component. METHODS: A German sample of n = 500 subjects, age and gender stratified, filled out the Stark Qol questionnaire along with various other questionnaires via internet. RESULTS: The physical component shows good reliability (Cronbach's alpha = McDonalds Omega = greatest lower bound = .93), the mental component can be improved (Cronbach's alpha = .63, McDonalds Omega = .72, greatest lower bound = .77). Confirmatory factor analysis shows a good fit (Bentlers CFI = .97). Construct validity was proven. CONCLUSION: The Stark QoL is a promising new development in measuring QoL, it is a short and easy to apply questionnaire. Additionally, it is particularly promising for international research.

Childhood neglect: exploring a short questionnaire in Poland and Germany.

BACKGROUND: Estimates about childhood abuse and neglect in various countries of the world indicate that cases of neglect outnumber cases of abuse by far. However, childhood neglect itself constitutes a neglected domain in psychological and medical research; far more articles have been published about abuse. SAMPLING AND METHODS: A ten-item questionnaire assessing childhood neglect was administered to two surveys in Poland (n = 508) and Germany (n = 500) via the internet. RESULTS: Internal consistency was high in both countries, i.e. Cronbach's α was 0.82 in Poland and 0.88 in Germany. No distinction could be made between physical and emotional neglect. Values for neglect were similar for Polish and German men, but German women reported more neglect than Polish women. CONCLUSIONS: The Neglect Questionnaire is suitable for research in both Poland and Germany.

[Efficacy of psychosomatic inpatient treatment for somatoform disorders: results of a multicenter study]. / Wie wirksam ist psychosomatische Therapie bei somatoformen Storungen? Ergebnisse einer Multicenterstudie.

OBJECTIVES: The present study describes self- and therapist-reported treatment effects of inpatient psychotherapy for various somatoform disorders. METHODS: A total of 2,062 patients with the primary diagnosis F45.XX (ICD-10, Somatoform Disorders) were treated at 17 psychosomatic clinics in Bavaria, Germany. Subgroup analyses were performed for F45.0X, F45.3X, and F45.4X as well as a combined group of F45.1X, F45.2X, and F45.5X. RESULTS: Symptom severity decreased for all subgroups of somatoform disorders. The pre-post effect size was d = -.58 for the Symptom Check-List 90-R (GSI), and -1.26 for the impairment score rated by the therapist. Symptom levels differed among the various subgroups; patients with somatoform pain had the highest scores. CONCLUSIONS: Patients with various somatoform disorders appear to profit well from psychosomatic inpatient psychotherapy. Patients with somatoform pain disorders reported the lowest effect on GSI, but received the highest effect in the therapist ratings.

[Validation of the Polish version of the symptom checklist-27-plus questionnaire]. / Walidacja polskiej wersji kwestionariusza the symptom checklist-27-plus.

AIM: The goal of this research is to evaluate the psychometric qualities of the Polish version of the SCL-27-plus questionnaire in terms of its five factor structure, internal consistency and theoretical accuracy. METHOD: A total of 1.350 persons of which 62% were males, participated in the study. 651 persons were tested with a paper version, 699 subjects received an electronic version of the questionnaire. 336 (tested with the paper version) were patients with diagnosed psychiatric disorders. Paper version participants also filled out the General Health Questionnaire (GHQ-28). RESULTS: Confirmatory factor analysis validated the five factor structure of SCL-27-plus when some errors terms within subscales are allowed to correlate (Depending on the sample: 1.64 < or = chi2/df < or = 2.46; 0.05 < or = RMSEA < or = 0.06; 0.91 < or = CFI < or = 0.95). Cronbach's Alpha reliability measures for the Global Severity Index was 0.90 to 0.92 and for the particular subscales 0.71 to 0.88. The GSI and symptom subscales for SCL-27-plus correlated with their equivalences in the GHQ-28 moderately to highly (r = 0.38 to 0.68). Strong differences occurred between the "clinical" and "non-clinical" groups in the levels of general and specific symptoms (Cohen's d from 0.42 to 1.15). CONCLUSIONS: The Polish version of the SCL-27-plus questionnaire demonstrates good psychometric qualities. It can be used to measure the general intensity of psychopathological impairment as well as the specific subscales.

Comparing a common clavicle maturation-based age estimation method to ordinary regression analyses with quadratic and sex-specific interaction terms in adolescents.

Established methods of age estimation are based on correlating defined maturation stages of bony structures with tables representing the observed range of biological ages in the majority of cases. In this retrospective monocentric study in southwestern Germany, common age estimation methodology was assessed in n = 198 subjects at the age of 25 or younger by analyzing the influence of age, quadratic age, biological sex and age-sex interaction on the ossification stages of the medial epiphysis fugue. Three readers (ICC ≥ 0.81 for left/right side) evaluated routine care computed tomography images of the clavicle with a slice thickness of 1 mm. By using least square regression analyses, to determine the real biological age a quadratic function was determined corrected for the age estimated by established methods and sex (R2 = 0.6 each side), reducing the mean absolute error and root mean squared error in the age estimation of women (2.57 and 3.19) and men (2.57 and 3.47) to 1.54 and 1.82 for women, and 1.54 and 2.25 for men. In women, the medial clavicle epiphysis seem to fuse faster, which was particularly observable from approximately 18 years of age. Before that age, the estimation method was relatively close to the ideal correlation between assessed and real age. To conclude, the presented new method enables more precise age estimation in individuals and facilitates the determination and quantification of additional variables, quantifying their influence on the maturation of the medial clavicle epiphysis based on the established ossification stages.

Fatal laryngeal attacks and mortality in hereditary angioedema due to C1-INH deficiency.

BACKGROUND: Hereditary angioedema due to C1 inhibitor deficiency (HAE-C1-INH) is characterized by relapsing skin swellings, abdominal pain attacks, and, less frequently, potentially life-threatening laryngeal attacks. OBJECTIVE: This study determined the mortality of patients with and without the diagnosis of HAE-C1-INH and analyzed fatal laryngeal attacks. METHODS: A cohort of 728 patients from 182 families with HAE-C1-INH was evaluated for death cases by analyzing pedigrees. Detailed information on fatal laryngeal attacks in 36 patients was obtained by questioning relatives and treating physicians. RESULTS: Of the 214 patients who had died, 70 asphyxiated during a laryngeal attack. Mortality by asphyxiation was higher in patients with undiagnosed HAE-C1-INH (63 cases) than in patients with diagnosed HAE-C1-INH (7 cases). The lifespan of asphyxiated patients with undiagnosed HAE-C1-INH was on average ∼31 years shorter than patients with undiagnosed HAE-C1-INH who died of other causes. Three phases were distinguished in the fatal laryngeal attacks. Phase 1, the predyspnea phase, lasted on average for 3.7 ± 3.2 hours (range, 0-11 hours). Phase 2, the dyspnea phase, lasted on average for 41 ± 49 minutes (range, 2 minutes to 4 hours). Phase 3, the loss of consciousness phase, lasted on average for 8.9 ± 5.1 minutes (range, 2-20 minutes). CONCLUSIONS: The high mortality in patients with undiagnosed HAE-C1-INH underscores the need to identify these patients and diagnose their condition. The analysis of fatal laryngeal attacks gives further insight into their course, thus helping to avoid fatalities in the future.

[The symptom checklist SCL-27-plus for patients with eating disorders]. / Die Symptomcheckliste SCL-27-plus bei Essstörungen.

The symptom checklist-27-plus has demonstrated good psychometric properties in various samples, but clinical data have not yet been published. Data from 690 mostly young female patients with eating disorders show reliabilities ranging from acceptable to very good (Cronbachs α between 0.76 und 0.89). Data from intake and discharge show a good ability to measure change (Cohen's d between 0.27 und 1.31). At intake, patients display a very high symptom load, which has decreased significantly at discharge.

Gene Mutations Linked to Hereditary Angioedema in Solitary Angioedema Patients With Normal C1 Inhibitor.

BACKGROUND: Chronic recurrent angioedema without wheals (CRA) with normal C1 inhibitor (C1-INH) that is unresponsive to antihistamines may involve patients with recurrent angioedema of unknown cause (ie, so-called non-histaminergic idiopathic angioedema) as well as patients with hereditary angioedema with normal C1-INH (HAEnCI) when HAEnCI occurs in only one family member. OBJECTIVE: To identify patients with one of type of HAEnCI in a group of patients with CRA with normal C1-INH that was unresponsive to antihistamines. METHODS: A total of 132 patients with CRA and normal C1-INH that was unresponsive to antihistamines underwent mutational and clinical analysis. The presence of hereditary angioedema-specific mutations in Factor XII, plasminogen, ANGPT1, KNG1, MYOF, and HS3ST6 genes was tested by Sanger sequencing. When an HAEnCI-causing mutation was identified, available asymptomatic relatives were genetically tested. RESULTS: In 116 of 132 solitary patients with CRA (87.9%), none of the six HAEnCI-linked mutations could be found. Ten patients (7.6%) had the Factor XII mutation c.983C>A (p.T328K) and six (4.5%) the plasminogen mutation c.988A>G (p.K330E). Other mutations linked to HAEnCI were not found in this patient series. In the 16 families with HAEnCI, 11 asymptomatic carriers of one of the HAEnCI-linked mutations were identified. CONCLUSIONS: A search for HAEnCI-linked mutations in patients with solitary CRA may lead to the detection of patients and families with HAEnCI. This is important because family members can be identified who are at risk for developing potentially life-threatening angioedema, although they were previously asymptomatic. Without genetic investigation, the risk for an HAEnCI would have remained undetected in these patients and asymptomatic relatives.

Forensic Identification: Dental Scan Data Sets of the Palatal Fold Pairs as an Individual Feature in a Longitudinal Cohort Study.

The INTERPOL standard for the identification of unknown individuals includes the established primary characteristics of fingerprint, DNA, and teeth. Exposure to noxious agents such as fire and water often severely limits the availability of usable material such as fingerprints. In addition to teeth, the protected oral cavity also houses palatal fold pairs, which are the subject of this study to demonstrate individuality and consequently support identification. Material and Methods: In this cohort study, 105 participants' palates were scanned twice with a dental intraoral scanner (Omnicam SIRONA®) over a 3 month period and were then analyzed using a matching program. The intraindividual and interindividual differences were determined, and the mean values and standard deviations were calculated and presented. Results: The intraindividual differences are highly significantly lower than the interindividual differences (p < 0.0001). Conclusions: Within the limitations of this study, the results suggest that palatal rugae pairs can be considered a highly individual feature and could be considered an identification feature in a young and healthy population.

Forensic Age Estimation: A Multifactorial Approach in a Retrospective Population Study.

Objectives: The objective of this study was to evaluate the accuracy of forensic age estimation in a German population by combining clavicle and wisdom teeth assessments based on cone beam computed tomography (CT) data. The study aimed to determine the reliability of this approach in predicting biological age. Material and Methods: A total of 161 CT data sets from 120 males and 41 females with known exact ages were evaluated by three raters. The clavicle was assessed according to stages 1-5 (including substages 2a-c and 3a-c), and the Demirjian stage's classification method was used for the wisdom teeth. Inter-class correlation (ICC) was calculated to assess the agreement among the three raters. Additionally, ordinary least square regressions were performed to predict chronological age using the clavicle or one of the four teeth. Finally, age prediction models using multiple indicators were developed. Results: The ICCs ranged from 0.82 for the clavicle to 0.86 and 0.88 for the wisdom teeth. Linear estimation tended to overestimate chronological age, especially in subjects over 18 years old. The clavicle showed the strongest overestimation. Combining age estimation from the clavicle with the upper and lower wisdom teeth improved the predictive power, resulting in a 14% and 15% increase in R² for the upper and lower wisdom teeth, respectively. Adding more than one tooth to the prediction did not improve the predictive power (all ΔR² < 1%). Conclusions: Age estimation using CT can be significantly improved by combining information from the analysis of wisdom teeth with age estimation based on the clavicle.

Auxiliary variables in multiple imputation in regression with missing X: a warning against including too many in small sample research.

BACKGROUND: Multiple imputation is becoming increasingly popular. Theoretical considerations as well as simulation studies have shown that the inclusion of auxiliary variables is generally of benefit. METHODS: A simulation study of a linear regression with a response Y and two predictors X1 and X2 was performed on data with n = 50, 100 and 200 using complete cases or multiple imputation with 0, 10, 20, 40 and 80 auxiliary variables. Mechanisms of missingness were either 100% MCAR or 50% MAR + 50% MCAR. Auxiliary variables had low (r=.10) vs. moderate correlations (r=.50) with X's and Y. RESULTS: The inclusion of auxiliary variables can improve a multiple imputation model. However, inclusion of too many variables leads to downward bias of regression coefficients and decreases precision. When the correlations are low, inclusion of auxiliary variables is not useful. CONCLUSION: More research on auxiliary variables in multiple imputation should be performed. A preliminary rule of thumb could be that the ratio of variables to cases with complete data should not go below 1 : 3.

Forensic Dental Age Estimation: Development of New Algorithm Based on the Minimal Necessary Databases.

Objectives Dental age determination relies on the presence of wisdom teeth, which can be assigned to specific age ranges according to their stage of development. The purpose of this study is to highlight the applicability of the Demirjian staging of layman compared to expert, as well as the inclusion of all four wisdom teeth in the overall assessment, in order to emphasize and critically highlight a precise age estimation in clinical practice, especially in the case of agenesis or the presence of less than all four wisdom teeth. Material and Methods: In this study, dental age determination is performed and compared by a trained layperson and an expert using 385 orthopantomograms. The radiographs of known chronological age from male patients in the age range of 11−22 years were acquired from the University Medical Center Mainz. All four wisdom teeth were radiologically viewed if present. Demirjian staging with stages A−H was applied, and regression analysis was performed. Results: The relationship between mineralization of wisdom teeth (18, 28, 38 and 48) and age was linear for all teeth (p < 0.01), except for tooth 18 (p = 0.02). Comparing the prediction of the four teeth individually revealed that the lower teeth gave better predictions than the upper ones (R2 ≥ 0.50 vs. R2 < 0.50). Conclusions: For clinical use, the mandibular wisdom teeth should be preferred when performing dental age estimation using the Demirjian staging method. As a result of the present analysis, two ways of determining dental age by wisdom teeth can be suggested. One is to take only tooth 38, with the formula: age = 3.3 + 0.73 × mineralization of tooth_38. The second recommendation would be to take tooth_48. If both are unavailable, the formula would be age = −0.5 + 0.94 × mineralization tooth_28. Utilizing tooth 18 would not lead to more precise results.