Rehabilitation für Kinder und Jugendliche

Pädiatrie & Pädologie - Rehabilitation für Kinder und Jugendliche im Indikationsbereich Mobilisierung beinhaltet die Therapie einer Vielzahl von akuten und chronischen...     

Aktuelle STIKO-Impfempfehlungen für Kinder und Jugendliche

The German Advisory Board for Vaccination (STIKO) at the Robert Koch-Institute proposes recommendations to prevent infectious diseases and associated complications through population-based immunization programs. STIKO recommendations focus on vaccination concepts that are of relevance for public health goals (“in public interest”). In addition, STIKO recommendations provide guidance about which vaccinations are indicated for specific risk situations, e.g. related to occupational hazards. Moreover, a comprehensive review on catch up vaccination programs for individuals with incomplete or unknown vaccination status is given. This article reviews the basics of current vaccination practices in Germany and describes the latest STIKO recommendations and its most important innovations.     

Update: Impfempfehlungen für Kinder und Jugendliche

Monatsschrift Kinderheilkunde - Die Empfehlungen der Ständigen Impfkommission (STIKO) am Robert Koch-Institut (RKI) haben das Ziel, Infektionskrankheiten und damit assoziierte Komplikationen,...     

Vorsorge- und Rehabilitationsmaßnahmen für Kinder und Jugendliche

As the result of new legislation introduced in 2007 children in Germany enjoy the same rights to prophylaxis and in-patient rehabilitation services as adults. The aim of pediatric rehabilitation is to prevent children from losing their ability to function or participate or to recover lost functions, activities and participation. The best interests of the child are the main consideration. Both preventative and rehabilitative measures may be employed for specific indications, usually following established guidelines. In pediatric rehabilitation, the parents of children under the age of 12 years may also be involved in the medical treatment and health education as “co-therapists”. In contrast, -child treatment programmes focus more on the parents. Based on requirements laid down by the insurer, the main emphasis of these latter programmes is on prevention, psychosocial aspects and parent-child interaction, which is integrated into the treatment plan. Every pediatrician should therefore know the differences between parent-child treatment programmes and approaches directed primarily at the child, in order to help the patients choose the appropriate rehabilitative therapy.     

Schulung Obeldicks für adip?se Kinder und Jugendliche

Background

Lifestyle intervention based on diet counseling, exercise, and behavioral therapy is the therapy of choice in childhood obesity. However, predictive factors for outcome are largely unknown. Therefore, the aim of this study was to analyze the impact of participants’ motivation and structured education for therapists on the outcome of the intervention Obeldicks.

Materials and methods

Age, gender, degree of overweight at baseline [as standard deviation score (SDS) of BMI], motivation (proved by participation in exercise groups, filling in questionnaires, and performing dietary records), and training of therapists in a 1-week seminar were correlated with the outcome of the intervention both at end of 1-year intervention and 1?year after end of treatment by multiple linear regression analyses. The intervention was offered at five centers in the Ruhr region in Germany.

Results

At total of 1,083 obese children and adolescents (median BMI 27.9?kg/m²) aged 8–15 years (55% females) were included in the analyses. Forty percent of the participants reduced their SDS-BMI >0.2. The dropout rate was 22%. In multiple linear regression analyses, the reduction of SDS-BMI at end of intervention was associated with motivation (p<0.001), training of therapists (p<0.001), age of participants (p<0.001), and degree of overweight (p=0.026). All these factors were also significantly related to SDS-BMI reduction 1?year after end of treatment.

Conclusion

Since younger age and lower degree of overweight were associated with better outcome, intervention should be offered early in childhood obesity. Patient’s motivation and training of therapists improve the outcome of lifestyle interventions.     

Übergewicht und Adipositas bei Kindern und Jugendlichen mit Diabetes mellitus Typ 1

Background. An increasing prevalence of overweight and obesity in children with diabetes has been documented.With the German database of pediatric diabetic patients (DPV) this study should calculate exact numbers of this prevalence and evaluate possible influences. Patients. We evaluated the datas of 13.599 children and adolescents,sampled from 1994 up to June 2001. As control we used the new German BMI-percentiles [21]. Results. The overall prevalence of overweight (11,3%) and obesity (5,3%) in diabetic patients was moderately elevated. In the age group 3–5 years the prevalence was a little higher (overweight 12,3/obesity 6,7%). In adolescents only the girls showed a high prevalence of overweight (16,6%) and obesity (11,4%). In girls above 15 years, there was a significant correlation between the prevalence of overweight and the duration of diabetes. In patients with overweight or obesity intensified insulintherapy was more often described than conventional therapy.     

Strukturierte Erfassung der Therapieangebote für adipöse Kinder und Jugendliche

Background

A structured survey of treatment programs for obese children is still missing in Germany. We performed this survey on behalf of the AGA (association for treatment of obesity in children and adolescents) to identify treatment programs and evaluate their success.

Methods

A structured questionnaire was sent to all members of the AGA, children's hospitals, social pediatric centers, public health offices, rehabilitation clinics, and the federation of health insurance providers in Germany (n=1464). In addition, a request for information was published in medical journals and on the home page of the AGA.

Results

A total of 119 outpatient and 56 inpatient treatment centers for obese children and adolescents were identified in Germany. They will be published on the Internet pages of the AGA. The recommendations of the AGA are not met by 51% of the outpatient and 27% of the inpatient therapy plans. Only 16% of the outpatient and 14% of the inpatient therapy institutions evaluate therapy success at the end of the treatment program.

Discussion

This survey demonstrates considerable heterogeneous quality in the therapy of obese children. The efficacy of treatment plans is still unclear since no long-term follow-up data are available. A controlled long-term follow-up study is necessary to improve the quality of treatment programs and to evaluate their efficacy.     

Rehabilitation f��r Kinder und Jugendliche in ?sterreich

In Austria a nationwide coordination and regulation of rehabilitation in children and adolescents is urgently needed. Legislation for financing and governmental responsibility are necessary as well as the establishment of child-specific institutions for rehabilitation with an overlap in indications, which are organized with quality assurance programs and defined structural criteria. In a first step data concerning the demand for rehabilitation beds in Austria were recently acquired. As part of the nationwide ??Dialogue for Child Health??, initiated by the Austrian Ministry of Health, first suggestions for legislation affairs, dimensions and localization of institutions for pediatric rehabilitation were developed. An adequate family oriented rehabilitation for e.g. pediatric hemato-oncological patients is of high priority. Rehabilitation in the field of mental health requires its own specific concept. Comparing neighboring countries, governmental legal regulation is exemplary in Germany while financial support via daily costs is optimized in Switzerland. In contrast Austria may be considered a developing country in this field concerning pediatric rehabilitation. Recent efforts must take into account that pediatric rehabilitation is a specific challenge requiring child-specific rehabilitation units which should not be routinely integrated into existing institutions for adults.     

Influenza und Influenzaimpfstoffe für Kinder

Influenza is viral disease with very typical clinical symptoms of sudden onset, high fever, coughing, sore throat, muscle pain and headache. The morbidity is highest for children whereby infants substantially contribute to spreading the disease. Infants and babies are often severely affected and must be hospitalized. The World Health Organization (WHO) now recommends the implementation of routine influenza immunization of healthy children between 6 and 59 months old. As conventional trivalent influenza vaccines (TIV) are not optimal for protection young children more effective vaccines are needed. Since 2011 a live attenuated influenza vaccine has been approved for the age group 2-17 years old which provides children with better protection against influenza than conventional TIV. A further possibility for increased effectiveness is coupling TIV with an adjuvant. A virosomal vaccine is available for children over 6 months old. Antigen enhancement of TIV in infants and young children may lead to better protection rates.     

Ätiopathogenese des Diabetes mellitus Typ 1

Type 1 diabetes mellitus results from a progressive loss of pancreatic beta cells. Environmental factors such as exposure to cow's milk protein and toxins such as nitrosamines are thought to play a pivotal role in the development of type 1 diabetes by influencing the penetrance of diabetes susceptibility genes. As one additional environmental factor viruses have long been considered to play a part in type 1 diabetes.The production of cytokines such as tumour necrosis factor-alpha (TNF), interleukin-1 beta (Il-1) and the synthesis of nitric oxide (NO) are known to lead to the destruction of beta cells which results in the development of diabetes. The destruction of pancreatic beta cells is thought to be a consequence of cytokine-induced programmed cell death. The molecular mechanisms and the cell's machinery leading to and enhancing apoptosis/programmed cell death have been elucidated. It has become evident that a number of independent and distinct signaling pathways involving proteins and enzymes such as STATs, tyrosine kinases and small G-proteins are all involved in regulating a network of intracellular enzymes, called caspases/interleukin converting enzymes (ICEs) that direct a cell's progression towards death. The production of pro-inflammatory cytokines is thought to be a consequence of the disruption of the finely tuned immune balance of Th1-helper and Th2-helper T lymphocytes. This derangement of the immune system leads to the selective activation of beta-cell-cytotoxic effector T cells. It is hoped that the knowledge of the aetiopathogenesis of type 1 diabetes will help to further develop strategies to prevent and ultimately cure the disease.     

Bessere Arzneimittel für Kinder

Background

The majority of drugs administered to children today have never been authorized for children. Drugs not tested in children carry increased risks as they may work differently and have different side effects than in adults. Paediatric drug studies have so far been hampered by several hurdles. The EU Paediatric Regulation, in force since 2007, aims to overcome these hurdles and to make more adequately tested drugs available for children. It consists of the requirement for paediatric development of all new drugs by pharmaceutical companies, incentives such as patent extension, and a Paediatric Committee to guide this process.

Current accomplishments

In the last 5 years, the Paediatric Committee has agreed almost 600 paediatric development plans, most of which are still ongoing. Several collateral measures to improve transparency and information and to stimulate paediatric research have already been implemented. As a result of the regulation, some drugs have already received new paediatric authorization, new age-appropriate formulations, or updates of product information with new paediatric data. However, their number is still small because of the short latency.

Conclusion

The Paediatric Regulation has implemented important steps to improve drug development for children. To achieve broad availability of authorized drugs for children will need more time.