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This article enhances the understanding of individual and school-related drivers of socialization connecting to trust in political institutions. Using data from the International Civic and Citizenship Education Study 2016, the authors show that pupils in Germany report high levels of trust in political institutions that is reduced for pupils with international biographies, experiences of teacher unfairness, and in schools with a high proportion of pupils with international biography, as well as in academic tracks (Gymnasium). [ABSTRACT FROM AUTHOR]

Do high job demands help employees to stay challenged at work, or do they challenge their well-being? Despite burnout being an ever-pressing matter in contemporary workspaces, the understanding of the link between job demands and burnout remains limited, especially considering the important multilayered role of context in organizations. Our study develops an integrated perspective on the antecedents of burnout, rather than viewing various elements in isolation. Specifically, we uncover a three-way interaction among job demands, collective trust, and competitive pressure across the three levels of study via a multilevel analysis of 5485 employees, nested into 2872 units in 89 German organizations. The three-way interaction of individual-level job demands with unit-level collective trust depends on the magnitude of competitive pressure at the organizational level. In a condition of low organizational-level competitive pressure, unit-level trust can mitigate the positive effect of individual job demands on burnout. Our findings indicate that job demands can be a double-edged sword, bringing with them both benefits and burdens. From a practical perspective, we provide guidance for organizations on how to maintain high job demands by emphasizing collective trust and open communication about organizational-level competitive pressure to mitigate burnout at work. [ABSTRACT FROM AUTHOR]

Objectives: Understanding how social categories like gender, migration background, lesbian/gay/bisexual/transgender (LGBT) status, education, and their intersections affect health outcomes is crucial. Challenges include avoiding stereotypes and fairly assessing health outcomes. This paper aims to demonstrate how to analyze these aspects., Study Design and Setting: The study used data from N = 19,994 respondents from the German Socio-Economic Panel 2021 data collection. Variations between and within intersectional social categories regarding depressive symptoms and self-reported depression diagnosis were analyzed. We employed intersectional Multilevel Analysis of Individual Heterogeneity and Discriminatory Accuracy to assess the impact of gender, lesbian/gay/bisexual/transgender status, migration, education, and their interconnectedness. A Configuration-Frequency Analysis assessed typicality of intersections. Differential Item Functioning analysis was conducted to check for biases in questionnaire items., Results: Intersectional multilevel analysis of individual heterogeneity and discriminatory accuracy analysis revealed significant interactions between these categories for depressive symptoms and depression diagnosis. The Configuration-Frequency Analysis showed that certain combinations of social categories occurred less frequently compared to their expected distribution. The Differential Item Functioning analysis showed no significant bias in a depression short scale across social categories., Conclusion: Results reveal interconnectedness between the social categories, affecting depressive symptoms and depression probabilities. More privileged groups had significant protective effects, while those with less societal privileges showed significant hazardous effects. Statistical significance was found in some interactions between categories. The variance within categories outweighs that between them, cautioning against individual-level conclusions., Competing Interests: Declaration of competing interest The authors declare no competing interests., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background: There is an ongoing debate about whether environmental characteristics influence dementia risk like individual traits do, and whether these differ by sex and gender.Objective: This study examines the influence of regional characteristics on the incidence of dementia and explores sex and gender differences using individual-level health information and regional characteristics.Methods: Using a random sample of 250,000 people aged 70 + insured through Germany's largest German public health agency, we analyzed quarterly data about diagnoses and place of residence from 2014 to 2019. Using five-digit postal codes, we added data on various dimensions of regional characteristics offered by the INKAR database and the 2011 Census database. We used multilevel survival regressions to tease out regional incidence differences while accounting for spatial clustering.Results: After adjusting for multi-morbidity and relocation-related selection bias, we saw that people living in regions with the highest tertile of income (HR = 0.87, p < 0.001), and who had the highest tertile of remaining life expectancy at age 60 (HR = 0.93, p = 0.012) had lower dementia risks. There was no gender difference in the regional income effect, but the effect of education (HR = 0.91, p = 0.015) was significant only for men and remaining life-expectancy was significant only for women (HR = 0.93, p = 0.026).Conclusion: Environmental characteristics related to wealth and health resources of a region influence the risk of dementia among the elderly in Germany. This effect is independent of the health profiles of the individuals and differs between the two genders. Health policies need to acknowledge these modifiable risk factors and consider how they affect men and women differently. [ABSTRACT FROM AUTHOR]

Regional clusters have become an inseparable component of modern economies. Spurred by the idea that clusters unrestrictedly encourage firm innovativeness, the cluster approach has particularly gained attention among politicians. Nevertheless, due to a lack of holistic consideration of different influencing variables, the scientific results about the effect of clusters on firm innovative performance are highly contradictive. Consequently, this paper aims to empirically investigate the conditions through which companies can gain from being located in clusters, focussing thereby particularly on moderating variables that relate to possible knowledge spillovers. Therefore, three different levels of analysis are considered separately and interactively. By analysing a unique multilevel dataset of 11.889 companies in Germany evidence is found that being located in a cluster has a positive impact on firm innovativeness. However, the results also indicate that firms benefit unequally within the cluster environment, depending on the specific firm, cluster and market/industry conditions. [ABSTRACT FROM AUTHOR]

Background: Intersectional approaches are needed to disaggregate the complex interaction of social identities contributing to (mental) health disparities. Health anxiety represents an overlooked public mental health issue. Therefore, intersectional inequalities in health anxiety were examined using multilevel analysis of individual heterogeneity and discriminatory accuracy (MAIHDA)., Methods: Analyses are based on cross-sectional data of the adult population living in Germany ( N  = 2,413). Health anxiety was assessed with the Whiteley Index-7. Applying intersectional MAIHDA, health anxiety in the intersectional strata of gender, history of migration, and income was predicted. Discriminatory accuracy was assessed via the intra-class correlation and the proportional change in variance., Results: Analyses revealed additive social inequalities in health anxiety with greatest impact of low income but no clear intersectional gradient. Most affected by health anxiety were females who immigrated themselves with low income, males whose parent(s) immigrated with low income, and males who immigrated themselves with medium income., Conclusion: Intersectional approaches contribute to a more comprehensive understanding of (mental) health disparities. In addition to general efforts to counteract health inequalities, combining universal screening and targeted psychotherapeutic treatment seems promising to specifically reduce inequalities in health anxiety., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Barbek, Lüdecke and von dem Knesebeck.)

Background: Discharge management is a central task in hospital management. Mitchell's quality health outcomes model offers a contextual framework to derive expectations about the relationship between indicators of hospital structures and processes with patient experiences of preparation for discharge. Purpose: The aim is to analyze the association between hospital structures and processes with patient experiences of preparation for discharge in breast cancer centers. Methodology: The data were collected between February 1 and July 31, 2014-2016, with annual cross-sectional postal surveys on patient experiences of preparation for discharge in breast cancer center hospitals in Germany. These data were combined with secondary data on hospital structures, obtained from structured quality reports 2014 and the accreditation institution certifying breast cancer centers, constituting a hierarchical data structure. A total of 10,750 newly diagnosed breast cancer patients from 67 hospitals were analyzed. Following listwise deletion, 9,762 patients could be included in linear hierarchical regression analyses. Results: Patients felt better prepared for discharge in hospitals that communicate the discharge date timely to patients, with good coordinative processes, and which cooperate with two other breast cancer center hospitals. Hospital structures, size, teaching status, and ownership were not associated with the patient experiences of preparation for discharge. Conclusion: The results suggest that timely and informative communication, well-organized care processes, and the network structure of centers allow for an improvement of preparation for discharge. Current and future approaches for the improvement of hospital discharge should consider the identified hospital resources. Practice Implications: Hospital management should increase the focus on structured communication and coordination processes to improve the discharge process. Cooperating networks should be expanded to increase expertise and resources. Results can be generalized to other care domains with caution. Patients' characteristics should further be assessed in order to use resources efficiently. [ABSTRACT FROM AUTHOR]

Purpose: The self-reported functional status (sr-FS) of prostate cancer (PCa) patients varies substantially between patients and health-care providers before treatment. Information about this issue is important for evaluating comparisons between health-care providers and to assist in treatment decision-making. There have been few reports on correlates of pretherapeutic sr-FS. The objective of the article, therefore, is to describe clinical and sociodemographic correlates of pretherapeutic sr-FS, based on a subset of the TrueNTH Global Registry, a prospective cohort study. Methods: A total of 3094 PCa patients receiving local treatment in 44 PCa centers in Germany were recruited between July 2016 and April 2018. Multilevel regression models were applied to predict five pretherapeutic sr-FS (EPIC-26) scores based on clinical characteristics (standard set suggested by the International Consortium for Health Outcomes Measurement), sociodemographic characteristics, and center characteristics. Results: Impaired pretherapeutic sr-FS tended to be associated with lower educational level and poorer disease characteristics—except for "urinary incontinence" which was only associated with age. Notably, age was a risk factor ("urinary incontinence," "urinary irritative/obstructive," "sexual") as well as a protective factor ("hormonal") for pretherapeutic sr-FS. Pretherapeutic sr-FS varies little across centers. Conclusions: Pretherapeutic sr-FS varies by clinical patient characteristics and age as well as by socioeconomic status. The findings point out the benefit of collecting and considering socioeconomic information in addition to clinical and demographic patient characteristics for treatment decision-making and fair comparisons between health-care providers. [ABSTRACT FROM AUTHOR]

Considering the scarce empirical evidence regarding talent predictors in female youth soccer, the present study aimed to investigate the long-term prognostic validity of elite female soccer players' adolescent motor performance for future success in adulthood. Additionally, the three-year development of highly talented girls' motor performance and the predictive value of this motor development for reaching a professional adult performance level (APL) was analysed. Overall, N = 737 female players participated in nationwide motor diagnostics (sprinting, agility, dribbling, ball control, shooting) within the German Soccer Association's talent identification and development programme at least twice between the age groups Under-12 (U12) and U15. Based on their APL at least four years later, participants were assigned to a professional (first German division, 6.2%) or non-professional group (lower divisions, 93.8%). Multilevel regression analyses revealed a general prognostic relevance for the investigated parameters with respect to players' APL. In addition, there was a non-linear improvement in participants' motor performance across all variables from U12 to U15. However, non-significant interactions between APL and these improvements indicate motor performance development itself cannot adequately predict players' future success in adulthood. Findings provide insightful information that can help coaches foster optimal support for young female soccer players' development. [ABSTRACT FROM AUTHOR]

Background: Cancer patients often suffer from psychological distress. Psycho‐oncological services (POS) have been established in some health care systems in order to address such issues. This study aims to identify patient and center characteristics that elucidate the use of POS by patients in prostate cancer centers (PCCs). Methods: Center‐reported certification and patient survey data from 3094 patients in 44 certified PCCs in Germany were gathered in the observational study (Prostate Cancer Outcomes). A multilevel analysis was conducted. Results: Model 1 showed that utilization of POS in PCCs is associated with patients' age (OR = 0.98; 95%‐CI = 0.96‐0.99; P <.001), number of comorbidities (1‐2 vs 0, OR = 1.27; 95%‐CI = 1.00‐1.60; P=.048), disease staging (localized high‐risk vs localized intermediate risk, OR = 1.41; 95%‐CI = 1.14‐1.74; P <.001), receiving androgen deprivation therapy before study inclusion (OR = 0.19; 95%‐CI = 0.10‐0.34; P <.001), and hospital teaching status (university vs academic, OR = 0.09; 95%‐CI = 0.02‐0.55; P =.009). Model 2 additionally includes information on treatment after study inclusion and shows that after inclusion, patients who receive primary radiotherapy (OR = 0.05; 95%‐CI = 0.03‐0.10; P <.001) or undergo active surveillance/watchful waiting (OR = 0.06; 95%‐CI = 0.02‐0.15; P <.001) are less likely to utilize POS than patients who undergo radical prostatectomy. Disease staging (localized high‐risk vs localized intermediate risk, OR = 1.31; 95%‐CI = 1.05‐1.62; P =.02) and teaching status (university vs academic, OR = 0.08; 95%‐CI = 0.01‐0.65; P =.02) are also significant predictors for POS use. The second model did not identify any other significant patient characteristics. Conclusions: Future research should explore the role of institutional teaching status and whether associations with therapy after study inclusion are due to treatment effects – for example, less need following radiotherapy – or because access to POS is more difficult for those receiving radiotherapy. [ABSTRACT FROM AUTHOR]

Summary: Knowledge about risk factors of mortality after hip fracture might encourage prevention and further improvements in care. This study identified patient risk factors as well as hospital and regional characteristics associated with a decreased risk. Variation of mortality was largest on patient level and modest on hospital and regional level. Introduction: Among numerous studies analyzing mortality as worst consequence after hip fracture, the majority focused on patient level and fewer on hospital and regional level. Comprehensive knowledge about contributing factors on all levels might help to reveal relevant inequalities, which would encourage prevention and further improvements in care. This study aimed at investigating variation of mortality after hip fracture on patient, hospital, and regional level in Germany. Methods: We performed a retrospective cohort study on hip fracture patients aged 65 and older using statutory health insurance claims data from Jan 2009 through Dec. 2012 and additional information from the Federal Statistical Office Germany. Regions were classified based on two-digit postal code. We applied a multilevel Cox proportional hazard model with random intercepts on hospital and regional level to investigate the risk factors for mortality within 6 and 12 months after hip fracture. Results: The dataset contained information on 123,119 hip fracture patients in 1014 hospitals in 95 German regions. Within 6/12 months, 20.9%/27.6% of the patients died. On patient level, male sex, increasing age, increased pre-fracture care level, and increasing comorbidity were associated with an increased hazard of mortality. Hospitals with increasing hip fracture volume or with orthogeriatric co-management and regions with increased population density were associated with a decreased hazard. Variation was largest on patient level and rather modest on hospital and regional level. Conclusions: The identification of patient-related risk factors enables prognosticating mortality after hip fracture. After adjusting for those, variation seemed to be attributable rather to hospitals than to regions. [ABSTRACT FROM AUTHOR]

There has been a long-lasting debate over whether increasing ethnic diversity undermines support for social welfare, and whether this conflict thesis applies not only to the United States, but also to European welfare states. In their 2016 ASR article, Schmidt-Catran and Spies analyzed a panel (1994 to 2010) of regional units in Germany and concluded that this thesis also holds for Germany. We argue that their analysis suffers from misspecification: their model specification assumes parallel time trends in welfare support in all German regions. However, time trends strongly differed between Western and Eastern Germany after reunification. In the 1990s, Eastern Germans' attitudes adapted to a less interventionist Western welfare system ("Goodbye Lenin effect"). When allowing for heterogeneous time trends, we find no evidence that increasing proportions of foreigners undermine welfare support, or that this association is moderated by economic hardship (high unemployment rates). We conclude with some general suggestions regarding the conceptualization of context effects in spatial analyses. [ABSTRACT FROM AUTHOR]

Relying on an importation and deprivation framework, the study assessed a variety of risk factors associated with self-reported teacher-targeted aggression among ninth grade students (n = 5,673). Using a cross-sectional school survey conducted in one German federal state, two forms of teacher-targeted aggression were assessed: verbal (insulting, threatening, and mocking) and physical (beating and pushing) aggression. Every ninth student reported verbal aggression, while 0.5% of students reported physical aggression against teachers. Multilevel probability models showed that individual importation factors (low self-control, male gender, and exposure to severe parental violence), together with individual deprivation factors (repeated victimization by teachers and low school achievement) play a role in explaining teacher-targeted aggression. The school-level deprivation factor of negative teacher-student relationships was also relevant, whereas low teacher control and attending lower-level schools were unrelated to the perpetration of teacher-targeted aggression. The present study stresses the need to acknowledge the multilevel etiology of teacher-targeted aggression. [ABSTRACT FROM AUTHOR]

Background: It is unclear whether specific components of individual social capital promote or protect against substance use and whether such effects vary across the life course. In this study, we investigated the effects of voluntary memberships and volunteering on alcohol and tobacco consumption in age comparison.Methods: Preregistration is accessible at https://osf.io/qhkrn/. We used data from the German Socio-Economic Panel (1984-2015), where alcohol consumption was assessed in 2006, 2008, and 2010 and smoking was assessed at least biennially since 1998. We divided participants into three age groups (14-29, 40-50, and 65-75 years of age at baseline). To disentangle intraindividual change over time and interindividual differences (potential selection effects), we employed multilevel analysis.Results: At the within level, voluntary memberships at one occasion predicted higher alcohol consumption a year later in middle-aged and older adults, but memberships had no significant longitudinal effects on smoking. Several positive effects of volunteering on alcohol and tobacco use one year later were found in males. No significant differences in the longitudinal effects between age groups or between nonpolitical and political volunteering emerged. At the between level, voluntary memberships and volunteering were usually associated with more alcohol consumption at low and moderate levels but with less smoking.Discussion: Over time, voluntary memberships and volunteering in Germany appear to promote, rather than to protect against, alcohol and tobacco use. On average, more engaged individuals drink more (at moderate levels) and smoke less, which may be due to selection effects. [ABSTRACT FROM AUTHOR]

What factors underlie immigrants' social distance towards natives? Previous studies found that immigrants who perceive themselves as rejected by natives express more negative intergroup attitudes towards natives. Another line of research found that contingent on their origin country, immigrants face different degrees of social distance from natives. In this study, we employ an intergroup threat approach to integrate these separate research strands. The theoretical model we develop predicts that immigrants from groups that receive greater social distance from natives will perceive more personal discrimination, which, as a mediating mechanism, will be associated with greater social distance towards natives. Empirically, we draw on a cross-sectional probability sample of 1789 immigrants from 38 origin countries living in Germany (i.e., a comparative origin design). The results of multilevel mediation analyses prove consistent with our theoretical expectations, which points to the benefits of examining social distance among immigrants and natives in conjunction., Competing Interests: Declaration of competing interest We have no known conflict of interest to disclose., (Copyright © 2023 Elsevier Inc. All rights reserved.)

This research examined how a predictable change in the social structure over time (from segregated to integrated) can affect the way intergroup contact and subjective categorization of ingroup and outgroup members (intergroup, superordinate, dual identity) impact on intergroup bias. A three-stage longitudinal study was conducted with six-month intervals ( N s = 708, 435, 418) involving high school students in Germany. Time 1 ( T 1) was characterized by structural segregation and Times 2 and 3 ( T 2, T 3) by structural integration. Longitudinal analysis between T 1 and T 2 showed that intergroup categorization (but not superordinate categorization or dual identity) improved intergroup relations. Between T 2 and T 3, dual identity reduced intergroup bias and marginally increased interpersonal closeness whereas superordinate categorization increased bias and reduced interpersonal closeness. There were no effects of intergroup categorization between T 2 and T 3. Overall, positive effects of contact increased over time, reaching significance from T 2 to T 3, supporting a consolidation hypothesis and intergroup contact theory more widely. These findings are also consistent with a congruence hypothesis that the impact of intergroup contact is partly determined by the match between how people categorize ingroup and outgroup members and the social structure that frames intergroup relations. [ABSTRACT FROM AUTHOR]

Objectives: Throughout 2021, the coronavirus disease (COVID-19) pandemic caused renewed restrictions across Germany. Given the growing evidence that the pandemic negatively affects older adults' health and well-being, this study investigated health sensitivity (emotional reactions to momentary health challenges) and its moderators (age, morbidity, perceived COVID-19 risks and worries) among older adults in their everyday lives during the second and third waves of the pandemic., Methods: Multilevel models were applied to self-reported momentary health and affect data, collected 6 times per day across 7 consecutive days in 104 participants (Mage = 76.35; range: 67-88 years), assessed between April and June 2021 (~300,000 COVID-19 cases in Germany at the time)., Results: Health sensitivity was unrelated to age and lower with higher morbidity. Importantly, older adults showed higher health sensitivity in moments when they also perceived a greater risk of contracting COVID-19., Discussion: Findings suggest that sociocontextual factors related to the pandemic modulate emotional reactions to momentary health challenges, thereby underscoring the consequences of COVID-19 for older adults' emotional experiences., (© The Author(s) 2023. Published by Oxford University Press on behalf of The Gerontological Society of America.)

In this study, we focus on the relevance of social influence to explain cyberbullying experiences among German high school students. Social influence is discussed in the context of computer-mediated communication. To obtain individual and sociostructural data, we conducted a survey study among German high school students (N = 4,282). Using multilevel modeling, we found that the attributes of the school class only contributed to the risk of being involved in cyberbullying to a small extent. Still, procyberbullying norms in class did enhance the risk of perpetration and victimization for students, even more so than their individual beliefs. Previous experiences with bullying and intensive, unrestricted use of the Internet were the strongest individual predictors of cyberbullying involvement. [ABSTRACT FROM AUTHOR]

Background: Multiple substance use among adolescents is associated with a number of negative consequences. Therefore, we aim to investigate multiple substance use patterns among young adolescents and identify possible multilevel predictors.Methods: We analyzed a longitudinal sample of 2490 German students (51% male; Mage=13.32, SD=0.57) at 45 schools in four German states (Bremen, Hesse, North Rhine-Westphalia, Schleswig-Holstein), who completed two assessments in fall, 2010 and fall, 2013. We conducted multilevel latent class analysis for follow-up data on a variety of outcomes, and tested our final 3-class-model for possible baseline predictors. Follow-up substance use measures included lifetime use, current use, and amount of substance for cigarettes and alcohol. Baseline covariates comprised age, gender, socio-economic status, bullying, victimization, peer and parental use, type of school, and health certification of school.Results: We identified three latent classes: non-users (n=1541; 61.9%), experimenters (n=722; 29.0%), and multiusers (n=227; 9.1%). Experimental consumption was predicted by higher baseline age (OR=1.71; 1.31-2.24), paternal drinking (OR=2.89; 1.23-6.79), and school type (OR=2.57; 1.83-3.61), while multiuse was predicted by peer smoking (OR=2.94; 1.80-4.80) and drinking (OR=2.13; 1.32-3.44), maternal drinking (OR=6.26; 2.02-19.43), bullying (OR=1.69; 1.15-2.48), higher age (OR=1.92; 1.40-2.62), and school type (OR=4.76; 2.75-8.24) compared to the non-users class.Conclusions: Prevention and further research on multiple substance use need to concentrate on social influence models and behavior-related interventions, especially at schools without a college-preparatory track. [ABSTRACT FROM AUTHOR]

Purpose – The purpose of this study is to elucidate the determinants of economic resilience at various levels of analysis. While the economic benefits of regional clustering are well-documented, the impact of external shocks on regional clusters has only recently gained attention. This study explores the antecedents of economic resilience, defined as sustained employment growth, prior to and during the global financial crisis within the German biotechnology industry. Design/methodology/approach – This study combines multilevel linear regression analysis with egocentric network analysis. This allows us to distinguish micro- and context-level effects in the analysis of economic resilience. Findings – The findings of this study indicate that while specialization at the network and context-level is conducive to firm growth prior to the crisis, these configurations seem to be particularly susceptible to external shocks. Conversely, diversity (diversified regional agglomerations and diverse networks) seems to be associated with economic resilience during the crisis. Moreover, we find that economic resilience is connected to adaptive capability at the micro-level, that is, the ability to expand and diversify a firms’ portfolio of network ties in the face of an external shock. Finally, we show that these adaptive processes are facilitated by geographical proximity among collaborating organizations. Originality/value – This study contributes to the existing literature by showing that the antecedents of economic resilience are located at multiple levels of analysis. An important implication of this study is that the examination of the resilience of regional clusters may thus be significantly enhanced by disentangling effects at the firm, network and regional (i.e. context) level. [ABSTRACT FROM AUTHOR]

Aims: The goal of this study was to analyse the influence of individual characteristics and tobacco control policies on smoking status and tobacco consumption amongst patients in (psycho-) somatic rehabilitation centres. Methods: A multicentre field study with pre-post-follow up design was carried out in 19 German rehabilitation centres. Each trainer of the cessation programme answered a tobacco control policy questionnaire ( N = 19). Data from 367 patients were assessed at admission and discharge; data from 262 patients were collected at telephone follow-up six months after intervention. Multilevel analyses (HLM) were applied to identify the predictive value of individual and tobacco control policy characteristics on smoking behaviour directly after the intervention and six months later. Findings: Enforcement of smoking restrictions was a significant positive predictor for cessation rate at discharge and reduction rate at follow-up. Significant individual predictors for quitting include education, motivation and self-efficacy. Reduction rates were influenced by individual characteristics like motivation, self-efficacy, tobacco dependence and smoking rate at admission. Conclusions: Evidence-based measures should be applied to the individual to raise cessation and reduction. Additionally, implementing and enforcing smoking restrictions is another effective method to improve the health of the public. [ABSTRACT FROM AUTHOR]

The literature on the factors influencing children’s consumption behaviour is vast; however, gender-specific consumption behaviour and the determinants driving these discriminative decisions are largely unknown. This article contributes insights to the role of gender in food preferences using the example of school milk consumption by German primary school children. Study subjects included pupils, their parents, teachers, and other school personnel. The results of the multilevel model reveal that there are various factors influencing the probability that a child will decide to order school milk. In addition to individual factors such as socio-economics, eating habits, and preferences, consumption behaviour is also affected by social environmental factors. These factors include the preferences of parents, the consumption behaviour of teachers, teachers’ attitudes, and the attitude of the school principal. Additionally, policy-driven aspects (e.g., school milk price, product range) were included in the analysis and proved to have an impact on a child’s decision to order school milk. Although the results are limited to consumption behaviour for school milk, they can be used in the development of new or the revision of existing school food programmes. The example of school milk may shed light on how specific measures affect boys’ and girls’ consumption, e.g., how they react to price reductions or specific school settings. [ABSTRACT FROM AUTHOR]

The objective of this study was to investigate the association between residential environment and type 2 diabetes. We pooled cross-sectional data from 5 population-based German studies (1997–2006): the Cardiovascular Disease, Living and Ageing in Halle Study, the Dortmund Health Study, the Heinz Nixdorf Recall Study, the Cooperative Health Research in the Region of Augsburg Study, and the Study of Health in Pomerania. The outcome of interest was the presence of self-reported type 2 diabetes. We conducted mixed logistic regression models in a hierarchical data set with 8,879 individuals aged 45–74 years on level 1; 226 neighborhoods on level 2; and 5 study regions on level 3. The analyses were adjusted for age, sex, social class, and employment status. The odds ratio for type 2 diabetes was highest in eastern Germany (odds ratio = 1.98, 95% confidence interval: 1.81, 2.14) and northeastern Germany (odds ratio = 1.58, 95% confidence interval: 1.40, 1.77) and lowest in southern Germany (reference) after adjustment for individual variables. Neighborhood unemployment rates explained a large proportion of regional differences. Individuals residing in neighborhoods with high unemployment rates had elevated odds of type 2 diabetes (odds ratio = 1.62, 95% confidence interval: 1.25, 2.09). The diverging levels of unemployment in neighborhoods and regions are an independent source of disparities in type 2 diabetes. [ABSTRACT FROM PUBLISHER]

Purpose: Inadequate use of antibiotics can lead to problems such as resistance. Overuse is especially a problem for children, since they are more affected by acute (often virus-caused) infections. While the problem has been addressed internationally over the past several years, regional variations in prescriptions are striking. Therefore, the present study aims to analyze regional variations in antibiotic prescription on a district level in Germany and tries to identify reasons for those variations through adding possible influencing factors to the analysis on individual and district levels. Methods: We analyzed 1.2 million children insured in a German health insurance fund. Antibiotic prescriptions were quantified in 2010 and reasons for prescriptions were analyzed in multilevel regressions based on the district of residence, regional deprivation, and age and sex of the child. Results: Thirty-six percent of all children aged 0-17 years received an antibiotic prescription in 2010. In the south, prevalences are generally lower, and also to the very north. The highest prevalences are found in the close-to-border districts in the west, as well as in a band throughout the middle of Germany, in rather low population density areas. Regional variation in the prevalence range from 19 to 53 % between districts. Regional deprivation can explain part of this variation. Conclusions: Including area deprivation measures helped identify an influence of especially regional income and occupational deprivation on antibiotic prescriptions for children. Regional analysis such as this can help identify specific regions and groups of persons to address information programs on the risks of preventable antibiotic consumption and alternative treatment methods. [ABSTRACT FROM AUTHOR]

The current paper analyzes the role of the individual and regional knowledge context in forming university students' entrepreneurial intentions. As access to knowledge resources is crucial for the growth and survival of knowledge-based start-ups, we argue that an individual's decision in favor or against becoming an entrepreneur should critically depend on the multilevel context providing her with access to strategically relevant knowledge. A unique dataset for German students and regions allows us to analyze a variety of personal and regional determinants of entrepreneurial intentions among students. At the individual level we find that role models facilitating the transfer of tacit knowledge and the expectation that strong ties will provide know-how and know-who positively impact entrepreneurial intentions. At the regional level we find that a high regional start-up rate in knowledge-based industries and a high growth rate of regional knowledge production positively influence entrepreneurial intentions. [ABSTRACT FROM AUTHOR]

This article builds on previous findings that border residents are less prone to be Eurosceptic. First, it enhances measurement by using a more exact distinction between border and core districts. Second, it extends theory by arguing that the lower propensity towards Euroscepticism among border residents is the result of their greater involvement in transnational networks and interactions. Third, the article adds to the interest-or-identity discussion in Euroscepticism research by distinguishing between goal-oriented and sociable forms of transnational interactions and testing their impact on Euroscepticism. Multilevel analyses of Eurobarometer data for France and Germany show that (1) the border effect holds only in Germany, (2) it is mediated by individual transnationalism, and (3) sociable forms of interaction are key to structuring attitudes towards European integration. [ABSTRACT FROM PUBLISHER]

Ethnic differences in violent behavior can be found in official crime statistics, as well as in surveys on juvenile delinquency. To explain these differences, research mainly focuses on factors like parental violence, violence legitimizing norms of masculinity, or socio-economic status. Little research has examined the role of friendship network’s ethnic composition on ethnic differences in violent behavior, although different sociological and criminological theories suggest that the composition of friendship networks can play an important role for attitudes and behavior of its members. Using data of a survey conducted in 2006 among all ninth-grade pupils in Hanover (Germany), we investigated the influence of friendship network’s ethnic composition on violent behavior in general, and on ethnic differences in violent behavior in particular. Due to the specific sampling procedure, it was also possible to look for neighborhood effects both on (ethnic differences in) juvenile delinquency and friendship network composition. Findings indicate that there are significant differences in the network composition across the ethnic groups. After controlling for these network characteristics, ethnic differences in violent behavior disappeared. Furthermore, the results show that the friendship network’s ethnic composition also depends on community characteristics. [ABSTRACT FROM AUTHOR]

Abstract: In this paper, we argue that conceptually disentangling the ‘context versus composition’ aspects of regional growth is a multilevel issue. By applying multilevel models (also called random-effects models), we show (1) the importance of considering firm-specific characteristics simultaneously with region-specific characteristics, as we find that a large part of what is traditionally assigned to the impact of the region should be assigned to firm-specific characteristics and (2) that existing single-level methodologies can be problematic, as they are vulnerable to the charge of estimating significance levels that are too liberally assigned and promote exaggerations. This is illustrated empirically by showing that single-level approaches would lead to the conclusion that innovation spillovers are highly significant in a setting of Dutch urban growth differentials, while multilevel analyses shows less liberally assigned significance levels. We conclude that multilevel-effect models better fit research questions that combine firm and spatial characteristics simultaneously, especially because they allow firm-specific characteristics to be differently linked to their regional contexts. [ABSTRACT FROM AUTHOR]

The objective of this study was to describe the relationship between the German National Expert Standard Pressure Ulcer Prevention and the pressure ulcer prevalence in German nursing homes and hospitals. The patient outcome pressure ulcer does not only depend on individual characteristics of patients, but also on institutional factors. In Germany, National Expert Standards are evidence-based instruments that build the basis of continuing improvement in health care quality. It is expected that after having implemented the National Expert Standard Pressure Ulcer Prevention, the number of pressure ulcers should decrease in health care institutions. The analysed data were obtained from two cross-sectional studies from 2004-2005. A multilevel analysis was performed to show the impact of the National Expert Standard Pressure Ulcer Prevention on pressure ulcer prevalence. A total of 41·5% of hospitals and 38·8% of the nursing homes claimed to use the National Expert Standard in the process of developing their local protocols. The overall pressure ulcer prevalence grade 2-4 was 4·7%. Adjusted for hospital departments, survey year and individual characteristics, there was no significant difference in the prevalence of pressure ulcers between institutions that refer to the National Expert Standard or those referring to other sources in developing their local protocols (OR = 1·14, 95% CI = 0·90-1·44). There was no empirical evidence demonstrating that local protocols of pressure ulcer prevention based on the National Expert Standard were superior to local protocols which refer other sources of knowledge with regard to the pressure ulcer prevalence. The use of the National Expert Standard Pressure Ulcer Prevention can neither be recommended nor be refused. The recent definition of implementation of Expert Standards should be mandatory for all health care institutions which introduce Expert Standards. [ABSTRACT FROM AUTHOR]

Abstract: A questionnaire study with 401 grade 8 and 9 students from academic-track secondary schools in Germany examined the hypotheses that the more students experience their teachers’ behavior toward them personally to be just, the better their individual experience of class climate, and that the belief in a just world (BJW) is positively related to both student experiences. Class climate was assessed in terms of two second-order dimensions: classroom climate (e.g., willingness to learn) and student climate (e.g., community). Multilevel analyses revealed that the more the students evaluated their teachers’ behavior toward them personally to be just, the more positively they evaluated the classroom and student climate. Moreover, students with a strong BJW tended to evaluate their teachers’ behavior toward them personally to be more just and the climate of their class to be more positive. Furthermore, the experience of teacher justice partly mediated the BJW’s effect on the climate evaluations. Thus, a strong BJW seems to function as a personal resource for students, explaining significant parts of their individual experience of both teacher justice and class climate at school. Most importantly, individually experienced teacher justice seems to be a significant factor when it comes to understanding class climate. Implications are discussed. [ABSTRACT FROM AUTHOR]

Background/Aims: This study applied a multilevel approach to examine the associations between school smoking policy and student smoking. It was tested whether individual characteristics are mediators of school policy effects. Methods: On the basis of cross-sectional data from 3,364 students and school principals from 40 schools in Germany, two multilevel nonlinear regression models were computed for current smoking. Results: In the first model, controlling for individual factors not influenced by school, smoking bans for students and evidence-based prevention activities were negatively associated with smoking prevalence. The second model included student characteristics potentially influenced by school (e.g. school engagement, peer smoking). As school variables remained significant, these characteristics obviously do not mediate school context effects. Conclusion: School context variables influence students’ smoking independent of individual factors. The data suggest that individual variables rather mediate family influences. Copyright © 2008 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

This article gives a brief overview of multilevel modelling. Multilevel analysis is an extension of linear and generalized linear regression analysis. The article describes situations of clustered data and specifies different terms to denote multilevel methods in different sciences. Since clustered data yield an underestimation of standard errors, multilevel statistical methods should be applied if individual level observations can be assigned to higher level contexts, and if characteristics of these contexts have an impact on the outcome of interest. Moreover, it will be argued that multilevel analysis provides options of statistical model-building which go far beyond just correcting the nuisance of incorrect standard errors. In most theories and many empirical studies in the social sciences, individual actors are embedded in social contexts like regions, schools or households and context-characteristics systematically affect individual behaviour and decision making. Using an example from migration research, it will be shown how spatial context-characteristics like "distance from the border" affect internal East-West migration of labour in Germany. Finally, recent developments in multilevel modelling, like the combination with event history or network analysis, will be outlined briefly. [ABSTRACT FROM AUTHOR]

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Objectives: Characteristics of childcare centers influence the daily time spent on moderate-to-vigorous physical activity (MVPA) by children younger than 6 years. The study explores the characteristics of childcare centers and the behavior of staff that influence children's MVPA levels., Methods: We used cross-sectional data from 8 childcare centers in the research project QueB 2. MVPA per day was measured with ActiGraph GT3X+accelerometers. Independent variables included were age, sex, staff MVPA levels and 8 items from a self-assessment-checklist for childcare centers. Hierarchical linear regression models were run with SAS., Results: Valid accelerometer data on 126 children (51.59% girls) were available. Girls spent a mean of 33.01, boys of 49.11 min per day in MVPA. Childcare centers accounted for only 1.72% of variance. Indoor space, rules concerning physical activity and staff participating in activities were significantly associated with children's MVPA., Conclusions: Individual variables (age, sex) seem to have a greater influence on children's daily time spent on MVPA than childcare center characteristics and should be taken into account when implementing interventions to promote physical activity., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

Aim: To identify factors for and perceived consequences of nursing errors by nursing staff in home care services in correlation with qualification, work experience, working hours and trainings., Background: Patient safety has increasingly been brought into focus of politics and care practices over the past few years. However, little evidence has been provided yet on nursing errors in out-of-hospital settings., Design: A cross-sectional study., Methods: Randomized sample of 107 home care services and 656 nurses and nursing assistants recruited from all 16 federal states in Germany., Results: Missing trainings on error management within the past 2 years were identified to be an important factor for mistakes regarding hygienic measures and medication administration. However, most errors arose in documentation without any significant differences in qualification, work experience, training and working hours., Conclusion: Findings indicate that insufficient hygiene and medication administration might be reduced by implementing error management trainings on a regular basis in home care services., (© 2020 The Authors. Nursing Open published by John Wiley & Sons Ltd.)

Objectives: To determine the prescription of guideline recommended drug therapy in patients with stable coronary heart disease (sCHD) prior to percutaneous coronary intervention (PCI) in Germany and to examine the role of patient characteristics and features of regional healthcare supply in a multilevel model., Design: Secondary data analysis of factors associated with the prescription of guideline recommended drug therapy using a multilevel model to analyse regional-level effects, over and above the effects of patient-level demographic and health status., Setting: Office-based prescriptions in the year prior to the invasive procedure., Participants: A linked nationwide dataset from Germany's three largest statutory health insurance funds of all patients receiving PCI in the year 2016., Main Outcome Measures: Patients' odds of receiving optimal medical therapy and symptom-oriented therapy within 1 year prior to PCI., Results: 68.6% of patients received at least one lipid-lowering drug and one symptom-oriented therapy prior to PCI. 43.6% received at least two agents to control their symptoms. Patients who received treatment in accordance with the recommendations had a greater number of diagnosed risk factors, a more severe history of cardiac disease and used a higher volume of ambulatory office-based physician services. The prescriptions prevalence for the symptom-oriented therapies differed significantly between eastern and western Germany, with a higher prevalence in the eastern districts., Conclusions: Guidelines can only provide decision-making corridors, and the applicability of recommendations must always be assessed on a case by case basis. Nevertheless, our analysis indicates that the prevalence of prescriptions in routine practice is subject to substantial variation and that conservative therapy options are not fully exhausted prior to PCI. This suggests that there might be room for improvement in the care of patients with sCHD., Competing Interests: Competing interests: JB is employed by the AOK Bundesverband, UM by the BARMER, DH-S by the TK. UZ reports personal fees from Astra Zeneca, Bayer, BMS, Daiichi Sankyo, Novartis, Sanofi, Amgen, Trommsdorf, Medicines Company, outside the submitted work. JF-T, ND-B and LS have nothing to declare., (© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Dimensions of social location such as socioeconomic position or sex/gender are often associated with low response rates in epidemiological studies. We applied an intersectionality-informed approach to analyze non-response among population strata defined by combinations of multiple dimensions of social location and subjective health in a health survey in Germany., Methods: We used data from the cross-sectional sample of the German Health Interview and Examination Survey for Adults (DEGS1) conducted between 2008 and 2011. Information about non-responders was available from a mailed non-responder questionnaire. Intersectional strata were constructed by combining all categories of age, sex/gender, marital status, and level of education in scenario 1. Subjective health was additionally used to construct intersectional strata in scenario 2. We applied multilevel analysis of individual heterogeneity and discriminatory accuracy (MAIHDA) to calculate measures of discriminatory accuracy, proportions of non-responders among intersectional strata, as well as stratum-specific total interaction effects (intersectional effects). Markov chain Monte Carlo methods were used to estimate multilevel logistic regression models., Results: Data was available for 6,534 individuals of whom 36% were non-responders. In scenario 2, we found weak discriminatory accuracy (variance partition coefficient = 3.6%) of intersectional strata, while predicted proportions of non-response ranged from 20.6% (95% credible interval (CI) 17.0%-24.9%) to 57.5% (95% CI 48.8%-66.5%) among intersectional strata. No evidence for intersectional effects was found. These results did not differ substantially between scenarios 1 and 2., Conclusions: MAIHDA revealed that proportions of non-response varied widely between intersectional strata. However, poor discriminatory accuracy of intersectional strata and no evidence for intersectional effects indicate that there is no justification to exclusively target specific intersectional strata in order to increase response, but that a combination of targeted and population-based measures might be appropriate to achieve more equal representation., Competing Interests: The authors have declared that no competing interests exist.

Background : This study examines if education, income, and loneliness are associated with physical functioning and optimism in an ageing population in Germany. Furthermore, time trends of physical functioning and optimism as well as of associations with social inequality and loneliness are analyzed. Methods : The German Ageing Survey (DEAS), a longitudinal population-based survey of individuals aged 40 years and older, was used (four waves between 2008 and 2017, total sample size N = 23,572). Physical functioning and optimism were introduced as indicators of ageing well. Educational level, net equivalent income, and loneliness were used as predictors in linear mixed models for longitudinal data. Results : Time trends show that physical functioning decreases over time, while optimism slightly increases. Education and income are positively associated with physical functioning, while higher loneliness correlates with lower physical functioning. Higher optimism was associated with higher income and particularly with lower loneliness. Income and notable educational inequalities in physical functioning increase over time. Time trends of the associations with optimism show decreasing income inequalities and increasing disparities in loneliness. Conclusions : Increasing educational inequalities in physical functioning and a strong association of loneliness with optimism provide information for further interventions. Targeted health promotion among the aged and addressing maladaptive social cognition are options to tackle these issues. Key areas for action on healthy ageing include, for instance, the alignment of health systems to the needs of older populations or the creation of age-friendly environments.

Introduction: The location of residence is a factor possibly contributing to social inequalities and emerging evidence indicates that it already affects perinatal development. The underlying pathways remain unknown; theory-based and hypothesis-driven analyses are lacking. To address these challenges, we aim to establish to what extent small-area characteristics contribute to low birth weight (LBW), independently of individual characteristics. First, we select small-area characteristics based on a conceptual model and measure them. Then, we empirically analyse the impact of these characteristics on LBW. Material and methods: Individual data were provided by the birth cohort study "Health of infants and children in Bielefeld/Germany." The sample consists of 892 eligible women and their infants distributed over 80 statistical districts in Bielefeld. Small-area data were obtained from local noise maps, emission inventory, Google Street View and civil registries. A linear multilevel analysis with a two-level structure (individuals nested within statistical districts) was conducted. Results: The effects of the selected small-area characteristics on LBW are small to non-existent, no significant effects are detected. The differences in proportion of LBW based on marginal effects are small, ranging from zero to 1.1%. Newborns from less aesthetic and subjectively perceived unsafe neighbourhoods tend to have higher proportions of LBW. Discussion: We could not find evidence for negative effects of small-area factors on LBW, but our study confirms that obtaining adequate sample size, reliable measure of exposure and using available data for operationalisation of the small-area context represent the core challenges in this field of research., (Copyright © 2020 Wandschneider, Sauzet, Breckenkamp, Spallek and Razum.)

Background: Challenges of future dementia care include increasing shortage of qualified healthcare providers and decreasing potential of informal care by relatives. In order to meet those challenges, changes in dementia care are needed. These changes should be based on data of both care utilisation and care supply. The aim of this study was to provide insight into individual and regional characteristics that influence the utilisation of long-term care by people with dementia., Methods: The study was a retrospective cross-sectional analysis of claims-based data and other available data referring to one index year. All data were aggregated for small geographic districts. The study population comprised people with a dementia diagnosis, 65 years and older in Baden-Wuerttemberg and insured by the largest health insurer. Utilisation of nursing home care, informal care, and respite care was analysed using binary coded logistic multilevel analyses., Results: Seventy nine thousand three hundred forty-nine people with dementia were included in the analyses. Nursing home care was used by 20.4%, informal care by 30.6%, and respite care by 3.5% of people with dementia. Individual characteristics that influence care utilisation included age, sex and the level of care dependency. The utilisation of informal care (OR = 1.713) and respite care (OR = 2.036) was higher in rural districts than in city districts. Respite care supply had an effect on the utilisation of respite care (OR = 1.173)., Conclusions: The study found differences between districts in the utilisation of long-term care for dementia. These differences were largely explained by the composition of the population within the districts. An exception was the utilisation of respite care, which was higher in districts which have higher supply. Individual characteristics that influenced care utilisation are age, sex, level of care dependency and, with regard to informal care, comorbidity. Further research should be conducted on a small-area level, include further individual characteristics as well as other care and living forms.

Job demands push employees to invest energy in certain behaviors to perform well, which can come with both costs and benefits to employees' well-being and motivation. Previous research presents contradictory results concerning whether specific job demands are a challenge (i.e., motivating) or a hindrance (i.e., only distressing). Building on the conservation of resources theory and the success resource model, we propose achievement experiences as an important work-related resource and indicator of whether job demands are challenging or hindering. We hypothesized that time pressure and emotional demands are positively related to achievement experiences (task-related and prosocial), contingent on the perception of unnecessary tasks, which in turn relate to work engagement and emotional exhaustion. Weekly diary data were gathered from 323 employees over the course of 4 weeks. Multilevel moderated mediation analyses revealed that time pressure and emotional demands unfold their challenging potential when unnecessary tasks are less frequent, and that these effects hold true for matching demands and achievement experiences (task-related and interpersonal dimensions). Overall, our study provides a resource-based theoretical rationale for the ambiguous results reported by various other studies, and it emphasizes the importance of subjective achievement experiences for employees' well-being. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Studies in rehabilitation science often investigate data representing different hierarchical data levels. Hierarchical sample structures prevail if single cases (e. g. rehabilitation patients) are grouped or are members of grouped entities or clusters (e. g. teams, groups, institutions), respectively. Analyzing data of rehabilitation patients treated in different institutions it has to be regarded that belonging to a specific institution (level 2; cluster-level) may be associated with individuals' (level 1) characteristics systematically. If rehabilitation patients take part in different training groups, specific characteristics of the training groups (level 2) may affect treatment effects of individuals (level 1) significantly. Multilevel analysis or hierarchical linear models allow for simultaneously modelling such multilevel data structures in an integrative and comprehensive manner. In this article it will be shown which specific aspects concerning hierarchical sampling procedures, data organization, specification of research hypotheses, statistical data analysis as well as interpretation of study results have be regarded to model potential clustering effects appropriately., Competing Interests: Der Autor gibt an, dass kein Interessenkonflikt besteht., (© Georg Thieme Verlag KG Stuttgart · New York.)

We proposed that effects of illegitimate tasks, which comprise unreasonable and unnecessary tasks, on self-esteem and counterproductive work behavior (CWB) are enhanced among employees who are highly sensitive to injustice. CWB was further proposed to be a moderating coping strategy, which restores justice and buffers the detrimental effects of illegitimate tasks on self-esteem. In this study, 241 employees participated in a diary study over five workdays and a follow-up questionnaire one week later. Daily effects were determined in multilevel analyses: Unreasonable tasks decreased self-esteem and increased CWB the same day, especially among employees high in trait justice sensitivity. Unnecessary tasks only related to more CWB the same day, regardless of one's justice sensitivity. Weekly effects were determined in cross-lagged panel analyses: Unreasonable and unnecessary tasks increased CWB, and justice sensitivity moderated the effect of unreasonable tasks on CWB and of unnecessary tasks on self-esteem. Moderating effects of CWB were split: In daily analyses, CWB buffered the negative effects of illegitimate tasks. In weekly analyses, CWB enhanced the negative effects of illegitimate tasks. Overall, illegitimate tasks rather affected CWB than self-esteem, with more consistent effects for unreasonable than for unnecessary tasks. Thus, we confirm illegitimate tasks as a relevant work stressor with issues of injustice being central to this concept and personality having an influence on what is perceived as (il)legitimate. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Background: Meals differ in their nutritional content. This variation has not been fully addressed despite its potential contribution in understanding eating behavior. The aim of this study was to investigate the between-meal and between-individual variance in energy and macronutrient intake as a measure of variation in intake and the meal type-specific relative importance of predictors of these intake variations., Methods: Energy and macronutrient intake were derived from three 24 h dietary recalls in an EPIC-Potsdam sub-cohort of 814 German adults. Intra-class correlation was calculated for participants and meal type. Predictors of intake were assessed using meal type-specific multilevel regression models in a structural equation modeling framework at intake and participant levels using the Pratt Index. The importance of the predictor energy misreporting was assessed in sensitivity analyses on 682 participants. 95% confidence intervals were calculated based on 1000 bootstrap samples., Results: Differences between meal types explain a large proportion of the variation in intake (intra-class correlation: 39% for energy, 25% for carbohydrates, 47% for protein, and 33% for fat). Between-participant variation in intake was much lower, with a maximum of 3% for carbohydrate and fat. Place of meal was the most important intake-level predictor of energy and macronutrient intake (Pratt Index of up to 65%). Week/weekend day was important in the breakfast meal, and prior interval (hours passed since last meal) was important for the afternoon snack and dinner. On the participant level, sex was the most important predictor, with Pratt Index of up to 95 and 59% in the main and in the sensitivity analysis, respectively. Energy misreporting was especially important at the afternoon snack, accounting for up to 69% of the explained variance., Conclusions: The meal type explains the highest variation in energy and macronutrient intakes. We identified key predictors of variation in the intake and in the participant levels. These findings suggest that successful dietary modification efforts should focus on improving specific meals.

This study seeks to explain the interplay between chronological age and technology-related strain through techno-stressors and coping strategy choices in organizational settings. Grounded in Lazarus´ stress theory, theories of cognitive aging, the life span theory of control and socioemotional selectivity theory, this study argues that even though older workers are more prone to techno-stressors, aging is connected to gaining coping skills, which in turn reduce technology-related strain over time. Understanding these processes enables modifying employees' coping strategy choices and mitigating negative outcomes of technostress at the workplace. Longitudinal data from 1,216 employees over a time period of 8 months were used to perform multilevel mediation modeling. The findings reveal that age was negatively related to technology-related strain. The link between age and technology-related strain was explained through behavioral disengagement, which older workers used less than younger workers. Active coping and social coping did not act as mediators of this relationship across time points. These relationships were stable after controlling for dependency on technology., Competing Interests: The authors have declared that no competing interests exist.

Objective: To extend evidence on the short-term variability of passive and active suicidal ideation (SI) and the association with suggested proximal risk factors such as interpersonal variables (perceived burdensomeness [PB], thwarted belongingness [TB], hopelessness, and depression) in real-time., Methods: This is an observational study using a prospective design applying ecological momentary assessments (EMA). Eligible for study inclusion were inpatients with unipolar depression, current or lifetime suicidal ideation, and fluent German. Over six days, 74 participants rated their momentary level of passive and active SI, PB, TB, depressiveness, and hopelessness up to 10 times per day on smartphones. Data was collected from August 2015 to July 2017. Compliance was excellent (89.7%)., Results: Mean squared successive differences supported temporal instability for all variables. According intra-class correlations, between 25% and 47% of variance was accounted for by within-person variability. Multilevel analysis demonstrated significant positive associations between hopelessness, depressiveness, PB, and TB with passive SI. Prospectively, hopelessness and PB remained predictors of passive SI. For active SI, hopelessness, depression, PB, and TB were significantly associated cross-sectionally. Prospectively, hopelessness, PB, and the interaction PBxTB predicted active SI. All models were controlled for previous level of SI., Conclusions: This study provides further evidence on the short-term variability of SI in very short time frames implying the need of assessing SI repeatedly in clinical and research settings. The associations between interpersonal variables and passive and active SI were only partial in line with assumptions of the Interpersonal Theory of Suicide. Overall, the effects were small warranting further investigation., (Copyright © 2018 Elsevier Masson SAS. All rights reserved.)

This study examines illegitimate tasks as a specific type of job stressors. Illegitimate tasks comprise unreasonable and unnecessary tasks and refer to inappropriate task assignments that go beyond an employee's role requirements. Building on the stressor-detachment model, we hypothesized that illegitimate tasks experienced during the day predict high negative affect and low self-esteem at the end of the workday, which in turn should predict poor psychological detachment from work during evening hours, resulting in sustained high levels of negative affect and low self-esteem at bedtime. Over the course of 1 workweek, 137 employees completed daily surveys at the end of the workday and at bedtime (total of 567 days). Multilevel path modeling revealed a distinct pattern of findings at the day and the person level. At the day level, unnecessary tasks predicted high negative affect and low self-esteem at the end of the workday, with low self-esteem predicting poor psychological detachment from work during afterwork hours. Poor psychological detachment predicted a further increase in negative affect and a decrease in self-esteem over evening hours. At the between-person level, unreasonable tasks were related to high negative affect and low self-esteem at the end of the workday, with negative affect being related to poor psychological detachment from work. Overall, the findings demonstrate that illegitimate tasks are associated with unfavorable states at the end of the workday and are indirectly related to poor psychological detachment from work, undermining recovery from the stressful events experienced at work. (PsycINFO Database Record, ((c) 2018 APA, all rights reserved).)

A validity test was conducted to determine how care level-based nurse-to-resident ratios compare with actual daily care times per resident in Germany. Stability across different long-term care facilities was tested. Care level-based nurse-to-resident ratios were compared with the standard minimum nurse-to-resident ratios. Levels of care are determined by classification authorities in long-term care insurance programs and are used to distribute resources. Care levels are a powerful tool for classifying authorities in long-term care insurance. We used observer-based measurement of assignable direct and indirect care time in 68 nursing units for 2028 residents across 2 working days. Organizational data were collected at the end of the quarter in which the observation was made. Data were collected from January to March, 2012. We used a null multilevel model with random intercepts and multilevel models with fixed and random slopes to analyze data at both the organization and resident levels. A total of 14% of the variance in total care time per day was explained by membership in nursing units. The impact of care levels on care time differed significantly between nursing units. Forty percent of residents at the lowest care level received less than the standard minimum registered nursing time per day. For facilities that have been significantly disadvantaged in the current staffing system, a higher minimum standard will function more effectively than a complex classification system without scientific controls.

Nationwide health surveys can be used to estimate regional differences in health. Using traditional estimation techniques, the spatial depth for these estimates is limited due to the constrained sample size. So far - without special refreshment samples - results have only been available for larger populated federal states of Germany. An alternative is regression-based small-area estimation techniques. These models can generate smaller-scale data, but are also subject to greater statistical uncertainties because of the model assumptions. In the present article, exemplary regionalized results based on the studies "Gesundheit in Deutschland aktuell" (GEDA studies) 2009, 2010 and 2012, are compared to the self-rated health status of the respondents. The aim of the article is to analyze the range of regional estimates in order to assess the usefulness of the techniques for health reporting more adequately. The results show that the estimated prevalence is relatively stable when using different samples. Important determinants of the variation of the estimates are the achieved sample size on the district level and the type of the district (cities vs. rural regions). Overall, the present study shows that small-area modeling of prevalence is associated with additional uncertainties compared to conventional estimates, which should be taken into account when interpreting the corresponding findings.