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Somatoform disorders (SD), commencing during adolescence, represent a major problem in health care systems. While literature underlines the high presence of mental health problems among children and adolescents afflicted by somatic symptoms in the general population, limited evidence is available on the prevalence of comorbid somatic symptoms in child and adolescent psychiatric populations. We assessed the prevalence of somatic symptoms, depression, and anxiety by validated questionnaires in an inpatient cohort. We further screened for the presence of SD. Out of 434 inpatients aged 11–17 years, 371 were included and a total of n = 288 (77.6%) children and adolescents participated in the study. A total of 93.8% of the inpatients reported somatic symptoms within the past six months and still almost half (45.7%) of the sample reported at least one somatic symptom within the last seven days prior to inquiry. Relating to the past six months, 59.5% were positively screened for SD, and 44.6% reported symptoms eligible for positive screening within the past seven days prior to the survey. Somatoform symptomatology was highly associated with anxiety and depression scores, but functional decline was amenable to the number of somatic symptoms only. We provide evidence that somatic symptoms are frequent in children and adolescents being treated in child and adolescent psychiatry and are relevant to everyday functioning. Screening for somatic symptoms should be introduced in the routine diagnostic procedures for early detection of SD in the commencing stages. [ABSTRACT FROM AUTHOR]

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

Aims Germany is experiencing a decline in alcohol consumption but not for every alcoholic beverage type. Given the differential health impacts of alcoholic beverage type, it is important to understand the drivers of these trends. We investigated: (a) temporal trends in beverage preference and (b) the effects of age, period and cohort on these trends. Methods Data came from nine waves (1995–2018; n total = 75,550) of the German Epidemiological Survey of Substance Abuse, a nationally representative household survey of individuals aged 18–59 years. The quantity of beer, wine, spirits and mixed drinks drank in the last 30 days was transformed into grammes of ethanol, and the beverage type preference was estimated as the proportion of total ethanol consumption. Fractional multinomial logit regression was applied to analyse the age, period and cohort effects on temporal trends of beverage preference by sex. Results The preference for spirits and mixed drinks decreased with increasing age, while the preference for wine increased with no age effect on beer. There was a general decrease in the preference for beer and an increase in the preference for wine among both sexes, with an additional increase in the preference for spirits in males. Conclusion Trends in beverage preference were more related to individual ageing and changes in the whole population than to cohorts. With the continued reduction in alcohol consumption, the decreasing preference for beer and the growing preference for wine suggest a positive development. Trends of an increasing preference for spirits in males are of concern. [ABSTRACT FROM AUTHOR]

Background. Hematopoietic stem cell transplantation (HSCT) is a curative treatment option for malignant and nonmalignant diseases that is highly distressing, especially for children. A valid assessment of pediatric patients' distress that is independent from their language skills would be beneficial. Research regarding HSCT-specific self-reporting or rater-reporting instruments is scarce. Method. In this single-center prospective study, pediatric patients and young adolescents undergoing HSCT were screened for mental and somatic distress using PO-Bado (Basic Documentation for Psycho-Oncology) ratings from parents and medical caregivers on eight observations days before, during, and up to 200 days after HSCT. Additionally, the stress biomarkers cortisol and α-amylase were monitored on the same observation days. Results. A total of 39 pediatric and young adult patients with a median age of 9.3 years (range 0.5–19.0), with 18 females (46%) and 21 males, were enrolled. The perceptions of the patients' somatic and mental distress of parents and medical caregivers of patients were significantly correlated (mental subscale ((r(276) = 0.31, p < 0.001., 95% CI of the correlation: (0.20, 0.41)) and somatic subscale ((r(284) = 0.46, p < 0.001., 95% CI of the correlation: 0.36, 0.54)). The time period between the days of transplantation until day +10 was rated as the most mentally and somatically distressing. Conclusions. While the somatic burden declined over time, the mental distress in the patients remained at a stable level, emphasizing the importance of further psychological and psycho-oncological support in these patients. The use of salivary α-amylase as a suitable distress detection marker in pediatric patients undergoing HSCT should be further investigated. [ABSTRACT FROM AUTHOR]

Simple Summary: Human papillomavirus (HPV) association is the most important predictor of survival in squamous cell carcinomas in the head and neck region (HNSCC). The role of HPV in cancer of unknown origin at this anatomic site (CUPHNSCC) is less well understood. The objective of this study was to identify prognostic classification markers in CUPHNSCC. Therefore, we investigated a consecutive cohort by multivariate modeling and testing for HPV DNA, mRNA, and p16INK4a (p16) expression. In 31% of CUPHNSCC, p16 was overexpressed, and high-risk HPV DNA was detected in 18/32 (56.3%) of them, which was mostly consistent with mRNA detection. In contrast to oropharyngeal cancer, detection of p16 without additional detailed HPV testing appears to be more appropriate for the classification of CUPHNSCC. Three risk groups can be stratified based on performance status and p16, but additional factors may become important in future data or for cases with particular risk profiles. Background: Human papillomavirus (HPV) status is the most important predictor of survival in oropharyngeal squamous cell carcinoma (OPSCC). In patients with cervical lymph node metastases of squamous cell carcinoma of unknown origin (CUPHNSCC), much less is known. Methods: We assessed a consecutive cohort of CUPHNSCC diagnosed from 2000–2018 for HPV DNA, mRNA, p16INK4a (p16) expression, and risk factors to identify prognostic classification markers. Results: In 32/103 (31%) CUPHNSCC, p16 was overexpressed, and high-risk HPV DNA was detected in 18/32 (56.3%). This was mostly consistent with mRNA detection. In recursive partitioning analysis, CUPHNSCC patients were classified into three risk groups according to performance status (ECOG) and p16. Principal component analysis suggests a negative correlation of p16, HPV DNA, and gender in relation to ECOG, as well as a correlation between N stage, extranodal extension, and tobacco/alcohol consumption. Conclusions: Despite obvious differences, CUPHNSCC shares similarities in risk profile with OPSCC. However, the detection of p16 alone appears to be more suitable for the classification of CUPHNSCC than for OPSCC and, in combination with ECOG, allows stratification into three risk groups. In the future, additional factors besides p16 and ECOG may become important in larger studies or cases with special risk profiles. [ABSTRACT FROM AUTHOR]

Existing theories of aging suggest that there may be similarities and differences in how COVID-19 impacts older people's psychosocial adaptation compared to younger age groups, particularly middle-aged individuals. To assess the degree to which these impacts vary, we analyzed data from 3098 participants between the ages of 40 and 79 from an online survey in Germany. Data were collected at three measurement occasions between the start of the nationwide lockdown in mid-March 2020 and the end of the lockdown in early August 2020. The survey focused on everyday experiences during the COVID-19 crisis and collected various satisfaction ratings (e.g., general life satisfaction, satisfaction with family life, satisfaction with social contacts). At baseline, participants also provided retrospective ratings of satisfaction for the period before the COVID-19 crisis. In our analyses, we compared satisfaction ratings of middle-aged (40–64 years) and older individuals (65–79 years) and found that both middle-aged and older participants experienced the greatest decreases in satisfaction with social contacts, with more pronounced decreases seen in middle-aged participants. A similar pattern was observed for general life satisfaction, but the overall decreases were less pronounced in both groups compared to the decreases in satisfaction with social contacts. We also observed a partial recovery effect in all measures at the last measurement occasion, and this effect was more pronounced in older adults. Findings were also confirmed using age as a continuous variable and checking for linear and nonlinear effects of outcomes across the age range. Although ageism arose during the pandemic in the sense that older adults were labeled as a "risk group," particularly at the start of the outbreak, we found consistently with other studies that middle-aged adults' satisfaction decreased to a greater extent than that of older adults. [ABSTRACT FROM AUTHOR]

Background: Multimorbidity is common among general practice patients and increases a general practitioner's (GP's) workload. But the extent of multimorbidity may depend on its definition and whether a time delimiter is included in the definition or not. Aims: The aims of the study were (1) to compare practice prevalence rates yielded by different models of multimorbidity, (2) to determine how a time delimiter influences the prevalence rates and (3) to assess the effects of multimorbidity on the number of direct and indirect patient contacts as an indicator of doctors' workload. Methods: This retrospective observational study used electronic medical records from 142 German general practices, covering 13 years from 1994 to 2007. The four models of multimorbidity ranged from a simple definition, requiring only two diseases, to an advanced definition requiring at least three chronic conditions. We also included a time delimiter for the definition of multimorbidity. Descriptive statistics, such as means and correlation coefficients, were applied. Findings: The annual percentage of multimorbid primary care patients ranged between 84% (simple model) and 16% (advanced model) and between 74% and 13% if a time delimiter was included. Multimorbid patients had about twice as many contacts annually than the remainder. The number of contacts were different for each model, but the ratio remained similar. The number of contacts correlated moderately with patient age (r = 0.35). The correlation between age and multimorbidity increased from model to model up to 0.28 while the correlations between contacts and multimorbidity varied around 0.2 in all four models. Conclusion: Multimorbidity seems to be less prevalent in primary care practices than usually estimated if advanced definitions of multimorbidity and a temporal delimiter are applied. Although multimorbidity increases in any model a doctor's workload, it is especially the older person with multiple chronic diseases who is a challenge for the GP. [ABSTRACT FROM AUTHOR]

Background: There is little information available regarding the decision-making process of clinicians, especially in the choice of therapy for a severely atrophic tooth gap. The aim of this research was to use case vignettes to determine the influence of possible factors on the decision making of maxillofacial and oral surgeons. Methods: A total of 250 maxillofacial (MFS) and oral (OS) surgeons in southern Germany were surveyed for atrophic single- or multiple-tooth gap with the help of case vignettes. The influence of different determinants on the therapy decision was investigated. Two case vignettes were designed for this purpose: vignette 1 with determinants "patient age" and "endocarditis prophylaxis" and vignette 2 with determinants "anxiety" and "bisphosphonate therapy". Furthermore, the specialist designation was assessed for both. The options available to achieve a sufficient implant site were "bone split", "bone block", "augmentation with bone substitute material" and "bone resection". Therapy was either recommended or rejected based on principle. Results: A total of 117 participants returned the questionnaire: 68 (58%) were OS and 49 (42%) MFS. "Patient age" and "patient anxiety" were not significantly associated with any therapy decision. However, required "endocarditis prophylaxis" led to significantly higher refusal rates for "bone split", "bone block" and "bone replacement material" and to higher rates of general refusal of a therapy. "Bisphosphonate therapy" was significantly associated with general refusal of therapy, but with no significant correlation with different therapy options. In vignette 1, OS refused therapy significantly more often than MFS, though there was no association with the specialist designation for other therapy modalities. In vignette 2, specialty was not significantly associated with the therapy decision. Conclusion: "Patient age" as well as "patient anxiety" appear to have no or little influence on the treatment decision for severely atrophic single- or multiple-tooth gap by specialist surgeons. Surgeons more often refuse treatment for patients with endocarditis prophylaxis and bisphosphonate therapy. [ABSTRACT FROM AUTHOR]

Objective: To participate in shared decision making (SDM), patients need to understand their options and develop trust in their own decision‐making abilities. Two experiments investigated the potential of decision aids (DAs) in preparing patients for SDM by raising awareness of preference‐sensitivity (Study 1) and showing possible personal motives for decision making (Study 2) in addition to providing information about the treatment options. Methods: Participants (Study 1: N = 117; Study 2: N = 217) were put into two scenarios (Study 1: cruciate ligament rupture; Study 2: contraception), watched a consultation video and were randomized into one of three groups where they received additional information in the form of (a) narrative patient testimonials; (b) non‐narrative decision strategies; and (c) an unrelated text (control group). Results: Participants who viewed the patient testimonials or decision strategies felt better prepared for a decision (Study 1: P <.001, ηP2 = 0.43; Study 2: P <.001, ηP2 = 0.57) and evaluated the decision‐making process more positively (Study 2: P <.001, ηP2 = 0.13) than participants in the control condition. Decision certainty (Study 1: P <.001, ηP2 = 0.05) and satisfaction (Study 1: P <.001, ηP2 = 0.11; Study 2: P =.003, d = 0.29) were higher across all conditions after watching the consultation video, and certainty and satisfaction were lower in the control condition (Study 2: P <.001, ηP2 = 0.05). Discussion: Decision aids that explain preference‐sensitivity and personal motives can be beneficial for improving people's feelings of being prepared and their perception of the decision‐making process. To reach decision certainty and satisfaction, being well informed of one's options is particularly relevant. We discuss the implications of our findings for future research and the design of DAs. [ABSTRACT FROM AUTHOR]

Background Since the first cases of the novel coronavirus disease SARS-CoV-2 were reported in December 2019 in China, the virus has spread in most countries. The aim of the present study was to assess initial data on the mental health burden of the German public during the COVID-19 pandemic. Methods A cross-sectional study was conducted in Germany and collected complete datasets from 15 704 German residents aged 18 years and over. Besides demographics, generalized anxiety (GAD-7), depression (PHQ-2) and psychological distress (DT) were assessed. Furthermore, COVID-19-related fear, trust in governmental actions to face COVID-19 and the subjective level of information regarding COVID-19 were covered. Results Significantly increased symptoms were highly prevalent in all dimensions: generalized anxiety (44.9%), depression (14.3%), psychological distress (65.2%) and COVID-19-related fear (59%). Females and younger people reported higher mental burden. Trust in governmental actions to face COVID-19 and the subjective level of information regarding COVID-19 are negatively associated with mental health burden. However, the subjective level of information regarding COVID-19 is positively associated with increased COVID-19-related fear. Conclusions The provision of appropriate psychological interventions for those in need and the provision of transparency and comprehensible information are crucial during the current pandemic. [ABSTRACT FROM AUTHOR]

In Germany and elsewhere, few hospital electronic patient record usability surveys are available. Moreover, there seems to be a complete lack of validated instruments in the respective literature. Hence, this study's purpose is to validate a scale for measuring the usability of hospital electronic patient record systems. The data used for the study's analyses (n = 949) were originally obtained during the German national initiative 'Hospital IT User Questionnaire'. In the course of the study, reliability and exploratory factor analyses were conducted and psychometric tests showed a reliable, valid and suitable instrument. Descriptive data analysis suggests a generally low user perception and variances hint at a high potential for future improvements. To our knowledge, this study shows that a general inventory (subscales from the IsoMetrics inventory) can be applied to measuring hospital electronic patient record usability as well. The validated instrument can be used to inform healthcare providers, decision makers and politicians of a given state of usability, discrepancies between different hospitals or systems providers, and serve as a basis for improvements. [ABSTRACT FROM AUTHOR]

Background: Many studies have shown that sociodemographic variables significantly predict the use of complementary and alternative medicine (CAM), although these predictions were not particularly strong. A multitude of predictors of the use or approval of CAM have been investigated in the field of personal values and worldviews, but the effects were small or doubtful due to non-representative samples. More recent psychological research has linked positive attitudes towards CAM with intuitive thinking, paranormal beliefs, ontological confusions and magical health beliefs, suggesting a common thinking style behind all these variables. The aim of this study is to identify the most important predictors of the use and approval of CAM. Methods: We performed a canonical correlation analysis on all 3480 records from the 2012 German General Social Survey (ALLBUS) with the lifetime use and opinion of CAM as the dependent variables. Results: Approval of paranormal practices such as fortune-telling, dowsing or spiritualism explained 32% of the variance in the dependent canonical variate "approval of CAM", while sociodemographic variables explained only 2%. Experience with paranormal practices explained 17% of the variance in the dependent canonical variate "experience with CAM", and sociodemographic variables explained 10% of the variance. Traditional religiosity, attitudes towards science and post-materialist values showed no relevant correlations with the dependent canonical variates. Conclusions: Paranormal beliefs and related measures are the most important known predictors of the use and approval of CAM. Experience with paranormal practices not only indicates paranormal beliefs but also explains experience with CAM that cannot be explained by approval of CAM. Female gender and higher socioeconomic status predict experience with CAM without predicting approval of CAM, but their influence should not be overstated. [ABSTRACT FROM AUTHOR]

Background: Health behavior is presumed to be influenced by organizational factors. This study analyzes how workplace characteristics influence health behavior in terms of participation at health measures. Methods: Employees of the German Federal Ministry of Defense were surveyed at the beginning (January / February 2015) and at the end (June 2015) of the trial phase of workplace health promotion (WHP). Differences in participation of characteristic groups were calculated using Pearson's Chi2-Test and T-Test, chances of participation were estimated using multilevel logistic regression. Results: Employees who reported higher satisfaction with work demand participated more often in health measures (aOR: 1.02, 95%-CI = 1.01, 1.04, p < 0.001). Large amount of variance in participation can be attributed to department level. Conclusion: Participation at WHP varies significantly between settings after controlling for individuals' characteristics. Thus, working characteristics should be considered as a decisive factor for WHP effectiveness. There is consensus that behavioral prevention is most effective when conditional prevention is granted as behavior is presumed to be influenced by individuals´ environmental conditions. Though objective working conditions may seem similar further context characteristics which remain unconsidered may lead to different behavior patterns. This article shows that more attention must be payed to setting specific characteristics with regard to effective Occupational Health Promotion. This project is registered by the Federal Ministry of Defense (research number: E/U2AD/ED003/EF555). [ABSTRACT FROM AUTHOR]

Students in psychology are often surveyed for personality. Empirical results show relevance of this topic, because personality influences academic success. In contrast, we know much less about the personality of students of cooperative education. So, we collected data from 5,863 students at Baden-Wuerttemberg Cooperative State University in August 2016. Multivariate analysis of covariance (MANCOVA) indicated that gender (partial η² = .06), academic field (partial η² = .01) and covariate university entrance scores (partial η² = .05) have an effect on Big Five personality traits controlling age and social class. The results can be used for selecting students in cooperative education for academic fields and compare them with other types of study. [ABSTRACT FROM AUTHOR]

Aim: The aim of this study was to give an overview of family caregiver satisfaction within the home palliative care situation in North Rhine-Westphalia, Germany. Design: A cross-sectional study. Methods: An anonymous questionnaire, with seven validated scales, and comprising of 71 items, was used. The items investigated perceived needs and burdens of families within a home-based palliative care situation. The satisfaction of the family caregivers with the services delivered by palliative care teams was measured by the FAMCARE-2 Scale. Descriptive statistics and analysis of covariance (ANCOVA) were performed. Results: A convenience sample of 106 family members agreed to participate in the study. Overall, we found high satisfaction within our sample. There was high satisfaction with how the services respected the dignity of families, and how they provided comfort to patients. Satisfaction was lower with regard to information about patients. Conclusion: High or low satisfaction with palliative care, tells us little about the quality of services. The high satisfaction within this study could be interpreted as a sign that palliative care was important to families at the time of availability. Regular and continuous assessment can serve to inform the continuous quality of care provision for patients and their families. [ABSTRACT FROM AUTHOR]

Objectives: even though a great number of research studies have shown that high education has protective effects against dementia, some studies did not observe such a significant effect. In that respect, the aim of our study was to investigate and compare various operationalisation approaches of education and how they impact dementia risk within one sample. Methods: data were derived from the Leipzig longitudinal study of the aged (LEILA75+). Individuals aged 75 and older underwent six cognitive assessments at an interval of 1.5 years and a final follow-up 15 years after the baseline assessment. We operationalised education according to different approaches used in previous studies and analysed the impact on dementia incidence via multivariate cox regression modelling. Results: the results showed that whether education is identified as significant protector against dementia strongly depends on the operationalisation of education. Whereas the pure number of years of education showed statistically significant protective effects on dementia risk, other more complex categorical classification approaches did not. Moreover, completing >10 years of education or a tertiary level seems to be an important threshold to significantly reduce dementia risk. Conclusion: findings suggest a protective effect of more years of education on a lower dementia risk with a particular critical threshold of completing >10 years of education. Further, the findings highlight that, when examining risks and protective factors of dementia, a careful consideration of the underlying definitions and operationalisation approaches is required. [ABSTRACT FROM AUTHOR]

Excess accumulation of visceral adipose tissue (VAT) is a known risk factor for cardiometabolic diseases; further, subcutaneous abdominal adipose tissue (SAAT) and the ratio of both (VAT:SAAT ratio) have been discussed as potentially detrimental. Information about the association between diet and adipose tissue is scarce. This study aimed to identify food group intake associated with VAT and SAAT and the VAT:SAAT ratio in a Northern German population. A cross-sectional analysis was conducted in 344 men and 241 women who underwent an MRI to quantify total volumes of VAT and SAAT. Intake of fourteen food groups was assessed with a self-administered 112-item FFQ. Linear regression models adjusted for age, sex, energy intake, physical activity, intake of other food groups and mutual adjustment for VAT and SAAT were calculated to analyse the associations between standardised food group intake and VAT and SAAT, or the VAT:SAAT ratio. Intakes of potatoes (P=0·043) and cakes (P=0·003) were positively and inversely, respectively, associated with both VAT and SAAT. By contrast, intake of cereals was negatively associated with VAT (P=0·045) only, whereas intakes of eggs (P=0·006) and non-alcoholic beverages (P=0·042) were positively associated with SAAT only. The association between eggs and non-alcoholic beverages with SAAT remained significant after further consideration of VAT. Intake of non-alcoholic beverages was also inversely associated with the VAT:SAAT ratio (P=0·001). Our analysis adds to the evidence that intake of foods is independently associated with VAT or SAAT volumes. [ABSTRACT FROM PUBLISHER]

Caregiver burden is a main outcome domain in caregiver intervention research. A recommended instrument for measuring burden is the Sense of Competence Questionnaire (SCQ). In this study, we evaluated the psychometric properties of the German version of the SCQ with informal caregivers of stroke patients. Baseline data of a randomized controlled trial ( n = 122) and survey data ( n = 76) of caregivers of stroke patients were used. Data were collected at the caregiver's or the care receiver's home or over the telephone. We evaluated the homogeneity, the construct validity, and the clinical validity of the German version and the homogeneity of a new abbreviated version. The homogeneity of the SCQ indicates good reliability (Cronbach's alpha: 0.89). The three-factor structure of the SCQ was mostly confirmed through principal components analyses using oblimin rotation. Clinical validity was supported through correlations between sense of competence and burden ( r = −0.51), depression ( r = −0.52), and care recipient's cognitive function ( r = 0.36). Sixteen items with consistent factor loadings were extracted and proposed as a new abbreviated version of the SCQ (Cronbach's alpha: 0.84). The abbreviated German rendition of the SCQ version that was validated in this study offers a consistent version that can be applied across different languages and among caregivers of stroke survivors or people with dementia. [ABSTRACT FROM AUTHOR]

Background: Previous studies have reported MRI abnormalities of the corpus callosum (CC) in patients with bipolar disorder (BD), although only a few studies have directly compared callosal areas in psychotic versus nonpsychotic patients with this disorder. We sought to compare regional callosal areas in a large international multicentre sample of patients with BD and healthy controls. Methods: We analyzed anatomic T1 MRI data of patients with BD-I and healthy controls recruited from 4 sites (France, Germany, Ireland and the United States). We obtained the mid-sagittal areas of 7 CC subregions using an automatic CC delineation. Differences in regional callosal areas between patients and controls were compared using linear mixed models (adjusting for age, sex, handedness, brain volume, history of alcohol abuse/dependence, lithium or antipsychotic medication status, symptomatic status and site) and multiple comparisons correction. We also compared regional areas of the CC between patients with BD with and without a history of psychotic features. Results: We included 172 patients and 146 controls in our study. Patients with BD had smaller adjusted mid-sagittal CC areas than controls along the posterior body, the isthmus and the splenium of the CC. Patients with a positive history of psychotic features had greater adjusted area of the rostral CC region than those without a history of psychotic features. Limitations: We found small to medium effect sizes, and there was no calibration technique among the sites. Conclusion: Our results suggest that BD with psychosis is associated with a different pattern of interhemispheric connectivity than BD without psychosis and could be considered a relevant neuroimaging subtype of BD. [ABSTRACT FROM AUTHOR]

Background: The dysfunction of specific brain areas might account for the distortion of body image in patients with anorexia nervosa. The present study was designed to reveal brain regions that are abnormal in structure and function in patients with this disorder. We hypothesized, based on brain areas of altered activity in patients with anorexia nervosa and regions involved in pain processing, an interrelation of structural aberrations in the frontoparietal-cingulate network and aberrant functional activation during thermal pain processing in patients with the disorder. Methods: We determined pain thresholds outside the MRI scanner in patients with anorexia nervosa and matched healthy controls. Thereafter, thermal pain stimuli were applied during fMRI imaging. Structural analyses with high-resolution structural T1-weighted volumes were performed using voxel-based morphometry and a surface-based approach. Results: Twenty-six patients and 26 controls participated in our study, and owing to technical difficulties, 15 participants in each group were included in our fMRI analysis. Structural analyses revealed significantly decreased grey matter volume and cortical thickness in the frontoparietal-cingulate network in patients with anorexia nervosa. We detected an increased blood oxygen level-dependent signal in patients during the painful 45°C condition in the midcingulate and posterior cingulate cortex, which positively correlated with increased pain thresholds. Decreased grey matter and cortical thickness correlated negatively with pain thresholds, symptom severity and illness duration, but not with body mass index. Limitations: The lack of a specific quantification of body image distortion is a limitation of our study. Conclusion: This study provides further evidence for confined structural and functional brain abnormalities in patients with anorexia nervosa in brain regions that are involved in perception and integration of bodily stimuli. The association of structural and functional deviations with thermal thresholds as well as with clinical characteristics might indicate a common neuronal origin. [ABSTRACT FROM AUTHOR]

Background: Patients with schizophrenia display metacognitive impairments, such as hasty decision-making during probabilistic reasoning -- the "jumping to conclusion" bias (JTC). Our recent fMRI study revealed reduced activations in the right ventral striatum (VS) and the ventral tegmental area (VTA) to be associated with decision-making in patients with schizophrenia. It is unclear whether these functional alterations occur in the at-risk mental state (ARMS). Methods: We administered the classical beads task and fMRI among ARMS patients and healthy controls matched for age, sex, education and premorbid verbal intelligence. None of the ARMS patients was treated with antipsychotics. Both tasks request probabilistic decisions after a variable amount of stimuli. We evaluated activation during decision-making under certainty versus uncertainty and the process of final decision-making. Results: We included 24 AMRS patients and 24 controls in our study. Compared with controls, ARMS patients tended to draw fewer beads and showed significantly more JTC bias in the classical beads task, mirroring findings in patients with schizophrenia. During fMRI, ARMS patients did not demonstrate JTC bias on the behavioural level, but showed a significant hypoactivation in the right VS during the decision stage. Limitations: Owing to the cross-sectional design of the study, results are constrained to a better insight into the neurobiology of risk constellations, but not pre-psychotic stages. Nine of the ARMS patients were treated with antidepressants and/or lorazepam. Conclusion: As in patients with schizophrenia, a striatal hypoactivation was found in ARMS patients. Confounding effects of antipsychotic medication can be excluded. Our findings indicate that error prediction signalling and reward anticipation may be linked to striatal dysfunction during prodromal stages and should be examined for their utility in predicting transition risk. [ABSTRACT FROM AUTHOR]

Background While there has been a clear move towards shared decision-making ( SDM) in the last few years, the measurement of SDM-related constructs remains challenging. There has been a call for further psychometric testing of known scales, especially regarding validity aspects. Objective To test convergent validity of the nine-item Shared Decision- Making Questionnaire ( SDM- Q-9) by comparing it to the OPTION Scale. Design Cross-sectional study. Setting and participants Data were collected in outpatient care practices. Patients suffering from chronic diseases and facing a medical decision were included in the study. Methods Consultations were evaluated using the OPTION Scale. Patients completed the SDM- Q-9 after the consultation. First, the internal consistency of both scales and the inter-rater reliability of the OPTION Scale were calculated. To analyse the convergent validity of the SDM- Q-9, correlation between the patient ( SDM- Q-9) and expert ratings ( OPTION Scale) was calculated. Results A total of 21 physicians provided analysable data of consultations with 63 patients. Analyses revealed good internal consistency of the SDM- Q-9 and limited internal consistency of the OPTION Scale. Inter-rater reliability of the latter was less than optimal. Association between the total scores of both instruments was weak with a Spearman correlation of r = 0.19 and did not reach statistical significance. Discussion By the use of the OPTION Scale convergent validity of the SDM- Q-9 could not be established. Several possible explanations for this result are discussed. Conclusion This study shows that the measurement of SDM remains challenging. [ABSTRACT FROM AUTHOR]

Background: Providing patient-centered care (PCC) during the last year of life (LYOL) can be challenging due to the complexity of the patients' medical, social and psychological needs, especially in case of chronic illnesses. Assessing PCC can be helpful in identifying areas for improvements. Since not all patients can be surveyed, a questionnaire for proxy informants was developed in order to retrospectively assess patient-centeredness in care during the whole LYOL. This study aimed to evaluate the feasibility and validity of an adapted version of the German Patient Assessment of Chronic Illness Care (PACIC) for surveying bereaved persons in order to assess PCC during the decedents' LYOL. Methods: The German PACIC short form (11 items) was adapted to a nine-item version for surveying bereaved persons on the decedent's LYOL (PACIC-S9-Proxy). Items were rated on a five-point Likert scale. The PACIC adaptation and validation was part of a cross-sectional survey in the region of Cologne. Participants were recruited through self-selection and active recruitment by practice partners. Sociodemographic characteristics and missing data were analyzed using descriptive statistics. An exploratory factor analysis was conducted in order to assess the structure of the PACIC-S9-Proxy. Internal consistency was estimated using Cronbach's alpha. Results: Of the 351 informants who participated in the survey, 230 (65.52%) considered their decedent to have suffered from chronic illness prior to death. 193 of these informants (83.91%) completed ≥5 items of the questionnaire and were included in the analysis. The least answered item was item (74.09%) was item 4 (encouragement to group & classes for coping). The most frequently answered item (96.89%) was item 2 (satisfaction with care organization). Informants rated the item" Given a copy of their treatment plan" highest (mean 3.96), whereas "encouragement to get to a specific group or class to cope with the condition" (mean 1.74) was rated lowest. Cronbach's alpha was 0.84. A unidimensional structure of the questionnaire was found (Kaiser-Meyer-Olkin 0.86, Bartlett's test for sphericity p < 0.001), with items' factor loadings ranging from 0.46 to 0.82. Conclusions: The nine-item questionnaire can be used as efficient tool for assessing PCC during the LYOL retrospectively and by proxies. Trial registration: The study was registered in the German Clinical Trials Register (DRKS00011925) on 13 June 2017. [ABSTRACT FROM AUTHOR]