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

Introduction: Regular moderate‐to‐vigorous physical activity (MVPA) is associated with improved mental health, but the evidence for the effect of reducing sedentary behavior (SB) or increasing light PA (LPA) in older adults is lacking. Using isotemporal substitution (IS) models, the aim of this paper was to investigate the effect of substituting SB with LPA or MVPA on associations with mental health in older adults. Methods: Data from 1360 older adults (mean age 75.18 years) in four countries were utilized. PA and SB was measured using ActiGraph wGT3X‐BT + accelerometers worn for 7 days. Self‐rated mental health was measured using the Hospital and Anxiety Depression Scale (HADS). IS models estimated cross‐sectional associations when 30 minutes of one behavior was substituted with another. Models were adjusted for age, sex, marital status, and educational attainment. Results: Substituting 30 minutes of SB with LPA (β −.37; 95% CI −0.42, −0.32) or MVPA (β −.14; 95% CI −0.21, −0.07) and substituting LPA with MVPA (β −.11; 95% CI −0.18, −0.04) were associated with improvements in anxiety. However, substituting 30 minutes of SB with LPA (β.55; 95% CI 0.49, 0.62) was associated with increased depression. Conclusion: Replacing 30 minutes of SB with LPA or MVPA was associated with improved anxiety symptoms in older adults. Greater benefits were observed when shifting SB and LPA to MVPA. [ABSTRACT FROM AUTHOR]

Objectives The epidemiology of periodontitis regarding oral-hygiene practices particularly the frequency of tooth brushing has been the subject of relatively few dedicated studies. This paper provides a systematic review of available relevant epidemiological studies and a meta-analysis of the effect of tooth brushing frequency on periodontitis. To review and to quantify the risk for periodontitis associated with frequency of tooth brushing. Methods Systematic literature search was conducted in nine online resources ( PUBMED, ISI and 7 additional databases). Related and cross-referencing publications were reviewed. Papers published until end of March 2013 reporting associations between tooth brushing frequency and periodontitis were considered. A meta-analysis was performed to quantify this association. Results Fourteen studies were identified. The test of heterogeneity for cross-sectional studies was not significant ( P = 0.31). A fixed-effects model yielded a significant overall odds ratio estimate of 1.41 (95% CI: 1.25-1.58, P < 0.0001) for infrequent compared to frequent tooth brushing. For all fourteen studies, there was a slight indication for heterogeneity ( I² = 48%, P = 0.02) and the corresponding result with a random-effects model was 1.44 (95% CI: 1.21-1.71, P < 0.0001). Conclusions There are relatively few studies evaluating the association between tooth brushing frequency and periodontitis. A clear effect was observed, indicating that infrequent tooth brushing was associated with severe forms of periodontal disease. Further epidemiological studies are needed to precisely estimate the effect of key risk factors for periodontitis and their interaction effects. [ABSTRACT FROM AUTHOR]

Abstract: Rationale, aims, and objectives: Patients with somatoform disorders are frequent attenders in primary and secondary care. While co‐morbid mental disorders, especially depression and anxiety, are frequently present, there is controversy on whether mental co‐morbidity leads to higher health care utilization (HCU). The present paper investigates the influence of co‐morbid depressive and anxiety disorders on primary, specialized somatic and mental HCU in primary care patients with somatoform disorders. Additionally, we investigated the predictive value of self‐rated health and illness perception on HCU. Methods: Patients in 19 primary care practices were screened with the Patient Health Questionnaire, and patients at high risk for somatoform disorders were assessed using the Composite International Diagnostic Interview. N = 71 patients with somatoform disorders were analysed. We analysed whether having one vs two co‐morbidities (depression and/or anxiety), self‐rated health, and illness perception were predictors for primary, specialized somatic and mental HCU using binominal and hierarchical regression analyses. Results: Having both co‐morbid depressive and anxiety disorder predicted higher primary HCU (IRR = 1.96, 95% CI, 1.30‐2.93), and increased the odds of being in mental health care (OR = 5.16, 95% CI, 1.10‐24.20), while only one co‐morbidity did not. No differences were found for specialized somatic HCU. Illness perception and self‐rated health did not predict HCU. Conclusion: Not a single but only the presence of multiple co‐morbidities predicts primary and mental HCU in patients with somatoform disorder. Health care utilization might be essentially influenced by the associated psychological distress, which should be considered in treatment. [ABSTRACT FROM AUTHOR]

Aims and objectives: Pressure ulcers (PUs) are a serious health problem. They can be considered as an indicator of the quality of health care and are associated with considerable cost increases for the health care system. The prevention of PUs is a major concern in hospital care. The aim of the study was to reveal the current PU prevention‐related processes and structures with a specific focus on the Accident and Emergency (A&E) Department. Method: In late 2018/early 2019, all German hospitals were invited to participate in a nationwide cross‐sectional survey. One standardized questionnaire was assigned to a representative of each hospital. The representative was asked to state what PU‐related structures and processes are implemented in their hospital, in general and specific to the A&E department. Besides mostly descriptive analysis, PU‐related processes were analysed on PU incidence in a multivariate linear regression model. Results: Two hundred seventy‐six hospitals participated in the survey. 63.4% (n = 175) of the participating hospitals had at least one PU manager. Skin inspection was the most frequently performed procedure. Although not recommended, 1.3% (2.1%) of the facilities still use sheepskins quite often (very often). In the regression model on PU incidence, only the process 'mobilization in bed' was statistically significantly associated. Although the risk of developing a PU in the emergency department is high, more than half of the facilities had no PU guidelines. Conclusion: Even if recommended procedures (skin inspection, 30° positioning) have been used frequently, regular training could help to bring new scientific findings such as the use of local skin protection dressings into clinical practice. Prevention guidelines should be established in all areas of care even for A&E as well as when patients are transferred inside or out of the hospital, where the risk of PU development was considered low. [ABSTRACT FROM AUTHOR]

Background: Endomyocardial biopsy (EMB) is a safe procedure performed in diagnostic work‐up of cardiac disease. Hypothesis: Data regarding temporal trends of total numbers, characteristics, in‐hospital outcomes, and complications of patients undergoing EMB are sparse. Methods: The nationwide German inpatient sample (2005–2019) was used for this analysis. Patient cases of EBM during the 5‐year cycles from 2005 to 2009, 2010 to 2014, and 2015 to 2019 were compared, and temporal trends regarding total numbers and presumable major and minor EMB‐associated complications were investigated. Results: Overall, 67 745 EMB were performed in Germany 2005–2019. Total number of EMB increased from 3083 in 2005 to 5646 in 2019 (β 0.40 [95% confidence interval [CI] 0.37–0.43], p <.001). Among these EMB, 19 083 (28.2%) were performed during the period 2005–2009, 22 867 (33.7%) 2010–2014, and 25 795 (38.1%) between 2015 and 2019. The proportion of patients aged ≥70 years was highest 2015–2019 (2005–2009: 9.3%; 2010–2014: 13.8%; 2015–2019: 16.1%, p <.001) and the most aggravated comorbidity profile (Charlson Comorbidity Index 2.25 ± 1.93; 2.67 ± 2.14; 3.01 ± 2.29, p <.001) was also detected 2015–2019. Major complications occurred less often in the period 2015–2019 compared to 2005–2009 (odds ratio [OR] 0.921 [95% CI 0.893–0.950], p <.001), whereas minor complications were more frequently observed between 2015 and 2019 (OR 1.067 [95% CI 1.042–1.093], p <.001). While a decrease in major complications was detected irrespective of age, an increase in minor complications was identified only in patients between 30–59 years. Conclusions: Annual numbers of EMB increased significantly in Germany 2005–2019. Patients who underwent EMB in recent years were older and showed an aggravated comorbidity profile accompanied by fewer major complications, underscoring safety of the procedure. [ABSTRACT FROM AUTHOR]

Drawing from team‐level job demands‐resources theory, we hypothesize that team workload demands moderate the positive link between team boundary work (i.e., boundary spanning and boundary buffering) and team effectiveness (i.e., team innovation and team performance), such that boundary work is more beneficial for team effectiveness when teams face higher team workload demands. Furthermore, we predict that this interaction occurs through increased team vigor, where team vigor is defined as an affective emergent state characterized by positive valences and high activation levels experienced by team members. We largely find support for our model across two field studies: a cross‐sectional survey using three independent data sources (89 automotive research and development teams, including 724 team members, 89 team leaders and 18 managers) and a time‐lagged survey using two independent data sources (139 teams working in a Chinese utility company, including 640 team members and 139 team leaders). Our article contributes to team research by broadening our understanding of when and how team boundary work is associated with greater team effectiveness. [ABSTRACT FROM AUTHOR]

Background Diminished oral health of the institutionalized elderly has frequently been reported. This is not only of significance with regard to nutrition and general health, but it can also affect oral health-related quality of life. This paper evaluates the effects of oral and general conditions on oral health-related quality of life for the institutionalized elderly, as measured by the Geriatric Oral Health Assessment Index ( GOHAI). Materials and Methods Ninety-four residents of four long-term care homes in southern Germany agreed to participate in this study, and interviews were conducted using the GOHAI questionnaire. The Revised Oral Health Assessment Guide was applied to allocate participants into two groups: satisfactory oral health and poor oral health. To evaluate the effects of age, gender, number of chronic diseases, frequently taken drugs, care level, Mini- Mental State Examination score, periodontitis (for participants with their own teeth), pressures caused by prostheses, and type of denture worn, a linear regression model with the total GOHAI score was calculated with these determinants. Results The mean ± SD GOHAI score was 53.3 ± 6.2 in the satisfactory oral health group and 48.7 ± 7.3 in the poor oral health group. Statistical analysis showed that the GOHAI scores were significantly different in satisfactory oral health and poor oral health groups ( P = 0.030) and were affected by care level ( P = 0.008) and type of dentures worn ( P = 0.006). Conclusions Within the limitations of this study, it can be concluded that oral health-related quality of life of the institutionalized elderly is low and is positively associated with better oral health. [ABSTRACT FROM AUTHOR]

Context Basic science teaching in undergraduate medical education faces several challenges. One prominent discussion is focused on the relevance of biomedical knowledge to the development and integration of clinical knowledge. Although the value of basic science knowledge is generally emphasised, theoretical positions on the relative role of this knowledge and the optimal approach to its instruction differ. The present paper addresses whether and to what extent biomedical knowledge is related to the development of clinical knowledge. Methods We analysed repeated-measures data for performances on basic science and clinical knowledge assessments. A sample of 598 medical students on a traditional curriculum participated in the study. The entire study covered a developmental phase of 2 years of medical education. Structural equation modelling was used to analyse the temporal relationship between biomedical knowledge and the acquisition of clinical knowledge. Results At the point at which formal basic science education ends and clinical training begins, students show the highest levels of biomedical knowledge. The present data suggest a decline in basic science knowledge that is complemented by a growth in clinical knowledge. Statistical comparison of several structural equation models revealed that the model to best explain the data specified unidirectional relationships between earlier states of biomedical knowledge and subsequent changes in clinical knowledge. However, the parameter estimates indicate that this association is negative. Discussion Our analysis suggests a negative relationship between earlier levels of basic science knowledge and subsequent gains in clinical knowledge. We discuss the limitations of the present study, such as the educational context in which it was conducted and its non-experimental nature. Although the present results do not necessarily contradict the relevance of basic sciences, we speculate on mechanisms that might be related to our findings. We conclude that our results hint at possibly critical issues in basic science education that have been rarely addressed thus far. [ABSTRACT FROM AUTHOR]

What is already known about this subject Gestational weight gain is a modifiable risk factor for childhood overweight., What this study adds Exceeding the recommended gestational weight gain increases the risk for childhood overweight by about 30%., Interventions to avoid excessive weight gain are needed., Background Overweight and obesity in children are thought to be related to prenatal priming. Gestational weight gain ( GWG) might be a potential modifiable risk factor for childhood overweight. Objective To quantify the associations of inadequate and excessive GWG with childhood overweight. Methods The electronic literature search in six databases was complemented by a hand search for relevant articles. Papers were selected and quality was assessed. The effect estimates of the individual studies were pooled using a random-effects model. Results The literature search yielded 1492 results in total, of which seven observational studies met the inclusion criteria. The studies had medium to good quality. The pooled estimate for the association between excessive GWG and childhood overweight yielded an odds ratio ( OR) of 1.38 (95% confidence interval [ CI]: 1.21-1.57). The association between inadequate GWG and childhood overweight yielded an OR of 0.91 (95% CI: 0.85-0.98). Conclusion These data provide evidence for at least a 21% risk for childhood overweight related to excessive GWG. Therefore, further efforts to design appropriate interventions against excessive GWG may appear warranted. [ABSTRACT FROM AUTHOR]

Objective This paper examines how negative experiences with the health-care system create a lack of confidence in receiving medical care in seven countries: Australia, Canada, Germany, the Netherlands, New Zealand, the United Kingdom, and the United States. Methods The empirical analysis is based on data from the Commonwealth Fund International Health Policy Survey 2007, with nationally representative samples of adults aged 18 and over. For the analysis of the experience of cost barriers and confidence in receiving medical care, we conducted pairwise comparisons of group percentages as well as country-wise multivariate logistic regression models. Results Individuals who have experienced cost barriers show a significantly lower level of confidence in receiving safe and quality medical care than those who have not. This effect is most pronounced in the United States, where people who have foregone necessary treatment because of costs are four times as likely to lack confidence as individuals without the experience of cost barriers (adjusted odds ratio 4.00). In New Zealand, Germany, and Canada, individuals with the experience of cost barriers are twice as likely to report low confidence compared with those without this experience (adjusted odds ratios of 1.95, 2.19 and 2.24, respectively). In the Netherlands and UK, cost barriers are only a marginal phenomenon. Conclusions The fact that the experience of financial barriers considerably lowers confidence indicates that financial incentives, such as private co-payments, have a negative effect on overall public support and therefore on the legitimacy of health-care systems. [ABSTRACT FROM AUTHOR]

Background: Previous studies have yielded mixed results on the association between gender and alcohol use disorder (AUD) treatment outcomes. Thus, additional research is needed to determine the effect of gender on AUD treatment outcomes, including quality of life (QoL), particularly among older adults. Aims: In a clinical sample of older adults with DSM‐5 AUD, we examined changes in QoL from the beginning of AUD treatment through 1 year of follow‐ups. We also examined the effect of gender and explored interaction effects with gender on QoL. Methods: We utilized data from the "Elderly Study," a multi‐national, single‐blind, randomized, controlled trial of 693 adults aged 60+ with DSM‐5 AUD. Alcohol use was assessed with the Form‐90, and QoL with the brief version of the World Health Organization QoL measure. Information was collected at treatment initiation and at 4‐, 12‐, 26‐, and 52‐week follow‐ups. Multilevel mixed‐effects logistic and linear regression models were used to examine QoL changes and the effect of gender on changes in QoL. Results: Following treatment, small, but significant improvements were seen over time in overall perceived health (p < 0.05). Improvements that persisted over the 1‐year follow‐up period were seen in the QoL domains of physical health (β: 2.6, 95% CI: 1.4–3.9), psychological health (β: 3.5, 95% CI: 3.3–3.8), social relationships (β: 4.0, 95% CI: 2.5–5.6), and environmental health (β: 1.4, 95% CI: 0.4–2.4). No significant changes were seen over time in overall perceived QoL (p = 0.58). Gender was not associated with changes in any of the QoL outcome measures (all p ≥ 0.05). Conclusions: Among 60+ year‐old adults receiving treatment for DSM‐5 AUD, improvements in QoL were achievable and maintained over time, but were not associated with gender. [ABSTRACT FROM AUTHOR]

Faced with competitive labor markets, firms increasingly use employer branding to build a qualified workforce and engage their employees. However, our understanding of the impact of employer branding orientation on firm performance and the theoretical firm‐level mechanisms underlying this potential impact is very limited. To address this gap, we integrate brand marketing theory with human resource management (HRM) research to develop a model explicating how employer branding orientation is linked to firm performance through a dual route by enhancing both recruitment efficiency (i.e., external route: applicants) and positive affective climate (i.e., internal route: incumbent employees). The results of a multisource study (i.e., top management, human resource managers, employees) with 93 firms show employer branding orientation is positively related to firm performance through positive affective climate but not recruitment efficiency. Using a brand equity approach to HRM, our results advance the literature by demonstrating the generalizability of employer branding effects independent of concrete brand attributes and explaining the firm‐level mediating mechanisms linking it to firm performance. [ABSTRACT FROM AUTHOR]

Suicide is an important cause of death in patients with mental health disorders, but little is known about the occurrence of suicidal ideation and attempts in outpatient psychotherapy patients. The aim of this study was to identify the proportion of patients with and correlates of suicidal ideation and attempts in community‐based psychotherapy practices. Using 983 applications for reimbursement of psychotherapy from individual patients, reports about suicidal thoughts and suicide attempts were extracted along with demographic, biographic and clinical data. Multivariate logistic regression analysis was used to identify correlates of suicidal ideation and attempts by calculating odds ratios (ORs). Among the patients, 19% presented with suicidal thoughts (11% currently and 8% in the past) and 6% with suicide attempts. Important correlates of suicidal thoughts were male gender (OR 1.7), lower education (OR 1.8), early retirement (OR 2.9), death of a parent when younger than 5 years old (OR 3.3), violence experienced from various people (OR 2.1), self‐harm behaviour (OR 7.9) and alcohol misuse (OR 1.7). Suicide attempts were associated with male gender (OR 5.6), lower education (OR 4.2), violence experienced from partner (OR 2.5) or from various people (OR 9.5) and self‐harm behaviour (OR 15.0). These results show that the proportion of suicidal patients seeking outpatient psychotherapy is high. It should therefore be a central topic in clinical training. Biographic data such as the loss of a parent at an early age or experiencing violence are associated with who is at increased risk and should be explored in detail. [ABSTRACT FROM AUTHOR]

Aims: To estimate the prevalence of family members affected by addictive disorders (FMA) with regard to various types of addictive disorders, and self‐rated health and depression in the general population. Design: Cross‐sectional general population survey. Setting: The German Health Update study (GEDA) 2014/2015, a nationally representative panel of German residents aged 15 years or older. Participants: A total of 24 824 residents aged 15 years or older. Measurements Participants were asked if they had a family member with current or past addictive disorder, the type of addiction and the relationship status. In addition, self‐rated health and depression were assessed using standardized questionnaires. Findings Of the respondents, 9.5% [95% confidence interval (CI) = 9.0–10.0] reported being affected by a current addictive disorder of a relative (cFMA), with a further 4.5% (95% CI = 4.2–4.9) reported having been affected by the addictive disorders of a relative in the past but not within the last 12 months (pFMA). Most FMAs reported having been affected by disorders due to alcohol, followed by cannabis and other drugs. Compared with life‐time non‐FMAs, FMAs reported significantly (P < 0.001) higher odds ratios for depression (cFM = 2.437; 95% CI = 2.082–2.853; pFMA = 1.850; 95% CI = 1.519–2.253) and ill‐health (cFMA = 1.574; 95% CI = 1.374–1.805; pFMA = 1.297; 95% CI = 1.082–1.555). Conclusions: In Germany, family members affected by addictive disorder are a substantial group within the general population. This group is characterized by ill‐health and has not yet been adequately addressed by the addiction treatment system. [ABSTRACT FROM AUTHOR]

Many researchers and practitioners consider ethnic segregation in neighbourhoods or schools detrimental to migrants' acculturation in host societies. Empirically, however, segregation is a 'mixed bag' and its effects depend crucially on the investigated acculturation domain (e.g., negative for language skills, positive for well‐being). As most prior studies have focused on a restricted spectrum of acculturation, a comprehensive assessment within one single study is needed to establish comparability across different acculturation domains. Among over 8000 immigrant‐background students from four countries, we investigated the association of classroom segregation, defined as opportunities for contact with natives and other migrants, with a broad spectrum of acculturation (academic, attitude‐related, identity‐related, social, health‐related, and psychological criteria). Some findings were consistent (e.g., academic acculturation), some were contrary to prior research (e.g., social acculturation). In sum, our results shed light on the 'mixed bag' of segregation and contribute to the understanding of a crucial social issue. [ABSTRACT FROM AUTHOR]

We present a dual‐pathway model that differentiates two underlying mechanisms by which age affects selection decisions. In two experimental studies, one with lay persons (n = 316) and one with experienced Human Resource professionals (n = 103), we demonstrate that the relationship between older age and hireability is negatively mediated by perceived appearance, indicating that older candidates receive less favorable ratings because they are perceived as being less physically appealing. Moreover, we demonstrate that the relationship between older age and hireability is positively mediated by perceived experience, indicating that older candidates receive more favorable ratings because they are perceived as being more experienced. Importantly, these two pathways neutralize each other, yielding a null effect when their effects are neglected. [ABSTRACT FROM AUTHOR]

Background and aims: Evidence for efficacy of brief alcohol interventions (BAIs) is mainly limited to primary care and at‐risk drinkers. The aim was to test the efficacy of a BAI addressing the full spectrum of alcohol use in a general population sample and across alcohol risk groups. Design Two‐parallel‐group randomized controlled trial (allocation ratio 1:1) with post‐baseline assessments at months 3, 6 and 12. Setting: One municipal registry office in Germany responsible for registration, passport and vehicle admission issues. Participants: A total of 1646 proactively recruited 18–64‐year‐old adults with past year alcohol use (56% women, 66% low‐risk drinkers) were randomized to intervention (n = 815) or control (n = 831). Intervention and comparator: The intervention consisted of assessment plus computer‐generated individualized feedback letters at baseline and months 3 and 6. Comparator was assessment only. Measurements Primary outcome was change in the self‐reported number of drinks/week from baseline to 12 months. Changes at 3 and 6 months were secondary outcomes. Moderator was alcohol risk group (low‐risk versus at‐risk drinking) according to the Alcohol Use Disorders Identification Test–Consumption, with scores from 1‐3 (women) and from 1‐4 (men) indicating low‐risk drinking. Findings For the whole sample, significant group differences were observed neither at 12‐month follow‐up [incidence rate ratio (IRR) = 1.01, 95% confidence interval (CI) = 0.87–1.17, Bayes factor (BE) = 0.52] nor at previous assessments (month 3: IRR = 1.01, 95% CI = 0.92–1.12, BE = 0.41; month 6: IRR = 0.93, 95% CI = 0.81–1.07, BE = 1.10). Moderator analyses revealed that low‐risk drinkers were more likely to benefit from BAI only at month 6 than at‐risk drinkers (IRR = 0.77, 95% CI = 0.70–0.86). Conclusions: In a randomized controlled trial, there was no clear evidence for efficacy of a computer‐based brief alcohol intervention in a general population sample, but there was some evidence of medium‐term benefits in the large but understudied group of low‐risk drinkers. [ABSTRACT FROM AUTHOR]

To ensure an adequate pain therapy with high patient adherence, it is necessary to know and consider patient preferences. A discrete choice experiment was used to obtain patients' preferences regarding treatment with systemic or topical pain medication. Patients with peripheral neuropathic pain (pNP) were recruited in two pain‐focused practices in Germany. To identify relevant attributes of topical or systemic pain medication, a literature review and face‐to‐face interviews with experts for pain treatment were conducted. The attributes used in the choice scenarios were noticeable onset of effect, time spent in medical office, risk of systemic and local side effects, and impairment of daily life with regard to sleep quality and sexuality. The model was estimated with a mixed multinomial logit regression model. The study included 153 participants suffering from moderate to severe pNP. Most important attributes from patient's perspective was noticeable onset of effect (odds ratio 2.141 [95% confidence interval 1.837 to 2.494]), followed by risk of systemic side effects (2.038 [1.731 to 2.400]) and risk of sexual dysfunction (1.839 [1.580 to 2.140]), while risk of local side effects regarding skin ranked fourth (1.612 [1.321 to 1.966]). The impairment of sleep quality was also significant but less important (1.556 [1.346 to 1.798]). Local side effects were more likely to be accepted than systemic side effects. The risk of sexual dysfunction as a side effect of treatment is very important for patients, although it has received little attention in the literature. [ABSTRACT FROM AUTHOR]

Despite the 2016 German "NationalRecommendationsforPhysicalActivityandPhysicalActivityPromotion" stating that adults (≥18 years) should engage in: [a] ≥150 minutes of aerobic moderate‐to‐vigorous‐intensity physical activity/week (MVPA); and [b] ≥2 days/week of muscle‐strengthening exercise (MSE), there is limited research on the descriptive epidemiology on the adherence to these guidelines among German adults. This study describes the prevalence and correlates of physical activity guideline adherence among a nationally representative sample of German adults. Data were drawn from the 2014 German Health Update survey, collected via a combination of web‐based and mail surveys. Self‐reported physical activity levels were assessed using the previously validated European Health Interview Survey Physical Activity Questionnaire. Weighted prevalence levels of the sample meeting the aerobic MVPA (≥150 minutes/week), MSE (≥2 times/week), and combined MVPA‐MSE guidelines were calculated. Poisson regressions were used to assess prevalence ratios for physical activity guideline adherence categories across sociodemographic and lifestyle‐related variables. Out of 24,016 participants (response rate = 27.6%), aged ≥ 18 years, 45.3% (95% CI: 44.5%‐46.0%), 29.4% (95% CI: 28.7%‐30.1%), and 22.6% (95% CI: 21.9%‐23.2%) met the aerobic MVPA, MSE, and combined guidelines, respectively. Population sub‐groups less likely to meet the combined guidelines included those with poor self‐rated health, being unemployed, low socioeconomic status, being a current smoker, and those being overweight or obese. Since ~ 80% of German adults do not meet the nationally recommended combined aerobic MVPA‐MSE physical activity guidelines, there is a necessity for large‐scale public health interventions promoting both aerobic MVPA and MSE. [ABSTRACT FROM AUTHOR]

Background: There are growing concerns about the increasing rate of caesarean section (CS) worldwide. Various strategies have been implemented to reduce the proportion of CS to a reasonable level. Most research on medical indications for CS focuses on nationwide evaluations. Comparative research between different countries is sparse. The aim of this study was to evaluate differences in the rate and indications for CS between Japan and Germany in 2012 and 2013. Methods: Comparison of the overall rate and medical indications for CS in two cohort studies from Germany and Japan. We used data from the German Perinatal Survey and the Japan Environment and Children's Study (JECS). Results: We analyzed data of 1 335 150 participants from the German perinatal survey and of 62 533 participants from JECS and found significant differences between the two countries in CS rate (30.6% vs 20.6%) and main medical indications: cephalopelvic disproportion (3.2% vs 1.3%; OR: 2.4 [95% CI: 2.2–2.6]), fetal distress (7.3% vs 2.3%; OR: 3.4 [95%‐CI: 3.2–3.6]), and past uterine surgery/repeat CS (8.4% vs 8.8%; OR: 0.9 [95%‐CI: 0.9–1]). Conclusion: There are differences in the rate and medical indications for CS between Germany and Japan at the population level. Fetal distress was identified as a medical indication for CS more often Germany than in Japan. Considering the substantial diagnostic uncertainty of electronic fetal monitoring (EFM) as the major indicator for fetal distress, it would seem to be reasonable to rethink CS decision algorithms. [ABSTRACT FROM AUTHOR]

Research collaboration is promoted by governments and research funders, but if the relative prevalence and merits of collaboration vary internationally then different national and disciplinary strategies may be needed to promote it. This study compares the team size and field normalized citation impact of research across all 27 Scopus broad fields in the 10 countries with the most journal articles indexed in Scopus 2008–2012. The results show that team size varies substantially by discipline and country, with Japan (4.2) having two‐thirds more authors per article than the United Kingdom (2.5). Solo authorship is rare in China (4%) but common in the United Kingdom (27%). While increasing team size associates with higher citation impact in almost all countries and fields, this association is much weaker in China than elsewhere. There are also field differences in the association between citation impact and collaboration. For example, larger team sizes in the Business, Management & Accounting category do not seem to associate with greater research impact, and for China and India, solo authorship associates with higher citation impact in this field. Overall, there are substantial international and field differences in the extent to which researchers collaborate and the extent to which collaboration associates with higher citation impact. [ABSTRACT FROM AUTHOR]

Summary: Background: Non‐alcoholic fatty liver disease (NAFLD), prediabetes and type 2 diabetes mellitus are known to be closely linked with obesity as early as during childhood. Objectives: The study aimed to determine the prevalence of prediabetes and T2DM in children with obesity with or without increased transaminases. Methods: Data from the observational multicentre (n = 51), cross‐sectional Adipositas Patienten Verlaufsbeobachtung registry were analyzed. Mild increase (mild group) was defined by alanine transaminase (ALT) >24 to ≤50 U/L and moderate to severe increase (advanced group) by ALT > 50 U/L. Prediabetes and T2DM were defined according to recent IDF/ISPAD guidelines. Results: The prevalence of prediabetes and T2DM was 11.9% (95% CI: 11.0–12.8) and 1.4% (95% CI: 1.1–1.7) among all participants (n = 4932; male = 2481; mean age 12.9 ± 2.7 years; BMI‐SDS 2.1 ± 0.5; Tanner stage 3.2 ± 1.5). The prevalence of impaired glucose metabolism (prediabetes and T2DM) was 13.8% (95% CI: 12.1–15.4) in the mild, 21.9% (95% CI: 18.8–25.1) in the advanced group, 10.7% (95% CI: 9.4–11.9) in the control group. Mild and advanced groups had greater odds ratios for prediabetes [1.42; 95% CI: 1.17–1.72, 2.26‐fold; (1.78–2.86), respectively], the advanced group also for T2DM [2.39 (1.36–4.21)] compared to controls. While an increase in transaminases predominantly affected boys, girls within the advanced group had a higher T2DM prevalence than males (5.4 vs. male 2.1%). Conclusions: Children with obesity and increased liver transaminases as surrogates of NAFLD should be screened for T2DM. [ABSTRACT FROM AUTHOR]

Aim: To describe general practitioners' (GPs) perspectives on end‐of‐life care of nursing home residents. Methods: We carried out a cross‐sectional study. A questionnaire was sent to a random sample of 1121 GPs in the German federal states of Bremen and Lower Saxony in 2018. Data were compared between GPs with a qualification in palliative medicine and those without such qualifications, and multivariable logistic regression was performed. Results: Overall, 375 questionnaires were returned (response rate 34%). The majority of GPs (71%) agreed that nursing home residents are treated too often in hospitals at the end of life, and more than half rated end‐of‐life care in nursing homes as "rather poor" (54%). For both questions, GPs with a qualification in palliative medicine showed higher agreements. In the multivariable analysis, a prior qualification in palliative medicine was also strongly associated with rating end‐of‐life care as "rather poor" (OR 1.89, 95% CI 1.10–3.23). Respondents cited higher staffing ratios and better trained nursing staff as the most important measures to improve end‐of‐life care. Furthermore, it was estimated that just 37% of residents have an advance directive, with only one‐third including valid information on end‐of‐life hospitalizations. Conclusions: This study showed that GPs tend to be critical regarding end‐of‐life care in nursing homes. To improve end‐of‐life care, better training in palliative care for nursing staff and GPs might be warranted. In addition, advance care planning can help to ensure that residents' wishes are respected. Geriatr Gerontol Int 2020; 20: 25–30. [ABSTRACT FROM AUTHOR]

Several international sports federations have implemented a standardized injury reporting system during their championships. However, very few studies have investigated athletes with disabilities during major championships apart from the Paralympic Games. Therefore, the aim of this study was to assess the rate and characteristics of injuries during the Wheelchair Basketball World Championships 2018 (WBWC). This prospective cohort study was conducted during the WBWC held in Hamburg, Germany, from August 16 to August 26, 2018. Physicians or physiotherapists of all 28 participating teams (total 336 players) were asked to report all newly incurred injuries (with location, diagnosis, cause, and estimated duration of absence) daily on a standardized injury report form. Prevalence and incidence rates were calculated. Medical staff of 11 teams (132 players) reported 100 injuries, equivalent to 75.8 per 100 players (95% CI: 60.9‐90.7) or 68.9 per 1000 player‐days (55.4‐82.4). Eight time‐loss injuries were reported (6.1 injuries per 100 players [95% CI: 1.9‐10.3] or 5.5 injuries per 1000 player‐days [1.7‐9.3]). More injuries were incurred during matches (n = 68) than during training. Most injuries affected the neck/cervical spine (16%), thoracic spine/upper back (15%), and shoulder (14%). The most frequent diagnosis was muscle spasms (25%), the most frequent cause was overuse (52%). A high rate of non–time‐loss injuries compared to Paralympic Games was reported. Future studies should focus on the etiology of muscle spasms and further identify injury mechanisms of traumatic and overuse injuries in wheelchair basketball players to develop adequate preventive measures. [ABSTRACT FROM AUTHOR]

Aims: Time needed for health‐related activities in people with diabetes is assumed to be substantial, yet available data are limited. Time spent on self‐management and associated factors was analysed using cross‐sectional data from people with diagnosed diabetes enrolled in a population‐based study. Methods: Mean total time spent on self‐management activities was estimated using a questionnaire for all participants with diagnosed diabetes in the KORA FF4 study (n = 227, 57% men, mean age 69.7, sd 9.9 years). Multiple two‐part regression models were fitted to evaluate associated factors. Multiple imputation was performed to adjust for bias due to missing values. Results: Some 86% of participants reported spending time on self‐management activities during the past week. Over the entire sample, a mean of 149 (sd 241) min/week were spent on self‐management‐activities. People with insulin or oral anti‐hyperglycaemic drug treatment, better diabetes education, HbA1c 48 to < 58 mmol/mol (6.5% to < 7.5%) or lower quality of life, spent more time on self‐management activities. For example, people without anti‐hyperglycaemic medication invested 66 min/week in self‐management, whereas those taking insulin and oral anti‐hyperglycaemic drugs invested 269 min/week (adjusted ratio 4.34, 95% confidence interval 1.85–10.18). Conclusions: Time spent on self‐management activities by people with diabetes was substantial and varied with an individual's characteristics. Because of the small sample size and missing values, the results should be interpreted in an explorative manner. Nevertheless, time needed for self‐management activities should be routinely considered because it may affect diabetes self‐care and quality of life. What's new?: Few studies have analysed time spent on self‐management activities in diabetes. Factors associated with patterns of health‐related activities remain under‐researched.This population‐based study analysed a comprehensive set of self‐management activities in people with diabetes. In our entire sample, an average of 2.5 h/week were spent on self‐management activities. Time investments differed according to diabetes treatment, diabetes education, HbA1c and quality of life.Time needed for self‐management activities should be routinely considered because it may affect diabetes self‐care and quality of life. [ABSTRACT FROM AUTHOR]

Background: Delirium is frequent in elderly patients presenting in the emergency department (ED). Despite the severe prognosis, the majority of delirium cases remain undetected by emergency physicians (EPs). At the time of our study there was no valid delirium screening tool available for EDs in German‐speaking regions. We aimed to evaluate the brief Confusion Assessment Method (bCAM) for a German ED during the daily work routine. Methods: We implemented the bCAM into practice in a German interdisciplinary high‐volume ED and evaluated the bCAM's validity in a convenience sample of medical patients aged ≥ 70 years. The bCAM, which assesses four core features of delirium, was performed by EPs during their daily work routine and compared to a criterion standard based on the criteria for delirium as described in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Results: Compared to the criterion standard, delirium was found to be present in 46 (16.0%) of the 288 nonsurgical patients enrolled. The bCAM showed 93.8% specificity (95% confidence interval [CI] = 90.0%–96.5%) and 65.2% sensitivity (95% CI = 49.8%–78.7%). Positive and negative likelihood ratios were 10.5 and 0.37, respectively, while the odds ratio was 28.4. Delirium was missed in 10 of 16 cases, since the bCAM did not indicate altered levels of consciousness and disorganized thinking. The level of agreement with the criterion standard increased for patients with low cognitive performance. Conclusion: This was the first study evaluating the bCAM for a German ED and when performed by EPs during routine work. The bCAM showed good specificity, but only moderate sensitivity. Nevertheless, application of the bCAM most likely improves the delirium detection rate in German EDs. However, it should only be applied by trained physicians to maximize diagnostic accuracy and hence improve the bCAM's sensitivity. Future studies should refine the bCAM. [ABSTRACT FROM AUTHOR]

Beside its positive impact on physical health, exercise is indicated to positively affect cognitive performance based on a relocation of cortical activity. This study examined the influence of different types of breaks on cognitive performance and related cortical activity in office‐based employees. Breaks were filled with exercise, resting or a usual break and a control condition where employees continued working without any break. Cognitive performance was assessed using the d2‐R test and two commercially available cognitive tasks. Brain cortical activity was recorded using electroencephalography before and after breaks. Individual's mood was analysed using a profile of mood state. Results indicate a positive effect of a 3‐min boxing intervention on cognitive performance, mirrored by a decrease in prefrontal cortex activity. Although perceived psychological state was increased after the usual break, this is reflected in neither cortical activity nor cognitive performance. With respect to the fact that also bike activity resulted an increase in prefrontal alpha‐2 activity, a positive effect of exercise on neuro‐cognitive performance can be stated. Health and economic benefits may result from brief physical activity breaks and help to maintain workplace performance and job satisfaction. Copyright © 2015 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Context The freshman year of medical school is a stressful period in the lives of future doctors. Resilience to this stress differs greatly, leading to different health outcomes. Less resilient students, whose health may deteriorate early in their education, are at greater risk for developing stress-related diseases. Early identification of individuals at risk and the provision of tailored health-promoting interventions might prevent this. Objectives This study was designed to investigate: (i) how the health of medical students develops over the freshman year, and (ii) whether certain protective factors can predict general and mental health status after 1 year of medical education. Methods A prospective, longitudinal, observational study was conducted at one medical school. Self-rated general and mental health status before and after the freshman year were used as outcomes. In addition to socio-demographic variables and leisure activities, personality and study-related behaviour and experience were surveyed as potential predictors. Both descriptive techniques and logistic regression analyses were employed to identify predictors for general and mental health separately. Results At baseline, 93% of medical students rated their general health and 88% rated their mental health as good. These frequencies declined over the first year to 76% and 84%, respectively. For general health, regular physical activity was the strongest predictor (odds ratio [ OR] 4.58). Satisfaction with life ( OR 1.18) and balance and mental stability ( OR 1.20) emerged as positive predictors, and age ( OR 0.85) and striving for perfection ( OR 0.76) as negative predictors. Mental health status was predicted by emotional distancing ( OR 1.25), experience of social support ( OR 0.73), neuroticism ( OR 0.89) and age ( OR 0.85). Conclusions Self-rated general and mental health declined throughout the first year of medical education. Physical activity proved to be a strong predictor for the maintenance of good general health. This finding may represent a starting point for health-promoting interventions, such as the provision of time slots for physical activity. [ABSTRACT FROM AUTHOR]

The Behavioral Activation for Depression Scale (BADS) was developed to measure core concepts of behavioural activation for depression. A number of studies, mostly based on analogue samples, have provided initial support for the BADS. In the present study, we examined the psychometric properties of the German version of the scale more broadly, including change sensitivity and clinical treatment data. A mixed sample of students ( N = 312) and depressed outpatients in partial remission undergoing cognitive-behavioural group treatment for depressive rumination ( N = 59) was examined. To analyze construct validity, a set of theoretically relevant constructs such as perseverative thinking, distraction and mindfulness was also assessed. Results indicated good psychometric properties, additional evidence for construct validity of the total scale and subscales, and adequate fit of the data to the original factor structure. Furthermore, the BADS proved to be sensitive to changes in participants undergoing treatment for depression. Copyright © 2015 John Wiley & Sons, Ltd. Key Practitioner Message Behavioural activation (BA) is an effective treatment for patients suffering from unipolar depression., The Behavioral Activation for Depression Scale (BADS) can be used to measure core elements of the BA treatment rationale. It is useful to track changes in activation within treatment., The BADS is available in different languages and has shown to possess good psychometric properties. [ABSTRACT FROM AUTHOR]

Background Maternal depression has been associated with excessive infant crying, feeding and sleeping problems, but the specificity of maternal depression, as compared with maternal anxiety remains unclear and manifest disorders prior to pregnancy have been widely neglected. In this prospective longitudinal study, the specific associations of maternal anxiety and depressive disorders prior to, during and after pregnancy and infants' crying, feeding and sleeping problems were investigated in the context of maternal parity. Methods In the Maternal Anxiety in Relation to Infant Development (MARI) Study, n = 306 primiparous and multiparous women were repeatedly interviewed from early pregnancy until 16 months post partum with the Composite International Diagnostic Interview for Women (CIDI-V) to assess DSM-IV anxiety and depressive disorders. Information on excessive infant crying, feeding and sleeping problems was obtained from n = 286 mothers during postpartum period via questionnaire and interview (Baby-DIPS). Results Findings from this study revealed syndrome-specific risk constellations for maternal anxiety and depressive disorders as early as prior to pregnancy: Excessive infant crying (10.1%) was specifically associated with maternal anxiety disorders, especially in infants of younger and lower educated first-time mothers. Feeding problems (36.4%) were predicted by maternal anxiety (and comorbid depressive) disorders in primiparous mothers and infants with lower birth weight. Infant sleeping problems (12.2%) were related to maternal depressive (and comorbid anxiety) disorders irrespective of maternal parity. Conclusions Primiparous mothers with anxiety disorders may be more prone to anxious misinterpretations of crying and feeding situations leading to an escalation of mother-infant interactions. The relation between maternal depressive and infant sleeping problems may be better explained by a transmission of unsettled maternal sleep to the fetus during pregnancy or a lack of daily structure and bedtime routine with the infant. Maternal disorders prior to pregnancy require more attention in research and clinical practice. [ABSTRACT FROM AUTHOR]

Interpersonal traits may influence psychotherapy success. One way of conceptualizing such traits is the interpersonal circumplex model. In this study, we analyse interpersonal circumplex data, assessed with the Inventory of Interpersonal Problems (Horowitz, Strauß, & Kordy, 1994) from a randomized study with 138 patients suffering from posttraumatic stress disorder after trauma in adulthood. The study compared cognitive processing therapy and dialogical exposure therapy, a Gestalt-based intervention. We divided the interpersonally heterogeneous sample according to the quadrants of the interpersonal circumplex. The division into quadrants yielded subgroups that did not differ in their general psychological distress, but the cold-submissive quadrant tended to exhibit higher posttraumatic stress disorder symptom severity and interpersonal distress than the other three. There was also a trend for patients in different quadrants to be affected differently by the treatments. Correlation analyses supported these results: in cognitive processing therapy, more dominant patients had more successful therapies, while in dialogical exposure therapy, success was not correlated with interpersonal style. Results indicate that especially patients with cold interpersonal styles profited differentially from the two treatments offered. Dividing samples according to the interpersonal circumplex quadrants seems promising. Copyright © 2015 John Wiley & Sons, Ltd. Key Practitioner Message: Interpersonal traits may contribute to psychotherapy outcome., Dividing the sample according to the quadrants of the interpersonal circumplex, as opposed to cluster analysis, yielded promising results., Patients higher in dominance fared better with cognitive processing therapy, while interpersonal style had no correlations with therapy success in dialogical exposure therapy. [ABSTRACT FROM AUTHOR]

Aim To identify risk factors for loss of molars during supportive periodontal therapy (SPT). Materials and Methods A total of 136 subjects with 1015 molars at baseline were examined retrospectively. The association of risk factors with loss of molars was assessed using a multilevel Cox regression analysis. Furcation involvement (FI) was assessed clinically at start of periodontal therapy and assigned according to Hamp et al. (1975). Results Fifty molars were extracted during active periodontal therapy (APT) and 154 molars over the average SPT period of 13.2 ± 2.8 years. FI degree III (HR 4.68, p < 0.001), baseline bone loss (BL) > 60% (HR 3.74, p = 0.009), residual mean probing pocket depth (PPD, HR 1.43, p = 0.027), and endodontic treatment (HR 2.98, p < 0.001) were identified as relevant tooth-related factors for loss of molars during SPT. However, mean survival time for molars with FI III or BL > 60% were 11.8 and 14.4 years, respectively. Among the patient data, age (HR 1.57, p = 0.01), female gender (HR 1.99, p = 0.035), smoking (HR 1.97, p = 0.034), and diabetes mellitus (HR 5.25, p = 0.021) were significant predictors for loss of molars. Conclusion Overall, periodontal therapy results in a good prognosis of molars. Degree III FI, progressive BL, endodontic treatment, residual PPD, age, female gender, smoking, and diabetes mellitus strongly influence the prognosis for molars after APT. [ABSTRACT FROM AUTHOR]

Background The increased risk of mental health problems in children and adolescents with intellectual disability ( ID) has been reported in several studies. However, almost no research has been conducted on parents' experiences with the general mental health system. We have investigated the prevalence of emotional and behavioural problems in children with ID as well as the availability and quality of mental health care from the parents' point of view. Methods Teachers of specialised schools for ID in Berlin were asked to complete the Teacher's Report Form ( TRF) of the Child Behavior Checklist. Information was collected for 1226 children and adolescents aged 6-18 years with mild to profound ID (response 70.5%). The availability and quality of mental health care was assessed by a questionnaire given to parents who had already been seeking help for their children. A total of 330 parents completed the questionnaires (response 62.0%). In addition to univariate analysis, we conducted multiple logistic regressions regarding the psychopathology reported by teachers ( TRF-syndrome scales) and difficulties concerning mental health care reported by parents for a paired sample of 308 children. Results Overall, 52.4% of the children and adolescents with ID had a total problem score on the TRF in the deviant range (47.1% when eliminating four items reflecting cognitive deficits). Compared with the general population normative sample of children, this is a three-time higher prevalence. The most striking problems were thought problems (schizoid and obsessive-compulsive), aggressive behaviour, attention problems and social problems. Parents whose children had more severe behavioural or emotional dysfunction reported more difficulties with the mental health system. From the parents' point of view, mental health professionals frequently did not feel responsible or were not sufficiently skilled for the treatment of children with ID. As a consequence, 96% of all parents were longing for specialised in- and outpatient services. Conclusions This study confirms the findings from other studies regarding the high rate of co-occurrence of ID and mental health problems in youths. Results indicate that both are strongly requested by parents: specialised in- and outpatient services, as well as more professional general services and equitable treatment for all children, with and without ID. [ABSTRACT FROM AUTHOR]

Background Secondary caries or caries adjacent to restorations is the most frequent reason for replacement of dental restorations. Though, limited data is available on variables influencing the development of secondary caries in primary teeth. Aim To investigate risk factors for the development of secondary caries adjacent to direct composite restorations in primary teeth. Design For this retrospective study, data of 2417 composite restorations, which were placed due to primary carious lesions, were considered. A total of 212 restorations failed due to secondary caries within a maximum observation period of 8 years. A control group was randomly selected. Mann-Whitney U-test, binomial logistic regression with backward elimination and Cox regression with frailty model were performed ( P < 0.05). Results The overall caries experience amounted to 6.3 dmft and 13.3 dmfs. 72.5% of restorations failed within the first 2 years. Older children and children from families with a higher socio-economic status showed a lower risk for secondary caries. Further, the dentist and the adhesive had a significant influence on the longevity. Posterior restorations had a higher risk to fail in comparison with anterior restorations. Conclusions Within the limitation of this study, it is concluded that the development of secondary caries is influenced by several factors. Nevertheless, the secondary caries rate was found to be relatively low in this high-risk population. [ABSTRACT FROM AUTHOR]

Background People with aphasia experience a pronounced decrease in quality of life (QoL). Beyond that identity negotiation is hindered, which is crucial for QoL. Biographic-narrative approaches use life story telling to support identity (re)development after disruptive events like stroke. Because of the language deficits inherent in aphasia such 'talk-based' approaches have to be modified for an optimal use. Aims To evaluate an adapted interdisciplinary biographic-narrative intervention using quantitative measures of health-related quality of life (HRQL) and mood. Additionally, semi-structured interviews were conducted to gain a deeper understanding of identity development processes in people with aphasia. Methods & Procedures Twenty-seven participants with various types of chronic aphasia were enrolled. The biographic narrative intervention consisted of five face-to-face in-depth interviews and seven group sessions conducted over 10 weeks in a mixed-method design with pre- and post-tests and a follow-up assessment 3 months post-intervention. For quantitative evaluation the Aachen Life Quality Inventory (ALQI), the Satisfaction with Life Scale (SWLS) and the Visual Analog Mood Scales (VAMS) were used. Semi-structured interviews were conducted post-treatment, including questions concerning the participants' experiences with the intervention and identity change. Results were analysed using interpretative principles from Grounded Theory. Outcomes & Results For all 27 participants, we found significant and stable growth in HRQL. Self-reported states of mood also improved. As expected, overall cognitively based life satisfaction did not change. The interviews revealed two main categories: 'evaluation of the face-to-face interviews' and 'evaluation of the group sessions'. Further analysis found four overlapping main themes which were identified as identity issues: agency, control, disease concept and doing things. Conclusions & Implications Our quantitative and qualitative results demonstrated the benefits associated with the biographic-narrative intervention. The participants' sense of self changed through the approach. The findings provide foundations for future work using biographic narrative interventions to influence QoL and identity renegotiation in people with aphasia. [ABSTRACT FROM AUTHOR]

Background This study presents age group-specific mortality rates and the average life expectancy of people with intellectual disabilities in Germany. Method For two samples from Westphalia-Lippe and Baden-Wuerttemberg, person-related data for the years 2007-2009 were analysed. Age group-specific mortality rates were estimated by exponential regression analyses. Results The average life expectancy of men with intellectual disabilities was 70.9 years in Westphalia-Lippe and 65.3 years in the Baden-Wuerttemberg sample. Women with intellectual disabilities reached a life expectancy of 72.8 years in the Westphalian sample and 69.9 years in Baden-Wuerttemberg. The mortality tables, the crude mortality rates and the standardized mortality rates according to the WHO standard population are reported. Conclusion Comparing the results with other international studies, the trend of increasing life expectancies of people with intellectual disabilities is confirmed. People with intellectual disabilities still have a lower average life expectancy than the general population, partly due to subgroups with low life expectancies. [ABSTRACT FROM AUTHOR]

In two studies, we tested the relationship between non-immigrant individuals' perceptions of deviant behavior carried out by Muslims and foreigners and discriminatory intentions towards these outgroups. Based on a longitudinal and a representative cross-sectional sample, we showed that two different types of perceived deviant behavior (Study 1, Muslims' unwillingness to integrate; and Study 2, foreigners' hostility towards the non-immigrant majority group) are related to increased intergroup threat, which in turn is related to increased intentions to show passive discrimination (i.e., avoidance) towards these outgroups. In line with theorizing about an increased sensitivity for threat in authoritarian individuals, the relationship between perceptions of deviant behavior and threat was especially strong among high authoritarian individuals. Theoretical and practical implications of our results are discussed. [ABSTRACT FROM AUTHOR]

Background and aims Internet gaming disorder (IGD) is included as a condition for further study in Section 3 of the DSM-5. Nine criteria were proposed with a threshold of five or more criteria recommended for diagnosis. The aims of this study were to assess how the specific criteria contribute to diagnosis and to estimate prevalence rates of IGD based on DSM-5 recommendations. Design Large-scale, state-representative school survey using a standardized questionnaire. Setting Germany (Lower Saxony). Participants A total of 11 003 ninth-graders aged 13-18 years (mean = 14.88, 51.09% male). Measurements IGD was assessed with a DSM-5 adapted version of the Video Game Dependency Scale that covered all nine criteria of IGD. Findings In total, 1.16% [95% confidence interval (CI) = 0.96, 1.36] of respondents were classified with IGD according to DSM-5 recommendations. IGD students played games for longer periods, skipped school more often, had lower grades in school, reported more sleep problems and more often endorsed feeling 'addicted to gaming' than their non-IGD counterparts. The most frequently reported DSM-5 criteria overall were 'escape adverse moods' (5.30%) and 'preoccupation' (3.91%), but endorsement of these criteria rarely related to IGD diagnosis. Conditional inference trees showed that the criteria 'give up other activities', 'tolerance' and 'withdrawal' were of key importance for identifying IGD as defined by DSM-5. Conclusions Based on a state-wide representative school survey in Germany, endorsement of five or more criteria of DSM-5 internet gaming disorder (IGD) occurred in 1.16% of the students, and these students evidence greater impairment compared with non-IGD students. Symptoms related to 'give up other activities', 'tolerance' and 'withdrawal' are most relevant for IGD diagnosis in this age group. [ABSTRACT FROM AUTHOR]

Objectives. The aim of this study was to determine the relationship between iso-body mass index (iso-BMI) and both dental caries status and caries increment among German school children. Methods. Six hundred and ninety-four students (age range 9-12 years, mean 10.34 0.56, 48% females) were recruited from the fifth grade of 18 primary schools. Weight, height, and oral health data number of decayed, missing and filled teeth (DMFT) as well as parent/legal guardian questionnaire (measuring SES) were collected during school dental examination at baseline and after one and a half-year follow-up. The body mass index (BMI) was calculated using the international classification system for childhood overweight and obesity (iso-BMI). Statistical analyses were performed using Poisson regression models. Results. Iso-BMI was significantly associated with dental caries prevalence and severity in the permanent dentition (P = 0.039). Low-normal weight children had a lower mean DMFT (0.56) than did overweight/obese children (0.70). In addition, a border-line significant association was found between overweight/obese children and caries increment (P = 0.055). Conclusion. Although iso-BMI was associated with dental caries prevalence and severity, the association between caries increment and iso-BMI did not reach a statistical significance. Overweight/ obese children however acquired more additional carious lesions during the follow-up period than children with low-normal weight. [ABSTRACT FROM AUTHOR]

Objective The aim of the article is to report on the psychometric properties of a newly developed self-rating scale (Munich Eating and Feeding Disorder Questionnaire) for the detailed assessment of eating and feeding disorders on the basis of the DSM-5 criteria. The questionnaire aims at developing a comprehensive assessment of eating disorder symptoms suitable for severity ratings with regard to total scale and subscales, for deriving eating disorder diagnoses according to DSM-5 and ICD-10 and for measuring (intervention induced) changes over time. Methods Items were formulated by clinical experts and entered into factor analysis in two separate samples of eating-disordered inpatients. Additionally, 47 clinical and 547 community control participants were assessed. Internal consistency and sensitivity to change over time are also reported. Results Three subscales were identified covering 'preoccupation with figure and weight', 'bingeing and vomiting' and 'inappropriate compensatory behaviour' for current and past state. Test-retest reliability for the three subscales ranged between .95 and .98 (current status). A high sensitivity to change during inpatient treatment from admission to discharge was expressed in high effect sizes; for the total score (current status) for all eating disorders, the effect size was 1.70. Effect sizes for anorexia nervosa were mostly lower than those for bulimia nervosa. Clinical and community controls obtained significantly lower scores compared with eating-disordered patients. Conclusion This new DSM-5 questionnaire shows satisfying psychometric properties and is well suited for the rating of eating disorder severity in clinical practice and research. Copyright © 2015 John Wiley & Sons, Ltd and Eating Disorders Association. [ABSTRACT FROM AUTHOR]

Background and Objective Periodontitis has been found to be associated with coronary heart disease ( CHD) and stroke. However, only little is known about whether periodontitis and associated confounders are associated with new cardiovascular events among patients with CHD. Material and Methods A total of 942 inpatients with CHD were examined regarding periodontitis, oral care habits, bacteria in the subgingival biofilm and the expression of interleukin-( IL)-6 c. (coding DNA)-174 genotypes (rs 1800793) to determine whether these confounders are associated with new cardiovascular events within a 1-year follow-up period. Adjusted hazard ratios ( HR) with respect of age, gender, smoking, body mass index, use of aids for interdental hygiene, plaque index, occurrence of severe periodontitis and further internal diseases such as diabetes, hypertension, dyslipoproteinemia, number of missing teeth, serological parameters and IL-6 genotypes were generated with Cox regression. Results In all, 941 cardiovascular patients completed the 1-year follow up and 7.3% of the patients achieved the primary endpoint (myocardial infarction: 2.1%, stroke/transient ischemic attack: 1.8%, cardiovascular deaths: 3.4%). Patients who reported practicing interdental cleaning were younger, less likely to be male or to have severe periodontitis, had a reduced tobacco exposure, had fewer missing teeth, less indices for plaque and bleeding on probing and a significant decreased adjusted risk for new cardiovascular events ( HR = 0.2, CI 0.06-0.6, p = 0.01) than those patients with CHD who did not report practicing interdental cleaning. We did not obtain significant increased HR for patients with severe periodontitis ( HR = 1.2, CI 0.7-2.1, p = 0.53), carriers of the IL-6 genotypes GC or CC ( HR = 1.4, CI 0.8-2.5, p = 0.24) and did not find a significant association between the number of detected various oral species and the incidence of the combined endpoint ( HR = 0.9, CI 0.8-1.01, p = 0.07). Conclusions These findings suggest that flossing and brushing of interdental spaces might reduce the risk for new cardiovascular events among patients with CHD. The hypothesis that interdental cleaning per se reduces the risk of new cardiovascular events should be examined in an interventional study. [ABSTRACT FROM AUTHOR]

Research on occupational health has consistently shown that job characteristics and personal resources predict employee well-being. Building on the associative network theory, we claim that - vice versa - well-being is likely to affect the perception of job characteristics and personal resources. The aim of this study was to expand the literature on job characteristics, personal resources, and employee well-being (1) by taking a reversed causation perspective and (2) by investigating the dynamic nature of these relations in a latent change model. More specifically, we hypothesized that baseline levels and change in affective well-being are related to change in emotional demands and autonomy, two core job characteristics for our sample of psychotherapists. In addition, we explored the mediating role of hope as a personal resource in this process. A total of 326 psychotherapists participated in a two-wave online survey with a 5-month time lag. Results revealed that baseline levels of and change in affective well-being were associated with change in emotional demands. Furthermore, change in hope mediated the effect of change in affective well-being on change in autonomy. In conclusion, the results show that affective well-being can mark a starting point for building personal resources and changing employees' perceptions of their job characteristics. Practitioner points Employees with high levels of affective well-being perceive fewer emotional demands at work over time., An increase in affective well-being over a period of 5 months further decreases their experience of emotional demands at work., Employees whose affective well-being increases over time build hope at work. This, in turn, goes along with a more positive perception of their autonomy at work. [ABSTRACT FROM AUTHOR]

The misinterpretation of bodily symptoms as an indicator of a serious illness is a key feature of the criteria and the cognitive-behavioural models of hypochondriasis. Previous research suggests that individuals suffering from health anxiety endorse attributions of physical disease, whereas persons with elevated general anxiety have the tendency to attribute psychological causes to their symptoms. However, whether a somatic attribution style is specific to patients with hypochondriasis, as opposed to those with anxiety disorders, has not yet been investigated and is therefore part of the present study. Fifty patients with hypochondriasis, 50 patients with a primary anxiety disorder and 50 healthy participants were presented with nine common bodily sensations and had to spontaneously attribute possible causes to the symptoms. Patients with hypochondriasis differed from patients with anxiety disorders and healthy controls in giving significantly fewer normalizing explanations, but attributing more often in terms of moderate or serious diseases. Patients with anxiety disorders also made significantly fewer normalizing attributions and more somatic attributions to a severe illness than healthy controls. There were no differences between the groups in the frequency of psychological attributions and somatic attributions concerning mild diseases. The present study demonstrates that hypochondriasis is associated with a disorder-specific attribution style connecting somatic symptoms primarily with moderate and serious diseases. By contrast, normalizing attributions are largely omitted from consideration by patients with hypochondriasis. The findings conform with the cognitive conception of hypochondriasis and support the strategy of modifying symptom attributions, as practiced in cognitive-behavioural therapy. Copyright © 2013 John Wiley & Sons, Ltd. Key Practitioner Message Patients with hypochondriasis show a disorder-specific attribution style, which is biased towards moderate and serious diseases., This finding stresses the importance of therapeutic interventions challenging dysfunctional symptom attributions., In addition to attributions in terms of moderate and serious diseases, patients with hypochondriasis also produce constructive attributions (normalizing, psychological or in terms of mild illnesses)., Therefore, particular emphasis should be placed on a comprehensive exploration of all existing symptom attributions. By identifying beneficial attributions already in existence, the patient's resources are brought into focus and form the basis for reattribution training. [ABSTRACT FROM AUTHOR]

Aim We aimed to assess changes of periodontal status in Germany. Materials & Methods The Studies of Health in Pomerania ( SHIP) are two cross-sectional population-based studies conducted during 1997-2001 ( SHIP-0, 20-81 years, n = 3736) and 2008-2012 ( SHIP-Trend, 20-84 years, n = 3622) in northeast Germany. The German Oral Health Studies ( DMS, 35-44 and 65-74 years) are national cross-sectional population-based surveys conducted in 1997 ( DMS III, n = 1454) and 2005 ( DMS IV, n = 1668), whose results were separately reported for West and East Germany. Prevalences, percentages and numbers of teeth affected were defined. Results In SHIP, prevalence of attachment loss ( AL) ≥3 mm decreased from 89.7% (95% confidence interval ( CI): 88.6-90.8) to 85.1% (95% CI: 83.9-86.3) ( p < 0.05) and the mean extent reduced from 62.8% (95% CI: 61.7-63.8) to 55.9% (95% CI: 54.9-56.9) ( p < 0.05). Probing depth ( PD) ≥4 mm and the respective extent remained unchanged. In West Germany, AL ≥3 mm decreased for 35-44-year-olds and increased for 65-74-year-olds ( p < 0.05). In SHIP and DMS, the number of teeth in dentates increased significantly in all age groups. Conclusions Prevalences and extents of AL improved almost in all age categories in SHIP and West German adults, whereas PDs remained unchanged. Nonetheless, the improvement of periodontal conditions implies an increase of treatment needs regarding moderately diseased teeth because of simultaneous increases of the number of present teeth. [ABSTRACT FROM AUTHOR]

Background More conservative techniques for managing dental caries including 'partial' and 'no caries removal' have been increasingly of interest. Aim To compare children's behaviour and pain perception, also technique acceptability (parents and dentists), when approximal dentinal lesions ( ICDAS 3-5) in primary molars (3-8-year-olds) were managed with three treatment strategies; conventional restorations ( CR), hall technique ( HT), and non-restorative caries treatment ( NRCT). Design Secondary care-based, three-arm parallel-group, randomised controlled trial, with 169 participants treated by 12 dentists. Outcome measures: child's pain perception (Visual Analogue Scale of Faces); behaviour (Frankl scale); and parents' and dentists' treatment opinions (5-point Likert scales). Results Children showed more negative behaviour in the CR group (37%) compared to NRCT (21%) and HT (13%) ( P = 0.047, CI = 0.41 to 0.52). Pain intensity was rated 'very low' or 'low' in 88% NRCT, 81% HT, and 72% CR ( P = 0.11, CI = 0.10 to 0.12). NRCT and HT were 'very easy' or 'easy' to perform for >77% of dentists, compared to 50% in CR group ( P < 0.000). There were no statistically significant differences in parents' rating of their child's level of comfort ( P = 0.46, CI = 0.45 to 0.48). Conclusions Dentists reported more negative behaviour in CR group. For all techniques, children's pain perception and dentist/parent acceptability were similar. [ABSTRACT FROM AUTHOR]

Here we report the results of a first-in-human study to evaluate the safety, tolerability pharmacokinetics, and pharmacodynamics of abediterol, a new β2-adrenergic agonist. Forty-eight healthy males aged 18-45 years received abediterol doses of 5, 10, 25, or 50 µg, or placebo. Safety and tolerability assessments included adverse event reporting, pulse and blood pressure monitoring, 12-lead electrocardiograms, laboratory tests, and physical examination. Pharmacodynamic assessments included whole body plethysmography to determine the bronchodilatory effect by means of airway conductance and resistance. Blood and urine samples were obtained for pharmacokinetic analyses. Abediterol showed an overall good safety and tolerability profile in the dose range tested, consistent with the expected characteristics of a β2-adrenergic agonist. A dose-dependent increase of systemic treatment-emergent adverse events was observed, the most frequent being palpitations, tremor, nausea, and asthenia; most were mild in intensity and resolved without the need for intervention. Improvements in airway conductance (increase) and resistance (decrease) were greater for all doses of abediterol tested compared with placebo at all time-points up to 36 hours. This first-in-human study suggests a potent, rapid, and sustained bronchodilatory effect of abediterol in healthy male subjects. Lower doses are currently under investigation in patients with asthma and in patients with COPD. [ABSTRACT FROM AUTHOR]

Aims To investigate the longitudinal patterns (stability and change) of problematic computer game use and its interdependencies with psychosocial wellbeing in different age groups. Design Three-wave, annual panel study using computer-assisted telephone surveys. Setting Germany. Participants A total of 112 adolescents aged between 14 and 18 years, 363 younger adults between 19-39 years and 427 adults aged 40 years and older (overall n = 902). Measurements Problematic game use was measured with the Gaming Addiction Short Scale ( GAS), which covers seven criteria including salience, withdrawal and conflict. Additionally, gaming behaviour and psychosocial wellbeing (social capital and support, life satisfaction and success) were measured in all three panel waves. Findings The generally low GAS scores were very stable in yearly intervals [average autocorrelation across waves and age groups: r = 0.74, confidence interval ( CI) = 0.71, 0.77]. Only nine respondents (1%, CI = 0.5, 1.9) consistently exhibited symptoms of problematic game use across all waves, while no respondent could be classified consistently as being addicted according to the GAS criteria. Changes in problematic gaming were not related consistently to changes in psychosocial wellbeing, although some cross-lagged effects were statistically significant in younger and older adult groups. Conclusions Within a 2-year time-frame, problematic use of computer games appears to be a less stable behaviour than reported previously and not related systematically to negative changes in the gamers' lives. [ABSTRACT FROM AUTHOR]

This study examines the effect of justice sensitivity on the life satisfaction and job-seeking behavior of unemployed individuals and considers the likelihood of experiencing long-term unemployment. We focus on two facets of dispositional justice sensitivity that reflect individual differences in perception and reactions to perpetrating injustice against others (perpetrator sensitivity) or suffering from the injustice of others as an innocent victim (victim sensitivity). We hypothesised that the negative effect of unemployment on life satisfaction is stronger among individuals with higher levels of victim sensitivity and perpetrator sensitivity. The former are more likely to perceive themselves as victims of an unjust situation, such as fate or the employer's decisions, whereas the latter are more likely to perceive themselves as perpetrators against the rules of social justice. Using survey data from approximately 400 participants, we found that unemployed individuals were less satisfied with life than employed individuals and that this relationship was stronger for perpetrator-sensitive individuals. Unemployed perpetrator-sensitive individuals were more likely to engage in active job-seeking behavior and faced a lower likelihood of long-term unemployment. The results are discussed in terms of the importance of justice-related personality aspects of unemployed individuals for their well-being and labor market outcomes. [ABSTRACT FROM AUTHOR]

Secondary transfer effects ( STEs) of intergroup contact refer to the generalization of contact effects from a primary encountered outgroup to attitudes towards secondary outgroups (Pettigrew, 2009). Using two large, cross-sectional data sets from Germany ( N = 1,381) and Northern Ireland ( N = 1,948), this article examined the extent to which STEs of intergroup contact on attitudes towards a range of secondary outgroups occur via a previously unexplored psychological construct, social identity complexity (operationalized as similarity complexity and overlap complexity). Study 1 found primary outgroup contact to be associated with greater similarity complexity, but no indirect effects on secondary outgroup attitudes via complexity emerged. Study 2, however, revealed indirect positive relationships between primary outgroup contact and secondary outgroup attitudes via increased similarity complexity and overlap complexity. These relationships were obtained while controlling for two previously tested mediating mechanisms, attitude generalization (operationalized as primary outgroup attitude) and deprovincialization (operationalized as ingroup attitude and identification). We discuss the theoretical implications of these findings and the contribution of social identity complexity to understanding processes underlying STEs of contact. [ABSTRACT FROM AUTHOR]