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Seebad Heringsdorf, Germany

Schiel R.,MEDIGREIF Inselklinik Heringsdorf GmbH | Stachow R.,Fachklinik Sylt fur Kinder und Jugendliche | Frohlich C.,Kinder Rehaklinik Am Nicolausholz | Koch S.,Fachklinik Gaissach | And 3 more authors.
Diabetologie und Stoffwechsel | Year: 2010

It was the goal of the trial to assess psychosocial characteristics of children and adolescents with type 1 diabetes mellitus admitted to an in-patient rehabilitation procedure German-wide. [nl]Methods:Between 01/01 and 12/31/2006 all patients younger than 20years, admitted to a hospital of the "Arbeitsgemeinschaft (AG) Rehabilitation in der pädiatrischen Diabetologie", were included in the trial. In total data of 757children and adolescents (age 12.1±4.0years, diabetes duration 4.6±3.6years, HbA1c at hospital admission 7.8±1.6%) were analysed. Results:69% of the children and adolescents admitted to an in-patient rehabilitation procedure lived in complex families with mother and father, 18% in structures with only one part (mother or father) and 3% in nursing homes or adopting families. 65% of the children and adolescents included in the trial had first-degree relatives (sisters and brothers). 91% of the patients derived out of German, 9% out of foreign or cultural mixed families. 12% of the children attending a Kindergarten, 36% were educating in general schools, 19% in higher-level schools, 15% in highest-level schools, 5% in schools for handicapped people, 7% in schools without specialisation and 1% were learning a profession. 2% reported about problems at school, sometimes with the result of non-ascending in the next higher class. The percentage of children and adolescents with problems at school was in the group aged≥12<20years slightly higher than in children aged≥6<12years (3% vs. 1%, p<0.05). Moreover patients in older age groups had higher HbA1c-levels too (8.3±1.7% vs 7.2±1.1%, p<0.05). Conclusions:In comparison to National statistics children and adolescents with type 1 diabetes mellitus, admitted to in-patient rehabilitation procedures, derived more frequently out of cultural mixed families and reported more often problems at school than in general population. Hence, patients admitted to in-patient rehabilitation procedures seem to be a negative selection cohort with specific diseases related problems. Also, this hypothesis is supported by higher HbA1c-levels in older age-groups and its association with patients' problems at school. Mostly, in an ambulatory setting these problems can not be treated sufficiently. The in-patient rehabilitation procedure is an important way for long-term and interdisciplinary intervention. It allows the integration of physicians, pedagogues, social workers and psychologists. © Georg Thieme Verlag KG Stuttgart - New York.

Schiel R.,Fakultat fur Gesundheitswissenschaften | Schiel R.,MEDIGREIF Inselklinik Heringsdorf GmbH | Palitzsch K.-D.,Stadtisches KlinikumMunchen GmbH
Diabetologe | Year: 2014

For patients with type 1 and type 2 diabetes mellitus structured teaching is an essential part of therapy. Following participation in a structured teaching program, patients should be able to find the best way for successful integration of diabetes in their own day-to-day life, to prevent negative acute or long-term consequences of diabetes and to guarantee an optimal quality of life (diabetes self-management). During recent years there were many changes in Germany with respect to the healthcare system. In hospitals the duration of inpatient treatment was shortened and more and more therapies are carried out in the outpatient sector or during ambulatory or inpatient rehabilitation. Additional changes concern an increase in the number of elderly people in the population and an increase in the prevalence of types 1 and 2 diabetes mellitus. Against the background of these changes it is often no longer possible to offer complete structured teaching programs during an inpatient stay of diabetic patients. Hence, the German Diabetes Association (Deutsche Diabetes- Gesellschaft, DDG) has allowed hospitals to offer structured inpatient teaching programs using modules since 2013. The modules consist of chapters out of well-evaluated structured treatment and teaching programs. Before choosing a specific topic and conception of the module patients should take part in an assessment during which the problems and needs, cognitive and social structure and factors of the context should be assessed. In the future inpatient teaching programs using modules need to be evaluated and performed on a scientific basis. © 2014 Springer-Verlag.

Schiel R.,MEDIGREIF Inselklinik Heringsdorf GmbH | Kaps A.,MEDIGREIF Inselklinik Heringsdorf GmbH | Stein G.,Friedrich - Schiller University of Jena | Steveling A.,University of Greifswald
Zeitschrift fur Evidenz, Fortbildung und Qualitat im Gesundheitswesen | Year: 2016

Introduction: Worldwide, overweight and obesity are known as posing serious health risks. Successful methods for weight reduction have remained elusive. It was the aim of the present trial to identify parameters and determinants to guarantee long-term weight reduction. Patients and methods: A total of 143/159 overweight and obese children and adolescents (90 %) completed the prospective multicenter trial (age 13.9±2.4 years, BMI 31.2±5.4kg/m2, BMI-SDS 2.51±0.57). During a 6-week rehabilitation period the patients participated in a structured treatment and teaching program (STTP). Following in-patient treatment the children and adolescents were monitored over a period of 24 months (physical examination, measurements of BMI, BMI-SDS, body composition, carotid intima-media thickness, laboratory parameters, blood pressure, standardized questionnaires to assess socio-demographic, socio-economic parameters, eating behavior, well-being, quality of life, intelligence, intrafamilial conflicts, self-efficacy, resilience, sense of coherence, stress management, social support, actual body shape). Results: 66% of the children and adolescents had abnormal laboratory parameters as well as higher blood pressure and/or an increased carotid intima-media thickness. The mean carotid intima-media thickness was 0.53. ±. 0.09. mm (range 0.40 to 0.80); 15% of the patients showed normal range values (< 0.45. mm), 40% a slightly elevated (≥ 0.45 to ≤ 0.50. mm) and 45% an elevated (> 0.50. mm) thickness. After the inpatient treatment lasting 40.4. ±. 4.1 (range 28 to 49) days, children and adolescents reached a mean weight reduction of 5.52. ±. 3.94 (0.4 to 13.3) kg (p <. 0.01) that was accompanied by a reduction in body fat mass. Using multivariate analyses, the most important psychological factors associated with long-term weight reduction were identified (R-square = 0.53): well-being (β = -0.543), resilience (β = 0.434), and sense of coherence (β = 0.315). Conclusion: The different parameters (i. e., well-being, resilience, sense of coherence) have demonstrated their utility, and strategies should be developed allowing an adaption of these into the STTPs and the integration of intervention into the therapeutic setting. © 2016.

Schiel R.,MEDIGREIF Inselklinik Heringsdorf GmbH | Schiel R.,Health Science University | Thomas A.,Medtronic GmbH | Kaps A.,MEDIGREIF Inselklinik Heringsdorf GmbH | Bieber G.,Fraunhofer Institute for Computer Graphics Research
Experimental and Clinical Endocrinology and Diabetes | Year: 2011

To assess physical activity in patients with type 1 diabetes an innovative telemedical support system has been developed. The aim of the feasibility trial was to prove its use in a clinical setting. Patients/methods: 16 children/adolescents with type 1 diabetes mellitus aged 14.5±2.2 years (diabetes duration 6.5±3.6 years, HbA1c 8.8±1.0%) were included in the study. During a period of 13 days all the patients received a telemedical assessment system. It consists of a sensor for physical activity integrated into a mobile phone (DiaTrace). Additionally it is combined with a system for continuous blood glucose monitoring (CGM). Results: The technical system was highly accepted by all the 16 children and adolescents. Physical activity measured was 13.3±5.5AU/d, mean duration of total physical activity was 204.9±66.5min/d (walking 102.5±62.5, running 7.4±5.8, cycling 39.2±32.7, driving 36.0±18.6, non-specific physical activity 57.0±29.7min/d). Periods without activity lasted for 386.5±187.2min/d. Daily energy expenditure was 1964.1±185.5kcal/d. Correlations between physical activity (measured with DiaTrace) and blood glucose profiles (measured with CGM) were calculated. Pearson's correlation coefficients ranged between 0.59 and 0.99 (median 0.91). Hence, these good correlation coefficients show the high and direct association between blood glucose values and activity units. The wide ranges in correlation coefficients demonstrate a huge variability of individualized reactions. Conclusions: Use of innovative electronic health technology is highly accepted by patients. It reveals an accurate, real-time assessment of an individual's physical activity. These information can use for insulin dose-adjustment. © 2011 J. A. Barth Verlag in Georg Thieme Verlag KG Stuttgart. New York.

Schiel R.,MEDIGREIF Inselklinik Heringsdorf GmbH | Schiel R.,Health Science University | Kaps A.,MEDIGREIF Inselklinik Heringsdorf GmbH | Bieber G.,Fraunhofer Institute for Computer Graphics Research
Appetite | Year: 2012

Objective: It was the goal of the trial to study the impact of electronic healthcare technology into treatment. Methods: One hundred and twenty-four children/adolescents (females 56%, age 13.5±2.8years, height 1.64±0.13m, weight 85.4±23.0kg, body-mass index (BMI) 31.3±5.2kg/m 2, BMI-standard deviation score (SDS) 2.50±0.5) were included. To assess physical activity and eating habits, a mobile motion sensor integrated into a mobile phone with digital camera was used. Results: The children/adolescents had a significant weight reduction of 7.1±3.0kg. BMI/BMI-SDS decreased (p<0.01). Intensity (14.1±6.4 activity units) and duration of physical activity (290.4±92.6min/day) were assessed with sensors. Time walking: median 45.5 (range, 2.5-206.5), running 8.0 (range, 0-39.5), cycling 27.7 (range, 0-72.5), car driving 23.7 (range, 0-83.0) min/day. Comparing self-reported physical activity (walking 292.9 (range, 9.6-496.1), running 84.8 (range, 8.4-130.2) min/day) with assessment with sensors there were significant differences (p<0.01). Duration of physical activity documented by children/adolescents was higher than the assessment with motion sensors (walking 292.9 vs 45.5min, p<0.01, running 84.8 vs 8.0min, p<0.01). Sensor derived energy intake was higher than recommended (469.14±88.75kcal vs 489.03±108.25kcal, p=0.09). Performing multivariate analysis the following parameters showed associations with weight reduction (R-square=0.75): body weight (β=-0.95, p<0.01), C-reactive protein (CRP, β=0.15, p=0.07), physical activity, time spent in activities measured with sensors (β=-0.18, p=0.04), stress management (β=0.16, p=0.06), body fat mass at onset of the trial (β=0.45, p<0.01) and body shape (β=-0.25, p=0.01). Conclusion: The innovative mobile movement detection system is highly accepted by children and adolescents. The system is able to augment existing weight reduction and stabilization strategies. © 2011 Elsevier Ltd.

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