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Zusammenfassung Fragestellung Assoziation zwischen Bildungsstand (BldS) der Eltern und diabetesbezogenen Outcomes bei Kindern mit Typ-1-Diabetes in Deutschland und Vergleich mit deren sozioökonomischem Status (SES). Material und Methode 1781 Kinder und Jugendliche mit Typ-1-Diabetes mellitus unter 18 Jahren aus 13 deutschen Diabeteszentren wurden von Juni 2013 bis Juni 2014 in die Studie eingeschlossen und Assoziationen des familiären BldS mit verschiedenen Diabetesoutcomes analysiert. Die Analyse wurde als Sekundäranalyse anhand des Datensatzes der DIAS-Studie durchgeführt. Diese hatte Assoziationen eines niedrigen SES (gemessen mit einem Index aus BldS, beruflicher Stellung und Haushaltseinkommen der Eltern) mit ungünstigen Diabetes- und Versorgungsoutcomes ermittelt. Die vorliegende Sekundäranalyse untersuchte Assoziationen derselben Outcomes mit dem BldS der Eltern, um zu prüfen, ob sich der BldS als vereinfachter Indikator für die Routinemessung des SES eignet.Die Daten wurden mittels der DPV-Software (Diabetes-Patienten-Verlaufsdokumentation) erfasst, die Analysen erfolgten je nach Verteilungscharakteristika der Outcomes mittels linearer, logistischer, negativ-binomialer oder Poisson-Modellen unter Adjustierung für Alter, Geschlecht, Diabetesdauer, jeweils mit und ohne zusätzliche Adjustierung für Migrationshintergrund. Ergebnisse Niedriger familiärer BldS war im Vergleich zu mittlerem/hohem BldS mit einer schlechteren glykämischen Einstellung (HbA1c) (8,1 % versus 7,8 %, p Zusammenfassung Der BldS der Eltern ist ein bedeutsamer Prädiktor für Gesundheits- und Versorgungsoutcomes bei Kindern mit Typ-1-Diabetes und sollte in der personalisierten Diabetestherapie von Kindern und Jugendlichen mehr Berücksichtigung erfahren. Als kurzer und leicht zu erhebender Indikator bildet er einen guten Näherungswert für die Routineerhebung der individuellen Stellung der Patientinnen und Patienten in der Sozialhierarchie in Diabetes-Standarddokumentationen.

Zusammenfassung Hintergrund Modulare Patientenschulungen sind bei chronisch kranken Kindern wirksam. Wenig ist über den Einfluss von sozioökonomischem Status (SoS), Migrationshintergrund (MH) und psychischen Auffälligkeiten der Kinder und ihrer Familien bekannt. Frage Beeinflussen SoS, MH oder psychische Auffälligkeiten den Erfolg von Patientenschulungen (Krankheitswissen, gesundheitsbezogene Lebensqualität (LQ) und Lebenszufriedenheit des Kindes und die elterliche Krankheitsbelastung)? Methoden Unterschiedlich chronisch kranke Kinder und ihre Eltern nahmen an Patientenschulungen teil. Vor bzw. 6 Wochen nach der Schulung wurden mit standardisierten Fragebögen SoS, MH, psychische Auffälligkeiten der Kinder, Krankheitswissen der Kinder und Eltern, gesundheitsbezogene LQ bzw. Lebenszufriedenheit der Kinder und elterliche Krankheitsbelastungen erfasst. Mit Varianz- und Regressionsanalysen wurde der Einfluss von SoS, MH und psychischen Auffälligkeiten auf den Schulungseffekt untersucht. Ergebnisse 398 Kinder (durchschnittlich 10,2 Jahre) und ihre Eltern nahmen an den Schulungen teil. SoS, MH und psychische Auffälligkeiten hatten keinen Einfluss auf die Verbesserungen des Krankheitswissens, der kindlichen gesundheitsbezogenen LQ und Lebenszufriedenheit sowie der elterlichen Belastung. In den Verlaufsuntersuchungen gingen ein niedriger SoS, ein MH und psychische Auffälligkeiten mit niedrigerem Wissen, niedrigerer gesundheitsbezogener LQ bzw. Lebenszufriedenheit des Kindes und erhöhter elterlicher Belastung einher. Diskussion Benachteiligte Familien und Kinder mit Verhaltensauffälligkeiten profitieren von Patientenschulungen, jedoch benötigen sie angesichts spezifischer Bedarfe einen erhöhten Schulungsumfang.

Background Caring for a child with type 1 diabetes is a tremendous challenge for a family. The aim of the study was to explore the experiences of transition to sensor-augmented pump therapy (SAP) in families with 2 affected children and the internal and external conditions which potentially impede or facilitate the adjustment process. Methods 5 families (9 parents, 8 children and adolescents) who used the SAP technology for 6 months were interviewed to describe their experiences. The interviews were analysed using thematic content analysis. Results Qualitative analysis of the transcribed interviews revealed that the adaptation process to SAP consisted of several phases and differed among families. There were benefits as well as hassles of using SAP with regard to managing the diabetes, and psychosocial issues: school and peer relations, as well as family relations. While parents clearly regarded the improved metabolic control and hypoglycaemic safety as the most important benefits of SAP, the hassles reported as most important covered a wide range, from technical problems of the system to family conflicts. On the whole, families rated the experience of using SAP as a positive one, with most recommending SAP to other families as long as they were willing to come to terms with the technology and commit to the work and time involved. Conclusion Sensor-augmented pump therapy can be extremely beneficial and a resource for families who care for more than one child with diabetes. During the adaptation process there is a great need of education and frequent follow-up e. g., by telemedical support.

Background: The introduction of continuous glucose monitoring (CGM) implies new challenges for diabetes care. As CGM systems are often directly linked to a web-based software solution, structured telemedicine care using a video-consultation may be a new option for families who care for children with type 1 diabetes mellitus (T1DM). Methods: “ViDiKi” (Virtual Diabetes Outpatient Clinic for Children and Youth) is a multicenter controlled trial carried out in Northern Germany. ViDiKi will examine if monthly telemedical consultations, in addition to regular care, will improve glycemic control and psychosocial outcomes. The primary outcome is glycemic control as measured by a change in glycated hemoglobin (HbA1c). A total of 240 participants aged between one year and 16 years using a CGM with multiple daily injections (MDI) or insulin pump therapy were recruited and assigned to a starter group or a six-month waiting control group. The sample size is designed to detect a between-group difference of 0.5% in HbA1c change at six months. Secondary outcomes are variability of blood glucose, health-related quality of life, self-efficacy, and satisfaction with telemedicine. To gain deeper insight into the experience of using telemedicine, qualitative interviews will be conducted. In a health-economic analysis, the costs of telemedicine and a cost-of-care analysis will be calculated. Conclusions: The results from the ViDiKi study shall give important information on the feasibility and putative benefits of telemedicine in children with T1DM and their caregivers. German Clinical Trails Register (DRKS): DRKS00012645

Objective To evaluate the association between socioeconomic status (SES) and diabetes outcomes in German children and adolescents. Methods A total of 1829 subjects

School victimization has adverse effects on mental and physical health. However, little is known about the influence of protective factors, socioeconomic status (SES), or a migration background (MB) on this association. The authors analyzed data from a multicenter longitudinal school study with a high proportion of pupils with a low SES and an MB. Victimization was defined as bullying or the experiences of interpersonal violence.In a cross-sectional design, 2483 pupils of secondary schools in northern Germany completed standardized questionnaires measuring families' SES, MB, school victimization, psychosomatic complaints, life satisfaction, health-related quality of life (HRQoL), and social and personal protective factors. The authors tested the association between victimization, low protective factors, low SES and MB, and subjective health parameters using linear regression models.A total of 39% of the pupils reported being bullied, and 16% had experienced interpersonal violence. Victimized children reported twice as many psychosomatic problems, lower life satisfaction, and reduced HRQoL (p.001) compared with children without victimization experiences. Regression models confirmed this association; in addition to victimization, low social and especially low personal protective factors increased the risk for low subjective health parameters. The SES and MB had no influence on the outcomes.The results underscore the strong association between school victimization and low subjective health factors. Strengthening pupils' self-efficacy and a supportive school climate can diminish the health consequences of victimization.

Modular patient education programs are effective in children with chronic conditions and their families. Little is known about the influence of socioeconomic status (SES), migration background (MB) and children's mental-health problems on the programs' effects.Do SES, MB or mental-health problems influence the success of education programs (disease-specific knowledge, children's health-related quality of life (HRQoL) and life satisfaction and parents' condition-specific burden)?Children with different chronic conditions and their parents participated in modular patient education programs. Before and 6 weeks after the participation SES, MB, children's mental-health problems, parents' und children's disease-specific knowledge, children's HRQoL and life satisfaction and parents' condition-specific burden were assessed by standardized questionnaires. The influence on the programs' effects of SoS, MH and mental-health problems were examined with variance and correlation analyses.398 children (mean age 10.2 yrs) and their parents participated. Irrespective of SoS, MH and mental-health problems the programs were associated with improved disease-specific knowledge, children's HRQoL and life satisfaction and parents' disease-specific burden. At follow-up SoS, MH and mental-health problems were associated with reduced knowledge, reduced children's' HRQoL and life satisfaction and increased parents' disease-specific burden.Disadvantaged families and children with mental-health problems benefit from education programs, but have an increased need of education due to special challenges.Modulare Patientenschulungen sind bei chronisch kranken Kindern wirksam. Wenig ist über den Einfluss von sozioökonomischem Status (SoS), Migrationshintergrund (MH) und psychischen Auffälligkeiten der Kinder und ihrer Familien bekannt.Beeinflussen SoS, MH oder psychische Auffälligkeiten den Erfolg von Patientenschulungen (Krankheitswissen, gesundheitsbezogene Lebensqualität (LQ) und Lebenszufriedenheit des Kindes und die elterliche Krankheitsbelastung)?Unterschiedlich chronisch kranke Kinder und ihre Eltern nahmen an Patientenschulungen teil. Vor bzw. 6 Wochen nach der Schulung wurden mit standardisierten Fragebögen SoS, MH, psychische Auffälligkeiten der Kinder, Krankheitswissen der Kinder und Eltern, gesundheitsbezogene LQ bzw. Lebenszufriedenheit der Kinder und elterliche Krankheitsbelastungen erfasst. Mit Varianz- und Regressionsanalysen wurde der Einfluss von SoS, MH und psychischen Auffälligkeiten auf den Schulungseffekt untersucht.398 Kinder (durchschnittlich 10,2 Jahre) und ihre Eltern nahmen an den Schulungen teil. SoS, MH und psychische Auffälligkeiten hatten keinen Einfluss auf die Verbesserungen des Krankheitswissens, der kindlichen gesundheitsbezogenen LQ und Lebenszufriedenheit sowie der elterlichen Belastung. In den Verlaufsuntersuchungen gingen ein niedriger SoS, ein MH und psychische Auffälligkeiten mit niedrigerem Wissen, niedrigerer gesundheitsbezogener LQ bzw. Lebenszufriedenheit des Kindes und erhöhter elterlicher Belastung einher.Benachteiligte Familien und Kinder mit Verhaltensauffälligkeiten profitieren von Patientenschulungen, jedoch benötigen sie angesichts spezifischer Bedarfe einen erhöhten Schulungsumfang.

Aim Increasingly, families' perspectives are taken into account in the appraisal of health services. The objective of this study was to cross-culturally analyse concepts related to healthcare needs, healthcare utilization and the appraisal and satisfaction with care of parents of children with chronic conditions with the aim of developing a cross-cultural measure. Methods Several approaches were employed in the study: (i) a deductive approach integrating existing measurements; and (ii) an inductive approach based on focus groups. Focus groups were conducted in seven countries with mothers and fathers as well as their children with seven different chronic conditions, and qualitatively analysed. Results As a result of an evaluation of the different existing methodological approaches, the basic structural components were identified: healthcare needs, the receipt of services, problems with receiving services as well as the appraisal of and satisfaction with the quality of care. While items referring to existing healthcare services were primarily derived by the work of an expert group, items related to quality of care and satisfaction with services mainly evolved from the focus group work. From the focus groups, 367 statements were extracted, which were further processed in a Q-sort rating by a multinational expert group in order to identify domains and salient items. The draft questionnaire to be pilot tested cross-nationally consisted of 101 items which were reduced on the basis of psychometric findings. Conclusion On the basis of results of focus groups and existing evidence, a comprehensive measure should be employed in paediatric health services research including structural, process and outcome parameters of care from the perspective of parents.

Aims To improve the quality of care in children with Type 1 diabetes who have limited access to specialized diabetes care in rural areas, by providing a mobile diabetes education and care team, affiliated with a University hospital paediatric diabetes centre. Methods A cohort of 107 children and their families from eight rural hospitals was followed between July 2000 and July 2002. Parameters on quality of metabolic control (HbA1c, hospitalization rate and number of episodes of severe hypoglycaemia), diabetes knowledge and quality of life at baseline (t0), 6 weeks (t1) and 6 months (t2) after the interventions were measured. Results Mean HbA1c was 7.9 ± 1.4% at t0. The proportion of HbA1c values 8.0% decreased significantly (P

Zusammenfassung. Kinder und Jugendliche mit Diabetes mellitus Typ 1 sowie ihre Eltern benötigen regelmäßig Schulungen, um die komplexe Diabetestherapie angemessen im Alltag umsetzen zu können. Seit 1999 bietet ein mobiles Diabetesschulungs- und Behandlungsteam der Universitätskinderklinik Lübeck in acht Kinderkliniken des Bundeslandes strukturierte, stationäre Diabetesschulungen für Kinder, Jugendliche und Eltern an. Das Schulungskonzept wird beschrieben und die Auswirkungen auf die Belastung der Eltern untersucht. Es fand sich eine verminderte Belastung der Eltern in Bezug auf die praktische Umsetzung der Diabetestherapie im Alltag. Persönliche und familiäre Probleme der Eltern wurden durch die Schulung nicht beeinflusst. Es ist anhand unserer Ergebnisse zu überlegen, ob Zeitrahmen und Setting des Schulungsmodells stärker auf die Belange von Eltern fokussieren sollten. Das Studienergebnis unterstreicht die Notwendigkeit der psychosozialen Unterstützung von Eltern diabeteserkrankter Kinder als ein wesentlicher Bestandteil der Langzeitbetreuung.

Aim: This study investigated insulin pump therapy in pediatric patients with type 1 diabetes and Turkish origin compared with those without migration background in Germany. Subjects and Methods: Using a nationwide documentation program, we estimated the prevalence of insulin pump therapy in patients

The effects of illness and treatment of diabetes mellitus extend beyond medical outcomes. We therefore evaluated health-related quality of life (HRQOL) in children (aged 8-12 years) and adolescents (aged 13-16 years) with type 1 diabetes to compare their results with healthy peers and to identify HRQOL determinants. A total of 68 children and adolescents from a tertiary care clinic which specialises in the management of diabetes, completed the generic KINDL-R questionnaire. This instrument for children and adolescents has six dimensions and an additional module assessing condition-related HRQOL. Overall, the HRQOL was not different between patients with type 1 diabetes and healthy controls. In some areas, children and adolescents with diabetes reported a better HRQOL compared to healthy peers: adolescents reported better psychological well-being (P0.05) and children higher levels of well-being in the school domain (P0.05). In general, children reported a better HRQOL (P0.05) than adolescents with type 1 diabetes confirming age-related differences in HRQOL in the general population. Lower HbA1c (8%) and intensified insulin therapy (3 injections/day) were associated with a better HRQOL in different domains (P0.05). The subscale "chronic illness" showed a better HRQOL (P0.001) in children and adolescents with diabetes compared to age-matched controls with other chronic conditions.Children and adolescents from a paediatric department specialising in diabetes management report good health-related quality of life. Younger age, good metabolic control and intensified insulin therapy are associated with a better health-related quality of life. Dimensions of health-related quality of life appear to play different roles at different ages, emphasising the importance of the multidimensional health-related quality of life concept and the value of age-appropriate self-reports.

Children with rheumatic oligoarthritis and polyarthritis frequently establish persistent parvovirus B19 infections that may be associated with the production of antiphospholipid antibodies (anti-PL IgG). In this study we analysed the influence of high-dose intravenous immunoglobulin (IVIG) therapy on virus load, on the level of anti-PL IgG and its potential capacity to improve the patients' clinical status. Four juvenile patients with long-lasting polyarticular rheumatic diseases and persistent parvovirus B19 infection, associated in three cases with the presence of antibodies against β2-glycoprotein I (anti-β2GPI IgG), were treated with two cycles of IVIG on five successive days (0.4 g/kg per day). Clinical parameters including scores of disease activity, virus load and anti-PL IgG levels were determined before, during and after treatment. Two patients showed a complete remission that has lasted 15 months. During that period they showed neither clinical nor laboratory signs of inflammation. Viral DNA was not detectable in serum, and a decrease in anti-β2GPI IgG was observed. As assessed by the Childhood Health Assessment Questionnaire and the Health-related Quality of Life Questionnaire for Children, both patients were no longer restricted in their activities of daily living and no impact on the health-related quality of life was observed. In one patient the therapy failed: there was no improvement of symptoms and no decrease in virus load or inflammatory parameters. In the fourth patient, clinical and laboratory parameters did not improve despite a decrease in both viral load and anti-PL IgG. Our results show that the use of IVIG to treat parvovirus B19-triggered polyarticular rheumatic disease of childhood might offer an opportunity to improve this disabling condition.