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BackgroundA standard questionnaire for generalized anxiety disorders is the GAD-7. Attempts to improve its screening capacity in oncological settings resulted in a discussion about lowering its cut-off. This study examines the diagnostic accuracy of the GAD-7 items depending on applied cut-offs and whether, similar to depressive symptoms, a distinction between somatic-emotional and cognitive items might be relevant.Patients and methodsScreening data from 4705 patients with cancer who were treated at the outpatient clinic of the National Centre for Tumour Diseases in Heidelberg were analysed. For the individual GAD-7 items sensitivity, specificity, positive and negative predictive values, and Clinical Utility Index were determined for cut-off ≥ 7, ≥ 8, ≥ 10 and ≥ 15 in the GAD-7 questionnaire.ResultsThe best overall diagnostic accuracy was found for a cut-off ≥ 8. The cognitive items had the best diagnostic accuracy for identifying severe GAD (cut-off ≥ 15), and the somatic-emotional items had the best diagnostic accuracy for identifying mild to moderate GAD (cut-off ≥ 7, ≥ 8 and ≥ 10).ConclusionsOur data support the recommendation of lowering the GAD-7 cut-off in oncology settings and suggest that in anxiety disorders, a symptom overlap between the physical illness and a possible mental disorder should be considered.

Abstract In low-income countries, Muscle Dysmorphia (MD) has only been investigated in adult south African amateur-bodybuilders. To date, there is no epidemic study about MD or its cardinal symptom “drive for muscularity” (DFM) and its impact on young men’s lives in African low-income settings. We analyzed a population-representative cross-sectional study of 838 adolescent males aged 12–20 in the rural northwestern Burkina Faso. Participants were assessed for MD with the research criteria of Pope and its cardinal symptom DFM based on the DFM scale (DMS). Since DFM has not been studied in a comparable sample so far, all possible influencing variables were examined exploratively in a linear regression model. Many respondents were underweight (41.5%) and few overweight (1.3%). No-one met standard clinical MD criteria. While 60.1% of 837 wished to be more muscular, only 8.7% of 824 desired a lower body-fat percentage. Regression analysis revealed that higher DMS scores were associated with greater internalization of the muscular body ideal, going to school, living in a rural area, older age, and a history of having faced sexual harassment or assault, but not with media exposure. Our results show that levels of DMS in Burkinabe adolescents were elevated. Risk factors for DFM in environmental circumstances where undernutrition and poverty are common are discussed.

ABSTRACTCuriosity, which has been called the third pillar of academic achievement and positively predicts academic performance (von Stumm et al., 2011), is widely recognized as an important factor in acquiring knowledge and skills in medical training, and may be critical for students´ sound mental health. Medical educators have advocated that curiosity should play a more significant role in medical training and have criticized didactic barriers impeding student curiosity. However, in medical training, curiosity is understudied partly due to a lack of methods for measuring curiosity. Therefore, this study was designed to develop and validate a scale to measure medical curiosity. After reviewing the literature and interviewing a panel of experts (n = 7), 25 preliminary items assessing medical curiosity were developed and administered to n = 305 medical students (n = 163 female and n = 142 male) at Heidelberg University across all medical school years. Following exploratory factor analysis (EFA) with oblique (promax) rotation, we measured medical curiosity in a medical student sample. We have identified two distinct factors: intellectual medical curiosity (IMC) and social medical curiosity (SMC). IMC describes the desire to acquire medical knowledge for curiosity’s sake, while SMC refers to curiosity about human nature and, in particular, patient health. Both factors showed good psychometric properties, with eigenvalues of 6.7 and 3.5, explaining 26.6% and 14.0% of the variance and internal consistencies of 0.796 and 0.866, respectively, and high convergent and discriminant validity. While first-year students showed significantly higher IMC scores than final-year medical students, SMC scores remained stable and tended to increase throughout medical school. This study has succeeded in developing the first scale to measure aspects of medical curiosity and, thus, lays the groundwork for future studies examining medical students’ curiosity. A deeper understanding of medical students’ curiosity can help to foster this curiosity effectively.

Climate change (CC) is adversely affecting human health and will become far more dangerous in the future, if no substantial measures are taken. Young people in particular are taking an energetic stand for CC awareness. Some CC experts argue that medical doctors are especially well positioned to inform about the impact of CC on public health, as it is well established that they are among the most trusted members of society. However, medical doctors seem to be unsure of their role in addressing CC. This study aimed to investigate future doctors´, i.e., final year medical students´ (FYMS), attitudes towards CC and their personal role in CC education and health care. A questionnaire was developed to examine (1) the expected consequences of CC for FYMS, (2) their perceived individual responsibility, and their attitudes towards an additional (3) professional responsibility. To examine the climate-questionnaire’s component correlations, we ran a factor analysis using oblique (promax) rotation and conducted a one-way ANOVA with repeated measures to compare the mean scores of the factors. Data are presented as mean ± SD or percentage, as appropriate. n = 65 FYMS (response rate: 87%) were participating and all of them completed the questionnaire. Items of the factor professional responsibility showed the lowest level of agreement (47.2 ± 21.2), while the 2 other factors showed higher levels of agreement (expected consequences (75.6 ± 18.4), individual responsibility (75.1 ± 20.6). Future doctors at Heidelberg University Hospital are well-informed about the expected health consequences of CC. They recognize human contributions to CC and make personal decisions to mitigate the impact. However, the opinion that they have a professional responsibility as physicians to patients or society in regard to CC is weaker. Specific teaching could help to change the way future doctors see their role and responsibility in tackling CC.

Abstract Purpose Cognitive impairment and reduced quality of life is a common condition in patients with heart failure (HF). Percutaneous mitral valve repair using (PMVR) MitraClip (MC) has emerged as a promising interventional tool, reducing all-cause mortality and hospitalization as well as increasing cognitive functioning and quality of life. However, the benefit of HF patients with severely depressed cognitive functioning remains unknown. Methods We assessed cognitive functioning (figural memory—FGT, executive function—TOL, TMT B), psychosocial functioning (depression—PHQ-9, quality of life—SF36), and clinical parameters (echocardiography, 6-min walk test distance, and cardiac biomarkers) 1 day before (t0) and 6 weeks after (t1) MC intervention in HF patients (n = 40). First, paired sample t tests were conducted to uncover improvements in cognitive functioning post-MC intervention. Second, the COGBAT Norm-sample, a representative age-matched healthy sample, was used to compare participants’ individual scores. Third, bivariate linear regressions were calculated for all key predictors of the detected improvements in cognitive functioning post-MC intervention (t1–t0). Results Following the MC intervention, we found significant improvements in figural memory, executive functioning, and psychosocial functioning. Most of the patients with depressed executive functioning before the MC intervention showed post-intervention test scores within the normal range (> 50th percentile; t0 22.5% vs. t1 60%) as compared to the normative COGBAT sample. Regression analyses revealed that lower baseline scores in planning ability before the MC intervention (t0) were associated with greater planning ability (TOL; B = − 0.78, 95% CI − 1.04 to − 0.53), figural memory (FGT; B = − 0.26, 95% CI − 0.44 to − 0.07), and cognitive flexibility (TMT B; B = − 0.36, 95% CI − 0.50 to − 0.23) improvement post-MC intervention (t1–t0). Psychosocial functioning and age were not associated with these improvements. Conclusions Patients with depressed executive functioning showed the greatest benefit from the MC intervention regarding cognitive functioning. Age and psychological functioning seem less important for cognitive performance improvements post-MC intervention. Hence, severely depressed cognitive functioning in patients is not a contraindication for PMVR using MitraClip.