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

Purpose: To extend knowledge about measurement equivalence of depression measures assessed by tablet and paper-pencil administration, the present study evaluated the effect of mode of administration (MoA) on scale and item level for the Patient Health Questionnaire (PHQ-9) and the Aachen Depression Item Bank (ADIB) in elderly patients.Methods: Primary care patients (N = 193, ≥60 years) were assessed following a crossover design in Leipzig, Germany. All participants filled out the PHQ-9 and the ADIB in both MoAs under study. Effects of MoA were analyzed by intra-class correlation, mixed-effects regression, and differential item functioning (DIF). Additionally, detection rates between both MoAs were compared using receiver operating characteristics analysis compared to a diagnostic interview (SCID-I, N = 163).Results: No effect of MoA was found in the PHQ-9 on scale score or item level. Two ADIB items showed DIF according to MoA. In terms of discriminatory power, MoA did not influence detection rates of both instruments.Conclusions: In summary, our findings suggest that no severe effect of mode of administration on self-report assessments of depression should be expected. It can be concluded that tablets provide a valid way to electronically assess depressive symptoms in elderly patients. Yet changes in item presentation can influence the psychometric properties and require equivalence testing using sophisticated analyses on item level such as DIF. [ABSTRACT FROM AUTHOR]

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

Objective: To assess rates of traversing barriers to care to access optimal clinical outcomes in people with migraine internationally. Background: People in need of medical care for migraine should consult a health care professional knowledgeable in migraine management, obtain an accurate diagnosis, and receive an individualized treatment plan, which includes scientific society guideline-recommended treatments where appropriate. Methods: The Chronic Migraine Epidemiology and Outcomes-International (CaMEO-I) Study was a cross-sectional, web-based survey conducted from July 2021 through March 2022 in Canada, France, Germany, Japan, the United Kingdom, and the United States (US). Respondents who met modified International Classification of Headache Disorders, 3rd edition, criteria for migraine and had Migraine Disability Assessment Scale (MIDAS) scores of ≥ 6 (i.e., mild, moderate, or severe disability) were deemed to need medical care and were included in this analysis. Minimally effective treatment required that participants were currently consulting a health care professional for headache (barrier 1), reported an accurate diagnosis (barrier 2), and reported use of minimally appropriate pharmacologic treatment (barrier 3; based on American Headache Society 2021 Consensus Statement recommendations). Proportions of respondents who successfully traversed each barrier were calculated, and chi-square tests were used to assess overall difference among countries. Results: Among 14,492 respondents with migraine, 8,330 had MIDAS scores of ≥ 6, were deemed in need of medical care, and were included in this analysis. Current headache consultation was reported by 35.1% (2926/8330) of respondents. Compared with the US, consultation rates and diagnosis rates were statistically significantly lower in all other countries except France where they were statistically significantly higher. Total appropriate treatment rates were also statistically significantly lower in all other countries compared with the US except France, which did not differ from the US. All 3 barriers were traversed by only 11.5% (955/8330) of respondents, with differences among countries (P < 0.001). Conclusions: Of people with migraine in need of medical care for migraine, less than 15% traverse all 3 barriers to care. Although rates of consultation, diagnosis, and treatment differed among countries, improvements are needed in all countries studied to reduce the global burden of migraine. Trial registration: NA. [ABSTRACT FROM AUTHOR]

Our aim was to provide data regarding uptake of gynecological early detection measures and performance of breast self-examinations among migrant women in Germany. Cross-sectional self-reported data were collected using paper-and-pencil questionnaires. Descriptive analyses, Chi square-tests, and logistic regression were applied. Results were adjusted for educational level. Of 5387 women, 89.9% were autochthonous, 4.1% German resettlers, 2.8% Turkish, 3.1% other migrants. Participation rates regarding cancer screening differed significantly, with the lowest proportion in Turkish migrants (65.0%), resettlers (67.8%), other migrants (68.2%) and autochthonous population (78.2%). No differences in performance of breast self-examinations were detected. When adjusted for education, results indicated only slight changes in the odds to participate in screening irregularly or not at all. Results support existing evidence by showing lower participation rates in cancer screening among migrant women, but there were no differences regarding breast self-examinations. Migrant women form a potential high-risk group for late-stage diagnosis of cervical or breast cancer. [ABSTRACT FROM AUTHOR]

Background: Childhood obesity is associated with various health outcomes. Restrictive measures to contain the spread of the Coronavirus Disease 2019 (COVID-19) pandemic, like lockdowns and school closures, affected children's daily structure, physical activity, dietary habits, and sleep quality, possibly exacerbating risk factors for childhood obesity and higher body mass index (BMI) in children. Poor socioeconomic conditions may have led to relatively higher risk for elevated BMI levels following pandemic measures. In this study, the impact of measures related to the COVID-19 pandemic on the BMI of third graders was investigated regarding children's socioeconomic background (SEB). Methods: Data from 41,728 children (8.84 ± 0.56 years, 20,431 female) were collected in the context of a cohort study. Children were tested either before the pandemic (preCOVID: Sept2017–March2020, n = 26,314), or following the first (postLDI: Aug2020–Dec2020, n = 6657) or second lockdown in Germany (postLDII: Aug2021–Jan2022, n = 8757). SEB was based on the official school type classification of the state of Berlin. Outcome was BMI standard deviation scores (SDS). Results: Significant effects of Time and SEB revealed elevated BMIs in postLDI (M = 0.23, p = 0.011) and postLDII (M = 0.22, p = 0.011) compared to preCOVID (M = 0.17) cohorts and higher BMIs for children with lower SEB (b = − 0.13, p < 0.001). A significant Time × SEB interaction indicated that the effect of SEB on children's BMI increased in response to lockdowns, especially in postLDII (b = − 0.05, p = 0.006). Results suggest that the COVID-19-related measures lead to increased BMI in children, and that children of lower SEB were at particular risk for higher BMIs following lockdowns. Conclusions: These findings highlight the dependency of children's BMI on societal circumstances. Over the course of two lockdowns in Germany, children have experienced BMI increments, particularly in low socioeconomic areas. Authorities are called into action to counteract increasing rates of childhood weight by promoting physical activity of children and establishing related post-pandemic offers. Key Points: Children's weight status and health could be affected in the short and long term as a consequence of increased BMI in primary school cohorts following COVID-19 pandemic-related lockdowns. Children from lower socioeconomic backgrounds are at particularly high risk of poor weight status and have higher BMIs. This socioeconomic gradient increased in post-lockdown cohorts, which is why the health of socioeconomically disadvantaged children may have been disproportionally affected by the pandemic. Authorities and policymakers are called upon to take countermeasures to minimize the impact of the COVID-19 pandemic on children's weight status and to counteract risks of increasing childhood obesity rates, especially in socioeconomically poorer regions. [ABSTRACT FROM AUTHOR]

Emergency inpatient admissions of children and adolescents are more difficult if the patient is admitted involuntarily and/or the caregivers or custodians of institutional care are absent. The present study aimed to clinically characterize involuntary versus voluntary admissions by examining the reasons for presentation and associated factors. We retrospectively analyzed patients who presented to the emergency department of a hospital for child and adolescent psychiatry in Bavaria, Germany, and were admitted as inpatients for crisis intervention in the 4th quarter of 2014–2018. Reasons for presentation, clinical and sociodemographic characteristics, and type of admission (voluntary versus involuntary) were analyzed for 431 emergency inpatient admissions. A total of 106 (24.6%) patients were involuntarily admitted. In a binominal logistic regression, presentation due to alcohol consumption, deviant social behavior, and psychosocial burden was positively associated, whereas difficulties at school and depression were negatively associated, with the likelihood of involuntary admission. 58.5% of the 123 unaccompanied patients were admitted involuntarily. Reasons for the presentation of unaccompanied and voluntary inpatient admissions were suicidal thoughts, psychosocial burden, and externalized aggression. A substantial number of child and adolescent psychiatric admissions represent emergency admissions. Involuntarily admitted patients and unaccompanied children/adolescents represent a non-negligible proportion of clinical routine and the clinical and legal background factors need to be further clarified in future studies. This study is registered in the German Clinical Trials Register (24 September 2019, DRKS00017689). [ABSTRACT FROM AUTHOR]

Background: Clinical trials and real-world studies revealed a spectrum of response to CGRP(-receptor) monoclonal antibodies (mAbs) in migraine prophylaxis, ranging from no effect at all to total migraine freedom. In this study, we aimed to compare clinical characteristics between super-responders (SR) and non-responders (NR) to CGRP(-receptor) mAbs. Methods: We performed a retrospective cohort study at the Headache Center, Charité – Universitätsmedizin Berlin. The definition of super-response was a ≥ 75% reduction in monthly headache days (MHD) in the third month after treatment initiation compared to the month prior to treatment begin (baseline). Non-response was defined as ≤ 25% reduction in MHD after three months of treatment with a CGRP-receptor mAb and subsequent three months of treatment with CGRP mAb, or vice versa. We collected demographic data, migraine disease characteristics, migraine symptoms during the attacks in both study groups (SR/NR) as well as the general medical history. SR and NR were compared using Chi-square test for categorical variables, and t-test for continuous variables. Results: Between November 2018 and June 2022, n = 260 patients with migraine received preventive treatment with CGRP(-receptor) mAbs and provided complete headache documentation for the baseline phase and the third treatment month. Among those, we identified n = 29 SR (11%) and n = 26 NR (10%). SR reported more often especially vomiting (SR n = 12/25, 48% vs. NR n = 4/22, 18%; p = 0.031) and typical migraine characteristics such as unilateral localization, pulsating character, photophobia and nausea. A subjective good response to triptans was significantly higher in SR (n = 26/29, 90%) than in NR (n = 15/25, 60%, p = 0.010). NR suffered more frequently from chronic migraine (NR n = 24/26, 92% vs. SR n = 15/29, 52%; p = 0.001), medication overuse headache (NR n = 14/24, 58% versus SR n = 8/29, 28%; p = 0.024), and concomitant depression (NR n = 17/26, 65% vs. SR n = 8/29, 28%; p = 0.005). Conclusion: Several clinical parameters differ between SR and NR to prophylactic CGRP(-R) mAbs. A thorough clinical evaluation prior to treatment initiation might help to achieve a more personalized management in patients with migraine. [ABSTRACT FROM AUTHOR]

Purpose: The benefits of antiviral treatment with remdesivir in hospitalized patients with COVID-19 remain controversial. Clinical analyses are needed to demonstrate which patient populations are most likely to benefit. Methods: In a retrospective monocentric analysis, patients with COVID-19 treated between July 1, 2020 and June 30, 2021 at Hospital St. Georg, Leipzig, Germany were evaluated. The primary endpoint was time to clinical improvement, and the secondary endpoint was 28-day mortality. Propensity score matching was used for the endpoint analysis. Results: A total of 839 patients were fully evaluated, 68% of whom received specific COVID-19 drug therapy. Remdesivir was used in 31.3% of the patients, corticosteroids in 61.7%, and monoclonal antibodies in 2.3%. While dexamethasone administration was the most common therapeutic approach during the second pandemic wave, combination therapy with remdesivir and corticosteroids predominated during the third wave. Cox regression analysis revealed that combination therapy was not associated with faster clinical improvement (median: 13 days in both matched groups, HR 0.97 [95% CI 0.77–1.21], P = 0.762). By contrast, 28-day mortality was significantly lower in the corticosteroid-remdesivir group (14.8% versus 22.2% in the corticosteroid group, HR 0.60 [95% CI 0.39–0.95], P = 0.03) in the low-care setting. This effect was also demonstrated in a subgroup analysis of patients with remdesivir monotherapy (n = 44) versus standard of care (SOC). Conclusion: In COVID-19 patients with only mild disease (low-flow oxygen therapy and treatment in a normal ward) who received corticosteroids and/or remdesivir in addition to SOC, early administration of remdesivir was associated with a measurable survival benefit. [ABSTRACT FROM AUTHOR]

Background: Bioethics can play an important role in addressing diversity both in and outside of academia, setting precedents for meaningful contributions to public discourse, research, teaching, training, and policy development. However, in order to do so, these conversations also need to reflect on the issue of diversity within the field of bioethics across the globe. This study aims to examine current gender representation and diversity at medical ethics and humanities institutes in Germany, the German-speaking areas of Switzerland, and Austria. Methods: A total of forty-nine medical ethics and humanities institutes from Germany (n=42), the German-speaking areas of Switzerland (n=5), and Austria (n=2) were included in the study. Institutes websites were reviewed in the first week of March 2021 and the details of each staff member listed on the website recorded. Results: Overall, a total of 964 staff members were identified at the forty-nine German-speaking medical ethics and humanities institutes. Just over half (530/964; 55%) of all staff were female. There were significant differences between gender in some staff positions: 64.6 per cent (31/48) of directors were male (χ2(1)=4.1, P=.04); 62.7 per cent (84/134) of student assistants were female (χ2(1)=8.6, P=.003); and 83.7 per cent (77/92) of administrative staff were female (χ2(1)=41.8, P<.001). There were no significant differences between staff gender for researchers and lecturers, or associated researchers. In addition, 65.5 per cent (19/29) of researchers and lecturers who had a professor title were male, but the difference between genders was not found to be significant. However, significantly more of the researchers and lecturers who had completed a habilitation were male (75.8% (25/33); χ2(1)=8.8, P=.003). When comparing the institute director's gender presentation with staff gender presentation, it was found that male-led institutes had 53.4 per cent (286/536) female staff overall but had 52.7 per cent (136/258) male researchers and lecturers. However, the difference between genders were not found to be significant. On the other hand, female-led institutes had significantly more female staff overall (59.9% (223/372); χ2(1)=14.7, P<.001) and also significantly more female researchers and lecturers (58.9% (119/202; χ2(1)=6.4, P=.01). Conclusions: There has been a significant push to address gender diversity in German-speaking academia, and this study finds overall good gender parity in medical ethics and humanities institutes. However, there has not been a similar openness to discussing issues of systemic racism or how other forms of inequality affect academic diversity. Taking diversity seriously requires opening up conversations around intersectionality, including difficult conversations around race and cultural background that have long been taboo in German-speaking countries. [ABSTRACT FROM AUTHOR]

About 84,710 Latin American migrants currently live in Germany. Knowledge about their work situation in relation to their skill level and its association with mental health is limited. Therefore, the aims of this study were to assess the prevalence of working below skill level and its association with the prevalence of distress in Latin Americans living in Germany. This cross-sectional study included a convenience sample of 282 Latin American migrants living in Germany. Participants were recruited by a short online (Facebook, personal contacts) or interview-based questionnaire from November 2015 to April 2016. Questions included skill level, job category (categorized by ISCO 2008 code), socio-demographics, violence at the workplace and distress. The latter was assessed by Goldberg's General Health Questionnaire using a cut-off of 4/5. Descriptive statistics were followed by logistic regression analyses adjusting for potential confounders. About half of the study population reported symptoms of distress (45%). 63% of the population worked below skill level. 12-months prevalence of violence at the workplace was 14%. After adjustment, working below skill level was statistically significantly related to distress (odds ratio 2.80; 95% confidence interval 1.58–4.95). Working below skill level is common in Latin American migrants in Germany and may result in poor psychosocial well-being. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study was to test psychometric properties of the Satisfaction with Life Scale (SWLS), to provide normative values, and to analyze associations between life satisfaction and sociodemographic and behavioral data.Methods: A German community sample (n = 9711) with an age range of 18-80 years was surveyed using the SWLS and several other questionnaires. Confirmatory factor analysis (CFA) was used to test the dimensionality of the SWLS. Invariance across gender and age groups was tested with multiple-group CFA. Associations between SWLS, sociodemographic variables, and behavioral variables were tested with ANOVAs.Results: Confirmatory factorial analysis results confirmed that the SWLS is a one-dimensional scale. Measurement invariance across gender was completely confirmed, while concerning age strict measurement invariance was confirmed. The effects of gender and age on satisfaction with life were weak. Satisfaction with life was associated with fatigue (r = - .49), the mental component of quality of life (r = .45), anxiety (r = - .42), dispositional optimism (r = .41), pessimism (r = - .34), sleep quality (r = - .32), and sociodemographic factors such as marital status, income, and occupational status. Non-smokers reported higher life satisfaction than smokers.Conclusions: Because of the good psychometric properties, the SWLS can be recommended for use in epidemiological research. Normative values based on a large community sample are provided. [ABSTRACT FROM AUTHOR]

Altered sensory perception has been found in patients with autism spectrum disorders (ASD) and might be related to aberrant sensory perception thresholds. We used the well-established, standardized Quantitative sensory testing (QST) protocol of the German Research Network on Neuropathic Pain to investigate 13 somatosensory parameters including thermal and tactile detection and pain thresholds in 13 ASD adults and 13 matched healthy controls with normal IQ values. There were no group differences between somatosensory detection and pain thresholds. Two ASD patients showed paradoxical heat sensations and another two ASD subjects presented dynamic mechanical allodynia; somatosensory features that were absent in controls. These findings suggest that central mechanisms during complex stimulus integration rather than peripheral dysfunctions probably determine somatosensory alterations in ASD. [ABSTRACT FROM AUTHOR]

Diagnosing Autism Spectrum Disorders (ASD) is important throughout the lifespan. The objective was to investigate the transcultural diagnostic validity of the Social Communication Questionnaire (SCQ) in a clinical sample of 451 adults with Intellectual Developmental Disorder (IDD) with and without ASD in Germany, the U.S.A. and Great Britain. Variables associated with higher SCQ sum-scores were higher levels of IDD, male gender, a diagnosis of ASD and the study site (Germany > U.S.A > G.B.). An ROC analysis revealed a cut-score of 13, which resulted in a sensitivity of 0.87 and a specificity of 0.58. It is recommended to adjust the cut-score according to level of IDD and gender. Further research is needed to align diagnostic assignment of ASD across different sites and countries. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study was to compare the demographics, injury patterns, and outcomes following major trauma between Alpine skiing, snowboarding, and sledding winter sports. Methods: An international population-based prospective trauma database (TraumaRegister DGU) was analyzed for demographic data, types and severity of injuries [body regions, Injury Severity Score (ISS)], early physiology [Glasgow Coma Scale (GCS), blood pressure, body temperature], rescue modality, surgical care, length of stay, and major complications (shock, multiple organ failure mortality). Participating countries included Germany, Austria, Switzerland, Finland, Slovenia, Belgium, Luxembourg, and The Netherlands. Results: A total of 243 winter sport athletes with major trauma were identified (1993-2012), and subjects were divided into Alpine skiers ( n = 174), snowboarders ( n = 29), and sledders ( n = 40). Athletes were predominantly male and presented hypothermic at emergency room arrival, despite a large proportion of air rescue (77 %). Alpine skiing was associated with higher injury severity (ISS 20.8 ± 14.0, p = 0.010) when compared with snowboarding (ISS 18.7 ± 14.0) and sledding (ISS 13.8 ± 9.5). Snowboarding was associated with the highest pre-hospital intubation rate (40.9 %, p = 0.007), despite comparable GCS values and prevalence of loss of consciousness at scene. The injury patterns were different between the three groups. Skiing was associated with head (47.1 %), chest (40.2 %, p = 0.047), and spinal injuries (40.9 %, p = 0.022). Snowboarding was associated with the highest percentage of upper extremity trauma. Sledders had the highest prevalence of facial and lower extremity trauma. Conclusions: Alpine skiing, snowboarding, and sledding result in different injury patterns and affect various age groups. Our data suggest an increased risk for chest and spinal injuries in Alpine skiers. Due to high-energy injury mechanisms, all three winter sports involve a risk of severe multiple trauma. While all athlete groups required a high rate of emergency surgery procedures, the observed in-hospital mortality from winter sports remains low. [ABSTRACT FROM AUTHOR]

How does spending a year abroad influence the personality and relationship development of adolescents? This question was studied using a prospective control group design comprising 457 sojourners (high school exchange students) and 284 control participants (German adolescents; 73.3 % female; mean age = 15.63, SD = 0.78), all of whom were assessed three times across one academic year. Sojourners demonstrated higher pre-departure levels of Extraversion and Agreeableness as well as lower levels of Neuroticism. Longitudinal results indicated a steeper increase in Openness and Agreeableness trajectories, as well as a buffered increase in Neuroticism for exchange students. As expected, sojourners' social relationships showed high fluctuation, which partially mediated sojourn effects on personality development. The role of international youth mobility for personal and social development in adolescence is discussed. [ABSTRACT FROM AUTHOR]

Digital media, especially mobile communication technologies, enable adolescents to explore and experiment with each other with only limited adult control. Conflicts between peers can be easily staged since nearly everybody can be reached at any time under the radar of authorities. Therefore, involvement in conflicts and bullying might depend on how adolescents use and behave online. In the present study, we provide a comprehensive picture of the role aspects of online communication play in long-term involvement in cyberbullying. We focused on a gender-specific perspective, as girls and boys were found to differ not only according to their online communication but also in their cyberbullying involvement. Using a two-wave panel survey of 1817 adolescents between 13 and 17 years (56 % female), we found that girls' cyberbullying involvement (perpetration and victimization) could be traced back to more intensive online social activities and a higher amount of online contact with strangers. In contrast, for boys, only higher exposure to antisocial media content predicted higher levels of victimization over time. The findings indicate that certain patterns of online communication increase the cyberbullying risk over time. However, it needs to be noted that these risk factors vary between girls and boys. [ABSTRACT FROM AUTHOR]

The article presents a cross-sectional study on adolescents with disabilities in Germany and their sexuality and sexual activities. Topics include adolescents with physical, visual, and hearing impairments coming from special education schools, their level of sexual activity, relationships, and experience of sexual intercourse compared to adolescents without disabilities, and results showing the predictors of sexual intercourse such as increasing age, no disability, and a stable relationship.

Pre-pregnancy overweight and obesity is associated with poor health outcomes for the mother and the child. General population studies suggest that childhood maltreatment is associated with obesity in adulthood. The aim of our study was to examine the association between pre-pregnancy overweight and obesity and a history of childhood abuse or neglect including different stages of severity of abuse and neglect. Three hundred twenty-six normal weight, overweight, or obese pregnant women reported demographic data, height and weight, and general psychological distress at 18-22 weeks of gestation. Childhood maltreatment was assessed using the Childhood Trauma Questionnaire. Associations were examined using logistic regression analyses and a reference group of normal weight women. Fifty percent reported a history of abuse or neglect. After adjusting for age, education, income, marital status, and the number of previous children, pre-pregnancy overweight and obesity were strongly associated with severe physical abuse (overweight: OR = 8.33, 95 % CI 1.48-47.03; obesity: OR = 6.31, 95 % CI 1.06-37.60). Women with severe physical neglect (OR = 4.25, 95 % CI 1.23-14.74) were at increased risk of pregnancy overweight. We found a dose-response relationship between physical abuse and pre-pregnancy overweight and obesity. Whereas other studies report an association between childhood maltreatment and pre-pregnancy obesity, this is the first study that found an association between childhood maltreatment and pre-pregnancy overweight. Considering the severe health risks of pre-pregnancy overweight and obesity and the long-term consequences of childhood maltreatment, affected women constitute a subgroup with special needs in prenatal care. Further research is needed to improve the understanding of the underlying mechanisms. [ABSTRACT FROM AUTHOR]

Background: The importance of trunk muscle strength (TMS) for physical fitness and athletic performance has been demonstrated by studies reporting significant correlations between those capacities. However, evidence-based knowledge regarding the magnitude of correlations between TMS and proxies of physical fitness and athletic performance as well as potential effects of core strength training (CST) on TMS, physical fitness and athletic performance variables is currently lacking for trained individuals. Objective: The aims of this systematic review and meta-analysis were to quantify associations between variables of TMS, physical fitness and athletic performance and effects of CST on these measures in healthy trained individuals. Data Sources: PubMed, Web of Science, and SPORTDiscus were systematically screened from January 1984 to March 2015. Study Eligibility Criteria: Studies were included that investigated healthy trained individuals aged 16-44 years and tested at least one measure of TMS, muscle strength, muscle power, balance, and/or athletic performance. Study Appraisal and Synthesis Methods: Z-transformed Pearson's correlation coefficients between measures of TMS and physical performance were aggregated and back-transformed to r values. Further, to quantify the effects of CST, weighted standardized mean differences (SMDs) of TMS and physical performance were calculated using random effects models. The methodological quality of CST studies was assessed by the Physiotherapy Evidence Database (PEDro) scale. Results: Small-sized relationships of TMS with physical performance measures (−0.05 ≤ r ≤ 0.18) were found in 15 correlation studies. Sixteen intervention studies revealed large effects of CST on measures of TMS (SMD = 1.07) but small-to-medium-sized effects on proxies of physical performance (0 ≤ SMD ≤ 0.71) compared with no training or regular training only. The methodological quality of CST studies was low (median PEDro score = 4). Conclusions: Our findings indicate that TMS plays only a minor role for physical fitness and athletic performance in trained individuals. In fact, CST appears to be an effective means to increase TMS and was associated with only limited gains in physical fitness and athletic performance measures when compared with no or only regular training. [ABSTRACT FROM AUTHOR]

Purpose: To describe age and time trends of energy and macronutrient intake during infancy and toddlerhood and to set a special focus on dietary practices with respect to milk, complementary food, and family food intake. Methods: Three-day dietary records ( n = 2241) collected at 3, 6, 9, 12, 18, 24, and 36 months (480 subjects) between 2004 and 2013 from the ongoing open cohort DONALD (Dortmund Nutritional and Anthropometric Longitudinally Designed) study were evaluated using repeated-measures regression analyses for trend analysis. Results: Significant age trends were found for macronutrients with a decrease in fat intake (% of energy intake, %E) and an increase in carbohydrates (%E) and protein (%E). Exclusive and partial breastfeeding rates at 3 and 6 months did not differ between 2004 and 2008 and 2009 and 2013 ( p > 0.05). Macronutrient pattern was virtually stable over time, whereas food group intake (% of total food intake excluding beverages, % TFI) changed significantly during the study period. Breast/bottle milk (% TFI) intake increased over time in the toddler subgroup, whereas family food (% TFI) decreased. Conclusions: Our data demonstrate a period of stagnation in the last 10 years with respect to breastfeeding duration in infancy. Further breastfeeding promotion in Germany is needed to continue the favourable progress of the previous decades. In toddlerhood, breast/bottle milk remains a substantial part of the diet and has increased during the last 10 years. Parents should be encouraged to implement healthy eating habits during early toddlerhood and to facilitate their child's participation in appropriate family meals. [ABSTRACT FROM AUTHOR]

This study investigated parenting behaviors of mothers and fathers of clinically anxious preschool children (with or without depressive comorbidity) and healthy comparison children. Studies assessing children from early school age onwards have found that parental control, rejection, and inconsistent discipline are associated with the presence of children's internalizing symptoms/disorders. Despite the scarcity of studies investigating these associations at preschool age, we assumed that findings with older children would also apply to children in this age group. In a cross-sectional study we assessed N = 176 children of preschool age ( M = 5; 2 years) and both of their parents. A diagnostic interview (Preschool Age Psychiatric Assessment) was conducted to determine children's psychiatric diagnoses, yielding the following results: a group of n = 67 children with pure anxiety disorders (AD group), a group of n = 38 children with anxiety disorders with depressive comorbidity (AD/DC group), and a comparison group of n = 71 children without psychiatric disorders. Both parents completed the German extended version of the Alabama Parenting Questionnaire. We evaluated maternal depressive symptoms and children's temperament as further correlates. All variables that differed significantly between groups were entered into multinomial logistic regression analyses to test which variables predict group membership. When comparing each of the two anxiety groups with the comparison group we obtained the following results: (1) Inconsistent paternal discipline and maternal depressive symptoms increased and children's positive affectivity decreased the probability of children of being in the AD group rather than in the comparison group. (2) Maternal overinvolvement, maternal depressive symptoms and children's negative affectivity increased and children's positive affectivity decreased the probability of children of belonging to the AD/DC group rather than to the comparison group. When comparing the two anxiety groups with each other, we found that inconsistent paternal discipline increased and children's negative affectivity decreased the probability of children of being in the AD group rather than in the AD/DC group. The results suggest that paternal parenting behaviors show different associations with internalizing disorders at preschool age than maternal parenting behaviors. This underlines the importance of including fathers in the prevention and treatment of internalizing disorders at preschool age. [ABSTRACT FROM AUTHOR]

Physicians frequently represent the first contact person for victims of intimate partner violence (IPV) within the health care system, yet adequate training to comply with these expectations is frequently not incorporated into graduate and post-graduate medical curricula. We developed the first mandatory university-wide training in Germany for the management of IPV victims focusing on communication and legally admissible documentation. Concurrently, we acquired information about previous experiences, attitudes, and barriers for active inquiry about IPV among medical staff. Ninety one percent of the 825 participants completed pre- and post- training surveys and a subgroup participated in a 6-18 month follow-up. Experience, training, and subjective comfort in asking were the most significant predictors of active inquiry in multivariable analyses. Structural limitations, such as time constraints, language barriers, and lack of safe locations represented the primary barriers for active inquiry. [ABSTRACT FROM AUTHOR]

Although there has been an increasing amount of research conducted on test anxiety in adolescence, little is known about the relation of test anxiety and school engagement. The current study addresses this gap by focusing on the potential gender-specific interplay of test anxiety and school engagement among adolescents, testing the role of parental support and parental pressure as mediators in this association. We performed latent multigroup structural equation modeling on a sample of 7th and 8th graders ( N = 1088; M = 13.7 years; SD = .53) in secondary schools in Brandenburg, Germany. The results suggest that there are gender differences in the interplay of test anxiety, perceived socio-academic parental support and pressure, and school engagement. Whereas girls' school engagement is more centered on the mother figure, for boys both parents seem to play an essential role concerning their school engagement as well as test anxiety. [ABSTRACT FROM AUTHOR]

To enhance understanding of impaired socio-emotional development in children of postpartum depressed or anxious mothers, this longitudinal study addressed the question of whether maternal postpartum depression and anxiety disorders result in deficits in children's processing of facial emotional expressions (FEEs) at pre-school age. Thirty-two mothers who had fulfilled Diagnostic and Statistical Manual of Mental Disorders IV (DSM-IV) criteria for postpartum depression and/or anxiety disorder and their pre-school aged children were tested for FEE processing abilities and compared to a healthy control group ( n = 29). Child assessments included separate tasks for emotion recognition and emotion labelling. Mothers completed an emotion recognition test as well as the Structured Clinical Interview for DSM-IV Axis I Disorders I (SCID-I). Children of postpartum depressed and/or anxious mothers performed significantly worse than control children at labelling, but not at recognizing facial expressions of basic emotions. Emotion labelling at pre-school age was predicted by child age and maternal postpartum mental health, but neither current maternal mental health nor current maternal emotion recognition was associated with child FEE processing. Results point to a specific importance of early social experiences for the development of FEE labelling skills. However, further studies involving sensitive measures of emotion recognition are needed to determine if there might also exist subtle effects on FEE recognition. [ABSTRACT FROM AUTHOR]

Purpose: We investigated the prevalence and quality of medication schedules of elderly ambulatory patients and assessed factors associated with the availability of a medication schedule. In particular, we evaluated whether sending out a blank medication schedule template would increase the chances to use such a document. Methods: Data originate from the ESTHER study, a cohort study conducted in Saarland, Germany, in which trained study physicians performed home visits. They scanned all medication schedules, recorded the participants' medication, and performed thorough geriatric assessments. As part of the intervention, a blank medication schedule template along with a brochure was mailed to half of the participants (intervention group) 4 weeks prior to the home visits. Results: In total, 553 of 2470 participants (22.4 %) had a medication schedule. Almost two thirds of the schedules were issued by health care professionals ( n = 353, 63.8 %). These schedules offered a higher quality, although important information such as over-the-counter (OTC) medication was regularly missing. Self-reported adherence was higher in participants who used self-issued medication schedules; however, self-reported medication adherence in patients with any medication schedule was poorer compared to those patients not using a schedule. Factors associated with the availability of a medication schedule were male sex, a higher number of medicines to take, and a more complex drug regimen. The intervention did not increase the number of patients having a medication schedule. Conclusion: Only a minority of elderly ambulatory patients had a medication schedule at home. Sending out a brochure along with a blank medication schedule template did not increase the prevalence of medication schedules. [ABSTRACT FROM AUTHOR]

The high prevalence of mental health problems (MHP) in childhood and adolescence is a global health challenge of the 21st century. Information about age of onset, persistence and development of MHP in young people is necessary to implement effective prevention and intervention strategies. We describe the design and methods of the longitudinal BELLA study, which investigates developmental trajectories of MHP from childhood into adulthood, their determinants, and the utilisation of mental health services. First results on the developmental course of MHP in children and adolescents are reported over a 6-year period. The BELLA study is the mental health module of the German National Health Interview and Examination Survey for children and adolescents (KiGGS). BELLA examines the mental health and well-being of children and adolescents aged 7-17 years (a representative subsample of KiGGS, n = 2,863 at baseline). Standardised screening measures served to identify MHP at baseline and at follow-ups (1, 2, and 6 years later). Among children and adolescents participating at all measurement points ( n = 1,255), 10 % showed clinically significant MHP at baseline ( n = 130). Over the 6-year period, 74.3 % showed no signs of MHP ( n = 933), 15.5 % had remitted ( n = 194), 2.9 % showed persistent ( n = 36) and 7.3 % acute or recurrent MHP ( n = 92). Overall, MHP were more likely to occur between the age of 7 and 12 and after the age of 19 years. Regarding mental health service use, 33 % of the participants with acute or recurrent MHP ( n = 30) and 63.9 % with persistent MHP used mental health services ( n = 23). Mental health problems in children and adolescents have a high risk to persist into adulthood. In children and adolescents a low rate of mental health service use was observed, even among those with mental health problems. [ABSTRACT FROM AUTHOR]

Factors that might account for the probability of children being exposed to secondhand smoke compared to those who are unexposed and characteristics associated with the urinary cotinine level (UCL) of those who are exposed were investigated. All households in a German region with a child aged 3 years or younger (n = 3,570) were invited to participate in a study that tested the efficacy of an intervention for reducing secondhand smoke exposure. In 1,282 households, at least one parent reported daily smoking. Among these, 915 (71.3 %) participated in the study. For data analyses, we used a two-part model. Characteristics of the households associated with SHSE of the youngest child were analyzed, as well as characteristics associated with UCL among those exposed. Exposure to secondhand smoke was defined using a UCL ≥ 10 ng/ml. Secondhand smoke exposure was detected in 57.1 % of the samples. Nursery attendance was associated with secondhand smoke exposure, in addition to the number of smokers living in the household, extent of home smoking ban and parental education. Among children exposed, nursery attendance, season of urine collection and age of the child were associated with UCL. Consideration of seasonal smoking behavior and a child's age at the time of intervention may increase attention to the adverse health effects of secondhand smoke exposure. [ABSTRACT FROM AUTHOR]

Background: Multidimensional tinnitus models describe dysfunctional cognitions as a complicating factor in the process of tinnitus habituation. However, this concept has rarely been investigated in previous research. Purpose: The present study investigated the effects of two cognitive-behavioral treatments on dysfunctional tinnitus-related cognitions in patients with chronic tinnitus. Furthermore, dysfunctional cognitions were examined as possible predictors of the therapeutic effect on tinnitus distress. Method: A total of 128 patients with chronic tinnitus were randomly assigned to either an Internet-delivered guided self-help treatment (Internet-based cognitive-behavioral therapy, ICBT), a conventional face-to-face group therapy (cognitive-behavioral group therapy, GCBT), or an active control group in the form of a web-based discussion forum (DF). To assess tinnitus-related dysfunctional thoughts, the Tinnitus Cognitions Scale (T-Cog) was used at pre- and post-assessment, as well as at the 6- and 12-month follow-up. Results: Multivariate ANOVAs with post hoc tests revealed significant and comparable reductions of dysfunctional tinnitus-related cognitions for both treatments (GCBT and ICBT), which remained stable over a 6- and 12-month period. Negative correlations were found between the catastrophic subscale of the T-Cog and therapy outcome for ICBT, but not for GCBT. This means a higher degree of catastrophic thinking at baseline was associated with lower benefit from ICBT directly after the treatment. Hierarchical regression analysis confirmed catastrophizing as a predictor of poorer therapy outcome regarding emotional tinnitus distress in ICBT. No associations were detected in the follow-up assessments. Conclusion: Both forms of CBT are successful in reducing dysfunctional tinnitus-related cognitions. Catastrophizing significantly predicted a less favorable outcome regarding emotional tinnitus distress in ICBT. Clinical implications of these results are described. Dysfunctional cognitions could be targeted more intensively in therapy and in future research on tinnitus. [ABSTRACT FROM AUTHOR]

Objectives: Administration of oral nutritional supplements (ONS) is an effective strategy to treat and avoid malnutrition, a persisting issue in nursing homes. However, little is known about compliance in the NH population. This study aimed to analyse the effects of compliance of NH residents with a low-volume, nutrientand energy-dense ONS on nutritional status and to identify residents' characteristics associated with compliance. Design & Setting: Randomized, controlled trial in nursing homes. Participants & Intervention: 87 nursing home residents (87±6y, 91% female) with malnutrition or at risk of malnutrition were randomly allocated to an intervention group (IG) receiving 2×125 ml ONS (2.4 kcal/ml)/d for 12 weeks, or the control group (CG) with usual care. Measurements: ONS intake was recorded daily and compliance calculated. Low and high compliance were defined as ≤30% and ≥80% of provided ONS actually consumed, respectively. Body weight (BW), BMI, upper-arm (UAC) and calf-circumference (CC) and MNA-SF were assessed at baseline and after 12 weeks. Associations between compliance and changes of nutritional parameters and residents' characteristics were analysed. Results: Compliance was high in 35.7% and low in 28.6% of the IG (n=42). BW change was significantly higher in subjects with high compliance (median +3.0 (interquartile range +2.1;+3.8) kg, n=15) than in those with low compliance (−0.2 (−2.2;+1.6) kg, n=12) and CG (−0.1 (−1.2; +0.6) kg, n=35; p<0.001), and significantly correlated with compliance in IG (r=0.691; p<0.001). Significant differences and correlations were also identified for BMI, UAC and MNA-SF. High compliance was more often observed in residents with malnutrition (66.7 vs. 27.3%) and chewing difficulties (77.8 vs. 24.2%) than in those without these conditions. Low compliance was more prevalent in residents who were immobile (45.0 vs. 13.6%), depressed (33.3 vs. 6.7%) or had gastrointestinal complaints (50.0 vs. 17.9%) (all p<0.05). Conclusions: A high compliance of nursing home residents with a low volume, nutrient- and energy dense ONS was related to a significantly improved nutritional status in comparison to low compliance and therefore enhanced the effectiveness of ONS. A higher compliance may be achieved by consideration of different residents' characteristics. [ABSTRACT FROM AUTHOR]

Justice sensitivity captures individual differences in the frequency with which injustice is perceived and the intensity of emotional, cognitive, and behavioral reactions to it. Persons with ADHD have been reported to show high justice sensitivity, and a recent study provided evidence for this notion in an adult sample. In 1,235 German 10-to 19-year olds, we measured ADHD symptoms, justice sensitivity from the victim, observer, and perpetrator perspective, the frequency of perceptions of injustice, anxious and angry rejection sensitivity, depressive symptoms, conduct problems, and self-esteem. Participants with ADHD symptoms reported significantly higher victim justice sensitivity, more perceptions of injustice, and higher anxious and angry rejection sensitivity, but significantly lower perpetrator justice sensitivity than controls. In latent path analyses, justice sensitivity as well as rejection sensitivity partially mediated the link between ADHD symptoms and comorbid problems when considered simultaneously. Thus, both justice sensitivity and rejection sensitivity may contribute to explaining the emergence and maintenance of problems typically associated with ADHD symptoms, and should therefore be considered in ADHD therapy. [ABSTRACT FROM AUTHOR]

This study examined the self-assessed religiosity and spirituality (R/S) of a representative sample of German physicians in private practice ( n = 414) and how this related to their addressing R/S issues with patients. The majority of physicians (49.3 %) reported a Protestant denomination, with the remainder indicating mainly either Catholic (12.5 %) or none (31.9 %). A significant proportion perceived themselves as either religious (42.8 %) or spiritual (29.0 %). Women were more likely to rate themselves R/S than did men. Women (compared to men) were also somewhat more likely to attend religious services (7.4 vs. 2.1 % at least once a week) and participate in private religious activities (14.9 vs. 13.7 % at least daily), although these differences were not statistically significant. The majority of physicians (67.2 %) never/seldom addressed R/S issues with a typical patient. Physicians with higher self-perceived R/S and more frequent public and private religious activity were much more likely to address R/S issues with patients. Implications for patient care and future research are discussed. [ABSTRACT FROM AUTHOR]

The study aims to evaluate the prevalence of depression and the severity of depressive symptoms among primary care patients, who are high utilizers (HU) of health care resources. A cross-sectional, two-stage design was applied to screen for depression using the Brief Psychiatric Health Questionnaire and the Diagnostic Expert System for Psychiatric Disorders. A total of 38 primary care physicians accredited to practice in Berlin and Potsdam in Germany participated in the study. A total of 1,775 patients participated, 507 were identified as HU, 182 (36 %) of these were depressed compared to 81 (11 %) of the typical utilizers ( p < 0.001). The depression score was higher and acute suicidality was more prevalent in HU than in typical utilizers ( p < 0.001). Our results suggest that HU represent a population with a high prevalence of depression in primary care and should be considered for routine depression screening. [ABSTRACT FROM AUTHOR]

Aim: Personal responsibility for one's health is frequently discussed when deciding on health-care allocation and corresponding costs. We address two questions: (1) Which health-related behavior qualifies for private contributions to treatment costs in the view of the German public? (2) Do acceptance rates for copayments depend on specific characteristics of the citizens? Subjects and methods: The findings are part of a larger representative survey from Germany. In a face-to-face interview (CAPI), participants stated their attitudes towards copayments for patients with risky health behaviors. Nonparametric statistics and regression models were applied to analyze the data. Results: The majority of respondents agreed to copayments for smokers, drug users, and patients who took part in extreme sports, consumed higher quantities of alcohol, sunbathed frequently or used a solarium. Copayments for an unhealthy diet or lack of physical exercise were rejected. Older participants, men, and people from East Germany agreed to additional contributions more often. For some health behaviors, attitudes seem to be driven by self-interest. Interestingly, however, smokers and heavy drinkers did not show this behavior. Furthermore, we observed both solidarity and competition between those groups of respondents who would be negatively affected by copayments for different potentially unhealthy lifestyles proposed in the questionnaire. Conclusion: Health policy makers may notice that several but not all unhealthy behaviors described in the survey are criteria that are accepted for the introduction of copayments. Furthermore, some groups of society may be more strongly opposed to respective policy measures than others. [ABSTRACT FROM AUTHOR]

The aim of this study was to describe the association of current smoking and nicotine dependence with psychological distress in socially disadvantaged urban areas of Germany and Kazakhstan. Random samples of people living in disadvantaged areas of Berlin, Germany, and Almaty, Kazakhstan, were assessed using the General Health Questionnaire with 28 items and the Fagerström Test for Nicotine Dependence. The association of both current smoking and nicotine dependence with psychological distress was assessed for each sample using linear regression analyses and compared between the two samples calculating t-values for the comparison of B-coefficients. Current smoking was equally associated with psychological distress in both countries, whereas the association of nicotine dependence and psychological distress was only seen for the Kazakh sample and significantly stronger than for the German sample. The results could not be explained by social characteristics. Possibly due to the lack of outpatient community mental health services for the treatment of common mental disorders, nicotine dependence was associated with psychological distress in the disadvantaged area of Kazakhstan. [ABSTRACT FROM AUTHOR]

Objectives: We compared the nutritional status of elderly people living in two different settings (shared-housing arrangements and home-living arrangements). Design: For this secondary analysis, a cross-sectional study was performed. Setting: For the home-living setting, home-dwelling elderly people from Hamburg, Germany who were participants in a prior study were included. For the shared-housing arrangements (SHA) setting, we used baseline data from the WGQual Study. Participants: The sample from the home-living setting comprised patients who were discharged from a geriatric rehabilitation clinic within the six months prior to data collection. The sample from the shared-housing arrangements comprised all residents that lived in SHAs. Measurements: Nutritional status was examined by administering the Mini Nutritional Assessment (MNA). Cognitive status was measured by the Mini Mental State Examination (MMSE). Results: Overall, 142 individuals participated in this study. Statistical analysis showed differences in both overall MNA scores and MNA assessment scores. Significantly more participants from the SHA setting were at risk of malnutrition compared to the home-living setting. Conclusion: Screening and assessment of nutritional status and prevention interventions should be considered in SHA settings. [ABSTRACT FROM AUTHOR]