Search

This paper reports follow-up findings for an Mentalization based treatment (MBT) parenting intervention delivered to a community mental health sample. Parents completed the 12-week version of the Lighthouse Parenting Program (LPP) and were evaluated on parenting practices, parent-child relationships, parental mental health indicators, and child problem behaviour levels. We evaluated the extent to which improvements in mentalizing at follow-up mediated changes in parenting, parental adjustment, mental health, and child outcomes. Results included a reduction in parental coercive behaviours and child problems, improved parent-child relationship, and better parental psychological adjustment and mental health. Improvement in self-focused mentalizing were observed. Self-focused mentalizing mediated the changes in most outcomes from baseline to 3-month follow-up. These results provide strong preliminary evidence that the LPP improves parent and child outcomes. [ABSTRACT FROM AUTHOR]

This paper presents the investigation and analysis of speech accommodation effects in data obtained from Spanish learners of German with varying proficiency levels. The production data were recorded during a collaborative map task of the Spanish learners of German among each other and with a native speaker of German. The map task was designed to target words and phrases with specific segmental and suprasegmental characteristics. These characteristics were derived from contrastive analyses of Spanish and German. The main objectives of the paper were to investigate whether segmental and suprasegmental characteristics of the target language German are affected by phonetic accommodation to varying degrees and whether these differences depend on the proficiency level of the speaker or the interlocutor. The statistical analysis, using regression analyses, revealed inconsistent accommodation effects across learners of different proficiency levels as well as different linguistic phenomena. In line with previous findings the results can best be accounted for by an adaptation of a dynamic system approach. [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]

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]

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]

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]

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]

Context: The LMU University Hospital is among the largest healthcare facilities in Germany. The measures implemented prior to and during the first pandemic wave of COVID-19, were evaluated in preparation of a second pandemic wave. This paper presents the pandemic management concept, evaluation and adaptation of LMU University Hospital. Methods: Between July and September 2020 the disaster management team of LMU University Hospital conducted a mixed-method evaluation of the hospital's pandemic management. A workshop series based on the After Action Review working group format was organized to examine the management structure, decision-making processes, documentation, and crisis preparedness response for a second COVID-19 wave. Further, the satisfaction of employees with the hospital's COVID-19 management was examined through an anonymous survey. Results: The workshop series highlighted a need for structural and operational adaptation of the COVID-19 management at LMU University Hospital. The results of the employee survey (N = 2182) provided positive feedback for the measures taken during the first pandemic wave. Specific actions were derived concerning the availability of personal protective equipment and emergency childcare services. A key outcome of both evaluation activities was the identified need for further improvement in communication between stakeholders. All changes were adopted prior to the second pandemic wave. [ABSTRACT FROM AUTHOR]

Background: In addition to the integrity of the meniscal hoop function, both the anterior and posterior meniscus roots as well as the meniscotibial and meniscofemoral ligaments are crucial in restraining meniscal extrusion. However, the interaction and load sharing between the roots and these peripheral attachments (PAs) are not known. Purposes: To investigate the influence of an insufficiency of the PAs on the forces acting on a posterior medial meniscus root repair (PMMRR) in both neutral and varus alignment and to explore whether meniscal centralization reduces these forces. Study Design: Controlled laboratory study. Methods: In 8 fresh-frozen human cadaveric knees, an arthroscopic transosseous root repair (step 1) was performed after sectioning the posterior root of the medial meniscus. The pull-out suture was connected to a load cell to allow measurement of the forces acting on the root repair. A medial closing-wedge distal femoral osteotomy was performed to change the mechanical axis from neutral to 5° of varus alignment. The meniscus was completely released from its PAs (step 2), followed by transosseous arthroscopic centralization (step 3). Each step was tested in both neutral and varus alignment. The specimens were subjected to nondestructive dynamic varus loading under axial compression of 300 N in 0°, 15°, 30°, 45°, and 60° flexion. The changes in force acting on the PMMRR were statistically analyzed using a mixed linear model. Results: Axial loading in neutral alignment led to an increase of the force of root repair of 3.1 ± 3.1 N (in 0° flexion) to 6.3 ± 4.4 N (in 60° flexion). In varus alignment, forces increased significantly from 30° (3.5 N; 95% CI, 1.1-5.8 N; P =.01) to 60° (7.1 N; 95% CI, 2.7-11.5 N; P =.007) flexion, in comparison with neutral alignment. Cutting of the PAs in neutral alignment led to a significant increase of root repair forces in all flexion angles, from 7.0 N (95% CI, 1.0-13.0 N; P =.02) to 9.1 N (95% CI, 4.1-14.1 N; P =.003), in comparison with the intact state. Varus alignment significantly increased the forces in the cut states from 4.8 N (95% CI, 1.0-8.5 N; P =.02) to 11.1 N (95% CI, 4.2-18.0 N; P =.006) from 30° to 60° flexion, in comparison with the neutral alignment. Arthroscopic centralization led to restoration of the native forces in both neutral and varus alignment, with no significant differences between the centralized and intact states. Conclusion: An insufficiency of the PAs of the medial meniscus, as well as varus alignment, led to increased forces acting on a PMMRR. These forces were reduced via an arthroscopic meniscal centralization. Clinical Relevance: Performing arthroscopic meniscal centralization concomitantly with PMMRR may reduce failure of the repair by reducing the load of the root. [ABSTRACT FROM AUTHOR]

Objective: Analysis of gender-specific differences in short- and long-term outcome after elective open abdominal aortic aneurysm repair (OAR) regarding the distal anastomosis. Methods: In this retrospective cohort study, data from 4853 patients of a German health insurance company undergoing OAR for infrarenal abdominal aortic aneurysms (AAAs) between 2010 and 2016 were analysed. The patients were followed through 2018. Results: A total of 4050 (83.5%) men and 803 (16.6%) women underwent OAR. Women were older than men (72.9 ± 8.7 vs 69.8 ± 8.5 years; P <.001). A tube graft was used in 2644 (54.5%) patients, an aorto-biiliac bifurcated graft in 1657 (34.1%) and an aorto-bifemoral bifurcated graft in 552 (11.4%). Perioperative mortality was not significantly different between men (5.7%) and women (6.5%) in the total patient population (P =.411). This was true for aorto-aortic tube grafting (P =.361), aorto-biiliac reconstructions (P = 1.000) and aorto-bifemoral reconstructions (P =.345). Kaplan-Meier estimated long-term survival of men after 9 years was better than that of women (55.0% vs 43.8%; P =.006). However, separated by the site of the distal anastomosis, this was only true for aorto-aortic reconstructions (survival men vs women 56.0% vs 42.1%; P =.005), not for aorto-biiliac and aorto-bifemoral reconstructions. In the multivariate Cox regression analysis, age over 80 years, heart failure, aorto-bifemoral reconstruction, chronic kidney disease stage 3-5, chronic obstructive pulmonary disease, peripheral artery disease, arterial hypertension, but not gender (P =.531), had a negative impact on long-term survival. Conclusion: If possible, an aorto-aortic tube graft should be preferred to aorto-biiliac and aorto-bifemoral reconstructions in OAR. Patients selected for aorto-bifemoral artery reconstruction exhibit higher perioperative morbidity and mortality as well as worse long-term survival compared to patients selected for an intra-abdominal reconstruction. In the multivariate regression analysis, gender was not an independent risk factor for either short- or long-term outcomes. [ABSTRACT FROM AUTHOR]

Aim: Measuring socioeconomic inequalities in health and health care, and understanding determinants of such inequalities, are critical for achieving higher equity in health. Equity in health is a prerequisite for public health and welfare. The aim of the paper is (1) to quantify inequality in diabetes morbidity patterns over patients’ entire life span, and (2) to compare levels of inequality measured through income and educational level, respectively, as proxies for socioeconomic status (SES). Method: Historic individual register data on the entire Danish diabetes population alive in 2011 were gathered. Cox survival analysis and a concentration index decomposition approach were applied to analyse relevant morbidity indicators reflecting patients’ health state at diagnosis and throughout their lives with diabetes. Results: Patients with high education have approximately 26% lower mortality hazard when diagnosed with diabetes and 10–15% lower hazard of developing complications as compared with patients with short education. The outcome variables: ‘severe complications at diagnosis’ and ‘years with severe complications’ inhibit the highest negative concentration index value, indicating that morbidity is concentrated among the lower SES groups, whereas the outcome variables ‘years without complications’ and ‘duration of diabetes’ concentrate among the socioeconomically better-off patients. Conclusions: Significant differences in diabetes patients’ morbidity patterns and survival indicate that diabetes impacts harder on patients of lower SES; these patients experience more severe complications and die earlier. Hence to reduce inequality in health, it is important to invest in efforts targeted towards socially vulnerable groups. [ABSTRACT FROM AUTHOR]

Background: Caring for terminally ill patients with minor children can be very stressful. The perceived quality of life is significantly influenced by the Meaning in Life (MiL). No studies were found that focus on the prioritized special needs of this patient group. Objectives: The aim is to compare and contrast terminally ill parents with minor children and palliative care patients in Germany, in order to provide appropriate support beyond medical, nursing or therapeutic interventions. Methods: Terminally ill parents diagnosed were surveyed using a validated instrument 'Schedule for Meaning in Life Evaluation (SMiLE)'. The study listed various areas that contribute to the MiL, followed by an evaluation of their importance and satisfaction levels. The researchers then compared these findings with data collected from palliative care patients. Results: In Germany, 54 patients, mostly female and with a mean age of 43, were included in this study between February 2017 and September 2020. The median age of the 96 children during the survey phase was 7 years. The comparison group consists of 100 palliative care patients in Germany; mostly aged 50 years and older. For terminally ill patients most important areas were in decreasing order family (100%), social relations (80%), leisure time (61%), nature/animals (39%) and home/garden (30%). Although the overall indices are close between both groups, there are significant and highly correlated differences between them. Parents felt limited by their illness in being a mother or father, as they wanted to be. Conclusion: The involvement with SMiLE led patients to consider their coping resources. The areas relevant to terminally ill parents differed from those relevant to palliative care patients. All participants identified family as the most important factor for MiL. The results suggest that evaluating MiL can serve as a coping strategy and help terminally ill parents with minor children. Plain language summary: A comparison of answers to the meaning in life from seriously ill parents with young children with the answers of other seriously ill patients Background: Caring for seriously ill patients with young children can be very stressful. The quality of life depends on meaning in life. No studies were found that focus on the needs of this patients. Objectives: The aim was to explore similarities and differences between seriously ill parents with young children and palliative care patients in Germany to find the best way to support them. Methods: The Meaning in Life questions were used to find this out. Two researchers asked seriously ill parents about different things that make their lives meaningful. The researchers then compared the results with data from other seriously ill patients in need of palliative care. In Germany, 54 seriously ill parents with young children were interviewed between February 2017 and September 2020. The children were usually seven years old. The compared group consisted of 100 palliative care patients and was mostly older than 49 years. For seriously ill patients most important were family, social relations, leisure time, nature/animals, and home/garden. The values seemed similar, but there are clear differences between the groups. Parents felt their illness limited them in being a mother or a father. Conclusion: The questions helped patients helped to remember meaning in life and set goals. The things that mattered to seriously ill parents were different from those that mattered to palliative care patients. All participants said that family was the most important thing for meaning in life. The results show that thinking about meaning in life can help. [ABSTRACT FROM AUTHOR]

Children with mathematical difficulties need to spend more time than typically achieving children on solving even simple equations. Since these tasks already require a larger share of their cognitive resources, additional demands imposed by the need to switch between tasks may lead to a greater decline of performance in children with mathematical difficulties. We explored differential task switch costs with respect to switching between addition versus subtraction with a tablet-based arithmetic verification task and additional standardized tests in German elementary school children in Grades 1 to 4. Two independent studies were conducted. In Study 1, we assessed the validity of a newly constructed tablet-based arithmetic verification task in a controlled classroom-setting (n = 165). Then, effects of switching between different types of arithmetic operations on accuracy and response latency were analyzed through generalized linear mixed models in an online-based testing (Study 2; n = 3,409). Children with mathematical difficulties needed more time and worked less accurately overall. They also exhibited a stronger performance decline when working in a task-switching condition, when working on subtraction (vs. addition) items and in operations with two-digit (vs. one-digit) operations. These results underline the value of process data in the context of assessing mathematical difficulties. [ABSTRACT FROM AUTHOR]

Background: Caring for parents continuing pregnancy after learning about a severe life-limiting condition in their unborn is challenging. Most existing studies focus on affected families, whereas research on the subjective experience of care professionals is scarce. Aim: We aimed to (1) explore experiences and needs of involved care professionals, (2) obtain information about existing care structures, and (3) identify requirements for a structured perinatal palliative care program. Design: Grounded Theory study using theoretical sampling. Data was collected by semi-structured interviews and analyzed following the principles of grounded theory coding and situational analysis. Setting: A total of 18 professionals from 12 different services in Munich and surroundings participated in the study: 8 physicians, 3 midwives, 2 nurses, 1 each pregnancy counselor, grief counselor, chaplain, clinical psychologist, and undertaker. Results: Several organizations provide support for affected parents, but inter-institutional communication is scarce. Due to the lack of a dedicated perinatal palliative care program, professionals make immense and partly unpaid efforts to support concerned parents. Providers experience "collateral beauty" in their work despite all the suffering and grief. This includes the development of a humble attitude and feelings of gratitude toward life, the feeling of having a meaningful task and professional as well as personal growth. Requirements for a structured perinatal palliative care program include: fostering peer support, ensuring regular supervision, and enhancing interdisciplinary exchange. Conclusions: Perinatal palliative care demands a high level of personal engagement but is experienced as highly rewarding by care professionals. [ABSTRACT FROM AUTHOR]

Under the recently enacted pharmaceutical price and reimbursement regulation in Germany, new drugs are subject to a rapid assessment to determine whether there is sufficient evidence of added clinical benefits compared with the existing standard of treatment. If such added benefits are confirmed, manufacturers and representatives of the Statutory Health Insurance (SHI) are expected to negotiate an appropriate reimbursement price. If parties fail to reach an agreement, a final decision on the reimbursement price will be made by an arbitration body. If one of the parties involved wishes so, then the Institute for Quality and Efficiency in Health Care (Institut für Qualität und Wirtschaftlichkeit im Gesundheitswesen, IQWiG) will be commissioned with a formal evaluation of costs and benefits of the product in question. IQWiG will make a recommendation for a reimbursement price based on the ‘efficiency frontier’ in a therapeutic area. The purpose of the assessments is to provide support for decision-making bodies that act on behalf of the SHI insurants. To determine the willingness to pay for new drugs, IQWiG uses the following decision rule: the incremental cost-effectiveness ratio of a new drug compared with the next effective intervention should not be higher than that of the next effective intervention compared with its comparator. The purpose of this paper was to investigate the theoretical and empirical relationship between the willingness to pay for drugs and their health benefits. The analysis shows that across disease areas IQWiG has a curvilinear relationship between willingness to pay and health benefits. Future research may address the validity of the willingness-to-pay function from the viewpoint of the individual SHI insurants. [ABSTRACT FROM PUBLISHER]

Background: Data from the core data set of the Hospice and Palliative Care Evaluation (HOPE) from 1999 to 2001 demonstrated considerable variance in the incidence of patients' symptoms and problems between participating services. This paper aims to investigate these differences more closely. Methods: During the evaluation period of HOPE in 2002 a telephone survey with a representative of each participating unit was performed. Telephone interviews assessed the professionals' definitions of selected symptoms and estimates of problem and symptom incidences. Content analysis was used to evaluate qualitative answers. Results: Staff members rated pain, weakness, nausea/emesis as the most frequent physical symptoms; anxiety, depression and amentia as most frequent psychological symptoms; wound treatment, mobilisation and weakness as nursing problems and organisation of care settings, loneliness, demands of relatives the most common social needs. Staff members used a wide range of definitions for cachexia, weakness and depression. Discussion: Standard definitions of symptoms and problems were lacking in the articulation of subjective staff members' perspectives. Meaningful evaluation of multicentre surveys would require training in symptom assessment and classification in order to produce a common basis for documentation. Even though definitions differed widely, underlying concepts seemed to be compatible. [ABSTRACT FROM AUTHOR]

Aims: The Study on Mental Health at Work (S-MGA) generates the first nationwide representative survey enabling the exploration of the relationship between working conditions, mental health and functioning. This paper describes the study design, sampling procedures and data collection, and presents a summary of the sample characteristics. Methods: S-MGA is a representative study of German employees aged 31–60 years subject to social security contributions. The sample was drawn from the employment register based on a two-stage cluster sampling procedure. Firstly, 206 municipalities were randomly selected from a pool of 12,227 municipalities in Germany. Secondly, 13,590 addresses were drawn from the selected municipalities for the purpose of conducting 4500 face-to-face interviews. The questionnaire covers psychosocial working and employment conditions, measures of mental health, work ability and functioning. Data from personal interviews were combined with employment histories from register data. Descriptive statistics of socio-demographic characteristics and logistic regressions analyses were used for comparing population, gross sample and respondents. Results: In total, 4511 face-to-face interviews were conducted. A test for sampling bias revealed that individuals in older cohorts participated more often, while individuals with an unknown educational level, residing in major cities or with a non-German ethnic background were slightly underrepresented. Conclusions: There is no indication of major deviations in characteristics between the basic population and the sample of respondents. Hence, S-MGA provides representative data for research on work and health, designed as a cohort study with plans to rerun the survey 5 years after the first assessment. [ABSTRACT FROM AUTHOR]

Disengaged responding poses a severe threat to the validity of educational large-scale assessments, because item responses from unmotivated test-takers do not reflect their actual ability. Existing identification approaches rely primarily on item response times, which bears the risk of misclassifying fast engaged or slow disengaged responses. Process data with its rich pool of additional information on the test-taking process could thus be used to improve existing identification approaches. In this study, three process data variables—text reread, item revisit, and answer change—were introduced as potential indicators of response engagement for multiple-choice items in a reading comprehension test. An extended latent class item response model for disengaged responding was developed by including the three new indicators as additional predictors of response engagement. In a sample of 1,932 German university students, the extended model indicated a better model fit than the baseline model, which included item response time as only indicator of response engagement. In the extended model, both item response time and text reread were significant predictors of response engagement. However, graphical analyses revealed no systematic differences in the item and person parameter estimation or item response classification between the models. These results suggest only a marginal improvement of the identification of disengaged responding by the new indicators. Implications of these results for future research on disengaged responding with process data are discussed. [ABSTRACT FROM AUTHOR]

This paper describes a cross-linguistic production study of devoicing for European Portuguese (EP), Italian, and German. We recorded all stops and fricatives in four vowel contexts and two word positions. We computed the devoicing of the time-varying patterns throughout the stop and fricative duration. Our results show that regarding devoicing behaviour, EP is more similar to German than Italian. While Italian shows almost no devoicing of all phonologically voiced consonants, both EP and German show strong and consistent devoicing through the entire consonant. Differences in consonant position showed no effect for EP and Italian, but were significantly different for German. The height of the vowel context had an effect for German and EP. For EP, we showed that a more posterior place of articulation and low vowel context lead to significantly more devoicing. However, in contrast to German, we could not find an influence of consonant position on devoicing. The high devoicing for all phonologically voiced stops and fricatives and the vowel context influence are a surprising new result. With respect to voicing maintenance, EP is more like German than other Romance languages. [ABSTRACT FROM PUBLISHER]

This paper reports on the prosody of rhetorical questions (RQs) and information-seeking questions (ISQs) in German for two question types—polar questions and constituent questions (henceforth " wh -questions"). The results are as follows: Phonologically, polar RQs were mainly realized with H-% (high plateau), while polar ISQs mostly ended in H-^H% (high-rise). Wh -RQs almost exclusively terminated in a low edge tone, whereas wh -ISQs allowed for more tonal variation (L-%, L-H%, H-^H%). Irrespective of question type, RQs were mainly produced with L*+H accents. Phonetically, RQs were more often realized with breathy voice quality than ISQs, in particular in the beginning of the interrogative. Furthermore, they were produced with longer constituent durations than ISQs, in particular at the end of the interrogative. While the difference between RQs and ISQs is reflected in the intonational terminus of the utterance, this does not happen in the way suggested in the semantic literature, and in addition, accent type and phonetic parameters also play a role. Crucially, a simple distinction between rising and falling intonation is insufficient to capture the realization of the different illocution types (RQs, ISQs), against frequent claims in the semantic and pragmatic literature. We suggest alternative ways to interpret the findings. [ABSTRACT FROM AUTHOR]

Background: The medial patellofemoral ligament (MPFL) has been investigated widely in the past 30 years, resulting in many research achievements in this field. Purpose: To perform a comprehensive bibliometric analysis to evaluate the 100 top-cited articles on the MPFL. Study design: Cross-sectional study. Methods: We searched the Scopus database in December 2022 using the terms "medial patellofemoral ligament" OR "MPFL." The search was confined to English-language articles, including technical notes, systematic reviews on clinical outcomes and/or complications, clinical studies, studies regarding complications, and basic science articles (either cadaveric or biomechanical); we excluded letters, case reports, personal opinions, guidelines, editorials, and narrative or other types of reviews. Analysis of the 100 top-cited articles was performed according to total number of citations, average citations per year (ACY), study type, country of origin, journal of publication, affiliated institution, and most published authors. Results: The total number of citations was 16,358 (range of citations per article, 72-692). The majority of articles were published as clinical studies (54%), with cadaveric studies being the second most common (21%). Most studies originated in the United States (32%), with Japan (15%) and Germany (13%) following. The American Journal of Sports Medicine published the majority of the 100 top-cited articles (37/100; 6304 citations) as well as the 10 top-cited articles according to ACY (7/10; mean, 285.14 citations). The most prolific authors were Nomura (8 articles); Burks (6 articles); and Inoue, Sillanpää, and Dreyhaupt (5 articles each). Conclusion: By analyzing the characteristics of the 100 top-cited articles, this study demonstrated that the MPFL is a growing and popular area of research, with the focus varying through timeline trends. Questions regarding MPFL anatomy, isometry, and biomechanics might have been answered adequately, but research regarding optimal fixation technique under various circumstances is still ongoing. [ABSTRACT FROM AUTHOR]

The paper reports on a perception experiment in German that investigated the neuro-cognitive processing of information structural concepts and their prosodic marking using event-related brain potentials (ERPs). Experimental conditions controlled the information status (given vs. new) of referring and non-referring target expressions (nouns vs. adjectives) and were elicited via context sentences, which did not – unlike most previous ERP studies in the field – trigger an explicit focus expectation. Target utterances displayed prosodic realizations of the critical words which differed in accent position and accent type. Electrophysiological results showed an effect of information status, maximally distributed over posterior sites, displaying a biphasic N400 - Late Positivity pattern for new information. We claim that this pattern reflects increased processing demands associated with new information, with the N400 indicating enhanced costs from linking information with the previous discourse and the Late Positivity indicating the listener’s effort to update his/her discourse model. The prosodic manipulation registered more pronounced effects over anterior regions and revealed an enhanced negativity followed by a Late Positivity for deaccentuation, probably also reflecting costs from discourse linking and updating respectively. The data further lend indirect support for the idea that givenness applies not only to referents but also to non-referential expressions (‘lexical givenness’). [ABSTRACT FROM PUBLISHER]

Early Life Family Care (ELFC) has so far neglected the needs of migrant families, partly due to professionals' lack of transcultural knowledge required to address these specific needs. Simultaneously, migrants face employment barriers, including the non-recognition of qualifications and competences. The EU-funded project addressed both these issues by developing an ELFC mentoring training scheme for migrants, who can use their existing and acquired competences to co-operate with parents in challenging transition phases (e.g. becoming new parents). The article discusses one key pillar of the project: the development of a 'competence profile'. This involved identifying both, ELFC needs of families, which can be addressed by mentoring, as well as the corresponding competences required by mentors. For this purpose, 25 semi-structured interviews with ELFC professionals and migrant parents were conducted. The results show migrant families' need for skilled support in the management of administrative, interface, relationship, participation and boundary issues. [ABSTRACT FROM AUTHOR]

This paper studies the prosodic realization of dual-focus in German, that is, two foci in a single sentence, with special consideration of the interaction between focus assignment and phrasing. In a production experiment, dual-focus was compared with its initial, final, and all-new counterparts in sentences with subject NPs and VPs of different lengths. The results showed that there were three different patterns of dual-focus realization: (1) The most frequent one was the two-peak pattern (57.8%), that is, a falling tone on both focused words and compressed and lowered pitch in-between; (2) the second most frequent was the two-phrase realization (23.5%), in which both foci were also realized as a falling tone, but in this case, a high boundary tone was inserted after the subject NP; (3) the least frequent pattern was the hat-pattern (18.7%), consisting of a rising tone on the first focus and a falling tone on the second one while the pitch in-between is kept as a high plateau. This was applied mostly in utterances containing a short subject NP. We interpret these results in terms of optional prosodic phrasing. A sentence with two foci can be realized in one or two intonation phrases, but in both cases, the focus is assigned within the prosodic domain derived from syntax. These results show that Culminativity, the principle requiring a one-to-one correspondence between prosodic domains and their heads, is violable in German. Two equally prominent pitch accents are allowed to co-exist in one intonation phrase. Finally, the metrical structure of dual-focus speaks for a recursive structure of German prosody. [ABSTRACT FROM AUTHOR]

Previous research suggests that beliefs about inequality are often biased in ways that serve people's own interests. By contrast, people might uphold system-justifying beliefs, such as meritocratic beliefs. We test these assumptions against real-life experience of highly selective university admission. Using panel data on German medical school applicants allows us to measure belief changes through experiences of success or failure in admission. We find support that self-serving bias in beliefs outweighs the motivation for system justification: success strengthens the belief that admission depends on effort, while failure reinforces the belief that admission depends on luck. These patterns partly manifest themselves in beliefs about societal inequality. Additionally, we argue that previous experiences (long-term experiences of social upbringing and short-term experiences in university admissions) provide a frame for new experiences, examine respective effect heterogeneity, and discuss implications of our findings of diverging paths in inequality beliefs of winners and losers for the persistence of inequality. [ABSTRACT FROM AUTHOR]

This paper addresses the impact of dialogue strategies and functional features of spatial arrangements on communicative success. To examine the sharing of cognition between two minds in order to achieve a joint goal, we collected a corpus of 24 extended German-language dialogues in a referential communication task that involved furnishing a dolls' house. Results show how successful communication, as evidenced by correct placement of furniture items, is affected by: (a) functionality of the furniture arrangement; (b) previous task experience; and (c) dialogue features such as description length and orientation information. To enhance research in this area, our 'Dolldialogue' corpus (www.dolldialogue.space) is now available as a free resource. [ABSTRACT FROM AUTHOR]

Background: When performing magnetic resonance imaging (MRI) in patients with a cochlear implant (CI), complication rates vary widely in the literature. The primary objective of this retrospective study was to determine the prevalence of complications, in particular magnet dislocation, in patients with CI undergoing 1.5 Tesla (T) MRI. As a secondary objective, the prevalence of magnet dislocation for specific cochlear implant device types was elaborated. Methods: In a single-center retrospective study, all patients with a cochlear implant presenting for an MRI examination at 1.5 T at our institution between January 1st, 2010 and December 31st, 2020 were included. Implants with axial and diametrical magnets were included in the study. MRI safety measures were applied before imaging. The prevalence of complications was evaluated. Magnet dislocation rates were calculated for device types with at least 20 MRI exposures. Results: During the study period, 196 MRI examinations were performed in a total of 128 patients, accounting for 149 different implants (21 implanted bilaterally) with a total of 231 implant exposures to MRI (average 1.69 ± 1.57; min. 1, max. 12). Complications were reported in 50 out of 231 cochlear implant exposures (21.6%). Magnet dislocation occurred in a total of 27 cases (11.7%). Dislocation rates were 29.6% for the Cochlear® CI500 series (24 dislocations from 81 exposures), 1.1% for the Cochlear® CI24RE series (1 from 87) and 0% for the MED-EL® Synchrony (0 from 36). The dislocation rate for the CI500 was significantly higher than for the CI24RE (χ2(1) = 26.86; p < 0.001; ϕ = 0.40) or the Synchrony (χ2(1) = 13.42; p < 0.001; ϕ = 0.34). Conclusions: For 1.5 T MRI, the risk of magnet dislocation ranges from 0 to 29.6% and depends on the CI device type. Implants with a diametrical magnet can be considered potentially MRI-safe, whereas in CIs with axial magnets, the CI500 is at high risk of magnet dislocation. Therefore, apart from a strict indication for an MRI and adherence to safety protocols, post-MRI follow-up examination to rule out magnet dislocation is recommended. [ABSTRACT FROM AUTHOR]

This study investigates the conceptual argument that constructive and explicit couple communication may reduce gender inequalities in couples' division of family work. We focus on the transition to parenthood which for most couples in Germany results in a shift towards a more traditional division of labour. Using 314 first-time parents from the German Family Panel, we apply growth curve models to assess whether partners' prenatal characteristics explain the division of housework and childcare around the time of childbirth and in the following years. After controlling for gender ideologies and economic resources, male partners' frequency of positive communication is associated with greater father involvement in housework and childcare from the start. However, neither men's nor women's communication behaviours dampen the shift towards a more traditional division of housework and childcare in the first years after childbirth. The frequency of negative communication does not correlate with the division of family work. [ABSTRACT FROM AUTHOR]

Although hate speech is widely recognized as an online phenomenon, very few studies have investigated hate speech among adolescents in offline settings (e.g., schools). At the same time, not much is known about countering hate speech (counterspeech) among adolescents and which factors are associated with it. To this end, the present study used the socio-ecological framework to investigate the direct and indirect links among one contextual factor (i.e., classroom climate) and two intrapersonal factors (i.e., empathy for victims of hate speech, self-efficacy regarding intervention in hate speech) to understand counterspeech among adolescents. The sample is based on self-reports of 3,225 students in Grades 7 to 9 (51.7% self-identified as female) from 36 schools in Germany and Switzerland. Self-report questionnaires were administered to measure classroom climate, empathy, self-efficacy, and counterspeech. After controlling for adolescents' grade, gender, immigrant background, and socioeconomic status (SES), the 2-(1-1)-1 multilevel mediation analysis showed that classroom climate (L2), empathy for victims of hate speech (L1), and self-efficacy toward intervention in hate speech (L1) had a positive effect on countering hate speech (L1). Classroom climate (L2) was also positively linked to empathy for victims of hate speech (L1), and self-efficacy toward intervention in hate speech (L1). Furthermore, classroom climate (L2) was indirectly associated with countering hate speech (L1) via greater empathy (L1) and self-efficacy (L1). The findings highlight the need to focus on contextual and intrapersonal factors when trying to facilitate adolescents' willingness to face hate speech with civic courage and proactively engage against it. [ABSTRACT FROM AUTHOR]

Objectives: In Germany, roughly 8.3 million people are in need of care, but only one-third of them receive state care benefits. The study investigates whether the individual network of a care-seeking person, as well as its resources, interact with health status on the likelihood of accessing formal care services. Methods: German data from the Survey of Health, Ageing and Retirement in Europe (SHARE) from 2015 were used in several Firth logistic regressions with interaction terms. Results: Health limitations are a significant predictor for the probability of receiving formal care benefits. As moderating factors, caregivers from the immediate family as well as caregivers with lower levels of education tend to contribute to an increase in this probability. Discussion: Findings are based on a limited data set and indicate the importance of further research in this area to examine the mechanisms of access to formal care more precisely. [ABSTRACT FROM AUTHOR]

As future employers, nurse managers are in a key position to assess the correspondence between the competence of graduating nursing students and work life demands. The aim of the present study was to assess the competence of graduating nursing students from the perspective of managers, and analyze the factors linked to it. Among European managers in six countries, a cross-sectional survey design with a convenience sample was applied. Data were collected using the Nurse Competence Scale. The study was reported using the STROBE guidelines. Managers (n =538, 65.8%) assessed the level of competence of graduating nursing students as good, but there were statistically significant differences between countries. In a multivariable analysis, managers who had a Doctoral/Master’s degree and were dissatisfied with the nursing program in their country assessed the level of competence as lower. Overall, graduating nursing students seem to meet the competence demands of current work life rather well. Further research is needed to confirm the connection between the managers’ competence assessment and their individual background factors. [ABSTRACT FROM AUTHOR]

Based on the terror management health model (TMHM), we examined the impact of terrorist attacks as reminders of death on implicit alcohol-related attitudes, including the moderating role of conscious death-related thoughts and alcohol-based self-esteem (ABS). With an online experiment (N = 487), we analyzed how thoughts and memories about a recent terrorist attack unconsciously (with a delay task) and consciously (without a delay task) affected implicit alcohol-related attitudes. We found that such thoughts increased the death-thought accessibility. While no main effect of the salience of the terrorist attack on alcohol-related attitudes existed, respondents with low ABS had more positive attitudes, when unconsciously thinking about the attack as compared to the control group. Respondents with high ABS in the delay task had lower alcohol-IAT scores. Overall, this study provides evidence that thoughts about terrorism that can be provoked through media affect alcohol-related attitudes. Such attitudes may cause negative health consequences through health-related decisions. [ABSTRACT FROM AUTHOR]

The voicing contrast is neutralized syllable and word finally in Dutch and German, leading to alternations within the morphological paradigm (e.g., Dutch ‘bed(s)’, be[t]-be[d]en, German ‘dog(s)’, Hun[t]-Hun[d]e). Despite structural similarity, language-specific morphological, phonological and lexical properties impact on the distribution of this alternation in the two languages. Previous acquisition research has focused on one language only, predominantly focusing on children’s production accuracy, concluding that alternations are not acquired until late in the acquisition process in either language. This paper adapts a perceptual method to investigate how voicing alternations are represented in the mental lexicon of Dutch and German 3-year-olds. Sensitivity to mispronunciations of voicing word-medially in plural forms was measured using a visual fixation procedure. Dutch children exhibited evidence of overgeneralizing the voicing alternation, whereas German children consistently preferred the correct pronunciation to mispronunciations. Results indicate that the acquisition of voicing alternations is influenced by language-specific factors beyond the alternation itself. [ABSTRACT FROM AUTHOR]

Objectives: Mothers of young children have been identified as a particularly vulnerable group during the COVID-19 pandemic. We aimed to explore how occupational, psychosocial and partnership-related factors were associated with their self-reported mental well-being during the first COVID-19 wave. Methods: Five hundred fifty participants of the BaBi cohort study (est. 2013, Bielefeld, North-Rhine Westphalia, Germany) were invited to complete an online survey and to take part in email interviews (April–May 2020). With survey data, we assessed self-reported mental well-being through validated instruments (eight-item Patient Health Questionnaire; short version of the Symptom Checklist) and ran linear regression models for occupational, psychosocial and partnership-related factors. We performed content analysis on the interviews' data to further understand the determinants of the women's mental well-being. Results: One hundred twenty-four women participated in the survey; of which 17 also participated in the interviews. A perceived lack of support in childcare was associated with higher levels of depressive symptoms, while having a higher internal locus of control was associated with lower levels. Psychological distress was higher in those reporting lack of emotional or childcare support. Interviews confirmed the interplay of potential stressors and highlighted the difficulties to reconcile different expectations of motherhood. Discussion: Occupational, psychosocial and partner-related factors can act (to varying degree) both as resources and stressors to the self-reported mental well-being of mothers of young children. These impacts took different forms and created opportunities or challenges, depending on specific life circumstances, such as work or family situations, relationships and own psychosocial resources. Although not representative, our study contributes to building the COVID-19 evidence base, delineating the mental health toll of the pandemic on mothers of young children and the factors that contribute to it. [ABSTRACT FROM AUTHOR]

The possible dependency of criterion validity on item formulation in a multicomponent measuring instrument is examined. The discussion is concerned with evaluation of the differences in criterion validity between two or more groups (populations/subpopulations) that have been administered instruments with items having differently formulated item stems. The case of complex item stems involving two stimuli description sentences (double-barreled questions) is thereby compared with the setting where items contained a single sentence. Using empirical data, the latent criterion validity differences are evaluated across three groups that are randomly assigned to conditions characterized by item stems with differing number of stimuli. The results indicate that validity of an instrument can be influenced by the specific way item stem is formulated. Implications for empirical educational, behavioral, and social science research are discussed. [ABSTRACT FROM AUTHOR]

Background: Nosocomial infections represent a serious challenge for healthcare systems worldwide. Adherence to hand hygiene plays a major role in infection prevention and control. These adherence rates can be improved through behaviour tracking innovations. This requires the systems to be widely implemented and accepted. Therefore, both a systematic analysis of the normative issues related and the evaluation of technology acceptance are equally important. Objectives: To explore and describe relevant aspects regarding the acceptance of technology and ethical implications using a tracking device to measure and improve adherence to hand hygiene. Research design: A quantitative study with a descriptive design was performed. Participants and research context: A total of 75 questionnaires were collected in three hospitals in Germany. Acceptance of technology was measured with n = 60 participants (n = 50 nurses; n = 9 physicians; n = 1 not disclosed) and ethical assessment with n = 15 participants (nurses only). Ethical considerations: Ethical approval for this study was obtained from the institutional review board. Findings: The acceptance of technologies improving hygiene in general was good (median = 80.5, interquartile range = 28, range: 0–100). The experience with technologies in general (median = 48.5, interquartile range = 57, range: 0–100) and the acceptance of the specific technology (mean = 82.23, standard deviation = 15.16 (range: 23–138)) was moderate. There was a significant positive correlation between the acceptance and experience of technology in general (r = 0.217, p =.025). Ethical concerns played a minor role. The need for practical support was a key topic. Discussion: Study participants accepted technologies improving hygiene; however, the specific device implemented was only moderately accepted. This creates specific opportunities in the implementation process for higher later acceptance. More practical support and an increase in experience may create opportunities for device implementation with high acceptance and low ethical concerns. Conclusion: Study results indicate a vast potential for improving the implementation process of hand hygiene technologies. Ethical concerns in this study did not seem to be a relevant barrier for successful implementation of hand hygiene technologies. [ABSTRACT FROM AUTHOR]

Recent revelations of the extent of sexual abuse in the Roman Catholic Church in Germany and the United States have once more triggered the debate about sexual abuse. Those inquiries identify cases that are known to authorities or have been recorded in these institutions. However, to assess the full magnitude of the problem, data beyond recorded or known cases are needed, as it can be assumed that a vast number of cases are not reported and are hence not included in such file reviews. Therefore, representative surveys are needed. The aim of the present study was to examine the prevalence of sexual abuse by priests and in different contexts in the German population based on a representative sample. A total of 2,510 participants (54.3% female, M = 48 years) were retrospectively asked about different experiences, offenders, contexts, and so on, of child sexual abuse using questions that were used to assess child sexual abuse in prior surveys and the Childhood Trauma Questionnaire (CTQ). In sum, 0.21% (n = 7) of the participants reported child sexual abuse by a priest or pastor. 0.16% reported child sexual abuse in an institution of the Roman Catholic Church. Results also indicated that victims of sexual abuse by priests and pastors reported rather severe types of sexual abuse based on the CTQ in comparison with other contexts, such as schools. Extrapolating the data for the population, it can be assumed that the estimated number of victims is much higher than those identified by research based on recorded cases. [ABSTRACT FROM AUTHOR]

This article presents data from three production experiments investigating the prosodic means of encoding information structure in Akan, a tone language that belongs to the Kwa branch of the Niger-Congo family, spoken in Ghana. Information structure was elicited via context questions that put target words either in wide, informational, or corrective focus, or in one of the experiments also in pre-focal or post-focal position rendering it as given. The prosodic parameters F0 and duration were measured on the target words. Duration is not consistently affected by information structure, but contrary to the prediction that High (H) and Low (L) tones are raised in ex situ (fronted) focus constructions we found a significantly lower realization of both H and L tones under corrective focus in ex situ and in situ focus constructions. Givenness does not seem to be marked prosodically. The data suggest that pragmatic prominence is expressed prosodically by means of a deviation from an unmarked prosodic structure. Results are thus contradicting the view of the effort code that predicts a positive correlation of more effort resulting in higher F0 targets. [ABSTRACT FROM AUTHOR]

Background: The impact of anterior cruciate ligament reconstruction (ACLR) on the performance and career of professional soccer players has not been extensively investigated. Purpose: To evaluate in professional European soccer players (1) the ACL injury incidence, (2) the return-to-play (RTP) rate and time after ACLR, (3) career survival and athlete performance in the first 3 postoperative seasons after RTP, (4) factors likely related to different outcomes after ACLR, and (5) any related differences between the top 8 European soccer leagues. Study Design: Descriptive epidemiology study. Methods: Included were professional soccer players in the top 8 European Soccer leagues (Serie A [Italy], Premier League [England], Ligue 1 [France], LaLiga [Spain], Bundesliga [Germany], Jupiler Pro League [Belgium], Liga NOS [Portugal], and Premier Liga [Russia]) who sustained an ACL injury during seasons 2014 to 2015, 2015 to 2016, and 2016 to 2017. Data were retrieved from publicly available online sources. Outcomes were evaluated based on player age (<25 years, 25-30 years, and >30 years), position (goalkeeper, defender, midfielder, and forward), affected side (dominant vs nondominant), and league. Results: Overall, 195 players sustained an ACL injury, for a mean annual ACL injury incidence of 1.42%. The RTP rate was 95%, with a mean RTP time of 248 ± 136 days. Within the third postoperative season, 66 players (36%) competed in a lower level national league, and 25 (13.6%) ended their careers; a significant reduction in the mean minutes played per season was found in all 3 postoperative seasons. Player age correlated significantly with reduction in performance or recovery from an ACL injury. No significant correlation was found between postoperative player performance and affected side, position, league, or time to RTP. Conclusion: A substantial ACL injury incidence was found in top European elite soccer players; however, a high RTP rate in a reasonable time was seen after ACLR. Nevertheless, professional soccer players experienced a short-term decline in their performance. [ABSTRACT FROM AUTHOR]

Older adults are often exposed to elderspeak, a specialized speech register linked with negative outcomes. However, previous research has mainly been conducted in nursing homes without considering multiple contextual conditions. Based on a novel contextually-driven framework, we examined elderspeak in an acute general versus geriatric German hospital setting. Individual-level information such as cognitive impairment (CI) and audio-recorded data from care interactions between 105 older patients (M = 83.2 years; 49% with severe CI) and 34 registered nurses (M = 38.9 years) were assessed. Psycholinguistic analyses were based on manual coding (κ =.85 to κ =.97) and computer-assisted procedures. First, diminutives (61%), collective pronouns (70%), and tag questions (97%) were detected. Second, patients' functional impairment emerged as an important factor for elderspeak. Our study suggests that functional impairment may be a more salient trigger of stereotype activation than CI and that elderspeak deserves more attention in acute hospital settings. [ABSTRACT FROM AUTHOR]

If information on single items in the Short Form–12 health survey (SF-12) is missing, the analysis of only complete cases causes a loss of statistical power and, in case of nonrandom missing data (MD), systematic bias. This study aimed at evaluating the concordance of real patient data and data estimated by different MD imputation procedures in the items of the SF-12 assessment. For this ends, MD were examined in a sample of 1,137 orthopedic patients. Additionally, MD were simulated (a) in the subsample of orthopedic patients exhibiting no MD (n = 810; 71%) as well as (b) in a sample of 6,970 respondents representing the German general population (95.8% participants with complete data) using logistic regression modelling. Simulated MD were replaced by mean values as well as regression-, expectation-maximization- (EM-), and multiple imputation estimates. Higher age and lower education were associated with enhanced probabilities of MD. In terms of accuracy in both data sets, the EM-procedure (ICC2,1 =.33-.72) outperformed alternative estimation approaches substantially (e.g., regression imputation: ICC2,1 =.18-.48). The EM-algorithm can be recommended to estimate MD in the items of the SF-12, because it reproduces the actual patient data most accurately. [ABSTRACT FROM AUTHOR]

Although general practitioners (GPs) are often the first contact for patients' sexual issues, little is known about how German GPs approach, diagnose, and treat sexual problems and disorders. Therefore, the present qualitative study explores approaches and management of sexual health issues used by GPs. The sample included 16 GPs from Kiel and surroundings and Sachsen-Anhalt. The in-depth, semi-structured interviews were coded according to the qualitative content analysis by Mayring using MAXQDA. The results revealed 5 main themes, 2 of which are explored in more detail in relation to the study objective (2 and 4): (1) sexual issues that arise in general practice, (2) addressing sexuality, (3) influencing factors in doctor-patient communication about sexuality, (4) diagnosing and treating sexual dysfunctions, and (5) changes in the approach to sexuality over time. Most GPs did not routinely ask their patients about sexual problems. Common barriers included lack of time, suspected embarrassment on both sides, and fear of offending patients. Almost all GPs tended to diagnose sexual problems individually adapted to patients' issues, not following a standardized approach. Medication was offered as the main treatment for sexual problems. For complex disorders, most GPs lack sexual medicine knowledge, and they requested a better range of training courses in sexual medicine. [ABSTRACT FROM AUTHOR]

Small-group interventions allow for tailored instruction for students with learning difficulties. A crucial first step is the accurate identification of students who need such an intervention. This study investigated how teachers decide whether their students need a remedial reading intervention. To this end, 64 teachers of 697 third-grade students from Germany were asked to rate whether a reading intervention for their students was "not necessary," "potentially necessary," or "definitely necessary." Independent experimenters tested the students' reading and spelling abilities with standardized tests, and a subsample of 370 children participated in standardized tests of phonological awareness and vocabulary. Findings show that teachers' decisions with regard to students' needing a reading intervention overlapped more with results from standardized spelling assessments than from reading assessments. Hierarchical linear models indicated that students' spelling abilities, along with phonological awareness and vocabulary, explained variance in teachers' ratings over and above students' reading skills. Teachers thus relied on proximal cues such as spelling skills to reach their decision. These findings are discussed in relation to clinical standards and educational contexts. Findings indicate that the teachers' assignment of children to interventions might be underspecified, and starting points for specific teacher training programs are outlined. [ABSTRACT FROM AUTHOR]

Background: Head and neck cancer (HNC) patients are particularly vulnerable to drug-related problems (DRPs) given the toxicity of concomitant chemoradiotherapy (CCRT). Objective: To investigate the number and type of potential DRPs (pDRPs) in HNC outpatients undergoing five consecutive cycles of CCRT. Methods: A single-centre, non-randomized, non-interventional, observational study was conducted at the Oncological Outpatient Clinic of the Center for Integrated Oncology at the University Hospital Bonn, Germany. Clinical pharmacists took a comprehensive medication history, documented laboratory data, assessed patients' symptom burden, and retrospectively performed medication reviews at study entry and on the first day of each therapy cycle without any clinical intervention. Results: In 26 patients, the mean number of pDRPs continuously increased during therapy course, from 4.8 (SD 2.7, range 2–12) at cycle 1 to 6.9 (SD 2.6, range 2–12) at cycle 5, with drug-drug interactions, adverse drug reactions, inappropriate durations of use, and inappropriate dosage intervals being the most common. Considering only new and recurrent pDRPs, the mean number was 4.3 (SD 2.3, range 2–9) at cycle 1 and lower in the further therapy course with an average of 1.3 (SD 1.7, range 0–7) at cycle 2 and 1.9 (SD 1.5, range 0–5) at cycle 5. The number of pDRPs was found to be associated with medication regimen complexity and health-related quality of life assessed in the first therapy cycle. Conclusion: pDRPs frequently occurred in HNC outpatients demonstrating the need for pharmaceutical care. A methodological framework for repeated medication reviews was established, facilitating implementation into routine healthcare practice. [ABSTRACT FROM AUTHOR]

Background: Comparative effectiveness of different types of palliative homecare is sparsely researched internationally—despite its potential to inform necessary decisions in palliative care infrastructure development. In Germany, specialized palliative homecare delivered by multi-professional teams has increased in recent years and factors beyond medical need seem to drive its involvement and affect the application of primary palliative care, delivered by general practitioners who are supported by nursing services. Aim: To compare effectiveness of primary palliative care and specialized palliative homecare in reducing potentially aggressive interventions at the end-of-life in cancer and non-cancer. Design: Retrospective population-based study with claims data from 95,962 deceased adults in Germany in 2016 using multivariable regression analyses. Settings/participants: Patients having received primary palliative care or specialized palliative homecare (alone or in addition to primary palliative care), for at least 14 days before death, differentiating between cancer and non-cancer patients. Results: Rates of potentially aggressive interventions in most indicators were higher in primary palliative care than in specialized palliative homecare (p < 0.01), in both cancer and non-cancer patients: death in hospital (odds ratio (OR) 4.541), hospital care (OR 2.720), intensive care treatment (OR 6.749), chemotherapy (OR 2.173), and application of a percutaneous endoscopic gastrostomy (OR 4.476), but not for parenteral nutrition (OR 0.477). Conclusion: Specialized palliative homecare is more strongly associated with reduction of potentially aggressive interventions than primary palliative care in the last days of life. Future research should identify elements of specialized palliative homecare applicable for more effective primary palliative care, too. German Clinical Trials Register (DRKS00014730). [ABSTRACT FROM AUTHOR]

There is a lack of intervention promoting physical activity targeted toward people living with dementia because their input has not been prioritized in the development of exercise programs. The aim of this study is to investigate motivators and barriers concerning physical activity in people living with dementia in care homes and to give recommendations for intervention development. Qualitative semi-structured interviews were conducted; transcripts were analyzed using qualitative content analysis. Following a tailored procedural model, inductive and deductive category development was applied. The value of Cohen's κ =.94 indicates the high intercoder reliability of the category system developed. Ten interviewees reported 24 different barriers and 12 motivators concerning physical activity in the context of the social-ecological model. The strong impact of intrapersonal factors and the living environment became apparent. Points of reference for how people living with dementia can overcome barriers and activate their motivators to achieve more physical activity are provided. [ABSTRACT FROM AUTHOR]

Objective: To examine whether robotic-assisted training as a supplement to usual therapy is safe, acceptable and improves function and patient reported outcome after proximal humeral fractures (PHF). Design: Multicentre, assessor-blinded, randomised controlled prospective trial. Setting: Three different rehabilitation hospitals in Germany. Subjects: In total 928 PHF patients between 35 and 70 years were screened. Forty-eight participants were included in the study (intervention group n = 23; control group n = 25). Intervention: The control group received usual occupational and physiotherapy over three weeks, and the intervention group received additional 12 robot-assisted training sessions at the ARMEO®-Spring. Main measures: Disabilities of the Arm, Shoulder and Hand Questionnaire (DASH), the Wolf Motor Function Test-Orthopaedic, active range of motion and grip strength were determined before and after intervention period. The DASH was additionally obtained postal 6 and 13 months following surgery. Results: The mean age of participants was 55 ± 10 years and was similar in both groups (p > 0.05). The change in DASH as the primary endpoint in the intervention group after intervention was −15 (CI = 8–22), at follow-up six month −7 (CI = −2 to 16) at follow up 13 month −9 (CI = 1–16); in control group −14 (CI = 11–18), at follow-up six month −13 (CI = 7–19) at follow up 13 month −6 (CI = −3 to 14). No difference in the change was found between groups (p > 0.05). None of the follow-up time points demonstrated an additional benefit of the robotic therapy. Conclusion: The additional robot-assisted therapy was safe, acceptable but showed no improvement in functional shoulder outcome compared to usual therapy only. [ABSTRACT FROM AUTHOR]

For-profit hospitals' market share has increased in many nations over recent decades. Previous studies suggest that their growth is not attributable to superior performance on access, quality of care, or efficiency. We analyzed other factors that we hypothesized may contribute to the increasing role of for-profit hospitals. We studied the historical development of the for-profit hospital sector across 4 nations with contrasting trends in for-profit hospital market share: the United States, the United Kingdom, Germany, and the Netherlands. We focused on 3 factors that we believed might help explain why the role of for-profits grew in some nations but not in others: (1) the treatment of for-profits by public reimbursement plans, (2) physicians' financial interests, and (3) the effect of the political environment. We conclude that access to subsidies and reimbursement under favorable terms from public health care payors is an important factor in the rise of for-profit hospitals. Arrangements that aligned financial incentives of physicians with the interests of for-profit hospitals were important in stimulating for-profit growth in an earlier era, but they play little role at present. Remarkably, the environment for for-profit ownership seems to have been largely immune to political shifts. [ABSTRACT FROM AUTHOR]

In Germany and elsewhere, few hospital electronic patient record usability surveys are available. Moreover, there seems to be a complete lack of validated instruments in the respective literature. Hence, this study's purpose is to validate a scale for measuring the usability of hospital electronic patient record systems. The data used for the study's analyses (n = 949) were originally obtained during the German national initiative 'Hospital IT User Questionnaire'. In the course of the study, reliability and exploratory factor analyses were conducted and psychometric tests showed a reliable, valid and suitable instrument. Descriptive data analysis suggests a generally low user perception and variances hint at a high potential for future improvements. To our knowledge, this study shows that a general inventory (subscales from the IsoMetrics inventory) can be applied to measuring hospital electronic patient record usability as well. The validated instrument can be used to inform healthcare providers, decision makers and politicians of a given state of usability, discrepancies between different hospitals or systems providers, and serve as a basis for improvements. [ABSTRACT FROM AUTHOR]