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Background: Based on the growing number of families and young children with a refugee background in Germany, day-care teachers face enormous challenges regarding culturally informed practice. The project "Gemeinsam stark durch den Start" (Stronger together by starting together) addresses these challenges on various levels. At the level of day-care teachers, training in culturally informed and sensitive education is combined with reflection sessions about their own attitudes and prevailing intercultural norms, thus contributing to the professionalization of day-care teachers., Aim: This paper focuses on mechanisms of action that contributed to the effectiveness of the training from two perspectives: the day-care teachers' perspective and the trainers' perspective., Methods: Staff members of 11 German day-care centers underwent graded online training sessions (team and in-depths trainings) addressing intercultural topics. All participants were presented with a questionnaire for their training evaluation before and after the training sessions. Also, participants of the in-depths trainings participated in semi-structured interviews on the training. Furthermore, qualitative interviews were conducted with all trainers ( N  = 4) of the workshops., Results: Day-care teachers evaluated the online training positively, especially the improvement of professionalization and the implementation of training elements. Results reveal that (work-related) reflexive sessions as well as sessions dealing with the implementation of exercise tools into daily practice were rated as fundamental parts in the training. Teachers from high-risk day-care centers estimated the trainings' effectiveness lower than those working in low-risk day-care centers. Qualitative data shows that the day-care teachers are in need of (theoretical) knowledge about all training elements and hands-on advice for dealing with specific situations. Especially day-care teachers within a high-risk environment, who already report having an elevated level of intercultural knowledge and skills, may need a higher dose training while low-risk day-care teachers may profit more from a low threshold training., Conclusion: The introduced training sessions focusing on intercultural sensitivity and competence present an important contribution to the professionalization of day-care teachers in working with children from different cultural backgrounds. Trainings should focus on reflexive elements as well as exercises in perspective taking and provide hands on materials for daily work., 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 © 2023 Buchner, Eberl and Hess.)

Background and Aims: While a number of studies have reported on individuals who exercise excessively, and feel unable to stop despite negative consequences, there is still insufficient evidence to categorize exercise as an addictive disorder. The aim of this meta-review is to summarize the published articles and to compile a list of symptoms reported in the qualitative literature in conjunction with excessive exercise. This list is compared with the DSM-5 criteria for gambling disorder, and initial diagnostic criteria for exercise addiction are suggested. Methods: The databases MEDLINE, Web of Science and PsycInfo were searched for qualitative studies or case reports, in which excessive exercise was the main focus. All symptoms reported in conjunction with excessive exercise were extracted from each study and documented. Symptoms were also compared to the diagnostic criteria for gambling disorder. Results: Seventeen studies were included in the review, yielding 56 distinct symptoms. The Critical Appraisal Skills Program tool showed that the majority of the studies were of acceptable quality. Exercise-related symptoms corresponded with seven of the nine DSM-5 criteria for gambling disorder. The ten suggested criteria for exercise addiction are: increasing volume, negative affect, inability to reduce, preoccupation, exercise as coping, continuation despite illness/injury, minimization, jeopardized relationships, continuation despite recognizing consequences, guilt when exercise is missed. Discussion: Our results suggest that excessive exercise may constitute a behavioral addiction, based on the criteria of the DSM-5. Conclusions: Subsequent studies should aim to systematically classify symptoms of excessive exercise; in addition, it should be noted that basic questionnaires may be need to be supplemented with detailed clinical examinations., (Copyright © 2020 Colledge, Cody, Buchner, Schmidt, Pühse, Gerber, Wiesbeck, Lang and Walter.)

Introduction: Affected others of disordered gamblers are often heavily impacted because of the illness. Up till now, there is no standardized German instrument to assess this impact. Internationally, the Short Questionnaire for Family Members-affected by addiction (SQFM-AA) is often used which is based on the Stress-Strain-Coping-Support-Modell. That is why we translated this questionnaire into the German Kurzfragebogen für suchtbelastete Familienmitglieder SQFM-AA (Version Glücksspiel) to be able to assess the impact on affected others and to compare our results internationally., Methods: The SQFM-AA was translated and retranslated and tested in an online convenience sample of affected others. Essential psychometric properties, discriminatory power, and internal consistency were calculated. Factor structure was analysed using an exploratory factor analysis (principal axis analysis, varimax rotation)., Results: Data collected from 122 affected others (87% female; 67% partners; 61% joint household) were analysed. Discriminatory power ranges between 0.30-0.94, Cronbach's alpha between 0.61-0.95. Factor analysis shows that 69% of variance can be explained in a solution with 9 factors., Discussion: Due to the methods used when translating and back-translating the SQFM-AA, it can be assumed that both versions are comparable. Internal consistency of all scales is in an acceptable to good range. In our sample, the postulated 11 sub-scales cannot be reproduced. The 9 factors found here can be derived based on theoretical preliminary considerations. 4 of the scales are reflected well in the analysis, 3 more factors show a relevant load on other scales. Furthermore, one item each does not load on the proposed factor for the 2 remaining scales. All in all, the factors can be interpreted well regarding their content. A modification of the questionnaire would improve some of the statistical values, but the international comparability would no longer be possible., Conclusion: With the adaptation presented here, impact on affected others of disordered gamblers can be assessed and relevant areas for therapy and counselling can be identified., (© Georg Thieme Verlag KG Stuttgart · New York.)

In Germany, there are two different approaches to inpatient treatment of pathological gambling (PG): Facilities focusing on addiction or on psychosomatic illness. However, little is known about how these differences influence utilization and structure of treatment. Therefore, in our study, we analyzed all known German gambling inpatient treatment centers concerning patients' sex, age and number of comorbid disorders and evaluated an expert assessment of the treatment system, access to treatment, and structure characteristics of inpatient treatment facilities. In 2011, 2,229 pathological gamblers were treated. This amounts to 1 % of all past-year pathological gamblers. 90 % of the patients were men, 93 % had at least one comorbid disorder. Access to treatment was mostly gained via psychosocial counseling centers, but was not readily available. Facilities with addiction departments treated less pathological gamblers per year (29.3 gamblers) than facilities with psychosomatic departments (53.3 gamblers) or with both departments (76.4 gamblers). Treatment duration was significantly longer in addiction departments treating PG as secondary diagnosis only, with a low rate of gamblers on all patients, or treating few gamblers. Some facilities specialized on PG and treated more gamblers, had a higher rate of gamblers on all patients, and offered specific treatment programs. The impact of this specialization on treatment outcome is still unclear. Although treatment numbers have risen steadily for the past years, only a small fraction of affected gamblers seek inpatient treatment. Therefore, awareness to the disease and access to treatment needs to be improved.

Background: The number of pathological gamblers seeking treatment has risen continuously till the present, and the trend shows no sign of reversal. Estimates of the number of pathological gamblers in Germany range from 103,000 to 290,000, corresponding to 0.2% to 0.6% of the population. Pathological gambling often accompanies other mental disturbances. Doctors who learn that their patients suffer from such disturbances should ask targeted questions about gambling behavior to increase the chance that this problem will be detected early on., Methods: This article is based on an analysis of secondary data obtained from the German Statutory Pension Insurance Scheme and the Federal Statistical Office and on a selective review of the literature on comorbidities and available interventions., Results: The rate of inpatient treatment for pathological gambling tripled from 2000 to 2010. Most pathological gamblers are men (70%-80%). More than 90% of the patients suffer from more than one mental disturbance; 40% of them carry five different psychiatric diagnoses. Simple screening instruments for pathological gambling are easy to use in routine practice and facilitate the diagnosis., Conclusion: As with alcoholics, only a small fraction of pathological gamblers receives the appropriate support and treatment. Educational seminars to raise awareness among physicians and targeted measures for early detection might result in more of the affected persons getting suitable help.