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Background: Students often show unfavourable attribution: they attribute poor school performance to stable factors such as lack of ability and good school performance to variable factors such as effort. However, attribution can be influenced by individualized digital re‐attributional feedback leading to positive motivational effects and higher learning outcomes. This is very promising, but it still is unclear, whether this digital re‐attributional feedback can also be successfully integrated in everyday classroom activities. Objectives: The present field experiment investigated how integrating digital re‐attributional feedback into classroom instruction affects student attribution, motivation and learning outcomes. Methods: In the experiment, 8th–10th grade high school students (N = 322) worked with a digital mathematics learning program which was integrated in a three‐week teaching unit. Half the students in each classroom received only standard feedback after each practice task (SF group); the other half received additionally an individual re‐attributional feedback (RF group) after every third task. Attribution, mathematics self‐concept, and self‐efficacy were measured by an online questionnaire twice a week; learning outcomes in mathematics were measured weekly. Results and Conclusion: Hierarchical analyses showed that re‐attributional feedback led to a more favourable attribution in case of success on stable factors. Especially low‐performing students benefited from this feedback. No effects on attribution in case of failure, self‐efficacy or learning outcomes could be found. Further research could investigate if certain adaptations to the digital re‐attributional feedback is more effective in a real classroom setting and has a broader impact on different students. Lay Description: What is already known about this topic: Working with computers in the classroom and at home is becoming more common.Re‐attributional feedback can increase student's motivation when given directly after solving a task and at a high density.Digital re‐attributive feedback can be given in a high density.Re‐attributional training sessions have been shown to be effective in individual training sessions or outside the students' classroom. What this paper adds: The study took place within a real teaching environment during mathematics class for 4 weeks.Digital re‐attributional feedback sessions were directly integrated into the students' online learning which was part of the teaching plan. The implications of study findings for practitioners: Computer‐based re‐attributional training show some limited effects in regular classroom instruction and could be well integrated in student online learning—when adapted accordingly.Low‐performing students show less favourable attribution than better‐performing students in case of success and benefit the most from re‐attributional training. [ABSTRACT FROM AUTHOR]

To investigate determinants of willingness to adopt telerehabilitation, willingness of technology use, core affect regarding using telerehabilitation, and digital competencies in rehabilitation professionals in Austria and Germany before and during the COVID-19 pandemic. A cross-sectional paper-based and online survey was conducted before and during COVID-19, respectively, with three cohorts of rehabilitation professionals. Outcomes were the willingness to adopt telerehabilitation evaluated using the extended Unified Theory of Acceptance and Use of Technology; willingness of technology use using the short scale for assessing the willingness of technology use; digital competencies and core affect using the Digital Competence Framework and semantic differential, respectively. Multivariate ordinal regression analysis was performed to determine predictors. Included were 603 rehabilitation professionals. Analysis revealed differences between Austria and Germany and before and during the pandemic for most outcomes. German residency, the pandemic, and a higher educational level were most important predictors of higher willingness to adopt telerehabilitation, willingness of technology use, digital competencies, and positive core affect. The pandemic increased most aspects of willingness to adopt telerehabilitation, willingness of technology use, digital competencies, and positive core affect. Results confirm that rehabilitation professionals with higher degrees are more prone to adopt innovations in healthcare.Registration: German Clinical Trials Register (DRKS00021464) The willingness to adopt telerehabilitation is associated with external factors increasing the need for alternative rehabilitation delivery, such as COVID-19, and with financial facilitators, such as reimbursement. As the willingness to adopt telerehabilitation is higher among speech and language therapists and dietitians, efforts are necessary to enhance its use in physiotherapists and occupational therapists. As a higher willingness to adopt telerehabilitation was observed in younger rehabilitation professionals and those with higher education, increasing the importance of telerehabilitation in education curricula and further knowledge transfer into practice for those already working in the field seems necessary. [ABSTRACT FROM AUTHOR]

Background: Reading comprehension is frequently impaired in persons with aphasia (PWA). For goal‐setting and outcome measurement, speech and language therapists (SLTs) need to determine an individual's perspective of their reading difficulties and everyday reading activities. The Comprehensive Assessment of Reading in Aphasia (CARA) reading questionnaire provides a person‐centred tool to find out the individual perception of reading functions, reading‐related emotions and reading activities in PWA. It was developed and evaluated in English. So far, there is no equivalent instrument in German. Aims: To translate and adapt the CARA reading questionnaire into German language and culture, to evaluate its practicability and acceptance, and to provide the first psychometric properties of the German version. Methods & Procedures: Based on translation and adaptation guidelines, we conducted two forward translations that were merged and then adapted. A back translation was prepared and compared with the original version. It was found to be semantically equivalent by one of the authors of the original version. We performed pilot testing with 12 PWA, and the pilot version was adapted according to the comments of these participants. We then collected data on self‐reported perception of reading and on psychometric properties of the translated and adapted German version. A total of 22 German‐speaking PWA completed the questionnaire at least five times during an intervention study. We analysed retest reliability with Spearman correlation, internal consistency with Cronbach's alpha, internal responsiveness with the standardized response mean, as well as the relationship between outcomes of the questionnaire and text comprehension measures using repeated measures correlations. Outcomes & Results: Our data suggest good practicability and acceptance of the German version of the CARA reading questionnaire as well as appropriate validity, reliability and sensitivity to measure therapy‐induced change. We found moderate correlations between outcomes of the questionnaire and text‐level reading speed. Conclusions & Implications: The German version of the CARA reading questionnaire could be helpful in intervention planning and goal‐setting with German‐speaking PWA. By using the questionnaire, SLTs can find out about a person's individual perception of reading difficulties as well as individually relevant reading activities. The questionnaire provides a tool to measure change and is therefore valuable to demonstrate self‐reported individual progress. As reading speed seems to be an indicator of personal perception of reading difficulty, it is important to consider reading speed in reading interventions and in reading comprehension assessments. WHAT THIS PAPER ADDS: What is already known on the subject: Reading comprehension is frequently impaired in PWA. Reading preferences, the perception of difficulties and the impact on everyday life reading activities are specific to the individual and thus need to be known for goal‐setting, intervention planning and monitoring of change. As part of a comprehensive assessment of reading, Morris et al. developed a person‐centred English language questionnaire for this purpose. So far, there is no equivalent tool in German. What this paper adds to the existing knowledge: In this study, we translated and adapted the questionnaire to German language and culture, and analysed its validity and reliability with German‐speaking PWA. We demonstrated that the German version is accessible for German‐speaking PWA, and that it has appropriate validity, reliability and sensitivity to measure self‐reported change. Outcomes of the questionnaire correlate with text level reading speed. What are the potential or actual clinical implications of this work?: The German version of the questionnaire could be a valuable self‐reported outcome measure to assess individual perceptions of reading and to measure progress (as perceived by an individual) as a consequence of recovery or intervention in either clinical or research settings. As reading speed might be an indicator of everyday life reading as perceived by an individual, it should be considered in reading assessments and interventions. [ABSTRACT FROM AUTHOR]

This paper addresses the challenges and solutions in developing a holistic prevention mobile health application (mHealth app) for Germany's healthcare sector. Despite Germany's lag in healthcare digitalization, the app aims to enhance primary prevention in physical activity, nutrition, and stress management. A significant focus is on user participation and usability to counter the prevalent issue of user attrition in mHealth applications, as described by Eysenbach's 'law of attrition'. The development process, conducted in a scientific and university context, faces constraints like limited budgets and external service providers. The study firstly presents the structure and functionality of the app for people with statutory health insurance in Germany and secondly the implementation of user participation through a usability study. User participation is executed via usability tests, particularly the think-aloud method, where users verbalize their thoughts while using the app. This approach has proven effective in identifying and resolving usability issues, although some user feedback could not be implemented due to cost-benefit considerations. The implementation of this study into the development process was able to show that user participation, facilitated by methods like think-aloud, is vital for developing mHealth apps. Especially in health prevention, where long-term engagement is a challenge. The findings highlight the importance of allocating time and resources for user participation in the development of mHealth applications. [ABSTRACT FROM AUTHOR]

Introduction: Various developments result in increasing workloads in general practices. New models of care and a restructuring of the division of tasks could provide relief. One approach is to extend the delegation of medical tasks from general practitioners (GPs) to medical practice assistants (MPAs). So far, there has been a lack of information about specific situations in which patients are willing to be treated exclusively by MPAs. Methods: In three German federal states, patients who visited a general practice were surveyed exploratively and cross-sectionally with a self-designed, paper-based questionnaire. The data were analysed descriptively and multivariate. A mixed binary logistic regression model was calculated to account for cluster effects at practice level (random intercept model). The dependent variable was patients' acceptance of task delegation. Results: A total of 1861 questionnaires from 61 general practices were included in the analysis. Regarding the current problem/request, a total of 30% of respondents could imagine being treated only by MPAs. Regarding theoretical reasons for consultation, more than half of the patients agreed to be treated by MPAs. According to the regression model, MPAs were preferred when patients were younger (10-year OR = 0.84, 95%-CI [0.75, 0.93]) or had a less complicated issue (OR = 0.44, 95%-CI [0.26, 0.8]). For four current problems/requests ("acute complaints" OR = 0.27, 95%-CI [0.17, 0.45], "routine health check" OR = 0.48, 95%-CI [0.3, 0.79], "new problem" OR = 0.13, 95%-CI [0.06, 0.28], "known problem" OR = 0.16, 95%-CI [0.1, 0.27]) patients prefer to be treated by GPs instead of MPAs. Discussion: For the first time, statements could be made on patients' acceptance of task delegation in relation to current and theoretical reasons for treatment in general practices in Germany. The discrepancy in response behaviour on a theoretical and individual level could be explained by different contexts of questions and differences at practice level. Overall, patients seem to be open to increased delegation of medical tasks, depending on the reason for treatment. Selection and response biases should be considered in the interpretation. Conclusion: The results are not completely opposed to an extension of task delegation. Further interventional studies could provide information on the possible effects of expansion of delegable tasks. [ABSTRACT FROM AUTHOR]

Background: Incontinence is a common disorder among older adults with a higher prevalence in nursing home settings than in community dwellings. There is a wide variety of absorbent continence products on the market used to manage continence. Aim: The study aimed to investigate the experience of caregivers of residents with incontinence in care home settings using the new MoliCare Premium Form design and to compare some of the product features with the previous design. Method: A questionnaire focusing on the key performance characteristics of the product was developed and administered to 74 nurses in Germany to obtain their opinions on the use of MoliCare Premium Form products. Findings: More than 90% of respondents rated each key performance aspect of the new product design as 'good' and 'OK'. More than 60% of the caregivers found the new product design to be better performing and 93% preferred the new design to the previous version. Conclusion: The newly redesigned continence pad performed very well on each of the individual performance features, indicating the high quality and optimised design of the product. The new design was found to be suitable and effective for individuals with incontinence. [ABSTRACT FROM AUTHOR]

To investigate effects of diaper-free times, elimination communication (EC) and early toilet training, a web-based survey was conducted for caregivers. The more diaper-free times an infant experienced during day, the earlier it was toilet trained (P <.001), which was enhanced by the usage of cloth diapers. The amount of diaper-free times significantly reduced the caregiver's continuous sleep, the occurrence of rashes and balm usage (P <.001) and lead to a more regular defecation frequency. Cloth diaper usage had no effect on rashes or balm usage, but on diaper change rate (P <.001). We could show that, although not as effective as full-time EC, part-time EC is more effective if cloth diapers are used, provided they are changed frequently. Furthermore, EC causes a more regular defecation in infants between 1 and 2 years. [ABSTRACT FROM AUTHOR]

Background: Conspiracy beliefs have become widespread throughout the COVID-19 pandemic. Previous studies have shown that endorsing conspiracy beliefs leads to lower protective guideline adherence (i.e., wearing face masks), posing a threat to public health measures. The current study expands this research across the lifespan, i.e., in a sample of adolescents with mental health problems. Here, we investigated the association between conspiracy beliefs and guideline adherence while also exploring the predictors of conspiracy beliefs. Methods: N = 93 adolescent psychiatric outpatients (57% female, mean age: 15.8) were assessed using anonymous paper–pencil questionnaires. Endorsement of generic and COVID-19 conspiracy beliefs was assessed, in addition to items measuring adherence to protective guidelines and mental health (stress, depressive symptoms, emotional/behavioral problems, and adverse childhood experiences). Multiple regressions and supervised machine learning (conditional random forests) were used for analyses. Results: Fourteen percent of our sample fully endorsed at least one COVID-19 conspiracy theory, while protective guidelines adherence was relatively high (M = 4.92, on a scale from 1 to 7). The endorsement of COVID-19 conspiracy beliefs—but not of generic conspiracy beliefs—was associated with lower guideline adherence (β = − 0.32, 95% CI − 0.53 to − 0.11, p <.001). Conditional random forests suggested that adverse childhood experiences and peer and conduct problems were relevant predictors of both conspiracy belief categories. Conclusion: While a significant proportion of our sample of adolescents in psychiatric treatment endorsed conspiracy beliefs, the majority did not. Furthermore, and to some degree, contrary to public perception, we found that adolescents show relatively good adherence to public health measures—even while experiencing a high degree of mental distress. The predictive value of adverse childhood experiences and peer/conduct problems for conspiracy beliefs might be explained by compensatory mechanisms to ensure the safety, structure, and inclusion that conspiracies provide. [ABSTRACT FROM AUTHOR]

Background This paper explores the role of providing structure for students within a new blended-learning family medicine curriculum at Saarland University. This study intends to clarify the role of different structural elements for different learning approaches (deep vs. structured vs. surface learning). Methods This study is based on a mixed-methods approach. Fifth year medical students' (n = 84) learning approaches, measured by a shortened version of the ASSIST questionnaire, were correlated with students' academic performance in state exams and the family medicine exam. Based on learning approaches and age, participants were purposefully sampled into two semi-structured group interviews with seven participants each. Results Although surface approach learning weakly correlated with lower performance in the first state exam (rho = 0.231), surface approach learning did not correlate with lower performance in the family medicine assessment. Based on qualitative results, the structural design of the curriculum seemed to have a high impact on students' satisfaction and motivation to learn. The reduction of extraneous cognitive load was identified as effective in motivating students to study. Deep-learning students highlighted the positive effects of curriculum activities that foster germane cognitive load through schema- based learning. Conclusions Especially for surface approach learners it may be important to provide structured guidance and provide a clear alignment of course content in a blended-learning curriculum, even in higher education. Deep and structured approach learners also benefit from a clear course structure that keeps extraneous cognitive load low and fosters schema acquisition. [ABSTRACT FROM AUTHOR]

The impact of algorithms on everyday life is ever increasing. Medicine and public health are not excluded from this development – algorithms in medicine do not only challenge, change and inform research (methods) but also clinical situations. Given this development, questions arise concerning the competency level of prospective physicians, thus medical students, on algorithm related topics. This paper, based on a master's thesis in library and information science written at Humboldt‐Universität zu Berlin, gives an insight into this topic by presenting and analysing the results of a knowledge test conducted among medical students in Germany. F. J. [ABSTRACT FROM AUTHOR]

Accessible summary: What is known on the subject?: Coercive interventions (CI) in emergency psychiatry face increasing criticism, as they can be an emotional, even traumatic event for all persons involved. They are thus considered the last resort.The use of coercive interventions differs widely with regard to type and frequency of measures across different countries and institutions.Individual staff characteristics, such as attitudes towards coercion, may play a vital role in the management of aggression.Little is known about the influence of emotions of staff members on CI, but they are likely to play an important role. What the paper adds to existing knowledge?: Most staff members surveyed had a rather critical view of coercion and considered it a "necessary evil."Staff members with the most work experience had a more critical view of coercion in comparison with less experienced staff. Nurses rated coercion more positively than did psychiatrists or psychologists.Emotions play an important role in decision‐making processes. The current study systematically asked for accompanying emotions during the application of CI and looked for individual differences. A majority of the participants experienced compassion; about half felt helplessness, grief or anxiety. Almost 20% stated that they felt a sense of power. Older staff members more often felt anger or guilt; women felt less power than men did. Nurses felt more desperation than other occupational groups.Staff members consider reflective interventions, such as team supervisions or post‐seclusion/restraint debriefings with the patient, as important. Nevertheless, only half reported that these interventions are carried out routinely.Staff members believe that certain risk factors (including stress, low staffing, a fully occupied ward and the presence of particular staff members) enhance the probability of CI. What are the implications for practice?: To reduce the use of coercive interventions, we recommend that psychiatric teams include highly experienced staff members as work experience has a positive effect on the attitudes towards coercive interventions.Structured post‐seclusion/restraint debriefings and team supervisions are considered helpful by staff members and are relatively easy to implement on acute wards. Enhancing staff members' ability to reflect on their own attitudes, emotions and actions is likely to reduce coercive interventions. Introduction: Little is known about staff attitudes towards coercive interventions (CI) and emotions accompanying these measures. Aim: The current study assessed attitudes, views on reflective interventions and accompanying emotions of different occupational groups towards CI, as well as factors, that increase the probability of CI. Method: Staff members (N = 138) of a large psychiatric hospital in Germany were assessed using the Staff Attitude to Coercion Scale (SACS) and newly developed items assessing staff members' emotions and views on coercion. Results: Experienced staff members were most critical of coercion. Nurses rated coercion significantly more positively than other staff. A majority experienced compassion; about half felt helplessness, grief or anxiety. Almost 20% felt a sense of power. Nurses felt the most desperation. Participants strongly desired reflective measures such as post‐seclusion/restraint debriefings with patients. According to staff members, stress on the wards and low staffing increases the probability of CI. Discussion: The study assessed accompanying emotions during the application of CI. Attitudes towards coercion and emotions are associated with individual staff characteristics (e.g. profession, work experience). Implications: The presence of experienced staff members may help prevent CI. Staff consider reflective interventions helpful in reducing CI. [ABSTRACT FROM AUTHOR]

Nutritional supplements (NS) are denned as concentrated sources of nutrients and other substances that have a nutritional or physiological effect and that are used in high frequency among athletes. The study aimed to create a prediction profile for young elite athletes to identify those athletes who have a higher relative risk for using NS. The second objective was to examine the hypothesis that the consumption of NS paves a gateway for the use of illicit drugs and doping substances. A self-designed anonymous paper-and-pencil questionnaire was used to examine the prevalence of NS consumption, doping, and illicit drug use in elite athletes with a mean age of 17 years (SD = 4 years). Logistic regression analysis was employed to assess whether NS consumption can be predicted by independent variables (e.g., biographical data, training characteristics, drug consumption behavior) to create the prediction profile for NS use. 55% and 5% of the athletes (n = 536) responded positively to having used NS and illicit drugs, respectively. Nutritional supplement consumption was positively correlated with age (OR: 1.92; CI: 1.21 to 3.05), the desire to enhance performance to become an Olympic or World Champion (OR: 3.72; CI: 2.33 to 6.01), and being educated about NS (OR: 2.76; CI: 1.73 to 4.45). It was negatively correlated with training frequency (OR: 0.55; CI: 0.35 to 0.86) and the use of nicotine (OR: 0.29; CI: 0.1 to 0.74) but did not correlate with illicit drug use and alcohol consumption. The present results show that NS are used on a large scale in elite sports. The prediction profile presented in this article may help to identify those athletes who have a high risk for using NS to plan potential education and prevention models more individually. [ABSTRACT FROM AUTHOR]

Over the last decades, ovarian cancer mortality in Europe has been decreasing, but disparities in trends were observed. In this paper, we analysed ovarian cancer mortality trends in Europe over the period 1990–2020 and predicted the number of deaths and rates by 2025. We extracted population and death certification data from ovarian cancer in women for 31 European countries, between 1990 and 2020 from the World Health Organization database. We computed age-standardised mortality rates (ASMR) per 100,000 women-years, based on the world standard population. We also obtained predictions for 2025 using a joinpoint regression model and calculated the number of avoided deaths over the period 1994–2025. Over the observed period, mortality from ovarian cancer showed a favourable pattern in most countries. In the EU-27, rates declined by 5.9% from 2010–2014 to 2015–2019, reaching an ASMR of 4.66/100,000. During the same period, the decline in ovarian cancer mortality was more pronounced in the EU-14 countries (−7.0%) compared to Transitional countries (−2.1%). Declines were also observed in the United Kingdom, to reach an ASMR of 5.29. Decreases in mortality from ovarian cancer are predicted until 2025, to 4.17/100,000 for the EU-27. Favourable trends in ovarian cancer mortality are expected to persist in Europe and can be mainly attributed to the increased use of oral contraceptives in subsequent generations of European women. Decreased use of menopausal Hormone Replacement Therapy and improved diagnosis and management may also have played a role. • Ovarian cancer mortality decreased over the last decade in most European countries. • Favourable trends will continue in the next 5 years. • Less favourable epidemiological situation was observed in Transitional countries. • The largest decrease of mortality in 2025 is predicted to be in Germany. • Until 2025 nearly 131,000 deaths from ovarian cancer would be avoided in EU. [ABSTRACT FROM AUTHOR]

Background: Scientific results as presented at conferences need to be published in journals so that the scientific community can become aware of the results. The aim of our study was to analyze the peer-review publication rate of abstracts presented at two German Cancer Congresses, based on various factors. Methods: We investigated 1,086 abstracts published by the German Cancer Congress in 2000 and 2010 in relation to the publication in peer-reviewed journals (PubMed publication) within the subsequent 6 years. Furthermore, we studied potential determinants of PubMed publications. For statistical analysis we used Kaplan-Meier estimates and Cox regression (hazard ratios, HR, and 95% confidence intervals). Results: Overall 456 abstracts (42%) were published as PubMed publications, 86 (8%) before the congresses and 370 (34%) after the congresses. The median time to PubMed publication was 16.2 months among 370 post-published abstracts. Abstracts presented as oral presentations had a shorter time to PubMed publication than abstracts presented as posters (14.2 months vs. 16.8 months respectively). In comparison to cell experiments, randomized controlled trials and animal experiments had a higher PubMed publication rate (HR=2.2, 95%CI 1.4--3.4 and HR=2.6, 95%CI 1.6--4.4 respectively). In comparison to abstracts including work in progress, abstracts that included finalized study results had a higher publication rate (HR=1.6, 95%CI 1.2--2.3). Discussion: Our study is the largest study of oncology congresses examining the publication rates and associated determinants. The publication rate was similar to other congresses. There is a considerable potential of publication bias as 58% of congress abstracts were not followed by a peer-reviewed full paper publication within 6 years. [ABSTRACT FROM AUTHOR]

This paper primarily examines the perspectives of dying persons in Germany, in terms of if and when the dying feels lonely during their final weeks. The author contrasts emic perceptions with public discourses in regards to the non-dying ones possibly neglecting or tabooing the terminally ill. Secondly, the paper explores how and where the dying persons included in the study want to pass away. The dying individuals involved did not feel tabooed or ignored by non-dying persons. Dying at home did not necessarily remain the preferred option compared to dying at institutions. The author collected data between 2013 and 2015 in Western Germany, using long-term participant observation and interviews with individuals diagnosed as terminally ill. [ABSTRACT FROM AUTHOR]

Aim: Health care–associated infections along with antibiotic resistance are a leading risk for patient safety in intensive care units. Hygienic hand disinfection is still regarded as the most effective, simplest, and most cost‐effective measure to reduce health care–associated infections. To improve hand hygiene compliance and to prevent health care–associated infections, interventions of the "German Clean Hands Campaign" were implemented in a university hospital. Methods: Observational single‐center study using direct observation and feedback. Hand hygiene performance was assessed in 12 intensive care units between 2013 and 2017. Linear mixed model regression analyses were used to estimate the compliance trend over time. Results: In total, 10 315 "my five moments for hand hygiene" were observed. The mean hand hygiene compliance rates increased from 75.1% to 88.6% during the study period, yielding an estimated increase of about 4.5% per year. However, there are differences in compliance between occupational groups (physicians: between 61.2% and 77.1%; nurses: between 80.2% and 90.9%; others: between 61.3% and 82.4%). Conclusions: After implementation of the "German Clean Hands Campaign" interventions, an overall significant improvement of hand hygiene was detected. Compliance measurements helped to raise awareness among health care professional groups. SUMMARY STATEMENT: What is already known about this topic? A significantly higher prevalence of infections has been observed in intensive care unit patients compared with patients in other wards.Hygienic hand disinfection is still regarded as the most effective, simplest, and most cost‐effective measure to reduce health care–associated infections.Low hand hygiene rates in intensive care units are a major problem for patient safety. What is already known about this topic? Implementation of the "German Clean Hands Campaign" showed continuous improvement in hand hygiene for all health care professionals in intensive care units over a period of 5 years.There are differences in compliance rates between health care profession and intensive care unit types.Pediatric intensive care units had the highest hand hygiene compliance rates. The implications of this paper: Overall, hand hygiene compliance in intensive care units increased over a period of 5 years after continuous campaigning, training, observation, compliance measurements, and direct feedback.It is necessary to raise awareness for hand hygiene in a repetitive manner within all health care professional groups now and in the future.Because of the differences in compliance rates between health care professionals, more tailored and evidence‐based interventions should be implemented. [ABSTRACT FROM AUTHOR]

Our aim was to provide data regarding uptake of gynecological early detection measures and performance of breast self-examinations among migrant women in Germany. Cross-sectional self-reported data were collected using paper-and-pencil questionnaires. Descriptive analyses, Chi square-tests, and logistic regression were applied. Results were adjusted for educational level. Of 5387 women, 89.9% were autochthonous, 4.1% German resettlers, 2.8% Turkish, 3.1% other migrants. Participation rates regarding cancer screening differed significantly, with the lowest proportion in Turkish migrants (65.0%), resettlers (67.8%), other migrants (68.2%) and autochthonous population (78.2%). No differences in performance of breast self-examinations were detected. When adjusted for education, results indicated only slight changes in the odds to participate in screening irregularly or not at all. Results support existing evidence by showing lower participation rates in cancer screening among migrant women, but there were no differences regarding breast self-examinations. Migrant women form a potential high-risk group for late-stage diagnosis of cervical or breast cancer. [ABSTRACT FROM AUTHOR]

• Survey respondents had their first suicidal thoughts, on average, at 13.6 years. • Forms of suicidal thoughts were passive, active and chronic suicidal ideation. • During and after leaving care, suicidal thoughts can re-occur and intensify. • English and German samples show similar occurrences of suicidal thoughts. • English participants judge their care experience to affect their attitude towards life. This paper investigates the range of suicidal ideation among people with care experience. People who grew up in care have an elevated risk of suicidal ideation, behavior and dying by suicide compared to people without care experience. However, a comprehensive and in-depth understanding of when suicidal ideation occurs and how care-experienced people experience suicidal thoughts, especially when leaving care in England and Germany, is currently not available but would help to inform suicide prevention tailored to care-experienced people across different ages. Aiming to address this gap, the current study applied a mixed-methods approach, combining an online survey and semi-structured interviews with young adults with care experience from England and Germany. The survey included 45 adults with care experience, age 18–40, and interviews were conducted with 13 care-experienced young adults from both countries. Descriptive statistical and significance tests were conducted to analyze the survey data with SPSS. Framework analysis was used to analyze the interviews. The findings show that many participants experienced suicidal thoughts from a young age and at different times up to adulthood. A range of suicidal thoughts and trajectories are identified with an increased risk of suicide for young people with care experience, especially during transitions such as when leaving care in early adulthood. The study underlines the need for a stronger recognition of suicide prevention in social work and the (leaving) care system across different countries. [ABSTRACT FROM AUTHOR]

This paper studies the prosodic realization of dual-focus in German, that is, two foci in a single sentence, with special consideration of the interaction between focus assignment and phrasing. In a production experiment, dual-focus was compared with its initial, final, and all-new counterparts in sentences with subject NPs and VPs of different lengths. The results showed that there were three different patterns of dual-focus realization: (1) The most frequent one was the two-peak pattern (57.8%), that is, a falling tone on both focused words and compressed and lowered pitch in-between; (2) the second most frequent was the two-phrase realization (23.5%), in which both foci were also realized as a falling tone, but in this case, a high boundary tone was inserted after the subject NP; (3) the least frequent pattern was the hat-pattern (18.7%), consisting of a rising tone on the first focus and a falling tone on the second one while the pitch in-between is kept as a high plateau. This was applied mostly in utterances containing a short subject NP. We interpret these results in terms of optional prosodic phrasing. A sentence with two foci can be realized in one or two intonation phrases, but in both cases, the focus is assigned within the prosodic domain derived from syntax. These results show that Culminativity, the principle requiring a one-to-one correspondence between prosodic domains and their heads, is violable in German. Two equally prominent pitch accents are allowed to co-exist in one intonation phrase. Finally, the metrical structure of dual-focus speaks for a recursive structure of German prosody. [ABSTRACT FROM AUTHOR]

The voicing contrast is neutralized syllable and word finally in Dutch and German, leading to alternations within the morphological paradigm (e.g., Dutch ‘bed(s)’, be[t]-be[d]en, German ‘dog(s)’, Hun[t]-Hun[d]e). Despite structural similarity, language-specific morphological, phonological and lexical properties impact on the distribution of this alternation in the two languages. Previous acquisition research has focused on one language only, predominantly focusing on children’s production accuracy, concluding that alternations are not acquired until late in the acquisition process in either language. This paper adapts a perceptual method to investigate how voicing alternations are represented in the mental lexicon of Dutch and German 3-year-olds. Sensitivity to mispronunciations of voicing word-medially in plural forms was measured using a visual fixation procedure. Dutch children exhibited evidence of overgeneralizing the voicing alternation, whereas German children consistently preferred the correct pronunciation to mispronunciations. Results indicate that the acquisition of voicing alternations is influenced by language-specific factors beyond the alternation itself. [ABSTRACT FROM AUTHOR]

Mild cognitive impairment, especially executive dysfunction might occur early in the course of Parkinson's disease. Cognitive training is thought to improve cognitive performance. However, transfer of improvements achieved in paper and pencil tests into daily life has been difficult. The aim of the current study was to investigate whether a multimodal cognitive rehabilitation programme including physical exercises might be more successful than cognitive training programmes without motor training. 240 PD-patients were included in the study and randomly allocated to three treatment arms, group A cognitive training, group B cognitive training and transfer training and group C cognitive training, transfer training and psychomotor and endurance training. The primary outcome measure was the ADAS-Cog. The secondary outcome measure was the SCOPA-Cog. Training was conducted for 4 weeks on a rehabilitation unit, followed by 6 months training at home. Caregivers received an education programme. The combination of cognitive training using paper and pencil and the computer, transfer training and physical training seems to have the greatest effect on cognitive function. Thus, patients of group C showed the greatest improvement on the ADAS-Cog and SCOPA-COG and were more likely to continue with the training programme after the study. [ABSTRACT FROM AUTHOR]

Aim To assess the association between nursing team continuity and quality of care. Background Research on nurse staffing and its effect on quality of care is investigated to different degrees. However, very few studies have observed whether the continuous deployment of nursing staff is associated with quality of care. Methods This study was conducted in two university neonatal intensive care units ( NICUs). We matched nurse schedule data for the NICUs with nursing-sensitive patient outcomes and quality of care, as perceived by parents. We used analysis of variance to analyse differences in nursing team continuity between NICUs and regression analyses to identify associations with the outcome measures. Results There were considerable differences between units in terms of team continuity of nursing staff. Positive associations were found between team continuity and a higher rate of non-invasive respiratory support as well as parents' perceptions of how well they knew their nurse. Conclusions The findings show remarkable differences in staff assignment in the different NICUs. In addition to appropriate staffing levels, scheduling nursing teams continuously would appear to play a role in influencing treatment quality. Implications for nursing management This paper emphasises the importance of carefully considered staff scheduling decisions. [ABSTRACT FROM AUTHOR]

Purpose: The European 'Healthy Lifestyle in Europe by Nutrition in Adolescence' (HELENA) project evaluated two different approaches to harmonize the matching procedures between 24-h recall data and food composition databases. In the first approach, the 24-h recall data were linked to the local/national food composition databases using standardized procedures, while in the second approach, the 24-h recall data were linked to the German BLS database which includes a larger food list. The aim of this paper was to compare the intakes of energy and eight nutrient components calculated via both approaches. Methods: Two non-consecutive 24-h recalls were performed in 1268 adolescents. Energy, carbohydrates, proteins, fat, fiber, water, alcohol, calcium and vitamin C were calculated via the two approaches at individual level. Paired samples t test and Pearson's correlations were used to compare the mean intakes of energy and the eight mentioned nutrients and to investigate the possible associations between the two approaches. Results: Small but significant differences were found between the intakes of energy and the eight food components when comparing both approaches. Very strong and strong correlations (0.70-0.95) were found between both methods for all nutrients. Conclusion: The dietary intakes obtained via the two different linking procedures are highly correlated for energy and the eight nutrients under study. [ABSTRACT FROM AUTHOR]

A brief, problem-oriented phase such as an inventing activity is one potential instructional method for preparing learners not only cognitively but also motivationally for learning. Student teachers often need to overcome motivational barriers in order to use computer-based learning opportunities. In a preliminary experiment, we found that student teachers who were given paper-based course material spent more time on follow-up coursework than teachers who were given a well-developed computer-based learning environment (CBLE), leading to higher learning outcomes. Thus, we tested inventing as an instructional method that may help overcome motivational barriers of teachers' use of computer-supported tools or learning environments in our main experimental study (N = 44). As a computer-based environment, we used the 'Assessment of Learning strategies in Learning journals'. The inventing group produced ideas about criteria to evaluate learning strategies based on student cases prior to the learning phase. The control condition read a text containing possible answers to the inventing problem. The inventing activity enhanced motivation prior to the learning phase and assessment skills as assessed by transfer problems. Hence, the inventing activity prepared student teachers to learn from a CBLE in a motivational as well as cognitive way. [ABSTRACT FROM AUTHOR]

Background: The Heidelberger Drogenbogen (HDB) is a German language assessment of substance-specific knowledge and consumption patterns of the illicit psychoactive substances cannabis, MDMA (ecstasy), amphetamines, cocaine, and hallucinogens. The behavior modules for each of these five drugs/drug groups allow for a diagnostic evaluation of the extent of harmful consumption behavior. Each of the five modules represents a single standardized test. Objectives: This paper outlines several statistical parameters, Cronbach's alpha, retest reliabilities, as well as numerous validity and cut-off-criteria of the behavioral modules. Methods: Participants (N = 4,794) were recruited at schools, universities, in subcultural contexts, and in institutions of substance abuse treatment. Results: Internal consistencies range from =.68 to.79 while test–retest reliabilities between.87 and.94 were found. The behavior modules of the HDB can discriminate between populations with and without clinical levels of substance use. Furthermore, this measure has incremental validity and higher diagnostic accuracy over competing measures. Conclusions: The behavior modules of the HDB are reliable and valid measures of substance use and misuse. [ABSTRACT FROM AUTHOR]

Background: The evolving approach of health literate health care organizations (HLHO) receives considerable support from health policy makers. Up to now, there are no performance measures available to assess the application of health literacy strategies by health care professionals in the primary care setting. This paper describes the development and validation of the Health Literate Primary Care Practice screener (HLPC). The screener can be used as a self-assessment tool for primary care organizations (PCO) that aim to elucidate the health literacy responsiveness of their organization. Methods: The HLPC is a 4-item screener developed in a multi-level process following a theory-driven approach including a literature review, consultations with scientists and cognitive tests with patients in PCO. The screener was applied in a national random sample of N = 1125 adults living in Germany. Item and psychometric properties were analyzed by determining item discrimination and reliability as well as performing a confirmatory factor analysis (CFA) to test the instruments unidimensionality. Criterion validity was investigated by performing bivariate correlations between the HLPC score and heath care quality measures. Results: The HLPC scale demonstrated good item discrimination and internal consistency (α = 0.86). CFA verified a one-factor structure of the scale and analysis on the criterion validity revealed a significant correlation between the HLPC score and patients satisfaction with the general practitioner, accessibility of the PCO and support in care-coordination received in the PCO. Conclusions: The HLPC is a valid screener to provide insights in the extent of the utilization of health literacy strategies in primary care practices. [ABSTRACT FROM AUTHOR]

The secular trend of reduced physical fitness (PF) leads to increased health risks. The aim of the present paper is to analyse various current factors that affect health behaviour with respect to the course of PF over 2 years. A path analysis combined with a latent growth curve analysis was based on a study that was conducted between June 2008 and June 2010 with 145 primary German school children (52.1% male, average age at baseline 7.95 years ± 0.95). PF was tested with the German Motor Test 6–18. For the mean PF and the course of PF, direct and indirect influences were shown over three levels, including migration background on the first level and physical activity (PA) on the second level. Body mass index (BMI) impacted the mean PF but not the course of PF. The influence of sedentary behaviour on the mean PF was diminished (compared to bivariate analysis) due to its common variance mainly with BMI. PA affected not only current PF in children but also the course of PF (aintercept =.28, P =.001; aslope =.27, P =.21). Consequently, preventive measures should focus on early adoption and maintenance of PA. [ABSTRACT FROM AUTHOR]

Population ageing occurs in all industrialised societies and is the demographic phenomenon that currently gets the highest attention from scientists, policy makers and the general public. The main aim of this paper is to broaden our understanding of its societal consequences, such as ageism and intergenerational solidarity. Our study is based on the 2008 investigation of attitudes towards population ageing and older people in seven European countries of Schoenmaeckers et al. We replicate their analysis in a specific human subpopulation in which the process of population ageing started earlier and is much more advanced than in the general societies: the members of Catholic orders. The study compares the attitudes of 148 nuns and monks from three Bavarian monasteries to those of the western German general population using descriptive and multivariate analyses in the context of the debate around population ageing in Germany. We discuss the specific characteristics of order members that might influence their attitudes and also take a brief look at their views on possible political strategies to solve the problems connected with the demographic changes. Our results confirm the findings of Schoenmaeckers et al. and reveal that worldly and monastic populations show an identical basic pattern of a positive attitude towards older people while at the same time considering population ageing a worrisome development. However, order members evaluate older people's abilities and their role in society more positively. This result gives rise to the optimistic perspective that in an aged population the younger and older generations can build a well-functioning society. [ABSTRACT FROM PUBLISHER]

Context Basic science teaching in undergraduate medical education faces several challenges. One prominent discussion is focused on the relevance of biomedical knowledge to the development and integration of clinical knowledge. Although the value of basic science knowledge is generally emphasised, theoretical positions on the relative role of this knowledge and the optimal approach to its instruction differ. The present paper addresses whether and to what extent biomedical knowledge is related to the development of clinical knowledge. Methods We analysed repeated-measures data for performances on basic science and clinical knowledge assessments. A sample of 598 medical students on a traditional curriculum participated in the study. The entire study covered a developmental phase of 2 years of medical education. Structural equation modelling was used to analyse the temporal relationship between biomedical knowledge and the acquisition of clinical knowledge. Results At the point at which formal basic science education ends and clinical training begins, students show the highest levels of biomedical knowledge. The present data suggest a decline in basic science knowledge that is complemented by a growth in clinical knowledge. Statistical comparison of several structural equation models revealed that the model to best explain the data specified unidirectional relationships between earlier states of biomedical knowledge and subsequent changes in clinical knowledge. However, the parameter estimates indicate that this association is negative. Discussion Our analysis suggests a negative relationship between earlier levels of basic science knowledge and subsequent gains in clinical knowledge. We discuss the limitations of the present study, such as the educational context in which it was conducted and its non-experimental nature. Although the present results do not necessarily contradict the relevance of basic sciences, we speculate on mechanisms that might be related to our findings. We conclude that our results hint at possibly critical issues in basic science education that have been rarely addressed thus far. [ABSTRACT FROM AUTHOR]

Recognizing the ageing of populations and expected increase in prevalence of dementia, the necessity of research involving persons with dementia is widely agreed upon. Autonomy is key to nursing home residents' well-being and quality of life, but this phenomenon has not been thoroughly assessed from the residents' perspective. The aim of this cross-sectional study was to investigate perceived autonomy of nursing home residents. Data on 560 randomly selected residents in 40 nursing homes in two German federal states were generated by face-to-face interviews, psychological and physical assessments, analysis of nursing records, and acquisition of institutional parameters. This paper reports on a subsample ( n = 179) that met screening requirements, including subjects with and without mild cognitive impairment ( Mini Mental Status Examination score 30-18), who completed the Hertz Perceived Enactment of Autonomy Scale ( HPEAS). The mean score of HPEAS was 101.1 ± 14.5 (range 54-122). In our population, Cronbach's alpha was 0.89. Scores in HPEAS were not related to demographical factors but positively associated with increasing self-efficacy and absence of pain. The novel findings contribute to an understanding of autonomy from the residents' perspective. [ABSTRACT FROM AUTHOR]

The present paper extends the needs-based model of reconciliation to contexts marked by status inequalities rather than by overt intergroup aggression. Specifically, we investigated whether and when members of high-status versus low-status groups experience divergent socio-emotional needs vis-à-vis members of the respective other status group. Building on research informed by social identity theory, we hypothesized that the groups' different positions in the social hierarchy only translate into divergent needs when the status differences are perceived as illegitimate. In Study 1 (N = 130), we tested this prediction by manipulating status and perceived legitimacy of status differences in a setting with artificially created groups. Results confirmed that the need to be socially accepted by members of the other status group was stronger in high-status compared with low-status group members but, as expected, only when the status differences were perceived to be illegitimate. Also as predicted, the need to be empowered by the other status group was stronger in low-status compared with high-status group members, again only under conditions of illegitimate status differences. Study 2 (N = 169) further corroborated our perspective by replicating these findings in a naturalistic intergroup context. Implications for the role of legitimacy perceptions in determining differential socio-emotional needs and for the promotion of sustainable social change are discussed. Copyright © 2013 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Background. Much work has been done to evaluate the outcome of integrative inpatient treatment but scarcely the costs. This paper evaluates the costs for inpatient treatment in three anthroposophic hospitals (AHs). Material and Methods. Cost and performance data from a total of 23,180 cases were analyzed and compared to national reference data. Subgroup analysis was performed between the cases with and without anthroposophic medical complex (AMC) treatment. Results. Costs and length of stay in the cases without AMC displayed no relevant differences compared to the national reference data. In contrast the inlier cases with AMC caused an average of € 1,394 more costs. However costs per diem were not higher than those in the national reference data. Hence, the delivery of AMC was associated with a prolonged length of stay. 46.6% of the cases with AMC were high outliers. Only 10.6% of the inlier cases with AMC were discharged before reaching the mean length of stay of each DRG. Discussion. Treatment in an AH is not generally associated with an increased use of resources. However, the provision of AMC leads to a prolonged length of stay and cannot be adequately reimbursed by the current G-DRG system. Due to the heterogeneity of the patient population, an additional payment should be negotiated individually. [ABSTRACT FROM AUTHOR]

Objective This paper examines how negative experiences with the health-care system create a lack of confidence in receiving medical care in seven countries: Australia, Canada, Germany, the Netherlands, New Zealand, the United Kingdom, and the United States. Methods The empirical analysis is based on data from the Commonwealth Fund International Health Policy Survey 2007, with nationally representative samples of adults aged 18 and over. For the analysis of the experience of cost barriers and confidence in receiving medical care, we conducted pairwise comparisons of group percentages as well as country-wise multivariate logistic regression models. Results Individuals who have experienced cost barriers show a significantly lower level of confidence in receiving safe and quality medical care than those who have not. This effect is most pronounced in the United States, where people who have foregone necessary treatment because of costs are four times as likely to lack confidence as individuals without the experience of cost barriers (adjusted odds ratio 4.00). In New Zealand, Germany, and Canada, individuals with the experience of cost barriers are twice as likely to report low confidence compared with those without this experience (adjusted odds ratios of 1.95, 2.19 and 2.24, respectively). In the Netherlands and UK, cost barriers are only a marginal phenomenon. Conclusions The fact that the experience of financial barriers considerably lowers confidence indicates that financial incentives, such as private co-payments, have a negative effect on overall public support and therefore on the legitimacy of health-care systems. [ABSTRACT FROM AUTHOR]

Background: To maintain patients' quality of life is one of the major goals in palliative home care provided by general practitioners (GPs). GPs need adequate training to care for palliative patients. The paper seeks to evaluate whether a specific training in Germany (PAMINO) has any improving impact on the care of palliative patients and their health-related quality of life. Methods: From September 2007 until June 2009, GPs and their palliative care patients with cancer participated in a study to evaluate palliative courses for GPs offered by a regional palliative care initiative (PAMINO). For a period of six months at most or until death, patients were asked monthly to judge their quality of life on the Quality of Life Questionnaire Core 15 Palliative (QLQ-C15-PAL) of the European Organization for Research and Treatment of Cancer(EORTC) and on the Palliative Care Outcome Scale (POS). The 'Overall quality of life' scale of the QLQ-C15-PAL takes values between 0 and 100 with higher values indicating a higher quality of life. The POS sum scale takes values between 0 and 40 with higher values indicating worse care outcomes. Patients cared for by PAMINO-trained GPs and patients cared for by other GPs (control group) are compared using t-tests for differences in group means. Results: One hundred patients participated in the study; 96 patients filled out the questionnaires at least once. On the QLQ-C15-PAL, mean quality of life of the patient groups of PAMINO-trained and other GPs were 37.7 (SD = 25.5)and 39.4 (SD = 26.3) (p = .76), respectively. On the POS, respective mean values of 13.6 (SD = 5.8) and 12.0 (SD = 6.5)(p = .26) were given. Patients cared for by a PAMINO-trained GP did not report better quality of life and care outcomes than patients cared for by other general practitioners. Conclusions: Patients cared for by PAMINO-trained and other GPs in our study did not report differences in quality of life. Quality of life and care outcomes of all patients were better than of palliative patients in institutional or specialized care, emphasizing the ability of GPs to provide adequate care for these vulnerable patients. However, conclusions need to be drawn cautiously since the study had a small sample size [ABSTRACT FROM AUTHOR]

Background: Parental palliative disease is a family affair, however adolescent's well-being and coping are still rarely considered. The objectives of this paper were a) to identify differences in psychosocial adjustment and health-related quality of life (HRQoL) among adolescents and young adults with parents suffering from palliative cancer or cancers in other disease stages, b) to relate psychosocial adjustment and health-related quality of life to adolescent coping, and c) to explore significant mediator and predictor variables. Methods: Cross-sectional data were derived from a multi-site research study of families before child-centered counselling. N=86 adolescents and young adults were included, their mean age 13.78 years (sd 2.45), 56% being female. Performed analyses included ANCOVA, multiple linear regression, and mediation analysis. Results: Adolescents with parents suffering from palliative cancers reported significantly less total psychosocial problems, and better overall HRQoL. There were no significant group differences regarding coping frequency and efficacy. Our set of coping items significantly mediated the effect of parental disease stage on psychosocial problems and HRQoL. Further, parental disease status and general family functioning predicted psychosocial problems (R2adj =.390) and HRQoL (R2adj =.239) best. Conclusion: The study indicates distress among adolescents throughout the entire parental disease process. Our analysis suggests that counselling services could offer supportive interventions which focus particularly on adolescent coping as well as family functioning. [ABSTRACT FROM AUTHOR]

Background: Data from the core data set of the Hospice and Palliative Care Evaluation (HOPE) from 1999 to 2001 demonstrated considerable variance in the incidence of patients' symptoms and problems between participating services. This paper aims to investigate these differences more closely. Methods: During the evaluation period of HOPE in 2002 a telephone survey with a representative of each participating unit was performed. Telephone interviews assessed the professionals' definitions of selected symptoms and estimates of problem and symptom incidences. Content analysis was used to evaluate qualitative answers. Results: Staff members rated pain, weakness, nausea/emesis as the most frequent physical symptoms; anxiety, depression and amentia as most frequent psychological symptoms; wound treatment, mobilisation and weakness as nursing problems and organisation of care settings, loneliness, demands of relatives the most common social needs. Staff members used a wide range of definitions for cachexia, weakness and depression. Discussion: Standard definitions of symptoms and problems were lacking in the articulation of subjective staff members' perspectives. Meaningful evaluation of multicentre surveys would require training in symptom assessment and classification in order to produce a common basis for documentation. Even though definitions differed widely, underlying concepts seemed to be compatible. [ABSTRACT FROM AUTHOR]