Health-related quality of life and associated developmental domains of children provided early with cochlear implants.

OBJECTIVES: Quality of life plays an important place in the psychosocial development of children with Cochlear Implants (CI). We assesd health-related quality of life (HRQoL) in children with CI and in hearing children and determined relationships between HRQoL and other developmental characteristics (social-emotional development, Theory of Mind (ToM), spoken language skills). METHODS: A longitudinal study was conducted including children with CI and hearing children. We used instruments that are widely employed and have been validated for research. At time 1 social-emotional development, ToM and spoken language skills were assessed.HRQoL was assessed using the generic KINDL questionnaire, as was social-emotional development, 2.5 years later (time 2). RESULTS: No significant difference was seen in HRQoL between hearing children and children with CI. We show that the age of detection, the age of hearing care, and the start of early intervention are not related to HRQoL of children with CI, but relationships with some domains of social-emotional development are evident. CONCLUSIONS: This study highlights the importance of targeted intervention not only to improve spoken language skills at preschool age, but also strengthen social-emotional and social-cognitive competences.

[Needs of Children with Oncological Diseases: Psychometric Review of the Survey Instrument "KiWuF-PädOnk" and First Results]. / Bedürfnisse onkologisch erkrankter Kinder: Psychometrische Überprüfung des Erhebungsinstruments "KiWuF-PädOnk" und erste Ergebnisse.

In der vorliegenden Querschnittstudie wurde ein neu konzipierter Bedürfnisfragebogen für 8- bis 13-jährige Krebspatienten psychometrisch überprüft (N=117). Auf der Grundlage einer explorativen Faktorenanalyse wurden 4 Skalen mit insgesamt 19 Items gebildet. Die interne Konsistenz des Fragebogens ist zufriedenstellend. Die Teilnehmenden äußerten ein starkes Bedürfnis nach sozialer Teilhabe, Sicherheit und Kontrollerleben sowie nach Normalität. Der KiWuF-PädOnk liefert Informationen zu Bedürfnissen aus Patientensicht und fördert somit eine individuumszentrierte psychosoziale Versorgung. In the present cross-sectional study, a newly designed needs questionnaire for 8- to 13-year-old cancer patients was psychometrically tested (N=117). Based on an exploratory factor analysis, 4 scales with a total of 19 items were formed. The internal consistency of the questionnaire is satisfactory. Participants expressed a strong need for social participation, safety and experience of control, and normality. The KiWuF-PädOnk provides information on needs from the patient's perspective and thus promotes individual-centered psychosocial care.

Mental health problems in adolescents with cochlear implants: peer problems persist after controlling for additional handicaps.

The aims of the present multi-center study were to investigate the extent of mental health problems in adolescents with a hearing loss and cochlear implants (CIs) in comparison to normal hearing (NH) peers and to investigate possible relations between the extent of mental health problems of young CI users and hearing variables, such as age at implantation, or functional gain of CI. The survey included 140 adolescents with CI (mean age = 14.7, SD = 1.5 years) and 140 NH adolescents (mean age = 14.8, SD = 1.4 years), their parents and teachers. Participants were matched by age, gender and social background. Within the CI group, 35 adolescents were identified as "risk cases" due to possible and manifest additional handicaps, and 11 adolescents were non-classifiable. Mental health problems were assessed with the Strengths and Difficulties Questionnaire (SDQ) in the versions "Self," "Parent," and "Teacher." The CI group showed significantly more "Peer Problems" than the NH group. When the CI group was split into a "risk-group" (35 "risk cases" and 11 non-classifiable persons) and a "non-risk group" (n = 94), increased peer problems were perceived in both CI subgroups by adolescents themselves. However, no further differences between the CI non-risk group and the NH group were observed in any rater. The CI risk-group showed significantly more hyperactivity compared to the NH group and more hyperactivity and conduct problems compared to the CI non-risk group. Cluster analyses confirmed that there were significantly more adolescents with high problems in the CI risk-group compared to the CI non-risk group and the NH group. Adolescents with CI, who were able to understand speech in noise had significantly less difficulties compared to constricted CI users. Parents, teachers, and clinicians should be aware that CI users with additionally special needs may have mental health problems. However, peer problems were also experienced by CI adolescents without additional handicaps.

The integration experience of hearing impaired elementary school students in separated and integrated school settings.

Integration experiences of hearing impaired German elementary school students in separate educational settings (n = 31) were compared with those of counterparts at the same level in integrated settings (n = 26), and evaluated in regard to psychosocial behavior, semantic-lexical abilities, and communicative skills. Analysis of questionnaire responses and intelligence subtests showed that the only difference between the samples concerned perceived well-being in school, and favored the integrated students. Other percentages of variance are explainable by school type (10%), parents' hearing status (12%), and use of bimodal communication (11%). The integrated students demonstrated a higher level of integration experience, associated with fewer psychosocial abnormalities and better communicative skills. The results indicate that educational setting is not the only factor influencing students' perceived well-being. Other contextual factors, e.g., hearing status of parents and communicative skills, have a similar positive impact on integration experiences

Psychic stress and quality of life in parents during decisive phases in the therapy of their hearing-impaired children.

OBJECTIVE: This study was performed to analyze psychic stress and quality of life in the parents of children with hearing impairment in the course of various phases of treatment. DESIGN: At three measuring points over a course of 12 months, the degree of parental stress and the quality of life was surveyed prospectively. In addition, the children's hearing and speech status was surveyed. Parents whose children were treated with hearing aids or cochlear implants were the target of this survey. At the outset of the study, data of 123 parents were available. The average age of the children was 38 months. RESULTS: It was not possible to demonstrate generally heightened psychic stress in any phase of treatment. Differentiation into subgroups must be performed, as parental stress depends on possible changes of treatment and the child's speech status. Initially, quality of life was clearly reduced but gradually became statistically insignificant. CONCLUSIONS: The results point out the necessity of supporting the parents with counseling and psychosocial support, especially in the initial fitting phase and in the various decision and orientation phases.

Parental distress: the initial phase of hearing aid and cochlear implant fitting.

The results of previous cross-section studies suggest that childhood hearing impairment may lead to parental psychosocial stress. The present study investigated whether modifications in parental psychic state can be ascertained in connection with the child's treatment events and the child's hearing and speech status, in a prospective study design. Data were available on 116 fathers and mothers regarding the pre-cochlear implant examination or hearing aid fitting of their child. In the course of the child's treatment, parental quality of life improved from a low to a normal level. Among children who were at the stage of pre-examination for a cochlear implant, better hearing and speech capacity was linked to more severe impairment of the parental state. It is emphasized that the parents whose children showed comparatively good language development at the time of pre-examination for a cochlear implant were especially subjected to stress.

The psychosocial evaluation of medically-ill inpatients - accordance between mental disorders and self-rated psychosocial distress.

BACKGROUND: Both psychometric questionnaires and structured psychodiagnostic interviews are used to identify medically-ill inpatients requiring psychotherapeutic treatment. The study examines the accordance between the diagnosis of a mental disorder (ICD-10) and self-rated psychosocial distress of unselected inpatients within the framework of a psychosomatic liaison service. METHODS: Of n=532 consecutive patients hospitalized in five departments of the University Hospital Freiburg, n=357 patients underwent a structured psychodiagnostic interview (Mini-DIPS) to obtain diagnoses according to ICD-10 F. Psychosocial distress (HADS), somatoform symptoms (SOMS-2 J), quality of life (EDLQ) and coping strategies (FQCI) were evaluated by self-rating questionnaires. RESULTS: A mental disorder requiring treatment was diagnosed in 44% of the patients. Predictors for the diagnosis of a mental disorder were the depression subscale of the HADS, the frequency of somatoform symptoms and depressive coping. The greatest accordance between mental disorders and screening instruments was found for the depression subscale of the HADS at a cut-off 8+. The area under the curve (AUC) was 0.75. With a specificity of 87% and a sensitivity of 53%, nearly half of all mental disorders requiring treatment were not identified by the HADS, especially in patients with neurotic, stress-related and somatoform disorders (F4), most of them cancer patients with adjustment disorders. CONCLUSIONS: Case selection by the HADS is successfull in disorders, where depressive symptoms are prevalent. For F4-diagnoses a lower cut-off of 6+ is recommended. The importance of a clinical interview is underlined. Other screening procedures, specific for the general hospital population, are discussed.

[Operationalized psychodynamic diagnostics (OPD) in patients with central serous chorioretinopathy]. / Operationalisierte psychodynamische Diagnostik (OPD) bei Patienten mit Chorioretinopathia centralis serosa.

Central Serous Chorioretinopathy (CSC) is a degenerative retinal disease still considered within ophthalmology as being of psychosomatic origin. Psychotherapeutic treatment of CSC patients has been demanded by several authors who, however, have failed to investigate the relevant preconditions. The present study examined subjective illness experience, treatment preconditions, and psychodynamic conflicts in 31 patients with CSC by means of axes I and III of the Operationalized Psychodynamic Diagnostics (OPD). Illness experience, psychological symptoms, capacity for insight into psychodynamic contexts and motivation towards psychotherapy were but slight. The conflicts of one half of the patients was evaluated as important. Predominant conflicts were dependency vs. autonomy, submission vs. control, providing vs. autarchy and self-esteem conflicts. All in all, the patients examined were more or less clinically inconspicuous, giving rather few reasons for psychotherapy. In order to control the results, further studies with higher case numbers are required.

Quality of life and psychological distress in parents of children with a cochlear implant.

OBJECTIVE: The goal of the study was to ascertain psychological distress and quality of life in the parents of children with a cochlear implant, and to test whether a poorer speech status of those children correlates directly with heightened parental psychological distress and reduction of quality of life. METHODS: In a cross-sectional study design, 52 mothers and 42 fathers of 55 children with cochlear implants completed the Symptom Checklist 90-R and the Everyday Life Questionnaire. The speech status of the children was ascertained by means of the scales of Geers and Moog. RESULTS: Twenty-one per cent of the parents showed heightened psychological distress. The parents' mean quality of life was reduced, lying between that of somatically ill patients and healthy persons. No statistically positive correlation was shown between the speech status of the children with cochlear implants and the parents' condition.

A comparison between parents of children with cochlear implants and parents of children with hearing aids regarding parental distress and treatment expectations.

OBJECTIVE: The aim of the present study was to compare the parents of children with a hearing aid (HA) and children with a cochlear implant (CI) regarding their psychological distress, their expectations from treatment, their family climate, and the way they first obtained information on HA/CI. METHODS: 154 parents (return quota 41%; 81 mothers and 73 fathers) of 90 children with a HA and 103 parents (return quota 59%; 57 mothers and 46 fathers) of 57 children with a CI were interviewed by means of a questionnaire. RESULTS: Both groups of parents felt distressed, particularly at the time of diagnosis. Their psychological well-being was gradually stabilized in the further course of rehabilitation. Due to the operation associated with it, fitting with a CI brought on a phase of heightened parental psychological distress compared with less invasive treatment with a HA. Regarding family climate, more distress was found in parents of CI children than in parents of HA children. Expectations from therapy appeared realistic in both parental groups; however, after CI fitting, the parents of the CI children showed heightened expectations by comparison with the parents of the HA children. CONCLUSIONS: The results of our study suggest that the parents of hearing impaired children fitted with a HA or a CI may be divided into two subgroups with divergent psychosocial parameters. For the counseling of the parents of hearing impaired children in clinical practice, it would seem important to take these specific differences into consideration.

Treatment selection in private practice psychodynamic psychotherapy: a naturalistic prospective longditudinal study.

In this naturalistic prospective longitudinal study, the authors evaluated the treatment selection decisions of 24 psychotherapists in private practice over a 12-month period. A comparison of the treatment selection criteria for patients who were accepted for treatment and for those who were not yielded 3 results: (a) Motivation was the outstanding factor determining whether a patient was accepted for treatment; (b) selection of short-term or long-term psychotherapy depended on the therapists' emotional response to the patient; and (c) psychiatric diagnosis and symptom severity contributed relatively little to treatment selection. These findings suggest that treatment selection in private practice psychodynamic psychotherapy is based on specific aspects of the therapist-patient relationship rather than on patient characteristics related to symptom severity or psychiatric diagnosis.

Psychosomatic liaison service in medicine - need for psychotherapeutic interventions and their realisation.

QUESTIONS UNDER STUDY: The aim of the study was to evaluate the need for psychotherapeutic interventions and their realisation within the framework of the psychosomatic liaison service. Apart from establishing the diagnosis of psychosocial distress and mental disorders, we assessed the motivation of the patients for psychotherapy. METHODS: 62 consecutive patients admitted to the Department of Medicine (Gastroenterology and Hepatology) Freiburg University Hospital, Freiburg, Germany, underwent standardised psychodiagnostic interviews and completed psychometric self-rating tests to identify mental disorders, psychosocial distress, and motivation for psychotherapy. In addition, the patients' need for psychotherapeutic treatment was rated by the liaison therapist. RESULTS: Using ICD 10-criteria, mental disorders were diagnosed in two thirds of the patients; most frequent were adjustment disorders, affective disorders, and disorders resulting from alcohol use. One third of the patients reported signs of psychological distress; half of them were interested in psychotherapy. A need for psychotherapeutic interventions, based on motivation of the patients and on expert estimate, was found in approximately one third of the patients. 36% received actual psychotherapy. CONCLUSIONS: Our study suggests that - in the patient population studied - the patients' motivation ought to be taken into consideration more strongly when evaluating the need for psychotherapy in clinical practice and further research.

Prediction of aqueous solubility of drugs and pesticides with COSMO-RS.

The COSMO-RS method, originally developed for the prediction of liquid-liquid and liquid-vapor equilibrium constants based on quantum chemical calculations, has been extended to solid compounds by addition of a heuristic expression for the Gibbs free energy of fusion. By this addition, COSMO-RS is now capable of a priori prediction of aqueous solubilities of a wide range of typical neutral drug and pesticide compounds. Only three parameters in the heuristic expression have been fitted on a data set of 150 drug-like compounds. On these data an rms deviation of 0.66 log-units was achieved. Later, the model was tested on a set of 107 pesticides, which have been critically selected based on two experimental data sources and by a crosscheck with an independent HQSAR model. On this data set an rms of 0.61 log-units was achieved, without any adjustments to the structurally extremely diverse pesticides. This result verifies the ability of this extended COSMO-RS to predict aqueous solubilities of drugs and pesticides of almost arbitrary structural classes. The new method is COSMO-RSol.