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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]

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]

Infants' speech perception is characterized by substantial changes during the first year of life that attune the processing mechanisms to the specific properties of the ambient language. This paper focuses on these developmental changes in vowel perception. More specifically, the emergence and potential cause of perceptual asymmetries in vowel perception are investigated by an experimental study on German 6- and 9-month-olds' discrimination of a vowel contrast that is not phonemic in German. Results show discrimination without any asymmetry in the 6-month-olds but an asymmetrical pattern with better performance when the vowel changes from the less focal to the more focal vowel than vice versa by the 9-month-olds. The results concerning the asymmetries are compatible with the Natural Referent Framework as well as with the Native Language Magnet model. Our results foster two main conclusions. First, bi-directional testing must be mandatory when testing vowel perception. Second, when testing non-native vowel perception, the relation of the stimuli to the native language vowel system has to be considered very carefully as this system impacts the perception of non-native vowels. [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: 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]

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]

The objective of universal health care systems is to achieve equality in the use of health services at the same level of care need. This study evaluates the relationship of socioeconomic position with the frequency of doctor visits in subjects with and without chronic diseases in Germany and Spain. The dependent variables included number of consultations and if a medical consultation occurred. The socioeconomic factors were income and education. The magnitude of the relationship between socioeconomic position and medical consultation frequency was estimated by calculating the percentage ratio using binomial regression and by calculating the difference in consultations by analysis of the covariance, in the case of number of visits. Statistically significant findings according to education were not observed. The percentage ratio in the medical consultations among those with lower and higher income was 1.03 (95% confidence interval [CI] 1.01-2.88) in Germany and 1.11 (95% CI 1.03-1.20) in Spain among subjects with any of the studied chronic conditions. Also, in Germany the difference in the average number of consultations comparing lower income subjects with higher was 3.98 (95% CI 2.40-5.57) in those with chronic conditions. In both countries, there were no differences in the frequency of doctor visits according to education. However, a pro-inequality trend exists in favor of subjects with lower income. [ABSTRACT FROM AUTHOR]

Introduction: Educators require focused training to foster the development of intercultural competence in nurses. Training programs for educators need to be based on a comprehensive profile with a focus on intercultural learning. This study aims to define and validate a profile of the Intercultural Nursing Educator (INE). Method: The Delphi method was used with an iterative, multi-stage process to transform opinions into group consensus. A total of 46 European, African, and American experts from the nursing and intercultural field participated. Inclusion criteria required English at a level of B2, expertise in the field of intercultural competence, experience in teaching intercultural competence in the nursing context, and publications focused on intercultural topics. Results: The INE profile was developed and all 126 competencies were validated. Discussion and conclusion: The profile is freely available on the project website and provides the basis for curricula, training programs and assessment of the required competences. [ABSTRACT FROM AUTHOR]

Background: Worldwide migration represents a major challenge of the 21st century. Despite the strong association between acculturation and mental health, research findings on underlining mechanisms remain inconsistent. Prior research urges to investigate sample characteristics in a more structured manner. Aims: The purpose of this study was to systematically investigate factors impacting acculturation and depressive symptoms in a large, not exclusively clinical, sample of Vietnamese migrants in Germany. Method: This study investigated, with multiple regressions, factors (age at arrival, gender, education, religiousness, language skills, residence status, economic status, occupational status, migration motivation, duration of stay, and depressive symptoms) impacting the two dimensions of acculturation, dominant society immersion (DSI) and ethnic society immersion (ESI), in a not exclusively clinical sample (n = 582) of first-generation Vietnamese migrants in Germany. Further, this study examined the relationship between depressive symptoms, DSI and ESI with correlations and acculturation strategies with an ANOVA. Results: Integration (72.5%) was the most common acculturation strategy, followed by separation (26.8%). In contrast, assimilation (0.5%) and marginalization (0.2%) were very rare acculturation strategies. As predictive factors for DSI lower depressive symptoms scores, male gender, higher education, and better German language skills were found significant. For ESI, less German language skills and older age at arrival were found to be significant. Higher ESI and DSI were correlated to lower depressive symptom scores. Compared to the three other acculturation strategies, integration was linked to the lowest depressive symptoms scores. Conclusions: The current study identified crucial factors in the acculturation process, such as depressive symptoms, language skills, education, gender, and age at arrival. Our findings emphasize that immersion into both the dominant and the ethnic culture plays an essential supportive role in the mental health of migrants. [ABSTRACT FROM AUTHOR]

Hemophilia is a bleeding disorder caused by a single absent/defective gene and characterized by a lack of functional clotting factors. People with hemophilia may experience joint damage, pain, and psychological impairments, all of which could contribute to reduced health-related quality of life (HRQoL). The current standard of care is clotting factor replacement, which is associated with regular infusions; therefore, alternative treatments such as gene therapy (GT) are in development. GT involves the delivery of a functional copy of the clotting factor 8/9 gene by a single infusion into the patient's cells, enabling them to produce their own clotting factor VIII/IX. The impact of treatment on patients' HRQoL can be assessed using hemophilia-specific patient-reported outcome (PRO) measures. Since these measures were designed before the advent of GT, there is a need for updated individualized PRO measures. Patient groups and regulatory authorities emphasize the need for increased patient engagement when considering clinical trial design. Here, we provide patients' perspective on undergoing GT and discuss how to capture the patient voice when measuring the therapy's transformative impact. [ABSTRACT FROM AUTHOR]

International migration of couples is rising. Still, there is little evidence on men's and women's domestic work hours before and after migration. This is despite the fact that domestic work provides deep insights into family life and, for migrants, is directly linked to integration. Therefore, this study examines how immigrant men and women change their domestic work hours following migration, using data from the German Socio-Economic Panel (SOEP). Our results show that domestic work hours increase for both genders after immigration. However, men are more responsible for running errands than women in the first years after migration. In the long term, the gender gaps return to the pre-migration state, with women shouldering a greater load than men. Accordingly, this study shows that migration only has a short-term impact on couples' division of domestic 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]

Background: Patient-reported outcome measures have the potential to improve outcomes, quality, and effectiveness of care. Digital use of patient-reported outcome measures could be an option to foster implementation in palliative care. The Palli-MONITOR study focused on developing and testing an electronic patient-reported outcome measure in specialised palliative home care. As part of this study, we examined setting-specific challenges for the development of the measure. Aim: We aimed to identify and explore challenges for the development of electronic patient-reported outcome measures as standardised assessment in specialised palliative home care. Design: Qualitative approach with semi-structured interviews and focus groups. Data were thematically analysed using the framework method. Setting/Participants: Patients and professionals from five German palliative home care teams. Results: Patients described potential problems in using electronic questionnaires due to their deteriorating health. Answering the electronic questionnaire encouraged patients to reflect on their current palliative situation, which was partly perceived as burdensome. Identified concerns and questions regarding the future roll-out of electronic patient-reported outcome measurement addressed the process of receiving and using the provided information in clinical care routine. Challenging factors on organisational and structural level were the potential undermining of the established 24-h emergency call system and the potential use for patients. Conclusions: Our results provide a multifaceted picture of challenges developing electronic systems for patient-reported outcome measurement in palliative home care on the individual and organisational level. The study underpins the benefit of stakeholder involvement creating digital health innovations and emphasises the importance to therefore mind setting specific culture. [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]

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]

Working time regimes in platform labour are so far either ignored as a topic in research on gig work, or they are framed as an allocative instrument only. This article argues that working time regimes instead have both a coordinating and controlling effect. Adopting the analytical framework of labour process theory, the article hence focuses on the interrelation of working time and control regimes. The empirical material presented stems from research on platform-based food courier work in Germany and is based on a mixed methods research design consisting of interviews, multi-sited ethnography and a survey. The findings show that platforms implement hybrid control regimes that are not only based on the sufficiently analysed algorithmic management, but also on complementary control through working time regimes: temporal control. Platforms organise intra-platform markets where workers compete for shifts by means of performance. Thus, platforms are able to ensure an efficient and simultaneously reliable use of an autonomous and spatially distributed workforce. Furthermore, it is shown that platform labour is not placeless, either. The effects of its control regime vary according to different local conditions. As a result, platforms cannot be analysed only as techno-cultural ecosystems, but also as local-specific socio-economic structures. [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]

Background: Ethical decision-making confidence develops from clinical expertise and is a core competency for nurse leaders. No tool exists to measure confidence levels in nurse leaders based upon an ethical decision-making framework. Aims: The objective of this research was to compare ethical decision-making among nurse leaders in the U.S. and three German-speaking countries in Europe by developing and testing a newly constructed Ethical Decision-Making Confidence (EDMC) scale. Methods: The cross-sectional survey included 18 theory-derived questions on ethical decision-making confidence which were used to develop the scale. Participants: A convenience sample of nurse leaders from the U.S. and three German-speaking countries in Europe who self-identified as holding a leadership position. Ethical Considerations: Ethical approval was given by the IRB Board of a U.S. university. Participation in the survey implied voluntary consent. Results: The scale's item structure dimensionality and subscale's reliability were analyzed and compared between nurse leaders from all four countries. A principal component analysis (PCA) produced a 15-item bi-dimensional EDMC scale yielding a skill-related (9-item) and a behavior-related (6-item) confidence dimension. EDMC subscales showed good-to-excellent internal consistency. In both subscales, U.S. nurse leaders rated their mean EDMC score higher than their German-speaking counterparts in Europe. Discussion: This exploratory study is the first of its kind to focus on nurse leaders' confidence regarding ethical decision-making in an international context. An overarching factor structure was identified, which is shared by the two samples of nurse leaders and to examine (sub)scales' psychometric properties. Conclusion: This newly developed scale is an effective tool for measuring ethical decision-making confidence in nurse leaders. The promising results of this study should be replicated to ensure validity and reliability of the EDMC scale measuring skill-related and behavior-related concepts and include nurse leaders from various cultural, social, and demographic groups. [ABSTRACT FROM AUTHOR]

This study explored the role that cross-country disability policy differences play in shaping individuals' work limitation reporting styles. We used anchoring vignettes available in comparable U.S. and European survey data to test and adjust for reporting differences in self-reported work limitation measures. We found that disability policy generosity scores showed statistically significant predictive power for respondents' work limitation classification scales, with the association stronger and more statistically significant at the lower end and the middle of the scale. That is, respondents under more generous disability regimes tended to apply a more inclusive (i.e., lenient) scale in classifying a mild, moderate, or severe work limitation. Because there is no natural interpretation of the magnitude of the correlation, we conducted counterfactual policy simulations to illustrate the strength of the association; for example, if the United States were to adopt more generous disability policies such as those in Sweden, there might be an associated increase of more than 36 percentage points in the proportion of Americans age 50 years and above reporting work limitation (of any severity). This research contributes to a better understanding of the role of disability policy in reporting heterogeneity in comparative disability research, an area that has been seldom studied. [ABSTRACT FROM AUTHOR]

Grandiose narcissism is a multidimensional construct consisting of agentic and antagonistic aspects with markedly distinct correlates and consequences. However, this complexity has not been reflected in how grandiose narcissism is measured and investigated in forensic contexts. To provide a more nuanced picture of narcissism in a forensic context, we harnessed the Narcissistic Admiration and Rivalry Concept. More precisely, we investigated the psychometric properties of the Narcissistic Admiration and Rivalry Questionnaire–Short Scale (NARQ-S) in self- and informant reports of 199 male prisoners. Results confirmed the two-dimensional structure, acceptable internal consistency, moderate self-other agreement, and a differentiated nomological network for the NARQ-S. Admiration and rivalry showed distinct associations with criminal history, institutional misbehaviors, and social status in the group of prisoners. Together, the findings provide initial evidence for the validity and utility of self- and informant reports of the NARQ-S in forensic contexts and its contribution to security and treatment recommendations. [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]

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]

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]

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]

The COVID-19 pandemic affected individuals, governments, and health care centers all around the globe. Social isolation obligation, restricted working shifts, and curfews posed unprecedented challenges for the population. Social isolation, boredom, and financial problems have been shown to stress peoples' mental health in previous comparable pandemics and even in regular situations. Individuals with a mental illness may particularly be at risk due to an already instable mental health status. While research mainly focused on the pandemic's impact on somatic health care and risk group patients, psychological obstacles caused by legal restrictions and their impact on already mentally affected individuals have been discussed, but so far only scarcely been investigated in a large sample. For this study, 12,028 people completed an online-survey during that time in Germany, when the COVID-19 outbreak gained momentum with a surge in cases and death rates as well as a lockdown of the public life. Generalized anxiety (GAD-7), depression (PHQ-2), distress (distress thermometer) and COVID-19-specific items, especially COVID-19-related fear, were assessed in healthy individuals, patients suffering from mental illnesses, and in patients with chronic somatic diseases, known to be at risk for an unfavorable course of COVID-19. Results show that the COVID-19-pandemic significantly worsens psychometric scores throughout the population – individuals with already heightened levels, like people with mental illnesses now reach concerning levels. Surprisingly, even though generalized anxiety, depressive symptoms, and perceived distress are elevated in individuals with mental illness, these individuals seem to be less affected by explicit COVID-19-related fear, than the general population or individuals with chronic somatic diseases. This study thus objectively quantifies the psychological impact of COVID-19 in a large sample and provides evidence for not only the public, but also critically affected individuals with a mental illness. [ABSTRACT FROM AUTHOR]

This investigation concentrates on value similarity between parents and their children during adulthood. The interplay between gender, age, relationship quality, and frequency of contact on value similarity was analyzed. A total of 600 adult German children (53.8% women) and their parents took part in a questionnaire study. Value orientation was measured with a short version of Schwartz's Portrait Values Questionnaire, and relationship quality with the Network of Relationships Inventory (Furman & Buhrmeister, 1992).Value similarity was higher in mother–daughter dyads compared to mother–son dyads, but in the other dyads, no significant differences were found. Regarding relationship quality, verbal intimacy was not related to value similarity. Parental satisfaction was associated with value similarity in the father–child dyads. Satisfaction, as perceived by adult children, was linked to value similarity in mother–child and father–son dyads. Furthermore, the frequency of contact related to value similarity between mothers and sons. [ABSTRACT FROM AUTHOR]

Ecological momentary assessment (EMA) was used in 24 adults with mild-to-moderate hearing loss who were seeking first hearing-aid (HA) fitting or HA renewal. At two stages in the aural rehabilitation process, just before HA fitting and after an average 3-month HA adjustment period, the participants used a smartphone-based EMA system for 3 to 4 days. A questionnaire app allowed for the description of the environmental context as well as assessments of various hearing-related dimensions and of well-being. In total, 2,042 surveys were collected. The main objectives of the analysis were threefold: First, describing the "auditory reality" of future and experienced HA users; second, examining the effects of HA fitting for individual participants, as well as for the subgroup of first-time HA-users; and third, reviewing whether the EMA data collected in the unaided condition predicted who ultimately decided for or against permanent HA use. The participants reported hearing-related disabilities across the full range of daily listening tasks, but communication events took the largest share. The effect of the HA intervention was small in experienced HA users. Generally, much larger changes and larger interindividual differences were observed in first-time compared with experienced HA users in all hearing-related dimensions. Changes were not correlated with hearing loss or with the duration of the HA adjustment period. EMA data collected in the unaided condition did not predict the cancelation of HA fitting. The study showed that EMA is feasible in a general population of HA candidates for establishing individual and multidimensional profiles of real-life hearing experiences. [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]

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]

Introduction: The prevalence of cancer diseases among migrants is lower relative to nonmigrants, although this equalizes with increasing duration of residence. There are differences in the health behaviors and disease coping strategies between these two groups. The aim of this analysis is to compare migrant and nonmigrant colorectal cancer (CRC) patients in Germany regarding their sources of support and information during disease. Method: Data from 522 CRC patients, collected through a survey about satisfaction with care, were analyzed by descriptive and multivariate statistics. Results: Migrants and nonmigrants differed in two aspects: Migrants reported to receive the most relevant support during disease more often by nonmedical people, compared with nonmigrants, and they favored videos explaining the therapeutic steps of CRC more than nonmigrants. Discussion: Anticipating which types of support and information sources patients will access during their disease may help guide future diversity management across the field of cancer care. [ABSTRACT FROM AUTHOR]

Against the background of different psychological conceptualizations of hope, this article elaborates and validates a measure to assess hope as perceived by the general public adapting it from the hope and optimism subscale of the World Health Organization Quality of Life Spirituality, Religion and Personal Beliefs Questionnaire. The results presented here are part of a yearly Internet-based cross-sectional survey in Germany and Switzerland called Hope-Barometer, from which 4 samples of 3 different years with about 17,500 participants have been used. Following the results of exploratory and confirmatory factor analyses as well as convergent validity, discriminant value, and predictive utility, our findings suggest that the six items of the resulting Perceived Hope Scale exhibits robust psychometric properties, and that perceived hope is distinct and broader than dispositional hope, in which it relates not only to cognitive but also to spiritual, religious, and altruistic dimensions. [ABSTRACT FROM AUTHOR]

This study investigated the relationship between imitation and both the perception and production abilities of second language (L2) learners for two non-native contrasts differing in their expected degree of difficulty. German learners of English were tested on perceptual categorization, imitation and a word reading task for the difficult English /ɛ/-/æ/ contrast, which tends not to be well encoded in the learners' phonological inventories, and the easy, near-native /i/-/ɪ/ contrast. As expected, within-task comparisons between contrasts revealed more robust perception and better differentiation during production for /i/-/ɪ/ than /ɛ/-/æ/. Imitation also followed this pattern, suggesting that imitation is modulated by the phonological encoding of L2 categories. Moreover, learners' ability to imitate /ɛ/ and /æ/ was related to their perception of that contrast, confirming a tight perception-production link at the phonological level for difficult L2 sound contrasts. However, no relationship was observed between acoustic measures for imitated and read-aloud tokens of /ɛ/ and /æ/. This dissociation is mostly attributed to the influence of inaccurate non-native lexical representations in the word reading task. We conclude that imitation is strongly related to the phonological representation of L2 sound contrasts, but does not need to reflect the learners' productive usage of such non-native distinctions. [ABSTRACT FROM AUTHOR]

The Healthy Cities Network (HCN) of the WHO seems to be an effective approach to introduce innovative ideas into the healthcare sector. It is a knowledge-based network and at the same time a learning network. Within literature, communication is carved out as an essential precondition for such organisational learning. Still, there exists no study that explicitly focusses on the communication processes of the HCN Germany. The aim of this study is to get first insights into such communication processes and the information flow within the HCN Germany and to analyse these with respect to the processes of inter-organisational learning. An online questionnaire was sent to all member institutions of the HCN Germany. The questionnaire analysed the communication between the member cities and also between the member cities and the other institutions of the HCN Germany. Furthermore, the efficiency and the outcome of the communication and information exchange is evaluated. The evaluation showed that the communication and the exchange of information within the network is rated rather good and that there is transfer as well as the sharing of knowledge. So far joint learning processes between the network members and also between the member cities and the other institutions of the HCN Germany are lacking. For the further development of the network and the development of the network as a learning organisation there should be also joint learning processes, which means the cooperation between the network members and the other network institutions should be deepened. [ABSTRACT FROM AUTHOR]

Objective Although effective Balint leadership is viewed as essential for good Balint practice, nearly no quantitative research is available regarding the importance of the person of the group leader in Balint group outcome. This study aims to identify Balint group leaders' impact on "typical Balint" learning processes in Balint groups. Method A total of 1460 medical doctors in 352 Balint groups in Germany, Austria, and Switzerland were investigated. Based on the three learning dimensions of the Balint Group Session Questionnaire, statistical analyses were conducted to identify differential effectiveness in Balint leadership. Results On the basis of the mean scores of the Balint Group Session Questionnaire items across all group participants of each group leader, the 80 certified Balint group leaders were clustered into two groups of more and less effective leaders by a hierarchichal cluster analysis. Mixed model analyses revealed that the effectiveness of the person of the Balint group leader was the most predictive factor for learning effects. Conclusions Training for Balint group leaders should take into account that effective learning processes in Balint groups are strongly related not only to the method itself but also to the person of the group leader. [ABSTRACT FROM AUTHOR]

A patient's perception of the service provided by a health care provider is essential for the successful delivery of health care. This study examines the value created by community pharmacies—defined as perceived customer value—in the prescription drug market through varying elements of service quality. We develop a path model that describes the relationship between service elements and perceived customer value. We then analyze the effect of perceived customer value on customer satisfaction and loyalty. We use data obtained from 289 standardized interviews on respondents' prescription fill in the last six months in Germany. The service elements personal interaction (path coefficient: 0.31), physical aspect (0.12), store policy (0.24), and availability (0.1) have a positive significant effect on perceived customer value. Consultation and reliability have no significant influence. We further find a strong positive interdependency between perceived customer value, customer satisfaction (0.75), and customer loyalty (0.71). Thus, pharmacies may enhance customer satisfaction and loyalty if they consider the customer perspective and focus on the relevant service elements. To enhance benefit, personal interaction appears to be most important to address appropriately. [ABSTRACT FROM AUTHOR]

Aims: Applying a gender- and age group-sensitive approach, we investigated the effect of labour-market transitions (job loss and re-employment) on subjective physical and mental health. Methods: A combination of the difference-in-differences approach and propensity score matching controls for selectivity and initial health differences. This allowed us to analyse the causal effect of job loss and re-employment on subjective health. We made use of data from the German Panel Study Labour Market and Social Security and combined survey information with administrative records of the Federal Employment Agency for employed and unemployed men and women 31–60 years of age (n = 2213). We controlled for labour-market experiences before the time period under study and for labour-market transitions between the interviews. Subjective health was assessed using the SF-12 health questionnaire, enabling us to differentiate between subjective mental and physical health functioning. Results: We found that physical health was affected mainly in older persons between 45 and 60 years old. Controlling for covariates using propensity score matching, mental health was affected only when living-wage jobs (i.e. jobs that provide sufficient income to achieve a defined minimum standard of living above the social benefit level) are gained or lost. Younger women showed a significant improvement in mental health after re-employment. In contrast, job loss affected only older individuals’ mental health, with a particularly negative effect observed for men. Conclusions: Our results not only showed that women and men are affected differently by job loss and re-employment, but also that age is an important factor. Older men were affected most severely by job loss, whereas re-employment was found to improve mental health only in women aged 31–44 years. It is therefore important to address the health problems of different socio-demographic groups separately, and to apply active labour-market policies with regard to unemployed men and women with health impairments. Based on our results, we suggest the promotion of employment with income levels above the maximum welfare benefit award. [ABSTRACT FROM AUTHOR]

Objectives: To translate the PROMIS Physical Function (PF) item bank version 1.2 into German and to investigate psychometric properties of resulting full bank and seven derived short forms. Design: Cross-sectional psychometric study. Setting: Inpatient and outpatient clinics of the Department of Psychosomatic Medicine at Charité–Universitätsmedizin Berlin, Germany. Subjects: A total of 10 adult patients with various chronic diseases participated in cognitive debriefing interviews. The final item bank was administered to n = 266 adult patients with a broad range of medical conditions. Interventions: Patient-reported outcome assessment as part of routine care. Main measures: PROMIS v1.2 PF bank; MOS SF-36 PF scale (PF-10). Results: Cross-cultural adaptation of the item bank followed established guidelines. For the final German translation, the corrected item-total correlations ranged from 0.44 to 0.84. Cronbach’s alpha was high for each PROMIS PF short form (α = 0.88–0.96). The full PROMIS PF bank and most short forms correlated highly with the SF-36 PF-10 (r = 0.85–0.90), with the exception of PROMIS Upper Extremity (r = 0.64). PROMIS Upper Extremity showed ceiling effects and lower agreement with the full bank than other short forms. Unidimensionality was supported for all PROMIS PF measures using traditional factor analysis and nonparametric item response theory. Conclusion: The German PROMIS PF bank was found to be conceptually equivalent to the English version and fulfilled the psychometric requirements for use of short forms in clinical practice. Future studies should pay particular attention to samples with upper extremity functional limitations to further investigate the dimensional structure of PF as conceptualized according to PROMIS. [ABSTRACT FROM AUTHOR]

Background/aim: Palliative care is based on multi-professional team work. In this study, we investigated how cleaning staff communicate and interact with seriously ill and dying patients as well as how cleaning staff cope with the situation of death and dying. Design: Sequential mixed methods, consisting of semi-structured interviews, focus groups, and a questionnaire. Interviews and focus group discussions were content analyzed and results were used to create a questionnaire. Quantitative data were submitted to descriptive analysis. Setting: Large university clinic in southern Germany. Participants: A total of 10 cleaning staff participated in the interviews and 6 cleaning staff took part in the focus group discussion. In addition, three managerial cleaning staff participated in a separate focus group. Questionnaires were given to all cleaning staff (n = 240) working at the clinic in September 2008, and response rate was 52% (125/240). Results: Cleaning staff described interactions with patients as an important and fulfilling aspect of their work. About half of participants indicated that patients talk with them every day, on average for 1–3 min. Conversations often revolved around casual topics such as weather and family, but patients also discussed their illness and, occasionally, thoughts regarding death with cleaning staff. When patients addressed illness and death, cleaning staff often felt uncomfortable and helpless. Conclusion: Cleaning staff perceive that they have an important role in the clinic—not only cleaning but also supporting patients. Likewise, patients appreciate being able to speak openly with cleaning staff. Still, it appears that cleaning staff may benefit from additional training in communication about sensitive issues such as illness and death. [ABSTRACT FROM AUTHOR]

Objective: To develop and validate parallel short forms for the assessment of general anxiety in cardiovascular rehabilitation patients, that facilitate repeated measurement over time without contamination from residual practice effect variance. Design: Development of the parallel short forms using Rasch analysis. Validation study. Setting: Cardiac rehabilitation centres in Germany. Subjects: Cardiovascular rehabilitation patients. Interventions: Not applicable. Main measures: Parallel short forms PaSA-cardio, Hospital Anxiety and Depression Scale, Short Form Health Survey SF-12 and Structured Clinical Interview for DSM-IV Axis I Disorders. Results: Each version of the parallel short forms (PaSA-cardio-I and PaSA-cardio-II) comprises ten items. The two forms fitted to the Rasch model with a non-significant item–trait interaction (PaSA-cardio-I: chi-square = 39.49, degrees of freedom = 30, probability = 0.12; PaSA-cardio-II: chi-square = 26.56, degrees of freedom = 30, probability = 0.65). Person-separation reliability was 0.75/0.76. Unidimensionality could be verified. Correlation between the two models was 0.94 and 0.95, and correlations with the underlying item bank were 0.95 and 0.93. Validity could be confirmed. The area under the curve was between 0.88 and 0.97 for PaSA-cardio-I and between 0.92 and 0.95 for PaSA-cardio-II. Conclusions: Assessment of general anxiety in cardiovascular rehabilitation patients with the PaSA-cardio was valid, economical and accurate. The two forms of the PaSA-cardio are equivalent and allow retest without contamination from residual practice effect variance. [ABSTRACT FROM AUTHOR]

Background: Decisions about medical indication are a relevant problem in pediatrics. Difficulties arise from the high prognostic uncertainty, the decisional incapacity of many children, the importance of the family, and conflicts with parents. The objectivity of judgments about medical indication has been questioned. Yet, little is known about the factors pediatricians actually include in their decisions. Aim: Our aims were to investigate which factors pediatricians apply in deciding about medical indication, and how they manage conflicts with parents. Design: We performed a qualitative focus group study with experienced pediatricians. The transcripts were subjected to qualitative content analysis. Setting/participants: We conducted three focus groups with pediatricians from different specialties caring for severely ill children/adolescents. They discussed life-sustaining treatment in two case scenarios that varied according to diagnosis, age, and gender. Results: The decisions about medical indication were based on considerations relating to the individual patient, to the family, and to other patients. Individual patient factors included clinical aspects and benefit–burden considerations. Physicians’ individual views and feelings influenced their decision-making. Different factors were applied or weighed differently in the two cases. In case of conflict with parents, physicians preferred solutions aimed at establishing consensus. Conclusion: The pediatricians defined medical indication on a case-by-case basis and were influenced by emotional reasoning. In contrast to prevailing ethico-legal principles, they included the interests of other persons in their decisions. Decision-making strategies should incorporate explicit discussions of social aspects and physicians’ feelings to improve the transparency of the decision-making process and reduce bias. [ABSTRACT FROM AUTHOR]

Objective: To compare the efficacy of intensive daily applied progressive group therapy task training with equally dosed individual progressive task training on self-reported mobility for patients with moderate to severe stroke during inpatient rehabilitation. Design: Randomized controlled clinical trial. Setting: In-patient rehabilitation center. Subjects: A total of 73 subacute patients with stroke who were not able to walk without physical assistance at randomisation. Interventions: Patients were allocated to group therapy task training (GT) or individual task training (IT). Both interventions were intended to improve walking competency and comprised 30 sessions of 90 minutes over six weeks. Main measures: Primary outcome was the mobility domain of the Stroke Impact Scale (SIS-3.0). Secondary outcomes were the other domains of SIS-3.0, standing balance, gait speed, walking distance, stair climbing, fatigue, anxiety and depression. Results: No adverse events were reported in either arm of the trial. There were no significant differences between groups for the SIS mobility domain at the end of the intervention (Z= −0.26, P = 0.79). No significant differences between groups were found in gait speed improvements (GT:0.38 ±0.23; IT:0.26±0.35), any other gait related parameters, or in non-physical outcomes such as depression and fatigue. Conclusion: Inpatient group therapy task training for patients with moderate to severe stroke is safe and equally effective as a dose-matched individual task training therapy. Group therapy task training may be delivered as an alternative to individual therapy or as valuable adjunct to increase time spent in gait-related activities. [ABSTRACT FROM AUTHOR]

Background: The Integrated Palliative care Outcome Scale is a newly developed advancement of the Palliative care Outcome Scale. It assesses patient-reported symptoms and other concerns. Cognitive interviewing is recommended for questionnaire refinement but not adopted widely in palliative care research. Aim: To explore German- and English-speaking patients’ views on the Integrated Palliative care Outcome Scale with a focus on comprehensibility and acceptability, and subsequently refine the questionnaire. Methods: Bi-national (United Kingdom/Germany) cognitive interview study using ‘think aloud’ and verbal probing techniques. Interviews were audio-recorded, transcribed verbatim and analysed using thematic analysis and pre-defined categories. Results from both countries were collated and discussed. The Integrated Palliative care Outcome Scale was then refined by consensus. Setting/participants: Purposely sampled patients from four palliative care teams in palliative care units, general hospital wards and in the community. Results: A total of 15 German and 10 UK interviews were conducted. Overall, comprehension and acceptability of the Integrated Palliative care Outcome Scale were good. Identified difficulties comprised the following: (1) comprehension problems with specific terms (e.g. ‘mouth problems’) and length of answer options; (2) judgement difficulties, for example, due to the 3-day recall for questions; and (3) layout problems. Combining the results from both countries (e.g. regarding ‘felt good about yourself’) and discussing them from both languages’ perspectives resulted in wider consideration of the items’ meaning, enabling more detailed refinement. Conclusion: Cognitive interviewing proved valuable to increase face and content validity of the questionnaire. The concurrent approach in two languages – to our knowledge the first such approach in palliative care – benefited the refinement. Psychometric validation of the refined Integrated Palliative care Outcome Scale is now underway. [ABSTRACT FROM AUTHOR]

Count data arise in numerous fields of interest. Analysis of these data frequently require distributional assumptions. Although the graphical display of a fitted model is straightforward in the univariate scenario, this becomes more complex if covariate information needs to be included into the model. Stratification is one way to proceed, but has its limitations if the covariate has many levels or the number of covariates is large. The article suggests a marginal method which works even in the case that all possible covariate combinations are different (i.e. no covariate combination occurs more than once). For each covariate combination the fitted model value is computed and then summed over the entire data set. The technique is quite general and works with all count distributional models as well as with all forms of covariate modelling. The article provides illustrations of the method for various situations and also shows that the proposed estimator as well as the empirical count frequency are consistent with respect to the same parameter. [ABSTRACT FROM AUTHOR]

This study examines the connection of love styles with relationship satisfaction on the basis of cross-cultural research, including Bosnia, Germany, Romania, Russia, and German immigrants from Russia and Turkey. Love styles include romantic love, friendship love, game-playing love, possessive love, altruistic love, and pragmatic love. The validation of the measurement model across cultural groups was successful because partial measurement invariance was secured, which allows for the application of correlation, regression, and path analysis. Results indicate that the effects of love styles on relationship satisfaction were consistent across cultures with the exception of game-playing love that negatively predicted relationship satisfaction for Germans, Romanians, and Turkish migrants but not for Bosnians, Russians, and Russian migrants. In addition, cultural variation occurred with respect to the strength of the associations. The implications of these findings are discussed in relation to universality and cultural relativity. In general, the effect of love styles on well-being turned out to be manifold. [ABSTRACT FROM AUTHOR]

The idea of an existential threat caused by the awareness of mortality has been rarely investigated within coping research. The study explores relationships between coping strategies and attitudes toward dying and death in a sample of German adults aged 20 to 93 years. Participants responded to a Stress Coping Inventory and a questionnaire for the multidimensional assessment of attitudes toward dying and death. Pearson correlations for men, women, and the young and old age-groups confirm the expectation that attitudes toward dying and death are mainly associated with disengagement and accommodative coping. Gender- and age-specific findings refer to drug intake and aggression. Results are discussed within both a coping and a thanatological frame of reference and issues for future research are outlined. [ABSTRACT FROM AUTHOR]

The article investigates the information-seeking behaviour of German patients who received planned care abroad. Topics include provisions on cross-border patient mobility of Directive 2011/24/EU of the European Union (EU). Also mentioned are Techniker Krankenkasse, a major German sickness fund, carrying a postal survey as well as the influence of certain predictors on whether Geman patients informed themselves before traveling for care being investigated using multiple logistic regression.