1
|
Paschke K, Diestelkamp S, Zapf A, Busch K, Arnaud N, Prehn-Kristensen A, Reis O, Stark M, Cloes JO, Schulz AL, Brauer H, Krömer T, Thomasius R. An app-based training for adolescents with problematic digital-media use and their parents (Res@t digital): protocol for a cluster-randomized clinical trial. Front Psychiatry 2024; 14:1245536. [PMID: 38328520 PMCID: PMC10847547 DOI: 10.3389/fpsyt.2023.1245536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 12/29/2023] [Indexed: 02/09/2024] Open
Abstract
Background Digital media-use disorders (DMUD) in adolescents are a rising phenomenon associated with psychological distress, comorbid mental disorders, and high burden on affected families. Since the ICD-11 introduced criteria for gaming disorder, these can now be transferred to describe additional DMUD associated with social media platforms and streaming services. Most evidence for effective treatments comes from cognitive-behavioral therapy (CBT). However, interventions based on theoretical models for adolescents and their parents are widely missing, leading to a significant clinical gap. Methods Res@t digital (Resource-Strengthening Training for Adolescents with Problematic Digital-Media Use and their Parents) is the app-based translation of the first model-based digital intervention for adolescents with DMUD and their parents based on CBT. It comprises separate but content-related modules for adolescents (Res@t-A) and parents (Res@t-P), applying multimodal techniques. The effectiveness of Res@t will be evaluated within a multicenter cluster-randomized controlled evaluator-blinded pre-post follow-up trial with the waitlist control group (CG). In addition to the Res@t program in the intervention group, both groups will receive treatment as usual within primary child and adolescent psychiatric/psychotherapeutic healthcare. The primary outcome addresses DMUD symptom reduction after 10 weeks. Secondary outcomes are related to a reduction in psychological and family-related problems and an increase in parental self-efficacy. All outcomes will be assessed using standardized self-report measures. A total of 1,334 participating adolescent-parent dyads from a large clinical network throughout Germany are planned to be included in the primary analyses based on an intention-to-treat approach, applying linear mixed models. Discussion Assuming superiority of Res@t over the control condition, the intervention has the potential to provide evidence-based treatment for a significant number of help-seeking families, supporting local healthcare structures and resources. It is a promising program for practicable implementation and flexible use in different settings. Clinical trial registration https://drks.de, DRKS00031043.
Collapse
Affiliation(s)
- Kerstin Paschke
- German Center for Addiction Research in Childhood and Adolescence (DZSKJ), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Silke Diestelkamp
- German Center for Addiction Research in Childhood and Adolescence (DZSKJ), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Antonia Zapf
- Institute of Medical Biometry and Epidemiology (IMBE), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Katharina Busch
- German Center for Addiction Research in Childhood and Adolescence (DZSKJ), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Nicolas Arnaud
- German Center for Addiction Research in Childhood and Adolescence (DZSKJ), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Alexander Prehn-Kristensen
- Institute of Child and Adolescent Psychiatry, Center for Integrative Psychiatry, School of Medicine, Christian-Albrecht University Kiel, Kiel, Germany
| | - Olaf Reis
- Department for Child and Adolescent Psychiatry and Neurology, Rostock University Medical Center, Rostock, Germany
| | - Maria Stark
- Institute of Medical Biometry and Epidemiology (IMBE), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Jan-Ole Cloes
- German Center for Addiction Research in Childhood and Adolescence (DZSKJ), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Anna-Lena Schulz
- German Center for Addiction Research in Childhood and Adolescence (DZSKJ), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Hannah Brauer
- Institute of Child and Adolescent Psychiatry, Center for Integrative Psychiatry, School of Medicine, Christian-Albrecht University Kiel, Kiel, Germany
| | - Thomas Krömer
- Collaborative Practice for Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, Hamburg, Germany
| | - Rainer Thomasius
- German Center for Addiction Research in Childhood and Adolescence (DZSKJ), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | | |
Collapse
|
2
|
Arnaud N, Holtmann M, Melchers P, Klein M, Schimansky G, Krömer T, Reis O, Thomasius R. [Use of Electronic Cigarettes (e-cigs) and e-Shishas by Children and Adolescents: Evidence Paper of the Joint Addiction Commission of the German Societies and Professional Associations of Child and Adolescent Psychiatry and Psychotherapy]. Z Kinder Jugendpsychiatr Psychother 2021; 50:121-132. [PMID: 34668740 DOI: 10.1024/1422-4917/a000831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Use of Electronic Cigarettes (e-cigs) and e-Shishas by Children and Adolescents: Evidence Paper of the Joint Addiction Commission of the German Societies and Professional Associations of Child and Adolescent Psychiatry and Psychotherapy Abstract. The particular risks associated with the consumption of electronic cigarettes (e-cigs) in children and adolescents are not sufficiently considered in the health policy discourse. The present article evaluates the current dissemination and consumption patterns of e-cigarettes as well as the health risks attached to children and adolescents. Based on data from current national and international studies, there has been a clear increase in the consumption of e-cigarettes over the past years. This stands in sharp contrast to the overall decline in tobacco consumption among both children and adolescents in Germany. Young people without tobacco experience are now consuming more frequently e-cigarettes than those who occasionally or regularly use tobacco. They also are experimenting more frequently with conventional cigarettes if they have previously consumed e-cigarettes. The largely unregulated availability of e-cigarette products to the newest generation, such as JUUL, led to a dramatic increase in their prevalence among high-school students in the USA. Products with high nicotine content and multiple flavors are being marketed intensively as trendy lifestyle products to young user groups via advertising and social media campaigns. These products are also becoming increasingly relevant in Germany. The success of tobacco prevention in recent years is presently jeopardized by the ongoing effective advertising for e-cigarettes. The Addiction Commission of the German Child and Youth Psychiatric Federations and Scientific Societies therefore call for an immediate, strict, and comprehensive ban of e-cigarette advertising.
Collapse
Affiliation(s)
- Nicolas Arnaud
- Deutsches Zentrum für Suchtfragen des Kindes- und Jugendalters (DZSKJ), Universitätsklinikum Hamburg-Eppendorf, Hamburg
| | - Martin Holtmann
- LWL-Universitätsklinik Hamm der Ruhr-Universität Bochum, Klinik für Kinder- und Jugendpsychiatrie, Psychotherapie und Psychosomatik, Hamm
| | - Peter Melchers
- Klinik für Kinder- und Jugendpsychiatrie, Psychosomatik und Psychotherapie, Klinikum Oberberg, Kreiskrankenhaus Gummersbach und Klinik Marienheide, Gummersbach
| | | | - Gisela Schimansky
- Praxis für Kinder- und Jugendpsychiatrie und Psychotherapie Dr. Schimansky, Hannover
| | - Thomas Krömer
- Gemeinschaftspraxis für Kinder- und Jugendpsychiatrie, Psychotherapie & Psychosomatik, Hamburg
| | - Olaf Reis
- Klinik für Psychiatrie, Neurologie, Psychosomatik und Psychotherapie im Kindes- und Jugendalter, Universitätsmedizin Rostock, Rostock
| | - Rainer Thomasius
- Deutsches Zentrum für Suchtfragen des Kindes- und Jugendalters (DZSKJ), Universitätsklinikum Hamburg-Eppendorf, Hamburg
| |
Collapse
|
3
|
Paschke K, Holtmann M, Melchers P, Klein M, Schimansky G, Krömer T, Reis O, Wartberg L, Thomasius R. [Media-associated disorders in childhood and adolescence: Evidence paper of the joint addiction commision of the German societies and professional associations of child and adolescent psychiatry and psychotherapy]. Z Kinder Jugendpsychiatr Psychother 2020; 48:303-317. [PMID: 32614281 DOI: 10.1024/1422-4917/a000735] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Media-associated disorders in childhood and adolescence: Evidence paper of the joint addiction commision of the German societies and professional associations of child and adolescent psychiatry and psychotherapy Abstract. Media-associated disorders (MAD) describe the problematic use of the internet, certain electronic devices in general as well as digital applications. During childhood and adolescence, digital games and social media are the most commonly used applications. In May 2019, as first MAD "gaming disorder" was included as a clinical diagnosis in the ICD-11. The prevalence of MAD in German children and adolescents is estimated to lie between 3 % and 5 %. In most cases, MAD are accompanied by psychiatric comorbidities. MAD ensue because of dysfunctional learning processes in combination with general and specific risk factors. They are associated with neural changes like those of substance-associated addictions. Diagnostics can be based on validated questionnaires and clinical exploration, though a standardized diagnostic path is not yet common. Treatment depends on the level of severity and generally comprises outpatient, day-clinic, and inpatient therapy approaches with elements from cognitive-behavioral therapy and under parental involvement. Suitable treatments are not yet available in all German regions and have also not been sufficiently evaluated. Moreover, only a few studies exist on the efficacy of prevention measures addressing MAD in children and adolescents. Thus, further research is strongly required.
Collapse
Affiliation(s)
- Kerstin Paschke
- Deutsches Zentrum für Suchtfragen des Kindes- und Jugendalters (DZSKJ), Universitätsklinikum Hamburg-Eppendorf, Hamburg
| | - Martin Holtmann
- vLWL-Universitätsklinik Hamm der Ruhr-Universität Bochum, Klinik für Kinder- und Jugendpsychiatrie, Psychotherapie und Psychosomatik, Hamm
| | - Peter Melchers
- Klinik für Kinder- und Jugendpsychiatrie, Psychosomatik und Psychotherapie, Klinikum Oberberg, Kreiskrankenhaus Gummersbach und Klinik Marienheide, Gummersbach
| | | | | | - Thomas Krömer
- Gemeinschaftspraxis für Kinder- und Jugendpsychiatrie, Psychotherapie & Psychosomatik, Hamburg
| | - Olaf Reis
- Klinik für Psychiatrie, Neurologie, Psychosomatik und Psychotherapie im Kindes- und Jugendalter, Universität Rostock, Rostock
| | - Lutz Wartberg
- Fakultät für Humanwissenschaften, MSH Medical School Hamburg, Hamburg
| | - Rainer Thomasius
- Deutsches Zentrum für Suchtfragen des Kindes- und Jugendalters (DZSKJ), Universitätsklinikum Hamburg-Eppendorf, Hamburg
| |
Collapse
|
4
|
Krömer T. Verbesserung der Mundhygiene pflegebedürftiger Menschen durch Schulungen des Pflegepersonals im Kreis Ostholstein – Ergebnisse einer Interventionsstudie. Das Gesundheitswesen 2018. [DOI: 10.1055/s-0038-1639221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- T Krömer
- Kreis Ostholstein Fachdienst Gesundheit/ Jugendzahnärztlicher Dienst, Eutin, Germany
| |
Collapse
|
5
|
Holtmann M, Thomasius R, Melchers P, Klein M, Schimansky G, Krömer T, Reis O. Anforderungen an die stationäre medizinische Rehabilitation für Jugendliche mit substanzbedingten Erkrankungen. Z Kinder Jugendpsychiatr Psychother 2018. [PMID: 29521187 DOI: 10.1024/1422-4917/a000573] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Martin Holtmann
- 1 Deutsche Gesellschaft für Kinder- und Jugendpsychiatrie, Psychosomatik und Psychotherapie (DGKJP)
| | - Rainer Thomasius
- 1 Deutsche Gesellschaft für Kinder- und Jugendpsychiatrie, Psychosomatik und Psychotherapie (DGKJP)
| | - Peter Melchers
- 1 Deutsche Gesellschaft für Kinder- und Jugendpsychiatrie, Psychosomatik und Psychotherapie (DGKJP)
| | - Marianne Klein
- 1 Deutsche Gesellschaft für Kinder- und Jugendpsychiatrie, Psychosomatik und Psychotherapie (DGKJP)
| | - Gisela Schimansky
- 1 Deutsche Gesellschaft für Kinder- und Jugendpsychiatrie, Psychosomatik und Psychotherapie (DGKJP)
| | - Thomas Krömer
- 1 Deutsche Gesellschaft für Kinder- und Jugendpsychiatrie, Psychosomatik und Psychotherapie (DGKJP)
| | - Olaf Reis
- 1 Deutsche Gesellschaft für Kinder- und Jugendpsychiatrie, Psychosomatik und Psychotherapie (DGKJP)
| |
Collapse
|
6
|
Mechler K, Krömer T, Landauer M, Dittmann RW, Häge A. Screening for ADHD-Related Symptoms in Preschoolers Should Be Considered-Results From a Representative Sample of 5-Year-Olds From a German Metropolitan Region. Front Psychiatry 2018; 9:612. [PMID: 30524321 PMCID: PMC6256242 DOI: 10.3389/fpsyt.2018.00612] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Accepted: 10/31/2018] [Indexed: 11/26/2022] Open
Abstract
Background: Early assessment and intervention are crucial to alleviate symptoms and prevent long-term negative outcomes in children suffering from Attention-deficit/hyperactivity disorder (ADHD). In Germany, at present, no standardized screening for ADHD is routinely administered. This study aims to evaluate a potential screening measure in a study population that is representative for a primary school entrance exam population in a German metropolitan region. Methods: Based on various socio-demographic variables, a sample of n = 500 5-year-old children (58% boys, 42% girls), representative of a primary school entrance exam population from a German metropolitan region, was selected. Their parents completed a written survey consisting of the CBCL and a brief screening tool for ADHD symptomatology based on the DISYPS-II questionnaire. Demographic data were also collected. Results: The subscale "Attention problems" of the CBCL/4-18 showed results in the clinical range for n = 10 (2%) participants. The ADHD screening identified n = 23 (4.6%) participants as suspect of having ADHD with a statistically significant gender difference (n = 17 boys vs. n = 6 girls, p = 0.03). In n = 5 (1%) participants, all boys, both CBCL/4-18 and the ADHD screening were indicative of ADHD. Conclusions: Results indicate that screening for ADHD in this population may be both feasible and reasonable given the high prevalence and chronic nature of this disorder and the benefit of an early initiation of treatment. Results match previously reported figures for prevalence of ADHD-related symptoms and gender differences in preschool and older pediatric populations and thus do not support the hypothesis that the prevalence of ADHD in a metropolitan region is significantly higher than in other regions.
Collapse
Affiliation(s)
- Konstantin Mechler
- Pediatric Psychopharmacology, Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Thomas Krömer
- Practice of Child and Adolescent Psychiatry and Psychotherapy, Hamburg, Germany
| | - Michael Landauer
- Pediatric Psychopharmacology, Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Ralf W Dittmann
- Pediatric Psychopharmacology, Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Alexander Häge
- Pediatric Psychopharmacology, Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| |
Collapse
|
7
|
Aguilar-Rodríguez PA, Krömer T, García-Franco JG, MacSwiney G MC. From dusk till dawn: nocturnal and diurnal pollination in the epiphyte Tillandsia heterophylla (Bromeliaceae). Plant Biol (Stuttg) 2016; 18:37-45. [PMID: 25683682 DOI: 10.1111/plb.12319] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/10/2014] [Accepted: 01/22/2015] [Indexed: 05/13/2023]
Abstract
In order to compare the effectiveness of diurnal and nocturnal pollinators, we studied the reproductive biology and pollinators of Tillandsia heterophylla E. Morren, an epiphytic tank bromeliad endemic to southeastern Mexico. Since anthesis in T. heterophylla is predominantly nocturnal but lasts until the following day, we hypothesised that this bromeliad would receive visits from both diurnal and nocturnal visitors, but that nocturnal visitors would be the most effective pollinators, since they arrive first to the receptive flower, and that bats would be the most frequent nocturnal visitors, given the characteristics of the nectar. Flowering of T. heterophylla began in May and lasted until July. The species is fully self-compatible, with an anthesis that lasts for ca. 15-16 h. Mean volume of nectar produced per flower was 82.21 μl, with a mean sugar concentration of 6.33%. The highest volume and concentration of nectar were found at 20:00 h, with a subsequent decline in both to almost zero over the following 12-h period. T. heterophylla has a generalist pollination system, since at least four different morphospecies of visitors pollinate its flowers: bats, moths, hummingbirds and bees. Most of the pollinating visits corresponded to bats and took place in the early evening, when stigma receptivity had already begun; making bats the probable pollinator on most occasions. However, diurnal pollinators may be important as a 'fail-safe' system by which to guarantee the pollination of T. heterophylla.
Collapse
Affiliation(s)
- P A Aguilar-Rodríguez
- Centro de Investigaciones Tropicales, Universidad Veracruzana, Xalapa, Veracruz, México
| | - T Krömer
- Centro de Investigaciones Tropicales, Universidad Veracruzana, Xalapa, Veracruz, México
| | - J G García-Franco
- Red de Ecología Funcional, Instituto de Ecología, A.C., Xalapa, Veracruz, México
| | - M C MacSwiney G
- Centro de Investigaciones Tropicales, Universidad Veracruzana, Xalapa, Veracruz, México
| |
Collapse
|
8
|
Krömer T, Kessler M, Lohaus G, Schmidt-Lebuhn AN. Nectar sugar composition and concentration in relation to pollination syndromes in Bromeliaceae. Plant Biol (Stuttg) 2008; 10:502-11. [PMID: 18557910 DOI: 10.1111/j.1438-8677.2008.00058.x] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
A first comprehensive dataset of nectar sugar composition and concentration in Bromeliaceae is presented, covering 111 species belonging to all three subfamilies. Based on this dataset, we examined the relationship between nectar traits and pollination syndromes in the family. Sugars in samples were assayed by high pressure liquid chromatography. All sampled species were grouped into three broad categories (trochilophilous, chiropterophilous, or lepidopterophilous) according to their main pollination mode. Significant differences between the different pollination syndromes were found in nectar sugar composition as well as concentration. For a total of four genera (Guzmania, Pitcairnia, Tillandsia and Vriesea), a comparison of nectar composition showed significant differences between trochilophilous and chiropterophilous species. Data presented here indicate that the characteristics of nectar in Bromeliaceae are predominantly determined by putative adaptations of nectar sugars to preferences of the pollinators rather than by phylogenetic relations.
Collapse
Affiliation(s)
- T Krömer
- Universität Göttingen, Albrecht-von-Haller-Institut für Pflanzenwissenschaften, Abteilung Systematische Botanik, Göttingen, Germany.
| | | | | | | |
Collapse
|
9
|
Altmeyer P, Erbler H, Krömer T, Duwe HP, Hoffmann K. Interferometry: a new method for no-touch measurement of the surface and volume of ulcerous skin lesions. Acta Derm Venereol 1995; 75:193-7. [PMID: 7653178 DOI: 10.2340/00015555751931972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023] Open
Abstract
A new interferometry procedure (Holon View measuring system) permits non-invasive and objective measurement of the surface, height/depth and volume of ulcerous lesions. The method, which uses a combination of the so-called phase-shift and gray-code technique, is new in dermatology. The measuring system consists of a diffraction grating projection system, a video camera and a computer-aided, digital image processing and analysis system. A diffraction grating consisting of 320 lines is projected onto the skin surface or a silicone impression of the ulcerous lesion. The course of the light-intersection lines is recorded by a video camera and read into an image computer. The special feature of the method is the combination of grey-code projection and a phase-shift procedure. For evaluation of the method in dermatology, 2,000 interferometric measurements of volume were carried out on objects of known volume, on silicone impressions and on leg ulcers. The accuracy of the method has been proven by means of the evaluation of objects of known volume. The results of interferometric measurements were compared with the values of the volume determined by water capacity and those of the surface determined by image analysis. The healing of a leg ulcer was followed over an 8-week period. The Holon View measuring system permits no-touch measurement of the volume and surface of ulcerous skin lesions with a high degree of accuracy and precision, in a short time.
Collapse
Affiliation(s)
- P Altmeyer
- Department of Dermatology, Ruhr-University, Bochum, Germany
| | | | | | | | | |
Collapse
|