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

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

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

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

Background: Peer support is increasingly recognized as crucial for improving health and psychosocial outcomes in oncological care. The integration of cancer self‐help groups (SHGs) into cancer care facilities has gained importance in recent years. Yet, there is a lack of knowledge of the extent and quality of cooperation between cancer care facilities and SHGs and their integration into routine care. The concept of self‐help friendliness (SHF) provides a feasible instrument for the measurement of cooperation and integration. Methods: A cross‐sectional study across Germany investigates the experiences of 266 leaders of cancer SHGs concerning their cooperation with cancer care facilities based on the criteria for SHF. The participatory study was developed and conducted with representatives of the House of Cancer Self‐Help and the federal associations of cancer self‐help. Results: According to the SHG leaders, about 80% of their members primarily find their way to an SHG via other patients and only less than 50% more or less frequently via hospitals or rehabilitation clinics. The quality of cooperation with cancer centres, hospitals and rehabilitation clinics, however, is rated as good to very good by more than 70% of the respondents. Nine out of 10 quality criteria for SHF are fully or at least partially implemented, the values vary between 53% and 87%. Overall, 58% of the SHG leaders feel well to be very well integrated into care facilities. Conclusions: The results show a positive assessment of the involvement of SHGs in oncological care, but differences between inpatient and outpatient care and low referrals to SHGs are prominent. The concept of SHF is a feasible solution for a systematic and measurable involvement of SHGs. Patient or Public Contribution: The perspectives and insight of patient representatives obtained through qualitative interviews were directly incorporated into this study. Representatives of cancer self‐help organizations were involved in the development of the questionnaire, reviewed it for content and comprehensibility, and further helped to recruit participants. [ABSTRACT FROM AUTHOR]

Background and purpose: Social engagement is an important active aging strategy to promote older adults' mental health. The purposes of this study were to compare social engagement in older populations around the world and explore associations with mental health outcomes. Materials and methods: An international cross‐sectional survey was conducted from 2017 to 2019. Data were retrieved from The International Social Survey Programme for a secondary data analysis across 30 countries. This study applied the Taxonomy of Social Activities and its six levels as operational definitions for a consistent concept of social engagement for international comparisons. Results: In total, 9403 older adults with a mean age of 72.85 ± 6.40 years responded. The highest levels of older adults' social engagement were found in Switzerland, Thailand, and New Zealand. Older adults of a higher age, with a lower educational level, who were permanently sick or disabled, who had no partner, who were widowed or whose civil partner had died, who lived alone, and who had lower self‐placement in society had significantly lower social engagement than did their counterparts. In the regression model, older adults' social engagement positively predicted general health, self‐accomplishment, and life satisfaction, but negatively predicted loneliness and depression. Conclusions: In aging societies worldwide, encouraging older adults' social engagement would be beneficial to promote mental health. Implications for nursing practice and health policies: Community professional nurses can develop strategies of social engagement based on the needs and sociodemographic factors of older adults to improve their mental health. Developing efficient strategies and local policies by learning from successful experiences in other countries is important to promote social engagement in aging societies. [ABSTRACT FROM AUTHOR]

Design: A cross‐sectional study was conducted in December 2020/January 2021 in the five significant cities of Germany. Sample: 135 of 244 identified service institutions took part in the evaluation. Measurements: This evaluation included changes in institutions' operating hours as well as capacity for homeless people. Service institutions described changes in guests' characteristics, moods, and mental burden. Finally, equipment including face masks, coveralls, and gloves was investigated. In addition, the study examined how the cooperation with the health authorities works. Results: Institutions reduced their operating hours and capacity for guests (62.4%). Increased costs, which they had to cover themselves, were reported by 70.9% of institutions. Institutions reported, that guests showed more symptoms of aggression (15%), anxiety (25%), and desperation (32%) and fewer signs of being relaxed (75%). The institutions reported room for improvement in PPE supplies and collaboration with health authorities. Conclusions: Services are limited for a vulnerable population, which shows changes in moods and mental health. Health authorities are not sufficiently engaged to take over the role of institutions in caring for homeless people. In the future, in‐depth investigation to improve this is necessary. [ABSTRACT FROM AUTHOR]

Background: Involving patients and citizens in health care decision‐making is considered increasingly important in Germany. Participatory structures have been implemented, especially in rehabilitative care. However, it is unknown whether and to what extent German patients and citizens want to participate in decisions that exceed their own medical treatment. Objective: This study aimed to survey participation preferences and associated factors of health service users in decisions regarding rehabilitative care at micro, meso and macro levels. Methods: A questionnaire was sent to 3872 former rehabilitants. We collected participation preferences using the Control Preference Scale or an adapted form. Possible influencing factors were examined using logistic regression models. Results: The response rate was 5.7% (n = 217). At all decision‐making levels, joint decision‐making was preferred. At the macro level, preferences for actively participating were the highest. Preferences were significantly interrelated between decision‐making levels. At the micro level, an orthopaedic indication significantly decreased the desire for participation compared to psychosomatic indications (odds ratio = 0.44, p =.019). Discussion: Participants wanted to be equally involved in decision‐making as experts. Higher preferences for active participation at the macro level might be due to dissatisfaction with the current health care organisation and lack of trust in politicians. Compared to the general public, our study sample was older (73.3% between 50 and 69 years) and more often chronically ill—factors associated with increased participation preferences in the literature. Conclusion: Contrary to the identified preferences, participation opportunities in the German health care system are rare. Further research on participation preferences and structures that enable meaningful involvement are needed. [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]

Purpose: This study illustrates the huge untapped potential of quantifying the impact of culture in making meaningful comparisons across groups. Our focus is on cross‐national differences in nurses' reports of their relations with physicians, and how the measurement of this complex construct and the evaluation of true differences are related to dimensions of national culture. Design: We examine across 14 European countries the association between indices of national culture from the seminal work of Hofstede and 39,435 nurses' ratings of their relations with physicians. Multilevel confirmatory factor analysis was used to evaluate strong factorial invariance across countries and to examine the influence of power distance and masculinity. Findings: There was wide variation across countries in nurses' reports of their relations with physicians. Strong factorial invariance was shown for a one‐factor model, which confirmed that across countries the seven survey items measure a common factor of physician‐nurse relations. This model showed no country bias for any of the seven survey items, which suggests that differences across countries reflect true differences. These true differences were significantly associated with variation in country values of power distance, which showed a significant negative correlation with physician–nurse relations. Conclusions: Continuously pursuing a better understanding of characteristics that impact the studied indicators, such as national culture, is elementary to better understand the construct under study. In this application, country values of power distance negatively impacted nurse‐reported relations with physicians, which strongly varied across countries. Clinical Relevance: Better nurse‐reported relations between nurses and physicians link to higher nurse job satisfaction, lower emotional exhaustion, better nurse‐perceived quality of care, and lower patient mortality. The Practice Environment Scale of the Nursing Work Index is an excellent instrument to characterize variation in working relations between nurses and physicians as well as physicians' professional posture towards nurses. [ABSTRACT FROM AUTHOR]

Parents addicted to methamphetamine ("crystal meth") are likely to be impaired in meeting parental responsibilities, and the developmental settings can be highly disadvantageous for children. Therefore, parenting by methamphetamine‐addicted mothers and fathers needs further exploration, while considering the impact on children affected by parental substance use. In our study, we analysed parenting practices and parental stress as well as children's behavioural problems using standardized assessments. The sample consisted of 87 methamphetamine‐addicted parents in recovery. We obtained data on parents' current substance use and on their psychological distress. Multiple regression analysis was performed to identify predictors of children's overall problems. Parents reported high levels of parental and psychological distress, even after achieving abstinence. Especially depressive perceptions of parenthood appeared problematic. While recovering from methamphetamine addiction, parents exhibited a precarious psychosocial situation and problematic parenting behaviour. Dysfunctional parenting practices were evident in both indifferent and overreactive tendencies. Children were at risk of behavioural and emotional problems. Variables associated with parenting showed significant predictive value for children's overall problems, beyond current substance use, and psychological distress. These findings are discussed in terms of a family‐oriented perspective in order to promote parenting capabilities of methamphetamine‐addicted parents and to prevent problematic development of their children. [ABSTRACT FROM AUTHOR]

Background In 2012 the Intelligibility in Context Scale (ICS) was published as a parent-report screening assessment that considers parents' perceptions of their children's functional intelligibility with a range of communication partners that differ in levels of authority and familiarity in real-life situations. To date, the ICS has been translated into 60 languages (including German). Aims To evaluate the psychometric properties of the German translation of the ICS ( = ICS-G), especially its reliability and validity, using four objective measures of speech sound disorder (SSD) severity: percentage of consonants correct (PCC); percentage of initial consonants correct (PICC); percentage of vowels correct (PVC); and percentage of phonemes correct (PPC). Methods & Procedures Children who were typically developing (TD) and children with SSD ( n = 181; 90 males, 81 females; mean age = 4.18 years, SD = 0.79 years, range = 3;0-5;11 years) were recruited through 13 kindergartens and 15 speech-language pathologists (SLPs) in Germany. All children's parents completed the ICS-G. To obtain an insight into the severity of SSD ( n = 30), children's speech skills were assessed with PLAKSS-II. For the analysis of test-retest reliability the ICS-G was re-administered with a subsample of parents ( n = 36) after 1 week. Outcomes & Results The ICS-G had high internal consistency ( α = .95, p < .001) and high test-retest reliability ( r = .998, p < .001). The ICS-G total scores and item scores for both samples showed significant correlations, indicating good construct validity. Analyses revealed low but significant correlations with external factors (e.g., age, social class). Criterion validity was established through significant correlations between the ICS-G and scores for PCC ( r = .43), PICC ( r = .43), PVC ( r = .62) and PPC ( r = .47). The discriminatory ability of the ICS-G was indicated by significantly higher mean scores for the TD group (mean = 4.49, SD = 0.47) than the SSD group (mean = 3.97, SD = 0.63). Conclusions & Implications The overall good psychometric properties of the ICS-G support its use by SLPs for clinical and research purposes with German-speaking children. [ABSTRACT FROM AUTHOR]

Objective Cognitive remediation therapy (CRT) is a specialized treatment approach targeting cognitive weaknesses in anorexia nervosa (AN). Regarding follow-up effects of CRT, there are only few studies available; for adolescents, there are no data. Methods Forty-eight adolescents with AN were assigned to receive either CRT and treatment as usual (TAU) or TAU alone. Assessments were performed at baseline ( n = 48) and compared with assessments at a 6-month follow-up ( n = 33). Outcome measures were set-shifting, central coherence, eating disorder and general psychopathology. Results The completion rate was higher in CRT compared with TAU. There were no significant differences in neuropsychological and clinical variables. Changes in body mass index percentile showed a trend towards significance for CRT. Dropout analyses revealed no significant predictors. Conclusions Results provide a first insight into follow-up-assessments of CRT in adolescent AN. More randomized controlled studies are needed to clarify the long-term effects of CRT. Copyright © 2017 John Wiley & Sons, Ltd and Eating Disorders Association. [ABSTRACT FROM AUTHOR]

Background The increased risk of mental health problems in children and adolescents with intellectual disability ( ID) has been reported in several studies. However, almost no research has been conducted on parents' experiences with the general mental health system. We have investigated the prevalence of emotional and behavioural problems in children with ID as well as the availability and quality of mental health care from the parents' point of view. Methods Teachers of specialised schools for ID in Berlin were asked to complete the Teacher's Report Form ( TRF) of the Child Behavior Checklist. Information was collected for 1226 children and adolescents aged 6-18 years with mild to profound ID (response 70.5%). The availability and quality of mental health care was assessed by a questionnaire given to parents who had already been seeking help for their children. A total of 330 parents completed the questionnaires (response 62.0%). In addition to univariate analysis, we conducted multiple logistic regressions regarding the psychopathology reported by teachers ( TRF-syndrome scales) and difficulties concerning mental health care reported by parents for a paired sample of 308 children. Results Overall, 52.4% of the children and adolescents with ID had a total problem score on the TRF in the deviant range (47.1% when eliminating four items reflecting cognitive deficits). Compared with the general population normative sample of children, this is a three-time higher prevalence. The most striking problems were thought problems (schizoid and obsessive-compulsive), aggressive behaviour, attention problems and social problems. Parents whose children had more severe behavioural or emotional dysfunction reported more difficulties with the mental health system. From the parents' point of view, mental health professionals frequently did not feel responsible or were not sufficiently skilled for the treatment of children with ID. As a consequence, 96% of all parents were longing for specialised in- and outpatient services. Conclusions This study confirms the findings from other studies regarding the high rate of co-occurrence of ID and mental health problems in youths. Results indicate that both are strongly requested by parents: specialised in- and outpatient services, as well as more professional general services and equitable treatment for all children, with and without ID. [ABSTRACT FROM AUTHOR]

Background People with aphasia experience a pronounced decrease in quality of life (QoL). Beyond that identity negotiation is hindered, which is crucial for QoL. Biographic-narrative approaches use life story telling to support identity (re)development after disruptive events like stroke. Because of the language deficits inherent in aphasia such 'talk-based' approaches have to be modified for an optimal use. Aims To evaluate an adapted interdisciplinary biographic-narrative intervention using quantitative measures of health-related quality of life (HRQL) and mood. Additionally, semi-structured interviews were conducted to gain a deeper understanding of identity development processes in people with aphasia. Methods & Procedures Twenty-seven participants with various types of chronic aphasia were enrolled. The biographic narrative intervention consisted of five face-to-face in-depth interviews and seven group sessions conducted over 10 weeks in a mixed-method design with pre- and post-tests and a follow-up assessment 3 months post-intervention. For quantitative evaluation the Aachen Life Quality Inventory (ALQI), the Satisfaction with Life Scale (SWLS) and the Visual Analog Mood Scales (VAMS) were used. Semi-structured interviews were conducted post-treatment, including questions concerning the participants' experiences with the intervention and identity change. Results were analysed using interpretative principles from Grounded Theory. Outcomes & Results For all 27 participants, we found significant and stable growth in HRQL. Self-reported states of mood also improved. As expected, overall cognitively based life satisfaction did not change. The interviews revealed two main categories: 'evaluation of the face-to-face interviews' and 'evaluation of the group sessions'. Further analysis found four overlapping main themes which were identified as identity issues: agency, control, disease concept and doing things. Conclusions & Implications Our quantitative and qualitative results demonstrated the benefits associated with the biographic-narrative intervention. The participants' sense of self changed through the approach. The findings provide foundations for future work using biographic narrative interventions to influence QoL and identity renegotiation in people with aphasia. [ABSTRACT FROM AUTHOR]

Objectives. The caries patterns of child populations in Germany have changed during the last 20 years. This affects the referrals and provision of specialist dental care for children. This study has two aims: first, to investigate referrals received by a specialized pediatric dental institution in 1995 and 2008, and second, to assess the treatments performed during full oral rehabilitations under general anesthesia in this institution from 2007 to 2008. Methods. All data of referred patients were evaluated for 1995 and 2008 separately. Comparisons were carried out for different socio-demographic, medical, and dental parameters. All patients treated under general anesthesia (GA) between March/2007 and December/2008 were examined retrospectively and their data were analyzed. Results. In 1995 (n = 191), significantly older children were referred to specialized pediatric dental care compared to 2008 (n = 179). In addition, a shift of surgical referrals to very young children with high caries levels was clearly noticed, resulting in considerably more oral rehabilitation performed under GA in 2008 (n = 73). Thus, the mean values of 6.4 fillings and 2.7 extractions per child were quite high. Conclusions. Preventive treatment approaches for primary dentition in Germany need further improvement by focusing on high caries-risk groups, as specialized pediatric dentistry bears the great burden of providing oral rehabilitations under GA in young children. [ABSTRACT FROM AUTHOR]

Objectives. The aim of this study was to determine the relationship between iso-body mass index (iso-BMI) and both dental caries status and caries increment among German school children. Methods. Six hundred and ninety-four students (age range 9-12 years, mean 10.34 0.56, 48% females) were recruited from the fifth grade of 18 primary schools. Weight, height, and oral health data number of decayed, missing and filled teeth (DMFT) as well as parent/legal guardian questionnaire (measuring SES) were collected during school dental examination at baseline and after one and a half-year follow-up. The body mass index (BMI) was calculated using the international classification system for childhood overweight and obesity (iso-BMI). Statistical analyses were performed using Poisson regression models. Results. Iso-BMI was significantly associated with dental caries prevalence and severity in the permanent dentition (P = 0.039). Low-normal weight children had a lower mean DMFT (0.56) than did overweight/obese children (0.70). In addition, a border-line significant association was found between overweight/obese children and caries increment (P = 0.055). Conclusion. Although iso-BMI was associated with dental caries prevalence and severity, the association between caries increment and iso-BMI did not reach a statistical significance. Overweight/ obese children however acquired more additional carious lesions during the follow-up period than children with low-normal weight. [ABSTRACT FROM AUTHOR]

Background and Objective Periodontitis has been found to be associated with coronary heart disease ( CHD) and stroke. However, only little is known about whether periodontitis and associated confounders are associated with new cardiovascular events among patients with CHD. Material and Methods A total of 942 inpatients with CHD were examined regarding periodontitis, oral care habits, bacteria in the subgingival biofilm and the expression of interleukin-( IL)-6 c. (coding DNA)-174 genotypes (rs 1800793) to determine whether these confounders are associated with new cardiovascular events within a 1-year follow-up period. Adjusted hazard ratios ( HR) with respect of age, gender, smoking, body mass index, use of aids for interdental hygiene, plaque index, occurrence of severe periodontitis and further internal diseases such as diabetes, hypertension, dyslipoproteinemia, number of missing teeth, serological parameters and IL-6 genotypes were generated with Cox regression. Results In all, 941 cardiovascular patients completed the 1-year follow up and 7.3% of the patients achieved the primary endpoint (myocardial infarction: 2.1%, stroke/transient ischemic attack: 1.8%, cardiovascular deaths: 3.4%). Patients who reported practicing interdental cleaning were younger, less likely to be male or to have severe periodontitis, had a reduced tobacco exposure, had fewer missing teeth, less indices for plaque and bleeding on probing and a significant decreased adjusted risk for new cardiovascular events ( HR = 0.2, CI 0.06-0.6, p = 0.01) than those patients with CHD who did not report practicing interdental cleaning. We did not obtain significant increased HR for patients with severe periodontitis ( HR = 1.2, CI 0.7-2.1, p = 0.53), carriers of the IL-6 genotypes GC or CC ( HR = 1.4, CI 0.8-2.5, p = 0.24) and did not find a significant association between the number of detected various oral species and the incidence of the combined endpoint ( HR = 0.9, CI 0.8-1.01, p = 0.07). Conclusions These findings suggest that flossing and brushing of interdental spaces might reduce the risk for new cardiovascular events among patients with CHD. The hypothesis that interdental cleaning per se reduces the risk of new cardiovascular events should be examined in an interventional study. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this study was to evaluate the veracity of a theoretically derived model of health that describes a non-linear trajectory of health from birth to death with available population data sets. Methods The distribution of mortality by age is directly related to health at that age, thus health approximates 1/mortality. The inverse of available all-cause mortality data from various time periods and populations was used as proxy data to compare with the theoretically derived non-linear health model predictions, using both qualitative approaches and quantitative one-sample Kolmogorov- Smirnov analysis with Monte Carlo simulation. Results The mortality data's inverse resembles a log-normal distribution as predicted by the proposed health model. The curves have identical slopes from birth and follow a logarithmic decline from peak health in young adulthood. A majority of the sampled populations had a good to excellent quantitative fit to a log-normal distribution, supporting the underlying model assumptions. Post hoc manipulation showed the model predictions to be stable. Conclusions This is a first theory of health to be validated by proxy data, namely the inverse of all-cause mortality. This non-linear model, derived from the notion of the interaction of physical, environmental, mental, emotional, social and sense-making domains of health, gives physicians a more rigorous basis to direct health care services and resources away from disease-focused elder care towards broad-based biopsychosocial interventions earlier in life. [ABSTRACT FROM AUTHOR]

Secondary transfer effects ( STEs) of intergroup contact refer to the generalization of contact effects from a primary encountered outgroup to attitudes towards secondary outgroups (Pettigrew, 2009). Using two large, cross-sectional data sets from Germany ( N = 1,381) and Northern Ireland ( N = 1,948), this article examined the extent to which STEs of intergroup contact on attitudes towards a range of secondary outgroups occur via a previously unexplored psychological construct, social identity complexity (operationalized as similarity complexity and overlap complexity). Study 1 found primary outgroup contact to be associated with greater similarity complexity, but no indirect effects on secondary outgroup attitudes via complexity emerged. Study 2, however, revealed indirect positive relationships between primary outgroup contact and secondary outgroup attitudes via increased similarity complexity and overlap complexity. These relationships were obtained while controlling for two previously tested mediating mechanisms, attitude generalization (operationalized as primary outgroup attitude) and deprovincialization (operationalized as ingroup attitude and identification). We discuss the theoretical implications of these findings and the contribution of social identity complexity to understanding processes underlying STEs of contact. [ABSTRACT FROM AUTHOR]

Background Diaries in the Intensive Care Unit ( ICU) support patients and relatives during and after a stay on the ICU. Barriers to implementation of the ICU diary are workload, unwanted closeness to patients and lack of time. Aims and objectives The purpose of the study was to evaluate the time nurses consume writing an ICU diary. Further questions were to examine whether the first diary entry, which includes a more detailed description about the admission, consumes more time than other entries and whether the time taken depends on experience or workload of the nurses. Design Quantitative, prospective, international observational multicentre study in four ICUs within the international diary network in Germany (two ICUs), Sweden and Switzerland (one ICU each). Method During a 6-month period in 2012/2013 nurses measured the time they consumed writing a diary in minutes and seconds, the number of diaries they contributed to and total number of diary entries, the nurse-patient ratio, their level of experience in writing diaries, interruptions while writing in a diary and additional information like photographs or follow-up visits. Results In summary 29 diaries were collected which included 195 written entries. The first entry needed significantly more time than following entries (first entry: mean 13:33 min versus following entries: mean 5:31, p < 0·001). The mean time for following entries differed significantly between the countries: Switzerland: 6:14, Sweden 5:31 and Germany 3:36 ( p < 0·001). Nurses with more experience used more time to write a diary (not significant). With increasing nurse-patient-ratio the time decreased for following entries (ratio 1:1: mean 5:42, ratio 1:2: mean 5:27, ratio 1:3: mean 3:12, p = 0·007). Conclusion Writing a diary for patients and relatives means an additional amount of time and workload, but according to the increased quality of nursing the time seems to be feasible for implementation. The measured time was self-reported, thus including possible bias for the results. [ABSTRACT FROM AUTHOR]

Objective A controlled clinical trial was conducted to evaluate the effects of oral prophylaxis on halitosis-associated, immunological and microbiological parameters. Methods Thirty subjects were included in this controlled clinical trial (patients with generalized chronic periodontitis and controls without clinical attachment loss; each n = 15). Before oral prophylaxis and 14 days after (including tongue cleaning) volatile sulphur compounds ( VSC), organoleptic scores and a tongue coating index were evaluated. The levels of IL-1β, IL-8, IL-10 and MMP-8 were measured in GCF, and also major periodontal pathogens were detected. Data were statistically analysed using anova and paired t-test. Results Supragingival plaque and calculus removal with combined tongue cleaning was able to reduce significantly ( P < 0.05) the VSC values in both groups (no significant differences between both groups). Two weeks after periodontal debridement, the VSC values were observed in the periodontitis group, but not in the control group, similar to the baseline values. The difference between the groups was statistically significant ( P < 0.05). Only a repeated prophylaxis session in the periodontitis group was able to reduce VSC values significantly in comparison with baseline ( P < 0.05). Organoleptic scores (10 and 30 cm) were significantly different ( P < 0.05) between both groups before and after the treatment. Periodontal pathogens and host-derived markers were not significantly affected by a single prophylaxis session. Conclusions Oral prophylaxis may result in a significant decrease in VSC values. However, in periodontal diseases, a more complex treatment seems to be necessary. [ABSTRACT FROM AUTHOR]

Objectives The antibacterial activity of two different formulations of a chlorhexidine/thymol varnish should be elucidated in vitro and in vivo. Methods The agar diffusion assay with Cervitec® and CervitecPlus® and three reference strains each of streptococci, lactobacilli, actinomyces and periodontal pathogens was performed. In a split-mouth study, 40 volunteers applied the test (CervitecPlus®, solvent water and ethanol) and control (Cervitec®, solvent ethyl acetate) varnish at buccal recessions of premolar teeth at baseline as well as after two, four and seven days. Supra- and subgingival plaques were collected 2 weeks before baseline and at the screening appointments. Supragingival plaque was analysed for mutans streptococci and lactobacilli and subgingival samples for Aggregatibacter actinomycetemcomitans, Fusobacterium nucleatum, Porphyromonas gingivalis and Porphyromonas intermedia. Friedman/Wilcoxon tests and U-test were used for statistical analysis ( P < 0.05). Results Most reference strains were susceptible with inhibition zones (mm) as follows: Cervitec®/CervitecPlus® streptococci 27 ± 1.7/21.3 ± 2.5, lactobacilli 26 ± 9.2/23.7 ± 4.9, actinomyces 36.3 ± 6.6/27.3 ± 1.5, periodontal pathogens 18.7 ± 7.6/18 ± 1.7. Both varnishes reduced significantly the counts of mutans streptococci and lactobacilli in the patients. However, no significant differences were found between test and control sides at any time. The total counts of periodontal pathogens were low. A tendency to higher counts of A. actinomycetemcomitans at the control side could be shown; the test side did not harbour significantly higher counts. Conclusion Both varnishes may influence the plaque formation and reduce mutans streptococci in supragingival plaque. [ABSTRACT FROM AUTHOR]

This research demonstrates social support from fellow group members as unique trigger of additional effort and performance in groups. Support-induced effort gains are shown both compared with groups without social support and individual work. Study 1 examined existing beliefs about motivating group work among employees with professional group work experience (n = 130). The results revealed social support as one of the most frequently reported sources of group-induced effort gains. Study 2 explored self-reported effort intentions in group training scenarios among athletes (n = 94). Finally, Study 3 examined performance as a manifest indicator of effort in an experimental persistence task among students (n = 88). The results of Study 2 and Study 3 showed significant gains due to social support in both self-reported effort and manifest performance, respectively. Together, the results demonstrate that receiving social support from fellow group members leads to higher effort in groups at the level of existing beliefs about motivating group work, at the level of effort intentions, and at the level of manifest performance behavior. The observed findings cannot be explained by established sources of motivation gains in groups such as social comparison or social indispensability. Copyright © 2014 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Objective The purpose of this ongoing randomized study was to assess differences in bone level changes and success rates using implants supporting single crowns in the posterior mandible either with platform matched or platform switched abutments. Material and Methods Patients aged 18 and above, missing at least two teeth in the posterior mandible and with a natural tooth mesial to the most proximal implant site were enrolled. Randomization followed implant placement. Definitive restorations were placed after a minimum transgingival healing period of 8 weeks. Changes in crestal bone level from surgery and loading (baseline) to 12-month post-loading were radiographically measured. Implant survival and success were determined. Results Sixty-eight patients received 74 implants in the platform switching group and 72 in the other one. The difference of mean marginal bone level change from surgery to 12 months was significant between groups ( p < 0.004). Radiographical mean bone gain or no bone loss from loading was noted for 67.1% of the platform switching and 49.2% of the platform matching implants. Implant success rates were 97.3% and 100%, respectively. Conclusions Within the same implant system the platform switching concept showed a positive effect on marginal bone levels when compared with restorations with platform matching. [ABSTRACT FROM AUTHOR]

Cold atmospheric plasma has already been shown to decrease the bacterial load in chronic wounds. However, until now it is not yet known if plasma treatment can also improve wound healing. We aimed to assess the impact of cold atmospheric argon plasma on the process of donor site healing. Forty patients with skin graft donor sites on the upper leg were enrolled in our study. The wound sites were divided into two equally sized areas that were randomly assigned to receive either plasma treatment or placebo (argon gas) for 2 minutes. Donor site healing was evaluated independently by two blinded dermatologists, who compared the wound areas with regard to reepithelialization, blood crusts, fibrin layers, and wound surroundings. From the second treatment day onwards, donor site wound areas treated with plasma ( n = 34) showed significantly improved healing compared with placebo-treated areas (day 1, p = 0.25; day 2, p = 0.011; day 3, p < 0.001; day 4, p < 0.001; day 5, p = 0.004; day 6, p = 0.008; day 7, p = 0.031). Positive effects were observed in terms of improved reepithelialization and fewer fibrin layers and blood crusts, whereas wound surroundings were always normal, independent of the type of treatment. Wound infection did not occur in any of the patients, and no relevant side effects were observed. Both types of treatment were well tolerated. The mechanisms contributing to these clinically observed effects should be further investigated. [ABSTRACT FROM AUTHOR]

In soccer, strength, power and speed are very important because of the large number of power actions performed during the game. Therefore, the aim of this study was to examine the influence of periodised strength training for power performance more than 2 years. In this study, 134 elite youth soccer players were recruited from two youth training centres. The cohorts were arranged as follows: A (under 19 years), B (under 17 years) and C (under 15 years). The participants in each cohort were divided into two groups. One group (Strength training group [STG]) was subjected to regular soccer training in addition to strength training twice a week for 2 years. The other group (Control group [CG]) completed only the regular soccer training. The strength training was periodised with hypertrophy and intramuscular coordination blocks. For strength training, both the front squat and the back squat were performed once a week. The subjects were tested on the one-repetition maximum (1RM) of the front and back squat and a linear sprint over 30 m. There was significantly better performance from the STG on 1RM (p <0.001). In the sprint, the STG displayed significantly better improvements (p <0.05 to p <0.001) of up to 6%. The effects of strength training are reflected in the sprint performance. Therefore, it seems beneficial for youth to perform strength training to exploit the reserve capacity in sprint performances. [ABSTRACT FROM AUTHOR]

Objectives As periodontal bacteria might be involved in the aetiology of rheumatic diseases, we analysed synovial fluid obtained from patients with rheumatoid arthritis ( RA) and controls for the presence of DNA of Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, Prevotella intermedia, Tannerella forsythia, and Treponema denticola. Methods In all, 42 patients suffering from RA (mean age 53.8 ± 16.7 years, 40.4% females) and 114 controls with no rheumatic diseases (mean age 56.1 ± 15.2 years, 52.4% females) were included. DNA from synovial fluid was isolated by QiaAmp kit (Qiagen, Hilden, Germany). Polymerase chain reactions ( PCRs) specific for the 16S rRNA genes of the above specified bacteria were developed. Subgingival bacterial colonization was analysed using micro-Ident® test (HAIN-Diagnostik, Nehren, Germany). Results In patients with RA DNA of P. gingivalis was detected in synovial fluid more often than in controls (15.7% versus 3.5%, p = 0.045). More patients than controls harboured DNA from P. gingivalis in both, oral plaque and synovial fluid (11.9% versus. 0.9%, p = 0.030). Among the patients group the number of missing teeth was correlated with the number of joints with movement restrictions caused by RA. Conclusions DNA of periodontopathogens can be found in synovial fluid and oral bacteria may play a role in the pathogenesis of arthritis. [ABSTRACT FROM AUTHOR]

International Journal of Paediatric Dentistry 2013; 23: 116-124 Objective This epidemiological study aimed to compare the caries experience in 10-year-olds with and without molar incisor hypomineralisation (MIH). Methods About 693 children from an ongoing birth cohort study (GINIplus10) were examined for caries lesions to determine the DMF index. Furthermore, enamel hypomineralisation (EH) was scored on all permanent teeth/surfaces, according to the criteria of the European Academy of Paediatric Dentistry. Children with EH were categorised into those with a minimum of one EH in the permanent dentition (MIH/1), with EH on at least one-first permanent molar (MIH/1A), on at least one-first permanent molar and permanent incisor (MIH/1B), and on other permanent teeth (MIH/1C). Results The mean caries experience was 0.4 (SD 0.9) DMFT. Existence of MIH/1, MIH/1A, MIH/1B, and MIH/1C was determined in 36.5%, 14.7%, 9.4%, and 21.8% of all children. The corresponding DMFT values were the following: no MIH: 0.3 (SD 0.8); MIH/1: 0.5 (SD 0.9); MIH/1A: 0.5 (SD 0.9); MIH/1B: 0.4 (SD 0.9); and MIH/1C: 0.4 (SD 0.9) DMFT. No significant differences were found between all groups. Conclusions There was no relationship between the presence of EH/MIH and caries in 10-year-olds. A ratio of one EH-associated defect to two caries lesions indicates that both conditions are prevalent and influence the oral health status of 10-year-old children from Munich, Germany. [ABSTRACT FROM AUTHOR]

Objective Self-efficacy - the confidence to carry out certain behaviour in order to achieve a specific goal - has increasingly been recognized as an essential prerequisite of effective self-management of chronic diseases. Therefore, valid and reliable measures are needed to evaluate self-efficacy in both research and clinical practice. This study explored the psychometric properties of the German version of the Self-Efficacy for Managing Chronic Disease 6-Item Scale (SES6G). Methods We performed standardized translation and cultural adaptation of the SES6G into German. The SES6G was externally validated with the German General Self-Efficacy Scale (SWE). Cronbach's alpha, descriptive statistics and principal component analysis were used to assess psychometric properties of the SES6G. We assessed the effect of the number of co-occurring chronic diseases on SES6G scores using linear regression modelling by controlling for age, gender and education level. Results We analysed data of 244 primary care patients in Germany. The SES6G showed good convergent construct validity to the SWE (spearman rank correlation 0.578, P < 0.001) and high internal consistency (Cronbach's alpha 0.930). Principal component analysis underlined the one-dimensional structure of the instrument. Adjusted for age and gender, increasing numbers of co-occurring chronic diseases were associated with lower SES6G scores (standardized β-value −0.27, P < 0.001). Education level showed no significant effect. Conclusions The SES6G is a reliable and valid instrument to assess patients' self-efficacy for managing chronic diseases. It may enhance further research in German-speaking countries and appears to be a valuable measure for clinical practice. [ABSTRACT FROM AUTHOR]

Objective To examine the psychometric properties of the German version of the 'observing patient involvement' scale (OPTION) by analysing video recordings of primary care consultations dealing with counselling in cardiovascular prevention. Design Cross-sectional assessment of physician-patient interaction by two rater pairs and two experts in shared decision making (SDM). Setting Primary care. Participants Fifteen general practitioners provided 40 videographed consultations. Measurements Video ratings using the OPTION instrument. Results Mean differences on item level between the four raters were quite large. Most items were skewed towards minimal levels of shared decision making. Measures of inter-rater association showed low to moderate associations on item level and high associations on total score level. Cronbach-α of the whole scale based on the data of all four raters is 0.90 and therefore on a high level. An oblique factor analysis revealed two factors, but both factors were highly correlated so we can confirm a one-dimensional structure of the instrument. ROC analyses between the rater total scores and dichotomized expert ratings (SDM yes/no) revealed a good discriminability of the OPTION total score. Physicians with more expertise in shared decision making received higher OPTION ratings. Conclusions The German version of the OPTION scale is reliable at total score level. Some items need further revision in the direction of more concrete, observable behaviour. We were only able to perform a quasi-validation of the scale. Validity issues need further research efforts. [ABSTRACT FROM AUTHOR]

Macrophage migration inhibitory factor ( MIF), a structurally and functionally unique pleiotropic mediator in inflammation and immune processes, was identified decades ago. There is now strong evidence that MIF promotes revascularization and is involved in wound healing processes. However, its exact role in wound healing is still a matter of debate. A cohort of 33 patients was recruited, including 14 patients with acute and 19 patients with chronic wounds. Both serum and wound fluid samples were collected from each patient, and MIF and cortisol concentrations were determined. To functionally underscore MIF's potential role in wound revascularization, a chemotaxis assay was adapted to test whether and to what extent serum samples and wound fluids of each group promote the chemotactic migration of endothelial progenitor cells ( EPCs). MIF serum levels were significantly higher in chronic wound patients than in acute wound patients. Wound exudates of chronic wounds, however, contained a significantly lower concentration of MIF. In chronic wound patients, EPC migration might be delayed, as suggested by in vitro chemotaxis experiments. Despite the overall descriptive nature of this study, we conclude that MIF is correlated with occurrence of chronic wound. The increased MIF levels in the serum of chronic wound patients might be due to MIF's systemic effect of its proinflammatory activities, while its locally decreased levels in chronic wound exudates might be responsible for impaired recruitment of EPCs. Additional prospective data and detailed in vivo models are needed for a more comprehensive understanding of the role of MIF in chronic wound healing. [ABSTRACT FROM AUTHOR]

ABSTRACT Aims To test age differences in the prevalence of DSM-IV alcohol dependence (AD) diagnostic criteria in the adult general population while controlling for drinking behaviour. Design and setting Cross-sectional data from the 2006 German Epidemiological Survey of Substance Abuse (ESA) were used, applying a two-stage probability sampling design. The survey used self-administered questionnaires and telephone interviews (mixed-mode design; 45% response rate). Participants The analytical sample consisted of n = 6984 individuals aged 18-64 years reporting alcohol consumption within the previous year. Measurements Age effects on individual AD criteria were estimated using logistic regression models, adjusting for eight mutually exclusive drinking groups (defined in terms of average daily alcohol intake and episodic heavy drinking) and socio-economic variables. Findings When controlling for drinking behaviour, 18-24-year-olds were more likely to meet the criteria 'tolerance', 'larger/longer' and 'time spent' relative to older age groups. In contrast, the likelihood of experiencing 'withdrawal' symptoms increased with age. There was no significant age effect on the diagnosis of AD. Conclusions Age differences in the prevalence of specific alcohol dependence diagnostic criteria such as 'tolerance', 'drinking larger amount or for longer than intended' and 'time spent recovering' cannot be fully explained by differences in drinking behaviour. [ABSTRACT FROM AUTHOR]