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Background: Deep Brain Stimulation (DBS) has been widely applied and accepted in the treatment of neurological and psychiatric disorders. Despite numerous studies exploring the effects of DBS on the progression of neurodegenerative diseases and the treatment of advanced Parkinson's disease (PD), there is a limited number of articles summarizing this research. The purpose of this study is to investigate the current trends, hot topics, and potential in research surrounding DBS therapy for PD, as well as to anticipate the challenges of such research. Methods: We searched the Web of Science Core Collection database (WoSCC) for DBS research literature related to PD published from January 2014 to January 2024, utilized CiteSpace, VOS viewer, the bibliometric online analysis platform, Scimago Graphica, Microsoft Excel 2021, and R software version 4.2.3 for data analysis. And we conducted quantitative research on publications, citations, journals, authors, countries, institutions, keywords, and references, visualized the results in network graphs. Results: From 2014 to 2024, papers from 39 journals from 11 countries were among the top 100 cited. Most papers were published in Neurology, with the highest average citations per paper in Nature Neuroscience. The United States (US) contributed the most publications, followed by the United Kingdom (UK) and Germany. In terms of total publications, University College London (UCL) contributed the most papers. The primary classifications of articles were Clinical Neurology, Neurosciences, and Surgery. The top five keywords were subthalamic nucleus, DBS, PD, medical therapy, and basal ganglia. Cluster analysis indicates that DBS research focus on improving quality of life and applying computational models. Conclusion: Through bibliometric analysis, researchers could quickly and clearly understand the hotspots and boundaries of their research field, thus guiding their research direction and scope to improve research efficiency and the quality of outcomes. Although studies indicate that DBS is currently a crucial method for treating advanced PD, in the long run, creating a personalized, lowcost treatment regimen with precise targeting and long-term efficacy poses a challenge. [ABSTRACT FROM AUTHOR]

This paper investigates which factors shape popular support for the taxation of wealth in Germany, a country with one of the highest levels of wealth inequality in Western Europe. Although public support for progressive taxation in general is strong, no tax on personal net wealth is currently levied. Against this backdrop, we ask how objective and subjective self-interest, information about wealth inequality and deservingness valuations regarding the wealthy affect popular support for a personal wealth tax. Particular attention is paid to the interaction between self-interest and deservingness. Using original survey data and a vignette design, we find that subjective self-interest is more important than objective self-interest, and that providing information on aggregate wealth inequality can shift the attitudes of those who are otherwise indifferent in favour of wealth taxation. Furthermore, deservingness valuations impact support for taxation in important ways. Factors indicating meritocratic wealth accumulation reduce support, and this is especially pronounced among low-status respondents. By contrast, while non-meritocratic factors increase support for taxation, these effects are largely off-set in privileged groups. Altogether, these findings suggest that self-interest and deservingness valuations impact attitudes towards wealth taxation in opposing directions, and that providing information to those otherwise indifferent might increase redistributive preferences. [ABSTRACT FROM AUTHOR]

Social work in the German rehabilitation sector is practiced with great variation and its interventions lack research evidence. The SWIMMER project aims to develop a program theory of social work in rehabilitation to explain this variation and to discuss possible conditions. The dealing with ethical dilemmas by social workers is one possible influence and the focus of this paper. The social workers' practice was analyzed using the triple mandate, a German-Swiss concept that describes three possible, sometimes simultaneous directives without a concrete call to action from society, the client or the profession. This qualitative, case-comparative research project collected data from interviews with social workers and managers, participant observation and counseling sessions in ten German rehabilitation facilities. Social workers were confronted with all three mandates. They prioritized either the societal mandate or the client mandate. A consequence for social work practice was the limitation of options under social law (mandate by society). Social workers relied on their professional experience to reflect on the mandates. They used a variety of strategies when faced with conflicting mandates. The research project has succeeded in systematizing the orientations of social workers in goal conflicts. Further investigation on this topic on a broader basis would be beneficial. [ABSTRACT FROM AUTHOR]

Purpose: On average, about 50% of cancer patients use complementary and alternative medicine (CAM) in addition to conventional cancer treatment. Since there is a high need for information, patients often search for information about CAM and share experiences with peers, especially in self-help groups. In this study, we tested and evaluated an educational concept developed for group leaders of cancer self-help groups on how to approach the topic of CAM in their peer groups. Methods: The educational concept has been developed and piloted with health care professionals and representatives from different self-help organizations in Germany. It aims to inform and discuss the possibilities and limitations of CAM in terms of scientific evidence, to reflect user behavior, and to provide a guide on how to find and evaluate reliable and evidence-based information sources. First, self-help group leaders took part in an on-site training where they were educated on various CAM topics with the goal of being able to conduct the educational concept in their respective self-help groups. Then, the educated group leaders performed this concept in their groups. The educational concept was evaluated by both the group leaders and participants with respect to acceptance, usefulness, and satisfaction using paper-pencil questionnaires. The study was conducted in Germany based on an observational study design with a six-month follow-up. For the analyses, descriptive and univariate statistics for dependent samples were used. Results: A total of n = 50 interested group leaders conducted the educational program in their groups. The most common implementation barriers were organizational or structural problems, as well as the feeling of being overwhelmed with managing the program in their groups. A total of n = 423 participants were educated with this program by their respective group leaders. The majority felt satisfied with the educational program and improved their knowledge about CAM. At the six months follow-up (T2), significantly more participants had consulted their physicians to inform themselves about CAM and felt more confident in finding reliable information about CAM. Conclusions: In this observational study, we have managed to successfully implement an educational concept with respect to the topic of CAM in cancer self-help groups. Based on the results, the concept approach will be modified to include both a CAM- professional and group leader to train the self-help groups. In the future, the effects of the program should be tested by a randomized trial. [ABSTRACT FROM AUTHOR]

Although there are several indirect methods that can be used to verify reference limits, they have a common weakness in that they assume a low proportion of pathological values. This paper investigates whether a Gaussian decomposition algorithm can identify the non-pathological fraction even if it is not the main subset of mixed data. All investigations are carried out in the R programming environment. The mclust package is used for Gaussian mixture modelling via the expectation maximization (EM) algorithm. For right-skewed distributions, logarithms of the original values are taken to approximate the Gaussian model. We use the Bayesian information criterion (BIC) for evaluation of the results. The reflimR and refineR packages serve as comparison procedures. We generate synthetic data mixtures with known normal distributions to demonstrate the feasibility and reliability of our approach. Application of the algorithm to real data from a Nigerian and a German population produces results, which help to interpret reference intervals of reflimR and refineR that are obviously too wide. In the first example, the mclust analysis of hemoglobin in Nigerian women supports the medical hypothesis that an anemia rate of more than 50 % leads to falsely low reference limits. Our algorithm proposes various scenarios based on the BIC values, one of which suggests reference limits that are close to published data for Nigeria but significantly lower than those established for the Caucasian population. In the second example, the standard statistical analysis of creatine kinase in German patients with predominantly cardiac diseases yields a reference interval that is clearly too wide. With mclust we identify overlapping fractions that explain this false result. Gaussian mixture modelling does not replace standard methods for reference interval estimation but is a valuable adjunct when these methods produce discrepant or implausible results. [ABSTRACT FROM AUTHOR]

Copyright of Clinical Child Psychology & Psychiatry is the property of Sage Publications Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Learning analytics dashboards are increasingly being used to communicate feedback to learners. However, little is known about learner preferences for dashboard designs and how they differ depending on the self‐regulated learning (SRL) phases the dashboards are presented (i.e., forethought, performance, and self‐reflection phases) and SRL skills. Insight into design preferences for dashboards with different reference frames (i.e., progress, social, internal achievement and external achievement) is important because the effectiveness of feedback can depend upon how a learner perceives it. Objective: This study examines workplace learner preferences for four dashboard designs for each SRL phase and how SRL skills relate to these preferences. Methods: Seventy participants enrolled in a chemical process apprenticeship program took part in the study. Preferences were determined using a method of adaptive comparative judgement and SRL skills were measured using a questionnaire. Preferences were tested on four dashboard designs informed by social and temporal comparison theory and goal setting theory. Multinomial logistic regressions were used to examine the relationship between dashboard preferences and SRL. Results and Conclusions: Results show that the progress reference frame is more preferred before and after task performance, and the social reference frame is less preferred before and after task performance. It was found that the higher the SRL skill score the higher the probability a learner preferred the progress reference frame compared to having no preference before task performance. The results are consistent with other findings, which suggest caution when using social comparison in designing dashboards which provide feedback. Lay Description: What is already known about this topic?: Learning analytics dashboards use visualisations to provide feedback on learning tasks to optimise learning.Learners can better understand the meaning of their feedback if it is presented alongside a point of comparison, such as a prior level of performance, the performance level of their peers or how their performance level compares to an achievement goal.Learning analytics dashboards can support learning behaviours before, during, and after learners perform a task.Learners can acquire information to improve their learning via learning analytics dashboards, such as feedback on performance, which illustrates areas of a task learners are stronger and weaker at, which in turn can help inform future training efforts. What this paper adds?: Workplace learners typically prefer dashboards which offer visualisations comparing their current performance level with past levels of performance.Comparison with peers is typically the least preferred point of comparison when offered in learning analytics dashboards.No clear preference emerged between reference frames containing assigned or self‐set goals in dashboards presented before and after task performance. Implications for practice: Designers should take into account learner preferences when designing learning analytics dashboard visualisations.Designers should consider presenting learning analytics dashboards before, during, and after task performance.Designers should gain more insight into how learners process learning analytic dashboards and act upon it. [ABSTRACT FROM AUTHOR]

Introduction: Digitalization in medicine is steadily increasing. Complex treatments, scarce personnel resources and a high level of documentation are a constant burden on healthcare systems. The balancing between correct manual documentation in the digital records and limited staff resources is rarely successful. The aim of this study is to evaluate the adherence between documentation and lack of documentation in the treatment of critical care patients. Material and Methods: For the evaluation, data from the hospital information system (HIS) of several intensive care units (ICU) were examined in conjunction with data collected from a checklist. All boluses of sedatives, analgesics and catecholamines were documented paper based across all shifts and all weekdays and compared with corresponding digital data from the HIS (2019–2022) of previous years. Results: 939 complete digital patient records revealed a massive under-documentation of the medication administration compared to that applied according to the checklist. Only 12% of all administered catecholamines, 11% of α2-agonists, 33% of propofol, 92% of midazolam and 46% of opioids were found in the digital recordings. In comparison, the effect was more pronounced on weekdays compared to weekends. In addition, the highest documentation gap was found in the comparison of early shifts. Comparing neurosurgical vs. internal vs. anesthesiologic ICUs there was a highly significant difference between anesthesiologic ICUs compared with other disciplines (p < 0.0001). Discussion: Our data shows that there is a remarkable documentation gap and incongruence in the area of applied boli. Automated documentation by connecting syringe pumps that enter data directly into the HIS can not only reduce the workload, but also lead to comprehensive and legally required documentation of all administered medication. [ABSTRACT FROM AUTHOR]

Introduction: The World Health Organization (WHO) adopted the International Classification of Functioning, Disability and Health (ICF) in 2001. The classification provides a framework for the standardised description of functioning and disability using health and health-related domains. The implementation of the ICF is diverse and has a wide range of applications. A thorough understanding of the ICF classification is essential for successful implementation. We developed and delivered an in-person interactive ICF training to facilitate the implementation of the ICF in Germany. The aim of this paper is to present the evaluation of this in-person interactive ICF training. Methods: The evaluation was conducted with questionnaires assessing the organisation of the workshops and the knowledge gained during the training using Likert scaled questions. Open-ended questions were used to gather feedback on the further development of the ICF training. Data were analysed descriptively using absolute and relative frequencies. Open-ended questions were analysed qualitatively. Results: Between 2017 and mid-2020, a team of trainers at the Chair of Public Health and Health Services Research (IBE) at LMU Munich organised 12 inperson interactive ICF trainings with a total of 191 participants. In total 151 participants filled in the questionnaires (response rate: 79.1%). The participants professional backgrounds were primarily in the social sector (n = 76; 50.3%), clinical sector (n = 36; 23.8%), and administrative sector (n = 31; 20.5%). 42.4% of the participants strongly agreed that the content was relevant to their work, while an additional 51.0% almost agreed. According to this evaluation, 82.1% of the participants would recommend the training to others. Discussion: A numberof constructive suggestions and proposalswere made for the further development of the training programme. Thesemainly related to the content of the training, such as the themes of children and youth and integration assistance. [ABSTRACT FROM AUTHOR]

This paper presents the investigation and analysis of speech accommodation effects in data obtained from Spanish learners of German with varying proficiency levels. The production data were recorded during a collaborative map task of the Spanish learners of German among each other and with a native speaker of German. The map task was designed to target words and phrases with specific segmental and suprasegmental characteristics. These characteristics were derived from contrastive analyses of Spanish and German. The main objectives of the paper were to investigate whether segmental and suprasegmental characteristics of the target language German are affected by phonetic accommodation to varying degrees and whether these differences depend on the proficiency level of the speaker or the interlocutor. The statistical analysis, using regression analyses, revealed inconsistent accommodation effects across learners of different proficiency levels as well as different linguistic phenomena. In line with previous findings the results can best be accounted for by an adaptation of a dynamic system approach. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this paper is to conceptualise a research study to examine leadership as a relational concept between leaders and followers. The context is within surgical practice examining how motivated consultant surgeons are to lead junior doctors and which type of leadership style they use. From a follower perspective, the motivation of junior doctors will be explored, and their leadership preferences will be correlated with those of the actual style of consultant surgeons. Design/methodology/approach: In this paper, the authors provide a detailed description of the methods for an international quantitative research study, exploring sequentially how motivated consultant surgeons are to lead and how leadership styles impact on the motivation of junior doctors. The objectives, method and data collection of this study are explained, and the justification for each method is described. Findings: The findings for this outline study illustrate how critical it is to redefine leadership as a relational concept of leader and follower to ensure adequate support is provided to the next generation of consultant surgeons. Without consideration of the relational model of leadership, attrition will continue to be a critical issue in the medical workforce. Research limitations/implications: The research limitations are that this is a proposed quantitative study due to the need to collect a large sample of data from surgeons across the UK, Egypt and Germany. This research will have immense implications in developing new knowledge of leadership as a relational concept in medicine and healthcare. This study additionally will impact on how leadership is conceptualised in the curriculum for specialist surgical practice. Practical implications: The practical implications are that relational leadership is supportive of generating a supportive leadership culture in the workplace and generating more effective teamwork. Originality/value: To the best of the authors' knowledge, this is the first study of its kind to look at a relational model of leadership in surgical practice between consultant surgeons and surgical trainees. This study will also identify any specific country differences between the UK, Germany and Egypt. [ABSTRACT FROM AUTHOR]

PURPOSE: Implementation science endeavors to facilitate the translation of evidence-based research into clinical routine. The clinical pharmacological/pharmaceutical care program evaluated in the randomized AMBORA trial on medication safety with oral antitumor therapeutics (OAT) optimizes care delivery and provides significant benefits for patients, treatment teams, and health care systems. Thus, we aimed to investigate the implementation of this care program within the AMBORA Competence and Consultation Center (AMBORA Center). METHODS: The AMBORA Center within a University Comprehensive Cancer Center offered several services (eg, patient consultations) and was evaluated according to the RE-AIM framework. This multicenter hybrid type III trial focused on implementation outcomes (eg, patient recruitment, referring units, evaluation of services) while concurrently investigating effectiveness (eg, side effects, medication errors). Quantitative and qualitative assessments were combined. RESULTS: The AMBORA Center conducted over 800 consultations with 420 patients in seven institutions. The primary end point of counseling 70% of patients treated with OAT was not reached. Patients were referred by 15 treatment units compared with 11 units in the AMBORA trial. On the basis of heterogeneous referral rates and characteristics across the institutions, barriers and facilitators of the implementation process were derived. Several survey results (eg, stakeholder interviews, online/paper-based questionnaires) reflected a high appreciation of services by patients and health care professionals. The severity of 60.1% (178 of 296) of detected side effects improved, and 86.3% (297 of 344) of medication errors were resolved. CONCLUSION: Despite not reaching the primary implementation outcome, the AMBORA Center included more treatment units and demonstrated patient benefit of the AMBORA care program by meeting all effectiveness outcomes. We outlined quantitative and qualitative implementation characteristics to enhance outreach and foster further dissemination of centers to optimize medication safety with OAT. The AMBORA Center to optimize medication safety with oral antitumor therapy: A hybrid type III trial. [ABSTRACT FROM AUTHOR]

Background: Mild cognitive impairment (MCI) is commonly defined as a transitional subclinical state between normal aging and dementia. A growing body of research indicates that health behaviors may play a protective role against cognitive decline and could potentially slow down the progression from MCI to dementia. The aim of this study is to conduct a bibliometric analysis of literature focusing on health behaviors and MCI to summarize the factors and evidence regarding the influence of health behaviors on MCI. Methods: The study performed a bibliometric analysis by retrieving publications from the Science Citation Index and Social Sciences Citation Index subdatabases within the Web of Science Core Collection. Utilizing VOSviewer and CiteSpace software, a total of 2,843 eligible articles underwent co-citation, cokeywords, and clustering analyses. This methodology aimed to investigate the current status, trends, major research questions, and potential future directions within the research domain. Results: The bibliometric analysis indicates that research on healthy behaviors in individuals with MCI originated in 2002 and experienced rapid growth in 2014, reflecting the increasing global interest in this area. The United States emerged as the primary contributor, accounting for more than one-third of the total scientific output with 982 articles. Journals that published the most articles on MCI-related health behaviors included "Journal of Alzheimer's Disease," "Neurobiology of Aging," "Frontiers in Aging Neuroscience," and other geriatricsrelated journals. High-impact papers identified by VOSviewer predominantly cover concepts related to MCI, such as diagnostic criteria, assessment, and multifactorial interventions. Co-occurrence keyword analysis highlights five research hotspots in health behavior associated with MCI: exercise, diet, risk factors and preventive measures for dementia, cognitive decline-related biomarkers, and clinical trials. Conclusion: This study provides a comprehensive review of literature on health behavior in individuals with MCI, emphasizing influential documents and journals. It outlines research trends and key focal points, offering valuable insights for researchers to comprehend significant contributions and steer future studies. [ABSTRACT FROM AUTHOR]

Background: Interleukin17 (IL17) is an important cytokine in host defense at mucosal surfaces and also mediates many autoimmune diseases, including rheumatoid arthritis (RA). In recent years, many types of research relevant to the structure and function of IL17 have been identified. However, there is no bibliometric analysis in this research field. This study aims to explore the history, research hotspots, and emerging trends of IL17 from the perspective of the structure and function dynamics. Methods: Articles relevant to IL17 in the last two decades were retrieved through the Web of Science Core Collection (WoSCC) database. The bibliometric analysis was performed by VOSview. Results: A total of 882 papers in this research were analyzed from 65 countries, and the rate of published articles has increased from 2008 annually, with the USA, China, and Germany leading the research effort. Frontiers in Immunology has significantly impacted research in this field and the University of Pittsburgh was the leading institution. Gaffen, Sarah L. from the University of Pittsburgh was the most productive researcher in this field and Papp Ka from the Probity Medical Research Incorporate of Canada is the most co-cited author. The analysis of keywords showed that inflammation, expression, Th17 cells, and cytokines were the main hotspots and frontier directions of IL17. The trend of clinical application in the future is the development of new therapy drugs based on the structure of IL17 or IL17 signaling pathway molecular. Conclusions: Our research summarized the developments and research trends of IL17 and would help researchers understand the research status of IL17 and provide a reference for future researchers as soon as possible. [ABSTRACT FROM AUTHOR]

SARS-CoV-2 serology may be helpful to retrospectively understand infection dynamics in specific settings including kindergartens. We assessed SARS-CoV-2 seroprevalence in individuals connected to kindergartens in Berlin, Germany in September 2021. Children, staff, and household members from 12 randomly selected kindergartens were interviewed on COVID-19 history and sociodemographic parameters. Blood samples were collected on filter paper. SARS-CoV-2 anti-S and anti-N antibodies were assessed using Roche Elecsys. We assessed seroprevalence and the proportion of so far unrecognized SARS-CoV-2 infections. We included 277 participants, comprising 48 (17.3%) kindergarten children, 37 (13.4%) staff, and 192 (69.3%) household members. SARS-CoV-2 antibodies were present in 65.0%, and 52.7% of all participants were vaccinated. Evidence of previous infection was observed in 16.7% of kindergarten children, 16.2% of staff, and 10.4% of household members. Undiagnosed infections were observed in 12.5%, 5.4%, and 3.6%, respectively. Preceding infections were associated with facemask neglect. In conclusion, two-thirds of our cohort were SARS-CoV-2 seroreactive in September 2021, largely as a result of vaccination in adults. Kindergarten children showed the highest proportion of non-vaccine-induced seropositivity and an increased proportion of previously unrecognized SARS-CoV-2 infection. Silent infections in pre-school children need to be considered when interpreting SARS-CoV-2 infections in the kindergarten context. [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]

College students have been recognized as a risk group for substance use. Nevertheless, coherent risk factors for stimulant use remain to be elucidated. The objective of this paper is to identify risk factors associated with the recreational use of MDMA, cocaine, amphetamine and methamphetamine. An online questionnaire was distributed among colleges in Berlin. A sample of 12,914 college students participated, of which 9,382 met the inclusion criteria. Past-month prevalence was 7.0% for MDMA, 6.7% for amphetamine, 5.8% for cocaine and 0.1% for methamphetamine. Associated factors included male gender, "other" gender, homosexual and bisexual orientation, open relationship status or being single, engaging in sexual risk-taking behavior, having a psychiatric diagnosis, tobacco use, drinking alcohol and an increased number of (illicit) substances consumed in the past month and in life. Berlin college students showed a substantially higher prevalence of stimulant use compared to both the general population and college students in other cities. Certain parameters, e.g., polydrug use, were particularly high in this group. The results can be used in further development of prevention efforts. However, conclusions about causality are limited by the cross-sectional nature of this study, highlighting the necessity for longitudinal studies in this field. [ABSTRACT FROM AUTHOR]

Copyright of European Journal of Social Work is the property of Taylor & Francis Ltd and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Aim: To describe activities and professional characteristics of nurses in expanded roles in acute care in Germany and achieve a greater understanding of the current situation of advanced practice nursing. Background: Advanced practice nursing plays an important role in meeting increased demands in healthcare and promoting high‐quality care. Introduction: In Germany, advanced practice nursing is still at an early stage with a lack of studies describing the scope of practice of nurses in expanded roles. Methods: We conducted a cross‐sectional‐study using a paper‐and‐pencil questionnaire. In a nationwide convenience sample, we surveyed nurses with an academic degree, who work in an acute care hospital and take over expanded roles in direct patient care. Reporting followed the STROBE checklist. Results: Of 108 eligible nurses, 84 (77%) completed the survey. The majority had a Master's degree (63.1%) and the average work experience was 18.2 years. Participants carried out activities in all the domains that were queried (direct clinical practice, guidance and coaching, consultation, leadership and research) with differences within and between domains. Foci were on direct clinical practice and coaching and guidance. Discussion: In Germany, qualifications are nearing the international standard of advanced practice nursing. Results suggest that participants partly undertake activities within the scope of registered nurses' practice that do not correspond fully to their formal qualifications. Conclusion and implications for nursing and/or health policy: In order to foster the role development of expanded practice nurses in Germany, political efforts are needed in terms of training (e.g. specific Master's programmes), funding of corresponding positions in practice and control mechanisms (e.g. professional registration). [ABSTRACT FROM AUTHOR]

Background: The aim of this study was to investigate the effects of different types of bleaching methods and repolishing on the whiteness index and staining susceptibility of additive and subtractive production resin-based materials and direct composite resins. Methods: In this study, a total of 96 samples (8*8*2m) were prepared using a nanohybrid composite resin (Neo SpectraTM-ST (NS)), a subtractive-manufactured nanoceramic resin (CerasmartTM270 (CS)), and an additive-manufactured permanent resin (Saremco print Crowntec (CT)). The samples were randomly divided into four treatment groups: control (distilled water, 14 days), in-office bleaching (Opalescence Boost-40% HP, 3*20min), at-home bleaching (Opalescence PF-16% CP, 6 h, 14 days), and toothpaste group (Opalescence Whitening, 2*5min, 14 days) (n:8). After each the bleaching procedure was completed, the samples were kept in coffee solution for 7 days. Following, all samples were repolished. The color of the samples was measured with a spectrophotometer at baseline (T0), after bleaching (T1), after staining in coffee (T2) and after repolishing (T3). The whiteness index change (∆WID, T1-T0), staining susceptibility (∆E1, T2-T1) and color change after repolishing (∆E2, T3-T1) of the samples were calculated in the CIE (Commission International De I'Eclairage) system. The data were analyzed by SPSS software One-Way ANOVA, post-hoc Tukey, post-hoc Tamhane's-T2 and Paired-samples T test (α = 0.05). Results: The ∆WID of all tested materials was significantly different in the in-office bleaching group compared to the control group (p < 0.05). Among the bleaching groups, the highest ∆WID was obtained in-office bleaching group of CT (2.91 ± 4.12). Staining susceptibility after bleaching (∆E1) was higher in the in-office and at-home bleaching groups compared to the control group in all tested materials. However, the difference between the treatment groups was statistically significant in NS and CS (p < 0.05). The highest ∆E1 was obtained in the in-office group of CT (7.36 ± 4.82). Color changes after repolishing (∆E2) of the tested materials were less in all groups compared to ∆E1. Conclusion: In-office and at-home bleaching can increase the whiteness index change and stain susceptibility of materials. Among the tested materials, the color stability of additive-manufactured CT was comparatively poorer. The repolishing was found to be beneficial in reducing staining. [ABSTRACT FROM AUTHOR]

Background: The aim of this study was to develop and psychometrically evaluate a parent-rated parenting assessment scale including positive and negative dimensions of parenting. Factorial validity, reliability, measurement invariance, latent mean differences and construct validity of the Assessment Scale of Positive and Negative Parenting Behavior (FPNE) were tested in a pooled sample of five studies of 1,879 school-aged children (6.00 to 12.11 years). Methods: Exploratory factor analysis (EFA) was performed on a first randomized split-half sample, and confirmatory factor analysis (CFA) and exploratory structural equation modeling (ESEM) were conducted in the second half of the sample. Measurement invariance tests were conducted to assess factor structure equivalence across gender and age. Results: The EFA results supported a two-factor structure and the CFA results revealed a model with two correlated factors (Positive Parenting, Negative Parenting), which included 23 items and showed acceptable model fit and good psychometric properties. ESEM did not yield a model with significantly better model fit. Internal consistencies were acceptable. Adequate concurrent validity was demonstrated by low to moderate correlations between the FPNE and similar constructs. The factor structure was invariant (configural, metric, scalar) across different age groups and gender. Tests of latent mean differences revealed that older children scored significantly higher on negative parenting than younger children, while boys showed lower levels of positive parenting and higher levels of negative parenting compared to girls. All effect sizes were small. Conclusions: The results suggest that the FPNE is a reliable and valid instrument for the assessment of parenting. [ABSTRACT FROM AUTHOR]

Background: The growing shortage of General Practitioners (GPs) is a Europe-wide challenge, particularly in rural areas. In Germany, the situation is worsened by an ageing workforce of GPs and insufficient training of new doctors. Many newly qualified physicians choose careers outside primary care or prefer to work part-time to balance work and family life. To address this problem, it is essential to understand the factors that influence medical students' specialty choice, and then to take action to encourage them to specialise in General Practice (GP). In addition to medical school experiences, rural placements, or characteristics of the specialty, personality traits have been shown to influence students' specialty decisions. A well-researched approach to assessing personality is the Five-Factor Model, which measures personality on the dimensions openness (to experience), conscientiousness, extraversion, agreeableness, and neuroticism. Using the findings about the links between students' personalities and an increased interest in a career in General Practice may be an approach to raising the number of GPs. Objectives: We aimed to examine how students' personality traits influence their interest in General Practice and their current intention to pursue General Practice as a specialty. Methods: In March 2021, we started an ongoing online survey among medical students at the University of Würzburg and assessed cross-sectional data about the 'Big Five' personality traits and aspects of career choice. Until December 2022, we invited three cohorts of first-year beginners, and one cohort each of third-, fifth- and sixth-year students via email to participate in the survey. For statistical analysis, we performed linear regression and extended it into a path model to examine the relationship between students' personality traits, their interest in General Practice, and whether they would currently choose General Practice for their future specialty. We controlled for possible confounding effects of age, gender, and current semester by using covariates. Results: Higher levels of agreeableness and neuroticism predicted greater interest in GPs, whereas higher levels of conscientiousness and openness predicted less interest in GPs. The effects of extraversion were unclear. Age was a significant predictor of interest, with older age associated with greater interest in General Practice. Gender was not a significant predictor of interest in General Practice, and the results for semester were inconclusive. The interest in General Practice is a predictor of the intention to choose GP as a specialty. The personality dimensions show an indirect predictive effect on the intention to choose GP, mediated by interest in GP. In total, R² = 7.7% of the variance of the interest in GP was explained by the combination of personality dimensions and covariates. Conclusion: Our study reveals that students' personality traits predict their interest in General Practice and their intention to choose it as a specialty. Personality assessments can be integrated into counselling services to help students better understand their traits. Our findings highlight the great potential of considering personality in career counselling during medical education or even the extent of admission criteria to medical school by personality-related criteria. [ABSTRACT FROM AUTHOR]

Objective: Over the last decades, psychotherapy of psychosis has increasingly gained attention. The quality of the therapeutic alliance has been shown to have an impact on therapy outcome. Yet, little is know about the influence of the therapeutic stance on the alliance. In this study, we explore psychotherapists' stance towards persons with psychosis with the aim of better understanding its characteristic—hindering and helpful—aspects. Method: 6 semi-structured interviews with psychotherapists from three different schools (CBT, PD, ST) were analysed with Grounded Theory. Credibility was checked through external and peer-researcher-supported debriefing. Results: 4 core categories were generated and interrelated in a theoretical model. Therapists' stance was initially characterized by uncertainty. Different ways of dealing with uncertainty yielded different stances: a monological and an open one. A helpful stance was conceived as stemming from openness and was characterized by a dialogical structure. A co-presence (or „dosing") of you and I was conceived as its core aspect. Conclusion: These findings specify the interpersonal dynamics arising from different stances and their impact on the therapeutic alliance and process. Research is still needed to further understand the characteristics of helpful and hindering therapeutic stances, which should also inform the training of psychotherapists. [ABSTRACT FROM AUTHOR]

Emergency workers are confronted with trauma as an essential part of their work. Learning how to moderate the impact and coping with traumatic experiences is at the center of this study. The researchers empirically chart ways that emergency workers cope with trauma, process and integrate these experiences, and describe what supports their learning. Findings suggest a need to engage in alternative forms of communication, differentiating between professional and emotional feedback in order to foster transformative learning. The study reveals two different, complementary ways to constructively communicate, each with its own architecture: structured debriefs and transformative conversations. Mezirow borrowed from Habermas's idea of rational discourse in dialogue, some of which is seen in debriefs, wherein emotions are set aside in the intensity of the moment in favor of processing facts and identifying decisions and actions for the future. In transformative conversations, by contrast, emergency workers seek to understand their inner selves and make meaning of their experiences. The research shows that certain conditions for transformative conversations need to be in place in order to work through emotions and unblock cognition by recognizing and working through affect, emotion, and potential vicarious trauma. This qualitative analysis derives from 57 reflective writings collected from paramedics and firefighters. [ABSTRACT FROM AUTHOR]

Background: Incident reporting systems (IRSs) have become a central instrument for improving patient safety in hospitals. In Germany, hospitals are legally required to implement internal IRSs, while participation in cross-institutional IRSs is voluntary. Methods: In a retrospective, descriptive cross-sectional study, the structured quality reports of all German hospitals from 2017 to 2022 (2598–2408 hospitals (2017–2022)) were analysed. The participation of hospitals in internal and cross-institutional IRSs was examined, as was the frequency of training and evaluations of incident reports. Results: The rate of participation in internal IRSs increased from 94.0% in 2017 to 96.6% in 2019 and remained stable at 96.0% in 2022. About 85% of hospitals conducted internal evaluations of the incident reports, with monthly evaluations being the most common (33.9%). Training on how to use IRSs was mostly provided on an ad hoc basis (41.6% in 2022), with regular training being less common. Participation in cross-institutional IRSs increased significantly from 44.5% in 2017 to 55% in 2019 and remained stable until 2022. Participation in hospital IRSs showed significant increases, while specialised systems exhibited lower participation rates. Conclusions: Internal IRSs have been established in German hospitals; however, there is still room for improvement in conducting regular training sessions and evaluations. Although participation in cross-institutional IRSs has increased, it remains fragmented. Further centralisation and standardisation could enhance efficiency and contribute to an improvement in patient safety. [ABSTRACT FROM AUTHOR]

Purpose: To give an overview of the multicenter Prostate Cancer Outcomes (PCO) study, involving paper-based and web-based collection of patient-reported outcome measures (PROM) in patients undergoing local treatment for prostate cancer in certified centers in Germany. The PCO study is part of the larger Movember-funded TrueNTH Global Registry. The article reports on the study's design and provides a brief progress report after the first 2 years of data collection. Methods: Prostate cancer centers (PCCs) certified according to German Cancer Society requirements were invited to participate in collecting patient-reported information on symptoms and function before and at least once (at 12 months) after treatment. The data were matched with disease and treatment information. This report describes progress in patient inclusion, response rate, and variations between centers relative to online/paper use, and also data quality, including recruitment variations relative to treatment in the first participating PCCs. Results: PCC participation increased over time; 44 centers had transferred data for 3094 patients at the time of this report. Patient recruitment varied widely across centers. Recruitment was highest among patients undergoing radical prostatectomy. The completeness of the data was good, except for comorbidity information. Conclusions: The PCO study benefits from a quality improvement system first established over 10 years ago, requiring collection and harmonization of a predefined clinical dataset across centers. Nevertheless, establishing a PROM routine requires substantial effort on the part of providers and constant monitoring in order to achieve high-quality data. The findings reported here may be useful for guiding implementation in similar initiatives. [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]

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]

Background: Delivering high quality care tailored to patients' needs necessitate patient-centered communication. High physical and mental workload, as well as organizational barriers, contribute to challenges nurses face in patient-centered communication. Participation in a communication skills training can help nurses to improve their patient-centered communication skills. Thus, the aim of this study was to investigate the experiences of nursing professionals in patient-centered communication and delineate the requisite content for a communication skills training. Methods: We conducted focus group interviews with nursing professionals working at an academic medical center in Germany. The focus group interviews were audio-recorded and transcribed verbatim. Data analysis was performed using Kuckartz's qualitative content analysis. Results: 31 nursing professionals from diverse medical disciplines (e.g., pediatrics, obstetrics, cardiology, neurology, oncology) participated in the study, unveiling a spectrum of communication experiences, including organizational and system-related challenges, constraints induced by the COVID-19 pandemic, management of personal emotions, and communication challenges with patients and relatives. They also identified aspects they experienced as beneficial for patient-centered communication (e.g., allocating sufficient time, being authentic, providing clear information). Furthermore, participants identified specific aspects, which should be included in a patient-centered communication skills training. Conclusion: The findings suggests that not only nurses from oncology and intensive care, but also from other medical disciplines, experience significant communication challenges with patients and relatives. Applying patient-centered aspects of communication was considered beneficial for effective communication. The needs identified through participants' experiences (e.g., core communication skills and strategies, handling escalating situations, and discussing serious illness, death and dying) informed the development of a patient-centered communication skills training specifically tailored for nursing professionals across diverse medical disinclines in Germany. [ABSTRACT FROM AUTHOR]

Background: The use of online information and communication is globally increasing in the healthcare sector. In addition to known benefits in other medical fields, possible specific potentials of eHealth lie in the monitoring of oncological patients undergoing outpatient therapy. Specifically, the treatment with immune checkpoint inhibitors (ICI) requires intensive monitoring due to various possible negative side effects. The present study explores cancer patients' perspectives on eHealth and demonstrates how eHealth applications, from the patients' point of view, can contribute to further improving outpatient immunotherapy. Methods and findings: Our multicenter study was executed at the university hospitals in Bonn and Aachen. A structured questionnaire was distributed to patients receiving outpatient immunotherapy. Contents addressed were (1) the patients' attitude towards eHealth applications, (2) the use of modern information and communications technologies (ICT) in (2a) everyday life and (2b) health-related information search including eHealth literacy, (3) the use of internet-enabled devices as well as (4) socio-demographic data. 164 patients were included in the study, of whom 39.0% were female and 61.0% male and the average age was 62.8 years. Overall, there was a high distribution of internet-enabled devices for everyday use and a great interest in integrating eHealth applications into outpatient immunotherapy. The assessment of eHealth potentials significantly depended on age. The younger participants demonstrated a broader use of modern ICT and a higher affinity for its use in outpatient immunotherapy. In some aspects, level of education and gender were also relevant factors influencing the patients' view on eHealth. Conclusion: This study demonstrates the potential for further integration of eHealth applications into outpatient immunotherapy from the patients' perspective. It indicates a dependency on age and educational level for the further integration of eHealth into patient care in oncology. Due to particular patient needs regarding age, level of education, gender and other subgroups, specific education and training as well as target-group specific digital health interventions are necessary to fully utilize the potentials of eHealth for outpatient immunotherapy. Future studies are required to specifically address target-group specific usability of eHealth applications and eHealth literacy, as well as to address information security and data protection. [ABSTRACT FROM AUTHOR]

Background: The opportunities of perinatal medicine have improved, but this has also been accompanied by increasing ethical challenges. Clinical ethics consultation services (CEC) could support medical teams facing these. However, nothing is currently known about the availability, utilization and evaluation of CEC in German neonatology units. Methods: This study was designed as a national, descriptive, mixed quantitative–qualitative questionnaire study. The head physicians of the pediatric departments and the heads (medical and nursing) of the corresponding neonatal intensive care units of the 213 German perinatal centers were asked to participate. Results: Ninety percent of the respondents (responding rate 24.4–38.0%) stated that CEC are established and available. However, utilization is rather low [rarely N = 40 (54.1%), never N = 12, (16.2%), occasionally N = 19 (25.7%)], although it was rated as very helpful. There was a significant correlation between utilization and perceived general usefulness (r = 0.224, p = 0.033) and support (r = 0.41, p < 0.001); whereas evaluations differed significantly between professional groups (t = −2.298, p = 0.23, Cohen's d = 0.42). Conclusions: The contradiction between the low utilization despite positive evaluations could be related to perceived hurdles. These and the different perceptions within the professional groups give rise to the consideration of whether alternative approaches, e.g., liaison services, would be preferable in neonatology. [ABSTRACT FROM AUTHOR]

Medical guidelines recommend actively addressing patients' information needs regarding complementary and integrative healthcare (CIH). Within the CCC-Integrativ study, an interprofessional counseling program on CIH was developed and implemented at four comprehensive cancer centers (CCCs) in Germany. As part of the process evaluation, this study examines cancer patients' experiences with interprofessional CIH counseling sessions conducted by a physician and a nurse. Forty problem-centered interviews were conducted using a semi-structured interview guide. All interviews were audio-recorded, transcribed verbatim, and analyzed using deductive–inductive content analysis based on Kuckartz and Rädiker's approach. Findings revealed that most participants had prior experience with CIH approaches and were burdened by physiological and psychological symptoms. Counseling sessions focused on cancer- and treatment-related symptoms and appropriate CIH recommendations (e.g., herbal poultice against anxieties and acupressure against nausea). Participants appreciated the mutual exchange and integration of perspectives from different healthcare professions within the interprofessional approach. They noted that the counseling team comprehensively addressed their healthcare and CIH information needs. Suggestions for improvement included the specificity of the CIH recommendations. As the participants only received counseling and no CIH treatments, information about reputable CIH providers was particularly important to many seeking advice. Patients with cancer receiving tailored CIH counseling from two healthcare professionals experienced benefits in CIH counseling for symptom management. The interprofessional teams offered a comprehensive perspective on patients' needs, proposing personalized recommendations for symptom control. These insights may foster collaboration between healthcare professionals interested in CIH counseling, enabling them to expand and consolidate their counseling services. [ABSTRACT FROM AUTHOR]

Background: In addition to the integrity of the meniscal hoop function, both the anterior and posterior meniscus roots as well as the meniscotibial and meniscofemoral ligaments are crucial in restraining meniscal extrusion. However, the interaction and load sharing between the roots and these peripheral attachments (PAs) are not known. Purposes: To investigate the influence of an insufficiency of the PAs on the forces acting on a posterior medial meniscus root repair (PMMRR) in both neutral and varus alignment and to explore whether meniscal centralization reduces these forces. Study Design: Controlled laboratory study. Methods: In 8 fresh-frozen human cadaveric knees, an arthroscopic transosseous root repair (step 1) was performed after sectioning the posterior root of the medial meniscus. The pull-out suture was connected to a load cell to allow measurement of the forces acting on the root repair. A medial closing-wedge distal femoral osteotomy was performed to change the mechanical axis from neutral to 5° of varus alignment. The meniscus was completely released from its PAs (step 2), followed by transosseous arthroscopic centralization (step 3). Each step was tested in both neutral and varus alignment. The specimens were subjected to nondestructive dynamic varus loading under axial compression of 300 N in 0°, 15°, 30°, 45°, and 60° flexion. The changes in force acting on the PMMRR were statistically analyzed using a mixed linear model. Results: Axial loading in neutral alignment led to an increase of the force of root repair of 3.1 ± 3.1 N (in 0° flexion) to 6.3 ± 4.4 N (in 60° flexion). In varus alignment, forces increased significantly from 30° (3.5 N; 95% CI, 1.1-5.8 N; P =.01) to 60° (7.1 N; 95% CI, 2.7-11.5 N; P =.007) flexion, in comparison with neutral alignment. Cutting of the PAs in neutral alignment led to a significant increase of root repair forces in all flexion angles, from 7.0 N (95% CI, 1.0-13.0 N; P =.02) to 9.1 N (95% CI, 4.1-14.1 N; P =.003), in comparison with the intact state. Varus alignment significantly increased the forces in the cut states from 4.8 N (95% CI, 1.0-8.5 N; P =.02) to 11.1 N (95% CI, 4.2-18.0 N; P =.006) from 30° to 60° flexion, in comparison with the neutral alignment. Arthroscopic centralization led to restoration of the native forces in both neutral and varus alignment, with no significant differences between the centralized and intact states. Conclusion: An insufficiency of the PAs of the medial meniscus, as well as varus alignment, led to increased forces acting on a PMMRR. These forces were reduced via an arthroscopic meniscal centralization. Clinical Relevance: Performing arthroscopic meniscal centralization concomitantly with PMMRR may reduce failure of the repair by reducing the load of the root. [ABSTRACT FROM AUTHOR]

Background: The use of Complementary and alternative medicine (CAM) in chronic liver disease (CLD) patients in Germany is unknown. This study investigated the frequency of CAM use and associated sociodemographic, clinical and personality factors in CLD patients in Germany. Methods: This is a cross-sectional multicenter study of CLD patients attending liver outpatient clinics of university hospitals in Halle(-Saale) and Homburg between 2015 and 2017. Dedicated questionnaires recorded CAM use, sociodemographic and personality factors (evaluated with the "Big five" model, "Hospital Anxiety and Depression"-, "Multidimensional Health Locus of Control"- score). Uni- and multivariate analyses assessed factors associated to CAM use. Results: Overall 378 patients were recruited, 92 (24.3%) reported to CAM use. On univariate analysis, female CAM users were older (p = 0.001) and more physically active (p = 0.002), male CAM users more often used homeopathy (p = 0.000), actively promoted their health (p = 0.010) or had UDC in their medication (p = 0.004). Logistic regression analysis adjusted for personality factors showed significant association of age, physical exercise (females) and satisfaction with alternative medicine (females, males) to CAM use. Conclusions: CAM use is prevalent among CLD patients in Germany and is significantly associated to satisfaction with alternative medicine (females, males), physical exercise and older age (females). Doctors should actively inquire CLD patients about CAM use, as hepatotoxicity or interaction with medication can occur. [ABSTRACT FROM AUTHOR]

Aim: Individual experiences shape perceptions of illness. Post-Soviet migrants have different expectations of chronic disease treatment than German patients. This study aimed to delve into perceptions of diabetes mellitus, a topic of increasing importance in global migration. Design: Qualitative, semi-structured interviews were conducted with 26 post-Soviet migrants with diabetes and three Russian-speaking diabetes counselors, mainly recruited through a snowball system. Methods: The research data were analyzed using a hermeneutic approach. The categories of the common-sense self-regulation model and developed subcategories were scrutinized by means of content analysis, ensuring a comprehensive understanding of the data. Results: The perception of diabetes mellitus varied depending on the country where the diagnosis was made. This included the individual recording of symptoms, the expected time course, and the allocation of different competencies. Opportunities for access to the local healthcare system in the former Soviet Union influenced these expectations. Conclusion: The study’s findings underscore the importance of healthcare access in the country of origin and the patient’s knowledge of diabetes mellitus in shaping their perception and treatment. These factors, influenced by the social environment and the patient’s level of education, continue to play a role even after immigration to Germany. [ABSTRACT FROM AUTHOR]

Purpose: Within the student population, students who study sport at the university level represent a special cohort struggling with specific academic and developmental challenges. Therefore, it is reasonable to assume that sports students are particularly affected by the COVID-19 pandemic in terms of their mental health. The aim of this study is to examine whether mental health (i.e. depression and well-being) among sports students changed during the COVID-19 pandemic compared to the data before the COVID-19 pandemic. Design/methodology/approach: The current study compared 907 German sports students before the COVID-19 pandemic to 1,124 German sports students during the COVID-19 pandemic (55.7% BA students, 13.3% MA students and 29.4% PE students). Mental health was assessed with the Patient Health Questionnaire (PHQ-2) (risk for depression) and the well-being index (WHO-5). To identify students at risk, a cut-off score of = 3 (PHQ-2) or of = 12 (WHO-5) was used. Findings: The results show that across all study programs, the risk for depression was significantly higher and well-being was significantly lower during the COVID-19 pandemic compared to the pre-pandemic period. Moreover, remarkably more sports students were at high risk for depression (11.1% vs 38.3%) or showed strongly decreased well-being (24.6% vs 57.3%) during the COVID-19 pandemic compared to the pre-pandemic period. Originality/value: The results are comparable to those of other fields of study that do not involve physical activity. Implications for further research, for sports students' mental health practice and for mental health professionals are discussed. It remains to be examined to what extent this impairment also has an impact on the further psychological development of the students after the pandemic. [ABSTRACT FROM AUTHOR]

Introduction. Pediatric traumatology is a complex field that requires a comprehensive understanding of physeal development, remodeling potential, and the ossification process in order to ensure appropriate patient treatment. The objective of this study was to assess the willingness of practicing physicians to participate in a telemedicine collaboration aimed at enhancing the exchange between the outpatient and inpatient sectors and promoting the digitalization of the pediatric sector. This is in response to the growing significance of digitalization in the medical field. Methods. A survey consisting of 15 items was sent to 800 practicing trauma surgeons, pediatric surgeons, and pediatricians within a 100 km radius of Hamburg, Germany. The survey included questions about the respondents' professional experience and telemedicine experience, as well as inquiries about possible telemedicine collaborations. Results. The response rate was 19.3%. Less than half of the participants already used telemedicine in daily practice. In general, 75% of respondents expressed an interest in collaborating with the inpatient sector. The most common reasons for hospital referral were the need for surgery, inadequate treatment of children in practice and co-assessment. The majority were in favor of flexible communication, either via video telephony, imaging applications like or messaging applications. Conclusions. The study revealed a high level of interest in telemedicine collaboration. Information exchange should be tailored to individual needs, with practitioners requiring a versatile and personalized approach that includes imaging. Strict enforcement of data protection regulations is essential. Further research is needed to evaluate the effectiveness of telemedicine collaboration in the treatment of pediatric trauma in both hospital and outpatient settings. [ABSTRACT FROM AUTHOR]

Background/Objectives: In recent years, changing paradigms, both culturally and scientifically, have fundamentally altered the approach to the treatment of children with Disorders of Sexual Development (DSD) prior to reaching the age of legal consent. In Germany, the situation changed with the introduction of legislation that includes a partial ban on DSD surgery in children in 2021. This study aims to analyze the impact of this legislation on clinical practice. Methods: From 2014 to 2024, all patients with DSD in our institution were included. The study group comprised all patients operated on after the legislation. All patients operated on before the legislation served as the control group. Karyotype, phenotype, resulting type of DSD, age at presentation and age at operation were recorded. Results: A total of 35 patients were included in this study, with 15 in the study group and 20 in the control group. The operation was authorized by the family court for all patients in the study group. A total of 46,XY patients with severe hypospadias and clinical aspect of intersexual outer genitalia were the largest proportion (25 patients, 71.4%). Nine patients (25.7%) were 46,XX girls with classical congenital adrenal hyperplasia (CAH) type. One patient (2.9%) showed a mixed gonadal dysgenesis. The mean age of the patients at first presentation in our institution was 10.7 months in the control group and 11.0 months in the study group. The mean age at operation was significantly higher in the study group (20.1 months) compared to the control group (15.1 months; p = 0.032, unpaired t-test). Conclusions: The introduction of the legislation with a partial ban of genital surgery in DSD children in Germany has led to a significant delay in surgery. Since the majority of the patients comprise severe hypospadias and 46,XX CAH patients, further amendments of the law are proposed to minimize potential harm. [ABSTRACT FROM AUTHOR]

Background: To assess quality of life and unmet needs after stroke, patient-reported outcome measures (PROMs) have gained increasing attention. However, patients' perspectives on assessing PROMs remain unclear, potentially hindering implementation into clinical practice. Therefore, this study explored patients' preferences on assessing PROMs after ischemic stroke. Methods: A paper-based questionnaire was sent to stroke survivors treated at the Department of Neurology, University of Leipzig, Germany. Health-related quality of life (HRQoL, EQ-5D-5L) and preferences regarding different aspects of data collection to assess PROMs were investigated and linked to socio-demographic and medical characteristics. Results: 158 persons were contacted and 80 replies were subsequently analyzed. Mean age was 70.16 years and mean HRQoL was 68.79 (visual analogue scale with a theoretical maximum of 100). Participants showed positive attitudes towards PROMs as they saw potential to improve care of other patients (n = 66/79; 83.54%) or to improve their own situation (n = 53/74; 71.62%). Participants preferred an annual interview after stroke (n = 39/80; 48.75%) and would preferably spend 15–30 min (n = 41/79; 51.90%) to answer a written survey (n = 69/80; 86.25%). The initially treating clinic was preferred as initiator of such surveys (n = 43/79; 54.43%). Stratification revealed that participants with more than 1 h of daily digital media usage preferred email as way of communication. Conclusions: For the first time, this study showed individual preferences on assessing PROMs after ischemic stroke, focusing on the way, time interval, duration, and initiation site of surveys. These insights might help to successfully implement PROMs after stroke and subsequently detect unmet needs and deficits in stroke care. [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]

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Reflective smartphone disengagement (i.e., deliberate actions to self-regulate when and how one should use one's smartphone) has become a necessary skill in our ever-connected lives, contributing to a healthy balance of related benefits and harms. However, disengaging from one's smartphone might compete with impulsive psychosocial motivators such as fear of missing out (FoMO) on others' rewarding experiences or feelings of loneliness. To shed light into these competitive processes, the present paper disentangles the reciprocal, over-time relationships between reflective smartphone disengagement, FoMO, and loneliness using data from a two-wave panel study among emerging adults (16–21 years of age). Measurement-invariant structural equation modeling suggests that FoMO and reflective smartphone disengagement negatively predict each other over time, indicating a possible spiraling process. In addition, reflective smartphone disengagement was also negatively related to feelings of loneliness. Together, these findings underline (a) how young people's impulsive and reflective system compete with each other over control of their smartphone usage, where (b) psychosocial benefits of reflective smartphone disengagement were validated among emerging adults, potentially helping them to strengthen the benefits and limit the harms of permanent interactions with and through technology. [ABSTRACT FROM AUTHOR]

The digitization of German hospitals is proceeding continuously, leading to the implementation of new digital technologies, such as electronic health records (EHRs) or other technologies, used for the purpose of medical documentation tasks. Even though the replacement of paper documentation through digitized documentation in general promises to come along with plenty of benefits, the daily utilization of technologies might also lead to stresses and strains among the medical staff, eventually possibly leading to the development of different negative work and health-related outcomes. This study, therefore, aims at identifying persisting digitization-associated stressors and resources among medical hospital staff, examining their influences on different work and health-related outcomes, and finally, identifying potential needs for preventive measures. A quantitative study in the form of an online questionnaire survey was conducted among physicians working in the medical field of neuro- and vascular surgery in German hospitals. The study was carried out between June and October 2022 utilizing an online questionnaire based on several standardized scales, such as the technology acceptance model (TAM) and the technostress model, as well as on several scales from the Copenhagen Psychosocial Questionnaire (COPSOQ). The study found medium levels of technostress among the participating physicians (n = 114), as well as low to medium levels of persisting resources. The queried physicians, on average, reported low levels of burnout symptoms, generally described their health status as good, and were mostly satisfied with their job. Despite the prevalence of technostress and the low levels of resources among the surveyed physicians, there is little awareness of the problem of digital stress, and preventive measures have not been widely implemented yet in the clinics, indicating a needs gap and the necessity for the strategic and quality-guided implementation of measures to effectively prevent digital stress from developing. [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]

Background/Objectives: Early childhood can be a stressful period for families with a significant impact on parents' mental health, the child's healthy development, and the development of a secure mother–child attachment. The goal of the cross-sectional study part of SKKIPPI was to assess the occurrence of psychosocial stress and mental health disorders in parents as well as in their offspring in early childhood in three German regions. Methods: Based on random samples from three residents' registration offices, parents with infants aged up to 12 months were invited to participate. An online screening questionnaire was developed in four languages to assess common psychosocial stressors and mental health problems of parents with small children. Results: The study enrolled 4984 mothers and 962 fathers. The most common potential psychosocial stressors were professional problems (mothers 22%, fathers 33%), lack of social support (20%, 14%), and severe, negative experiences in childhood (22%, 16%). Obsessive–compulsive thoughts (21%, 16%) and depressive (9%, 9%) and anxiety symptoms (11%, 7%) were the most frequently reported mental health problems by both parents. Regulatory problems of the child were reported by between 1.5% and 5.1% of parents. Conclusions: The study showed that a substantial proportion of parents are burdened by psychosocial problems and suffer from mental health problems in the first years after the birth of their children. Early preventive and low-threshold support measures should be available in the health and social care system. Low-threshold questionnaires, which cover a wide range of possible stress factors, should be further developed for the practical healthcare of this group of people. [ABSTRACT FROM AUTHOR]

Background: Caring for terminally ill patients with minor children can be very stressful. The perceived quality of life is significantly influenced by the Meaning in Life (MiL). No studies were found that focus on the prioritized special needs of this patient group. Objectives: The aim is to compare and contrast terminally ill parents with minor children and palliative care patients in Germany, in order to provide appropriate support beyond medical, nursing or therapeutic interventions. Methods: Terminally ill parents diagnosed were surveyed using a validated instrument 'Schedule for Meaning in Life Evaluation (SMiLE)'. The study listed various areas that contribute to the MiL, followed by an evaluation of their importance and satisfaction levels. The researchers then compared these findings with data collected from palliative care patients. Results: In Germany, 54 patients, mostly female and with a mean age of 43, were included in this study between February 2017 and September 2020. The median age of the 96 children during the survey phase was 7 years. The comparison group consists of 100 palliative care patients in Germany; mostly aged 50 years and older. For terminally ill patients most important areas were in decreasing order family (100%), social relations (80%), leisure time (61%), nature/animals (39%) and home/garden (30%). Although the overall indices are close between both groups, there are significant and highly correlated differences between them. Parents felt limited by their illness in being a mother or father, as they wanted to be. Conclusion: The involvement with SMiLE led patients to consider their coping resources. The areas relevant to terminally ill parents differed from those relevant to palliative care patients. All participants identified family as the most important factor for MiL. The results suggest that evaluating MiL can serve as a coping strategy and help terminally ill parents with minor children. Plain language summary: A comparison of answers to the meaning in life from seriously ill parents with young children with the answers of other seriously ill patients Background: Caring for seriously ill patients with young children can be very stressful. The quality of life depends on meaning in life. No studies were found that focus on the needs of this patients. Objectives: The aim was to explore similarities and differences between seriously ill parents with young children and palliative care patients in Germany to find the best way to support them. Methods: The Meaning in Life questions were used to find this out. Two researchers asked seriously ill parents about different things that make their lives meaningful. The researchers then compared the results with data from other seriously ill patients in need of palliative care. In Germany, 54 seriously ill parents with young children were interviewed between February 2017 and September 2020. The children were usually seven years old. The compared group consisted of 100 palliative care patients and was mostly older than 49 years. For seriously ill patients most important were family, social relations, leisure time, nature/animals, and home/garden. The values seemed similar, but there are clear differences between the groups. Parents felt their illness limited them in being a mother or a father. Conclusion: The questions helped patients helped to remember meaning in life and set goals. The things that mattered to seriously ill parents were different from those that mattered to palliative care patients. All participants said that family was the most important thing for meaning in life. The results show that thinking about meaning in life can help. [ABSTRACT FROM AUTHOR]

Purpose: Poor mental health in men and women is attributable to disparities in physical traits, social roles, power and health-seeking behaviours. This study aims to examine the gender differences in mental health among Pakistan and German university students and focuses on their right to seek mental health care. Design/methodology/approach: Data on depression, anxiety and stress symptoms, as well as positive mental health (PMH), resilience, social support and life satisfaction, were gathered from Pakistani and German students. Findings: In contrast to the Pakistani group, where no such gender differences were seen, women in Germany reported higher degrees of stress, anxiety and depression, as well as a lower level of overall good mental health. In comparison to German men and women, Pakistani women scored equally high on resilience. While gender had no bearing on life happiness in either Pakistan or Germany, women in both countries perceived more social support than men did. Research limitations/implications: The study's strengths include its large sample size and battery of mental health measures. The results of partial weak measurement Invariance (MI) on the stress subscale underlined the importance of using MI in cross-cultural studies. The validity of a direct comparisons on sum score between different language versions or country samples shall be cautious. Still, there are limitations. Firstly, the authors did not differentiate gender and biological sex, and there was no group of non-binary gender. Pakistani (N = 1,840) and German (N = 7,890) students were in unequal numbers. Again, only university students were sampled, so the results cannot be generalised to older (probably less educated) populations. Self-reported data that mainly obtained via online survey were the third limitation. This design is cost-effective and easy to administer for cross-cultural survey research. However, social desirability and memory bias are common in self-report inventories. Fourthly, although English is an official language in Pakistan and the medium of instruction in education, the authors recommend future study to use questionnaires that have been translated and validated into Urdu (Pakistan's national language) and investigate gender differences in a general population. Fifthly, this is a cross-sectional survey; the authors were not able to explore the causality or risk factors that contribute to the poor mental well-being in Pakistan students in general or the relatively worse mental health in German women. Future studies may investigate the mechanism behind the phenomena observed in this study with longitudinal or experimental design. Last but not least, Germany and Pakistan differ in so many different aspects from culture, religions and history to social structure and economic status, which make it hard to claim whether the observed differences were due to national differences, cultural differences, economic differences, gender inequality differences or other effects. It would be helpful for future studies to include more country samples with clear definitions of different "culture" aspects for a better understanding of gender differences in other countries and in different mental well-being constructs. Practical implications: The current study is the first attempt to compare the gender difference patterns in positive and negative mental health between European and South Asian counties and focuses on gender-specific approaches. Although Pakistani university students reported in general worse mental well-being, the differences between the two genders in mental health (e.g. depression, anxiety, general PMH) were not as pronounced as in the German student sample. Gender comparisons in these mental health constructs would help to improve protective factors against mental illness and to develop appropriate management programmes based on cultural differences. The results suggest that the gender differences found in western countries cannot always be directly translated into the South Asian cultural framework. Our results also highlight the importance of improving the general situation of Pakistan (students) instead of focusing on one gender. At the same time, in Germany, prevention and intervention plans are more warranted for women. It could be that once the general situation in Pakistan is improved, the gender-related differences in mental health will be clearly observed. Originality/value: These findings imply the significance of cultural context when inferring gender variations in mental health. Moreover, it supports the advancement of comprehensive policies to reduce gender-related mental health inequalities and focuses on the equal rights of men and women to get mental health care. [ABSTRACT FROM AUTHOR]

The present study explores how coming out to parents – in terms of both status (being out vs. not) and, if out, experience (continuum from rejection to acceptance) – affects trans people's mental health. Participants were 509 young adult trans individuals from Germany (community-based sample; 50% gender binary, 50% nonbinary; 16-35 years). The cross-sectional online study used standardized measures of coming out response, social support, and mental health. More participants were out to their mother than their father, but mothers did not respond with more acceptance. At the bivariate level, coming out experience, but not coming out status, was positively related to mental health. At the multivariate level, parental support mediated the association between both coming out variables and mental health. That is, trans people who were out to their parents and, if out, had a positive coming out experience received more parental support, which, in turn, was conducive to their mental health. There were no substantial differences between maternal and paternal effects, and effect sizes were equal for coming out status and experience. This study confirmed the crucial role that parents play when it comes to their child's coming out as trans – by accepting their child's gender identity early on and providing them with support. [ABSTRACT FROM AUTHOR]

Children with mathematical difficulties need to spend more time than typically achieving children on solving even simple equations. Since these tasks already require a larger share of their cognitive resources, additional demands imposed by the need to switch between tasks may lead to a greater decline of performance in children with mathematical difficulties. We explored differential task switch costs with respect to switching between addition versus subtraction with a tablet-based arithmetic verification task and additional standardized tests in German elementary school children in Grades 1 to 4. Two independent studies were conducted. In Study 1, we assessed the validity of a newly constructed tablet-based arithmetic verification task in a controlled classroom-setting (n = 165). Then, effects of switching between different types of arithmetic operations on accuracy and response latency were analyzed through generalized linear mixed models in an online-based testing (Study 2; n = 3,409). Children with mathematical difficulties needed more time and worked less accurately overall. They also exhibited a stronger performance decline when working in a task-switching condition, when working on subtraction (vs. addition) items and in operations with two-digit (vs. one-digit) operations. These results underline the value of process data in the context of assessing mathematical difficulties. [ABSTRACT FROM AUTHOR]

Objective: This cross-sectional, case-control study aimed to explore the psychodynamic characteristics that influenced adolescents' mental health during the COVID-19 pandemic. Methods: Personality structure impairments, psychodynamic conflicts, defense styles, and mental health issues were examined using the OPD-Structure- and Conflict-Questionnaires, the Defense Style Questionnaire, and the Patient Health Questionnaire in adolescents before (n = 288) and after (n = 451) the COVID-19 pandemic in Germany. Results: Adolescents with mental health issues exhibited greater impairments in personality structure, more immature defense styles, and higher levels of psychodynamic conflicts both before and after the pandemic onset. Comparisons between pre-pandemic and pandemic samples indicated a lower level of the conflict of taking care of oneself versus being cared for in passive mode among adolescents during the pandemic. In-depth analysis of adolescents with mental health issues from the pandemic group revealed significant associations between personality structure impairments and a maladaptive defense style with somatoform, depressive, anxiety, eating, and alcohol use disorders. Conclusion: The findings provide clinically relevant insights into the psychodynamic factors that contributed to the psychological vulnerability of adolescents during the COVID-19 pandemic. These insights can guide the development of targeted psychodynamic interventions to support adolescents' mental health in similar future crises. [ABSTRACT FROM AUTHOR]