[Emotional Maltreatment of Children and Adolescents - Definitions, Prevalences, Risk Factors and Psychological Consequences]

The aim of this article is to provide an introductory overview of the phenomenon of emotional maltreatment of children and adolescents by presenting national and international literature and, in particular, to illustrate the consequences for the mental health of those affected. First, relevant definitions are made and forms of appearance of emotional child maltreatment are presented. A comparison of national and global prevalences shows that emotional child maltreatment is one of the most prevalent forms of child maltreatment. There are different risk factors that can exist at the level of the parents as well as at the level of the children or the environment. The risk that children and adolescents who have experienced emotional violence will have experienced other forms of childmaltreatment is high.There aremultiple consequences for victims of emotional child maltreatment which can result in different, longterm participatory impairments. Especially the psychological and somatic consequences of emotional childmaltreatment can be compared to the consequences of child sexual abuse and physical child maltreatment. Nevertheless, the significance of emotional maltreatment for affected children and adolescents is still underestimated in practice. Often, the effects of emotionalmaltreatment on those affected are not visible. Froma child and adolescent psychiatric/ psychotherapeutic perspective, the psychological consequences must therefore be clearly stated. Finally, there is a need for a broader understanding of emotional child maltreatment that also includes peer and sibling violence.

Helminths and their management in Swiss Army horses: differences between riding horses and pack horses evidence the need of improvement

INTRODUCTION

Intestinal helminth management in horses has both clinical and epidemiologic relevance, in additional association with anthelmintic resistance. The Swiss Army employs military owned riding horses and privately owned pack horses, which are brought together for service periods up to 12 weeks. We compared husbandry conditions and intestinal helminth management of both groups via questionnaire and analysed faecal samples of 53 riding horses and 130 pack horses using combined sedimentation/flotation, the McMaster method and larval cultures. Riding horses only had cyathostomin infections (prevalence: 60,4 %), while pack horses harboured cyathostomins (71,5 %), Parascaris sp. (6,9 %) and Strongylus vulgaris (1,5 %). Regression models combining faecal sample results with questionnaire data unveiled correlations of husbandry practices with parasite frequencies identifying risk and protective factors. Pasture management, hygiene and deworming practices were highly variable for pack horses, while for riding horses there was an overall concept. This included a selective deworming strategy with faecal egg counts (FECs) of strongyles prior to deworming, applying a threshold of 200 eggs per gram of faeces (epg). Anthelmintic treatments based on FECs, weekly faeces removal on pastures (pastures), the use of macrocyclic lactones and deworming horses regularly were identified as protective factors regarding the 200 epg threshold for strongyle eggs. Accordingly, the mean epg for strongyle eggs between the groups (111 and 539 in riding and pack horses, respectively) was significantly different (p < 0,001). Overall, intestinal helminth management in pack -horses showed room for improvement regarding pasture hygiene, the used anthelmintics and the frequency of deworming, from which all Swiss Army horses would benefit, as they share pastures during their -service, therefore entailing the risk of parasite transmission.

An Update on Feline Calicivirus

INTRODUCTION

Feline Calicivirus (FCV) is one of the most common viral pathogens in domestic cats worldwide. The first report of FCV dates back to 1957, when FCV was isolated from the gastrointestinal tract of cats in New Zealand. Subsequent reports recognised FCV as a cause of respiratory disease in cats, and at present, feline practitioners worldwide are daily confronted with cats suffering from suspected FCV. The highly mutagenic nature of FCV and its high genetic plasticity enable the virus to successfully survive in the feline population, and pose a special challenge as regards the diagnosis, treatment, and prevention of FCV-induced disease. Upper respiratory tract disease has been considered a common clinical sign of FCV infection. A study from Switzerland demonstrated that oral ulcerations, salivation and gingivitis-stomatitis were more commonly associated with FCV infection than upper respiratory tract disease, and less than half of the cats suspected to have FCV infection were found to be FCV-positive. Furthermore, a study investigating FCV isolates from Switzerland found some evidence that the genetic background of cats might influence their susceptibility to FCV infection. This review article provides a comprehensive summary of the FCV literature, and integrates the results of recent research on FCV's genetic characteristics, the cellular and humoral immunity evoked by FCV vaccination and infection, the diagnosis of FCV, FCV prevention/vaccination, the risk factors associated with FCV, and the hygienic measures necessary in FCV-contaminated areas. After each section, the key points are summarised, and relevant information is outlined to help feline practitioners in FCV diagnosis, treatment and prevention.

A five-year retrospective study on ascarid infections in dogs in southern Italy

INTRODUCTION

A 5-year retrospective analysis of ascarid infections (Toxocara canis and Toxascaris leonina) in dogs from southern Italy was performed to update the epidemiological scenario of these parasites and to identify the risk factors which may favour these infections in animals in this study area. A total of 8,149 dogs, referred to our labs for copromicroscopic analysis using the FLOTAC technique, was considered. A sub-sample of 500 faecal samples were analysed also with the Mini-FLOTAC technique. Of the overall dog samples analysed, 9,2 % (95 % CI = 8,6-9,8) resulted positive for T. canis while 0,5 % (95 % CI = 0,4-0,7) resulted positive for T. leonina. Co-infections with T. canis and T. leonina were found in 0,1 % of dogs (95 % CI = 0,0-0,1). The results obtained by the FLOTAC and Mini-FLOTAC examinations showed a nearly perfect k agreement (k = 0,99, P < 0,001) between these two techniques. Chi-square test showed positivity to T. canis and T. leonina significantly (P < 0,001) associated with dogs housed outdoor (i.e., that lived in garden or in kennel). Moreover, the positivity for T. canis was significantly associated (P < 0,001) also with age (i.e., puppies), as shown by the logistic regression. The decreasing overall prevalence both for T. canis and T. leonina during the years of monitoring, showed that, as suggested by the European Scientific Counsel Companion Animal Parasites, the regular diagnosis could contribute to an efficient control of these parasites.

[Differences in epaAC© in heart failure patients with or without readmission: A retrospective case-control study]

Differences in epaAC© in heart failure patients with or without readmission: a retrospective case-control study Abstract. Background: Heart failure is one of the most frequent reasons for hospitalization in elderly people. In heart failure, approximately 22.8 % of hospitalised patients are rehospitalised within 30 days. The nursing assessment tool epaAC could provide information on risk factors for readmission. Aim: The aim of this study was to identify possible group differences in the items and scores of the epaAC discharge assessment with regard to the endpoint of unplanned readmissions within 30 days after discharge from index-hospitalisation. Methods: Using a retrospective case-control design, differences in the epaAC variables were investigated by descriptive and comparative statistics. Chi-square test, Wilcoxon test and t-test were performed with two-sided alpha level α < 0.05. Alpha error accumulation was accounted for by Benjamini & Hochberg correction. Results: No significant group differences were found in all items and scores of the discharge epaAC. There is only weak evidence that the presence of acute respiratory impairment at time of discharge is higher in the patient with rehospitalisation than in those without rehospitalisation. Conclusions: The items and scores of the nursing assessment instrument epaAC did not significantly differ between patients with or without 30-days readmission. Further exploration to assess the epaAC's potential to predict rehospitalisation in heart failure is needed.

[CME: Hypertension and the COVID-19 Pandemic: What to Consider in Medical Practice]

CME: Hypertension and the COVID-19 Pandemic: What to Consider in Medical Practice Abstract. The COVID-19 pandemic represents a major public health problem. A fraction of the population is at increased risk of developing complications of this disease, in particular older subjects as well as diabetic, obese and hypertensive patients. With regard to patients with high blood pressure, the existence of an increased risk remains to be confirmed in large controlled trials. So far the findings regarding this question are reassuring, whether these patients are treated or not. There seems to be no reason to worry when using blockers of the renin-angiotensin system. The observations available to date suggest that COVID-19 vaccine can be administered safely to hypertensive patients. In conclusion, there is no reason to implement changes in the care of hypertensive patients due to the pandemic.

[CME/Answers: Hypertension and the COVID-19 Pandemic: What to Consider in Medical Practice]

CME/Answers: Hypertension and the COVID-19 Pandemic: What to Consider in Medical Practice Abstract. The COVID-19 pandemic represents a major public health problem. A fraction of the population is at increased risk of developing complications of this disease, in particular older subjects as well as diabetic, obese and hypertensive patients. With regard to patients with high blood pressure, the existence of an increased risk remains to be confirmed in large controlled trials. So far the findings regarding this question are reassuring, whether these patients are treated or not. There seems to be no reason to worry when using blockers of the renin-angiotensin system. The observations available to date suggest that COVID-19 vaccine can be administered safely to hypertensive patients. In conclusion, there is no reason to implement changes in the care of hypertensive patients due to the pandemic.

[Unusual Cause of Acute Kidney Failure in a Patient with Metastatic Bladder Carcinoma Undergoing Palliative Chemotherapy]

Unusual Cause of Acute Kidney Failure in a Patient with Metastatic Bladder Carcinoma Undergoing Palliative Chemotherapy Abstract. Tumour lysis syndrome is a potentially life-threatening complication of cancer and its treatment. It mostly occurs in highly proliferative haematological neoplasms under cytotoxic therapy but can also be seen spontaneously and in solid neoplasms, particularly with high tumour burden and/or high chemosensitivity. The present case report describes a tumour lysis syndrome in a patient with metastatic bladder cancer with an elevated lactate dehydrogenase as only potential correlate of a high tumour burden.

[Not Available]

Socio-Economic Differences in the Lausanne CoLaus Cohort Abstract. The CoLaus study allowed to highlight the existence of broad social inequalities in health among the population of the city of Lausanne. In fact, participants with low socioeconomic status had a higher prevalence of cardio-metabolic risk factors, risk behaviors, sleep disturbances, and higher inflammatory markers compared to the more socio-economically advantaged participants in the study. In most cases, these inequalities are similar to those found in the neighboring cantons and countries.

[Primary Prevention of Acute Stroke]

Primary Prevention of Acute Stroke Abstract. Strokes are frequent. Vascular risk factors are increasing the stroke risk. Most vascular risk factors are treatable. Their therapy is important in the primary prevention of stroke. According to the INTERSTROKE study, arterial hypertension, inactivity, overweight, dyslipidemia, smoking, unhealthy diet, cardiac pathologies such as major arrhythmia, diabetes mellitus, stress/depression and overconsumption of alcohol are the most important treatable vascular risk factors. In this article, we will also report on at present less well known treatable vascular risk factors such as sleep apnea, atheromatosis of the aortic arch and of arteries supplying the brain, migraine with aura and chronic inflammatory disorders and infections.

Risk and protective factors for pre- and postnatal bonding

Since disturbances in the mother-child bond increase the risk of negative consequences for child development, it is important to identify risk and protective factors for bonding as well as longitudinal associations. Previous research has used different bonding instruments during pregnancy and the postnatal phase, leading to inconsistent results. In the current study, the same instrument was used during the various phases. In a large, community-based sample (N = 793), general information, feelings of pre- and postnatal bonding (Pre- and Postnatal Bonding Scale), depressive symptoms (Edinburgh Postnatal Depression Scale), and partner support (subscale Tilburg Pregnancy/Postnatal Distress Scale) were measured at both 32 weeks of pregnancy and 8 months postnatally. Partner support was found to be a protective factor for suboptimal pre- and postnatal bonding, as was the engagement with fetal movements for prenatal bonding. High maternal educational level was a risk factor for suboptimal prenatal bonding, as were depressive symptoms for suboptimal postnatal bonding. The associations between most prenatal determinants and postnatal bonding were mediated by prenatal bonding, which underlines the importance of promoting prenatal bonding. Professionals in clinical practice should be aware of partner support, engagement with fetal movements, and postnatal depressive symptoms: All these factors offer opportunities for improving the bonding processes.

[Sexual Dysfunction in Primary Health Care]

Sexual Dysfunction in Primary Health Care Abstract. In primary health care, sexual dysfunctions are usually only insufficiently recorded. At the same time, these disorders are relatively common and often remain untreated. This study investigated sexual dysfunction and how it is influenced by lifestyle in patients in a general practitioner's practice (HP).

METHODS

A sample of HP patients was asked about their sexuality, psychosocial situation and lifestyle, using validated questionnaires.

RESULTS

The sample consisted of 30 women and 37 men. Of these, about two thirds have never spoken to a physician about their sex life and more than four fifths have never been asked about it by a phyisican. In 75 % of the sample there was no evidence of sexual dysfunction. Men with questionnaire values indicating sexual dysfunction showed significantly higher psychological stress than those with inconspicuous values.

CONCLUSION

Despite an inconspicuous anamnesis regarding risk factors of sexual dysfunction, about a quarter of the sample found evidence of sexual dysfunction. An inconspicuous anamnesis in the areas of alcohol/tobacco consumption and depression does not make a targeted questioning about sexual dysfunction superfluous. Particularly for men, acute psychological stress should be a sufficient reason to address the topic of sexuality and to deepen it if necessary.

[Prediction of binge drinking in young adults: a cohort study over nine years]

Prediction of binge drinking in young adults: a cohort study over nine years Abstract.

OBJECTIVE

Which person characteristics and environmental factors predict binge drinking at age 21?

METHOD

A longitudinal observational study with a nine-year follow-up. A total of 5,176 adolescents from the German states Schleswig-Holstein and Saxony-Anhalt were surveyed in 2006 with paper-pencil questionnaires (mean age 12.6 years, SD = 0.6). A follow-up assessment was conducted in the year 2015. Baseline predictors were age, gender, school type, school performance, parenting style, early experience with alcohol, alcohol use of parents, alcohol use of friends, and sensation seeking. Primary outcome in 2015 was binge drinking at least once a month (six or more alcoholic drinks during one drinking occasion).

RESULTS

A subsample of 1,087 (20.9 %) of the former students could be surveyed nine years after baseline (mean age 21.6 years, SD = 0.8). One out of four (25.4 %) reported binge drinking at least once in a month. A multiple regression model revealed three significant predictors of binge drinking: male gender, early experience with alcohol and frequency of parental alcohol use at baseline.

CONCLUSIONS

Perceived frequency of parental alcohol use might be an important risk factor for children's alcohol use in early adulthood. Parents need to reflect their role as alcohol-specific socialization agents.

[Factors affecting in-hospital mortality in patients with sepsis: Development of a risk-adjusted model based on administrative data from German hospitals]

BACKGROUND

Inpatient administrative data from hospitals is already used nationally and internationally in many areas of internal and public quality assurance in healthcare. For sepsis as the principal condition, only a few published approaches are available for Germany. The aim of this investigation is to identify factors influencing hospital mortality by employing appropriate analytical methods in order to improve the internal quality management of sepsis.

METHODS

The analysis was based on data from 754,727 DRG cases of the CLINOTEL hospital network charged in 2015. The association then included 45 hospitals of all supply levels with the exception of university hospitals (range of beds: 100 to 1,172 per hospital). Cases of sepsis were identified via the ICD codes of their principal diagnosis. Multiple logistic regression analysis was used to determine the factors influencing in-hospital lethality for this population. The model was developed using sociodemographic and other potential variables that could be derived from the DRG data set, and taking into account current literature data. The model obtained was validated with inpatient administrative data of 2016 (51 hospitals, 850,776 DRG cases).

RESULTS

Following the definition of the inclusion criteria, 5,608 cases of sepsis (2016: 6,384 cases) were identified in 2015. A total of 12 significant and, over both years, stable factors were identified, including age, severity of sepsis, reason for hospital admission and various comorbidities. The AUC value of the model, as a measure of predictability, is above 0.8 (H-L test p>0.05, R² value=0.27), which is an excellent result.

CONCLUSION

The CLINOTEL model of risk adjustment for in-hospital lethality can be used to determine the mortality probability of patients with sepsis as principal diagnosis with a very high degree of accuracy, taking into account the case mix. Further studies are needed to confirm whether the model presented here will prove its value in the internal quality assurance of hospitals.

Clinicopathologic and prognostic factors in short- and long-term surviving dogs with protein-losing enteropathy

INTRODUCTION

The aim of the present study was to investigate the differences in the characteristics of short- and long-term surviving dogs with protein-losing enteropathy (PLE) and to identify factors that predict its outcome. We retrospectively reviewed the medical records of 59 client- owned dogs with PLE diagnosed at three different hospitals between January 2009 and November 2013. The dogs were classified as either short-term (= 6 months; STs) or long-term (> 6 months; LTs) survivors. Clinical and clinicopathological variables were investigated between the groups and receiver operating characteristic (ROC) curve analysis was performed. Nineteen dogs were classified as STs and 40 as LTs. Body weight and blood urea nitrogen concentrations were significantly higher in the STs at diagnosis (P < 0.05). At 1 month after initiation of immunosuppressive therapy (data- driven cut-off, T1), chronic canine enteropathy clinical activity index (CCECAI) scores were higher (P < 0.01) and albumin, serum total protein and total cholesterol concentrations were lower (P < 0.01) in the STs. ROC curve analysis showed that CCECAI > 5 evaluated at T1 was the best predictor of poor outcome. Although the severity of clinical signs and the majority of clinicopathological findings at diagnosis did not influence the outcome, survival time was shorter in the dogs with high CCECAI scores at T1 and which did not respond to therapy.

[Effect of herd health management on the prevalence of Postpartum Dysgalaktie Syndrome (PPDS) and the treatment incidence]

INTRODUCTION

The Postpartum Dysgalaktie Syndrome (PPDS) also known as metritis agalactia mastitis (MMA), is considered the most common disease of the sow after farrowing. The reasons for PPDS are multifactorial and are to be found in the areas of management and hygiene, feeding, water supply and animal specific factors such as body condition and age of the sows. In this study a veterinary herd health management was carried out in 28 pig farms with PPDS, with the aim to reduce the PPDS prevalence and animal treatment incidence (TI). In 20 of 28 problem farms the PPDS-prevalence could be decreased from 37.4% (± 21.8%) to 24.5% (± 14.1%). The TI was not significantly reduced. The most effective procedures to reduce the PPDS-prevalence were the use of a prepartal transition feed, optimizing the PPDSdiagnostic and the use of nonsteroidal antiinflammatory drugs (NSAID) and oxytocin in the PPDS-treatment.

PSYCHOLOGY OF BOYS AT RISK: INDICATORS FROM 0-5

In utero and during the first 5 years of life, boys face unique risks as a result of neurobiological and environmental factors. This introductory article to the Special Issue describes the background of this gender-specific inquiry and outlines some of those risks, drawing attention to the areas that will be covered in depth in the following contributions. We also describe the basis of this inquiry as the link between early life and the subsequent difficulties that adolescent boys and many young men face, and pay particular attention to the circumstances of young men of color and to the growing knowledge about the contributions of fathers to boys' development.

[Male Urinary Incontinence--a Taboo Issue]

Male urinary incontinence is an underestimated and frequently not broached issue. The urinary incontinence is divided into stress-, urge incontinence and hybrid forms as well as overflow incontinence. The fact that there are increasingly more men over 60 means that the prevalence of the urinary incontinence is up to 40%, and urinary incontinence will increasingly gain importance in daily routine practice. Many investigations and therapies can be realized by the general practitioner. Already simple therapy approaches can lead to a considerable clinical improvement of male urinary incontinence. If the initial therapy fails or pathological results (i. e. microhaematuria, recurrent urinary tract infections, raised residual urine and so on) are found, the patient should be referred to a urologist.

[The treatment of epistaxis]

Epistaxis is one of the most common ENT emergencies and highly prevalent in the general population. Most cases are self-limiting and patients do not usually seek medical attention. However, some cases can be severe and life-threatening. While most anterior bleeds can be effectively managed by simple measures, including pressure application, vasoconstrictive agents and cautery, some will require additional measures such as nasal packing. Posterior epistaxis can be difficult to control. Latest studies showed that surgical ligation of the sphenopalatine and/or anterior ethmoidal arteries is the most effective treatment and less painful and distressing than nasal packing. But packing is the therapeutic option that is readily available.

[Identification and assessment of suicidality]

Suicidality is a frequently observed but unfortunately frequently overlooked phenomenon. Every year over 1000 persons in Switzerland commit suicide; the number of attempted suicides is much higher. If suicidality is recognized promptly, appropriately assessed and adequate therapy initiated, suicides can be prevented. The assessment of suicidality can be facilitated by knowledge of the most important risk groups and factors, but also of protective factors. Various instruments are available which provide an overview of the influential factors, whereby some risk factors, e.g. access to suicidal methods or concrete suicide plans, involve a greater suicide risk than others. Such instruments, however, can never replace the overall assessment of a clinician which ought to arise from a dialogue characterized by empathy and transparency.

[Adolescent parenting – developmental risks for the mother-child dyad]

Adolescent mothers and their children are exposed to multiple psychosocial risk factors and represent a high-risk group for adverse developmental outcomes. It is not the mother's young age alone which contributes to the developmental risk of the mother-child dyad. Rather, both the combination of risks, such as poverty, domestic violence, dysfunctional family relationships, or a psychiatric disorder, all of which predispose to adolescent pregnancy, as well as the strains of parenthood during the mother's own developmental stage add to the psychosocial risks of children of teenage mothers. Early motherhood can lead to lower levels of education and a lower socioeconomic status. In addition, there is a higher risk for psychopathology in both the teenage mother and her child. This article provides an overview of the current research findings regarding adolescent parenting and its associated risks. Risk factors leading to early motherhood are reviewed and associated with differences in parenting behaviors and the developmental outcomes of their children. This article will conclude with a short overview on intervention programs for adolescent mothers and their children. Further research is needed to develop age-appropriate support programs for adolescent mothers and their children to cope with the complexity of risks and improve their developmental trajectories.