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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]

The number of obstetric departments in German hospitals has declined in the last decades. In particular, rural hospitals are challenged to sustain their delivery services. In this paper, we analyse the role of variation and overheads of obstetric departments from the perspective of current and future German hospital financing. For this purpose, we develop a Monte Carlo simulation model that analyses the workload of the labour room and the obstetric ward. The results show that a hospital with less than 640 deliveries per year cannot break even. In order to offer services 24 h per day, 365 days per year, five nurses, five midwives, and five gynaecologists are needed. This results in high fixed costs. At the same time, the variation coefficient of the labour room and the obstetric ward declines with an increasing number of deliveries. Consequently, small hospitals have a higher risk of over- and under-utilization in the course of the year. This paper acknowledges that economics is not the only decision dimension. The quality of the institution and the transport to the hospital have to be considered, as well as the population's wish for nearby services. However, the simulations clearly demonstrate that unless the hospital financing system is changed fundamentally, the decline in the number of hospitals offering delivery services will continue. [ABSTRACT FROM AUTHOR]

Aims: To investigate factors that influence the willingness of inactive nurses to return to nursing in a crisis situation and to identify aspects that need to be considered with regard to a possible deployment. Design: A deductive and inductive qualitative content analysis of semi-structured focus group interviews. Methods: Semi-structured focus group interviews with inactive or marginally employed nurses, nurses who have been inactive for some time and nursing home managers in October and November 2021. The participating inactive nurses had declared their willingness for a deployment during the COVID-19 pandemic or not. Data were analysed using qualitative content analysis. Results: Communication was seen as essential by the participants for an informed decision for or against a temporary return to nursing and to potential or actual deployments. To make them feel safe, inactive nurses need to know what to expect and what is expected of them, for example, regarding required training and responsibilities. Considering their current employment status, some flexibility in terms of deployment conditions is needed. A remaining attachment to care can trigger a sense of duty. Knowledge of (regular) working conditions in nursing can lead to both a desire to support former colleagues and a refusal to be exposed to these conditions again. Conclusion: Past working experiences and the current employment situation play a major role in the willingness of inactive nurses to return to nursing in a crisis situation. Unbureaucratic arrangements must be provided for those who are willing to return. Summary Statement: • What already is known - In crisis situations, not every inactive nurse is willing or able to return to nursing and therefore, the 'silent reserve' may not be as large as suspected. • What this paper adds - Inactive nurses need to know what to expect and what is expected of them for their decision regarding a return to active patient care during a crisis situation. • Implications for practice/policy -- Inactive nurses need to be informed and should be offered free training and refresher courses to ensure patient safety. Impact: This research shows that the group of inactive nurses are not a silent workforce which can be activated anytime. Those who are able and willing to return to direct patient care in crisis situations need the best possible support -- during and between crises. Reporting Method: This study adhered to COREQ guidelines. No Patient or Public Contribution: The involvement of patients or members of the public did not apply for the study, as the aim was to gain insight into the motivations and attitudes of the group of inactive nurses. [ABSTRACT FROM AUTHOR]

Recent research has shown an indirect effect of generativity on fear of death through ego-integrity in older adults. The present paper aims at demonstrating that the indirect effect is valid even when controlling for social desirability. For that purpose, participants (N = 260 German adults) in study 1 provided self-reports on generativity, ego-integrity, fear of death, and social desirability. Analyses confirmed the indirect effect when the tendency for socially desirable responding was statistically controlled. In study 2, participants (N = 133 German adults) also reported on their generativity and ego-integrity. Fear of death, however, was assessed with a reaction time-based measure (i.e., the Implicit Associations Test). Again, the indirect effect could be confirmed. Taken together, the studies lend further credibility to the extant findings on the indirect effect of generativity on fear of death through ego-integrity. [ABSTRACT FROM AUTHOR]

This paper describes the development and validation of an instrument to assess how students deal with emotionally challenging classroom situations (the DECCS Questionnaire). The questionnaire is based on a vignette with one learning and one performance situation in a classroom, and is intended for students in grades 4 to 7. On a sample of N = 639 students (M ag e = 10.6 years; SD = 1.25, 52.4% girls) in northwest Germany, factor analytic procedures for the subdimensions of students dealing with emotionally challenging classroom situations show that two factors can be distinguished each for students' appraisals, for students' adaptive behavior, for students' maladaptive behavior, and for students' desired teacher behavior. The questionnaire and subscales demonstrate good reliability and validity values. Thus, the DECCS questionnaire shows good psychometric properties and is well suited for determining how students deal with emotionally challenging classroom situations. [ABSTRACT FROM AUTHOR]

Copyright of Die Anaesthesiologie is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background and Objectives Given the increasing academic interest in older migrants, this study aims at examining the likelihood of establishing contact and cooperation in a survey among first-generation migrants in Germany, comparing migrants of age 50 and older with younger migrants (aged 16–49). Research Design and Methods We analyze data from the Migrants' Welfare State Attitudes (MIFARE) study collected in Germany, which contains information about first-generation migrants from 9 different origin groups living in private households. Potential survey participants were contacted via mail and invited to participate in a paper- or online-based survey. In addition, an incentive experiment was implemented and age-dependent response rates were analyzed. Using logistic regression analyses, we compare older and younger migrants with regard to their likelihood of contact, cooperation, reaction to incentives, and mode choice. Results Within the MIFARE study, older migrants are more likely to be contacted than younger ones. Older migrants are also more likely to cooperate in survey research than younger migrants. Both groups respond equally positively to the use of unconditional incentives. Lastly, older migrants show a strong preference to fill out the questionnaire on paper, rather than online. Discussion and Implications Older first-generation migrants living in private households are easier to contact and are more likely to cooperate in survey research than younger first-generation migrants. Offering unconditional incentives and surveys on paper are likely to increase response rates among older migrants. [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]

Introduction: Various developments result in increasing workloads in general practices. New models of care and a restructuring of the division of tasks could provide relief. One approach is to extend the delegation of medical tasks from general practitioners (GPs) to medical practice assistants (MPAs). So far, there has been a lack of information about specific situations in which patients are willing to be treated exclusively by MPAs. Methods: In three German federal states, patients who visited a general practice were surveyed exploratively and cross-sectionally with a self-designed, paper-based questionnaire. The data were analysed descriptively and multivariate. A mixed binary logistic regression model was calculated to account for cluster effects at practice level (random intercept model). The dependent variable was patients' acceptance of task delegation. Results: A total of 1861 questionnaires from 61 general practices were included in the analysis. Regarding the current problem/request, a total of 30% of respondents could imagine being treated only by MPAs. Regarding theoretical reasons for consultation, more than half of the patients agreed to be treated by MPAs. According to the regression model, MPAs were preferred when patients were younger (10-year OR = 0.84, 95%-CI [0.75, 0.93]) or had a less complicated issue (OR = 0.44, 95%-CI [0.26, 0.8]). For four current problems/requests ("acute complaints" OR = 0.27, 95%-CI [0.17, 0.45], "routine health check" OR = 0.48, 95%-CI [0.3, 0.79], "new problem" OR = 0.13, 95%-CI [0.06, 0.28], "known problem" OR = 0.16, 95%-CI [0.1, 0.27]) patients prefer to be treated by GPs instead of MPAs. Discussion: For the first time, statements could be made on patients' acceptance of task delegation in relation to current and theoretical reasons for treatment in general practices in Germany. The discrepancy in response behaviour on a theoretical and individual level could be explained by different contexts of questions and differences at practice level. Overall, patients seem to be open to increased delegation of medical tasks, depending on the reason for treatment. Selection and response biases should be considered in the interpretation. Conclusion: The results are not completely opposed to an extension of task delegation. Further interventional studies could provide information on the possible effects of expansion of delegable tasks. [ABSTRACT FROM AUTHOR]

Background: The international study PRICOV-19 aims to assess the impact of the COVID-19 pandemic on the organisation of primary health care. The German part focuses on German general practitioners during the second wave of the COVID-19 pandemic. This paper addresses the following research questions: (1) How were changes in tasks on primary care and patient treatment perceived by GPs?, (2) What was the role of GPs during the pandemic, and how was their wellbeing?, (3) How did GPs perceive health policy measures?, and, (4) What influenced the attitudes of GPs on health policy measures? Methods: This study pursues a multi-country cross-sectional design. Data collection took place throughout Germany from 01.02. to 28.02.2021 with a quantitative online questionnaire consisting of 53 items. The questionnaire was analysed through descriptive and inferential analyses using correlation and multiple regression models. Results: The response rate was 20.4% (n = 349). The respondents were mainly GPs (59.6%) in single practices (62.5%) with a mean work experience of 15 to 20 years. GPs experienced a change in their work and practice organisation (80.3%). They felt a high responsibility (70.6%) and found their work has become more meaningful to them (76%). They also saw a lack of political support (75.2%) and that the measures taken by the government overburdened the daily practice (66.4%). Not many GPs were at risk of being distressed (53.4%) but rated the health policies rather negatively (60%). The multiple regression showed, the more GPs were exposed to risk of distress, the worse they assessed the government's measures. Conclusion: GPs perceived their work as relevant and felt confident they could fulfil their tasks, but noticed that health policy initially hardly supported the outpatient sector. Health policies should increase their competence in relation to primary care, ensure its needs and consider an active inclusion of GPs in preparedness plans. [ABSTRACT FROM AUTHOR]

Copyright of Anaesthesiologie & Intensivmedizin is the property of DGAI e.V. - Deutsche Gesellschaft fur Anasthesiologie und Intensivmedizin e.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

In Germany, as in many other European countries, vast changes in the welfare regime – towards workfare – have taken place. As a central activating element of workfare, sanctions were introduced to take effect by temporarily increasing deprivation through benefit cuts. This paper provides first quantitative insights on the effect of first sanctions on deprivation and contributes to the recent debate on the (un)constitutionality of sanctions, which re-emerged after a verdict of the Federal Constitutional Court, criticizing the lack of knowledge about the effects of sanctions on those affected. We implement a difference-in-differences propensity score matching approach that addresses selection on observables and individual time constant unobserved differences. High data accuracy is ensured by combining the "Panel Labour Market and Social Security" (PASS) with administrative data from the Federal Employment Agency. The results illustrate a slightly higher yet statistically insignificant level of deprivation for first-sanctioned unemployment/basic income recipients compared to non-sanctioned recipients. The results hint in the direction that higher levels of deprivation are not what activates the sanctioned beneficiaries to reintegrate into the labour market. We discuss whether the results imply a significant deviation from the socio-cultural subsistence minimum of sanctioned recipients and a failure of the welfare state. [ABSTRACT FROM AUTHOR]

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

Intimate partner violence (IPV) continues to be a global problem. The increasing international research, focussing on children who witness IPV between their parents, indicates that these circumstances might influence children in different ways. Despite these efforts, little evidence stems from Germany. Using data from a German school student survey from 2017 and 2019 (N = 21,382), this paper aims to examine the consequences of witnessing IPV. The present paper takes a closer look at children's violent behaviour, attitudes and quality of life while controlling for other potential influences (e.g. physical and psychological child abuse). Results indicate that IPV has a significant negative effect on children's quality of life, in particular on children's sense of security at home and children's life satisfaction. No other effects were significant. In discussing these complex dynamics, the results of the present study highlight the importance of considering children who witness IPV as direct victims. A home with personal threats cannot provide emotional and physical security. Coping with this absence of a secure base at home may lead to the neglect of important developmental tasks during that time, which can have possible far-reaching implications on different areas of children's lives (e.g. social competence). Further research examining the severity and duration of witnessing IPV within the context of a longitudinal design is recommended. [ABSTRACT FROM AUTHOR]

This paper explores the knowledge transfer of internationally mobile scientists. It builds upon previous work on the development of methods for detecting the knowledge transfer of German scientists. Using abstract terms of publications covered in Scopus, this paper proposes a lexical‐based approach to identify knowledge transmitters. These scientists are characterized by acquiring knowledge from their co‐workers during their international stay and transferring it upon return to German co‐workers. Knowledge is operationalized as the co‐occurrence of rarely used abstract terms. Knowledge transfer is expressed as the diffusion of these term combinations in co‐authorship networks. The method developed was validated by contacting the bibliometrically identified knowledge transmitters and asking them what they believe they learned during their stay abroad. A control group of internationally mobile scientists without traceable knowledge transfer was similarly asked to report on their knowledge acquisition. The findings suggest that bibliometric data are capable of detecting knowledge transmitters among German scientists who were internationally mobile. The juxtaposition of the responses on their perceived knowledge acquisition and the bibliometrically identified lexical terms shows that the method proposed is well suited to studying the knowledge transfer of internationally mobile scientists. The strength of the method is its simplicity and high precision. [ABSTRACT FROM AUTHOR]

Purpose: This paper aims to analyze the convergence of the testing and positivity rates for the COVID-19 pandemic focusing on Germany and Italy. Design/methodology/approach: The authors employ the two-regime threshold autoregressive (TAR) panel unit root test by using the weekly data in the period of 2020:03-2021:04. Findings: Following finding out that the testing and positivity rates are nonlinear, the authors determine that the transition country between the two regimes is Italy for the testing rates and Germany for the positivity rates. Their findings support the partial convergence for the testing rates for Germany and Italy. On the other hand, the authors could not find any convergence for the positivity rates of these two countries. Originality/value: This paper contributes to academic literature in several ways. Firstly, to the best of their knowledge, this paper is the first study that analyzes the convergence of testing and positivity data. This paper further focuses on two Euro-Area countries which have suffered significantly from the COVID-19 pandemic. In addition, the authors employ the two-regime threshold autoregressive (TAR) panel unit root proposed by Beyaert and Camacho (2008) in their empirical analysis. This recent panel data methodology aims to test real convergence in a nonlinear framework by incorporating the threshold model, panel data unit root test and the calculation of critical values by bootstrap simulation. [ABSTRACT FROM AUTHOR]

The digitization of German hospitals is proceeding continuously, leading to the implementation of new digital technologies, such as electronic health records (EHRs) or other technologies, used for the purpose of medical documentation tasks. Even though the replacement of paper documentation through digitized documentation in general promises to come along with plenty of benefits, the daily utilization of technologies might also lead to stresses and strains among the medical staff, eventually possibly leading to the development of different negative work and health-related outcomes. This study, therefore, aims at identifying persisting digitization-associated stressors and resources among medical hospital staff, examining their influences on different work and health-related outcomes, and finally, identifying potential needs for preventive measures. A quantitative study in the form of an online questionnaire survey was conducted among physicians working in the medical field of neuro- and vascular surgery in German hospitals. The study was carried out between June and October 2022 utilizing an online questionnaire based on several standardized scales, such as the technology acceptance model (TAM) and the technostress model, as well as on several scales from the Copenhagen Psychosocial Questionnaire (COPSOQ). The study found medium levels of technostress among the participating physicians (n = 114), as well as low to medium levels of persisting resources. The queried physicians, on average, reported low levels of burnout symptoms, generally described their health status as good, and were mostly satisfied with their job. Despite the prevalence of technostress and the low levels of resources among the surveyed physicians, there is little awareness of the problem of digital stress, and preventive measures have not been widely implemented yet in the clinics, indicating a needs gap and the necessity for the strategic and quality-guided implementation of measures to effectively prevent digital stress from developing. [ABSTRACT FROM AUTHOR]

Background: Students often show unfavourable attribution: they attribute poor school performance to stable factors such as lack of ability and good school performance to variable factors such as effort. However, attribution can be influenced by individualized digital re‐attributional feedback leading to positive motivational effects and higher learning outcomes. This is very promising, but it still is unclear, whether this digital re‐attributional feedback can also be successfully integrated in everyday classroom activities. Objectives: The present field experiment investigated how integrating digital re‐attributional feedback into classroom instruction affects student attribution, motivation and learning outcomes. Methods: In the experiment, 8th–10th grade high school students (N = 322) worked with a digital mathematics learning program which was integrated in a three‐week teaching unit. Half the students in each classroom received only standard feedback after each practice task (SF group); the other half received additionally an individual re‐attributional feedback (RF group) after every third task. Attribution, mathematics self‐concept, and self‐efficacy were measured by an online questionnaire twice a week; learning outcomes in mathematics were measured weekly. Results and Conclusion: Hierarchical analyses showed that re‐attributional feedback led to a more favourable attribution in case of success on stable factors. Especially low‐performing students benefited from this feedback. No effects on attribution in case of failure, self‐efficacy or learning outcomes could be found. Further research could investigate if certain adaptations to the digital re‐attributional feedback is more effective in a real classroom setting and has a broader impact on different students. Lay Description: What is already known about this topic: Working with computers in the classroom and at home is becoming more common.Re‐attributional feedback can increase student's motivation when given directly after solving a task and at a high density.Digital re‐attributive feedback can be given in a high density.Re‐attributional training sessions have been shown to be effective in individual training sessions or outside the students' classroom. What this paper adds: The study took place within a real teaching environment during mathematics class for 4 weeks.Digital re‐attributional feedback sessions were directly integrated into the students' online learning which was part of the teaching plan. The implications of study findings for practitioners: Computer‐based re‐attributional training show some limited effects in regular classroom instruction and could be well integrated in student online learning—when adapted accordingly.Low‐performing students show less favourable attribution than better‐performing students in case of success and benefit the most from re‐attributional training. [ABSTRACT FROM AUTHOR]

To investigate determinants of willingness to adopt telerehabilitation, willingness of technology use, core affect regarding using telerehabilitation, and digital competencies in rehabilitation professionals in Austria and Germany before and during the COVID-19 pandemic. A cross-sectional paper-based and online survey was conducted before and during COVID-19, respectively, with three cohorts of rehabilitation professionals. Outcomes were the willingness to adopt telerehabilitation evaluated using the extended Unified Theory of Acceptance and Use of Technology; willingness of technology use using the short scale for assessing the willingness of technology use; digital competencies and core affect using the Digital Competence Framework and semantic differential, respectively. Multivariate ordinal regression analysis was performed to determine predictors. Included were 603 rehabilitation professionals. Analysis revealed differences between Austria and Germany and before and during the pandemic for most outcomes. German residency, the pandemic, and a higher educational level were most important predictors of higher willingness to adopt telerehabilitation, willingness of technology use, digital competencies, and positive core affect. The pandemic increased most aspects of willingness to adopt telerehabilitation, willingness of technology use, digital competencies, and positive core affect. Results confirm that rehabilitation professionals with higher degrees are more prone to adopt innovations in healthcare.Registration: German Clinical Trials Register (DRKS00021464) The willingness to adopt telerehabilitation is associated with external factors increasing the need for alternative rehabilitation delivery, such as COVID-19, and with financial facilitators, such as reimbursement. As the willingness to adopt telerehabilitation is higher among speech and language therapists and dietitians, efforts are necessary to enhance its use in physiotherapists and occupational therapists. As a higher willingness to adopt telerehabilitation was observed in younger rehabilitation professionals and those with higher education, increasing the importance of telerehabilitation in education curricula and further knowledge transfer into practice for those already working in the field seems necessary. [ABSTRACT FROM AUTHOR]

Handwriting is a complex task that includes planning the content and the execution of handwriting movements on paper or on a tool (e.g., a tablet). This execution depends on the involvement of specific muscles in the hand (distal) and arm (proximal). The present study combines the parallel recording of the writing process on tablets and the related muscle activity with electromyography to investigate the differences in handwriting movements in two groups. A total of 37 intermediate writers (third and fourth graders, mean age 9.6 years, SD 0.5) and 18 skilled adults (mean age 28.6 years, SD 5.5) participated in three handwriting tasks. The tablet data results replicate previous findings in handwriting research for the writing process. The muscle activity data reflected a differential relationship between distinct muscle activity and handwriting performance depending on the handwriting skill (intermediate or advanced writers). Furthermore, the combination of both methods revealed that skilled writers tend to involve rather distal muscles to control the pressure of the writing pen on the surface, whereas developing writers mainly use their proximal muscles to control the velocity of their handwriting movements. This research contributes to a deeper understanding of the underlying processes of handwriting and the development of efficient handwriting execution. [ABSTRACT FROM AUTHOR]

Purpose: Teachers are exposed to many stressors. Compared to other occupational groups, they are more frequently affected by psychosomatic complaints. In recent decades, numerous prevention and intervention measures for promoting health have been developed and implemented for this target group. However, it remains unclear how the uptake of health-promotion measures (HPMs) by teachers can be increased in order to prevent stress-related disorders. This paper examines two facets of health literacy—health awareness and health value—in terms of their importance in both the take-up and intended take-up of HPMs. Design/methodology/approach: In the 2017/2018 school year, data were collected by paper and pencil from a representative sample of 830 teachers across all school types in the German State of Brandenburg. Findings: Teachers who place great value on their own health show significantly higher levels of take-up and intended take-up of HPMs. The findings regarding health awareness are more heterogeneous. Further associations were found with age and psychosocial stress. Originality/value: While there has been growing academic interest in developing HPMs for teachers, there has been relatively little focus on the factors that may influence the implementation and uptake of these measures. The paper contributes to addressing this gap by shedding light on the relevance of two facets of health literacy. Strengthening the perceived importance of health could be a starting point for increasing the use of HPMs by teachers and thus improving their health. [ABSTRACT FROM AUTHOR]

Purpose: Prior to the Covid-19 pandemic, the German coworking industry has grown rapidly as one of the fastest-growing coworking markets globally. The pandemic, however, has brought the industry to an abrupt halt. The purpose of this paper is, therefore, to explore the impact the pandemic has had so far on German coworking spaces. Design/methodology/approach: Using an online questionnaire, quantitative data from 38 coworking space owners, operators and employees of a total of 77 spaces in Germany has been collected regarding their situation before, during and after the peak of the first wave of the pandemic from Spring until Summer 2020. The data has been analyzed using descriptive statistics. Findings: The reported income losses significantly outweigh a decrease in costs of the spaces. Nevertheless, the member base seems rather unaffected, and coworking spaces are exploring adaptations to their businesses with a strong shift to the digital environment. Fear of re-imposed governmental restrictions is evident, as well as justified with a looming second infection wave. Research limitations/implications: Due to the sample size, the data may lack generalizability. Therefore, recommendations for future research are provided. Originality/value: Data on the impact of the pandemic on coworking spaces is scarce. This paper provides a first necessary overview for the industry as well as the academic field to allow for action to be taken. [ABSTRACT FROM AUTHOR]

Background: The present study aimed at the translation and cross-cultural adaptation of six PROMIS® pediatric self- and proxy- item banks and short forms to universal German: anxiety (ANX), anger (ANG), depressive symptoms (DEP), Fatigue (FAT), pain interference (P) and peer relationships (PR). Methods: Using standardized methodology approved by the PROMIS Statistical Center and in line with recommendations of the International Society for Pharmacoeconomics and Outcomes Research (ISPOR) PRO Translation Task Force, two translators for each German-speaking country (Germany, Austria, and Switzerland) commented on and rated the translation difficulty and provided forward translations, followed by a review and reconciliation phase. An independent translator performed back translations, which were reviewed and harmonized. The items were tested in cognitive interviews with 58 children and adolescents from Germany (16), Austria (22), and Switzerland (20) for the self-report and 42 parents and other caregivers (Germany (12), Austria (17), and Switzerland (13)) for the proxy-report. Results: Translators rated the translation difficulty of most items (95%) as easy or feasible. Pretesting showed that items of the universal German version were understood as they were intended, as only 14 out of 82 items of the self-report and 15 out of 82 items of the proxy-report versions required minor rewording. However, on average German translators rated the items more difficult to translate (M = 1.5, SD = 0.20) than the Austrian (M = 1.3, SD = 0.16) and the Swiss translators (M = 1.2, SD = 0.14) on a three-point Likert scale. Conclusions: The translated German short forms are ready for use by researchers and clinicians (https://www.healthmeasures.net/search-view-measures). Plain English summary: A multitude of questionnaires exist, which are not comparable due to different questions or no available translations. PROMIS is an initiative, which was funded by the National Institute of Health in the US, to build better, i.e., more precise and efficient questionnaires, which can be used and compared worldwide. The PROMIS questionnaires include paper-and-pencil short forms and computerized adaptive tests. So far numerous PROMIS surveys have been created using advanced methodologies. They can be used by health care professionals to assess different aspects of health and compare the results internationally. To allow for international comparability of studies using those questionnaires, they need to be translated. This study reports the thorough translation process of the US-American PROMIS® questionnaires measuring anxiety, anger, depressive symptoms, fatigue, pain interference, and peer relationships in children and adolescents into German. The translation included researchers, children, and parents from Germany, Austria, and Switzerland to ensure that the final German version is fully and equally well understood in all of those German-speaking countries. The article describes the translation process, so that the user can understand the translations and use them in an informed way. The translated German questionnaires are ready for use by researchers and clinicians. (https://www.healthmeasures.net/search-view-measures). [ABSTRACT FROM AUTHOR]

Background: Conspiracy beliefs have become widespread throughout the COVID-19 pandemic. Previous studies have shown that endorsing conspiracy beliefs leads to lower protective guideline adherence (i.e., wearing face masks), posing a threat to public health measures. The current study expands this research across the lifespan, i.e., in a sample of adolescents with mental health problems. Here, we investigated the association between conspiracy beliefs and guideline adherence while also exploring the predictors of conspiracy beliefs. Methods: N = 93 adolescent psychiatric outpatients (57% female, mean age: 15.8) were assessed using anonymous paper–pencil questionnaires. Endorsement of generic and COVID-19 conspiracy beliefs was assessed, in addition to items measuring adherence to protective guidelines and mental health (stress, depressive symptoms, emotional/behavioral problems, and adverse childhood experiences). Multiple regressions and supervised machine learning (conditional random forests) were used for analyses. Results: Fourteen percent of our sample fully endorsed at least one COVID-19 conspiracy theory, while protective guidelines adherence was relatively high (M = 4.92, on a scale from 1 to 7). The endorsement of COVID-19 conspiracy beliefs—but not of generic conspiracy beliefs—was associated with lower guideline adherence (β = − 0.32, 95% CI − 0.53 to − 0.11, p <.001). Conditional random forests suggested that adverse childhood experiences and peer and conduct problems were relevant predictors of both conspiracy belief categories. Conclusion: While a significant proportion of our sample of adolescents in psychiatric treatment endorsed conspiracy beliefs, the majority did not. Furthermore, and to some degree, contrary to public perception, we found that adolescents show relatively good adherence to public health measures—even while experiencing a high degree of mental distress. The predictive value of adverse childhood experiences and peer/conduct problems for conspiracy beliefs might be explained by compensatory mechanisms to ensure the safety, structure, and inclusion that conspiracies provide. [ABSTRACT FROM AUTHOR]

Background: Research has shown that routinely assessed, patient-reported outcome measures (PROMs) have positive effects in patients with advanced oncologic diseases. However, the transferability of these results to specialist palliative care is uncertain because patients are more impaired and staff doubt the feasibility and benefits. The aim of this study is to evaluate the feasibility of patient self-assessment of PROMs, their use by staff and the benefits in palliative care wards. Method: A multicentre observational study was conducted in the context of the implementation of the Integrated Patient Outcome Scale (IPOS) in three specialist palliative care wards at university hospitals in Germany. All admitted patients who screened positive regarding their ability to complete questionnaires were asked to participate and complete the IPOS on paper weekly, with assistance if necessary. Feasibility of questionnaire completion (e.g. proportion of patients able to complete them), use (e.g. involvement of different professional groups) and benefit (e.g. unexpected information in IPOS as rated by treating physicians) were assessed. Staff members' opinion was obtained in a written, anonymous evaluation survey, patients' opinion in a short written evaluation. Results: A total of 557 patients were screened for eligibility, 235 were assessed as able to complete the IPOS (42.2%) and 137 participated in the study (24.6%). A majority needed support in completing the IPOS; 40 staff members and 73 patients completed the evaluation. Unexpected information was marked by physicians in 95 of the 137 patient questionnaires (69.3%). The staff differed in their opinions on the question of whether this also improved treatment. A majority of 32 staff members (80.0%) were in favour of continuing the use of IPOS (4 against continuation, 4 no answer); 43 (58.9%) patients rated their overall experience of IPOS use as 'positive', 29 (39.7%) as 'neutral' and 1 (1.4%) as 'negative'. Conclusions: While most staff wished to continue using IPOS, it was a challenge to integrate the effort to support the completion of IPOS into daily practice. Digital implementation was not successful, despite various attempts. To explore the effects on care and patient outcomes, multicentre cluster-randomised trials could be employed. Trial registration: German Clinical Trials Register DRKS-ID: DRKS00016681 (24/04/2019). [ABSTRACT FROM AUTHOR]

This study examines the access to healthcare for children and adolescents with three common chronic diseases (type-1 diabetes (T1D), obesity, or juvenile idiopathic arthritis (JIA)) within the 4th (Delta), 5th (Omicron), and beginning of the 6th (Omicron) wave (June 2021 until July 2022) of the COVID-19 pandemic in Germany in a cross-sectional study using three national patient registries. A paper-and-pencil questionnaire was given to parents of pediatric patients (<21 years) during the routine check-ups. The questionnaire contains self-constructed items assessing the frequency of healthcare appointments and cancellations, remote healthcare, and satisfaction with healthcare. In total, 905 parents participated in the T1D-sample, 175 in the obesity-sample, and 786 in the JIA-sample. In general, satisfaction with healthcare (scale: 0–10; 10 reflecting the highest satisfaction) was quite high (median values: T1D 10, JIA 10, obesity 8.5). The proportion of children and adolescents with canceled appointments was relatively small (T1D 14.1%, JIA 11.1%, obesity 20%), with a median of 1 missed appointment, respectively. Only a few parents (T1D 8.6%; obesity 13.1%; JIA 5%) reported obstacles regarding health services during the pandemic. To conclude, it seems that access to healthcare was largely preserved for children and adolescents with chronic health conditions during the COVID-19 pandemic in Germany. [ABSTRACT FROM AUTHOR]

The administrative burden for physicians in the hospital can affect the quality of patient care. The Service Center Medical Informatics (SMI) of the University Hospital Würzburg developed and implemented the smartphone-based mobile application (MA) ukw.mobile1 that uses speech recognition for the point-of-care ordering of radiological examinations. The aim of this study was to examine the usability of the MA workflow for the point-of-care ordering of radiological examinations. All physicians at the Department of Trauma and Plastic Surgery at the University Hospital Würzburg, Germany, were asked to participate in a survey including the short version of the User Experience Questionnaire (UEQ-S) and the Unified Theory of Acceptance and Use of Technology (UTAUT). For the analysis of the different domains of user experience (overall attractiveness, pragmatic quality and hedonic quality), we used a two-sided dependent sample t-test. For the determinants of the acceptance model, we employed regression analysis. Twenty-one of 30 physicians (mean age 34 ± 8 years, 62% male) completed the questionnaire. Compared to the conventional desktop application (DA) workflow, the new MA workflow showed superior overall attractiveness (mean difference 2.15 ± 1.33), pragmatic quality (mean difference 1.90 ± 1.16), and hedonic quality (mean difference 2.41 ± 1.62; all p <.001). The user acceptance measured by the UTAUT (mean 4.49 ± 0.41; min. 1, max. 5) was also high. Performance expectancy (beta = 0.57, p =.02) and effort expectancy (beta = 0.36, p =.04) were identified as predictors of acceptance, the full predictive model explained 65.4% of its variance. Point-of-care mHealth solutions using innovative technology such as speech-recognition seem to address the users' needs and to offer higher usability in comparison to conventional technology. Implementation of user-centered mHealth innovations might therefore help to facilitate physicians' daily work. [ABSTRACT FROM AUTHOR]

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Background: The professional knowledge of pre‐service teachers is highly important for effective and successful teaching. In recent years, many research groups have been engaged in developing simulated classroom environments to capture especially the pedagogical knowledge (PK) of pre‐service teachers, neglecting the content‐related facets of professional knowledge such as pedagogical content knowledge (PCK). Objectives: In the present study, we describe the development of a simulated classroom environment—the Simulated Classroom Biology (SCRBio)—and provide evidence regarding its validity to assess pre‐service biology teachers' action‐oriented PCK in the area of evolution. Methods: This study examined the evidence supporting the validity of using the SCRBio to investigate action‐oriented PCK of pre‐service biology teachers. The (1) evidence based on test content (expert ratings) and the (2) evidence based on relation to other variables (known‐groups comparison) was obtained. We tested the SCRBio with N = 76 German pre‐service biology teachers. Results and Conclusions: Our results show the successfully operationalized PCK in the SCRBio through explicit allocation of specific misconceptions to each virtual student's answer and the valid measurement of pre‐service biology teachers' action‐oriented PCK. This results in a validated simulated classroom environment for pre‐service but also in‐service teachers. In the future, the SCRBio will be developed from an assessment instrument to a training tool to simulate explicit teaching situations. This allows to complement the predominantly theoretical components of university‐based teacher education with practice‐based simulated classroom environments. Lay Description: What is already known about this topic: The professional knowledge of pre‐service teachers is a prerequisite for quality teaching in the future, as well as student achievement.Simulated classroom environments are already being used, primarily to examine and train the pedagogical knowledge of pre‐service teachers.The action‐oriented character of simulated classroom environments can bridge the theory‐practice gap of university‐based education programs. What this paper adds: Description of an innovative simulated classroom environment—the Simulated Classroom Biology.Ability to capture several domains of professional knowledge in an action‐oriented setting.Validation of the Simulated Classroom Biology using various validity aspects.Implications of study findings for practitioners.Description of validation steps for developing simulated classroom environments.A validated simulated classroom environment is provided to capture various knowledge domains of professional knowledge in an actionable setting.The Simulated Classroom Biology can be adapted to new subjects and teaching topics by changing the content. [ABSTRACT FROM AUTHOR]

This paper addresses the challenges and solutions in developing a holistic prevention mobile health application (mHealth app) for Germany's healthcare sector. Despite Germany's lag in healthcare digitalization, the app aims to enhance primary prevention in physical activity, nutrition, and stress management. A significant focus is on user participation and usability to counter the prevalent issue of user attrition in mHealth applications, as described by Eysenbach's 'law of attrition'. The development process, conducted in a scientific and university context, faces constraints like limited budgets and external service providers. The study firstly presents the structure and functionality of the app for people with statutory health insurance in Germany and secondly the implementation of user participation through a usability study. User participation is executed via usability tests, particularly the think-aloud method, where users verbalize their thoughts while using the app. This approach has proven effective in identifying and resolving usability issues, although some user feedback could not be implemented due to cost-benefit considerations. The implementation of this study into the development process was able to show that user participation, facilitated by methods like think-aloud, is vital for developing mHealth apps. Especially in health prevention, where long-term engagement is a challenge. The findings highlight the importance of allocating time and resources for user participation in the development of mHealth applications. [ABSTRACT FROM AUTHOR]

Assessing the impact of dysarthria on a patient's ability to communicate should be an integral part of patient management. However, due to the high demands on reliable quantification of communication limitations, hardly any formal clinical tests with approved psychometric properties have been developed so far. This study investigates a web-based assessment of communication impairment in dysarthria, named KommPaS. The test comprises measures of intelligibility, naturalness, perceived listener effort and communication efficiency, as well as a total score that integrates these parameters. The approach is characterized by a quasi-random access to a large inventory of test materials and to a large group of naïve listeners, recruited via crowdsourcing. As part of a larger research program to establish the clinical applicability of this new approach, the present paper focuses on two psychometric issues, namely specificity and sensitivity (study 1) and retest-reliability (study 2). Study 1: KommPaS was administered to 54 healthy adults and 100 adult persons with dysarthria (PWD). Non-parametric criterion-based norms (specificity: 0.95) were used to derive a standard metric for each of the four component variables, and corresponding sensitivity values for the presence of dysarthria were identified. Overall classification accuracy of the total score was determined using a ROC analysis. The resulting cutscores showed a high accuracy in the separation of PWD from healthy speakers for the naturalness and the total score. Study 2: A sub-group of 20 PWD enrolled in study 1 were administered a second KommPaS examination. ICC analyses revealed good to excellent retest reliabilities for all parameters. [ABSTRACT FROM AUTHOR]

Copyright of ZFA: Zeitschrift für Allgemeinmedizin is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Complementary medicine (CM) is frequently used by patients, but little is known about the usage of CM in surgical patients. The study aimed to elucidate the relevance of CM in surgery. Methods: This cross-sectional, multi-center survey utilized a paper-based questionnaire consisting of 21 questions to capture CM usage and interest as well as CM communication in visceral and thoracic surgical patients being hospitalized at the corresponding departments of surgery at the University Medical Centers in Freiburg, Heidelberg und Ulm, Germany. Results: Overall, 151 patients consented to the survey. On average, current CM usage was stated by 44% of patients. Most frequently used CM approaches were physical exercise (63%), nutritional supplements (59%) and herbal medicine (56%). Strong interest in CM counselling was stated by 51% of patients. Almost 80% of patients wanted to be treated in a holistic manner and desired for reliable information about CM as well as CM informed physicians. Only 12% of patients communicated CM usage and interest with their attending physician. Review of literature revealed similar results showing an overall CM usage of 43%, preferring nutritional supplements and herbal medicine. Conclusion: The results of our cross-sectional study indicate a high percentage of CM users and a strong interest in CM among surgical patients. Indeed, the current communication about CM between patients and surgeons is poor. With respect to safety and quality reasons, but also to pay attention to patients' demands, physicians should be aware of patients' CM usage in surgery. Trial registration: German Clinical Trial register (DRKS00015445). [ABSTRACT FROM AUTHOR]

Purpose: Mid-level executives are confronted with many dilemma situations, in which they are forced to decide between conflicting options, none of them leading to the desired result. If they fail to cope with them constructively, their individual risk for mental strains increases (Gerlmaier and Latniak, 2013). Initial findings focusing on executives in industry (Bossmann, 2020) show that fostering effective dilemma management in executives is a preventive factor against stress-related diseases. Yet, there is little empirical research that evaluates the contribution of dilemma management training on leadership's mental health prevention in hospitals. This study aims to examine whether such a training program, adapted to current working conditions in German hospitals, promotes mid-level executives' mental health. Design/methodology/approach: A 10-month training program was administered to N = 69 senior physicians, senior nurses and senior service and administrative staff in four hospitals. To evaluate training effects on perceived stress reactivity, on cognitive and emotional irritation over time as well as the effects of the training dose on these results, participants' self-reported measures were collected at four points in time: before (t0), during (t1), immediately after (t2) and three months after the intervention (t3). Findings: Overall, participants showed less cognitive irritation and perceived stress reactivity over time. However, their emotional irritation did not change significantly. The dose of training participation did not moderate these results. Originality/value: This paper contributes to the prevention of stress-related diseases and the promotion of sensemaking in mid-level executives' dilemma management routine in the face of increasingly aggravating working conditions due to financial restrictions in the German health-care system. Findings of this study are explained in greater depth using previously reported qualitative data from the same research project. [ABSTRACT FROM AUTHOR]

The German version of the Parenting stress Index from Abidin, the Eltern-Belastungs-Inventar (EBI) merely provides reference samples of 538 mothers of children in toddlers and preschool age. Although meant to measure parenting stress, there are no father specific reference samples provided. The aim was to investigate differences in parenting stress between fathers and the provided reference samples of German mothers. Furthermore, the aim was to examine potential differences in the perceived stress between fathers who did and those who did not take parental leave. A total of 497 fathers living in Germany, of which more than half took parental leave, filled out the questionnaire via an online survey or the paper-pencil-version. All fathers completed the EBI and provided socio-economic data. The collected data were analyzed in terms of test quality, such as mean and standard deviation, corrected item–total correlation and reliability. Moreover, differences between the provided norm data and our sample were calculated. Analyses showed that fathers reported significantly higher levels of parenting stress than mothers. Furthermore, fathers taking parental leave did not differ significantly from those who did not, regarding their level of education or their perceived parenting stress. In conclusion, as it stands right now, the EBI does not adequately measure parenting stress in fathers, and father specific norms are needed to properly assess their levels of parenting stress. The results concerning parenting stress and parental leave were thus inconclusive. Furthermore, since reducing parenting stress in fathers is beneficial for the child's development and the welfare of the parents, further studies focusing on fathers' parenting stress are needed. [ABSTRACT FROM AUTHOR]

Forecasts predict a growing shortage of skilled nursing staff in countries worldwide. Nurse migration is already a common strategy used to address nursing workforce needs. Germany, the UK, and Australia are reviewed here as examples of destination countries for nurse migrants. Agreements exist between countries to facilitate nurse migration; however, it is not evident how nurse migrants have contributed to data on which these arrangements are based. We examined existing primary research on nurse migration, including educational needs and initiatives to support policymakers', stakeholders', and health professions educators' decisions on measures for ethical and sustainable nurse migration. We conducted a rapid evidence assessment to review available empirical research data which involved, was developed with, or considered migrant nurses to address the research question: what are the findings of research that directly involves migrant nurses in producing primary research data? A total of 56 papers were included. Four main themes were identified in this research data: Research does not clearly define what is meant by the term migrant nurses; discrimination is often reported by migrant nurses; language and communication competencies are important; and structured integration programs are highly valued by migrant nurses and destination healthcare employers. Migrant nurses continue to experience discrimination and reduced career opportunities and therefore should be included in research about them to better inform policy. Structured integration programs can improve the experience of migrant nurses by providing language support (if necessary), a country-specific bridging program and help with organisational hurdles. Not only researching migrant nurses but making them active partners in research is of great importance for successful, ethical, and sustainable migration policies. A broader evidence base, especially with regard to the views and experiences of migrant nurses and their educational support needs, should be promoted to make future immigration policy more needs-based, sustainable and ethically acceptable. [ABSTRACT FROM AUTHOR]

Background: Incontinence is a common disorder among older adults with a higher prevalence in nursing home settings than in community dwellings. There is a wide variety of absorbent continence products on the market used to manage continence. Aim: The study aimed to investigate the experience of caregivers of residents with incontinence in care home settings using the new MoliCare Premium Form design and to compare some of the product features with the previous design. Method: A questionnaire focusing on the key performance characteristics of the product was developed and administered to 74 nurses in Germany to obtain their opinions on the use of MoliCare Premium Form products. Findings: More than 90% of respondents rated each key performance aspect of the new product design as 'good' and 'OK'. More than 60% of the caregivers found the new product design to be better performing and 93% preferred the new design to the previous version. Conclusion: The newly redesigned continence pad performed very well on each of the individual performance features, indicating the high quality and optimised design of the product. The new design was found to be suitable and effective for individuals with incontinence. [ABSTRACT FROM AUTHOR]

Aim: With the COVID-19 pandemic, we witnessed an increase in purchases of certain products, such as toilet paper, disinfectants, or groceries. In the present study, we examined the individual and socio-psychological determinants of stockpiling behavior. For this purpose, we defined an explanatory model based on the Health Belief Model (HBM), which includes threat perceptions, barriers and benefits, and self-efficacy beliefs as main predictors of health-related behaviors, and extended the model to include social norms. Subject and methods: Participants were recruited via social media platforms and data collection was conducted via an online survey. The final sample included 861 German respondents (male = 199, female = 642, mean age = 36.76, SD = 12.38). Results: Perceived barriers of stockpiling, such as financial constraints or regulations in supermarkets, turned out to be the strongest predictors of stockpiling. Regarding the role of threat perception, the perceived severity of the disease in particular was positively related to stockpiling behavior. Finally, our results suggest a significant impact of social cues, showing that descriptive normative beliefs are associated with stockpiling behavior. Conclusion: Based on these findings, we propose targeted interventions to a) reduce perceived benefits of stockpiling and severity beliefs related to COVID-19, b) emphasize disadvantages of stockpiling, and c) reduce media exposure of stockpiling behavior to prevent panic buying. [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: Little is known about importance and implementation of end-of-life care (EOLC) in German intensive care units (ICU). This survey analyses preferences and differences in training between "medical" (internal medicine, neurology) and "surgical" (surgery, anaesthesiology) residents during intensive care rotation. Methods: This is a point-prevalence study, in which intensive care medicine course participants of one educational course were surveyed. Physicians from multiple ICU and university as well as non-university hospitals and all care levels were asked to participate. The questionnaire was composed of a paper and an electronic part. Demographic and structural data were prompted and EOLC data (48 questions) were grouped into six categories considering importance and implementation: category 1 (important, always implemented), 2 (important, sometimes implemented), 3 (important, never implemented) and 4–6 (unimportant, implementation always, sometimes, never). The trial is registered at the "Deutsches Register für klinische Studien (DRKS)", Study number DRKS00026619, registered on September 10th 2021, www.drks.de. Results: Overall, 194/ 220 (88%) participants responded. Mean age was 29.7 years, 55% were female and 60% had scant ICU working experience. There were 64% medical and 35% surgical residents. Level of care and size of ICU differed significantly between medical and surgical (both p < 0.001). Sufficient implementation was stated for 66% of EOLC questions, room for improvement (category 2 and 3) was seen in 25, and 8% were classified as irrelevant (category 6). Areas with the most potential for improvement included prognosis and outcome and patient autonomy. There were no significant differences between medical and surgical residents. Conclusions: Even though EOLC is predominantly regarded as sufficiently implemented in German ICU of all specialties, our survey unveiled still 25% room for improvement for medical as well as surgical ICU residents. This is important, as areas of improvement potential may be addressed with reasonable effort, like individualizing EOLC procedures or setting up EOLC teams. Health care providers as well as medical societies should emphasize EOLC training in their curricula. [ABSTRACT FROM AUTHOR]

Unemployment strongly influences a person's economic resources and life chances. Especially for unemployed individuals who have to rely on means-tested benefits, episodes of unemployment often go along with substantial material restrictions. Therefore, from a policy perspective, measures or regulations that might shorten unemployment episodes and reduce overall unemployment are particularly important. In this paper, we analyse whether concessions regarding the characteristics of the job searched for influence an individual's unemployment duration. In doing so, we focus on a particular aspect of availability requirements in Germany. This is the fact that for unemployed recipients of means-tested benefits almost all types of jobs count as suitable employment and, therefore, recipients are obliged to make job-related concessions if offered a job requiring such concessions. The results indicate that there is no positive effect of making concessions regarding qualification requirements or status on employment chances. In contrast, there are positive effects of wage concessions. However, searching for a job in a different occupation (that does not necessarily imply a concession) has a comparable, positive effect on finding employment. Thus, it appears that being generally flexible regarding one's future occupation might be at least as important for employment chances as making concessions. [ABSTRACT FROM AUTHOR]

Objectives Multimorbidity poses various challenges, and previous research has indicated a causal relation with depression. As multimorbidity is not curable, the underlying mechanisms are of great interest. Positive affect is a major resource for coping with chronic conditions and for the prevention of depression. Long-term multimorbidity, however, may deplete positive affect. The purpose of this paper is to investigate the role of positive affect in the association between multimorbidity and depressive symptoms. Method We used four consecutive waves (2008, 2011, 2014, 2017) of the nationally representative German Ageing Survey (DEAS) with a total of 1,558 older adults aged 40 and over. To account for time-varying confounding, exposure-induced mediator-outcome confounding, and reciprocities, we applied the mediational g-formula with inverse-probability weighting techniques. We also tested for exposure-mediator interaction to adjust for differences in mediation across the duration of multimorbidity. Results We confirmed a positive longitudinal relation between multimorbidity and depressive symptoms, both of which were negatively associated with while positive affect. The model without interaction indicated a share mediated of ca. 18.3% on the total effect of multimorbidity on depressive symptoms. Addition of interaction led to substantial differences for multimorbidity duration and levels of positive affect. Associations for long-term multimorbidity (at least two survey waves) were more substantial, and the share mediated doubled (>40%). Additionally, the direct effect of multimorbidity on depressive symptoms diminished for short-term multimorbidity. Conclusion Strengthening positive affect could reduce depressive symptoms in those facing multimorbidity. This study also discusses methodological challenges in performing longitudinal mediation analysis. We advise researchers to consider the mediational g-formula and exposure-mediator interaction. [ABSTRACT FROM AUTHOR]

Purpose: Over the course of COVID-19 pandemic, evidence has accumulated that SARS-CoV-2 infections may affect multiple organs and have serious clinical sequelae, but on-site clinical examinations with non-hospitalized samples are rare. We, therefore, aimed to systematically assess the long-term health status of samples of hospitalized and non-hospitalized SARS-CoV-2 infected individuals from three regions in Germany. Methods: The present paper describes the COVIDOM-study within the population-based cohort platform (POP) which has been established under the auspices of the NAPKON infrastructure (German National Pandemic Cohort Network) of the national Network University Medicine (NUM). Comprehensive health assessments among SARS-CoV-2 infected individuals are conducted at least 6 months after the acute infection at the study sites Kiel, Würzburg and Berlin. Potential participants were identified and contacted via the local public health authorities, irrespective of the severity of the initial infection. A harmonized examination protocol has been implemented, consisting of detailed assessments of medical history, physical examinations, and the collection of multiple biosamples (e.g., serum, plasma, saliva, urine) for future analyses. In addition, patient-reported perception of the impact of local pandemic-related measures and infection on quality-of-life are obtained. Results: As of July 2021, in total 6813 individuals infected in 2020 have been invited into the COVIDOM-study. Of these, about 36% wished to participate and 1295 have already been examined at least once. Conclusion: NAPKON-POP COVIDOM-study complements other Long COVID studies assessing the long-term consequences of an infection with SARS-CoV-2 by providing detailed health data of population-based samples, including individuals with various degrees of disease severity. Trial registration: Registered at the German registry for clinical studies (DRKS00023742). [ABSTRACT FROM AUTHOR]

Background: Although research on mathematics learning programs has taken off in recent years, little is known about how different person characteristics are related to practice behaviour with such programs. When implementing a mathematics learning program in the classroom, it might be important to know whether students with specific characteristics need more encouragement to make use of this learning opportunity. Objectives: Using a supply‐use model, we analysed the predictive power of students' cognitive characteristics (prior mathematics knowledge), personality traits (conscientiousness), motivational‐affective characteristics (mathematics self‐concept and mathematics anxiety), and family background characteristics (socioeconomic status and migration background) for practising with an adaptive arithmetic learning program. Methods: We used longitudinal data from 203 fifth graders from seven non‐academic‐track schools in Germany. Practice behaviour, measured by completed tasks in the learning program, was recorded weekly for every student over a period of 22 weeks. Results and Conclusions: The results of our multilevel analyses showed that mathematics anxious students practised less with the program. We did not find any relationship with the other characteristics. Takeaways: Our results suggest that mathematics anxious students need more encouragement when practising with a mathematics learning program; otherwise, they do not get the chance to benefit from the use. Lay Description: What is already known about this topic: The use of mathematics learning programmes in mathematics education has recently intensified.It is important that students practice with such learning programmes regularly over a longer period of time in order for them to achieve learning success.Students differ in their mathematics learning behaviour. What this paper adds: Little is known about how person characteristics are related to practice behaviour with mathematics learning programmes.Students may differ in their use of a mathematics learning programme, which is why cognitive characteristics, personality traits, motivational‐affective characteristics, and family background characteristics may affect students' practice behaviour. Implications for practice: Mathematics anxious students practiced less with a mathematics learning program, and need more encouragement to benefit equally from the implementation in school.Teachers should keep in mind that after the initial enthusiasm, practice with a programme may decrease over time, especially after school holidays. [ABSTRACT FROM AUTHOR]

Background: Formative assessments are needed to enable monitoring how student knowledge develops throughout a unit. Constructed response items which require learners to formulate their own free‐text responses are well suited for testing their active knowledge. However, assessing such constructed responses in an automated fashion is a complex task and requires the application of natural language processing methodology. In this article, we implement and evaluate multiple machine learning models for coding energy knowledge in free‐text responses of German K‐12 students to items in formative science assessments which were conducted during synchronous online learning sessions. Dataset: The dataset we collected for this purpose consists of German constructed responses from 38 different items dealing with aspects of energy such as manifestation and transformation. The units and items were implemented with the help of project‐based pedagogy and evidence‐centered design, and the responses were coded for seven core ideas concerning the manifestation and transformation of energy. The data was collected from students in seventh, eighth and ninth grade. Methodology: We train various transformer‐ and feature‐based models and compare their ability to recognize the respective ideas in students' writing. Moreover, as domain knowledge and its development can be formally modeled through knowledge networks, we evaluate how well the detection of the ideas within responses translated into accurate co‐occurrence‐based knowledge networks. Finally, in terms of the descriptive accuracy of our models, we inspect what features played a role for which prediction outcome and if the models pick up on undesired shortcuts. In addition to this, we analyze how much the models match human coders in what evidence within responses they consider important for their coding decisions. Results: A model based on a modified GBERT‐large can achieve the overall most promising results, although descriptive accuracy varies much more than predictive accuracy for the different ideas assessed. For reasons of comparability, we also evaluate the same machine learning architecture using the SciEntsBank 3‐Way benchmark with an English RoBERTa‐large model, where it achieves state‐of‐the‐art results in two out of three evaluation categories. Lay Description: What is already known about this topic?: Formative assessments are needed to test and monitor the development of learners' knowledge throughout a unit to provide them with appropriate automated feedback.Constructed response items which require learners to formulate their own free‐text responses are well suited for testing their active knowledge.Assessing constructed responses in an automated fashion is a widely researched topic, but the problem is far from solved and most of the work focuses on predicting holistic scores or grades.To allow for a more fine‐grained and analytic assessment of learners' knowledge, systems which go beyond predicting simple grades are required.To guarantee that models are stable and make their predictions for the correct reasons, methods for explaining the models are required. What this papers adds?: A core topic in physics education is the concept of energy.We implement and evaluate multiple systems based on natural language processing technology for assessing learners' conceptual knowledge about energy physics using transformer language models as well as feature‐based approaches.The systems assess students' knowledge about various forms of energy, indicators for the same and the transformation of energy from form into another.As our systems are based on machine learning methodology, we introduce a novel German short answer dataset for training them to detect the respective knowledge elements within students' free‐text responses.We evaluate the performance of these systems using this dataset as well as the well‐established SciEntsBand‐3‐Way dataset and manage to achieve, to our best knowledge, new state‐of‐the‐art results for the latter.Moreover, we apply methodology for explaining model predictions to assess whether predictions are carried out for the correct reasons. Implications for practice and/or policy: It is indeed possible to assess constructed responses for the demonstrated knowledge about energy physics in an analytic fashion using natural language processing.Transformer language models can outperform more specialized feature‐based approaches for this task in terms of predictive and descriptive accuracy.Co‐occurrences of different concepts within the same responses can lead models to learn undesired shortcuts which make them unstable. [ABSTRACT FROM AUTHOR]

Background: Computer‐based assessment allows for the monitoring of reader behaviour. The identification of patterns in this behaviour can provide insights that may be useful in informing educational interventions. Objectives: Our study aims to explore what different patterns of reading activity exist, and investigates their interpretation and consistency across different task sets (units), countries, and languages. Three patterns were expected: on‐task, exploring and disengaged. Methods: Using log data from the PISA 2012 digital reading assessment (9226 students from seven countries), we conducted hierarchical cluster analyses with typical process indicators of digital reading assessments. We identified different patterns and explored whether they remained consistent across different units. To validate the interpretation of the identified patterns, we examined their relationship to performance and student characteristics (gender, socio‐economic status, print reading skills). Results and Conclusions: The results indicate a small number of transnational clusters, with unit‐specific differences. Cluster interpretation is supported by associations with student characteristics—for example, students with low print reading skills were more likely to show a disengaged pattern than proficient readers. Exploring behaviour tended to be exhibited only once across the three units: It occurred in the first unit for proficient readers and in later units for less skilled readers. Major Takeaways: Behavioural patterns can be identified in digital reading tasks that may prove useful for educational monitoring and intervention. Although task situations are designed to evoke certain behaviours, the interpretation of observed behavioural patterns requires validation based on task requirements, assessment context and relationships to other available information. Lay Description: What is already known about the subject matter?: Students differ in how they read, comprehend and use digital information.Indicators from process data provide insight about how students engage with digital reading tasks. What does this paper add to the subject matter?: Based on multiple process indicators, a small number of clusters indicating different behavioural activity can be distinguished.These clusters can be described as on‐task, passive, hasty, exploring, disengaged, persistent and lost interest.A meaningful interpretation of the clusters must consider the requirements of the underlying tasks. Implications for practice and/or policy: Knowledge of how students engage with digital resources may provide useful feedback for teachers to guide students' learning or intervene when they struggle.Educational monitoring: The high comparability of country‐specific results suggests an invariant set of solution strategies in the digital reading assessment. [ABSTRACT FROM AUTHOR]

Background: Health care costs of migraine constitute a major issue in health economics. Several publications analyzed health care costs for adult migraine patients, based on questionnaires or secondary (health insurance) data. Although migraine often starts already in primary school age, data on migraine related costs in children is scarce. In this paper we aimed to assess the migraine-related health care costs in 6 to 11 year old children in Germany. Methods: Using claims data of a large German health insurer (BARMER), overall annual health care costs of 6 to 11 year old children with a diagnosis of migraine in 2017 (n = 2597) were compared to a control group of 6 to 11 year old children without a headache diagnosis between 2013 and 2017 (n = 306,926). The association of migraine and costs was modeled by generalized linear regression (Gamma regression) with adjustment for sex, age and comorbidities. Results: Children with migraine caused considerably higher annual per capita health care costs than children without a headache diagnosis (migraine group: € 1018, control group: € 618). Excess costs directly related to migraine amounted to € 115. The remaining excess costs were related to comorbidities, which were more frequent in the migraine group. Mental and behavioural disorders constituted the most expensive comorbidity, accounting for € 105 of the € 400 annual excess costs in the migraine group. Conclusion: 6 to 11 year old children with a migraine diagnosis cause significant direct and comorbidity related excess costs in the German health care system. [ABSTRACT FROM AUTHOR]

The impact of algorithms on everyday life is ever increasing. Medicine and public health are not excluded from this development – algorithms in medicine do not only challenge, change and inform research (methods) but also clinical situations. Given this development, questions arise concerning the competency level of prospective physicians, thus medical students, on algorithm related topics. This paper, based on a master's thesis in library and information science written at Humboldt‐Universität zu Berlin, gives an insight into this topic by presenting and analysing the results of a knowledge test conducted among medical students in Germany. F. J. [ABSTRACT FROM AUTHOR]

Physical fitness is an important health resource. From 2003 onwards, the MoMo study, a part of the German Health Interview and Examination Survey for Children and Adolescents (KiGGS), has investigated physical fitness on the basis of nationally representative data. The objective of this paper was to analyse trends in physical fitness of three cohorts at the ages of 4–17 years. Changes within 10 test items of the MoMo-test profile are reported. The mean values of physical fitness and the relevant influencing factors were directly compared across cohorts (in the total group and in age-and sex-subgroups). Statistical significance of differences was examined by calculating the confidence intervals (95% CI) for complex samples; effect sizes were determined using Cohen's d. The results indicated that physical fitness levels of German children and adolescents initially slightly increased between MoMo baseline (2003–2006) and wave 1 (2009–2012). This could partly be attributed to increased physical activity in sports clubs and in extracurricular sports at school. Then, between MoMo wave 1 and MoMo wave 2 (2014–2017) the physical fitness of children and adolescents in Germany remained the same, as did all influencing factors with the exception of extracurricular sport. From a public health perspective, programmes and measures that can increase the chances for all children and adolescents to strive for greater physical fitness should be of the highest priority. [ABSTRACT FROM AUTHOR]

Introduction: Increasing sub-specialization has reduced the number of general surgeons involved in the care of trauma patients in German-speaking countries (Germany, Austria and Switzerland) over the past decades. Thus, the aim of this study was to assess, to what extent level 1 trauma centers are still prepared to provide immediate emergency surgery in patients with thoracic or abdominal trauma. Methods: Web-based and paper questionnaires were sent to all level 1 trauma centers participating in the TraumaRegister DGU® (TR-DGU) in Germany, Austria, and Switzerland from Feb 2017 to Sep 2017. The centers were asked about the presence or availability of surgeons who were able to perform an emergency laparotomy or thoracotomy. Results: Of all 117 level 1 trauma centers participating in the TR-DGU in Germany, Austria, and Switzerland, 97 (83%) gave a response. A board-certified surgeon who is able to perform an emergency laparotomy is present 24 h/7 days a week in 72% of the centers (emergency thoracotomy: 57%). In centers where no such surgeon was present the whole time, the mean maximum time of arrival of the surgeon on call was 18.9 min (SD 7.0, range 10–40 min) regarding the ability to perform an emergency laparotomy and 19.9 min (SD 7.0, range 10–40 min) regarding the emergency thoracotomy. Conclusion: The majority of level 1 trauma centers in Germany, Switzerland, and Austria in the TR-DGU seem to be well prepared to treat severe injuries of the abdominal and thoracic cavities. In some centers, however, a surgeon able to perform an emergency laparotomy or thoracotomy is not available within 30 min. [ABSTRACT FROM AUTHOR]