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Study Design: Retrospective study design., Objective: Evaluate correlations between preoperative expectations for pain improvement and 12-month functional outcomes and satisfaction following 1-2-level primary anterior cervical surgery., Summary of Background Data: Limited data exists evaluating correlations between patients' preoperative expectations for pain relief and subsequent functional and satisfaction outcomes following primary anterior cervical surgery. Understanding correlations between expectations and outcomes may help identify patients most likely to benefit from surgery., Materials and Methods: Patients who underwent 1-2-level primary anterior cervical discectomy and fusion (ACDF) or cervical disc arthroplasty for degenerative disease between 2016 and 2021 were included. All patients had 12-month Neck Disability Index (NDI) data. Preoperative expectations for pain relief were collected at the initial clinic visit using 5-point Likert scales. Preoperative and 12-month postoperative satisfaction were recorded using 7-point Likert scales. Covariates include age, sex, procedure type, smoking status, opioid use, worker's compensation/litigation, body mass index, and indication (radiculopathy vs. myelopathy). Linear regression models were constructed to assess the 12-month NDI change score versus pain relief expectations. Additional regression models assessed expectations versus achievement of minimum clinically important difference at 3 and 12 months and satisfaction at 12 months., Results: 198 ACDF (56.1% female, median age 57) and 52 CDR patients (55.8% female, median age 51) were included. Regression models found no significant correlations between pain relief expectations and degree of NDI score improvement at the 12-month postoperative timepoint or minimum clinically important difference achievement at the 3- and 12-month postoperative timepoints. There was no association between preoperative expectations and 12-month satisfaction. However, greater preoperative dissatisfaction was significantly associated with greater 12-month improvement in NDI score., Conclusion: Preoperative pain relief expectations were not associated with functional outcomes or satisfaction following 1-2 level primary ACDF or CDR at 12-month follow-up. Patients' dissatisfaction with their preoperative spinal condition was significantly associated with greater 12-month NDI improvement. Assessing preoperative satisfaction may help identify those most likely to benefit from surgery., Competing Interests: The authors report no conflicts of interest., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Background: Serial measurement of virological and immunological biomarkers in patients admitted to hospital with COVID-19 can give valuable insight into the pathogenic roles of viral replication and immune dysregulation. We aimed to characterise biomarker trajectories and their associations with clinical outcomes., Methods: In this international, prospective cohort study, patients admitted to hospital with COVID-19 and enrolled in the Therapeutics for Inpatients with COVID-19 platform trial within the Accelerating COVID-19 Therapeutic Interventions and Vaccines programme between Aug 5, 2020 and Sept 30, 2021 were included. Participants were included from 108 sites in Denmark, Greece, Poland, Singapore, Spain, Switzerland, Uganda, the UK, and the USA, and randomised to placebo or one of four neutralising monoclonal antibodies: bamlanivimab (Aug 5 to Oct 13, 2020), sotrovimab (Dec 16, 2020, to March 1, 2021), amubarvimab-romlusevimab (Dec 16, 2020, to March 1, 2021), and tixagevimab-cilgavimab (Feb 10 to Sept 30, 2021). This trial included an analysis of 2149 participants with plasma nucleocapsid antigen, anti-nucleocapsid antibody, C-reactive protein (CRP), IL-6, and D-dimer measured at baseline and day 1, day 3, and day 5 of enrolment. Day-90 follow-up status was available for 1790 participants. Biomarker trajectories were evaluated for associations with baseline characteristics, a 7-day pulmonary ordinal outcome, 90-day mortality, and 90-day rate of sustained recovery., Findings: The study included 2149 participants. Participant median age was 57 years (IQR 46-68), 1246 (58·0%) of 2149 participants were male and 903 (42·0%) were female; 1792 (83·4%) had at least one comorbidity, and 1764 (82·1%) were unvaccinated. Mortality to day 90 was 172 (8·0%) of 2149 and 189 (8·8%) participants had sustained recovery. A pattern of less favourable trajectories of low anti-nucleocapsid antibody, high plasma nucleocapsid antigen, and high inflammatory markers over the first 5 days was observed for high-risk baseline clinical characteristics or factors related to SARS-CoV-2 infection. For example, participants with chronic kidney disease demonstrated plasma nucleocapsid antigen 424% higher (95% CI 319-559), CRP 174% higher (150-202), IL-6 173% higher (144-208), D-dimer 149% higher (134-165), and anti-nucleocapsid antibody 39% lower (60-18) to day 5 than those without chronic kidney disease. Participants in the highest quartile for plasma nucleocapsid antigen, CRP, and IL-6 at baseline and day 5 had worse clinical outcomes, including 90-day all-cause mortality (plasma nucleocapsid antigen hazard ratio (HR) 4·50 (95% CI 3·29-6·15), CRP HR 3·37 (2·30-4·94), and IL-6 HR 5·67 (4·12-7·80). This risk persisted for plasma nucleocapsid antigen and CRP after adjustment for baseline biomarker values and other baseline factors., Interpretation: Patients admitted to hospital with less favourable 5-day biomarker trajectories had worse prognosis, suggesting that persistent viral burden might drive inflammation in the pathogenesis of COVID-19, identifying patients that might benefit from escalation of antiviral or anti-inflammatory treatment., Funding: US National Institutes of Health., Competing Interests: Declaration of interests ALG reports receiving institutional funding from Novavax, institutional partnership with AstraZeneca, and being personally named as inventor on a patent used by AstraZeneca. DDM reports receiving grants from the Danish National Research Foundation. DL reports participation in a study funded by Gilead with no salary support. EM reports payments to his institution received from SciClone Pharmaceuticals, Regeneron Pharmaceuticals, Pfizer, Chemic Labs and KODA Therapeutics, and Cidara, and payment for participating in an advisory board for Basilea. KW reports honorarium for Acute Respiratory Distress Syndrome (ARDS) International Conference in 2023, and travel support from University of California San Francisco. MAM reports institutional funding by the US Department of Defence, Roche-Genetech, and Quantum Health, and personal consulting fees from Gilead, Novartis, and Johnson & Johnson. MKJ reports grants received from Regeneron, Laurent, and Gilead, honoraria from Gilead, and a leadership role with the HIV Medicine Association Board of Directors. PC reports consulting fees from Eli Lilly and Regeneron. All other authors declare no competing interests. All authors were not precluded from accessing data in the study., (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Background: Neutralizing monoclonal antibodies (nmAbs) failed to show clear benefit for hospitalized patients with coronavirus disease 2019 (COVID-19). Dynamics of virologic and immunologic biomarkers remain poorly understood., Methods: Participants enrolled in the Therapeutics for Inpatients with COVID-19 trials were randomized to nmAb versus placebo. Longitudinal differences between treatment and placebo groups in levels of plasma nucleocapsid antigen (N-Ag), anti-nucleocapsid antibody, C-reactive protein, interleukin-6, and D-dimer at enrollment, day 1, 3, and 5 were estimated using linear mixed models. A 7-point pulmonary ordinal scale assessed at day 5 was compared using proportional odds models., Results: Analysis included 2149 participants enrolled between August 2020 and September 2021. Treatment resulted in 20% lower levels of plasma N-Ag compared with placebo (95% confidence interval, 12%-27%; P < .001), and a steeper rate of decline through the first 5 days (P < .001). The treatment difference did not vary between subgroups, and no difference was observed in trajectories of other biomarkers or the day 5 pulmonary ordinal scale., Conclusions: Our study suggests that nmAb has an antiviral effect assessed by plasma N-Ag among hospitalized patients with COVID-19, with no blunting of the endogenous anti-nucleocapsid antibody response. No effect on systemic inflammation or day 5 clinical status was observed., Clinical Trials Registration: NCT04501978., Competing Interests: Potential conflicts of interest. A. L. G. reports receiving institutional funding from Novavax, insititutaional partnership with Astra Zeneca, and reports being personally named as inventor on a patent used by Astra Zeneca. D. D. M. reports receiving grant from the Danish National research Foundation. E. M. reports payments to his institution received from SciClone Pharmaceuticals, Regeneron Pharmaceuticals, Pfizer, Chemic Labs/KODA Therapeutics, Cidara, and Leidos Biomedical Research Inc; E. M. also reports being on an advisory board for Basilea. K. W. reports receiving a honorarium for international ARDS conference and travel support from UCSF. M. A. reports a grant from NINDS. M. A. M. reports institutional grants from NHLBI/NIAID, the department of defence, California Institute of Regeneration, Roche-Genentech, and Quantum Health. M. A. M. has also received personal consulting fees from Novartis, Pliant Therapeutics, Johnson and Johnson, Gilead, and Citius Pharmaceuticals. M. K. J. reports institutional grants from Gilead, Laurent, and Regeneron; personal consulting fees from Gilead; and personal honoraria from Cooper Clinic. S. T. is funded by grants from the Australian Medical Foundation and New South Wales Health. The remaining authors report no potential conflicts. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed., (© The Author(s) 2023. Published by Oxford University Press on behalf of Infectious Diseases Society of America.)

Background: Inflammatory subphenotypes have been identified in acute respiratory distress syndrome (ARDS). Hyperferritinaemia in sepsis is associated with hyperinflammation, worse clinical outcomes, and may predict benefit with immunomodulation. Our aim was to determine if raised ferritin identified a subphenotype in patients with ARDS., Methods: Baseline plasma ferritin concentrations were measured in patients with ARDS from two randomised controlled trials of simvastatin (Hydroxymethylglutaryl-CoA Reductase Inhibition with Simvastatin in Acute Lung Injury to Reduce Pulmonary Dysfunction-2 (HARP-2); discovery cohort, UK) and neuromuscular blockade (ROSE; validation cohort, USA). Results were analysed using a logistic regression model with restricted cubic splines, to determine the ferritin threshold associated with 28-day mortality., Results: Ferritin was measured in 511 patients from HARP-2 (95% of patients enrolled) and 847 patients (84% of patients enrolled) from ROSE. Ferritin was consistently associated with 28-day mortality in both studies and following a meta-analysis, a log-fold increase in ferritin was associated with an OR 1.71 (95% CI 1.01 to 2.90) for 28-day mortality. Patients with ferritin >1380 ng/mL (HARP-2 28%, ROSE 24%) had a significantly higher 28-day mortality and fewer ventilator-free days in both studies. Mediation analysis, including confounders (acute physiology and chronic health evaluation-II score and ARDS aetiology) demonstrated a statistically significant contribution of interleukin (IL)-18 as an intermediate pathway between ferritin and mortality., Conclusions: Ferritin is a clinically useful biomarker in ARDS and is associated with worse patient outcomes. These results provide support for prospective interventional trials of immunomodulatory agents targeting IL-18 in this hyperferritinaemic subgroup of patients with ARDS., Competing Interests: Competing interests: PM and RJS are/were clinical training fellows within the Experimental Medicine Initiative to Explore New Therapies (EMINENT) network and receive project funding unrelated to this article from the Medical Research Council and GlaxoSmithKline. PM also receives co-funding by the National Institute for Health Research (NIHR) University College London Hospitals Biomedical Research Centre. RJS receives co-funding by the Cambridge NIHR Biomedical Research Centre. PM reports consultancy fees from SOBI, UCB, Lilly, AbbVie, Boehringer and EUSA Pharma outside the submitted work. KW reports grants from National Institutes of Health, during the conduct of the study. TM reports PhD studentship funding from the Department for the Economy Northern Ireland. RCC reports grants from the Royal Society and the Academy of Medical Sciences during the conduct of the study; personal fees from BioAge Labs, personal fees from ImmVention Therapeutix, outside the submitted work; In addition, RCC has a patent US 10,538,487 licensed to Inflazome Ltd, a patent PCT/IB2017/053059 licensed to Inflazome Ltd and a patent PCT/EP2017/053498 licensed to Inflazome Ltd. AJB reports received funding from the Northern Ireland Health and Social Care Research and Development office for research outside of the submitted work. MS-H reports grants and other from National Institute for Health Research, during the conduct of the study. MS-H is supported by the NIHR Clinician Scientist Award (CS-2016-16-011). AR reports other from Merck, outside the submitted work. CSC reports grants from NIH R35-HL140026, during the conduct of the study; grants and personal fees from Roche/Genentech, grants and personal fees from Bayer, personal fees from Quark Pharmaceuticals, personal fees from Gen1e Life Sciences, personal fees from Vasomune, grants from Quantum Leap Healthcare Collaborative, outside the submitted work. MAM reports grants from Roche Genentec, personal fees from Novartis, personal fees from Johnson and Johnson, personal fees from Gilead Pharmaceuticals, personal fees from Pliant Therapeutics, outside the submitted work. CS is the Director of the EMINENT research training scheme supporting RJS and PM, and reports research funding to her institution from the Wellcome Trust, the Medical Research Council, the NIHR, GlaxoSmithKline, AstraZeneca and the Cambridge NIHR Biomedical Research Centre, all unrelated to this work. CS also reports personal fees for consultancy from Roche, GlaxoSmithKline and AbbVie. RCC reports grants from UKRI-MRC, NIHR-UCLH BRC and GSK, outside the submitted work. DFMA chairs the NIHR and Medical Research Council funding committee for COVID-19 for therapeutics and vaccines. DFMA reports personal fees from consultancy for ARDS for GlaxoSmithKline, Boehringer Ingelheim, and Bayer; in addition, his institution has received funds from grants from the UK NIHR, Wellcome Trust, Innovate UK and others, all unrelated to this Correspondence. DFMA also has a patent issued to his institution for a treatment for ARDS. DFMA is a Director of Research for the Intensive Care Society and NIHR Efficacy and Mechanism Evaluation Programme Director. CMOK reports grant funding from the Wellcome Trust, MRC, Innovate UK and NIHSC R&D for unrelated work. CMOK reports fees for consultancy from Insmed and for reviews from the California Institute of Regenerative Medicine (CIRM) unrelated to this work. CMOK’s spouse has received consultancy fees from BI, Bayer and GSK unrelated to this work. All other authors declare no competing interests. The views expressed in this manuscript are those of the authors and not necessarily those of the Medical Research Council (MRC), National Health Service, NIHR or Department of Health and Social Care. This study was supported by the UK EME Programme, an MRC and NIHR partnership (08/99/08 and 16/33/01). The EME Programme is funded by the MRC and NIHR, with contributions from the Chief Scientist Office in Scotland, the National Institute for Social Care and Health Research in Wales, and the Health and Social Care (HSC) Research and Development Division, Public Health Agency for Northern Ireland. TM is supported by a PhD studentship from the Department for the Economy Northern Ireland. RCC is supported by an Academy of Medical Sciences Springboard Award (SBF005\1104), a Royal Society Research Grant (RGS\R1\201127), and institutional funding from the Wellcome-Wolfson Institute for Experimental Medicine and Queen’s University Belfast., (© Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ.)

Background and Purpose: Mental Health First Aid (MHFA) training was designed to help participants identify mental health challenges and provide support to those in need. The objective of this study was to evaluate the perceptions of a required first-year didactic MHFA course and to determine if MHFA reduces stigma and increases confidence in first-year pharmacy students' abilities to offer help to those experiencing a mental health challenge or a crisis., Educational Activity and Setting: Participants were first-year doctor of pharmacy students at a single site in the United States. Methods include the utilization of a survey-based study among a single pharmacy program. Students enrolled in this required MHFA training were asked to voluntarily complete pre- and post-training surveys., Findings: A total of 69 first-year pharmacy students participated in the MHFA training. Results demonstrated that students agreed with being able to identify stigmatizing words associated with mental health disorders and that they will work to reduce or avoid using words that can be perceived as stigmatizing related to mental health (P < .001). Students reported increased confidence in their ability to start a conversation with someone who may need mental health help compared to their confidence level before the training (P < .001)., Summary: Completing MHFA training during the early phases of didactic education can help reduce stigma and increase confidence in abilities to help those experiencing a mental health challenge. Programs should consider implementing MHFA or similar training early in the didactic curriculum., Competing Interests: Declaration of Competing Interest None., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Background: Approximately 6,2 million people with limited literacy live in Germany. They are unable to communicate in written language beyond single sentences and thus experience limited social participation in many everyday areas. In addition, they are also excluded from participation in survey-based social science research., Method: In order to enable persons with limited literacy to participate in written surveys, existing questionnaires need to be converted to easy language and their psychometric quality needs to be reexamined. We went through this process for the Self-Efficacy Expectancy (SWE) questionnaire and tested the new scale in easy language (SWE-LS) on a representative sample of the German population aged 14 years and older (N=2,531)., Results: The SWE-LS scale showed good internal consistency (Cronbach's-Alpha=0,84) and adequate item difficulty and discriminatory power. We found correlations consistent with expectations for the demographic variables surveyed. Thus, men and persons with higher education and higher income showed significantly higher self-efficacy expectations. The effect was also evident for East Germans versus West Germans, married persons living together versus separated, unmarried, or persons living as singles., Discussion: Compared to the original SWE scale, the SWE-LS scale in easy language has no methodological disadvantages. The additional effort of linguistic adaptation and renewed psychometric testing is thus directly offset by enabling participation in survey-based research by over 12% of the adult population. A systematic translation of particularly frequently used questionnaires or those that do not concern fundamental research but research areas in which demographic variables themselves are part of the research object would be desirable., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

Introduction: Beyond participation as a civil right, social participation has already been considered from legal, ethical, socio-psychological and political perspectives as an important component of the self- and external evaluation of a person as a valuable member of a society. Thus, social psychological studies frequently showed the importance of the sense of belonging as a central psychological component of social participation for both personal and social self-esteem. From a medical-psychological perspective, the association of global self-esteem and self-efficacy with health is well established. However, it is an open question whether social participation is directly related to psychological and physical well-being or whether this relationship is mediated via global self-esteem., Material and Methods: Based on a nationwide representative survey in Germany (N=2.531; age 14-93, M=48.58; 55.4% women), the variables social participation (KsT-5), global self-esteem (SISE), and physical and mental health (EQ5D) were measured using standardized questionnaires to examine a potential mediation., Results: As expected, significant positive correlations between social participation, global self-esteem and physical and mental health were found with medium ranged effect sizes. However, global self-esteem only partially mediated the association between social participation and health, i. e. a direct significant association between social participation and health could be proven., Discussion: The results underline the direct relevance of social participation for physical and mental health. This opens a hitherto hardly used perspective for health promotion in interaction with socio-political challenges in the topics of integration, inclusion and the sense of belonging., Competing Interests: Die Autor:innen geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

Background: Autogenic training (AT) is frequently used as therapeutic approach in multimodal pain therapy. The aim of this systematic review and meta-analysis is to investigate the efficacy of AT in individuals suffering from chronic pain in comparison to passive and active control groups., Methods: A comprehensive literature search in Medline, Web of Science, PsycInfo, and PubPsych and manual searches (last search April 7, 2021) were conducted to locate randomized controlled trials (RCTs). Treatment guidelines and references of relevant articles and previous reviews were checked. ProQuest Dissertations and Theses Full Text database, DART-Europe E-theses Portal, Networked Digital Library of Theses and Dissertations (NDLTD), and the Theses Database of the German National Library were screened to identify any unpublished material., Results: A total of 13 eligible studies (k = 15 comparisons) including 576 participants were identified. Random-effects meta-analyses revealed a significantly positive, moderate effect of AT on the primary outcome pain compared to passive control groups (g = 0.58, 95% CI [0.36; 0.79], k = 9, I 2  = 0%). In comparison with other psychological interventions, no difference was found (g = - 0.05, 95% CI [- 0.30; 0.20], k = 6, I 2  = 0%). Sensitivity analyses proved the robustness of findings. Overall risk-of-bias judgment was 'some concerns' in the majority of studies., Conclusions: Beneficial effects of AT on pain reduction were demonstrated, but findings are prone to bias. Furthermore, high methodological quality RCTs are needed to strengthen the promising evidence of AT for individuals with chronic pain., (© 2021. The Author(s).)

Background: Given that recent studies report negative secular declines in physical fitness, associations between fitness and cognition in childhood are strongly discussed. The preschool age is characterized by high neuroplasticity which effects motor skill learning, physical fitness, and cognitive development. The aim of this study was to assess the relation of physical fitness and attention (including its individual dimensions (quantitative, qualitative)) as one domain of cognitive performance in preschool children. We hypothesized that fitness components which need precise coordination compared to simple fitness components are stronger related to attention., Methods: Physical fitness components like static balance (i.e., single-leg stance), muscle strength (i.e., handgrip strength), muscle power (i.e., standing long jump), and coordination (i.e., hopping on one leg) were assessed in 61 healthy children (mean age 4.5 ± 0.6 years; girls n = 30). Attention was measured with the "Konzentrations-Handlungsverfahren für Vorschulkinder" [concentration-action procedure for preschoolers]). Analyses were adjusted for age, body height, and body mass., Results: Results from single linear regression analysis revealed a significant (p < 0.05) association between physical fitness (composite score) and attention (composite score) (standardized ß = 0.40), showing a small to medium effect (F 2  = 0.14). Further, coordination had a significant relation with the composite score and the quantitative dimension of attention (standardized ß = 0.35; p < 0.01; standardized ß =  - 0.33; p < 0.05). Coordination explained about 11% (composite score) and 9% (quantitative dimension) of the variance in the stepwise multiple regression model., Conclusion: The results indicate that performance in physical fitness, particularly coordination, is related to attention in preschool children. Thus, high performance in complex fitness components (i.e., hopping on one leg) tends to predict attention in preschool children. Further longitudinal studies should focus on the effectiveness of physical activity programs implementing coordination and complex exercises at preschool age to examine cause-effect relationships between physical fitness and attention precisely., (© 2022. The Author(s).)

Study Design: Retrospective cohort., Objective: To aim of this study was to identify patient variables, injury characteristics, and costs associated with operative and non-operative treatment following inter-facility transfer of patients with isolated cervical spine fractures., Summary of Background Data: Patients with isolated cervical spine fractures are subject to inter-facility transfer for surgical assessment, yet are often treated nonoperatively. The American College of Surgeons' benchmark rate of "secondary over-triage" is <50%. Identifying patient and injury characteristics as well as costs associated with treatment following transfer of patients with isolated cervical spine fractures may help reduce rates of secondary over-triage and healthcare expenditures., Methods: Patients transferred to a Level-1 trauma center with isolated cervical spine fractures between January 2015 and September 2020 were identified. Patient demographics, comorbidities, insurance data, injury characteristics, imaging workup, treatment, and financial data were collected for all patients. Multivariable logistic regression models were constructed to identify patient and injury characteristics associated with surgical treatment., Results: Nearly 75% of patients were treated non-operatively. Over 97% of transfers were accepted by the general surgery trauma service. Multivariable modeling found that higher BMI, presence of any neurologic deficit including spinal cord or isolated spinal nerve root injuries, present smoking status, or cervical spine magnetic resonance imaging obtained post-transfer, were associated with surgical treatment for isolated cervical spine fractures. Among patients with type II dens fractures, increased fracture displacement was associated with surgical treatment. Median charges to patients treated operatively and nonoperatively were $380,890 and $90,734, respectively. Median hospital expenditures for patients treated operatively and nonoperatively were $55,115 and $12,131, respectively., Conclusion: A large proportion of patients with isolated cervical spine fractures are subject to over-triage. Injury characteristics are important for determining need for surgical treatment, and therefore interfacility transfer. Improving communication with spine surgeons when deciding to transfer patients may significantly reduce health care costs and resource use.Level of Evidence: 4., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

Abstract: Wick, K, Kriemler, S, and Granacher, U. Effects of a strength-dominated exercise program on physical fitness and cognitive performance in preschool children. J Strength Cond Res 35(4): 983-990, 2021-Childhood is characterized by high neuroplasticity that affords qualitative rather than quantitative components of physical activity to maximize the potential to sufficiently develop motor skills and foster long-term engagement in regular physical activity. This study examined the effects of an integrative strength-dominated exercise program on measures of physical fitness and cognitive performance in preschool children. Children aged 4-6 years from 3 kindergartens were randomized into an intervention (INT) group (n = 32) or a control group (n = 22). The 10-week intervention period was conducted 3 times per week (each session lasted 30 minutes) and included exercises for the promotion of muscle strength and power, coordination, and balance. Pre and post training, tests were conducted for the assessment of muscle strength (i.e., handgrip strength), muscle power (i.e., standing long jump), balance (i.e., timed single-leg stand), coordination (hopping on right/left leg), and attentional span (i.e., "Konzentrations-Handlungsverfahren für Vorschulkinder" [concentration-action procedure for preschoolers]). Results from 2 × 2 repeated-measures analysis of covariance revealed a significant (p ≤ 0.05) and near significant (p = 0.051) group × time interaction for the standing long jump test and the Konzentrations-Handlungsverfahren. Post hoc tests showed significant pre-post changes for the INT (p < 0.001; d = 1.53) but not the CON (p = 0.72; d = 0.83). Our results indicate that a 10-week strength-dominated exercise program increased jump performance with a concomitant trend toward improvements in attentional capacity of preschool children. Thus, we recommend implementing this type of exercise program for preschoolers., (Copyright © 2021 National Strength and Conditioning Association.)

Social participation is politically as well as socially and psychologically relevant for the coexistence of people in our society and the well-being of the individual. In light of the German Federal Participation Act and the partial equalization of the terms "(Social) Participation" and "Inclusion", social participation in recent years has frequently been restricted to people with disabilities with regard to the "International Classification of Functioning, Disability and Health (ICF)" of the World Health Organization and the UN Convention on the Rights of Persons with Disabilities. The question of participation, however, affects all people and is not only dependent on the degree of functional capacity or disability, but also on social inclusion, financial possibilities, regional affiliation, education, self-esteem and is correlated with health. In the present study, a new short scale of 5 items (KsT-5) for measuring the aspects "belonging", "self-efficacy", "need for recognition", "self-esteem" and "integration in the social environment" was tested on a German representative general population sample (N=2531) with regard to their psychometric quality criteria. It showed a good fit with a one-factor solution, a satisfactory internal consistency of Cronbach's α=0,73 and McDonald's ω=0,73 as well as good convergent validity over positive correlations with self-esteem and psychological as well as physical health. This study provides norm values of the new KsT-5 stratified according to gender and age as a prerequisite for use in future studies., Competing Interests: Die Repräsentativbefragung (REP26) fand unter der wissenschaftlichen Federführung von Prof. Dr. Elmar Brähler statt. Alle Teilnehmenden wurden vor Beginn der Interviews über das Vorgehen der Studie sowie über die Erhebung und anonyme Speicherung aller persönlichen Daten aufgeklärt und um ihr verbales Einverständnis zur Teilnahme gebeten (bei minderjährigen Teilnehmenden wurde zudem das Einverständnis des Vormundes eingeholt). Außerdem erhielten alle Interviewten eine ausführliche Datenschutzerklärung. Die Studie umfasste Fragebögen zu Aspekten psychischer und körperlicher Gesundheit sowie persönlichen Einstellungen in Interviewform und befolgte die Richtlinien des ICC/ESOMAR International Code of Marketing and Social Research Practice. Für die REP26 liegt ein positives Votum der Ethikkommission der Medizinischen Fakultät Leipzig vor (23.10.2017, AZ 418/17-ek).Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (Georg Thieme Verlag KG Rüdigerstraße 14, 70469 Stuttgart, Germany.)

Previous research points to a significant impact of social integration and self-esteem on well-being. The present study examined whether self-esteem constitutes one pathway from social integration in the classroom to mental and physical well-being of students and accordingly serves as a mediator. Therefore, 163 students (mean age: 12.98 years, age range: 9-17 years, 57.9% male) of three German secondary schools were examined regarding their experience of social integration, self-esteem, and mental as well as physical well-being. Results revealed that self-esteem mediated the effect of social integration on mental and physical well-being. This finding elucidates one pathway from social integration to well-being and points to the importance of improving both self-esteem and social integration for the promotion of well-being among adolescents.

Background: Approximately 7% of pupils in Germany have special educational needs. This is accompanied by a general reduction in social participation, partly due to a reduction in language comprehension. The endeavour for social inclusion therefore includes the provision of text information in simple language. Since written surveys play an important role in social science and clinical research, this also applies to psychometric questionnaires., Objective: Comparison of psychometric quality of the original scale measuring self-efficacy (German version: SWE, English version: GSE) and a version of the same scale translated into simple language (SWE-LS)., Methods: Both versions of the SWE were completed by N=94 pupils aged between 12 and 19 years with special educational needs from 7 special schools in Thuringia. Internal consistency and convergent validity of both scales were measured., Results: Both scale versions achieved satisfactory internal consistency (SWE:=0.74, SWE-LS:=0.78). However, the mean scale values differ significantly. The convergent validity was r=0.69, whereby 3 items did not correlate significantly (-0.010.21). The proportion of missing values is significantly higher for the original SWE with 16% listwise and 6.7% pairwise than for the SWE-LS with 3.2  and 0.5%, respectively., Discussion: Overall, the SWE-LS translated into simple language has a better psychometric quality than the original scale. The lower proportion of missing values also speaks for the use of the SWE-LS., Conclusion: The translation of standardised questionnaires into simple language offers the possibility of also including groups of participants who have so far been excluded or who have only been surveyed indirectly (e. g. through caregivers). The cost of translation is comparable to that of translation into other languages. In the case of simple language, however, a back translation and thus a verification of the validity of the content are not possible., Competing Interests: Die Autoren geben an, dass kein Interessenkonflikt besteht., (© Georg Thieme Verlag KG Stuttgart · New York.)

Background: The key drivers of symptom severity and health-related quality of life (hr-QOL) in patients with atrial fibrillation (AF) remain unclear. We aimed to determine the relative contribution to symptom severity and hr-QOL of clinical factors including left ventricular (LV) diastolic function and ventricular rate control during AF and of psychological functioning., Methods: Seventy-eight consecutive patients with symptomatic AF and preserved LV systolic function underwent detailed evaluation of i) AF symptom severity and hr-QOL; ii) clinical factors including left ventricular (LV) diastolic function, AF burden, and ventricular rate during AF and iii) state and trait aspects of psychological functioning., Results: Moderate-to-severe AF-related symptoms were reported by 64% of the study population whilst 36% reported no more than mild symptoms. Worse symptom severity was associated with a higher score on the Perceived Stress Scale (16.7 ± 4.4 vs. 5.4 ± 4.4, p < 0.0001) and higher prevalence of the Type D Personality (20/50 vs. 4/28, p = 0.012). In multivariable models, only a predisposition to subjectively appraise life situations as stressful (higher PSS score) and a personality with a higher degree of negative affectivity and social inhibition (higher TDPS score) were independent predictors of higher AF symptom severity and poorer hr-QOL. No clinical factors including AF burden, ventricular rates during AF or LV diastolic function were significant predictors of AF-specific symptoms or hr-QOL., Conclusion: In a tertiary AF population with preserved LV systolic function, only psychological functioning consistently predicts both AF-related symptoms and hr-QOL. LV diastolic function, AF burden, and ventricular rate during AF are not independent predictors., (Copyright © 2018 Elsevier B.V. All rights reserved.)

Background An association between atrial fibrillation ( AF ), anxiety, and depression is recognized, but the spectrum of psychological distress remains unclear. We aimed to characterize the severity and predictors of distress associated with AF in a tertiary population and its response to AF management. Methods and Results Seventy-eight patients with symptomatic AF underwent evaluation, including of AF symptom severity, health-related quality of life, psychological distress, suicidal ideation, and specific personality traits. Twenty participants underwent AF ablation and 58 were managed medically, with repeat assessments at 4, 8, and 12 months. Severe distress (Hospital Anxiety and Depression Scale score, ≥15/42) was identified in 27 of 78 (35%). Independent predictors were a personality marked by vulnerability to stress (Perceived Stress Scale: R 2 , 0.54; β=0.7±0.1; t=7.8; P<0.001) and 1 marked by negativity/social inhibition (Type D Personality Scale: R 2 , 0.47; β=0.7±0.1; t=6.7; P<0.001). Suicidal ideation was reported by 16 of 78 (20%) and was predicted by personality traits (Perceived Stress Scale score: R 2 , 0.35; odds ratio, 1.22±0.06; P<0.001; Type D Personality Scale score: R 2 , 0.48; odds ratio, 1.43±0.14; P<0.001). Effective AF ablation (median AF burden 1% [0-1%] over 12 months) was associated with significant reductions in distress (Hospital Anxiety and Depression Scale score, 13.9±1.8 to 4.3±1.8; P<0.05) and prevalence of suicidal ideation (30-5%; P=0.02). Conclusions There was a high prevalence of severe psychological distress (35%) and of suicidal ideation (20%) in a tertiary AF population, with personality traits predicting both. Effective AF ablation was associated with significant improvements, suggesting AF itself may be a treatable causative factor of distress.

Background: Prevalence rates for eating disorders remained stable over the years despite the implementation of numerous prevention strategies. This may be due to discrepancies between research and practice and scientific findings are not fully applied to the care of risk groups. The school-based programs PriMa and Torera for primary prevention of eating disorders have been delivered in Thuringian schools since 2004. A current survey provides information on barriers and facilitators for a long-term implementation in the school routine., Objectives and Methods: Using the "Consolidated Framework for Implementation Research", factors which impact the implementation process are discussed., Results: Impeding factors for a long-term implementation are missing framework conditions, staff turnover and a lack of financial support from politicians. Possible solutions could be the establishment of extra time in the curriculum, the employment of individuals responsible for prevention and a close network between all people involved., Conclusion: According to the Society for Prevention Research, discussing implementation factors builds the last part of comprehensive program evaluations. We illustrate the barriers for the integration of evidence-based prevention programs in daily school life. It is important to implement new structures prior to the implementation of resource-intensive new prevention programs in order to increase the effectiveness of said programs and enable long-term implementation., Competing Interests: Die Autoren geben an, dass kein Interessenkonflikt besteht., (© Georg Thieme Verlag KG Stuttgart · New York.)

Sedentarism is considered an independent cardiovascular risk factor. Thus, the present study investigated the effects of employing standing desks in classrooms on cognitive function. The intervention class (IG; n = 19) was supplied with standing desks and balance pads for 11 weeks. The control class (CG; n = 19) received lessons as usual. Standing time was assessed objectively (accelerometers) and subjectively (self-report sheets, external classroom observers). The impact of standing on the digit span task and Eriksen flanker task was analysed. The standing time of the IG was higher during the school day in comparison to the CG (lesson: p = 0.004; break: p = 0.003). The intra-class correlation coefficient between self-reports and external observation was high (ICC = 0.94). The IG improved slightly on the Digit Span Task compared to CG. Employing standing desks for at least 1 h per school day serves as a feasible and effective opportunity to improve cognitive function., Competing Interests: The authors declare no conflict of interest.

Background: Proficiency in fundamental movement skills (FMS) lays the foundation for being physically active and developing more complex motor skills. Improving these motor skills may provide enhanced opportunities for the development of a variety of perceptual, social, and cognitive skills., Objective: The objective of this systematic review and meta-analysis was to assess the effects of FMS interventions on actual FMS, targeting typically developing young children., Method: Searches in seven databases (CINAHL, Embase, MEDLINE, PsycINFO, PubMed, Scopus, Web of Science) up to August 2015 were completed. Trials with children (aged 2-6 years) in childcare or kindergarten settings that applied FMS-enhancing intervention programs of at least 4 weeks and meeting the inclusion criteria were included. Standardized data extraction forms were used. Risk of bias was assessed using a standard scoring scheme (Effective Public Health Practice Project-Quality Assessment Tool for Quantitative Studies [EPHPP]). We calculated effects on overall FMS, object control and locomotor subscales (OCS and LMS) by weighted standardized mean differences (SMD between ) using random-effects models. Certainty in training effects was evaluated using GRADE (Grading of Recommendations Assessment, Development, and Evaluation System)., Results: Thirty trials (15 randomized controlled trials and 15 controlled trials) involving 6126 preschoolers (aged 3.3-5.5 years) revealed significant differences among groups in favor of the intervention group (INT) with small-to-large effects on overall FMS (SMD between 0.46), OCS (SMD between 1.36), and LMS (SMD between 0.94). Our certainty in the treatment estimates based on GRADE is very low., Conclusions: Although there is relevant effectiveness of programs to improve FMS proficiency in healthy young children, they need to be interpreted with care as they are based on low-quality evidence and immediate post-intervention effects without long-term follow-up.

Purpose: This is the first study to evaluate the long-term effectiveness of a school-based prevention program in Germany. The aim is to determine the long-term effects of the primary prevention program PriMa (Primary prevention of anorexia nervosa in preadolescent girls) on disordered eating and body self-esteem from childhood to young adulthood., Methods: PriMa was conducted and successfully evaluated in a quasi-experimental pre-post design with a control group from 2007 to 2008 consisting of 11-13year old girls (N=1508) from Thuringian schools in Germany. Seven to eight years after the intervention, the same cohort (mean age 19.8years) was invited to complete an online survey. Disordered eating (EAT-26), body self-esteem (FBeK) and BMI were assessed via self-report. The response rate at seven-to-eight-year follow-up was very low (7%). Data of N=100 girls were analyzed., Results: Concerning changes in disordered eating, results revealed no significant long-term effect of PriMa seven to eight years after the intervention. During this time, disordered eating remained stable without a significant increase or decrease. Regarding changes in body self-esteem, group courses differed significantly from each other. The results revealed a significant main effect of group, indicating significant differences in changes of body self-esteem between the intervention and the control group. Following the analysis of these changes of body self-esteem over time, it was found that the intervention group revealed an increase of body self-esteem after program participation and remained stable over time. By contrast, the control group revealed a decrease of body self-esteem over time., Conclusions: Long-term intervention effects of PriMa could be found for body self-esteem but not for disordered eating. The findings suggest that PriMa prevented a decrease of body self-esteem from childhood to young adulthood. For a broader dissemination it is necessary to implement prevention programs consistently in school settings. In order to maintain the prevention effects, it would be interesting to investigate the effects of booster sessions which refresh the programs content on a regular basis. Furthermore, the results of this study revealed the implementation difficulties of primary prevention programs especially concerning the retention of the sample size., (Copyright © 2016 Elsevier Ltd. All rights reserved.)

Background: Bariatric surgery can lower body weight and comorbidities. Different factors might influence the outcome of this treatment. This pilot study examines whether patients' attachment style can influence surgical outcome. Methods: The sample consisted of 32 patients (f=24; m=8; BMI preoperative=47,8 kg/m 2 ±5,2; age=53±9,84) who underwent a laparoscopic sleeve gastrectomy. The following variables were assessed pre- and postoperatively via questionnaires: quality of life (BAROS), self esteem (SES), depression, anxiety, psychological distress (SCL-90R), feelings of hunger, cognitive control, irritated eating behaviour (FEV) and weight related variables (BMI, EWL%, EBL%, TBL). Attachment style was determined postoperatively using the BPQE. Results: None of the participating patients suffered from a binge eating disorder. There was no significant difference of the BMI at any time between the 12 securely attached (SA) patients and the 19 insecurely attachted (IA) patients. Compared to the SA patients IA patients preoperatively showed lower outcomes in variables concerning eating behaviour and mental health. Comparing the 2 groups postoperatively the IA patients achieved lower levels in variables concerning mental health than SA patients and did not reach the preoperative values of the SA patients. Both groups benefited from surgery related to weight loss, mental health and eating behaviour. There was no difference found in the development from pre- to postoperative between SA and IA patients. Discussion & Conclusion: Patients profit by a bariatric intervention independent of their attachment style. By evaluating the attachment style, it could be possible to individually optimize pre- and postoperative patients support in order to gain more effective surgery results. Follow up studies extended to multi-site assessment are required., (© Georg Thieme Verlag KG Stuttgart · New York.)

Objectives: Whether occupational physical activity (PA) will be assessed via questionnaires or accelerometry depends on available resources. Although self-reported data collection seems feasible and inexpensive, obtained information could be biased by demographic determinants. Thus, we aimed at comparing self-reported and objectively measured occupational sitting, standing, and walking times adjusted for socio-demographic variables., Methods: Thirty-eight office employees (eight males, 30 females, age 40.8 ± 11.4 years, BMI 23.9 ± 4.2 kg/m(2)) supplied with height-adjustable working desks were asked to report sitting, standing, and walking times using the Occupational Sitting and Physical Activity Questionnaire during one working week. The ActiGraph wGT3X-BT was used to objectively measure occupational PA during the same week. Subjectively and objectively measured data were compared computing the intra-class correlation coefficients, paired t tests and Bland-Altman plots. Furthermore, repeated-measurement ANOVAs for measurement (subjective vs. objective) and socio-demographic variables were calculated., Results: Self-reported data yielded a significant underestimation of standing time (13.3 vs. 17.9%) and an overestimation of walking time (12.7 vs. 5.0%). Significant interaction effects of age and measurement of standing time (F = 6.0, p = .02, ηp(2) = .14) and BMI group and measurement of walking time were found (F = 3.7, p = .04, ηp(2) = .17). Older employees (>39 years) underestimated their standing time, while underweight workers (BMI < 20 kg/m(2)) overestimated their walking time., Conclusions: Self-reported PA data differ from objective data. Demographic variables (age, BMI) affect the amount of self-reported misjudging of PA. In order to improve the validity of self-reported data, a correction formula for the economic assessment of PA by subjective measures is needed, considering age and BMI.

Introduction: Interprofessional collaboration is crucial to the optimization of patient care., Aim: This paper aims to provide recommendations for implementing an innovative constructivist educational concept with the core element of video-based self-assessment., Methodology: A course for students in medicine, physiotherapy, and nursing was developed through interprofessional, cross-institutional collaboration. The course consisted of drawing on prior knowledge about the work done by each professional group in regard to a specific clinical scenario and an interprofessional treatment situation, filming a role play of this treatment situation, and a structured self-assessment of the role play. We evaluated the preparation and implementation of the three courses conducted thus far. Concrete recommendations for implementation were made based on evaluation sheets (students), open discussions (tutors, instructors, institutions) and recorded meeting minutes (project managers, project participants)., Results: Basic recommendations for implementation include: selecting appropriate criteria for self-assessment and a simulated situation that offers members of each professional group an equal opportunity to act in the role play. In terms of administrative implementation we recommend early coordination among the professions and educational institutions regarding the target groups, scheduling and attendance policy to ensure participant recruitment across all professions. Procedural planning should include developing teaching materials, such as the case vignette and treatment scenario, and providing technical equipment that can be operated intuitively in order to ensure efficient recording., Conclusion: These recommendations serve as an aid for implementing an innovative constructivist educational concept with video-based self-assessment at its core.

The aim of this study was to assess the effects of 2 German school-based primary prevention programmes for (pre)adolescents, aged 11-13 years, with 9 manual-guided lessons. 92 (PriMa, n=1,553 girls) and 22 (Torera, n=256 boys, 277 girls) Thuringian secondary schools participated in controlled trials with pre-post assessment. Girls and students at risk showed significant improvements of conspicuous eating behaviour and body self-esteem with small to medium effect sizes. Implementation costs were € 2.50 per student., (© Georg Thieme Verlag KG Stuttgart · New York.)

Introduction: Patients on the waiting list for organ transplantation are exposed to different stress factors and use individual resources for coping. The present study examines these factors in the context of health-related quality of life in different patient groups (patients with renal vs. liver insufficiency) and attachment pattern., Material & Methods: The following variables were measured by questionnaire in a clinical sample of 103 patients waiting for a liver or kidney transplant in Thuringia: Physical complaints (GBB), Depression and Anxiety (HADS-D), Coping (EFK), Self-efficacy expectations (SWE), Resilience (RS-13), Social support (F-SozU-K-14), Health-related quality of life (SF-8) and Attachment style (BFPE)., Results: Patients with liver insufficiency have a higher level of anxiety and show more often an insecure attachment style as renal failure patients. Differences between secure and insecure attached patients waiting for a kidney transplant are found in physical complaints, depression, depressive coping and self-efficacy, resilience, social support, active coping and mental health, in favor of secure attachment. Insecure attachment in patients with liver insufficiency leads to a less frequent usage of active coping strategies. Furthermore, the variables anxiety, depression, resilience, social support and dysfunctional coping mediate the relationship between attachment and mental health completely., Discussion: RESULTS suggest that psychological interventions should specifically consider the variables anxiety, depression, resilience, self-efficacy, social support, coping and attachment., Conclusion: The gained insights of this study make it possible to derive implications for interventions to reduce risk factors for the development of co-morbid mental disorders and to strengthen protective factors and thus improve the well-being and quality of life of patients., (© Georg Thieme Verlag KG Stuttgart · New York.)

Representative surveys indicate that eating disorders are an increasing problem, especially among (pre)adolescents. We assessed the effects of a German school-based primary prevention program ("Torera") for seventh graders. Torera especially relates to pathological eating behavior in the realm of bulimia nervosa or binge eating disorder. The program is built upon two previously evaluated modules for sixth graders with a gender-specific adaption. The coeducational intervention involves nine manual-guided lessons touching a wide range of eating-related problems. Twenty-two Thuringian secondary schools (n = 256 boys and 277 girls, aged 11-13 years at baseline) participated in a trial with 2 control groups (untreated and pretreated) with pre-post assessment. Primary outcomes were conspicuous eating behavior and body self-esteem, measured by standardized questionnaires (SCOFF, EAT-26D, and FBeK). Girls and students at risk showed significant improvement with small (d = 0.35) to medium (d = 0.66) effect sizes on eating behavior, significantly mediated by body self-esteem. Boys only improved with respect to eating attitudes, revealing a small effect size (d = 0.35). With relatively low implementation costs (about 2.50 per student), Torera provides an efficient model for reducing risky eating behavior and strengthening body self-esteem without negative side effects. To improve the effectiveness of the intervention, further research efforts focusing on at-risk groups (secondary prevention) and structural actions for prevention (e.g., offering healthy school catering) are needed.

The physician assistant (PA) profession emerged to utilize the skills of returning Vietnam-era military medics and corpsmen to fortify deficits in the health care workforce. Today, the nation again faces projected health care workforce shortages and a significant armed forces drawdown. The authors describe national efforts to address both issues by facilitating veterans' entrance into civilian PA careers and leveraging their skills.More than 50,000 service personnel with military health care training were discharged between 2006 and 2010. These veterans' health care experience and maturity make them ideal candidates for civilian training as primary care providers. They trained and practiced in teams and functioned under minimal supervision to care for a broad range of patients. Military health care personnel are experienced in emergency medicine, urgent care, primary care, public health, and disaster medicine. However, the PA profession scarcely taps this valuable resource. Fewer than 4% of veterans with health care experience may ever apply for civilian PA training.The Health Resources and Services Administration (HRSA) implements two strategies to help prepare and graduate veterans from PA education programs. First, Primary Care Training and Enhancement (PCTE) grants help develop the primary care workforce. In 2012, HRSA introduced reserved review points for PCTE: Physician Assistant Training in Primary Care applicants with veteran-targeted activities, increasing their likelihood of receiving funding. Second, HRSA leads civilian and military stakeholder workgroups that are identifying recruitment and retention activities and curricula adaptations that maximize veterans' potential as PAs. Both strategies are described, and early outcomes are presented.

Identifying significant determinants of groundwater nitrate contamination is critical in order to define sensible agri-environmental indicators that support the design, enforcement, and monitoring of regulatory policies. We use data from approximately 1200 Austrian municipalities to provide a detailed statistical analysis of (1) the factors influencing groundwater nitrate contamination and (2) the predictive capacity of the Gross Nitrogen Balance, one of the most commonly used agri-environmental indicators. We find that the percentage of cropland in a given region correlates positively with nitrate concentration in groundwater. Additionally, environmental characteristics such as temperature and precipitation are important co-factors. Higher average temperatures result in lower nitrate contamination of groundwater, possibly due to increased evapotranspiration. Higher average precipitation dilutes nitrates in the soil, further reducing groundwater nitrate concentration. Finally, we assess whether the Gross Nitrogen Balance is a valid predictor of groundwater nitrate contamination. Our regression analysis reveals that the Gross Nitrogen Balance is a statistically significant predictor for nitrate contamination. We also show that its predictive power can be improved if we account for average regional precipitation. The Gross Nitrogen Balance predicts nitrate contamination in groundwater more precisely in regions with higher average precipitation., (Copyright © 2012 Elsevier Ltd. All rights reserved.)

To detect risky eating behavior questionnaires should be economic but at the same time they should fulfill the psychometric quality criteria. Available instruments are too long for the target group (e. g. EDE-Q, 28 items), restricted on primary symptoms (short version of EDI, 23 items) and with minor reliability (e. g. SCOFF and WC-Scale, 5 items each). Using the German version of the Eating Attitudes Test (EAT-26D, which comprises 26 items) in a community sample of 1 331 11-13 year old girls and 906 boys from Thuringia, Germany, we measured a internal consistency of Cronbachs' Alpha=0.85 for girls and 0.78 for boys. In a principal factor analysis, we could replicate the 6-factorial structure of previous studies. A confirmatory factor analysis verified the suitability of the EAT-26D for both, girls and boys. Reducing the EAT-26D on the 3 core-factors leads to an economic 13 item short version with an internal consistency of 0.87 for girls and 0.80 for boys., (© Georg Thieme Verlag KG Stuttgart · New York.)

To detect eating disorders and risky eating behaviour at an early stage, screening tests should be economic, i. e. as short as possible but at the same time they should fulfil the psychometric quality criteria. We compared the German version of the Eating Attitudes Test (EAT-26D, which comprises 26 items) and the German version of the SCOFF test (which contains only 5 Yes-no questions) in a community sample of 425 12-year-old girls and 382 boys from Thuringia, Germany. Although the EAT-26D reached higher psychometric properties, the SCOFF has been proved as a useful screening tool with a test-retest reliability of r (tt)=0.73 and a maximum accuracy of 82% (area under the ROC curve). With the EAT-26D (20 point cut-off) as a reference the sensitivity of the SCOFF was 79%, specificity 74%, positive predictive value 25%, and the negative predictive value, which is more relevant for screenings, was 97%. The criterion validity reached r=0.53., (© Georg Thieme Verlag KG Stuttgart · New York.)

The decision to measure or to ask about data concerning height and weight in order to calculate body mass index (BMI) has an influence on the economy and validity of the measurements. Although self-reported information is less expensive, this information may possibly have a bias on the determined prevalences of different weight groups. Using representative data from the KiGGS study with a comparison of directly measured and self-reported BMI data, Kurth and Ellert (2010) developed two correction formulas for prevalences resulting from self-reported information. The aim of the study was to examine the practicability of the proposed correction formulas on our own data concerning self-reported BMI data of 11- to 13-year-old girls (n=1,271) and to assess the plausibility of the corrected measurements. As a result, the prevalences of our own data changed in the expected direction both for underweight and for overweight. Both formulas were found to be practicable, the consideration of the subjective weight status (formula 2) resulted in a greater change in prevalences compared to the first correction formula.

The onset of puberty is considered a critical period for the development of overweight and obesity. For prevention purposes, we developed the school-based intervention program TOPP (Teenage Obesity Prevention Program), especially for boys. In order to test the effectiveness, we conducted a controlled study using a pre-post design. A total of 84 schools in Thuringian, Germany, with 1,199 boys participated in the study. Program effectiveness was analyzed with mostly standardized questionnaires referring to body-related self esteem, eating behavior, physical activity, teasing, and knowledge. The program was performed during the course of a school project within at least 3 weeks or during the regular school lessons for more than 6 weeks. After 9×90-minute, manual-based lessons, including interactive exercises and poster-based group discussions, significant improvement was only reached for nutritional knowledge. As a main outcome, it could be demonstrated how an area-wide prevention program with low costs could be successfully implemented. The school environment enables us to create a universal, socially equitable, and low-threshold access.

Objective: Anorexia nervosa ('AN') is notoriously difficult to treat, has high mortality rates, and has a prevalence peak in 15-year-old girls. We developed a German school-based intervention program ('PriMa') for the primary prevention of AN in preadolescent girls and assessed the effects in a sample of Thuringian girls., Method: Intervention involved nine guided lessons with special posters and group discussions. A parallel controlled trial with pre-post measurements and a three-month follow-up was conducted in 92 Thuringian schools (n=1553 girls) in 2007 and 2008. Primary outcomes were conspicuous eating behavior, body self esteem, and AN-related knowledge., Results: After adjusting for the girls' ages and the type of school, we observed significant improvements in the areas of knowledge (d=.24) and body self esteem (d=.29), but not for eating behavior., Conclusion: The PriMa intervention provides an efficient and practical model to increase AN-related protection factors., (Copyright © 2010 Elsevier Inc. All rights reserved.)

Background: The online information seeking of multiple sclerosis (MS) patients, their reasons for doing so, and its importance for physician-patient communication have not been described., Methods: Patients (n = 61) presenting for the first time at an MS clinic from December 2003 to July 2005 were interviewed pre- and postappointment and administered standard measures of pain and health quality of life. Consultations were audio recorded. Quantitative data were analyzed in light of qualitative data., Results: Eighty-two percent of patients reported gathering medical information online before their first appointment; 36% discussed this information with their physician. Qualitative reasons for Internet information seeking and for not communicating it show some signs of wariness of health care potentially leading to nonadherence., Conclusions: Most MS patients are informed by online information, but are unlikely to discuss that research with physicians for reasons that may have implications for patient adherence.

Knowledge about the structural elements of skin and its appendices is an essential prerequisite for understanding their complex functions and interactions. The hence necessary morphological description across several orders of scale not only requires the investigation at the light microscopic level but also ultrastructural investigation, ideally on the identical sample. For a correlative and multimodal observation one unique preparation protocol is mandatory. As a compromise between sample sizes of >500 microm in diameter on the one hand and optimal preservation of antigenicity and morphology on the other, we developed a new preparation protocol that allows (i) 3D reconstruction of the resin-embedded sample by confocal light microscopy prior to (ii) direct immunolocalization of target proteins within selected sample planes by light and fluorescence microscopy or transmission electron microscopy. Alternatively, (iii) serial cryosections of the frozen sample can be taken for characterizing the sample in toto. With this unique approach we were able to fully demonstrate the structural complexity of axillary skin samples, increasing the structural resolution from 3D reconstruction of the whole gland up to ultrastructural investigations at the subcellular level. We could demonstrate that axillary sweat glands are not separately distributed, as has been assumed to date; instead, they seem to be intricately twisted into one another. This promotes the concept of a complex axillary sweat gland organ instead of single sweat gland entities.

The hammerhead ribozyme is one of the best-studied small RNA enzymes, yet is mechanistically still poorly understood. We measured the Mg(2+) dependencies of folding and catalysis for two distinct hammerhead ribozymes, HHL and HH alpha. HHL has three long helical stems and was previously used to characterize Mg(2+)-induced folding. HH alpha has shorter stems and an A.U tandem next to the cleavage site that increases activity approximately 10-fold at 10 mM Mg(2+). We find that both ribozymes cleave with fast rates (5-10 min(-1), at pH 8 and 25 degrees C) at nonphysiologically high Mg(2+) concentrations, but with distinct Mg(2+) dissociation constants for catalysis: 90 mM for HHL and 10 mM for HH alpha. Using time-resolved fluorescence resonance energy transfer, we measured the stem I-stem II distance distribution as a function of Mg(2+) concentration, in the presence and absence of 100 mM Na(+), at 4 and 25 degrees C. Our data show two structural transitions. The larger transition (with Mg(2+) dissociation constants in the physiological range of approximately 1 mM, below the catalytic dissociation constants) brings stems I and II close together and is hindered by Na(+). The second, globally minor, rearrangement coincides with catalytic activation and is not hindered by Na(+). Additionally, the more active HH alpha exhibits a higher flexibility than HHL under all conditions. Finally, both ribozyme-product complexes have a bimodal stem I-stem II distance distribution, suggesting a fast equilibrium between distinct conformers. We propose that the role of diffusely bound Mg(2+) is to increase the probability of formation of a properly aligned catalytic core, thus compensating for the absence of naturally occurring kissing-loop interactions.

Over the last several years, a great level of interest has rallied behind understanding how the pivotal kinase, 3'-phosphoinositide dependent kinase 1 (PDK1) is regulated. PDK1 phosphorylates and activates members of the AGC kinase family shown to be activated downstream of phosphoinositide 3-kinase (P13K); however, the functional dependency of PDK1 on P13K for activation of its targets is less clear. The P13K signaling pathway mediates numerous cellular responses upon growth factor and hormone stimulation. Specifically, P13K signaling influences many of the metabolic and mitogenic functions of the anabolic hormone, insulin. Thus, the regulation of P13K and its downstream targets by insulin has become an important topic for investigation. Given its central role as the kinase upstream of those signaling pathways linked to P13K, the regulation of PDK1 by insulin and other factors is at the height of many of these investigations. Current theories on PDK1 regulation propose substrate conformation and subcellular localization as the primary mediators of PDK1 function. The array of PDK1 substrates suggests, however, that in cells PDK1 may be more tightly regulated. Recent data support phosphorylation as a potential regulatory mechanism that may play an additional role in directing the specificity of PDK1 towards its physiological substrates. The combination of these regulatory mechanisms along with the potential for multiple PDK1 isoforms with select tissue distribution may contribute to the diversified actions of insulin signaling. The targeting of these various aspects of PDK1 regulation may provide for novel therapeutic treatments for diseases such as diabetes and cancer.

The binding of IL-4 to its receptor results in rapid tyrosine phosphorylation of STAT6 by IL-4R-associated Jak kinases. Phosphorylated STAT6 dimerizes and translocates to the nucleus where it acts as a transcription factor to regulate a number of important immune response-related genes in a variety of cell types. Studies of other STAT proteins have demonstrated a role for serine phosphorylation in addition to tyrosine phosphorylation in the regulation of STAT-mediated gene transcription. In this study, phosphoamino acid analysis and two-dimensional phosphopeptide mapping of STAT6 from mouse splenic B cells demonstrated that IL-4 induces phosphorylation of STAT6 on multiple serines. Expression and analysis of a mutant STAT6 protein in which tyrosine 641 (Y641) was replaced with phenylalanine demonstrated that Y641 is necessary for tyrosine phosphorylation of STAT6, but that tyrosine phosphorylation is not necessary for serine phosphorylation. Analysis of STAT6 deletion mutants localized the majority of serine phosphorylation sites to a region between residues 719 and 789, within the previously described transactivation domain. IL-4-stimulated serine phosphorylation of STAT6 was resistant to H7 and HA1004, inhibitors of many serine/threonine kinases including PKC. Serine phosphorylation was also resistant to Wortmannin and LY294002, demonstrating that the IRS/PI 3-kinase pathway is also not required. These data, coupled with previous studies showing that IL-4 does not activate MAPK pathways in lymphocytes, suggest that IL-4 may induce serine phosphorylation of STAT6 by a novel-signaling pathway.

Decentralized training for the didactic portion of allied health programs has been assessed for its ability to increase the likelihood that graduates will practice in underserved areas. The question still remains whether these distant sites provide an education that is comparable to that offered at the main campuses. Exams and final grades for all classes over the course of five years at MEDEX Northwest in Seattle were compared to determine whether there was any major discrepancy between the main training location and the decentralized sites. With the exception of three individual cases, overall academic performances in all training sites were comparable. This suggests that programs employing some of the curricular and administrative controls in place at MEDEX Northwest can achieve a parity in education across their various training sites.

BACKGROUND: A number of studies have highlighted the problems with driving reported by wearers of monovision contact lens corrections. In this study, we wished to investigate this further, by determining whether driving performance as measured on the open road under daytime conditions is worse when drivers wear their monovision contact lenses compared to their habitual correction. METHODS: Thirteen subjects with healthy eyes and corrected visual acuity of 6/6 were selected. Each had worn monovision contact lenses for at least three months. All subjects had their driving performance assessed while driving their own vehicles on an open road course, with both monovision contact lenses and their other habitual correction (spectacles or unaided). RESULTS: No statistically significant differences were found in driving performance when subjects wore their monovision contact lenses compared to when they wore their habitual distance correction. CONCLUSIONS: The results indicate that monovision does not adversely affect driving performance in daylight hours for adapted wearers. However, limitations in the study design are acknowledged, including the relatively small sample size, lack of standardisation of the habitual correction and the use of adapted wearers. Future studies are recommended to investigate these issues further.

The objective of this retrospective study was to compare the birth characteristics and perinatal mortality of babies conceived from the use of cryopreserved embryos with those resulting from in-vitro fertilization (IVF) and fresh embryo transfer. A total of 232 consecutive births, one pregnancy termination and a total of 283 babies in the cryopreserved group were studied. The IVF data included 763 births, three terminations and 961 babies, based on a previous analysis. There was no difference in the incidence of twin (18 versus 19%) and triplet births (2 versus 3%) in the cryopreserved and IVF groups respectively. The mean gestational age and birthweight of singleton, twin and triplet births were not significantly different between the groups. No difference was found in the perinatal mortality rates. The incidence of major congenital malformations in the cryopreserved group (1%) was significantly lower than that in the IVF group (3%; P < 0.05). It is concluded that the birth characteristics of babies conceived from cryopreserved/thawed embryos are similar to those from fresh embryos. There are fewer congenital malformations in the cryopreserved group.

Conventional press-and-breathe metered dose inhalers (MDIs) are widely prescribed but are often difficult for many patients to properly use. A total of 501 patients from different medical specialties were enrolled in this study, which evaluated how the patients used their MDIs. Using a conservative method (minimum number of errors) of determining errors, we found that 388 (77.5%) of the patients made at least one error when demonstrating how they use their MDI for two observers. Using a liberal (maximum number of errors) method of analysis, we found that 447 (89.2%) of the patients made at least one error. There was no difference in errors made stratified by patient gender, patient age, or the medical specialty that treated the patient's pulmonary disease. The two most common errors made by patients were failure to breathe out to functional residual capacity before actuation (225 by minimum method, 280 by maximum method) and not actuating the canister at the start of inhalation (207 by minimum method, 323 by maximum method). Of the patients with improper timing of actuation, the majority (121 patients by minimum method and 187 patients by maximum method) actuated the canister early. In this large patient sample, regardless of which medical specialty provided the treatment, the majority of the patients evaluated had less than optimal MDI technique. Routine assessment of MDI technique should be instituted as standard practice care.

Two three-way crossover studies were done to characterize the drug release characteristics of Monospan (3M Pharmaceuticals, St. Paul, MN) capsules, a new once-a-day theophylline formulation. In the first study, 22 healthy males received single 450-mg doses of Monospan in the presence and absence of a high-fat breakfast; the same dose of Somophyllin (Fisons, Rochester, NY) immediate-release liquid was given to fasted subjects as a reference. The second study involved 29 healthy males given a single dose of 900 mg of Monospan in the presence and absence of the same high-fat meal; Theo-24 (G. D. Searle and Co., Skokie, IL) capsules were given to fasted subjects as a reference. The results of both studies showed that food did not affect the absorption of theophylline from Monospan; peak concentration, to and area under the serum concentration-time curve were all unchanged. The absorption rates were similar with both strengths and dietary conditions and showed that theophylline was absorbed slowly from Monospan at a constant rate (approximately 3.2%/h) over 24 h. Absorption continued past 24 h, and the extent of absorption from Monospan compared with that from each reference averaged 88% or higher. A good correlation (r > 0.980) was observed for Monospan between the amount absorbed in vivo and the amount released in the in vitro dissolution test, a result that demonstrates the precise rate control of Monospan. We conclude that Monospan is a suitable once-a-day formulation that can be taken without regard to food.

The inhalation of atropine sulfate from a pressurized metered-dose inhaler was investigated in a nonrandomized four-period rising-dose study. Eight healthy, nonsmoking subjects received 1.7, 3.4, and 5.2 mg of atropine sulfate by inhalation and 1.67 mg of atropine free base (equivalent to 2 mg of atropine sulfate) by intramuscular (i.m.) injection. Serum atropine sulfate concentrations were measured over a 24-h period by gas chromatography/mass spectrometry. Mean serum concentrations increased nonproportionally as the inhaled dose increased. Mean peak concentrations were 4.9, 6.1, and 7.9 ng/ml for the inhaled doses and 8.4 ng/ml for the i.m. dose. Typical anticholinergic effects were seen after all doses.

This prospective partly-randomized study assessed the relative efficacy of two strategies of patient management for the replacement of frozen-thawed embryos. A luteinizing hormone-releasing hormone (LHRH) agonist was used to induce a temporary hypogonadism in a group of patients who were then prepared for implantation by endometrial priming with hormone replacement therapy (HRT): oral oestradiol valerate and then oestradiol valerate and injections of progesterone. A second group of patients had their frozen-thawed embryos replaced during their natural cycles. Of the 84 patients treated with the LHRH regimen, 80 had embryos replaced and 16 (20%) clinical pregnancies were established. Of the 78 patients treated with natural cycles, 70 had embryos replaced and 14 (20%) achieved clinical pregnancies. There were no statistical differences between the two groups in terms of age, obstetric history, duration of infertility, number of oocytes retrieved and fertilized or the number of embryos frozen following ovarian stimulation in the embryo 'generating' cycle. In terms of pregnancy rates, both protocols were equally effective. However, the LHRH-HRT protocol was of great value in the management of oligomenorrhoeic patients and in establishing standard conditions for implantation in cyclic patients.

Amino acids in lac repressor protein which form cross-links to lac operator DNA specifically substituted with bromodeoxyuridine (BrdU) have been identified. Five sites of cross-linking in BrdU-substituted operator DNA were found at positions +3, +4, +14, +18, and +19 relative to the initiation site for transcription (Wick, K.L., and Matthews, K.S. (1991) J. Biol. Chem. 266, 6106-6112). Irradiation of complexes of repressor and each of these five singly substituted operator DNAs was executed under large scale conditions to generate sufficient complex for proteolysis, separation of the peptide-DNA, and peptide sequencing. The DNAs substituted with BrdU for thymidine at positions +3, +18, and +19 yielded cross-links to the peptide spanning residues 23-33, with the cross-link identified at His-29. Substitution at position +14 resulted in a cross-link to Tyr-17 within the peptide containing amino acids 13-22. These results are consistent with the structure determined by NMR and molecular dynamics calculations of the NH2-terminal headpiece-symmetric operator complex (Lamerichs, R.M.J.N., Boelens, R., van der Marel, G.A., van Boom, J.H., Kaptein, R., Buck, F., Fera, B., and Rüterjans, H. (1989) Biochemistry 28, 2895-2991; de Vlieg, J., Berendsen, H.J.C., and van Gunsteren, W.F. (1989) Proteins 6, 104-127). This structure indicates proximity of His-29 in the major groove to thymidines at positions +3 and +4. Since base pairs at positions +18 and +19 occupy symmetrical positions to +3 and +4 in the promoter distal region of the operator, it would be anticipated that cross-links similar to the +3 and +4 positions would form at these sites; this prediction is not borne out by the behavior at +4/+18, as no peptide could be identified cross-linked to DNA substituted at +4. Molecular dynamics simulations and the NMR data indicate that Tyr-17 interacts with the thymine at position +8, which is symmetrically related to position +14. Although BrdU-associated strand scission at +8 is protected, this site does not cross-link with bound lac repressor; inversely, DNA substituted with BrdU at +14 cross-links to repressor, but is not protected from strand scission by the presence of the protein. These differences at symmetrically related nucleotide positions (+4 versus +18, +8 versus +14) reflect the inherent asymmetry in the interaction. The identification of amino acids in proximity to specifically substituted sites confirms that positions of several amino acids in the intact protein-operator complex correspond to those in the structure of the NH2-terminal headpiece-operator DNA complex.

Specific contacts between the lac repressor and operator have been explored using 5-bromodeoxyuridine-substituted DNA. Substitution of BrdU for single thymidine positions in a synthetic 40-base pair operator provides substrate for ultraviolet irradiation; upon irradiation, strand scission occurs at the BrdU residues. When bound, lac repressor protein provides protection against UV-induced breakage depending on the nature of the sites and type of interaction. We have confirmed 13 unique sites of inducer-sensitive protection along the operator sequence using this method compared to complete substitution with BrdU; differences were observed at two positions for singly substituted versus completely substituted DNAs (Ogata, R., and Gilbert, W. (1977) Proc. Natl. Acad. Sci. U.S.A. 74, 4973-4976). The ability of these photosensitive DNAs to form short range cross-links to bound protein has been used to determine the efficiency with which cross-linked protein-DNA complexes are generated at each individual site of BrdU substitution. Five sites of high efficiency cross-linking to the repressor protein have been identified. At one site, cross-linking without protection from strand scission was observed; this result suggests an unusual mechanism of strand scission and/or cross-linking at this site. Comparison of the UV protection results and the cross-linking data show that these processes provide complementary tools for identifying and analyzing individual protein-DNA contacts.

The survival of cleaving embryos after freezing and thawing has been assessed. First, comparisons were made of the proportions of embryos in which all blastomeres were viable cells after thawing, following various forms of ovarian stimulation. A flare-up protocol using a GnRH-agonist (buserelin) produced significantly higher numbers of these embryos than a pituitary down-regulation protocol (P less than 0.05), though neither was significantly different from clomiphene citrate/HMG stimulation. Secondly, other parameters of embryo survival e.g. proportions with one or more surviving cells and pregnancy rates were assessed and were similar among stimulation protocols and treatments in the embryo replacement cycle. Survival of blastomeres in 2- to 8-cell embryos was inversely related to the theoretical total surface area of all blastomeres in the embryo. Thawed embryos with one or more blastomeres damaged during freezing had the same capacity to produce pregnancies as did those with all blastomeres intact. The survival of individual cells was clearly related to the stage at which the cleaving embryo is frozen, but moderate loss of cells does not significantly influence implantation.