Marco Daniel Gulewitsch

Placebo effects in children: a review

Of more than 155,000 PubMed citations found with the search term “placebo,” only ~9,000 (5.8%) included the terms “children” or “adolescents.” When all these papers were screened, only ~2,000 of them investigated the placebo effect per se, and of those, only ~50 (2.5%) discussed the placebo effect in children and adolescents. In this narrative review, we explore four aspects of the placebo response in children and adolescents: (i) the legal and ethical limitations and restrictions for the inclusion of children in clinical trials as well as in experimental (placebo) research that may explain the poor knowledge base; (ii) the question of whether or not the placebo effect is larger in children and adolescents as compared with adults; (iii) whether the mechanisms underlying the placebo effect are similar between children and adults; and (iv) whether mediators and moderators of the placebo effect are comparable between children and adults. We finally discuss some of the consequences from the current placebo research in adults that may affect both experimental and clinical research in children and adolescents.

Irritable bowel syndrome symptoms among German students: prevalence, characteristics, and associations to somatic complaints, sleep, quality of life, and childhood abdominal pain

Objectives Irritable bowel syndrome (IBS) is a common disorder in the general population, and is linked to considerable impairments in daily functioning. Little is known about the prevalence of IBS symptoms among students. This study examined the prevalence and characteristics of IBS, sex differences, associations to other somatic complaints and sleep, quality of life (QoL), and childhood abdominal pain in a German university student population. Methods Using an Internet-based questionnaire, we assessed IBS criteria (according to Rome III), health complaints, health-related QoL (12-item short-form), healthcare-seeking behavior, absenteeism from classes, and subjective attributions in a sample of 2399 university students (mean age: 24.16 years; 1701 female and 696 male students). Results The prevalence of IBS-like symptoms was 18.1% with a significant difference between male (15.2%) and female (21.0%) students. Logistic regression models showed that being long-term student doubles the risk for having IBS [adjusted Odds ratio (OR)=2.16], as did the presence of other health problems: recurrent backaches (adjusted OR=2.15), troubles falling asleep (adjusted OR=1.52), and recurrent abdominal pain during childhood (adjusted OR=2.01). The IBS group had significant impairment on 12-item short-form physical and mental dimensions compared with asymptomatic students. Approximately 60% of participants fulfilling IBS criteria never consulted a physician. Male students attributed their symptoms significantly more to nutrition than female students did, who attributed their symptoms significantly more often to stress and anxiety. Conclusion IBS is a common syndrome among German university students and goes along with impaired health-related QoL. According to our data, students reporting recurrent abdominal pain in childhood are especially at risk for IBS.

Rome III criteria in parents' hands: pain-related functional gastrointestinal disorders in community children and associations with somatic complaints and mental health

Objectives To determine (a) the prevalence of Rome III abdominal pain-related functional gastrointestinal disorders in a western community sample of children, (b) their associations with sociodemographic factors, and (c) whether children fulfilling Rome III abdominal pain diagnoses show higher rates of psychological distress and somatization. Methods Data were collected from parents of 6–10-year-old children who were recruited from 22 public grammar schools in Germany. A total of 1537 questionnaires were included in the analysis. Abdominal pain-related functional gastrointestinal disorders were diagnosed on the basis of questionnaire responses by Rome III criteria. Further, somatic complaints as well as emotional and behavioral problems were assessed. Results In total, 7.7% of children aged 6–10 years fulfilled the criteria for at least one Rome III abdominal pain-related functional gastrointestinal disorder according to their parents. The most prevalent diagnoses were irritable bowel syndrome (4.9%) and functional abdominal pain (2.0%). Assigned diagnoses were not associated with sociodemographic factors. We could confirm that abdominal pain-related functional disorders, especially irritable bowel syndrome, were strongly associated with somatization and emotional problems in community. Conclusion Rome III abdominal pain-related functional gastrointestinal disorders are a common health problem in children and are, even in community, strongly associated with other somatic complaints and psychological distress.

Sleep characteristics, sleep problems, and associations of self-efficacy among German university students

Background Sleep problems, especially insomnia, are a common complaint among adults. International studies on university students have shown prevalence rates between 4.7% and 36.2% for sleep difficulties, and 13.1% and 28.1% for insomnia. Sleep problems are associated with lower social and academic performance and can have a severe impact on psychological and physical health. Objective The goal of this study was to outline sleep characteristics, prevalence of sleep problems, insomnia, and associations with self-efficacy among German university students. Methods A total of 2196 university students (70.9% women; mean age 24.16 years) participated in the study. Sleep characteristics, sleep problems, insomnia, and self-efficacy were assessed using a questionnaire. Results and conclusion Analyses revealed that more than 16% of surveyed students needed more than 30 minutes to fall asleep. About 7.7% of the students suffered from insomnia. Short sleep was significantly associated with a considerably increased rate of insomnia (20%). Insomniacs showed lower self-efficacy than students without sleep problems.

Mental Strain and Chronic Stress among University Students with Symptoms of Irritable Bowel Syndrome

Aim. To investigate the degree of mental strain and chronic stress in a German community sample of students with IBS-like symptoms. Methods and Materials. Following an internet-based survey about stress, this study recruited 176 German university students (23.45 ± 2.48 years; 48.3% males) with IBS-like symptoms according to Rome III and 181 students without IBS (23.55 ± 2.82 years; 50.3% males) and compared them regarding current mental strain (SCL-90-R) and the extend of chronic stress. Beyond this, IBS subtypes, IBS severity, and health care utilization were assessed. Results. Students fulfilling IBS criteria showed significantly elevated values of mental strain and chronic stress. Nearly 40% of the IBS group (versus 20% of the controls) reached a clinically relevant value on the SCL-90-R global severity scale. IBS subtypes did not differ in terms of mental distress or chronic stress. Somatization, anxiety, and the chronic stressors “work overload,” “social tension,” and “dissatisfaction with job” were most closely connected to IBS symptom severity. Regarding health care utilization, our results show that consulting a physician frequently was not associated significantly with elevated mental strain or chronic stress but with IBS symptom severity. Conclusion. Our data contribute additional evidence to the distinct association between psychological stress and IBS in community samples.

PreDictor Research in Obesity during Medical care - weight Loss in children and adolescents during an INpatient rehabilitation: rationale and design of the DROMLIN study

BackgroundObesity in adults and children is increasing worldwide at alarming rates. Obese children and adolescents are likely to become obese adults with increased risk of a number of comorbidities. In addition to preventing the development of obesity at young age, it is necessary to individualize the therapy of already obese children and adolescents in order to increase the likelihood of weight loss and maintenance. Therefore, the aim of this study is to identify predictors which play a significant role in successful weight loss and weight loss maintenance in children and adolescents.Methods/DesignOver a one year period, 60 obese children and adolescents between 9 to 17 years of age shall be recruited at an inpatient children rehabilitation facility in Germany. They will be investigated twice within a few days following admission and prior to discharge. The study will be an integrated component of an established inpatient weight-loss and in part psychosomatic therapy. The collected data can be grouped into four clusters: 1) demographic, sociometric and psychometric data, 2) objective and subjective parameters of body condition, 3) autonomic nervous system regulated functions and 4) objective and subjective parameters for eating behavior. Primary outcome is the change of the body mass index standard deviation score (BMI-SDS). In order to evaluate the data appropriately, all examinations will be also conducted in a normal-weight reference group, matched for age and gender.DiscussionFor some of the collected parameters the time span between measures may be too short. Therefore, a 6 months, 1 year and 2 year follow-up will be performed for evaluating the different predictors and their influence in regard to a successful intervention. Further middle- and long-term follow-up studies are planned.Trial RegistrationThe study protocol was approved by the Ethics Committee of the University Hospital Tübingen, Germany. This study is registered at the German Clinical Trials Register (DRKS) with the clinical trial numberDRKS00005122.

Bacterial infections in childhood: A risk factor for gastrointestinal and other diseases?

Background There is evidence for post-infectious irritable bowel syndrome (PI-IBS) in adults, but little is known about PI-IBS in children. The nationwide representative German Health Interview and Examination Survey for Children and Adolescents (KiGGS) assessed children’s health. Objective and methods We identified 643 children (50.1% males) in the KiGGS cohort (N = 15,878, 51% males) with a history of Salmonella infection. The number was validated comparing this group with the known infection statistics from the Robert Koch-Institute registry. We compared this group to the remaining KiGGS cohort (n = 12,951) with respect to sociodemographic characteristics, pain and quality of life. To check for specificity, we repeated the comparisons with a group with a history of scarlet fever. Results Infection statistics predicted 504 cases of Salmonella infection in the KiGGS cohort, indicating high validity of the data. In children between 3 and 10 years with a history of Salmonella infection, significantly more abdominal pain (31.7% versus 21.9%, p < 0.001) and headache (27.2% versus 15.1%, p < 0.001) were reported. This group showed lower quality of life (p < 0.001). Comparison to a group of scarlet fever-infected children revealed poor specificity of the data. Conclusion Differences found between children with and without Salmonella infection reveal the role of gastrointestinal infection in the development of post-infectious abdominal problems, but poor specificity may point toward a psychosocial (“somatization”) rather than a Salmonella-specific mechanism.

Stress reactivity in childhood functional abdominal pain or irritable bowel syndrome

Frequent abdominal pain (AP) in childhood has been shown to be associated with elevated experience of stress and with deficits in stress coping, but psychophysiological stress reactivity has been studied rarely.

Nightmares and Associations with Sleep Quality and Self-Efficacy among University Students

Sleep problems are a common complaint among adults. In university students international studies showed prevalence rates between 4.7 and 36.2% for sleep difficulties and 2-3% of students report nightmares. Previous studies show that nightmares are often associated with insomnia and mental strain, but also with gender. The goal of this study was to outline nightmares, associations with sleep disturbances and mental strain as well as self-efficacy among university students. An amount of 2196 students (70.9% women; mean age 24.16 years) participated in the study. Sleep characteristics, nightmares, mental strain and self-efficacy were assessed by self-report questionnaires. Analyses revealed that more than 24.3% of surveyed students suffered from nightmares, 18.5% reported nightmares more often than once a week and 5.8% suffered from nightmares at least 3 times a week. Moreover, nightmares were associated with symptoms of insomnia and low self-efficacy was significantly associated with an increased rate of nightmares. Besides, a total of 52% of students reported fitful sleep.

Sleep and somatic complaints in university students

Background Sleep problems are common among university students. Poor sleep is associated with impaired daily functioning, increased risk of psychiatric symptoms, and somatic complaints such as pain. Previous results suggest that poor sleep exacerbates pain, which in turn negatively affects sleep. The purpose of the present study was to determine prevalence rates, comorbidity, and role of depression as a factor of moderating the relationship between sleep and physical complaints in German university students. Samples and methods In total, 2443 German university students (65% women) completed a web survey. Self-report measures included the Pittsburg Sleep Quality Index, three modules of the Patient Health Questionnaire, and a questionnaire on the functional somatic syndromes (FSSs). Results More than one-third (36.9%) reported poor sleep as assessed by the Pittsburgh Sleep Quality Index. Somatoform syndrome was identified in 23.5%, and the prevalence of any FSS was 12.8%. Self-reported sleep quality, sleep onset latency, sleep disturbances, use of sleep medications, and daytime dysfunctioning were significant predictors of somatoform syndrome, whereas sleep efficiency and sleep duration influenced somatic complaints indirectly. Moderate correlations were found between stress, anxiety, somatoform syndrome, depression, and overall sleep quality. The effect of somatic complaints on sleep quality was associated with the severity of depression. Anxiety shows direct effects on somatization and depression but only indirect associations with sleep quality.