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Additional file 1. SPIRIT 2013 Checklist.

Supplemental Material, sj-pdf-1-her-10.1177_19375867231165763 for Designing Well-Being: A Qualitative Investigation of Young Patients’ Perspectives on the Material Hospital Environment by Shahin Payam, Jihad Hossaini, Katharina Zaschka, Anna Friedmann and Volker Mall in HERD: Health Environments Research & Design Journal

Measures implemented to contain the Covid 19 pandemic have led to systematic changes in familiar structures over the past 3 years, resulting in multiple psychosocial stresses among families. Psychosocial stress can have a harmful impact on children's health and development (1-3), with young children being particularly vulnerable (4). Psychosocial stress during the pandemic is reflected in an increase of parenting stress (5-7) and psychological problems among parents (8,9). Given the close association between parenting stress, parental mental health, and parenting behaviors (10-12), it is not surprising that parent-child relationships have also suffered in the course of the pandemic (13). In addition, children may have missed important educational and learning opportunities due to limited access to childcare facilities. These factors might have had an impact on children’s mental health during the pandemic. The Bavaria-wide CoronabaBY study - the first project in Germany to explicitly address psychosocial stress in families with infants and young children during the pandemic – has demonstrated clear signs of psychosocial stress in young families compared to pre-pandemic data (14). Even during periods of low incidences and associated "relaxations" (i.e., the summer months), stress parameters did not decrease. Rather, the number of psychosocially stressed families increased steadily during the course of the pandemic (15). Alongside the pandemic, other societal challenges, such as the onset of the economic crisis, the impact of the Ukraine war, and climate change have led to the experience of “multi-crisis times”, and can fuel fears and concerns about the future and place additional stress on young families. Systematic and reliable identification of families with psychosocial support needs is urgently indicated in order to prevent negative direct and indirect effects on child health. Burdened families could also find easier access to appropriate support services by communicating information in a needs-based manner (e.g., via smartphone app). Hence, we aim to examine (1) psychosocial stress factors in N = 5,000 families with children aged 0-6 years old (2) the effectiveness of an app-based information module on psychosocial support for young families (=intervention). We therefore perform a Bavaria-wide intervention study (JuFaBY) over a study period of 18 months in total with two measurement time points for each participant (at study entry and 6 months later). (1) Werner, E. E. (1993). Risk, resilience, and recovery: Perspectives from the Kauai Longitudinal Study. Development and Psychopathology, 5, 503-515. (2) Laucht, M., Esser, G. & Schmid, M. H. (1997). Developmental Outcome of Infants Born with Biological and Psychosocial Risks. Journal of Child Psychology and Psychiatry, 38(7), 843-854. (3) Laucht, M., Schmidt, M. H. & Esser, G. (2002). Motorische, kognitive und sozial-emotionale Entwicklung von 11-Jährigen mit frühkindlichen Risikobelastungen: späte Folgen. Zeitschrift für Kinder- und Jugendpsychiatrie, 30(1), 5-19. (4) Schlack, H. G. (2009). Sozialpädiatrie: Eine Standortbestimmung. In H. G. Schlack, R. von Kries & U. Thyen (Eds.), Sozialpädiatrie. Gesundheitswissenschaft und pädiatrischer Alltag (pp. 1-8). Berlin, Heidelberg: Springer. (5) Giannotti, M., Mazzoni, N., Bentenuto, A., Venuti, P. & de Falco, S (2021). Family adjustment to COVID-19 lockdown in Italy: Parental stress, coparenting, and child externalizing behavior. Fam Process, 1-19. (6) Spinelli, M., Lionetti, F., Setti, A. & Fasolo, M (2020). Parenting Stress During the COVID-19 Outbreak: Socioeconomic and Environmental Risk Factors and Implications for Children Emotion Regulation. Fam Process, 60(2):639-53. (7) Taubman-Ben-Ari, O., Ben-Yaakov, O. & Chasson, M (2021). Parenting stress among new parents before and during the COVID-19 pandemic. Child Abuse Negl, 117:105080. (8) Panda, P.K., Gupta, J., Chowdhury, S.R., Kumar, R., Meena, A.K., Madaan, P. et al. (2021). Psychological and Behavioral Impact of Lockdown and Quarantine Measures for COVID-19 Pandemic on Children, Adolescents and Caregivers: A Systematic Review and Meta-Analysis. J Trop Pediatr, 67(1). (9) Racine, N., Hetherington, E., McArthur, B.A., McDonald, S., Edwards, S., Tough, S. et al. (2021). Maternal depressive and anxiety symptoms before and during the COVID-19 pandemic in Canada: a longitudinal analysis. The Lancet Psychiatry, 8(5):405-15. (10) Farmer, A.Y. & Lee, S.K. (2011). The Effects of Parenting Stress, Perceived Mastery, and Maternal Depression on Parent-Child Interaction. Journal of Social Service Research, 37(5):516-25. (11) Thomason, E., Volling, B.L., Flynn, H.A., McDonough, S.C., Marcus, S.M., Lopez, J.F. & Vazquez, D.M (2014). Parenting stress and depressive symptoms in postpartum mothers: bidirectional or unidirectional effects? Infant Behavior and Development, 37(3): 406-415. (12) Vismara, L., Rollè, L., Agostini, F., Sechi, C., Fenaroli, V., Molgora S. et al. (2016). Perinatal Parenting Stress, Anxiety, and Depression Outcomes in First-Time Mothers and Fathers: A 3- to 6-Months Postpartum Follow-Up Study. Front Psychol, 7. (13) Russell, B.S., Hutchison, M., Tambling, R., Tomkunas, A.J. & Horton, A.L. (2020). Initial Challenges of Caregiving During COVID-19: Caregiver Burden, Mental Health, and the Parent-Child Relationship. Child Psychiatry Hum Dev, 51(5):671-82. (14) Buechel, C., Nehring, I., Seifert, C., Eber, S., Behrends, U., Mall, V., Friedmann, A. (2022). A cross-sectional investigation of psychosocial stress factors in German families with children aged 0-3 years during the COVID-19 pandemic: initial results of the CoronabaBY study. Child and Adolescent Psychiatry and Mental Health, 16, 37. (15) Buechel, C., Nehring, I., Seifert, C., Eber, S., Laub, O., Ewald, D., Behrends, U., Mall, V., Friedmann, A. (2022). Abnahme der Pandemiebeschränkungen = Abnahme der psychosozialen Belastungen bei Familien mit Kindern im Alter von 0-3 Jahren? Ein repetitiver Querschnitts-Vergleich in Bayern (CoronabaBY-Studie). Posterpräsentation. Kongress für Kinder- und Jugendmedizin 2022. Düsseldorf, 08.09.22.

Background Our goal was to accurately detect young children at risk for long-term psychiatric disturbances after potentially traumatic experiences in the course of relocation. In addition to detailed assessment of parent-rated parent and child symptomatology, we focused on disruptive behaviors in the education environment summarized as survival states, as these frequently lead to clinical referral. Methods We screened 52 refugee children aged 3–7 (M = 5.14 years, SD = 1.17) for symptoms of Posttraumatic Stress Disorder (PTSD) with the Child and Adolescent Trauma Screening (CATS) in parent rating. The parents’ mental health was assessed using the Refugee Health Screener (RHS-15). Furthermore, the child’s educators were asked to evaluate the pathological survival states of the child and we made a general assessment of the children’s symptoms with the Strengths and Difficulties Questionnaire (SDQ) rated by parents and educators. Children in the refugee sample completed a working memory learning task (Subtest Atlantis from the Kaufmann Assessment Battery for Children, KABC-II) and delivered saliva samples for testing of the cortisol level. Results The parental rating of their child’s PTSD symptoms was significantly related to their own mental well-being (r = .50, p

Fatigue, depression and loss in health-related quality of life (HRQoL) have been reported to occur in a substantial amount of patients with pediatric-onset MS (POMS). This study aims to evaluate depression, fatigue and HRQoL and its relationship in a cohort of patients with POMS and matched healthy controls (HCs).In a multicenter cross-sectional study, Beck Depression Inventory II, Depressionstest für Kinder, the Pediatric Quality of Life Inventory (PedsQL™) 4.0 Generic Core Scale and the PedsQL™ Multidimensional Fatique Scale were performed.In a cohort of 106 patients with POMS and 210 matched HCs, patients were significantly more often depressed (21.7% vs. 11.4%, p = 0.014) experienced greater fatigue (40.6% vs. 17.3%, p 0.001) and a greater loss of HRQoL (43.4% vs. 15%, p 0.001) than controls. Depression predicted 51.8% of variance of fatigue. Fatigue was also predicted by female gender. Loss of HRQoL was predicted by EDSS, depression and fatigue. Depression and fatigue together explained 67.7% of variance of HRQoL.Patients with POMS are at a significant increased risk for depression, fatigue and loss of HRQoL. Furthermore, fatigue and depression significantly predict reduced HRQoL in POMS, suggesting that testing for these symptoms and early therapy is of utmost importance in all patients with POMS.

Additional file 1: Figure S1. Mutation distribution analysis in published RSTS cases and additional MRI results. Figure S2. Immunohistological analysis of the hippocampus, neocortex and olfactory bulb, myelination analysis and olfactory behavior testing. Figure S3. Immunohistological analysis of prenatal stages E14.5 and E16. Figure S4. Cell volume and dendrite branch analysis. Figure S5. Supplementary data on neurogenesis and migration in the olfactory bulb, the V-SVZ and the corpus callosum at P15 and P30.

A full-sine (biphasic) pulse waveform is most commonly used for repetitive transcranial magnetic stimulation (TMS), but little is known about how variations in duration or amplitude of distinct pulse segments influence the effectiveness of a single TMS pulse to elicit a corticomotor response. Using a novel TMS device, we systematically varied the configuration of full-sine pulses to assess the impact of configuration changes on resting motor threshold (RMT) as measure of stimulation effectiveness with single-pulse TMS of the non-dominant motor hand area (M1). In young healthy volunteers, we (i) compared monophasic, half-sine, and full-sine pulses, (ii) applied two-segment pulses consisting of two identical half-sines, and (iii) manipulated amplitude, duration, and current direction of the first or second full-sine pulse half-segments. RMT was significantly higher using half-sine or monophasic pulses compared with full-sine. Pulses combining two half-sines of identical polarity and duration were also characterized by higher RMT than full-sine stimuli resulting. For full-sine stimuli, decreasing the amplitude of the half-segment inducing posterior-anterior oriented current in M1 resulted in considerably higher RMT, whereas varying the amplitude of the half-segment inducing anterior-posterior current had a smaller effect. These findings provide direct experimental evidence that the pulse segment inducing a posterior-anterior directed current in M1 contributes most to corticospinal pathway excitation. Preferential excitation of neuronal target cells in the posterior-anterior segment or targeting of different neuronal structures by the two half-segments can explain this result. Thus, our findings help understanding the mechanisms of neural stimulation by full-sine TMS.

BACKGROUND Paediatric Neurology (PN) is a discipline focused on diagnosis, comprehensive management and research into diseases of the central and peripheral nervous system from fetal life to transition into adulthood. The European Paediatric Neurology Society first designed and published the European PN training programme in the European Paediatric Neurology Syllabus in 2002. This was important in gaining recognition for the sub-specialty from the European Academy of Paediatrics and the European Academy of Neurology and in 2003 PN was recognized as a sub-specialty of paediatrics and neurology by the Board of the European Union of Medical Specialties. In 2004, the EPNS founded the Committee of National Advisors (CNA) that comprised representatives from national Paediatric Neurology societies, in order to further enhance Europe wide standards in training and practice., The EPNS Training Advisory Board (TAB) offers nation specific advice/support to PN societies on developing training and care systems. In 2019, the 2nd revision of the Paediatric Neurology Syllabus was approved by the EPNS Board and CNA. We aim to give an overview of the training of Paediatric Neurology (PN) specialists (i.e. Paediatric Neurologists), the relevant professional bodies and the current practice of Paediatric Neurology in Europe, as defined geographically by the World Health Organization. METHODS A structured online data collection form was completed by CNA representatives from European countries. The data included training routes and structure of training, epidemiological data, nature of professional societies, organization of Paediatric Neurology care, research, academic life and recognition of the specialty. RESULTS Data was collected from 43 European countries of which 38 have a national PN Society. In 10 (6 European Union (EU) and 4 non-EU countries) PN is recognized as a core specialty. In 26 countries PN is recognized as a sub-specialty of Paediatrics, Neurology or both (15 EU-11 non-EU). PN is not recognized as a core or sub-specialty in 7 countries (4 EU and 3 non-EU). In 35 countries paediatric neurologists begin their training from Paediatrics, but in 19 countries PN training from Neurology is also possible or the preferred route. Training in PN differs, but in over 50% of countries the three main training modules named in the 2019 2nd revision of the European PN Syllabus (PN, Paediatrics and adult Neurology) are included. Many countries have already adapted their curriculum to the suggestions in the European PN syllabus. CONCLUSIONS There is diversity among European countries in terms of professional organization and PN training. The European PN syllabus has had impact on the development of PN training throughout Europe, independent of duration of training or route from paediatrics or neurology. The syllabus provides a basis for the future development of PN training, the recognition of PN as a (sub) specialty in individual countries and for improving the care of children with neurological disorders in Europe.

Freezing of Gait (FOG) ist eine plötzlich auftretende Blockade beim Gehen. Es wurden 36 Patienten mittels FOG-Score untersucht und dabei Videoaufnahmen angefertigt. Die minimale klinisch relevante Veränderung des FOG-Scores lag bei 3 Punkten. Es zeigten sich starke Korrelationen zwischen der prozentualen Dauer des Freezings und dem FOG-Score-Rating (r = 0,87; p < 0,0001). Diese Resultate untermauern die Validität des FOG-Scores und der prozentualen Freezingzeit als Messmethoden von FOG. Freezing of Gait (FOG) is a swiftly occurring gait disturbance. 36 patients were examined using the FOG score and video recording. The minimal clinically relevant change of the FOG score was 3 points. There were strong correlations between the time spent frozen and the FOG score rating (r = 0,87; p < 0.0001). These correlations corroborate the validity of the FOG score and the time spent frozen as assessment methods for FOG.

In dieser Studie zeigt sich, dass das Elternurteil der kindlichen Traumafolgesymptomatik von der eigenen Belastung überlagert ist und die Beeinträchtigung der Kinder zu unterschätzen scheint. Die diagnostische Einschätzung der pädagogischen Fachkräfte liefert daher wichtige Ergänzungen: Die Kinder mit überlebensfokussierten Zuständen im Betreuungsumfeld zeigen verminderte Lernleistungen und höhere Abend-Kortisolwerte, was auf eine stärkere stressbedingte Beeinträchtigung hindeutet. In this study, the parental rating of their children’s trauma-related symptoms was significantly related to the parents’ own mental well-being and appeared to underestimate the children’s trauma-related pathology. Children with survival states in educator rating exhibited weaker learning performance and higher evening cortisol levels. Thus, survival states are promising indicators for children’s level of impairment after adverse childhood experiences complementary to parent rating.

Untersucht wurde die Induktion neuronaler Plastizität im menschlichen M1 anhand des neu etablierten TMS-Protokolls mit Quadri-Pulse Theta Burst Stimulation mit doppelter Sinusvollwelle. Bidirektionale Änderungen im Sinne von LTP- und LTD-ähnlichen Effekten nach DSqTBS in I-Wellen Periodizität wurden in Abhängigkeit der Stromflussrichtung gezeigt. Außerhalb der I-Wellen waren die Ergebnisse vom Interstimulusintervall (5/50 ms) und der Stromflussrichtung (AP/PA) abhängig. Perspektivisch ist eine grundlagenwissenschaftliche und therapeutische Nutzung möglich. The induction of neuronal plasticity in the human M1 was investigated using a newly established TMS protocol with Quadri-Pulse Theta Burst Stimulation with double-sine wave. Bidirectional changes in the sense of LTP- and LTD-like plasticity after DSqTBS in I-wave latency demonstrated dependence on the current direction. Outside I-wave latency results were in relation to the interstimulus interval (5/50 ms) and the current direction (AP/PA). The results may advance fundamental science and therapeutic use.

Ziel dieser Arbeit war die Analyse der Altersabhängigkeit eines Gangindex von Kindern ohne Entwicklungsstörungen und eine Evaluierung von Änderungen pathologischer Gangabweichungen durch eine Orthesenversorgung bei schweren Entwicklungsstörungen. Der Gangindex zeigte bei den gesunden Kindern einen starken Zusammenhang mit dem Alter. Die bei Kindern mit Cerebralparese untersuchte Orthese verbesserte das pathologische Gangmuster in der Schwungphase. In der späten Standphase sowie in funktionellen Parametern konnten keine Verbesserungen induziert werden. The aim of this thesis was the assessment of age related changes of a gait index to measure the kinematic profile in healthy children and the evaluation of the efficacy of an ankle foot orthosis in children with severe developmental disorders via instrumented gait analysis. There was a strong correlation between the gait index and the children`s age. The pathological gait pattern during swing improved in children with cerebral palsy when wearing the orthosis. There was no improvement during late stance or in functional outcomes.

Im kontrollierten Gruppenvergleich konnte bei Zweit- bis Viertklässlern festgestellt werden, dass drei bis vier Untersuchungsinstrumente ausreichen, um Kinder mit Auditiver Verarbeitungs- und Wahr-nehmungsstörungen (AVWS) von Normalhörenden (Non-AVWS) zu unterscheiden (vgl. Nickisch und Kiese-Himmel, 2009; Nickisch et al., 2013). Ziel dieser Studie ist es herauszufinden, ob die Gruppen-trennung auch bei Erstklässlern gelingt. Die Ergebnisse von 83 Erstklässlern, aufgeteilt in zwei Gruppen (AVWS N=41 vs. Non-AVWS N=42) wurden in acht audiologischen Tests einer AVWS-Testbatterie miteinander verglichen. Die signifikante Gruppenunterscheidung gelang in 93,9 % der Fälle (kreuzvalidiert: 92,7 %) durch vier Tests: (1) Mottier-Test, (2) „Zahlenfolgengedächtnis“ des PET, (3) „Phonemdifferenzierung“ des HLAD, (4) Sprachverstehen im Störgeräusch. Bei Erstklässlern sind zur Gruppentrennung vier Untersuchungsinstrumente notwendig. A controlled group comparison showed that children with auditory processing disorders (APD) could be discriminated from normal hearing children (non-APD) in 2nd to 4th grade by three to four diagnostic tools (cf. Nickisch and Kiese-Himmel, 2009; Nickisch et al., 2013). Aim of the current study was, to see if a separation is also possible in 1st graders. Performance of 83 1st graders in two confirmed groups (APD n=41 vs. non-APD n=42) in eight auditory processing tests of an electric test battery were compared. Children with APD were significantly separated from non-APD children (accuracy: 93.9 %; cross-validated: 92.7 %) by following four tests: (1) Nonword Repetition, (2) Auditory Sequential memory of digits, (3) Phoneme Discrimination, (4) Word Understanding in Background Noise. Using four diagnostic tolls 1st graders can be separated too.

Die Dissertation untersucht die Selektion und Ermordung von geistig und/oder körperlich behinderten Kindern in der Heil- und Pflegeanstalt Eglfing-Haar zwischen 1940 und 1945. Dazu werden alle erhaltenen Krankenakten der im Rahmen des sog. „Reichsausschußverfahrens“ aufgenommenen Kinder ausgewertet, um die Schicksale im Sinne einer kollektiven Biografie darzustellen und einzelne individuelle Lebensgeschichten nachzuzeichnen. Ferner werden die durch die Täter angewandten Selektionskriterien herausgearbeitet und deren Forschungsinteressen sowie die Reaktionen der Angehörigen analysiert. The thesis examines how the selection and murder of mentally and/or physically ill children was conducted by the „Reich Committe“ in Eglfing-Haar between 1940 and 1945. The evalutation of preserved medical files makes it possible to present the patients’ lives as a collective and to portray individual life histories. It can be shown what kind of criteria were used by the perpetrators to select children for “euthanasia”. Furthermore, the scientific interests of the physicians and the reactions of the relatives are analyzed.

Die vorliegende Arbeit beschäftigt sich mit dem ersten Praxiseinsatz des „Pädiatrischen Anhaltsbogens zur Einschätzung von psychosozialem Unterstützungsbedarf (U3-U6)“, dem bisher einzigen deutschsprachigen Instrument, mit dem Pädiater_innen psychosoziale Belastungen während der U-Untersuchungen erfassen können. Die prospektive Kohortenstudie (N=511 Familien) untersucht die Evaluation der bei „U5“ (Alter Kinder ca. 6 Monate) identifizierten Belastungsfaktoren der Patientenfamilien. Bei einem Follow-up zur „U6“ (Alter Kinder ca. 12 Monate) erfolgte eine Verlaufsbeobachtung der belasteten Familien sowie die Identifikation von Zusammenhängen zwischen bei „U5“ und „U6“ festgestellten Belastungsfaktoren. Auch die Betreuung belasteter Familien und die Vermittlungsrate zu Frühen Hilfen wurden beleuchtet. Zuletzt wurde die Praktikabilität des Pädiatrischen Anhaltsbogens im Praxisalltag ermittelt. This thesis deals with the first field application of the "Pädiatrischer Anhaltsbogen zur Einschätzung von psychosozialem Unterstützungsbedarf (U3-U6)", the only German-language assessment tool for psychosocial problems during paediatric early check-ups to date. The prospective cohort study (N=511 families) examines stress factors of the patient families identified as part of the early check-up “U5” (children’s age approximately 6 months). During a follow-up at the early check-up “U6” (children’s age approximately 12 months), the course of affected families was monitored and correlations between stress factors determined at “U5” and “U6” were identified. In addition, the care provided to affected families and the rate of referring them to “Frühe Hilfen“ were examined. Finally, it was investigated whether the “Pädiatrischer Anhaltsbogen“ could be applicable in everyday practice.

Es wurde der Einfluss individueller kortikaler Oszillationen (sog. I-Wellen) auf die Induktion synaptischer Plastizität im primär menschlichen motorischen Kortex (M1) anhand eines neu etablierten hoch-frequenten Transkraniellen Magnetstimulations (TMS)-Protokoll mit gepaarten Pulsen untersucht. Es fand sich eine starke Korrelation zwischen den individuellen Latenzen der I-Wellen und der synaptischen Plastizität. Die Ergebnisse unterstreichen die Notwendigkeit einer individuellen TMS, auch um therapeutische Effekte zu optimieren. This study investigated the influence of individual cortical oscillations (so called I-waves) on spike timing mechanisms of synaptic plasticity in human primary motor cortex (M1) using a newly established ultra high-frequent transcranial magnetic stimulation (TMS) protocol with paired pulses. We observed a strong correlation between individual latencies of these oscillations and synaptic plasticity. This indicates mechanisms of high-fidelity spike timing mechanisms in human M1 and underlines the necessity to individualize TMS for therapeutic purposes.

Mittels eines neuen hochfrequenten rTMS-Protokolls, der biphasischen Quattropulsstimulation, konnte der Einfluss der Stromflussrichtung und des Interstimulusintervalls auf die Plastizitätsinduktion im menschlichen Motorcortex evaluiert werden. In diesem Zusammenhang ist auch die Bedeutung der I-Wellen zu erwähnen. Erstmalig gelang mit dieser Arbeit der Nachweis, dass die I-Wellen-adaptierte Stimulation (ISI von 1,5ms) eine bidirektionale neuronale Plastizität zur Folge hat. Dieses Wissen über die Bidirektionalität für das Stimulationsprotokoll QPS 1,5_200 ist ein weiterer Schritt für den gezielteren Einsatz der transkraniellen Magnetstimulation in Klinik und Forschung. By using a new high frequent rTMS protocol, the biphasic quadro-pulse stimulation, it was possible to evaluate the influence of the current flow direction and the interstimulus interval on the induction of plasticity oft he human motor cortex. In this context it is important to mention the so-called I-waves. For the first time it was able to show that the I-wave-adapted stimulation (with an interstimulus interval of 1,5 ms) produces a bidirectional neuronal plasticity. This knowledge about the bidirectionality of the stimulation protocol QPS 1,5_200 is a fine step forward particularly for the specific application of the transcranial magnetic stimulation in clinics and research.