The experience of benefit-finding and growth (BFG), defined as perceiving positive life changes resulting from adversity, is increasingly studied among youths with chronic health conditions (CCs). ...However, empirical evidence is scarce for explaining individual differences in BFG. The study aimed to test a model of BFG, including an interplay of personal and environmental factors and coping processes.
A sample of N = 498 youths (12-21 years) recruited from three German patient registries for CCs (type 1 diabetes: n = 388, juvenile idiopathic arthritis: n = 82, cystic fibrosis: n = 28) completed a questionnaire including self-reported optimism, social support from parents and peers, coping strategies, and BFG. The model was created to reflect the theoretical assumptions of the Life Crisis and Personal Growth model and current empirical evidence. Structural equation modeling was conducted to evaluate the incremental explanatory power of optimism, peer group integration, parental support, acceptance, cognitive reappraisal, and seeking social support over and above sociodemographic and disease-related characteristics.
The model (CFI = 0.93; RMSEA = 0.04; SRMR = 0.05) explained 32% of the variance in BFG. Controlling for sociodemographic and disease-related characteristics, acceptance, cognitive reappraisal, and seeking social support were directly and positively linked to BFG. All tested coping strategies significantly mediated the association between optimism and BFG, whereas seeking social support significantly mediated the relation between peer group integration and BFG.
The study stresses the prominent role of emotion-focused coping strategies and peer group integration in enhancing BFG in youths with CCs.
German Clinical Trials Register (DRKS), no. DRKS00025125. Registered on May 17, 2021.
Counselling adolescents with chronic medical conditions (CMCs) can be challenging regarding suitable interviewing skills and clinicians' attitudes toward the patient. Successful communication can be ...a key element of treatment. Motivational Interviewing (MI) is broadly applicable in managing behavioural problems and diseases by increasing patient motivation for lifestyle changes. However, data concerning the applicability, feasibility and implementation of MI sessions in everyday practice are missing from the physicians' point of view.
The present study was conducted as a mixed methods design. Twenty paediatricians were randomized to a 2-day MI course followed by MI consultations. Data were collected through a questionnaire one year after MI training. Factors for effective training and possible barriers to successful use of MI were examined.
Completed questionnaires were returned by 19 of 20 paediatricians. The paediatricians' experiences with MI demonstrate that MI is regarded as a valuable tool when working with adolescents with CMCs. 95% of all respondents reported that they found MI education necessary for their clinical work and were using it also outside the COACH-MI study context. 73.7% percent saw potential to strengthen the connection to their patients by using MI. The doctors were already using more MI conversation techniques after a 2-day MI course. Obstacles were seen in the short training, the lack of time and missing undisturbed environment (interruptions by telephone, staff, etc.) during clinical flow.
MI techniques are not yet a regular part of medical training. However, a 2-day MI course was rated effective and provided a lasting impact by physicians caring for children and adolescents with chronic medical conditions (CMCs), although booster sessions should be offered regularly.
The study was registered in the German Clinical Trials Register (DRKS00014043) on 26/04/2018.
Introduction Currently, over two million war refugees live in Germany. Exposure to war and flight is associated with a high burden of diseases, not limited to mental disorders and infections. We ...aimed to analyze diabetes treatment and outcomes of pediatric refugees and migrants from Ukraine and Syria/Afghanistan with type 1 diabetes (T1D) in German-speaking countries. Materials and methods We included patients with T1D documented between January 2013 and June 2023 in the German/Austrian/Luxembourgian/Swiss DPV registry, aged < 20 years, born in Ukraine U, in Syria or Afghanistan S/A, or without migration background C. Using logistic, linear, and negative binomial regression models, we compared diabetes technology use, BMI-SDS, HbA1c values, as well as severe hypoglycemia and DKA rates between groups in the first year of treatment in the host country. Results were adjusted for sex, age, diabetes duration, and time spent in the host country. Results Among all patients with T1D aged < 20 years, 615 were born in Ukraine U, 624 in Syria or Afghanistan S/A, and 28,106 had no migration background C. Compared to the two other groups, patients from Syria or Afghanistan had a higher adjusted BMI-SDS (0.34 95%-CI: 0.21–0.48 S/A vs. 0.13 - 0.02–0.27 U and 0.20 0.19–0.21 C; all p<0.001), a lower use of CGM or AID system (57.6% and 4.6%, respectively S/A vs. 83.7% and 7.8% U, and 87.7% and 21.8% C, all p<0.05) and a higher rate of severe hypoglycemia (15.3/100 PY S/A vs. 7.6/100 PY C, and vs. 4.8/100 PY U, all p<0.05). Compared to the two other groups, patients from Ukraine had a lower adjusted HbA1c (6.96% 95%-CI: 6.77–7.14 U vs. 7.49% 7.32–7.66 S/A and 7.37% 7.36–7.39 C, all p<0.001). Discussion In their first treatment year in the host country, young Syrian or Afghan refugees had higher BMI-SDS, lower use of diabetes technology, higher HbA1c, and a higher rate of severe hypoglycemia compared to young Ukrainian refugees. Diabetologists should be aware of the different cultural and socioeconomic backgrounds of refugees to adapt diabetes treatment and education to specific needs.
Relatively little is known about protective factors and the emergence and maintenance of positive outcomes in the field of adolescents with chronic conditions. Therefore, the primary aim of the study ...is to acquire a deeper understanding of the dynamic process of resilience factors, coping strategies and psychosocial adjustment of adolescents living with chronic conditions.
We plan to consecutively recruit N = 450 adolescents (12-21 years) from three German patient registries for chronic conditions (type 1 diabetes, cystic fibrosis, or juvenile idiopathic arthritis). Based on screening for anxiety and depression, adolescents are assigned to two parallel groups - "inconspicuous" (PHQ-9 and GAD-7 < 7) vs. "conspicuous" (PHQ-9 or GAD-7 ≥ 7) - participating in a prospective online survey at baseline and 12-month follow-up. At two time points (T1, T2), we assess (1) intra- and interpersonal resiliency factors, (2) coping strategies, and (3) health-related quality of life, well-being, satisfaction with life, anxiety and depression. Using a cross-lagged panel design, we will examine the bidirectional longitudinal relations between resiliency factors and coping strategies, psychological adaptation, and psychosocial adjustment. To monitor Covid-19 pandemic effects, participants are also invited to take part in an intermediate online survey.
The study will provide a deeper understanding of adaptive, potentially modifiable processes and will therefore help to develop novel, tailored interventions supporting a positive adaptation in youths with a chronic condition. These strategies should not only support those at risk but also promote the maintenance of a successful adaptation.
German Clinical Trials Register (DRKS), no. DRKS00025125 . Registered on May 17, 2021.
The daily demands of type 1 diabetes management may jeopardize adolescents' mental health. We aimed to assess anxiety and depression symptoms by broad-scale, tablet-based outpatient screening in ...adolescents with type 1 diabetes in Germany.
Adolescent patients with type 1 diabetes mellitus (n = 2,394; mean age 15.4 y SD 2.0; 50.7% male) were screened for anxiety (GAD-7) and depression symptoms (PHQ-9) by self-report questionnaires and linked to clinical data from the DPV patient registry. Logistic regression was used to estimate the contribution of clinical parameters to positive screening results.
Altogether, 30.2% showed a positive screening (score ≥ 7 in either test), and 11.3% reported suicidal ideations or self-harm. Patients with anxiety and depression symptoms were older (15.7 y CI 15.5-15.8 vs. 15.3 y CI 15.2-15.4; p < 0.0001), had higher HbA1c levels (7.9% CI 7.8-8.0 (63 mmol/mol) vs. 7.5% CI 7.4-7.5 (58 mmol/mol); p < 0.0001), and had higher hospitalization rates. Females (adjusted odds ratio (aOR) 2.66 CI 2.21-3.19; p < 0.0001), patients > 15 years (aOR 1.40 1.16-1.68; p < 0.001), who were overweight (aOR 1.40 CI 1.14-1.71; p = 0.001), with HbA1c > 9% (> 75 mmol/mol; aOR 2.58 1.83-3.64; each p < 0.0001), with a migration background (aOR 1.46 CI 1.17-1.81; p < 0.001), or smoking (aOR 2.72 CI 1.41-5.23; p = 0.003) had a higher risk. Regular exercise was a significant protective factor (aOR 0.65 CI 0.51-0.82; p < 0.001). Advanced diabetes technologies did not influence screening outcomes.
Electronic mental health screening was implemented in 42 centers in parallel, and outcomes showed an association with clinical parameters from sociodemographic, lifestyle, and diabetes-related data. It should be integrated into holistic patient counseling, enabling early recognition of mild mental health symptoms for preventive measures. Females were disproportionally adversely affected. The use of advanced diabetes technologies did not yet reduce the odds of anxiety and depression symptoms in this cross-sectional assessment.
The common gamma chain (γ
) contributes to the formation of different cytokine receptors e.g., IL-2 receptor (IL-2R), IL-7R, and IL-15R, which are important for generation of self-reactive T-cells in ...autoimmune diseases, like in type 1 diabetes (T1D). Whereas, the roles of membrane and soluble IL-2Rα and IL-7Rα variants in T1D disease pathogenesis are well-described, effects of γ
expression and availability for dependent receptors remain elusive. We investigated expression of the γ
and dependent receptors on T-cells and soluble γ
concentrations in serum from patients with T1D (
= 34) and healthy controls (
= 27). Effector T-cell cytokines as well as IL-2, IL-7, and IL-15 induced STAT5 phosphorylation were analyzed to determine functional implications of differential γ
expression of CD4
T-cell subsets classified by t-distributed Stochastic Neighbor Embedding (t-SNE) analyses. We found increased γ
and IL-7Rα expression of CD4
T-cells from T1D patients as compared to controls. t-SNE analyses assigned differential expression to subsets of memory T-cells co-expressing γ
and IL-7Rα. Whereas, γ
expression was positively correlated with IL-2Rα in memory T-cells from healthy controls, no dependency was found for patients with T1D. Similarly, the effector T-cell cytokine, IL-21, correlated inversely with γ
expression in healthy controls, but not in T1D patients. Finally, T1D patients with high γ
expression had increased proportions of IL-2 sensitive pSTAT5
effector T-cells. These results indicated aberrantly high γ
expression of T-cells from T1D patients with implications on dependent cytokine receptor signaling and effector T-cell cytokine production.
The highest genetic type 1 diabetes risk is conferred by HLA class II haplotypes defined by alleles at the
and -
loci. The combination of
and
alleles (summarized as 'HLA-DQ8') is reported to be among ...the two most prevalent HLA class II haplotypes in Caucasian type 1 diabetes patients. This classification is based on conventional genotyping of exon 2 of the DQ gene locus and excludes exon 3. In this study, HLA genotyping on the type 1 diabetes susceptibility loci
,
and
was performed using a high-resolution next generation sequencing method. In addition to the routinely examined exon 2, exon 3 was also sequenced. Samples from 229 children with type 1 diabetes were included and compared to a cohort of 9,786 controls. In addition to previously described HLA-DQ haplotypes in type 1 diabetes patients, we found that as well as
also contributed to HLA-DQ8.
differs from
by one nucleotide substitution in exon 3 at position 160, leading to a single amino acid replacement.
was exclusively associated with
whereas the
haplotype comprised either
or
. Significantly increased type 1 diabetes risk was confirmed for all these haplotypes with only minor differences between
and
alleles. This study identified the
allele as an addition to the already known type 1 diabetes risk haplotypes, and can contribute to more precise HLA genotyping approaches.
This cluster-randomised monocentric controlled trial focuses on improving the uptake symptoms of mental health care in adolescents with chronic medical conditions who have been identified by ...screening to have depression or anxiety. The study aims to determine the efficacy of motivational interviewing (MI) delivered by trained physicians to increase 12- to 20-year-old adolescents' utilisation of psychological health care for symptoms of anxiety or depression.
In this single-centre approach, n = 1,000 adolescents will be screened (using PHQ-9 and GAD-7), and adolescents with results indicative of anxiety or depressive symptoms (n = 162) will be advised to seek psychological health care in clusters from treating physicians in specialised outpatient departments. Participants who screen positive will receive either two sessions of MI or treatment as usual (TAU; regarded as the typical daily clinical practice), which is focused on recommending them to seek psychological health care for further evaluation. MI efficacy will be compared to the current TAU as the control condition. The primary outcome is the utilisation rate of psychological health care after counselling by an MI-trained physician vs. an untrained physician. Additionally, reasons for not claiming psychological support and changes in disease-related parameters will be evaluated in a 6-month follow-up session.
This trial will evaluate the feasibility of MI as a way to improve the utilisation of mental health-care services by adolescents who need further support other than that provided by standard care for chronic diseases. Physicians offering MI to adolescents may serve as a model for optimising health-care management in daily clinical practice, which may improve adolescents' long-term well-being by improving adherence to medical treatment and preventing negative lifelong consequences into adulthood.
German Trials Register (DRKS), DRKS00014043 . Registered on 26 April 2018. Düsseldorf University study ID: 2017114504.
Major histocompatibility complex class II genes are considered major genetic risk factors for autoimmune diabetes. We analysed Human Leukocyte Antigen (HLA)
and
haplotypes in a cohort with ...early-onset (age < 5 years), long term type 1 diabetes (T1D) and explored their influence on clinical and laboratory parameters.
Intermediate resolution
,
and
typing was performed in 233 samples from the German Paediatric Diabetes Biobank and compared with a local control cohort of 19,544 cases. Clinical follow-up data of 195 patients (diabetes duration 14.2 ± 2.9 years) and residual C-peptide levels were compared between three HLA risk groups using multiple linear regression analysis.
Genetic variability was low, 44.6% (104/233) of early-onset T1D patients carried the highest-risk genotype
(
denoting
), and 231 of 233 individuals carried at least one of six risk haplotypes. Comparing clinical data between the highest (
= 83), moderate (
= 106) and low risk (
= 6) genotypes, we found no difference in age at diagnosis (mean age 2.8 ± 1.1 vs. 2.8 ± 1.2 vs. 3.2 ± 1.5 years), metabolic control, or frequency of associated autoimmune diseases between HLA risk groups (each
> 0.05). Residual C-peptide was detectable in 23.5% and C-peptide levels in the highest-risk group were comparable to levels in moderate to high risk genotypes.
In this study, we saw no evidence for a different clinical course of early-onset T1D based on the HLA genotype within the first ten years after manifestation.
The objective of this study was to assess overall and segmented trends in the incidence of type 1 diabetes mellitus (T1DMM) and type 2 diabetes mellitus (T2DMM) in children and adolescents younger ...than 20 years, from 2002–2022.
This study used registry data on physician-diagnosed T1DM or T2DM from primary and secondary sources, covering the German federal state of North Rhine-Westphalia with 18 million inhabitants. The ages at T1DM and T2DM onset ranged from 0–19 and 10–19 years, respectively. The main outcomes were direct age- and/or sex-standardized incidence rates per 100,000 person-years (PYs) and trends estimated as annual percentage changes (APCs), both with 95% confidence intervals. The segmented trends for subperiods were based on joinpoint regression models.
From 2002–2022, 17,470 and 819 persons had incident T1DM and T2DM, respectively. The total number of PYs was 73,743,982 for T1DM and 39,210,453 for T2DM, with a mean coverage rate of 98% for T1DM and 90% for T2DM. The standardized T1DM incidence increased from 17.6 16.3;18.9} in 2002 to 33.2 31.3;35.1 in 2022, with an APC of 2.7% 2.3%;3.1%. The standardized T2DM incidence increased from 1.3 0.8;1.7 in 2002 to 2.8 2.0;3.6 in 2022, with an APC of 6.4% 4.9%;8.0%. There were four different segmented trends for T1DM and T2DM, with the incidence peaking in 2021 and subsequently declining.
The incidence rates of T1DM and T2DM have increased over the past 20 years, with a wave-like pattern during the Covid-19 pandemic.
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