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Purpose: The purpose of this paper is to conceptualise a research study to examine leadership as a relational concept between leaders and followers. The context is within surgical practice examining how motivated consultant surgeons are to lead junior doctors and which type of leadership style they use. From a follower perspective, the motivation of junior doctors will be explored, and their leadership preferences will be correlated with those of the actual style of consultant surgeons. Design/methodology/approach: In this paper, the authors provide a detailed description of the methods for an international quantitative research study, exploring sequentially how motivated consultant surgeons are to lead and how leadership styles impact on the motivation of junior doctors. The objectives, method and data collection of this study are explained, and the justification for each method is described. Findings: The findings for this outline study illustrate how critical it is to redefine leadership as a relational concept of leader and follower to ensure adequate support is provided to the next generation of consultant surgeons. Without consideration of the relational model of leadership, attrition will continue to be a critical issue in the medical workforce. Research limitations/implications: The research limitations are that this is a proposed quantitative study due to the need to collect a large sample of data from surgeons across the UK, Egypt and Germany. This research will have immense implications in developing new knowledge of leadership as a relational concept in medicine and healthcare. This study additionally will impact on how leadership is conceptualised in the curriculum for specialist surgical practice. Practical implications: The practical implications are that relational leadership is supportive of generating a supportive leadership culture in the workplace and generating more effective teamwork. Originality/value: To the best of the authors' knowledge, this is the first study of its kind to look at a relational model of leadership in surgical practice between consultant surgeons and surgical trainees. This study will also identify any specific country differences between the UK, Germany and Egypt. [ABSTRACT FROM AUTHOR]

Introduction: Digitalization in medicine is steadily increasing. Complex treatments, scarce personnel resources and a high level of documentation are a constant burden on healthcare systems. The balancing between correct manual documentation in the digital records and limited staff resources is rarely successful. The aim of this study is to evaluate the adherence between documentation and lack of documentation in the treatment of critical care patients. Material and Methods: For the evaluation, data from the hospital information system (HIS) of several intensive care units (ICU) were examined in conjunction with data collected from a checklist. All boluses of sedatives, analgesics and catecholamines were documented paper based across all shifts and all weekdays and compared with corresponding digital data from the HIS (2019–2022) of previous years. Results: 939 complete digital patient records revealed a massive under-documentation of the medication administration compared to that applied according to the checklist. Only 12% of all administered catecholamines, 11% of α2-agonists, 33% of propofol, 92% of midazolam and 46% of opioids were found in the digital recordings. In comparison, the effect was more pronounced on weekdays compared to weekends. In addition, the highest documentation gap was found in the comparison of early shifts. Comparing neurosurgical vs. internal vs. anesthesiologic ICUs there was a highly significant difference between anesthesiologic ICUs compared with other disciplines (p < 0.0001). Discussion: Our data shows that there is a remarkable documentation gap and incongruence in the area of applied boli. Automated documentation by connecting syringe pumps that enter data directly into the HIS can not only reduce the workload, but also lead to comprehensive and legally required documentation of all administered medication. [ABSTRACT FROM AUTHOR]

Purpose: This paper aims to empirically identify foodie features and examine their relevance in segmenting German consumers. Furthermore, this study explored potential differences between foodie segments in terms of food involvement and food knowledge. Design/methodology/approach: Data were collected from 500 German respondents in October 2015 by means of two online surveys using a newly developed version of the foodie instrument based on existing literature. Confirmatory factor analysis, cluster analysis, analysis of variance and post hoc tests were applied to analyse the data. Findings: Six distinct consumer segments were identified: passionate foodies (12.0%), interested foodies (21.5%); moderate foodies (21.7%), traditional foodies (17.1%), light foodies (18.2%) and non-foodies (9.5%). The nutritional knowledge questionnaire suggests that passionate foodies have only an average level of food literacy compared to other segments. Research limitations/implications: Behavioural traits and socio-demographic characteristics of foodies and other culinary consumer segments could be time-sensitive, thus future research should take a longitudinal approach so that subsequent decision-making is appropriately dynamic. Originality/value: To the best of the authors' knowledge, this paper is a first step towards the development of a new foodie lifestyle scale which will be useful to identify, characterise and develop effective marketing strategies for targeting highly involved food consumers. [ABSTRACT FROM AUTHOR]

Theoretical background: Participatory budgets (PBs) have become a widely known innovation used to engage citizens in policymaking. Since 2011, citizens in Polish municipalities can decide on how a portion of local budget can be spent. In Germany, PBs originally served the purpose of getting feedback from citizens in the context of fiscal strains. However, since about 2015, German PBs are increasingly taking after the model established in Poland, establishing fixed pools of funds. Does it present a case of between-country convergence in the functionalities of PBs and their quality? So far, such comparative questions remained mostly unanswered in the field of PB-related studies. Purpose of the article: The aim of the paper was to investigate this possibility of convergence in PB-quality by comparing the state of and changes in the quality of PBs with fixed funds between Poland and Germany. To evaluate the quality and scope of functionality of PBs, the amount of planned PB-funds per capita and participation rates (voter turnout levels) were inspected. Two research hypotheses were formulated. The first one stipulates a higher performance level of Polish PBs by the two criteria, across a variety of municipality types. The second hypothesis posits that the differences in the quality of PBs tend to diminish over time, as the latest to innovate launch their first experiments. Research methods: Works on the diffusion of PBs in both countries were reviewed to provide background for the study. Two datasets were constructed containing data on the two measures of PB-quality, the population size, and the status of innovator. The data were first compared graphically. In a later step, statistical methods were applied, including variance analysis for the two dependent variables related to PB-quality at once (MANOVA) and for each of them separately (ANOVA). Results of the study were presented and discussed in the context of interactions between innovators and potential adopters in social networks, as well as political agendas in the two countries of interest. Main findings: Research findings allowed to confirm the research hypotheses. PBs in both countries have been mostly simple innovations of limited quality, but those in Poland tended to perform better, judged by the two chosen criteria. The gap, especially for PB-funds, is closing, but that does not mean that in the course of innovators’ and regulators’ actions a unified innovation model has emerged. PBs in both countries utilize their functionalities in diverse ways, based on specific experiences and traditions in policymaking. Thus, PBs in Poland and Germany have different trajectories of development with fixed pools of funds as the simplistic innovation core that makes them highly adaptable in different policy contexts. [ABSTRACT FROM AUTHOR]

To investigate effects of diaper-free times, elimination communication (EC) and early toilet training, a web-based survey was conducted for caregivers. The more diaper-free times an infant experienced during day, the earlier it was toilet trained (P <.001), which was enhanced by the usage of cloth diapers. The amount of diaper-free times significantly reduced the caregiver's continuous sleep, the occurrence of rashes and balm usage (P <.001) and lead to a more regular defecation frequency. Cloth diaper usage had no effect on rashes or balm usage, but on diaper change rate (P <.001). We could show that, although not as effective as full-time EC, part-time EC is more effective if cloth diapers are used, provided they are changed frequently. Furthermore, EC causes a more regular defecation in infants between 1 and 2 years. [ABSTRACT FROM AUTHOR]

Background: Effects of the aging process on the flexural strength of Y-TZP and different Y-PSZ ceramics of different thicknesses were investigated. Methods: 300 disc-shaped samples (12 mm diameter, 0.8 and 1.5 mm thicknesses) were made from 5 different zirconia materials 3Y-TZP LA, 4Y-PSZ, 5Y-PSZ, 3 + 5Y-PSZ and 4 + 5Y-PSZ. Experimental groups were artificially aged in an autoclave at 134 °C, 2 bar pressure for 1 and 5 h; control groups were not subjected to any treatment. Microstructural analysis was conducted using Scanning Electron Microscopy, and X-Ray Diffraction analysis determined the crystalline phase content. The impact of aging on flexural strength was investigated with the use of the biaxial flexural strength test. Data were analyzed using three-way ANOVA tests with a significance level of p < 0.05, applying Bonferroni correction for multiple comparisons. Results: Statistically significant differences in flexural strength were observed among the materials and the material thicknesses (p < 0.05), while there were no significant differences among the aging times (p > 0.05). The highest mean flexural strength values were recorded in the case of the 3 Y-TZP-1.5 mm–5 h group (744.1 ± 61.2 MPa), which was attributed to phase-transformation toughening. The lowest values were observed in the case of the 5 Y-PSZ-1.5 mm–5 h (338.3 ± 34.8 MPa) group. Conclusions: Both material type and thickness significantly affect the flexural strength of zirconia ceramics, whereas aging time does not; thus, material selection and thickness are crucial considerations for clinicians. [ABSTRACT FROM AUTHOR]

Purpose: Poor mental health in men and women is attributable to disparities in physical traits, social roles, power and health-seeking behaviours. This study aims to examine the gender differences in mental health among Pakistan and German university students and focuses on their right to seek mental health care. Design/methodology/approach: Data on depression, anxiety and stress symptoms, as well as positive mental health (PMH), resilience, social support and life satisfaction, were gathered from Pakistani and German students. Findings: In contrast to the Pakistani group, where no such gender differences were seen, women in Germany reported higher degrees of stress, anxiety and depression, as well as a lower level of overall good mental health. In comparison to German men and women, Pakistani women scored equally high on resilience. While gender had no bearing on life happiness in either Pakistan or Germany, women in both countries perceived more social support than men did. Research limitations/implications: The study's strengths include its large sample size and battery of mental health measures. The results of partial weak measurement Invariance (MI) on the stress subscale underlined the importance of using MI in cross-cultural studies. The validity of a direct comparisons on sum score between different language versions or country samples shall be cautious. Still, there are limitations. Firstly, the authors did not differentiate gender and biological sex, and there was no group of non-binary gender. Pakistani (N = 1,840) and German (N = 7,890) students were in unequal numbers. Again, only university students were sampled, so the results cannot be generalised to older (probably less educated) populations. Self-reported data that mainly obtained via online survey were the third limitation. This design is cost-effective and easy to administer for cross-cultural survey research. However, social desirability and memory bias are common in self-report inventories. Fourthly, although English is an official language in Pakistan and the medium of instruction in education, the authors recommend future study to use questionnaires that have been translated and validated into Urdu (Pakistan's national language) and investigate gender differences in a general population. Fifthly, this is a cross-sectional survey; the authors were not able to explore the causality or risk factors that contribute to the poor mental well-being in Pakistan students in general or the relatively worse mental health in German women. Future studies may investigate the mechanism behind the phenomena observed in this study with longitudinal or experimental design. Last but not least, Germany and Pakistan differ in so many different aspects from culture, religions and history to social structure and economic status, which make it hard to claim whether the observed differences were due to national differences, cultural differences, economic differences, gender inequality differences or other effects. It would be helpful for future studies to include more country samples with clear definitions of different "culture" aspects for a better understanding of gender differences in other countries and in different mental well-being constructs. Practical implications: The current study is the first attempt to compare the gender difference patterns in positive and negative mental health between European and South Asian counties and focuses on gender-specific approaches. Although Pakistani university students reported in general worse mental well-being, the differences between the two genders in mental health (e.g. depression, anxiety, general PMH) were not as pronounced as in the German student sample. Gender comparisons in these mental health constructs would help to improve protective factors against mental illness and to develop appropriate management programmes based on cultural differences. The results suggest that the gender differences found in western countries cannot always be directly translated into the South Asian cultural framework. Our results also highlight the importance of improving the general situation of Pakistan (students) instead of focusing on one gender. At the same time, in Germany, prevention and intervention plans are more warranted for women. It could be that once the general situation in Pakistan is improved, the gender-related differences in mental health will be clearly observed. Originality/value: These findings imply the significance of cultural context when inferring gender variations in mental health. Moreover, it supports the advancement of comprehensive policies to reduce gender-related mental health inequalities and focuses on the equal rights of men and women to get mental health care. [ABSTRACT FROM AUTHOR]

Reflecting team is a structured and guided method for peer collaborative reflection on critical incidents in teaching. The present evaluation study combining quantitative and qualitative data investigates the perceived usefulness and central insights associated with the participation in a reflecting team session. This method was implemented among three groups of teachers in Germany: student teachers, school teachers, and higher education teachers. All three groups reported high levels of perceived usefulness of the method and provided insights into their central experiences in connection with the reflecting team. Differences between the three groups in terms of perceived usefulness and central insights of peer reflection stem from participants' distinct organizational and educational contexts and show various ways of how teachers can derive benefits from the reflecting team method. [ABSTRACT FROM AUTHOR]

Introduction: To date, there has been little research on the general health literacy of trans and gender diverse individuals, even though previous research undermines the importance of good health literacy in this sample. The aim of the article is therefore to describe the general health literacy of trans and gender diverse individuals based on a German survey. Methods: In September 2022, a survey study was conducted in which health literacy was recorded using HLS-EU-16. Data will be presented descriptively; gender differences will be explored using a Χ2- test and a univariate analysis of variance (ANOVA). Results: Out of N = 223 participants, n = 129 individuals (57.8%) identified as non-binary; n = 49 (22.0%) identified themselves as male, while n = 45 (20.2%) identified as female. Mean age was 28.03 years. Overall, 26.4% of all the participants showed an inadequate health literacy, as proposed by the HLS-EU-16. In trend, health-related task related to media use were more often perceived as easy compared to the German general population. Conclusion: Individuals, who identify as trans and gender diverse may have a general health literacy below average compared to the German general population. However, tasks related to media use were perceived as easy, which might be a good starting point for health literacy related interventions. Trial registration: DRKS00026249, Date of registration: 15/03/2022. [ABSTRACT FROM AUTHOR]

Background: After Russian invasion many Ukrainians fled to European countries including Germany. In this context, the German health care system faced challenges delivering dental care to a displaced population. Recently surfaced obstacles as well as different cultural and medical traits need to be considered in order to deliver appropriate medical care. The aim of this study was to evaluate oral health and hygiene of Ukrainian refugees, identify barriers accessing dental health care and explore the relation to their mental health state. Methods: This cross-sectional study was conducted using a self-assessment questionnaire, distributed via non-probability snowball sampling method among war-affected Ukrainians, who fled to Germany. The online form was distributed via web-based platforms, the printed version was hand-delivered across diverse local venues. Chi-Square Tests, T-Tests and Mann-Whitney-U Tests were performed. Analysis of variance and Spearman correlation coefficient analysis were also conducted. Results: From 819 completed questionnaires, 724 questionnaires were included in the analysis with 78 males (10.8%) and 640 females (88.6%) and a mean age of 37.5 years (SD = 10.5). The majority of participants rated their state of teeth (77%) and gums (81%) as average or better. The main problems, caused by state of their teeth, were: "Have avoided smiling because of teeth" (23.6%) or "Felt embarrassed due to appearance of teeth" (22.2%). The most frequent limiting factors to access dental care were finances (82.6%), language (82.2%) and complicated health care system (74.1%). 45.8% of the participants scored 10 or more in the Patient Health Questionnaire and 37.4% in the Generalized Anxiety Disorder 7-item scale, respectively. These participants were more likely to report pain, poor state of teeth and gums and to fail a dental consultation. Overall, 59.6% participants reported not consulting a dentist, when needed. Failed consultations were associated with a poorer reported state of teeth and gums. Conclusions: Ukrainian refugees reported barriers accessing dental health care in Germany. It is important to improve oral health literacy and dental services for displaced people and provide help and guidance in seeking dental care. [ABSTRACT FROM AUTHOR]

SARS-CoV-2 infection causes transient cardiorespiratory and neurological disorders, and severe acute illness is rare among children. Post COVID-19 condition (PCC) may cause profound, persistent phenotypes with increasing prevalence. Its manifestation and risk factors remain elusive. In this monocentric study, we hypothesized that atopy, the tendency to produce an exaggerated immunoglobulin E (IgE) immune response, is a risk factor for the manifestation of pediatric PCC. We present a patient cohort (n = 28) from an early pandemic period (2021–2022) with comprehensive evaluations of phenotypes, pulmonary function, and molecular investigations. PCC predominantly affected adolescents and presented with fatigue, dyspnea, and post-exertional malaise. Sensitizations to aeroallergens were found in 93% of cases. We observed elevated IgE levels (mean 174.2 kU/L, reference < 100 kU/L) regardless of disease severity. Concurrent Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) was found in 29% of patients that also faced challenges in school attendance. ME/CFS manifestation was significantly associated with elevated immunoglobulin G subclasses IgG3 (p < 0.05) and IgG4 (p < 0.05). A total of 57% of patients showed self-limiting disease courses with mean recovery at 12.7 months (range 5–25 months), 29% at 19.2 months (range 12–30 months), and the rest demonstrated overall improvement. These findings offer additional insights into immune dysregulation as a risk factor for pediatric PCC. [ABSTRACT FROM AUTHOR]

The COVID-19 has had an impact on almost every aspect of life throughout the world. The quarantine, limited social life, and fear of contamination have triggered psychological symptoms in societies. The need for mental health services has increased, and online psychological counselling, which provides psychological help with no risk of infection, has become more popular. The purpose of this study was to examine the impact of the COVID-19 on psychological counselling services and compare the general situation of publications on online psychological counselling before and during the pandemic. For this purpose, 463 publications related to online psychological counselling in the Web of Science (WoS) database were examined. The results were discussed in the context of trends and differences before and during COVID-19. [ABSTRACT FROM AUTHOR]

The aim of this study was to analyze the relationship between quality of life (QoL) and supportive care needs (SCNs) in cancer patients. It is difficult to relate SCNs to detriments in QoL since SCNs and QoL assessment tools generally comprise different dimensions that cannot be directly related to each other. Therefore, we developed a short questionnaire with eight dimensions for uniformly measuring SCNs, QoL, and the subjective importance of these dimensions. A total of 1108 cancer patients with mixed diagnoses assessed eight dimensions of health-related QoL concerning SCNs, satisfaction, and importance. Among the eight dimensions of QoL, physical functioning received the highest SCN assessments (M = 3.4), while autonomy (M = 20.7) and social relationships (M = 1.88) were the dimensions with the lowest SCN mean scores on the 1–5 scale. For each of the eight dimensions, high levels of SCNs were reported by those patients who had low levels of satisfaction with that dimension (r between −0.32 and −0.66). The subjective importance of the dimensions was not consistently correlated with SCNs (r between −0.19 and 0.20). Females reported higher SCNs than males in six of the eight specific dimensions. Patients with prostate and male genital cancers reported the lowest SCNs. These results suggest gender-specific SCN patterns that warrant further exploration. This study highlights the value of a unified assessment instrument for SCNs and QoL, providing a robust basis for future cancer care strategies. [ABSTRACT FROM AUTHOR]

The goal of this study was to examine how regular physical activity before and during pregnancy affected life quality throughout pregnancy. Between July 2020 and May 2021, 218 pregnant women were recruited from 11 outpatient clinics for this survey. Data were collected prospectively in a panel format beginning with the 10th gestational week over a 20-week period. Prior to pregnancy, a previous time point was also defined. The International Physical Activity Questionnaire, the EQ-5D-3L questionnaire, and the EQ-VAS questionnaire were used to collect data on the duration and intensity of daily physical exercises, as well as to assess health-related quality of life and self-estimated health status. The final survey included data from 113 women. During pregnancy, physical activity decreased dramatically. The duration of strenuous activities, but not moderate activities, was significantly reduced. Continuous physical activity independently predicted higher life quality scores at all points of assessment. Cases who participated in moderate and strenuous activities on a regular basis had higher self-estimated health status scores than cases who only participated in moderate activity. Instead of focusing solely on specific types of physical activity, we believe that strategies for motivating all pregnant women to be constantly active should be developed. [ABSTRACT FROM AUTHOR]

In light of a large proportion of older workers leaving the German labour market in the near future, policy makers aim to extend working lives to ensure sustainability of the social security system. In this context, safe and healthy working conditions are considered a precondition for encouraging employment participation. To understand better the role of the work environment in pre-retirement years, we draw upon an established model of five job quality profiles for the German ageing workforce. We explored seven-year profile development and linked selected manual and non-manual job quality trajectories to the motivation to work (MTW) using data from the 2011, 2014 and 2018 assessments of the lidA cohort study (valid N = 2,863). We found that older workers shifted to physically less-demanding profiles. Individual profile stability was prevalent among one-third of the workers. In 2018, there was a higher MTW when job quality remained favourable or improved early, while later improvements were associated with lower MTW. Early deterioration of job quality was associated with lower MTW levels among workers with non-manual trajectories only. The results highlight the dynamic job quality situation of the older German workforce and the importance of adopting a person-centred perspective when investigating working conditions and its effects. They further underline the need to consider quality of work when designing and implementing strategies to extend working lives. [ABSTRACT FROM AUTHOR]

Automated vehicles (AVs) enable driver-passengers to perform non-driving related tasks (NDRTs). However, it remains unclear if and how they would engage with NDRTs. Therefore, we developed a questionnaire on NDRTs, the QNDRT, for SAE Level 3 (L3) and 5 (L5) driving automation. It comprises 24 items with a general NDRT Work subscale querying general aspects of working while driving in an AV (8 items; L3: 4 items, L5: 4) and a specific NDRT Communication subscale assessing different communication modalities (16 items; L3: 8, L5: 8). Hence, we carried out a cross-sectional questionnaire study and queried 725 participants (351 female, 374 male) from 18 to 96 years. We applied factor analyses and extracted a stable unidimensional factor structure for both NDRT subscales with good psychometric properties (e.g. high and clear factor loadings; satisfactory communalities, item discrimination, and internal consistency). The initial findings revealed that significantly smaller values were assigned to both subscale factors by participants older than 55 years in contrast to younger ones and by women when compared to men. The QNDRT can be used in future (quasi-)experimental L3 and L5 studies and in population surveys to obtain more insight into working and communicating while driving in an AV. [ABSTRACT FROM AUTHOR]

Numerous research results have already pointed towards the negative influence of increased mental stress on educational processes and motivational criteria. It has also been shown that the global public health crisis induced by COVID-19 was related to anxiety symptoms and elevated levels of distress. To holistically elucidate the dynamics of the pandemic-related mental stress of first-year medical students, the associated parameters of three different cohorts were measured at the beginning of the pandemic-related restrictions on university life in Germany (20/21), at the peak of the COVID-19-related restrictions (21/22) and during the easing of the restrictions in the winter term 22/23. In a repeated cross-sectional study design, the constructs of worries, tension, demands and joy were collected from first-year medical students (n = 578) using the Perceived Stress Questionnaire. The results demonstrate significantly increased values of the constructs worries (p < 0.001), tension (p < 0.001) and demands (p < 0.001) at the peak of the pandemic related restrictions compared to the previous and following year as well as significantly decreasing values of general joy of life during the observed period of 3 years (all p-values < 0.001). A confirmatory factor analysis was performed to verify the questionnaire's factor structure regarding the addressed target group during the pandemic (CFI: 0.908, RMSEA: 0.071, SRMR: 0.052). These data, collected over a period of three years, provide information regarding dynamically manifesting mental stress during the COVID-19 pandemic, and refer to new areas of responsibility for the faculties to adequately counteract future crisis situations. [ABSTRACT FROM AUTHOR]

Background: The huge increase of refugees to Germany caused a great challenge to the health system. We aimed to examine the level of patient-centredness in medical consultations with refugee patients, aided by video interpreters in primary care walk-in clinics (PCWC) in Hamburg. Methods: Videotaped consultations (N = 92) of 83 patients from 2017 to 2018 were analysed. Two raters used the Measure of Patient-Centered Communication (MPCC) and the International Classification of primary care (ICPC-2). MPCC scores with regard to patients' reason for seeking medical care and the procedures taken were explored using variance analyses adjusted for age, gender, and the duration of the consultation. The duration was further explored by Pearson correlations. Results: Patient-centredness of all consultations on average was 64% (95% CI 60–67) according to MPCC, with health-related issues affecting the results. The highest level of patient-centredness was achieved in psychological health issues with 79% (65–94), the lowest in respiratory ones with 55% (49–61). Longer consultations resulted in higher MPCC scores. Conclusions: The level of patient-centredness varied in the addressed health issues as well as in the duration of the consultation. Despite the variation, video interpreting in consultations supports a solid patient-centredness. Practice implications: We recommend the use of remote video interpreting services for outpatient healthcare to support patient-centred communication and to fill the gap of underrepresentation of qualified interpreters on site, regarding a high diversity of spoken languages. [ABSTRACT FROM AUTHOR]

If children in child protection cannot be cared for by their natural parents, should they be adopted or live in foster home? Results from a study of representative samples of populations (n = 12 330), in eight European countries—Austria, England, Estonia, Finland, Germany, Ireland, Norway and Spain—and California, USA, reveal that people would recommend adoption over foster care, if a child in public care cannot grow up with their natural parent(s). There are cross‐country differences between populations, and examining if institutional context such as type of child protection system explains differences, we find that child maltreatment‐oriented systems are more supportive of adoption than other types of systems. Citizens having little confidence in the child protection system were only weakly correlated with preference for adoption. In conclusion, people prefer adoption as placement options for children in care are more than foster homes, and possible this finding reflects a sort of refamalialization of children into the private sphere. [ABSTRACT FROM AUTHOR]

This study investigates assistant nurses' views on and needs for orientation to care robot use in three European countries. The use of care robots is gradually being incorporated into welfare services. Orientation to care robot use (in short, introduction to the use of the care robot technology) has thus become a key issue for care services. A survey was sent to assistant nurses in Finland, Germany, and Sweden, to which 302 participants responded (Finland n = 117; Germany n = 73; Sweden n = 112). Only 11.3% of assistant nurses had experience of giving orientation to care robot use to older adults or colleagues, but over 50% were willing to do so. Those with experience of using care robots should take part in orientation. Orientation to care robot use should be seen as part of care management and an issue that may affect the whole organisation. Management should, firstly, allow assistant nurses to get to know care robots by offering information, and secondly, consider with the assistant nurses the ways care robots can change their work and the implications of this change. Emphasising the social factors and practical orientation to care robot use extends the previous theories and perspectives of technology acceptance, adoption and diffusion. [ABSTRACT FROM AUTHOR]

BACKGROUND: The findings of the effectiveness of physical activity on adults' cognitive abilities have not yet been transferred into corresponding fields of application. OBJECTIVE: The present study evaluates a motor-cognitive coordination programme in a company to improve employees' cognitive performance in the short and medium term. METHODS: A total of 67 employees — 32 men and 35 women aged between 19 and 61 years — participated in this study, and 55 completed the study. The sample was randomly divided into an experimental group, which received a motor-cognitive coordination training, and a control group, which received a relaxation and mobility training. Both groups met for 15-minute sessions three times a week for eight weeks. Before and after the intervention, working memory, attention, information-processing capacity, divergent thinking, and mood were measured. In addition, acute effects regarding attention and mood were tested. RESULTS: The results showed that the motor-cognitive coordination break improves working memory and divergent thinking after eight weeks of intervention, whereas neither the mood nor the information processing speed improved more for the experimental group compared to the control group. The results on the acute increase in attention performance failed to reach significance. CONCLUSION: The new approach of this study was not only the derivation and development of targeted exercises, but also their testing and evaluation in the field of application. Motor-cognitive coordination exercise in the workplace might play an important role in both occupational health management and personnel development, especially for companies that are under highly competitive and innovative pressure. [ABSTRACT FROM AUTHOR]

Aims Remote patient management (RPM) enables early detection and prevention of deterioration in heart failure (HF) patients by measuring vital parameters. The analysis objective is to assess patient reported experience with RPM, adherence to daily measurements, and outline affecting factors both. Methods and results Telemedical interventional management in-HF2 was conducted in 2013–18 with 1 538 HF patients with a 12-month follow-up. Under guidance of HF nurses, patients had to measure daily weight, blood pressure, electrocardiogram, and self-rated health status. At the end of the study, patients received a programme survey to analyse patient perceptions and satisfaction with telemedicine care and study organization. Adherence was distinguished between measurement of at least one [incomplete adherence (IA)] and all vital parameters [complete adherence (CA)] and defined as ratio of the number of days of measurements taken divided by the number of days of possible measurements. All data and group differences were analysed descriptively (mean ± SD) and by analysis of variance and t-t est. Survey response rate was 79.7%. Patients were satisfied with the programme and device usability. CA was 89.1 ± 14.1%, consistently high over the study course and independent of severity of disease (left ventricular ejection fraction, N terminals pro brain natriuretic peptide, New York Heart Association). Lower IA was found with patients <70 years and prior to unplanned cardiovascular (CV) hospitalizations (difference by −5.2 ± 20.5%) and after unplanned CV hospitalizations compared with the entire study period (lower by −12.8 ± 24.7%). Patients from rural areas were found to have higher CA than patients from urban regions. Conclusions With user-friendly devices, pre-interventional patient training, regular patient contact and close cooperation between primary physicians and telemedical centre, a long-lasting high adherence and satisfaction could be achieved. A change in adherence might detect health deterioration and indicate the need to intensify RPM. Registration ClinicalTrials.gov (NCT01878630) and Deutsches Register Klinischer Studien (DRKS00010239). [ABSTRACT FROM AUTHOR]

Background: Research has highlighted that personal characteristics such as teachers' attitudes play an important role in the implementation of inclusive education. However, there are only a few studies that have shed empirical evidence on the relationship of attitudes and inclusive teaching approaches, such as differentiated instruction. In this vein, the present study tackles this research gap and aims to explore teachers' attitudes specifically towards the inclusive practice of DI in Germany. Aims: The present study aimed to investigate teacher profiles based on their attitudes towards differentiated instruction, as well as further to explore whether teachers differentiated instructional implementation varies between the teacher profiles. Sample: The sample consists of 450 teachers (Mage = 42.89, SD = 10.48, 65% female), from different school tracks in Germany. Methods: A two‐step cluster analysis was performed in order to identify teacher attitude profiles concerning their implementation of differentiated instruction. Moreover, an analysis of variance was conducted in order to identify variations in terms of the implementation of differentiated instruction across the three clusters. Results: Results from the cluster analyses indicate three distinct teacher attitude profiles: Cluster 1 'The valuing‐teacher', Cluster 2 'The non‐valuing‐teacher' and Cluster 3 'The challenged‐but‐valuing‐teacher'. Moreover, the findings reveal gender and school track differences between the three teacher attitude profiles. Lastly, an analysis of variance indicated that teachers' differentiated instruction practice varied significantly across the clusters. Conclusions: The findings from the present study indicate that teachers not only perceive the value of DI but also the insufficient resources. Thus, it can be assumed that teachers identify both the 'positive' and the 'negative' aspect of DI, and more importantly, they can recognize both attitude domains towards DI in a similar or different level. Consequently, the results show that attitudes in the context of inclusion cannot be characterised as continuum with two distinct poles. [ABSTRACT FROM AUTHOR]

Localisation of low- and high-frequency sounds in single-sided deaf cochlear implant users was investigated using noise stimuli designed to mitigate monaural localisation cues. Within subject design. Sound source localisation was tested in the horizontal plane using an array of seven loudspeakers along the azimuthal angle span from −90° to +90°. Stimuli were broadband noise and high- and low-frequency noise. Twelve adult subjects with single-sided deafness participated in the study. All had normal hearing in the healthy ear and were supplied with a cochlear implant (CI) in their deaf ear. With broadband noise, the mean angular localisation error was 39° in aided condition as compared to a median angular error of 83.6° when the speech processor was not worn. For high-frequency noise, the median angular error was 30° and for low-frequency noise, it was 46° in the CI-aided condition. Single-sided deaf CI users show the best sound localisation for high-frequency sounds. This supports the view that interaural level differences are dominant for sound localisation in these listeners. Nonetheless, a limited ability to localise low-frequency sounds was observed, which may be based on the supportive perception of interaural time differences. [ABSTRACT FROM AUTHOR]

The study aims to (1) investigate current levels of patient acceptance of mHealth in Germany; (2) determine the influencing factors of patients' intention to use, and (3) test the influence of prescription and reimbursement status on patient acceptance. Online survey with 1349 participants, of which 1051 were complete and included for statistical analysis, from a broad cross-section of the German population, addressing both users of mobile health (mHealth) applications and people without prior experience. SEM modeling based on a combination of two theoretical frameworks: the extended Unified Theory of Acceptance and Use of Technology and Health Protective Behavior Theories were used to assess acceptance. Users of mHealth in Germany are mostly patients between the ages of 30 – 50 with mental health or endocrine conditions. General willingness to use mHealth apps / DiGAs (mHealth apps fully reimbursed by social health insurance) is high at 76%, especially if they are governmentally certified, however only 27% of respondents were willing to pay out of pocket. With the exception of a spike in performance expectancy and data security, DiGAs lack a clear differentiation from mHealth apps. Perceived self-efficacy and performance expectancy are significant predictors of willingness to use digital health interventions; with age, attitude, and e-literacy being key demographic predictors. A key takeaway for regulators, providers of mHealth apps/ DiGAs, and other stakeholders involved in mHealth adoption is the importance of addressing negative beliefs early on, targeted communication around effortless usage of mHealth services across age groups and demographics, and focus on highlighting expected benefits of mHealth app/ DiGA usage. [ABSTRACT FROM AUTHOR]

The forward testing effect (FTE) refers to the finding that retrieval practice of previously studied material can facilitate recall of newly studied (critical) material. Such interim retrieval practice can also lead to a differential FTE, i.e., a more pronounced FTE for items at early than later serial positions in the critical material. The present study examined whether this differential FTE also holds with interim semantic generation of extra-list items, and whether it is influenced by study material. Consistent with prior work, the results of two experiments showed that both interim retrieval practice and interim semantic generation induce the general (list-level) FTE when unrelated study lists are applied, whereas retrieval practice only creates the effect with categorised study lists. Critically, however, the differential FTE was present in response to retrieval practice but absent in response to semantic generation. This pattern held regardless of which material was studied, thus experimentally dissociating the general (list-level) from the differential (item-level) FTE. The findings may suggest that retrieval practice, but not semantic generation, induces a reset of the encoding process which promotes attentional encoding such that a more pronounced FTE arises for early than middle and late serial positions in the critical list. [ABSTRACT FROM AUTHOR]

Physiotherapists promote physical activity and exercise, yet patient adherence is often poor. To support patient adherence, behavior change techniques (BCTs) should be applied. These are insufficiently covered in physiotherapy curricula. The aim of this study was to evaluate a behavior change counseling training program for physiotherapists. The specific aims were to investigate: (1) physiotherapists' satisfaction with the training; (2) changes in physiotherapists' knowledge of BCTs and communication techniques immediately after the training and 6 weeks later; and (3) changes in physiotherapists' self-reported use of these techniques 6 weeks after the training. We conducted a single-group pre-post intervention study. Data of 56 physiotherapists (47 female, mean age 48.0 years) who participated in the training program "BeFo" (German: "Bewegungstherapie-Fortbildungen") were analyzed. Knowledge of BCTs and communication techniques, intention to apply these techniques, action and coping planning were assessed at baseline (t1), after the training (t2), and 6 weeks later (t3) using questionnaires. Participants' satisfaction was evaluated at t2, their use of BCTs and communication techniques at t1 and t3. Fifty-four participants (96.4%) were satisfied with BeFo. One-way repeated-measures ANOVAs and Friedman's ANOVA revealed increased knowledge (Chi2(2) = 28.12, p <.001) and improved action planning (F(2, 98) = 22.65; p <.001) and coping planning (F(2, 100) = 19.28, p <.001) at t2 and t3. Higher use of BCTs and communication techniques at t3 was identified when participants with high baseline values were excluded. BeFo could be successfully implemented for physiotherapists. Our results imply that BeFo is a promising approach to improve physiotherapists' behavior change counseling skills. [ABSTRACT FROM AUTHOR]

Physicians' attire seems to play an important role in the success of patient treatment. The classic doctor's white coat initiates a strong signal to the patient and can have a determining effect on a successful doctor–patient relationship. In a quantitative online questionnaire study comprising 52 questions, participants were shown four photos of an interprofessional German family medicine team in varying attire. One important study feature relating to the ongoing coronavirus pandemic was that the team was portrayed wearing FFP2 masks in one photo. We measured core values regarding the team's perception in terms of sympathy, competence, trust, choosing the practice as a personal health care provider, and wanting to participate in the team. The questionnaire was posted online between March and May 2021. It was accessed 1435 times and 906 sheets were qualified for statistical analysis. For the first time in this field of research, a practice team's attire was investigated. We found a significant influence of different clothing on the perception of sympathy, competence, trust, elective practice, and team participation. Wearing an FFP2 mask promotes feelings of security and competence. The study shows that in times of fast social changes due to rapid digitalization and an ongoing pandemic, we should present ourselves in different ways as a medical team depending on the patient groups we are targeting and the feelings we want to evoke. [ABSTRACT FROM AUTHOR]

Background: The early COVID-19-pandemic was characterized by changes in decision making, decision-relevant value systems and the related perception of decisional uncertainties and conflicts resulting in decisional burden and stress. The vulnerability of clinical care professionals to these decisional dilemmas has not been characterized yet. Methods: A cross-sectional questionnaire study (540 patients, 322 physicians and 369 nurses in 11 institutions throughout Germany) was carried out. The inclusion criterion was active involvement in clinical treatment or decision making in oncology or psychiatry during the first year of COVID-19. The questionnaires covered five decision dimensions (conflicts and uncertainty, resources, risk perception, perception of consequences for clinical processes, and the perception of consequences for patients). Data analysis was performed using ANOVA, Pearson rank correlations, and the Chi²-test, and for inferential analysis, nominal logistic regression and tree classification were conducted. Results: Professionals reported changes in clinical management (27.5%) and a higher workload (29.2%), resulting in decisional uncertainty (19.2%) and decisional conflicts (22.7%), with significant differences between professional groups (p < 0.005), including anxiety, depression, loneliness and stress in professional subgroups (p < 0.001). Nominal regression analysis targeting "Decisional Uncertainty" provided a highly significant prediction model (LQ p < 0.001) containing eight variables, and the analysis for "Decisional Conflicts" included six items. The classification rates were 64.4% and 92.7%, respectively. Tree analysis confirmed three levels of determinants. Conclusions: Decisional uncertainty and conflicts during the COVID-19 pandemic were independent of the actual pandemic load. Vulnerable professional groups for the perception of a high number of decisional dilemmas were characterized by individual perception and the psychological framework. Coping and management strategies should target vulnerability, enable the handling of the individual perception of decisional dilemmas and ensure information availability and specific support for younger professionals. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to reveal the effects of discrimination perceived by Turkish immigrants on their mental health. Design and Methods: The participants of this pilot study were 111 Turkish immigrant patients treated at the Neuro‐Psychiatrisches Zentrum Riem. Findings: The preliminary findings illustrated that perceived individual discrimination was significantly correlated with three coping strategies, namely, substance use, friend support, and personal support. Practice Implications: This study contributes to the literature by highlighting the coping strategies and social support mechanisms of Turkish immigrants who perceived discrimination and employed strategies to combat it. [ABSTRACT FROM AUTHOR]

How do violations of predictability and plausibility affect online language processing? How does it affect longer-term memory and learning when predictions are disconfirmed by plausible or implausible words? We investigated these questions using a self-paced sentence reading and noun recognition task. Critical sentences violated predictability or plausibility or both, for example, "Since Anne is afraid of spiders, she doesn't like going down into the ... basement (predictable, plausible), garden (unpredictable, somewhat plausible), moon (unpredictable, deeply implausible)." Results from sentence reading showed earlier-emerging effects of predictability violations on the critical noun, but later-emerging effects of plausibility violations after the noun. Recognition memory was exclusively enhanced for deeply implausible nouns. The earlier-emerging predictability effect indicates that having word form predictions disconfirmed is registered very early in the processing stream, irrespective of semantics. The later-emerging plausibility effect supports models that argue for a staged architecture of reading comprehension, where plausibility only affects a post-lexical integration stage. Our memory results suggest that, in order to facilitate memory and learning, a certain magnitude of prediction error is required. [ABSTRACT FROM AUTHOR]

Dance therapy and dance theatre are innovative interventions for patients with a chronic disease such as cancer. In this pilot study we investigate both how dance theatre as a supportive intervention may influence the mental health and quality of life of male cancer survivors and how participants experience this type of intervention. We used a pre-post design with two points of measurement based on a mixed-methods approach including quantitative and qualitative data. The sample (N = 16) included male cancer survivors and men indirectly affected by cancer. The results show that the level of distress and depressive symptoms slightly improved during the project. Anxiety symptoms showed a significant reduction. The results of the interviews revealed positive effects of the dance project in terms of coping with late effects, physical strengthening, emotional disclosure and developing personal empowerment and increased self-esteem. The results are preliminary and encourage validation in future studies. [ABSTRACT FROM AUTHOR]

Aims and objectives: To test a mediating effect of compassion satisfaction on the relationship between personality traits (Big Five) and intent to leave. Background: Nursing professionals work in high‐stress environments and exhibit more emotional distress and mental health disorders than other hospital professionals. This translates to increased intention to leave their profession. Evidence suggests that compassion satisfaction reduces intention to leave. Research also indicates that personality factors are associated with compassion satisfaction and intent to leave. Design: Using a cross‐sectional design, we collected data from 536 nurses in a maximum‐care hospital in Germany via questionnaires; the analyses included 518 participants. Method: We applied the structural equation model and followed the STROBE checklist. Results: 30% of our study participants reported high intent to leave. Compassion satisfaction mediated the relationship between agreeableness and intent to leave. Openness to experience and neuroticism had positive direct effects on intent to leave. Conclusions: The results suggest that high compassion satisfaction levels may decrease intention to leave levels. Personality traits impact compassion satisfaction and intention to leave. Relevance to Clinical Practice: Nursing professionals' compassion satisfaction needs to be improved, for example by resilience training. As personality factors remain relatively stable over time, caregivers need to consider them when identifying appropriate areas of work and responsibility. [ABSTRACT FROM AUTHOR]

To analyze which pandemic related changes of attitudes and behaviors were perceived by Seventh-day Adventists (SDA) and how these relate to wellbeing, a cross-sectional survey with standardized questionnaires was performed. Participants (n = 1,494) stated changes for Relationships, Digital media usage and Nature/Silence/Contemplation, but not for Spirituality or Reflection of life. Best predictors of psychological wellbeing (WHO-5) were Spiritual wellbeing, perceived Restrictions and Awe/Gratitude (R2 =.32). Mediation analyses (R2 = 0.51) revealed a mediation effect of Awe/Gratitude between spiritual to psychological wellbeing (β = 0.11, p < 0.0001). Perceived changes were less relevant to buffer the negative effects of the pandemic; instead, they were related to fears of future. More relevant to stabilize SDAs´ wellbeing was their spirituality. [ABSTRACT FROM AUTHOR]

Background: The coronavirus (COVID-19) pandemic brought about restrictions, additional workload, insecurity, or need for inventing new routines for professionals worldwide. The pandemic and its restrictions have been discussed as a career shock. OBJECTIVE: Adding knowledge to this, our study investigated the academic and family (care) situation of young scientists in a German technical university. METHODS: We conducted an online survey including young scientists from a technical university in Germany in April 2021. 346 participants (mean age 33 years, 37% women) gave self-ratings on academic and life situation during the pandemic year, care work, preferences for scientific career and family life. RESULTS: Family and career were independent priorities (r = 0.021, p = 0.676). Two thirds (68%) of the young scientists reported no deterioration in scientific outcome during the pandefmic year. But, care times and number of children impacted negatively on scientific productivity in terms of publications. This was true for both women and men. CONCLUSIONS: Young scientists need individual support for their career perspective, according to their concrete career level and life situation. [ABSTRACT FROM AUTHOR]

Nudging users to keep them secure online has become a growing research field in cybersecurity. While existing approaches are mainly blackbox based, showing aggregated visualisations as one-size-fits-all nudges, personalisation turned out promising to enhance the efficacy of nudges within the high variance of users and contexts. This article presents a disaggregated whitebox-based visualisation of critical information as a novel nudge. By segmenting users according to their decision-making and information processing styles, we investigate if the novel nudge is more effective for specific users than a common black-box nudge. Based on existing literature about critical factors in password security, we designed a dynamic radar chart and parallel coordinates as disaggregated visualisations. We evaluated the short-term effectiveness and users' perception of the nudges in a think-aloud prestudy and a representative online evaluation (N=1.012). Our findings suggest that dynamic radar charts present a moderately effective nudge towards stronger passwords regarding short-term efficacy and are appreciated particularly by players of role-playing games. [ABSTRACT FROM AUTHOR]

Social participation is an important factor for students' socio-emotional/academic development. The literature on the topic discusses four domains in this regard: friendships, interactions, social acceptance, and self-perception of social inclusion. It shows that marginalized groups (e.g., students with behavioral problems/learning deficiencies/physical disabilities) are experience difficulties in those domains. Little, however, is known about the effect of a migration background (one of the most commonly marginalized groups) in this context. Therefore, self-ratings and peer ratings of 818 fourth graders (148 with a migration background, defined by their first learned language not being German) were assessed. The results of the ANOVA indicate that students with a migration background show a decreased level of friendships, interactions, and social acceptance. Gender effects on self-perceived social inclusion were also found. This suggests that social participation is a rather complex concept, which is also impaired for marginalized groups due to social factors like a migration background. Highlights: Friendships, interactions and social acceptance are negatively affected by a migration background. Self-perception of social inclusion is not affected by a migration background. Self-perception of social inclusion is negatively affected by Gender (boys). Social participation is impaired for students with a migration background. [ABSTRACT FROM AUTHOR]

The aim was to create and validate an audiovisual version of the German matrix sentence test (MST), which uses the existing audio-only speech material. Video recordings were recorded and dubbed with the audio of the existing German MST. The current study evaluates the MST in conditions including audio and visual modalities, speech in quiet and noise, and open and closed-set response formats. One female talker recorded repetitions of the German MST sentences. Twenty-eight young normal-hearing participants completed the evaluation study. The audiovisual benefit in quiet was 7.0 dB in sound pressure level (SPL). In noise, the audiovisual benefit was 4.9 dB in signal-to-noise ratio (SNR). Speechreading scores ranged from 0% to 84% speech reception in visual-only sentences (mean = 50%). Audiovisual speech reception thresholds (SRTs) had a larger standard deviation than audio-only SRTs. Audiovisual SRTs improved successively with increasing number of lists performed. The final video recordings are openly available. The video material achieved similar results as the literature in terms of gross speech intelligibility, despite the inherent asynchronies of dubbing. Due to ceiling effects, adaptive procedures targeting 80% intelligibility should be used. At least one or two training lists should be performed. [ABSTRACT FROM AUTHOR]

Purpose: The main objective of this study is to estimate and evaluate 10-year follow-up costs after prostate cancer treatment with curative (surgery, radiotherapy) and non-curative intent (hormone, androgen deprivation) per patient in Germany in 2000, 2008, and 2015.Methods: Prostate cancer follow-up recommendations were extracted from the European Association of Urology guidelines from 2000 to 2015. Per patient costs were calculated with a detailed micro-costing approach considering direct and indirect medical expenses. Input parameters were derived from expert interviews, literature research, and official scales of tariffs. Costs for insurers, providers, and payers were included to estimate societal costs.Results: Mean 10-year follow-up costs per patient after treatment with curative intent amounted to EUR 4415 in 2000, EUR 4224 in 2008 (p < 0.001), and EUR 5159 in 2015 (p < 0.001). Costs after hormone therapy with metastasis cumulated to EUR 10,846 in 2000, EUR 9818 in 2008 (p < 0.001), and EUR 11,978 in 2015 (p < 0.001). While insurers covered 37% of costs in 2000 (EUR 1664), only 23% of costs were reimbursed in 2015 (EUR 1195; p < 0.001). Cost sources mainly included consultations (55%), transportation (18%), and imaging (27%).Conclusion: Early detection and advances in prostate cancer treatment increased 10-year survival rates beyond 80% in Germany, ultimately expanding the number of survivors requiring follow-up. Statutory insurers reacted by decreasing the reimbursement rates to reduce per patient cost by up to 46%. Consequently, the economic burden was mainly shifted to payers and providers.Implications For Cancer Survivors: Equitable and effective follow-up schedules covered by insurance funds are necessary to care for prostate cancer patients. [ABSTRACT FROM AUTHOR]

Objective: The goal of this study was to investigate barriers to utilisation of cancer rehabilitation by querying a large sample of various professionals in health care with a comprehensive set of barriers. Methods: We developed a questionnaire comprising 55 barriers to utilisation of cancer rehabilitation and administered it to four different types of medical, care and social work experts involved in the referral to cancer rehabilitation. An exploratory factor analysis was conducted and the extracted factors were ranked by mean values. Additionally, ANOVAs were calculated to test for group differences. Results: Our sample (N = 606) consisted of 249 physicians, 194 social workers, 105 nurses and 55 psychologists in Germany. We identified seven barrier‐dimensions: low appreciation of rehabilitation by professionals, insufficient coordination, insufficient application procedure, rehabilitation requirements not met, patients' unfulfilled demands, patients' social responsibilities and patients' coping style, with the latter being rated as the most obstructive thereof. Furthermore, we found statistically significant group differences for six of these factors with small‐ to medium‐sized effects. Conclusion: Our results support previous publications implicating the patients' coping style as a barrier. We furthermore found evidence for barriers relating to processes and organisational issues, thereby expanding on the scope of patient‐oriented publications. Suggestions for improving patients' health services accessibility are made. [ABSTRACT FROM AUTHOR]

Studies on education generally find that higher education has a positive impact on various aspects of life. Nevertheless, studies focused on elderly people and their psychosocial health and development seldom view higher education as an important factor. Our aim was to explore the relation between higher education and ego integrity, a measure based on Erikson's concept of psychological maturity in later life. We used four national samples of non-institutionalized elderly people from Cameroon (N = 238), China (N = 254), Czech Republic (N = 167), and Germany (N = 240). Relationships between ego integrity and several possible moderator variables were tested by multivariate regressions in each sample. Between-subject ANOVA was employed to test differences in ego integrity between university educated and non-university educated people. We found that ego integrity is affected by culture in interaction with gender and the level of education attained. University-educated people reported higher ego integrity than persons with lower education in three of four cultural samples, which suggests a relatively stable relationship between university education and ego integrity when controlling for gender, age, and working status. These findings highlight the importance of education in late adulthood. In terms of policies and practice, they underscore the importance of reduction of educational inequalities as well as desirability of improved access to higher education, expansion of opportunities for the achievement of complete education in later life, and facilitation and support of lifelong learning. [ABSTRACT FROM AUTHOR]

To examine the possible contributions of capability, opportunity, and motivation for explaining long-term physical activity among people with multiple sclerosis and to report the results of a German survey study. The questionnaire, which was based on an expert interview study and behavior change theory, was structured and detailed applying the Theoretical Domains Framework. A total of 1027 people with multiple sclerosis provided data on sociodemographics, disease-related characteristics, and a set of constructs possibly related to long-term adherence. Participants were assigned to three groups: not regularly active, currently regularly active, and long-term regularly active. Eta squared was calculated to assess the magnitude of differences between groups using ANOVA. Moderate or large differences between groups were identified for many domains within capability, opportunity, and motivation. For the following theoretical domains, large differences (η2 ≥0.140) were observed: Intention, Behavioural Regulation, Beliefs about Capabilities and Goals. Our results suggest that capability, opportunity, and motivation should be targeted simultaneously when designing future interventions. Inactive people with multiple sclerosis might benefit most from interventions increasing action self-efficacy and intention. Boosting autonomous motivation, goal setting, action planning as well as maintenance and recovery self-efficacy could have a positive effect on long-term adherence. This study applied the COM-B model and Theoretical Domains Framework to identify a set of constructs for explaining long-term physical activity among people with MS. Behaviour change and maintenance interventions for people with MS should include techniques that foster intention, perceived self-efficacy and self-regulatory skills, and promote goal setting and autonomy of motivation for regular physical activity. Although barriers of the physical and social environmental context did not seem to be that important in our sample, scientists should consider addressing them in interventions for inactive and more disabled people with MS. Information about the benefits of physical activity should be regularly provided in MS rehabilitation, while further research should explore the relevance of information provision and knowledge for behaviour change in different groups of people with MS. [ABSTRACT FROM AUTHOR]

Background: The impact of vitamin D on musculoskeletal health is well-established, although its influence on physical performance is unclear. Therefore, we conducted this study to evaluate the impact of 25-hydroxy-vitamin D (25-OH vitamin D) concentrations with maximal aerobic power of professional indoor athletes. Results: A total of 112 male professional athletes were included in this cross-sectional study, consisting of 88 handball and 24 ice hockey players. The maximal aerobic power was assessed with a standardized cycling ergometer test. Athletes were assigned to two groups according to their 25-OH vitamin D status: insufficient (< 30 ng/mL) and sufficient (≥ 30 ng/mL). Thirty-four players (30.4%) displayed insufficient (21.9 ± 5.9 ng/mL) and 78 (69.6%) sufficient 25-OH vitamin D concentrations (41.6 ± 8.6 ng/mL). Athletes with sufficient levels achieved a higher maximal aerobic power (3.9 ± 0.9 vs. 3.5 ± 0.8 W/kg, p = 0.03) compared to those with insufficient levels. Conclusions: There is a high prevalence of 25-OH vitamin D insufficiency in professional indoor athletes, even in summer. Insufficient 25-OH vitamin D concentrations were associated with lower maximal aerobic power in male professional indoor athletes. Further, the 25-OH vitamin D concentration was identified as the only independent predictor of maximal aerobic power in these athletes, highlighting the impact of 25-OH vitamin D on physical performance. Therefore, 25-OH vitamin D concentrations of ≥ 30 ng/mL should be maintained to ensure optimal physical performance in these athletes. [ABSTRACT FROM AUTHOR]

Individuals with Autism Spectrum Disorder (ASD) are thought to under-rely on prior knowledge in perceptual decision-making. This study examined whether this applies to decisions of attention allocation, of relevance for 'predictive-coding' accounts of ASD. In a visual search task, a salient but task-irrelevant distractor appeared with higher probability in one display half. Individuals with ASD learned to avoid 'attentional capture' by distractors in the probable region as effectively as control participants—indicating typical priors for deploying attention. However, capture by a 'surprising' distractor at an unlikely location led to greatly slowed identification of a subsequent target at that location—indicating that individuals with ASD attempt to control surprise (unexpected attentional capture) by over-regulating parameters in post-selective decision-making. [ABSTRACT FROM AUTHOR]

Aim: We aim to determine the frequency of stressful life events (SLEs) and investigate the association of single and aggregated SLEs with mental health and general subjective health, which has not been reported for an aging representative sample to date. Subjects and methods: A total of 12,947 participants (35–74 years old) of the Gutenberg Health Study (GHS) in Germany were analyzed. SLEs were analyzed at the item and aggregated level with unweighted and weighted sum scores. Additionally, the survey included measures of mental health, general subjective health and demographics. Descriptive analyses were stratified by sex, age and socioeconomic status. Results: Multivariate analyses of variance with SLE at the item level revealed large main effects for sex (ηp2 = 0.30) and age (ηp2 = 0.30); a moderate effect was found for socioeconomic status (ηp2 = 0.08). Interaction effects of sex with age and SES were also significant, but with negligible effect sizes. Regression analyses revealed similar results for unweighted and weighted SLE sum scores controlling for sociodemographic variables, supporting the detrimental relations among cumulated SLEs, depression (β = 0.18/0.19) and anxiety (β =0.17/0.17), but not general health. Mental health indicators showed the highest correlations with single SLEs such as change of sleep habits or personal finances. Severe SLEs according to proposed weight scores showed no or only weak associations with mental health. Conclusion: Representative data support a more distinct impact of SLEs on mental health than on general health. Single SLEs show strong associations with mental health outcome (e.g., change of sleep habits). The low associations between severe single SLEs and mental health merit further attention. [ABSTRACT FROM AUTHOR]