EEG spectral power in developmental coordination disorder and attention-deficit/hyperactivity disorder: a pilot study.

Developmental coordination disorder (DCD) and attention-deficit/hyperactivity disorder (ADHD) overlap in symptoms and often co-occur. Differentiation of DCD and ADHD is crucial for a better understanding of the conditions and targeted support. Measuring electrical brain activity with EEG may help to discern and better understand the conditions given that it can objectively capture changes and potential differences in brain activity related to externally measurable symptoms beneficial for targeted interventions. Therefore, a pilot study was conducted to exploratorily examine neurophysiological differences between adults with DCD and/or ADHD at rest. A total of N = 46 adults with DCD (n = 12), ADHD (n = 9), both DCD + ADHD (n = 8), or typical development (n = 17) completed 2 min of rest with eyes-closed and eyes-open while their EEG was recorded. Spectral power was calculated for frequency bands: delta (0.5-3 Hz), theta (3.5-7 Hz), alpha (7.5-12.5 Hz), beta (13-25 Hz), mu (8-13 Hz), gamma (low: 30-40 Hz; high: 40-50 Hz). Within-participants, spectral power in a majority of waveforms significantly increased from eyes-open to eyes-closed conditions. Groups differed significantly in occipital beta power during the eyes-open condition, driven by the DCD versus typically developing group comparison. However, other group comparisons reached only marginal significance, including whole brain alpha and mu power with eyes-open, and frontal beta and occipital high gamma power during eyes-closed. While no strong markers could be determined to differentiate DCD versus ADHD, we theorize that several patterns in beta activity were indicative of potential motor maintenance differences in DCD at rest. Therefore, larger studies comparing EEG spectral power may be useful to identify neurological mechanisms of DCD and continued differentiation of DCD and ADHD.

Sudden gains in routine clinical care: application of a permutation test for trauma-focused cognitive behavioural therapy.

Background: Sudden gains, defined as large and stable improvements of psychopathological symptoms, are a ubiquitous phenomenon in psychotherapy. They have been shown to occur across several clinical contexts and to be associated with better short-term and long-term treatment outcome. However, the approach of sudden gains has been criticized for its tautological character: sudden gains are included in the computation of treatment outcomes, ultimately resulting in a circular conclusion. Furthermore, some authors criticize sudden gains as merely being random fluctuations.Objective: Use of efficient methods to evaluate whether the amount of sudden gains in a given sample lies above chance level.Method: We used permutation tests in a sample of 85 patients with posttraumatic stress disorder (PTSD) treated with trauma-focused cognitive behaviour therapy in routine clinical care. Scores of self-reported PTSD symptom severity were permuted 10.000 times within sessions and between participants to receive a random distribution.Results: Altogether, 18 participants showed a total of 24 sudden gains within the first 20 sessions. The permutation test yielded that the frequency of sudden gains was not beyond chance level. No significant predictors of sudden gains were identified and sudden gains in general were not predictive of treatment outcome. However, subjects with early sudden gains had a significantly lower symptom severity after treatment.Conclusions: Our data suggest that a significant proportion of sudden gains are due to chance. Further research is needed on the differential effects of early and late sudden gains.

Treatment-related sudden gains exhibit clinical significance when their manifestation is above chance level.We used permutation tests to examine their occurrence in trauma-focused cognitive behaviour therapy as applied in a naturalistic treatment setting.The occurrence of sudden gains in general was not significantly higher than chance, yet early sudden gains were associated with improved treatment outcome.

Alcohol does not influence trust in others or oxytocin, but increases positive affect and risk-taking: a randomized, controlled, within-subject trial.

BACKGROUND: Alcohol consumption to facilitate social interaction is an important drinking motive. Here, we tested whether alcohol influences trust in others via modulation of oxytocin and/or androgens. We also aimed at confirming previously shown alcohol effects on positive affect and risk-taking, because of their role in facilitating social interaction. METHODS: This randomized, controlled, within-subject, parallel group, alcohol-challenge experiment investigated the effects of alcohol (versus water, both mixed with orange juice) on perceived trustworthiness via salivary oxytocin (primary and secondary endpoint) as well as testosterone, dihydrotestosterone, positive affect, and risk-taking (additional endpoints). We compared 56 male participants in the alcohol condition (1.07 ± 0.18 per mille blood alcohol concentration) with 20 in the control condition. RESULTS: The group (alcohol versus control condition) × time (before [versus during] versus after drinking) interactions were not significantly associated with perceived trustworthiness (η2 < 0.001) or oxytocin (η2 = 0.003). Bayes factors provided also substantial evidence for the absence of these effects (BF01 = 3.65; BF01 = 7.53). The group × time interactions were related to dihydrotestosterone (η2 = 0.018 with an increase in the control condition) as well as positive affect and risk-taking (η2 = 0.027 and 0.007 with increases in the alcohol condition), but not significantly to testosterone. DISCUSSION: The results do not verify alcohol effects on perceived trustworthiness or oxytocin in male individuals. However, they indicate that alcohol (versus control) might inhibit an increase in dihydrotestosterone and confirm that alcohol amplifies positive affect and risk-taking. This provides novel mechanistic insight into social facilitation as an alcohol-drinking motive.

Getting specific: participation preference in urooncological decision-making.

BACKGROUND: Shared decision-making is the gold standard for good clinical practice, and thus, psychometric instruments have been established to assess patients' generic preference for participation (e.g., the Autonomy Preference Index, API). However, patients' preferences may vary depending on the specific disease and with respect to the specific decision context. With a modified preference index (API-Uro), we assessed patients' specific participation preference in preference-sensitive decisions pertaining to urological cancer treatments and compared this with their generic participation preference. METHODS: In Study 1, we recruited (N = 469) urological outpatients (43.1% urooncological) at a large university hospital. Participation preference was assessed with generic measures (API and API case vignettes) and with the disease-specific API-Uro (urooncological case vignettes describing medical decisions of variable difficulty). A polychoric exploratory factor analysis was used to establish factorial validity and reduce items. In Study 2, we collected data from N = 204 bladder cancer patients in a multicenter study to validate the factorial structure with confirmatory factor analysis. Differences between the participation preference for different decision contexts were analyzed. RESULTS: Study 1: Scores on the specific urooncological case vignettes (API-Uro) correlated with the generic measure (r = .44) but also provided incremental information. Among the disease-specific vignettes of the API-Uro, there were two factors with good internal consistency (α ≥ .8): treatment versus diagnostic decisions. Patients desired more participation for treatment decisions (77.8%) than for diagnostic decisions (22%), χ2(1) = 245.1, p ≤ .001. Study 2: Replicated the correlation of the API-Uro with the API (r = .39) and its factorial structure (SRMR = .08; CFI = .974). Bladder cancer patients also desired more participation for treatment decisions (57.4%) than for diagnostic decisions (13.3%), χ²(1) =84, p ≤ .001. CONCLUSIONS: The desire to participate varies between treatment versus diagnostic decisions among urological patients. This underscores the importance of assessing participation preference for specific contexts. Overall, the new API-Uro has good psychometric properties and is well suited to assess patients' preferences. In routine care, measures of participation preference for specific decision contexts may provide incremental, allowing clinicians to better address their patients' individual needs.

Automatic facial coding predicts self-report of emotion, advertisement and brand effects elicited by video commercials.

Introduction: Consumers' emotional responses are the prime target for marketing commercials. Facial expressions provide information about a person's emotional state and technological advances have enabled machines to automatically decode them. Method: With automatic facial coding we investigated the relationships between facial movements (i.e., action unit activity) and self-report of commercials advertisement emotion, advertisement and brand effects. Therefore, we recorded and analyzed the facial responses of 219 participants while they watched a broad array of video commercials. Results: Facial expressions significantly predicted self-report of emotion as well as advertisement and brand effects. Interestingly, facial expressions had incremental value beyond self-report of emotion in the prediction of advertisement and brand effects. Hence, automatic facial coding appears to be useful as a non-verbal quantification of advertisement effects beyond self-report. Discussion: This is the first study to measure a broad spectrum of automatically scored facial responses to video commercials. Automatic facial coding is a promising non-invasive and non-verbal method to measure emotional responses in marketing.

Do changes in dysfunctional posttraumatic cognitions differentially predict PTSD symptom clusters?

OBJECTIVE: In recent years, it has been suggested that the modification of dysfunctional posttraumatic cognitions plays a central role as a mechanism of change in cognitive behavioral therapy (CBT) for posttraumatic stress disorder (PTSD). Indeed, several studies have shown that changes in dysfunctional posttraumatic cognitions precede and predict symptom change. However, these studies have investigated the influence on overall symptom severity-despite the well-known multidimensionality of PTSD. The present study therefore aimed to explore differential associations between change in dysfunctional conditions and change in PTSD symptom clusters. METHOD: As part of a naturalistic effectiveness study evaluating trauma-focused cognitive behavioral therapy for PTSD in routine clinical care, 61 patients with PTSD filled out measures of dysfunctional posttraumatic cognitions and PTSD symptom severity every five sessions during the course of treatment. Lagged associations between dysfunctional cognitions and symptom severity at the following timepoint were examined using linear mixed models. RESULTS: Over the course of therapy, both dysfunctional cognitions and PTSD symptoms decreased. Posttraumatic cognitions predicted subsequent total PTSD symptom severity, although this effect was at least partly explained by the time factor. Moreover, dysfunctional cognitions predicted three out of four symptom clusters as expected. However, these effects were no longer statistically significant when the general effect for time was controlled for. CONCLUSION: The present study provides preliminary evidence that dysfunctional posttraumatic cognitions predict PTSD symptom clusters differentially. However, different findings when employing a traditional versus a more rigorous statistical approach make interpretation of findings difficult. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Training machine learning algorithms for automatic facial coding: The role of emotional facial expressions' prototypicality.

Automatic facial coding (AFC) is a promising new research tool to efficiently analyze emotional facial expressions. AFC is based on machine learning procedures to infer emotion categorization from facial movements (i.e., Action Units). State-of-the-art AFC accurately classifies intense and prototypical facial expressions, whereas it is less accurate for non-prototypical and less intense facial expressions. A potential reason might be that AFC is typically trained with standardized and prototypical facial expression inventories. Because AFC would be useful to analyze less prototypical research material as well, we set out to determine the role of prototypicality in the training material. We trained established machine learning algorithms either with standardized expressions from widely used research inventories or with unstandardized emotional facial expressions obtained in a typical laboratory setting and tested them on identical or cross-over material. All machine learning models' accuracies were comparable when trained and tested with held-out dataset from the same dataset (acc. = [83.4% to 92.5%]). Strikingly, we found a substantial drop in accuracies for models trained with the highly prototypical standardized dataset when tested in the unstandardized dataset (acc. = [52.8%; 69.8%]). However, when they were trained with unstandardized expressions and tested with standardized datasets, accuracies held up (acc. = [82.7%; 92.5%]). These findings demonstrate a strong impact of the training material's prototypicality on AFC's ability to classify emotional faces. Because AFC would be useful for analyzing emotional facial expressions in research or even naturalistic scenarios, future developments should include more naturalistic facial expressions for training. This approach will improve the generalizability of AFC to encode more naturalistic facial expressions and increase robustness for future applications of this promising technology.

When attitudes and beliefs get in the way of shared decision-making: A mediation analysis of participation preference.

INTRODUCTION: Certain sociodemographic characteristics (e.g., older age) have previously been identified as barriers to patients' participation preference in shared decision-making (SDM). We aim to demonstrate that this relationship is mediated by the perceived power imbalance that manifests itself in patients' negative attitudes and beliefs about their role in decision-making. METHODS: We recruited a large sample (N = 434) of outpatients with a range of urological diagnoses (42.2% urooncological). Before the medical consultation at a university hospital, patients completed the Patients' Attitudes and Beliefs Scale and the Autonomy Preference Index. We evaluated attitudes as a mediator between sociodemographic factors and participation preference in a path model. RESULTS: We replicated associations between relevant sociodemographic factors and participation preference. Importantly, attitudes and beliefs about one's own role as a patient mediated this relationship. The mediation path model explained a substantial proportion of the variance in participation preference (27.8%). Participation preferences and attitudes did not differ for oncological and nononcological patients. CONCLUSION: Patients' attitudes and beliefs about their role determine whether they are willing to participate in medical decision-making. Thus, inviting patients to participate in SDM should encompass an assessment of their attitudes and beliefs. Importantly, negative attitudes may be accessible to change. Unlike stable sociodemographic characteristics, such values are promising targets for interventions to foster more active participation in SDM. PATIENT OR PUBLIC CONTRIBUTION: This study was part of a larger project on implementing SDM in urological practice. Several stakeholders were involved in the design, planning and conduction of this study, for example, three authors are practising urologists, and three are psychologists with experience in patient care. In addition, the survey was piloted with patients, and their feedback was integrated into the questionnaire. The data presented in this study is based on patients' responses. Results may help to empower our patients.

State anxiety by itself does not change political attitudes: A threat of shock experiment.

Previous research suggests that state anxiety may sway political attitudes. However, previous experimental procedures induced anxiety using political contexts (e.g., social or economic threat). In a pre-registered laboratory experiment, we set out to examine if anxiety that is unrelated to political contexts can influence political attitudes. We induced anxiety with a threat of shock paradigm, void of any political connotation. All participants were instructed that they might receive an electric stimulus during specified threat periods and none during safety periods. Participants were randomly assigned to one of two conditions: Political attitudes (implicit and explicit) were assessed under safety in one condition and under threat in the other. Psychometric, as well as physiological data (skin conductance, heart rate), confirmed that anxiety was induced successfully. However, this emotional state did not alter political attitudes. In a Bayesian analytical approach, we confirmed the absence of an effect. Our results suggest that state anxiety by itself does not sway political attitudes. Previously observed effects that were attributed to anxiety may be conditional on a political context of threat.

Developmental Coordination Disorder (DCD): Relevance for Clinical Psychologists in Europe.

Background: Developmental Coordination Disorder (DCD) is a common neurodevelopmental disorder primarily characterized by fine and gross motor coordination difficulties. Yet, many aspects remain unclear regarding the clinical presentation of secondary symptoms and their implications for Clinical Psychology. Therefore, the purpose of this review is to provide an update about the current understanding of DCD for clinical psychologists and psychotherapists across Europe, particularly based on new insights stemming from the last decade of research. Method: We provide a narrative review of articles published in the last decade on the topic of DCD, and relevant aspects to clinical psychologist, including lesser known aspects of DCD (e.g., executive functions, psychological consequences, and adult DCD). Results: DCD is a highly prevalent, disruptive, and complex disorder, which should be investigated further in many areas (e.g., co-occurrence to ADHD). Existing evidence points toward a key role of executive functioning difficulties at all ages. Most patients report secondary psychological problems, but little headway has been made in examining the effectiveness of psychotherapy for DCD. Conclusions: Insights and remaining research gaps are discussed. It is critical for psychologists and clinical researchers to raise awareness for DCD, take note of the growing literature, and foster continued interdisciplinary approaches to research and treatment of DCD.

Time is a great healer: Peak-end memory bias in anxiety - Induced by threat of shock.

Recently, we demonstrated that the peak-end memory bias, which is well established in the context of pain, can also be observed in anxiety: Retrospective evaluations of a frightening experience are worse when peak anxiety is experienced at the end of an episode. Here, we set out to conceptually replicate and extend this finding with rigorous experimental control in a threat of shock paradigm. We induced two intensity levels of anxiety by presenting visual cues that indicated different strengths of electric stimuli. Each of the 59 participants went through one of two conditions that only differed in the order of moderate and high threat phases. As a manipulation check, orbicularis-EMG to auditory startle probes, electrodermal activity, and state anxiety confirmed the effects of the specific threat exposure. Critically, after some time had passed, participants for whom exposure had ended with high threat reported more anxiety for the entire episode than those for whom it ended with moderate threat. Moreover, they ranked their experience as more aversive when compared to other unpleasant everyday experiences. This study overcomes several previous limitations and speaks to the generalizability of the peak-end bias. Most notably, the findings bear implications for exposure therapy in clinical anxiety.

Behavioural and functional evidence revealing the role of RBFOX1 variation in multiple psychiatric disorders and traits.

Common variation in the gene encoding the neuron-specific RNA splicing factor RNA Binding Fox-1 Homolog 1 (RBFOX1) has been identified as a risk factor for several psychiatric conditions, and rare genetic variants have been found causal for autism spectrum disorder (ASD). Here, we explored the genetic landscape of RBFOX1 more deeply, integrating evidence from existing and new human studies as well as studies in Rbfox1 knockout mice. Mining existing data from large-scale studies of human common genetic variants, we confirmed gene-based and genome-wide association of RBFOX1 with risk tolerance, major depressive disorder and schizophrenia. Data on six mental disorders revealed copy number losses and gains to be more frequent in ASD cases than in controls. Consistently, RBFOX1 expression appeared decreased in post-mortem frontal and temporal cortices of individuals with ASD and prefrontal cortex of individuals with schizophrenia. Brain-functional MRI studies demonstrated that carriers of a common RBFOX1 variant, rs6500744, displayed increased neural reactivity to emotional stimuli, reduced prefrontal processing during cognitive control, and enhanced fear expression after fear conditioning, going along with increased avoidance behaviour. Investigating Rbfox1 neuron-specific knockout mice allowed us to further specify the role of this gene in behaviour. The model was characterised by pronounced hyperactivity, stereotyped behaviour, impairments in fear acquisition and extinction, reduced social interest, and lack of aggression; it provides excellent construct and face validity as an animal model of ASD. In conclusion, convergent translational evidence shows that common variants in RBFOX1 are associated with a broad spectrum of psychiatric traits and disorders, while rare genetic variation seems to expose to early-onset neurodevelopmental psychiatric disorders with and without developmental delay like ASD, in particular. Studying the pleiotropic nature of RBFOX1 can profoundly enhance our understanding of mental disorder vulnerability.

What the future holds: Machine learning to predict success in psychotherapy.

Machine learning (ML) may help to predict successful psychotherapy outcomes and to identify relevant predictors of success. So far, ML applications are scant in psychotherapy research and they are typically based on small samples or focused on specific diagnoses. In this study, we predict successful therapy outcomes with ML in a heterogeneous sample in routine outpatient care. We trained established ML models (decision trees and ensembles of them) with routinely collected clinical baseline information from n = 685 outpatients to predict a successful outcome of cognitive behavioral therapy. Treatment success was defined as clinically significant change (CSC) on the Brief-Symptom-Checklist (reached by 326 patients; 48%). The best performing model (Gradient Boosting Machines) achieved a balanced accuracy of 69% (p < .001) on unseen validation data. Out of 383 variables, we identified the 16 most important predictors, which were still able to predict CSC with 67% balanced accuracy. Our study demonstrates that ML models built on data, which is typically available at the outset of therapy, can predict whether an individual will substantially benefit from the intervention. Some of the predictors were theoretically expected (e.g., level of functioning), but others need further validation (e.g., somatization). From a theoretical and practical perspective, ML is clearly an attractive addition to more established psychotherapy research methodology.

The adult developmental coordination disorders/dyspraxia checklist - German: adapted factor structure for the differentiation of DCD and ADHD.

BACKGROUND: The Adult Dyspraxia/DCD Checklist (ADC) is the only existing self-report questionnaire to screen adults for potential Developmental Coordination Disorder (DCD). It was developed in English and Hebrew, however, its factor structure has not yet been assessed. AIMS: The goals of the current study were to (1) develop and refine a German translation, (2) explore the emerging factors in a new and restructured ADC in German and apply this structure to an English ADC, and (3) explore its potential for distinguishing DCD versus ADHD. METHOD: In a series of three studies, we assessed comprehensibility of the translation and revisions to the questionnaire. We further examined subscale structure in a sample of N = 148 individuals with DCD or ADHD and retested it in an English-speaking sample (N = 134). RESULTS: Overall, we found decent reliability and construct validity for the German ADC. Three components emerged with themes of fine motor coordination, gross motor coordination, and executive functions which had strong psychometric properties in German and English. CONCLUSIONS: The studies collectively highlight the German translation is effective and has strong potential to differentiate DCD and ADHD. Most notably, there are unique symptom profiles in motor and executive functioning difficulties in adults with DCD or ADHD. WHAT THIS PAPER ADDS?: The translation and preliminary validation of the German ADC in this study has the potential to screen for probable DCD in German-speaking adults for the first time. In addition, the new subscale structure can be generalized to the English version as well and allows for the potential assessment of several key symptomatic patterns in the realms of gross motor, fine motor, and executive functioning skills that differ between adults with DCD and ADHD. These differences were fairly consistent between English- and German-speaking samples, indicating potential for more widespread assessment and differentiation of DCD and ADHD.

Effect of Cleft Lip on Adolescent Evaluation of Faces: An Eye-Tracking Study.

PURPOSE: Adolescence is a delicate phase during life in which self-stigmatization increases and acceptance by peers becomes more important. However, little is known about how adolescents with cleft lip and/or palate experience this stage of life. Therefore, the purpose of this study was to investigate how cleft lip and/or palate (CLP) adolescents are looked at by their peers and how they look at others with/without CLP. METHODS: In this prospective, cross-sectional study 54 observers (CLP versus control) performed an eye-tracking task and gave attractiveness/ valence ratings. For this purpose, they were shown pictures of patients with and without CLP with neutral or smiling facial expressions. RESULTS: Adolescents with CLP were looked at differently compared to their unaffected peers, with shorter fixations of the eyes and longer fixations of the nose and mouth. Smiling altered the scan path toward the mouth for all faces. Contrary to the control group, adolescents with CLP tended to spend less time fixating the eyes. In the attractiveness/valence ratings, CLP adolescents were rated more negatively. CONCLUSIONS: Adolescents with cleft lip and/or palate look differently at peers and are also viewed with an alternate scan path.

What's in a face: Automatic facial coding of untrained study participants compared to standardized inventories.

Automatic facial coding (AFC) is a novel research tool to automatically analyze emotional facial expressions. AFC can classify emotional expressions with high accuracy in standardized picture inventories of intensively posed and prototypical expressions. However, classification of facial expressions of untrained study participants is more error prone. This discrepancy requires a direct comparison between these two sources of facial expressions. To this end, 70 untrained participants were asked to express joy, anger, surprise, sadness, disgust, and fear in a typical laboratory setting. Recorded videos were scored with a well-established AFC software (FaceReader, Noldus Information Technology). These were compared with AFC measures of standardized pictures from 70 trained actors (i.e., standardized inventories). We report the probability estimates of specific emotion categories and, in addition, Action Unit (AU) profiles for each emotion. Based on this, we used a novel machine learning approach to determine the relevant AUs for each emotion, separately for both datasets. First, misclassification was more frequent for some emotions of untrained participants. Second, AU intensities were generally lower in pictures of untrained participants compared to standardized pictures for all emotions. Third, although profiles of relevant AU overlapped substantially across the two data sets, there were also substantial differences in their AU profiles. This research provides evidence that the application of AFC is not limited to standardized facial expression inventories but can also be used to code facial expressions of untrained participants in a typical laboratory setting.

Different patients, different preferences: A multicenter assessment of patients' personality traits and anxiety in shared decision making.

OBJECTIVE: Patient-centered care and shared decision making (SDM) are generally recognized as the gold standard for medical consultations, especially for preference-sensitive decisions. However, little is known about psychological patient characteristics that influence patient-reported preferences. We set out to explore the role of personality and anxiety for a preference-sensitive decision in bladder cancer patients (choice of urinary diversion, UD) and to determine if anxiety predicts patients' participation preferences. METHODS: We recruited a sample of bladder cancer patients (N = 180, primarily male, retired) who awaited a medical consultation on radical cystectomy and their choice of UD. We asked patients to fill in a set of self-report questionnaires before this consultation, including measures of treatment preference, personality (BFI-10), anxiety (STAI), and participation preference (API and API-Uro), as well as sociodemographic characteristics. RESULTS: Most patients (79%) indicated a clear preference for one of the treatment options (44% continent UD, 34% incontinent UD). Patients who reported more conscientiousness were more likely to prefer more complex methods (continent UD). The majority (62%) preferred to delegate decision making to healthcare professionals. A substantial number of patients reported elevated anxiety (32%), and more anxiety was predictive of higher participation preference, specifically for uro-oncological decisions (ß = 0.207, p < 0.01). CONCLUSIONS: Our findings provide insight into the role of psychological patient characteristics for SDM. Aspects of personality such as conscientiousness influence treatment preferences. Anxiety contributes to patients' motivation to be involved in pertinent decisions. Thus, personality and negative affect should be considered to improve SDM.

A Smarter Way to Use Your Smartphone: An Intervention to Limit Smartphone-Related Distractions Reduces Hyperactivity but Not Inattention Symptoms.

INTRODUCTION: Smartphones are often helpful in our everyday lives. Yet, they also tend to interrupt us during other activities. It has been argued that such distractions contribute to attention-deficit/hyperactivity disorder-like symptoms. However, since there are mostly correlational studies, the causal nature of this relationship is unclear. Our aim was to test whether reducing smartphone-related distractions might have a beneficial effect on inattention and hyperactive symptoms. METHODS: We conducted a 1-week field experiment with 37 healthy undergraduates and quasi-randomly assigned them to an intervention or control group (CG). The intervention group was given theory-based specific instructions that aimed at reducing smartphone-related distractions, whereas the CG received no intervention. The outcomes of interest were inattention level, hyperactive symptoms, and working memory accuracy. RESULTS: Compared to those in the control condition, participants who limited their smartphone use showed considerable reductions in hyperactive symptoms after 1 week - particularly those who displayed high problematic smartphone use. However, there were no group differences regarding inattention symptoms and working memory accuracy. DISCUSSION: The results give a first hint that strategically reducing smartphone-related distractions via specific but simple use modifications can mitigate hyperactive symptoms. Especially people with problematic smartphone use seem to profit from such an intervention. Remaining questions and directions are discussed.

Decision Aids for Shared Decision-making in Uro-oncology: A Systematic Review.

CONTEXT: Decision aids (DAs) aim to support patients in the process of shared decision-making for complex treatment decisions. To improve patient-centered care in uro-oncology, it is essential to evaluate the availability and quality of existing DAs. OBJECTIVE: To assess the quality of existing DAs for patients across the most prevalent uro-oncological entities. EVIDENCE ACQUISITION: This study was conducted in accordance with the Preferred Reporting Items for Systematic Review and Meta-analyses (PRISMA) guidelines. A systematic literature search (MedLine, Cochrane Library, Web of Science Core Collection, and CCMed) was conducted to identify DAs for treatment decisions for patients with prostate, renal, or bladder cancer. All studies reporting on the development or evaluation of DAs were included. The DAs were examined based on the International Patient Decision Aid Standards (IPDAS) and the evaluation studies were compared in accordance with Standards for Universal reporting of a patient Decision Aid Evaluations (SUNDAE). EVIDENCE SYNTHESIS: The literature search identified 1995 potentially relevant publications. Thirty-two studies reporting on 25 DAs met the inclusion criteria. Twenty-two DAs address prostate cancer, two renal tumor, and one bladder cancer. In the majority of DAs (n = 20), patients can enter individual data. A few (n = 6) DAs allow for personalization using a risk-adapted presentation of treatment options. The percentage of IPDAS criteria met in DAs ranged between 50% and 100% (median 87.5%), and the studies' adherence to the SUNDAE checklist was between 62% and 96% (median 86.6%). Evaluation studies suggest that interventions are likely efficacious. However, a preliminary meta-analysis revealed no significant difference between "DA" and "usual care" for decisional conflict or decisional regret. CONCLUSIONS: This review highlights that a number of well-developed DAs exist in urology. However, there is a need for specific instruments targeting kidney and bladder cancer. Personalization of tools and adherence to international standards of DAs should be further improved. PATIENT SUMMARY: The majority of uro-oncological decision aids target prostate cancer, whereas fewer address kidney or bladder cancer. The quality of the existing instruments is high, but can be increased further to better address specific needs of individual patients.

Evaluation of a new screening instrument for psychological distress in postacute rehabilitation in older person.

PURPOSE: Although psychological distress has a negative impact on functional recovery, institutionalisation and mortality rates, there is typically no established procedure to screen for psychological distress in geriatric rehabilitation. The aim of the study was to evaluate a brief single-item Verbal Numerical Rating Scale (VNRS-PD) as a screening tool for psychological distress in multimorbid geriatric rehabilitation patients. METHODS: In this cross-sectional study, N = 132 geriatric rehabilitation in-patients (M = 82 years old; 70.5% female) completed a verbal numerical rating scale (VNRS-PD) on satisfaction with their mood as well as the Hospital Anxiety and Depression Scale (HADS) and the short-form of the Geriatric Depression Scale (GDS). Based on the questionnaire data, the rehabilitation patients were classified as high or low in psychopathology. Using receiver-operating characteristic (ROC) curve analysis, optimal cutoff scores of the VNRS-PD were calculated for each questionnaire to detect significant psychological distress. RESULTS: Between 28.8% (HADS ≥ 18) and 43.9% (GDS ≥ 6) of the sample had above-cutoff questionnaire scores. The area under the curve (AUC) of the VNRS-PD varied from 0.785 (95%-CI 0.709-0.861) (GDS ≥ 6) and 0.790 (95%-CI 0.716-0.864) (HADS ≥ 18) to 0.807 (95%-CI 0.734-0.880) (GDS ≥ 7). A score of ≤ 5 in the VNRS-PD proved to be the cutoff with an optimal trade-off between sensitivity (0.776-0.867) and specificity (0.638-0.703). CONCLUSION: The VNRS-PD may be a suitable screening instrument to detect patients with psychological distress in inpatient geriatric rehabilitation for and to initiate further diagnostics within a graduated psychodiagnostic scheme. This first step may help to identify older patients with psychological distress and mental disorders, to initiate targeted interventions. Further research is needed to replicate these findings in a larger sample.