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Several studies suggest that pain is a trigger for challenging behaviour in older adults with cognitive impairment. However, such measured relationships might be confounded due to item overlap as instruments share similar or identical items. The purpose of this study was to examine whether the frequently observed association between pain and challenging behaviour might be traced back to item overlap. This multicentre cross-sectional study was conducted in 13 nursing homes and examined pain (measure: Pain Assessment in Advanced Dementia Scale) and challenging behaviour (measure: Cohen-Mansfield Agitation Inventory) in 150 residents with severe cognitive impairment. The extent of item overlap was determined by juxtaposition of both measures' original items. As expected, comparison between these instruments revealed an extensive item overlap. The statistical relationship between the two phenomena can be traced back mainly to the contribution of the overlapping items, which renders the frequently stated relationship between pain and challenging behaviour trivial. The status quo of measuring such associations must be contested: constructs' discrimination and instruments' discrimination have to be discussed critically as item overlap may lead to biased conclusions and assumptions in research as well as to inadequate care measures in nursing practice. [ABSTRACT FROM AUTHOR]

Behavioral inhibition (BI) is a suspected precursor of selective mutism. However, investigations on early behavioral inhibition of children with selective mutism are lacking. Children aged 3-18 with lifetime selective mutism ( n = 109), social phobia ( n = 61), internalizing behavior ( n = 46) and healthy controls ( n = 118) were assessed using the parent-rated Retrospective Infant Behavioral Inhibition (RIBI) questionnaire. Analyses showed that children with lifetime selective mutism and social phobia were more inhibited as infants and toddlers than children of the internalizing and healthy control groups, who displayed similar low levels of behavioral inhibition. Moreover, behavioral inhibition was higher in infants with lifetime selective mutism than in participants with social phobia according to the Total BI score ( p = 0.012) and the Shyness subscale ( p < 0.001). Infant behavioral inhibition, particularly towards social stimuli, is a temperamental feature associated with a lifetime diagnosis of selective mutism. Results yield first evidence of the recently hypothesized temperamental origin of selective mutism. Children at risk should be screened for this debilitating child psychiatric condition. [ABSTRACT FROM AUTHOR]

We investigated how two types of care setting (home care and nursing home) and type of ownership (for‐profit vs. public/non‐profit) of geriatric care services interacted in influencing registered nurses’ intention to give up their profession. In prior research, employment in for‐profit‐organizations, high job demands, and low job control were important antecedents of nurses’ intent to leave. However, the impact of care setting on these associations was inconclusive. Therefore, we tested a mediated moderation model predicting that adverse work characteristics would drive professional leaving intentions, particularly in for‐profit services and in nursing homes. A representative German sample of 304 registered nurses working in 78 different teams participated in our cross‐sectional study. As predicted, lower job control and higher job demands were associated with higher professional leaving intentions, and nurses reported higher job demands in public/non‐profit care than in for‐profit care, and in nursing homes compared to home care. Overall, RNs in nursing homes and home care reported similar intent to leave, but in for‐profit settings only, nurses working in nursing homes reported higher professional leaving intentions than did nurses in home care, which was linked to lower job control in the for‐profit nursing home setting, supporting mediated moderation. Taken together, our results indicate that the interplay of care setting and type of ownership is important when explaining nurses’ intentions to give up their profession. © 2016 Wiley Periodicals, Inc. [ABSTRACT FROM AUTHOR]

Introduction: Data evaluating mortality benefit from replacing sedentary time with physical activity are sparse. We explored reallocating time spent in sedentary behavior to physical activity of different intensities in relation to mortality risk. Methods: Women and men age 50-85 yr from the National Health and Nutrition Examination Survey 2003-2004 and 2005-2006 cycles with follow-up through December 31, 2011, were included. Sedentary time and physical activity were assessed using an ActiGraph accelerometer. Isotemporal substitution models were used to estimate the effect of replacing one activity behavior with another activity behavior for the same amount of time while holding total accelerometer wear time constant. Results: During a mean follow-up of 6.35 yr, 697 deaths from any cause occurred. Replacing 30 min of sedentary time with an equal amount of light activity was associated with 14% reduced risk of mortality (multivariable-adjusted hazard ratio (HR), 0.86; 95% confidence interval (CI), 0.83-0.90). Replacement of sedentary time with moderate to vigorous activity was related to 50% mortality risk reduction (HR, 0.50; 95% CI, 0.31-0.80). We also noted a 42% reduced risk of mortality when light physical activity was replaced by moderate to vigorous activity (HR, 0.58; 95% CI, 0.36-0.93). Conclusion: Replacing sedentary time with an equal amount of physical activity may protect against preterm mortality. Replacement of light physical activity with moderate to vigorous activity is also associated with protection from premature mortality. [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]

Background: Long axis strain (LAS) has been shown to be a fast assessable parameter representing global left ventricular (LV) longitudinal function in cardiovascular magnetic resonance (CMR). However, the prognostic value of LAS in cardiomyopathies with reduced left ventricular ejection fraction (LVEF) has not been evaluated yet. Methods and results: In 146 subjects with non-ischemic dilated cardiomyopathy (NIDCM, LVEF =45 %) LAS was assessed retrospectively from standard non-contrast SSFP cine sequences by measuring the distance between the epicardial border of the left ventricular apex and the midpoint of a line connecting the origins of the mitral valve leaflets in end-systole and end-diastole. The final values were calculated according to the strain formula. The primary endpoint of the study was defined as a combination of cardiac death, heart transplantation or aborted sudden cardiac death and occurred in 24 subjects during follow-up. Patients with LAS values > -5 % showed a significant higher rate of cardiac events independent of the presence of late gadolinium enhancement (LGE). The multivariate Cox regression analysis revealed that LVEDV/BSA (HR: 1.01, p < 0.05), presence of LGE (HR: 2.51, p < 0.05) and LAS (HR: 1.28, p < 0.05) were independent predictors for cardiac events. In a sequential cox regression analysis LAS offered significant incremental information (p < 0.05) for the prediction of outcome in addition to LGE and LVEDV/BSA. Using a dichotomous three point scoring model for risk stratification, including LVEF <35 %, LAS > -10 % and the presence of LGE, patients with 3 points had a significantly higher risk for cardiac events than those with 2 or less points. Conclusion: Assessment of long axis function with LAS offers significant incremental information for the prediction of cardiac events in NIDCM and improves risk stratification beyond established CMR parameters. [ABSTRACT FROM AUTHOR]

Objectives: Although age-related differences in planning ability are well known, their cognitive foundations remain a matter of contention. To elucidate the specific processes underlying planning decrements in older age, the relative contributions of fluid reasoning, working memory (WM) capacity, and processing speed to accuracy on the Tower of London (TOL) planning task were investigated. Method: Mediation analyses were used to relate overall and search depth-related TOL accuracy from older (N = 106; 60-89 years) and younger adults (N = 69; 18-54 years) to age and measures of fluid reasoning, WM capacity, and speed. Results: For overall planning, fluid abilities mediated the effects of age, WM capacity, and speed in older adults. By contrast, fluid abilities and WM capacity mediated each other in younger adults. For planning accuracy under low demands on the depth of search, WM capacity was specifically important in older age, whereas younger adults recruited both WM capacity and fluid reasoning. Under high search-depth-demands, fluid abilities underlay the cognitive operations critical for resolving move interdependencies in both age groups. Discussion: Fluid abilities and WM capacity undergo significant changes from younger to older age in their unique contribution to planning, which might represent a mechanism whereby planning decrements in older age are brought about. [ABSTRACT FROM AUTHOR]

ABSTRACT Objective Weight bias internalization (WBI) is associated with eating disorder psychopathology and non-normative eating behaviors among individuals with overweight and obesity, but has rarely been investigated in prebariatric patients. Based on findings demonstrating a relationship between emotion dysregulation and eating behavior, this study sought to investigate the association between WBI and eating disorder psychopathology as well as non-normative eating behaviors (i.e., food addiction, emotional eating, and eating in the absence of hunger), mediated by emotion dysregulation. Method Within a consecutive multicenter study, 240 prebariatric patients were assessed using self-report questionnaires. The mediating role of emotion dysregulation was examined using structural equation modeling. Results The analyses yielded no mediational effect of emotion dysregulation on the association between WBI and eating disorder psychopathology. However, emotion dysregulation fully mediated the associations between WBI and emotional eating as well as eating in the absence of hunger. Further, emotion dysregulation partially mediated the relationship between WBI and food addiction symptoms. Discussion Prebariatric patients with high levels of WBI are at risk for non-normative eating behaviors, especially if they experience emotion regulation difficulties. These findings highlight the importance of interventions targeting WBI and improving emotion regulation skills for the normalization of eating behavior in prebariatric patients. © 2015 Wiley Periodicals, Inc. (Int J Eat Disord 2016; 49:182-187). [ABSTRACT FROM AUTHOR]

Integrating the perspectives of psychological contract and sex differences, this study examines how organizational decision to reduce labour costs influences employees' perceived psychological contract breach and their commitment to their organizations. Using two experiments, we found three-way interaction effects among the decision to reduce labour costs, employee sex, and the managerial control over the decision. The decision of labour costs reduction leads to stronger feelings of psychological contract breach for females when the decision is in low than in high levels of managerial control, but the same decision leads to stronger psychological contract breach for males when the decision is in high than in low levels of managerial control. Furthermore, the indirect effect of labour costs reduction on employees' organizational commitment through psychological contract breach is also contingent upon the interaction between employee sex and managerial control. Our findings expand the literature of psychological contract and shed light on timely practical issues of management's decisions regarding labour costs reduction. Practitioner points Labour costs reductions in economic downturns lead to different responses from employees, and managers are advised to plan their actions bearing in mind such differences., Management in crisis or difficulties calls for more delicate considerations of employees' psychological feelings towards the organization., Nuanced empirical evidence informs us about the different needs and responses of a diverse group of employees and how their responses contradict. [ABSTRACT FROM AUTHOR]

Much work has been carried out on sexist attitudes, but only little on sexist behaviors. The goal of the present research was to close this gap by testing how a variety of benevolent and hostile sexist behaviors correlate with implicit and explicit sexist attitudes. In Study 1 ( N = 126), we developed implicit association tests for benevolent sexism and hostile sexism and illustrated that implicit and explicit benevolent sexist beliefs, as well as implicit and explicit hostile sexist beliefs, were positively correlated. In Study 2 ( N = 83 of Study 1), we tested whether implicit and explicit benevolent and hostile sexist attitudes correlate with benevolent and hostile sexist behaviors. As expected, explicit benevolent (but not hostile) sexist attitudes predicted benevolent sexist behavior, whereas explicit hostile (but not benevolent) sexist attitudes predicted hostile sexist behavior. Implicit sexist attitudes did not predict sexist behavior. The implications of these findings are discussed. [ABSTRACT FROM AUTHOR]

Although playing a crucial role for the prevention of long-term health impairment, interventions aiming at the improvement of employees' recovery processes are still scarce. In this study, we therefore investigated the effectiveness of a low-dose mindfulness intervention for recovery from work. In addition, differential responding to the treatment in terms of treatment-by-baseline interactions was studied. A sample of 140 employees participated in a randomized field experiment with a self-training and a wait-list control group. Three central recovery processes (psychological detachment, sleep quality, and sleep duration) were assessed with event-sampling methodology involving daily measurements over 10 workdays. Growth curve analyses revealed intervention effects on sleep quality and sleep duration. No effects were found for psychological detachment after work and for the proposed treatment-by-baseline interactions. Our findings are discussed in the context of occupational health promotion in general and mindfulness-based interventions in specific. Practitioner points Although daily recovery from the demands of work has been shown to be vital for employee well-being and performance, research on how workplace interventions can help improve recovery is still scarce., This study investigated the effectiveness of a brief, economic mindfulness intervention on processes that are vital for recovery - psychological detachment, sleep quality, and sleep duration., Findings revealed positive effects of the intervention on sleep quality and duration, but not on psychological detachment. [ABSTRACT FROM AUTHOR]

Background: Continuity of care is important for outcomes and patient satisfaction and includes additional considerations in the context of cross-border health care. Although this has been discussed in research and was picked up in the recently transposed Directive on patients' rights (2011/24/EU), there is limited evidence about related issues actually encountered by patients crossing borders. Methods: An anonymous postal survey was carried out by the Techniker Krankenkasse, one of the largest sickness funds in Germany. The questionnaire was sent to 45 189 individuals who had received treatment in EU/EEA countries and included items on relational, management and informational continuity. Results: The survey had a response rate of 41% (n = 17 543). Of those respondents who had travelled for care (n = 3307), ∼19% (n = 570) did so due to a relationship of trust with a given provider. Only 8% of all respondents required emergency follow-up services due to complications, the majority of which was obtained back in Germany. Twelve percentage of those who were prescribed medication abroad (n = 4208) reported problems, spanning unknown products, dispensation and reimbursement. Information exchange between providers across borders was rare and largely carried out by the patients themselves. Conclusions: Although relational continuity may be important to specific groups of patients travelling for care, it is primarily informational continuity and its interrelation with management continuity that need to be addressed in the cross-border context. Information exchange should be endorsed at European level. Additional focus is required on informing patients about documentation rights and requirements and providing health records that are comprehensive and comprehensible. [ABSTRACT FROM AUTHOR]

Background: Whole-body magnetic resonance imaging (MRI) is the gold standard for the assessment of skeletal muscle (SM) and adipose tissue volumes. It is unclear whether single-slice estimates can replace whole-body data. Objective: We evaluated the accuracy of the best single lumbar and midthigh MRI slice to assess whole-body SM, visceral adipose tissue (VAT), and subcutaneous adipose tissue (SAT). Design: Whole-body MRI was performed in 142 healthy adults aged 19-65 y [mean ± SD age: 37.0 ± 11.8 y; BMI (in kg/m²): 25.3 ± 5.9]. Single slices were taken at lumbar vertebrae L1-L5 plus intervertebral discs and the thigh (midthigh, 10 cm distally from the midthigh, and 10 cm proximally from the midthigh). The value of single-slice areas was also tested in a longitudinal study on 48 healthy volunteers during weight loss (8.2 ± 5.2 kg). Results: Cross-sectionally, all SM and adipose tissue single-slice areas correlated with total tissue volumes (P < 0.01). Because of the close associations between L3 areas and corresponding tissue volumes (r = 0.832-0.986, P < 0.01), this location was identified as the reference to estimate SM and adipose tissue in both sexes. SM, SAT, and VAT areas at L3 explained most of the variance of total tissue volumes (69-97%, with SEs of estimation of 1.96 and 2.03 L for SM, 0.23 and 0.61 L for VAT, and 4.44 and 2.47 L for SAT for men and women, respectively. There was no major effect on the explained variance compared with that for optimal slices. For SM, the optimal slice area was shown at midthigh. With weight-loss changes in total SM, VAT, and SAT, volumes were significantly different from those at baseline (SM changes: 22.8 ± 2.9 L; VAT changes: 20.7 ± 1.0 L; SAT changes: 25.1 ± 6.0 L). The area at L3 reflected changes in total VAT and SAT. To assess changes in total SM volumes, areas at midthigh showed the best evidence. Conclusion: In both sexes, a single MRI scan at the level of L3 is the best compromise site to assess total tissue volumes of SM, VAT, and SAT. By contrast, L3 does not predict changes in tissue components. This trial was registered at clinicaltrials.gov as NCT01737034. [ABSTRACT FROM AUTHOR]

Purpose: To assess rate of late presentation with HIV in Southwestern Germany and to identify patient characteristics correlated with CD4 nadir. Methods: Patients with primary diagnosis who presented to one of ten participating clinics rated on knowledge and behavior towards HIV testing on a self-developed questionnaire, whereas clinical data was assessed by the physician. Results: 161 patients were included. Risk factors were homosexual (59.5 %) or heterosexual contacts (26.8 %), drug use (2.0 %), migration (3.9 %), or others (7.8 %). 63.5 % had a CD4 T cell count < 350/µl. 52.5, 17.4, and 31.1 % were diagnosed in CDC stadium A, B or C, respectively. 209 disease episodes were reported, from whom 83.7 % had led to the diagnosis of HIV. 75.2 and 68.3 % said to have been well-informed about ways of transmission and testing offerings, respectively, and 20.4 % admitted to have psychologically repressed the possibility of being infected. 48 patients rated their personal behavioral risk as 'high' or 'very high'. Of these, however, only ten had performed at test in the precedent year. Performing a regression analysis, younger age and previous testing were correlated with a higher CD4 T cell nadir ( p = 0.005, and 0.018, resp.). Conclusion: The rate of late presentation in this region was even higher compared to national or European surveys. Most infected patients perceived to have had only a low risk. Several disease episodes did not lead to the initiation of HIV testing by the physician. [ABSTRACT FROM AUTHOR]

Objectives Spondyloarthritis ( Sp A) is one of the most frequently observed inflammatory joint diseases in HIV-1-seropositive patients. T-cells were described frequently as one of the major driving forces in SpA, therefore we tried to look for T-cell aberrancies in our HIV-positive patients with SpA. Methods A total of 1098 files for HIV-positive patients who attended the HIV out-patient clinic of the Department of Clinical Immunology and Rheumatology at the Medical University Hanover for at least one visit between January 2004 and December 2010 were screened for the presence of a diagnosis of Sp A. A cross-sectional study was conducted to investigate aberrancies in T-cell homeostasis induced by HIV-1 in these subjects. Results The prevalence of Sp A in the HIV-positive patients was 1.6% (18 of 1098). Interestingly, the percentage of patients with Sp A who were human leucocyte antigen ( HLA)- B27 negative in our HIV-positive cohort was 80%. Despite combination antiretroviral therapy (c ART) and viral suppression, an incomplete immune recovery of T-cell naïve/memory distribution and turnover, as identified by intracellular Ki-67 expression, was observed in HIV-positive patients with Sp A. Conclusions Independent of HLA- B27 status and despite c ART, HIV-positive patients can develop Sp A and exhibit an increased T-cell turnover rate. [ABSTRACT FROM AUTHOR]

Background: Visceral (VAT) and subcutaneous abdominal (SAAT) and trunk (STRAT) adipose tissue (AT) have been suggested to be differentially influenced by diet. Objective: We investigated whether and to what extent usual patterns of nutrient intake are associated with VAT, SAAT, and STRAT compared with nondietary predictors in northern German adults (n = 583). Design: AT volumes were quantified by magnetic resonance imaging. Nutrient intake was estimated by a 112-item food-frequency questionnaire linked to the German Food Code and Nutrient Database. Exploratory nutrient patterns were derived by principal components analysis (PCA) and partial least-squares regression (PLS) of 87 nutrients. Cross-sectional associations between nutrient patterns, single nutrients, or total energy intake and AT compartments were analyzed by multiple linear regression. Results: Next to sex and age, respectively, which were important nondietary predictors and accounted for more of the variation in VAT (~13% and ~4%) than in SAAT or STRAT (both 4-7% and <1%), variation in VAT (16.8% or 17.6%) was explained to a greater extent by 9 or 2 nutrient patterns derived by principal components analysis or partial least-squares regression, respectively, than was variation in SAAT (10.6% or 8.2%) or STRAT (11.5% or 8.6%). Whereas VAT (16.6%) was primarily explained by nutrient quality, SAAT (6.9%) and STRAT (7.4%) were mainly explained by total energy intake. VATwas positively associated with nutrients characteristic of animal (except for dairy) products, including arachidonic acid (standardized β 0.25; 95% CI: 0.15, 0.34; P < 0.0001), but negatively with dietary fiber, including polypentoses (standardized β: -0.17; 95% CI: -0.24, -0.09; P < 0.0001), and nutrients found in milk. The direction and strength of many associations, however, depended strongly on sex and adjustment for BMI. Conclusion: VAT may be particularly associated with sex-specific interplays of nutrients found in animal products and fiber, whereas SAAT and STRAT are associated with total energy intake. Am J Clin Nutr 2015;101:794-807. [ABSTRACT FROM AUTHOR]

Objective To correlate the amount and types of pain medications prescribed to CRPS patients, using the Medication Quantification Scale, and patients' subjective pain levels. Design An international, multisite, retrospective review. Setting University medical centers in the United States, Israel, Germany, and the Netherlands. Subjects/Methods A total of 89 subjects were enrolled from four different countries: 27 from the United States, 20 Germany, 18 Netherlands, and 24 Israel. The main outcome measures used were the Medication Quantification Scale III and numerical analog pain scale. Results There was no statistically significant correlation noted between the medication quantification scale and the visual analog scale for any site except for a moderate positive correlation at German sites. The medication quantification scale mean differences between the United States and Germany, the Netherlands, and Israel were 9.793 ( P < 0.002), 10.389 ( P < 0.001), and 4.984 ( P = 0.303), respectively. Conclusions There appears to be only a weak correlation between amount of pain medication prescribed and patients' reported subjective pain intensity within this limited patient population. The Medication Quantification Scale is a viable tool for the analysis of pharmaceutical treatment of CRPS patients and would be useful in further prospective studies of pain medication prescription practices in the CRPS population worldwide. [ABSTRACT FROM AUTHOR]

The article discusses the concept of gender role strain paradigm in masculinity ideology. Topics mentioned include relationship between masculinity ideology and psychological strain for men in female-dominated occupations, increased stressors experienced by men adherent to masculinity ideology, and behaviors associated with masculinity ideology including avoiding appearing feminine, demonstrating heterosexuality, and not displaying strong emotions.

Objective: Even if significantly distressed, many patients with cancer do not seek psychological help. There is growing evidence that attitudes are central barriers for help‐seeking, and instruments to assess cancer patients' attitudes towards help‐seeking are urgently needed. This study aimed to evaluate the German Attitudes towards Seeking Help after Cancer Scale (ASHCa‐G) and investigated the relationship between patients' attitudes and psychological care utilisation. Methods: The ASHCa‐G was presented to 270 patients with cancer (age 63.0 ± 12.7 years, 44.8% women). Item analyses, principal component analysis and associations with age, social support, help‐seeking intention and psychological care utilisation were calculated. A hierarchical logistic regression was performed to ascertain the leading role of attitudes in explaining psychological care utilisation. Results: Principal component analysis supported a two‐component solution, which showed good internal consistency for the positive attitudes (α = 0.80) and negative attitudes (α = 0.75) subscales. The associations with age, distress and help‐seeking intention confirmed the validity of the ASHCa‐G. Positive attitudes explained most variance of cancer patients' current psychological care utilisation. Conclusion: The ASHCa‐G seems to be a reliable and valid questionnaire for assessing attitudes towards seeking psychological help among patients with cancer. Clinical practice might profit from identifying attitudinal barriers that hinder patients with cancer from seeking psychological help. [ABSTRACT FROM AUTHOR]