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Interface management after inpatient care for mentally ill children and adolescents has been proven to be a breaking point in good transition of care between child and adolescent psychiatry, social welfare services, schools, job centre and the judicial system. Criteria for successful discharge management do not exist in child and adolescent psychiatry. Aim of the study ASpeKT was to survey parents on their perception of interface management and to derive recommendations for discharge management.Data regarding interface management were retrieved from parents (T3, n = 124, T4, n = 81) 6 months (T3) and 12 months (T4) after discharge.The parents stated that accessible help after discharge from inpatient treatment is essential for stability and requires a good coordination. Parents named that they perceived helpful for successful interface management: a case manager, early round table meetings, support in returning to school, seamless access to outpatient follow-up appointments as well as information on further treatment options and contact data.From the perspective of affected families a proactive early individual and reliable care coordination by a constant contact person is essential for a good discharge management.HINTERGRUND UND FRAGESTELLUNG: Schnittstellen zwischen stationärer Behandlung psychisch erkrankter Kinder und Jugendlicher in der Kinder- und Jugendpsychiatrie, Jugendhilfe, Schulen, Arbeitsamt und Justiz sind nachweislich Sollbruchstellen für eine gelingende Schnittstellenkoordination im Sinne eines Entlassmanagements. Kriterien für ein Entlassmanagement in der Kinder- und Jugendpsychiatrie existieren nicht. Ziel der Studie ASpeKT (Aussagen zu Schnittstellenkoordination bei psychisch erkrankten Kindern und Teens) war es, den Iststand von Schnittstellenmanagement anhand von Aussagen von Eltern zu erheben und Empfehlungen für ein Entlassmanagement abzuleiten.Zu zwei Zeitpunkten (T3 = 6 Monate, T4 = 12 Monate nach Entlassung) wurden Eltern (T3: n = 124, T4: n = 81) zu den erfolgten Hilfen und deren Koordination befragt.Eltern benennen, dass erreichbare poststationäre Hilfen für eine Stabilität nach stationärer Behandlung essenziell sind und einer guten Koordination bedürfen. Für eine gelingende Schnittstellenkoordination werden aus Sicht der Eltern benannt: vorhandene Case-Manager, frühzeitige Runde Tische, eine gute Übergabe an schulische Strukturen, nahtlose Anschlusstermine zur ambulanten Weiterbehandlung sowie Information zu Anlaufstellen und Behandlungsmöglichkeiten.Proaktive frühzeitige individuelle Koordination von Hilfen durch einen konstanten Ansprechpartner ist aus Sicht der betroffenen Familien für ein gutes Entlassmanagement essenziell.

The Covid-19 pandemic has been profoundly affecting nearly everybody, but families with minors have been hit particularly. Closure of schools and kindergartens, home schooling, and working from home have led to a profound upheaval in family life. Parental adverse childhood experiences (ACEs) are an important determinant for parenting behavior. Importantly, ACEs can increase the vulnerability to stress and impair coping strategies. The current pandemic leads to increased parental stress, a risk factor for harsh parenting behavior, Therefore, we aimed to assess the role of ACEs and sociodemographic factors associated to parental coping during the current pandemic. In a cross-sectional online survey, 687 parents of minors in Germany were included. Demographic and psychosocial factors associated to parental coping during the first lockdown due to the Covid-19 pandemic were assessed. Results show that younger age of the respective child, income loss, dissatisfaction with the sharing of childcare duties, and ACEs were significantly associated with an increase of potential harmful parenting behavior during the Covid-19 pandemic. An increase of dissatisfaction with the sharing of childcare duties during the pandemic was predicted by working from home and taking care of the children mainly by oneself, while sharing childcare duties with the partner equally resulted even in an increase of satisfaction with sharing of childcare duties during the pandemic. These findings demonstrate that a history of childhood adversity in a parent is a risk factor for harmful parenting during the pandemic. Parental satisfaction with sharing of caregiving is an important factor for parental coping during the pandemic. Sharing of caregiving between partners should be encouraged., publishedVersion

Purpose is to investigate and compare professional quality of life (ProQoL) among health care providers (HCPs) in cystic fibrosis (CF) ambulances and inpatient clinic for child and adolescent psychiatry. The ProQoL R-IV Inventory was administered to 96 HCPs to investigate: compassion satisfaction, burnout, and secondary traumatic stress (STS). HCPs in CF centers and inpatient psychiatry did not differ in their ProQoL. However, the occupational groups differed regarding STS (F(3,92)=3.726, p=.01). Physicians reported more STS than other groups. Longer work experience was associated with more STS (r=-0.21, p=.04). Regular screening should be put in place to identify HCPs at risk of decreased ProQoL.

Die Wissenschaftsplattform Nachhaltigkeit 2030 ist ein zentraler Ort der Wissenschaft, an dem sie drängende Fragen der Nachhaltigkeits-politik reflektiert und diskutiert – im Austausch mit Politik, Wirtschaft und Gesellschaft. Wissen für Nachhaltigkeit wird dort zusammengetragen und weitergetragen, insbesondere im Hinblick auf die Umsetzung der Deutschen Nachhaltigkeits-strategie. Die Plattform arbeitet unabhängig und ist systematisch eingebunden in den offiziellen politischen Steuerungs-, Dialog- und Umsetzungsprozess der Agenda 2030. Träger der Plattform sind SDSN Germany, DKN Future Earth und das IASS Potsdam.

Background: International studies show that child maltreatment is a widespread but often underestimated problem that causes high individual, social and economic costs. Child maltreatment is an important topic for the medical sector as well. On the one hand, affected persons often seek support and help from healthcare professionals, but on the other hand, assaults can also occur in medical institutions by healthcare professionals. Surprisingly, there is hardly any data on the frequency of child maltreatment by healthcare professionals in general and particularly by nursing staff. Methods: Therefore, in a large representative survey of the German population of 2,516 subjects aged between 14 and 91, the experience of child maltreatment in medical institutions by nursing staff was assessed retrospectively. Results: Of the 46 subjects who had an inpatient stay in a child and adolescent psychiatry before the age of 18, 33.3% reported to have experienced maltreatment by nursing staff, while 17.3% of the 474 persons who had an inpatient stay in general or pediatric hospitals experienced maltreatment by nursing staff. All forms of maltreatment were significantly more frequent in psychiatric compared to general and pediatric hospitals. Conclusions: The results of our representative retrospective survey demonstrate that maltreatment by nursing staff are not rare individual cases, but that medical facilities bear systemic risks for assault. Therefore, it is necessary that all medical institutions, in particular psychiatric hospitals, address this issue. In order to reduce the risk for assaults, it is important not only to implement structural measures but also to develop an attitude that emphasizes zero tolerance for violence against children and adolescents., publishedVersion

Background Child maltreatment (CM) has severe effects on psychological and physical health. The hypothalamic-pituitary-adrenal (HPA) axis, the major stress system of the body, is dysregulated after CM. The analysis of cortisol and dehydroepiandrosterone (DHEA) in scalp hair presents a new and promising methodological approach to assess chronic HPA axis activity. This study investigated the effects of CM on HPA axis activity in the last trimester of pregnancy by measuring the two important signaling molecules, cortisol and DHEA in hair, shortly after parturition. In addition, we explored potential effects of maternal CM on her offspring’s endocrine milieu during pregnancy by measuring cortisol and DHEA in newborns’ hair. Methods CM was assessed with the Childhood Trauma Questionnaire (CTQ). Cortisol and DHEA were measured in hair samples of 94 mothers and 30 newborns, collected within six days after delivery. Associations of maternal CM on her own and her newborn’s cortisol as well as DHEA concentrations in hair were analyzed with heteroscedastic regression models. Results Higher CM was associated with significantly higher DHEA levels, but not cortisol concentrations in maternal hair. Moreover, maternal CM was positively, but only as a non-significant trend, associated with higher DHEA levels in the newborns’ hair. Conclusions Results suggest that the steroid milieu of the mother, at least on the level of DHEA, is altered after CM, possibly leading to non-genomic transgenerational effects on the developing fetus in utero. Indeed, we observed on an explorative level first hints that the endocrine milieu for the developing child might be altered in CM mothers. These results need extension and replication in future studies. The measurement of hair steroids in mothers and their newborns is promising, but more research is needed to better understand the effects of a maternal history of CM on the developing fetus. Electronic supplementary material The online version of this article (doi:10.1186/s12888-017-1367-2) contains supplementary material, which is available to authorized users.

Problemstellung/Ziele: Knapp ein Drittel der Gesellschaft hat als Kind oder Jugendlicher eine Misshandlungserfahrung gemacht [ref:1]. Gesundheitsfachkräfte sind hierbei häufig Erstansprechpersonen [ref:2]. Die Evaluation des Online-Kurses „Kinderschutz in der[zum vollständigen Text gelangen Sie über die oben angegebene URL], Jahrestagung der Gesellschaft für Medizinische Ausbildung (GMA)

Problemstellung/Ziele: Zahlreiche neue Maßnahmen und Gesetzesänderungen zum Kinderschutz sind in den Gesundheitsberufen noch zu wenig bekannt und führen zu Unsicherheiten bezüglich der Handlungsbefugnis. Dabei sind Gesundheitsfachkräfte wichtige Akteur_innen im Kinderschutz[zum vollständigen Text gelangen Sie über die oben angegebene URL], Jahrestagung der Gesellschaft für Medizinische Ausbildung (GMA)

Problemstellung/Ziele: Fachkräfte der Heilberufe sind für Kinder und Jugendliche, die von sexuellem Missbrauch oder anderen Formen von Kindesmisshandlung betroffen sind, bevorzugte Erstansprechpersonen. Jedoch sind diese häufig nicht ausreichend qualifiziert sind, um angemessene [zum vollständigen Text gelangen Sie über die oben angegebene URL], Jahrestagung der Gesellschaft für Medizinische Ausbildung (GMA)

Problemstellung/Ziele: NSSV ist unter Jugendlichen ein weit verbreitetes Phänomen, so dass Fachkräfte, welche beruflich in der Primärversorgung von psychisch kranken Jugendlichen tätig sind, Wissen über den Umgang mit NSSV haben sollten. Dieses Wissen stellt die seit dem[zum vollständigen Text gelangen Sie über die oben angegebene URL], Jahrestagung der Gesellschaft für Medizinische Ausbildung (GMA)

Problemstellung/Ziele: Sexueller Missbrauch ist ein traumatisches Kindheitserlebnis mit oft schwerwiegenden und lang andauernden persönlichen, aber auch gesamtgesellschaftlichen Folgen. Die Häufigkeit liegt ungefähr im oberen einstelligen Prozentbereich, somit ergibt sich eine Dimension[zum vollständigen Text gelangen Sie über die oben angegebene URL], Jahrestagung der Gesellschaft für Medizinische Ausbildung (GMA)

Kinderschutz betrifft alle Ärzt*innen und stellt meist einen Stressfaktor sowie eine multidisziplinäre Herausforderung dar. Trotz des durch das Bundeskinderschutzgesetz geschaffenen rechtlichen Rahmens schätzen viele Ärzt*innen ihr Wissen diesbezüglich als unzureichend[zum vollständigen Text gelangen Sie über die oben angegebene URL], 67. Jahrestagung der Norddeutschen Gesellschaft für Kinder- und Jugendmedizin (NDGKJ)

Background This study examined the prevalence of non-suicidal self-injury (NSSI), suicide attempts, suicide threats and suicidal ideation in a German school sample and compared the rates with a similar sample of adolescents from the midwestern USA by using cross-nationally validated assessment tools. Method Data were provided from 665 adolescents (mean age 14.8 years, s.d.=0.66, range 14-17 years) in a school setting. Students completed the Self-Harm Behavior Questionnaire (SHBQ), the Ottawa Self-Injury Inventory (OSI) and a German version of the Center for Epidemiological Studies-Depression Scale (CES-D). Results A quarter of the participants (25.6%) endorsed at least one act of NSSI in their life, and 9.5% of those students answered that they had hurt themselves repetitively (more than four times). Forty-three (6.5%) of the students reported a history of a suicide attempt. No statistically significant differences were observed between the German and US samples in terms of self-injury or suicidal behaviors. Conclusions By using the same validated assessment tools, no differences were found in the prevalence and characteristics of self-injury and suicidal behaviors between adolescents from Germany and the USA. Thus, it seems that NSSI has to be understood as worldwide phenomenon, at least in Western cultures

Suicides account for over one million deaths per year worldwide with depression among the most important risk factors. Epidemiological research into the relationship between antidepressant utilization and suicide mortality has shown heterogeneous and contradictory results. Different methodological approaches and limitations could at least partially explain varying results. This is the first study assessing the association of suicide mortality and antidepressant sales across Germany using complex statistical approaches in order to control for possible confounding factors including spatial dependency of data. German suicide counts were analyzed on a district level (n = 402) utilizing ecological Poisson regressions within a hierarchical Bayesian framework. Due to significant spatial effects between adjacent districts spatial models were calculated in addition to a baseline non-spatial model. Models were adjusted for several confounders including socioeconomic variables, quality of psychosocial care, and depression prevalence. Separate analyses were performed for Eastern and Western Germany and for different classes of antidepressants (SSRIs and TCAs). Overall antidepressant sales were significantly negatively associated with suicide mortality in the non-spatial baseline model, while after adjusting for spatially structured and unstructured effects the association turned out to be insignificant. In sub-analyses, analogue results were found for SSRIs and TCAs separately. Suicide risk shows a distinct heterogeneous pattern with a pronounced relative risk in Southeast Germany. In conclusion, the results reflect the heterogeneous findings of previous studies on the association between suicide mortality and antidepressant sales and point to the complexity of this hypothesized link. Furthermore, the findings support tailored suicide preventive efforts within high risk areas.

Zielsetzung: Die Ulmer Studie zur Familienfreundlichkeit des Medizinstudiums ermittelte Faktoren für eine erfolgreiche Kombination von Medizinstudium und Familie. Sie zeigt, inwieweit das Studium als richtiger Zeitpunkt für eine Familiengründung geeignet ist. Die Ergebnisse der Studie dienen als Grundlage einer evidenzbasierten Curriculumreform nach familienfreundlichen Kriterien. Methodik: Im Jahr 2009 wurde eine qualitative Interviewstudie mit 37 der 79 Medizinstudierende mit Kindern der Universität Ulm durchgeführt und inhaltsanalytisch ausgewertet. Auf Grundlage der festgestellten Problem- und Lösungsfaktoren wurde eine quantitative Fragebogenerhebung durchgeführt, an der 45 studierende Eltern und 53 Lehrende in der Medizin teilnahmen. Ergebnisse: Studierende Eltern der Ulmer Humanmedizin sind durchschnittlich älter, häufiger verheiratet und haben bereits häufiger als andere Studierende eine Erstausbildung absolviert. Knapp ein Drittel der befragten Studierenden und Lehrenden sehen keinen idealen Zeitpunkt für die Familiengründung im Arztberuf. Allerdings wird die Vereinbarkeit von Familie und Studium mehrheitlich leichter eingeschätzt (61% der befragten Studierenden) als die Vereinbarkeit im Arztberuf, insbesondere während der Facharztausbildung. Die Ulmer Interviewdaten zeigen, dass sich vor allem das Ende des Studiums – idealerweise mit Geburtstermin in den Semesterferien – zur Familiengründung ohne größeren Zeitverlust eignet. Schlussfolgerung: Sowohl die Lebensbiographien als auch die Ausbildungs- und Berufsprofile von studierenden Eltern weisen Besonderheiten auf. Die Universitäten und Kliniken sind gefordert, Vereinbarkeitsfragen nicht mehr nur der Verantwortung der jungen Nachwuchskräfte in der Medizin zu überlassen, sondern verlässliche Strukturen zu schaffen, die es ermöglichen die Familienphase parallel zur Ausbildungsphase zu beginnen. Hierzu gehören neben dem Ausbau von Kinderbetreuungsmöglichkeiten auch die stärkere Unterstützung der Universitäten im Bereich Studienberatung und Karriereförderung., GMS Zeitschrift für Medizinische Ausbildung; 28(1):Doc14; ISSN 1860-3572

Zielsetzung: EGONE ist ein E-Learning-Portal für Gynäkologie, Geburtshilfe, Neonatologie und Reproduktions-Endokrinologie basierend auf dem Schweizerischen Lehr-Lernziel-Katalog. Seit zwei Semestern werden den Studierenden im Blockpraktikum Gynäkologie der Medizinischen Fakultät [for full text, please go to the a.m. URL], 14. Workshop der gmds-Arbeitsgruppe "Computerunterstützte Lehr- und Lernsysteme in der Medizin (CBT)" und des GMA-Ausschusses "Neue Medien"

Purpose The service configuration with distinct child and adolescent mental health services (CAMHS) and adult mental health services (AMHS) may be a barrier to continuity of care. Because of a lack of transition policy, CAMHS clinicians have to decide whether and when a young person should transition to AMHS. This study describes which characteristics are associated with the clinicians’ advice to continue treatment at AMHS. Methods Demographic, family, clinical, treatment, and service-use characteristics of the MILESTONE cohort of 763 young people from 39 CAMHS in Europe were assessed using multi-informant and standardized assessment tools. Logistic mixed models were fitted to assess the relationship between these characteristics and clinicians’ transition recommendations. Results Young people with higher clinician-rated severity of psychopathology scores, with self- and parent-reported need for ongoing treatment, with lower everyday functional skills and without self-reported psychotic experiences were more likely to be recommended to continue treatment. Among those who had been recommended to continue treatment, young people who used psychotropic medication, who had been in CAMHS for more than a year, and for whom appropriate AMHS were available were more likely to be recommended to continue treatment at AMHS. Young people whose parents indicated a need for ongoing treatment were more likely to be recommended to stay in CAMHS. Conclusion Although the decision regarding continuity of treatment was mostly determined by a small set of clinical characteristics, the recommendation to continue treatment at AMHS was mostly affected by service-use related characteristics, such as the availability of appropriate services.

Background: Adverse childhood experiences (ACEs) have been associated with poor mental and somatic health. Accumulating evidence indicates that accelerated biological aging-indexed by altered telomere-related markers-may contribute to associations between ACEs and negative long-term health outcomes. Telomeres are repeated, non-coding deoxyribonucleic acid (DNA) sequences at the end of chromosomes. Telomeres shorten during repeated cell divisions over time and are being used as a marker of biological aging. Objectives: The aim of the current paper is to review the literature on the relationship between ACEs and telomere length (TL), with a specific focus on how the heterogeneity of sample and ACEs characteristics lead to varying associations between ACEs and TL. Methods: Multiple databases were searched for relevant English peer-reviewed articles. Thirty-eight papers were found to be eligible for inclusion in the current review. Results: Overall, the studies indicated a negative association between ACEs and TL, although many papers presented mixed findings and about a quarter of eligible studies found no association. Studies with smaller sample sizes more often reported significant associations than studies with larger samples. Also, studies reporting on non-clinical and younger samples more often found associations between ACEs and TL compared to studies with clinical and older samples. Reviewing the included studies based on the "Stressor Exposure Characteristics" recently proposed by Epel et al. (2018) revealed a lack of detailed information regarding ACEs characteristics in many studies. Conclusion: Overall, it is difficult to achieve firm conclusions about associations of ACEs with TL due to the heterogeneity of study and ACE characteristics and the heterogeneity in reported findings. The field would benefit from more detailed descriptions of study samples and measurement of ACEs.