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Aim Type 1 diabetes is the most common chronic metabolic disease in childhood. Often diagnosis comes with acutely life-threatening ketoacidosis and requires hospitalization. To avoid this, early detection of children at a pre-symptomatic stage is worthwhile. This task is met by a population-based screening in Bavaria, Germany – the Fr1da study. Here, we aim to evaluate the study concept, feasibility and medical evidence of the Fr1da study. Methods 308 pediatricians, 16 diabetes care centers and participating families were asked to evaluate the Fr1da study by completing questionnaires assessing study concept and feasibility, educational program and study organization. The assessment was done anonymously. In order to evaluate the effectiveness of the training the parents had to answer questionnaires to assess their knowledge about diabetes. Results 48% of pediatricians and 56% of pediatric diabetes care centers filled out the questionnaire. The majority positively judged the collaboration with the Fr1da coordinating center and the feasibility to integrate the project into daily routine. Medical evidence of the screening was recognized and most of the respondents endorsed the screening to be permanently integrated into standard care-program. The majority of parents would recommend the study to other parents with young children since they were satisfied with the collaboration with pediatricians, diabetes care centers and the coordinating center. Quality control of the educational program revealed good understanding of the teaching content. Conclusion The Fr1da study received high acceptance and recognition by both, health care providers and participating families, and demonstrated sustainable success with the developed educational program. &nbsp

Background: Although detection of children at high risk of developing type 1 diabetes and diagnosis of early stages is possible, up to now there exists no approved therapy to delay or prevent type 1 diabetes. Thus it is vital to develop evidence-based interventions. For this a sufficient number of trial participants is crucial but difficult to obtain especially in asymptomatic children. Aim: Identifying family characteristics that lead to or impede trial participation and analyze reasons stated by families for non-participation. Methods: Participants for the Fr1da Insulin Intervention study are recruited from the Fr1da study, a population based screening for early stage type 1 diabetes in Bavaria. Families with eligible children were invited to enroll. We analyzed sex and age of the child, distance of the family to the study center in Munich and the existence of a first degree family member with type 1 as possible influential factors for study participation. We also analyzed reasons stated by families who declined study participation in a phone interview. Results: Of 146 eligible children 77 (53%) were enrolled into the trial. None of the tested family characteristics differed significantly between the enrolling and the families not participating, but in general enrolling families lived closer to the study site than families not participating. This is also reflected in the reasons given by non-participating families. The most frequent reason stated were time restrictions. The second most frequent reason was the venous blood draw. Conclusion: The factors for non-participation identified in this project need be taken into account for the design of future trials in young children to ensure proper recruitment and thus to generate valid results for medical treatment of children. More research on the reason of participation and non-participation in clinical trials is needed. Keywords: Type 1 diabetes, Trial recruitment, Trial enrollment, Infants, Children, Asymptomatic

Die Beurteilung des Wachstums sollte jeder Arzt, der Kinder betreut, beherrschen. Ein gesundes Kind wachst gut, ein krankes schlecht. Viele, insbesondere chronische Erkrankungen gehen langfristig mit einer Wachstumsstorung einher. Lesen Sie, wie Sie genetische von ernahrungsbedingten oder hormonellen Ursachen abgrenzen, in welchen Fallen eine weitere Abklarung angezeigt ist und wann Sie zum Abwarten raten konnen.

Background : Over the years, poor medical documentation is a well known phenomenon in medical practice but the magnitude of the problem in our setting has not been defined. Objective : To assess the overall frequency of missed detection of anomalies of external genitalia following the routine newborn physical examination and to describe the general pattern of its documentation. Methods : In this hospital-based descriptive cross-sectional study, 915 full-term newborn infants in an open population survey were systematically screened for anomalies of the external genitalia, using a checklist derived by modifying parameters in the Prader scoring system and the External masculinization score charts. The pattern of documentation was assessed in 915 case files. The findings of the researchers were then compared to those previously documented by the attending physician/midwife. The study was conducted in two Nigerian hospitals (University of Benin Teaching Hospital and St Philomena Catholic Hospital) in Benin City. All members of staff of the two hospitals were blinded to the fact that the previous examination findings documented in the case files were being assessed during this study. Results : Of the 915 infants, 19 (2.1%; 95% CI= 1.2-3.0) had anomaly of the external genitalia at birth. The overall frequency of missed diagnosis of external genital anomalies was 68.4% with undescended testes (UDT) being the most frequently missed. The level of documentation of the findings of the external genital examination was poor in both hospitals. Combining the two hospitals, the external genital examination findings were not documented in 76.1% of case files. Conclusions : The routine newborn examination as currently practiced in the two hospitals was weak in detecting external genital anomalies. Poor documentation of the external genital findings is a common occurrence in the setting where we practice, irrespective of whether the health institution is tertiary or secondary. Key words : Audit, clinical documentation, external genitalia anomalies, missed diagnosis, routine newborn examination.

Hintergrund:Uber die Plasmaspiegel des Lipoprotein (a), einem bedeutenden kodominant vererbten Risikofaktor fur koronare- und zerebrovaskulare Erkrankungen, ist bei Kindern wenig bekannt. Methode: Wir untersuchten die Lipoprotein-(a)-Werte bei 111 gesunden Kindern (Altersverlaufstudie), davon in 37 Fallen auch die der jeweiligen Eltern (Familienstudie) und dokumentierten mit Hilfe eines Fragebogens anamnestisch erfasbare koronare Risikofaktoren. Ergebnisse: Der Mittelwert der Lipoprotein-(a)-Serumkonzentration in der Altersverlaufstudie betrug 16±20 mg/dl (Medianwert 9 mg/dl). Von den untersuchten Kinder hatten 23 (20%) erhohte Werte (≥30 mg/dl). Dies ging einher mit signifikant erhohten Mittelwerten fur Gesamt- und Low-Density-Lipoprotein-Cholesterin (LDL-Cholesterin) gegenuber der ubrigen Population. Es fand sich eine deutlich positive Korrelation zwischen den Lipoprotein-(a)-Werten und den Serumkonzentrationen von Gesamt- bzw. LDL-Cholesterin (p