How do mindfulness-based interventions promote coping and self-efficacy in patients with cancer: A systematic review of qualitative and quantitative data.

OBJECTIVE: The purpose of this study was to review the existing quantitative and qualitative evidence regarding how mindfulness-based interventions (MBIs) help cope with cancer-related challenges and increase affected patients' perceived self-efficacy. METHODS: A systematic literature search was conducted on PubMed, PsycInfo, PubPsych, and CINAHL. Quantitative, qualitative, and mixed methods studies were included if they (1) evaluated MBIs (2) for patients with cancer or cancer survivors (3) regarding their impact on coping with cancer and perceived self-efficacy. The reports were screened by two independent reviewers and conflicts were resolved by a third reviewer. The review was pre-registered on PROSPERO (CRD42022368765). RESULTS: Findings from 28 reports of 19 quantitative studies, six qualitative studies, and three mixed-methods studies (total N = 1722) were extracted and integrated. The synthesis of quantitative data showed considerable heterogeneity in outcomes and measurement instruments. Most often reported were significant positive impacts of mindfulness on general coping skills, self-regulation, and perceived efficacy in coping with cancer. Qualitative interviews with patients supported those results. The three meta-themes identified were that MBI (1) provided patients with tools to use in stressful situations, (2) promoted a general change of mindset and (3) created a feeling of social connectedness. CONCLUSIONS: The reviewed studies suggest that MBI can promote coping and enhance the perceived self-efficacy of patients with cancer. In the future, more research investigating the different aspects of coping and the potentially moderating role of self-efficacy could provide further insights with respect to how coping and self-efficacy related to MBI.

Anxiety and Somatoform Syndromes Predict Transplant-Focused Internet Use in the Course of an Organ Transplantation.

Background: e-Health interventions are increasing in the field of organ transplantations; however, the literature lacks evidence regarding needs, attitudes, and preferences of organ recipients and donors during the course of an organ transplantation. Methods: In a cross-sectional study, 70 subjects were assessed using self-rated and validated questionnaires, such as the PRIME MD Patient Health Questionnaire (PHQ-D) and the Essen Resource Inventory (ERI). Group differences and a multiple linear regression were also applied. Results: Organ recipients had significantly higher scores for depression (U = 245.00, z = -2.65, p = 0.008, Cohen's d = 0.32), somatoform (U = 224.50, z = -2.99, p = 0.003, Cohen's d = 0.37), and stress syndromes (U = 266.00, z = -2.25, p = 0.008, Cohen's d = 0.27). They also named the internet and apps as resources to find information regarding organ transplants (U = 177.50, z = -2.07, p = 0.017, Cohen's d = 0.28; Z = -2.308, p = 0.021) and preferred to use apps to monitor the physical condition (Z = -2.12, p = 0.034) significantly more than organ donors. Anxiety and somatoform syndromes were significant predictors to search for information regarding the transplant process (F[6,38] = 3.98, p < 0.001; R2 = 0.386). Conclusions: e-Health interventions are promising in accompanying the course of an organ transplant for patients to be informed and educated. Predominantly, potential organ recipients might benefit from apps to record physical parameters. However, anxiety syndromes might hinder patients from searching for information about the transplant process, while somatoform syndromes might enable patients who are searching for such information.

[Impact of the COVID pandemic on the anxiety of patients with functional gastrointestinal symptoms]. / Auswirkungen der COVID-Pandemie auf die Besorgtheit von Patient:innen mit funktionellen gastrointestinalen Symptomen.

Functional gastrointestinal disorders such as functional dyspepsia (FD) and irritable bowel syndrome (IBS) are stress-associated. The COVID-19 pandemic, which has been rampant since 2020, has caused anxiety and stress in the population. Distancing measures to combat the pandemic have affected mental health. Our objective was to examine the impact of the 3rd lockdown in Germany in December 2020 and January 2021 on the apprehension of patients with FD and IBS.Patients diagnosed with FD or IBS treated in a tertiary or primary care hospital in the South of Baden-Württemberg in 2020 voluntarily participated in an anonymous online survey. Questions about concomitant diseases, concern about COVID-19 and stress perception were answered.A total of 106 patients (♀=67, ♂=38, 1 diverse) participated in the survey. Of these, 16 had FD (♀=9, ♂=6, diverse=1), 80 had IBS (♀=52, ♂=28), and 10 had both (♀=6, ♂=4). The average age was 43.6 years. Depressive and anxiety disorders were most frequently reported comorbidities in both the FD (25% each) and IBS group (20% each), followed by joint wear and tear (FD: 13%, RDS: 14%). In a direct comparison of participants with FD and IBS, those with IBS showed significantly higher scores for an increase in gastrointestinal (GI) symptoms during the pandemic (p=0.007), more frequent presentation to a physician during the pandemic, and greater social withdrawal due to GI symptoms (p=0.05). In direct comparison, those with IBS showed higher scores for fear that vaccination against COVID-19 would adversely affect GI symptoms compared to FD (p=0.05).In times of the pandemic, interdisciplinary collaboration in the care of patients with FD or IBS seems more necessary than ever to address concerns and provide good patient care.

[Burden of Affected Persons with MRKH Syndrome: Effect of an Intervention to Support Surgical Neovaginal Placement]. / Belastung von Betroffenen mit MRKH-Syndrom: Effekt einer Intervention zur Unterstützung bei Neovagina-Anlage.

The diagnosis of Mayer-Rokitansky-Küster-Hauser syndrome (MRKHS), a rare variant of female sexual development, is usually made during puberty. The uncertainty in self-image and the impos-sibility of becoming pregnant often lead to considerable stress. Although psychosomatic support is consistently recommended in the literature, there have been only a few studies on the psychological aspects of MRKHS. The aim of the present study is to investigate the quality of life or distress of women with MRKHS undergoing neovaginal surgery and, on the other hand, to evaluate effects of the intervention for support during treatment. Methods In an explorative quasi-experimental pre-post study at a national centre for neovaginal surgery, all patients were offered a psychosomatic intervention (intervention group IG, n=23) and their sexual function (FSFI), psychological distress (PHQ-D) and health-related quality of life (SF-12) were assessed before surgery (t0) and six months after (t1). These were compared with data from a sample collected before and after the intervention period (comparison group VG, n=30). Results While the physical quality of life (SF-12) of both groups was unremarkable at both time points, there was a significant impairment in the psychological quality of life. Both groups (IG, VG) improved from t0 to t1 in their sexual function (FSFI) and showed lower depression scores (PHQ-D). The specific intervention developed was well accepted by those affected and rated as helpful. However, this subjectively perceived effectiveness of the intervention was not reflected by improvement on the quality of life scale (SF-12) and depression scale (PHQ-D). Conclusion Those affected show a clear, clinically relevant distress (SF-12), but this is not reflected in the form of psychological comorbidity (PHQ-D). This apparent discrepancy points to psychologically stable women with acute distress due to the diagnosis of variant sex de-evolution. For them, a low-threshold support service with a supportive character seems to be necessary and helpful during the surgical treatment. The reconstructive therapy for the creation of a neovagina seems to have a positive influence on the psychological quality of life. The fact that pregnancy is still not possible due to the missing uterus could be a reason for not reaching the quality of life of the average population.

[Mindfulness and Skills Based Distress Reduction in Oncology: The Web-Based Psycho-Oncological Make It Training]. / Mindfulness and Skills Based Distress Reduction in Oncology: Das Webbasierte Psychoonkologische Make It Training.

In rural areas, breast cancer-affected patients still do not receive sufficient psycho-oncological care that addresses their specific needs. As a partial solution, telemedicine and web-based applications (eHealth) can add value to their psycho-oncological care as part of self-management regardless of personnel resources, geographical distance from providers, and time constraints. Thus far, however, those supportive aspects of psycho-oncological care are lacking in German-speaking rural areas. For this reason a web-based intervention was developed. Based on the results of a representative cross-sectional and the current literature, we developed a manual and program called Make It Training (Mindfulness and skills based distress reduction in oncology) which was programmed for the websetting. The interactive web-based intervention with 8 sessions integrates different media, including tutorial videos, audio, personal skills box and individual exercises to enhance knowledge about specific disease-related themes. The intervention derives from mindfulness and conveys psychoeducational elements and cognitive behavioural skills with the themes of emotion management, resources, stress management, and self-compassion. The acceptance testing (N=35) showed considerable acceptance and satisfaction. 87% of the patients would recommend the Make it Training to other patient. Prospectively, this training could convey effective strategies for coping with disease-related burden. The Make It Training is an innovative self-management program that can be used for the stepped-care approach and be implemented in rural areas and thereby enhance current outpatient care.

Chances and Limitations of Video Games in the Fight against Childhood Obesity-A Systematic Review.

OBJECTIVE AND METHOD: A systematic literature search was conducted to assess the chances and limitations of video games to combat and prevent childhood obesity. This search included studies with video or computer games targeting nutrition, physical activity and obesity for children between 7 and 15 years of age. RESULTS: The study distinguished between games that aimed to (i) improve knowledge about nutrition, eating habits and exercise; (ii) increase physical activity; or (iii) combine both approaches. Overall, the games were well accepted. On a qualitative level, most studies reported positive effects on obesity-related outcomes (improvement of weight-related parameters, physical activity or dietary behaviour/knowledge). However, the observed effects were small. The games did not address psychosocial aspects. CONCLUSIONS: Using video games for weight management exclusively does not deliver satisfying results. Video games as an additional guided component of prevention and treatment programs have the potential to increase compliance and thus enhance treatment outcome. Copyright © 2017 John Wiley & Sons, Ltd and Eating Disorders Association.

[Religious/Spiritual Needs and Psychosocial Burden of Melanoma Patients]. / Religiöse/spirituelle Bedürfnisse und psychosoziale Belastung von Patienten mit malignem Melanom.

Questions of meaning and purpose in life are becoming relevant during cancer. Studies have shown that most patients have spiritual needs and that religion/spirituality can be an important ressource in coping with illness. So far, only few studies examine the psychosocial burden and the role of spiritual needs during the treatment process of patients with malignant melanoma. 22 patients were included in this study and assessed for psychosocial distress and spiritual needs while being screened for cancer metastases (t1) and 8 weeks later (t2). Distress, anxiety and depression, furthermore spiritual needs and religiousness were examined with standardized assessments (HSI, DT, HADS, PHQ-2, SpNQ, SpREUK). All patients express spiritual needs independent of the time of measurement and overall burden. Important needs are the need to be complete and safe, the need for social support, for actively giving and for inner peace and the possibility to talk about anxiety and sorrow. Analyses have shown that religious patients are less distressed 8 weeks later, while there was no difference in the first time of measurement. The results show the importance to include spiritual needs in the process of treatment of cancer in a clinical and ambulatory context. Results indicate that religion/spirituality could be an important resource to cope with cancer. During the process of treatment, spiritual needs could be addressed by psychooncology and pastoral care with respect for their different approach and address this topic to support cancer patients.

[Patient's Autonomy and Information in Psycho-Oncology: Computer Based Distress Screening for an Interactive Treatment Planning (ePOS-react)]. / Patientenautonomie und -informiertheit in der Psychoonkologie: Computerbasiertes Belastungs-screening zur interaktiven Behandlungsplanung (ePOS-react).

To identify distressed patients in oncology using screening questionnaires is quite challenging in clinical routine. Up to now there is no evidence based recommendation which instrument is most suitable and how to put a screening to practice. Using computer based screening tools offers the possibility to automatically analyse patient's data, inform psycho-oncological and medical staff about the results, and use reactive questionnaires. Studies on how to empower patients in decision making in psycho-oncology are rare.Methods Women with breast and gynaecological cancer have been consecutively included in this study (n=103) at time of inpatient surgical treatment in a gynaecological clinic. They answered the computer based screening questionnaire (ePOS-react) for routine distress screening at time of admission. At the end of the tool an individual recommendation concerning psycho-oncological treatment is given ( i) psycho-oncological counselling, ii) brief psycho-oncological contact, iii) no treatment suggestion). The informed patients could choose autonomously either the recommended treatment or an individually more favoured alternative possibility. Additionally, a clinical interview (approx. 30 min) based on the "Psychoonkologische Basisdiagnostik (PO-Bado)" has been carried out for a third-party assessment of patients' need for treatment.Results 68.9% followed the treatment recommendation. 22.3% asked for a more "intense" (e. g. counselling instead of recommended brief contact) and 8,7% for a "less intense" intervention than recommended. The accordance of third-party assessment (clinical interview "PO-Bado") and treatment recommendation is about 72.8%. The accordance of third-party assessment and patient's choice (ePOS-react) is about 58.3%. The latter is smaller because 29.1% asked for a brief psycho-oncological contact for whom from the third-party assessment's perspective no indication for treatment has been existent.Discussion A direct response of the screening result (treatment recommendation) during the computer based screening and asking for a patient's choice leads to an increase of brief psycho-oncological contacts for personal information about psycho-oncological interventions. Compared with a third-party assessment (clinical interview) there is no improvement of the accuracy of the indications. But it improves the transparency for the access to psycho-oncological interventions which may strengthen patient's autonomy and adherence.

Psychological Distress, Anxiety, and Depression of Cancer-Affected BRCA1/2 Mutation Carriers: a Systematic Review.

Understanding the intermediate- and long-term psychological consequences of genetic testing for cancer patients has led to encouraging research, but a clear consensus of the psychosocial impact and clinical routine for cancer-affected BRCA1 and BRCA2 mutation carriers is still missing. We performed a systematic review of intermediate- and long-term studies investigating the psychological impact like psychological distress, anxiety, and depression in cancer-affected BRCA mutation carriers compared to unaffected mutation carriers. This review included the screening of 1243 studies. Eight intermediate- and long-term studies focusing on distress, anxiety, and depression symptoms among cancer-affected mutation carriers at least six months after the disclosure of genetic testing results were included. Studies reported a great variety of designs, methods, and patient outcomes. We found evidence indicating that cancer-affected mutation carriers experienced a negative effect in relation to psychological well-being in terms of an increase in symptoms of distress, anxiety, and depression in the first months after test disclosure. In the intermediate- and long-term, no significant clinical relevant symptoms occurred. However, none of the included studies used specific measurements, which can clearly identify psychological burdens of cancer-affected mutation carriers. We concluded that current well-implemented distress screening instruments are not sufficient for precisely identifying the psychological burden of genetic testing. Therefore, future studies should implement coping strategies, specific personality structures, the impact of genetic testing, supportive care needs and disease management behaviour to clearly screen for the possible intermediate- and long-term psychological impact of a positive test disclosure.

Acne and PCOS are less frequent in women with Mayer-Rokitansky-Küster-Hauser syndrome despite a high rate of hyperandrogenemia: a cross-sectional study.

BACKGROUND: Acne is a very common skin condition during adolescence and adulthood. Patients with uterovaginal agenesis (Mayer-Rokitansky-Küster-Hauser syndrome, MRKH) treated at the Tübingen University Center for Rare Female Genital Malformations, however, clinically appeared to be less frequently affected by acne. The etiology of MRKH syndrome remains unknown. The only known MRKH-associated mutations are located within the WNT4 gene and lead to an atypical form of MRKH syndrome associated with clinical and biochemical hyperandrogenism. Our study aimed to assess the frequency, severity, and self-evaluation of acne in MRKH patients and to correlate the clinical findings with hormone analyses. METHODS: As part of a cross-sectional longterm follow-up study after laparoscopic assisted creation of a neovagina a questionnaire was sent to 149 MRKH patients aged 16-44 years comprising 26 items concerning prevalence and self-evaluation of acne, and the effects of acne on quality of life. The questionnaire was derived from one used in a former epidemiological study of acne in 4,000 women. Blood for hormone analyses was collected routinely during the clinical visit. RESULTS: Fully completed, evaluable questionnaires were returned by 69/149 (46%) women. Of these respondents, 42 (60.1%) showed hyperandrogenemia without other clinical signs of virilization but only 17 (24.6%) reported acne (8 (11.6%) had physiological acne and 9 (13.0%) clinical acne) and only 10 (14.5%) reported receiving medical treatment for their acne. Effects of acne on quality of life were minor. Only 4 patients (5.8%) with PCOS were identified, among them one with physiological acne, the other three within the acne-free group. CONCLUSIONS: Although hyperandrogenemia is common, acne is significantly less frequent in women with MRKH than reported in the literature for non-MRKH women, and is seldom treated medically. Patients in this study appeared resistant to acne to some extent, possibly due to the sebaceous glands in the acne regions being less sensitive to androgens compared to the normal population. A WNT4 mutation is unlikely to be the main cause of MRKH syndrome in our hyperandrogenemic patients.

Adaptations of interpersonal psychotherapy in psycho-oncology and its effects on distress, depression, and anxiety in patients with cancer: a systematic review.

Objective: Patients with cancer experience significant psychosocial distress. Stressors include interpersonal difficulties like loneliness, isolation, thwarted belongingness, communication impediments, and conflicts. Interventions are required that address their specific psychosocial needs. Interpersonal Psychotherapy (IPT) is a promising concept for the treatment of psychosocial distress associated with cancer because it addresses patients' interactions and role transformations. This review aims to provide an overview of the current evidence regarding interventions for patients with cancer based on IPT. Methods: A systematic review following PRISM guidelines was conducted, including randomized controlled trials of IPT-based interventions in patients with cancer, assessing effects on distress, depression, and anxiety. Results: Eight studies were included, sampling 390 patients in total. Seven out of eight studies assessed exclusively women with breast cancer. Two studies described IPT interventions and showed stronger improvement in depression and anxiety compared to TAU and equal improvement in depression compared to other psychotherapy interventions. Six studies described remote Interpersonal Counselling (IPC). One found remote IPC to be superior to control conditions regarding depression, and one found remote IPC to be superior to attention control, but not active control conditions. No study found remote IPC to be superior to control conditions regarding distress. Discussion: There are few randomized controlled trials of IPT for patients with cancer. Results regarding depression and anxiety are promising for in-person IPT, but mixed for remote IPC. Conclusion: The review suggests in-person IPT, but not remote IPC, may yield benefits for patients with cancer. Research on the subject is scarce, and to inform implementation of IPT interventions, research with diverse groups of patients with cancer is required. Systematic trial registration: PROSPERO, Identifier CRD42023410687.

Communication training for advanced medical students improves information recall of medical laypersons in simulated informed consent talks--a randomized controlled trial.

BACKGROUND: Informed consent talks are mandatory before invasive interventions. However, the patients' information recall has been shown to be rather poor. We investigated, whether medical laypersons recalled more information items from a simulated informed consent talk after advanced medical students participated in a communication training aiming to reduce a layperson's cognitive load. METHODS: Using a randomized, controlled, prospective cross-over-design, 30 5th and 6th year medical students were randomized into two groups. One group received communication training, followed by a comparison intervention (early intervention group, EI); the other group first received the comparison intervention and then communication training (late intervention group, LI). Before and after the interventions, the 30 medical students performed simulated informed consent talks with 30 blinded medical laypersons using a standardized set of information. We then recorded the number of information items the medical laypersons recalled. RESULTS: After the communication training both groups of medical laypersons recalled significantly more information items (EI: 41 ± 9% vs. 23 ± 9%, p < .0001, LI 49 ± 10% vs. 35 ± 6%, p < .0001). After the comparison intervention the improvement was modest and significant only in the LI (EI: 42 ± 9% vs. 40 ± 9%, p = .41, LI 35 ± 6% vs. 29 ± 9%, p = .016). CONCLUSION: Short communication training for advanced medical students improves information recall of medical laypersons in simulated informed consent talks.

[Acceptance and reliability of an electronic psychooncological screening of patients with breast cancer: a randomized controlled study]. / Akzeptanz und Reliabilität eines elektronischen psychoonkologischen Screenings bei Patientinnen mit Brustkrebs: eine randomisiert-kontrollierte Studie.

Many oncology centres have implemented a screening to identify distress in cancer patients. Assessments using paper-pencil questionnaires are time-consuming to score and may cause delays in providing psychooncological care. This challenges care-givers because it reduces the time available for inpatient treatment. In a randomized-controlled study, we examined an electronic screening tool which would enhance psychooncological clinical care by improving information flow, and by meeting demands of an electronic patient chart. In total 206 patients with breast cancer randomly received either a paper-pencil or electronic questionnaire to measure distress, as well as, the acceptance of the current screening procedure. The acceptance of the electronic screening was greater compared to that of the paper-pencil screening. The results of the two assessment approaches did not -differ. An electronic screening may provide a time -saving alternative with excellent data quality.

Stigmatization of obese individuals by human resource professionals: an experimental study.

BACKGROUND: Weight-related stigmatization is a public health problem. It impairs the psychological well-being of obese individuals and hinders them from adopting weight-loss behaviors. We conducted an experimental study to investigate weight stigmatization in work settings using a sample of experienced human resource (HR) professionals from a real-life employment setting. METHODS: In a cross-sectional, computer-based experimental study, a volunteer sample of 127 HR professionals (age: 41.1 ± 10.9 yrs., 56% female), who regularly make career decisions about other people, evaluated individuals shown in standardized photographs regarding work-related prestige and achievements. The photographed individuals differed with respect to gender, ethnicity, and Body Mass Index (BMI). RESULTS: Participants underestimated the occupational prestige of obese individuals and overestimated it for normal-weight individuals. Obese people were more often disqualified from being hired and less often nominated for a supervisory position, while non-ethnic normal-weight individuals were favored. Stigmatization was most pronounced in obese females. CONCLUSIONS: The data suggest that HR professionals are prone to pronounced weight stigmatization, especially in women. This highlights the need for interventions targeting this stigmatization as well as stigma-management strategies for obese individuals. Weight stigmatization and its consequences needs to be a topic that is more strongly addressed in clinical obesity care.

Psychiatric comorbidities in cancer survivors across tumor subtypes: A systematic review.

BACKGROUND: Psychiatric disorders are common but underdiagnosed in cancer survivors. Research suggests that tumor type has an effect on the prevalence of clinically relevant depression, anxiety, comorbid anxiety-depression and posttraumatic stress disorder (PTSD). AIM: To identify studies that examined the prevalence of clinically relevant levels of depression, anxiety, comorbid anxiety-depression and PTSD for patients with one or more tumor sites and compare those prevalences between cancer subtypes. METHODS: Four databases (PubMed, PsycInfo, PubPsych and the Cochrane Database) were searched and resulted in a total of 2387 articles to be screened. To be included, a study must have investigated cancer-free and posttreatment survivors using tools to assess clinically relevant levels of the listed psychiatric comorbidities. All articles were screened by two authors with a third author reviewing debated articles. RESULTS: Twenty-six studies on ten different tumor types fulfilled all inclusion criteria and were included in the review. The studies showed heterogeneity regarding the study characteristics, number of participants, time since diagnosis, and assessment tools. Generally, all four comorbidities show higher prevalences in cancer survivors than the general population. Brain tumor survivors were reported to have a relatively high prevalence of both depression and anxiety. Studies with melanoma survivors reported high prevalences of all four psychiatric comorbidities. Regarding comorbidities, a wide range in prevalence existed across the tumor types. Within one cancer site, the prevalence also varied considerably among the studies. CONCLUSION: Psychiatric comorbidities are more frequent in cancer survivors than in the general population, as reflected by the prevalence of depression, anxiety, comorbid anxiety-depression and PTSD across all tumor subtypes. Developing generalized screening tools that examine psychological distress in cancer survivors up to at least ten years after diagnosis could help to understand and address the psychological burden of cancer survivors.

Personality Traits and Coping Strategies Relevant to Posttraumatic Growth in Patients with Cancer and Survivors: A Systematic Literature Review.

The possibility of positive psychological changes after cancer, namely, posttraumatic growth, is a growing field of research. Identifying personality traits and coping strategies related to posttraumatic growth may help find vulnerable individuals as well as promote helpful coping strategies to help more patients make positive changes at an early stage. The aim of this systematic literature review is to provide an overview of the quantitative data on coping strategies and personality traits associated with posttraumatic growth in patients with cancer and cancer survivors as well as the methods used in included studies. A systematic literature search was conducted using five databases (PubMed, PubPsych, PsycInfo, Web of Science, and PSYNDEXplus). The 70 reports of included studies assessed posttraumatic growth using questionnaires in a sample of patients with cancer or survivors. In addition, associations with a personality trait or coping strategy had to be examined cross-sectionally or longitudinally. All 1698 articles were screened for titles and abstracts by two authors, after which disputed articles were reviewed by a third author. Afterwards, articles were screened for full texts. Most studies had a cross-sectional design and used a sample of patients with breast cancer. Coping strategies have been researched more than personality factors. The personality traits of resilience, hardiness, dispositional positive affectivity, and dispositional gratitude seem to be related to posttraumatic growth, while the Big Five personality traits (openness to experience, conscientiousness, extraversion, agreeableness, neuroticism) have been less researched and/or seem to be unrelated. The use of social support, religious coping, positive reframing, and reflection during illness as coping strategies seems to be related to posttraumatic growth. The findings can be used for the development of interventions. Future studies should investigate associations longitudinally.

Resilience as a Factor Influencing Psychological Distress Experience in Patients with Neuro-Oncological Disease.

Cancer causes psychological distress. Approximately one-third of all patients with cancer suffer from distress requiring psycho-oncological treatment. Examining factors contributing to their distress can inform approaches to counteracting them. Among such factors, resilience is considered to be a psychological adaptive capacity resulting from complex genetic, epigenetic, psychological, and environmental influences. For that reason, we investigated resilience as a factor of psychological distress experience among patients with neuro-oncological disease. To assess distress among patients with neuro-oncological diseases, we performed electronic psycho-oncological screening in the Department of Neurosurgery at Tübingen University Hospital (n = 100) following tumor surgery (T0) using the Resilience Scale 13, the Hornheider Screening Instrument, the Patient Health Questionnaire-2, the Generalized Anxiety Disorder Scale-2, and the Distress Thermometer, all administered on tablets. Follow-up was done 6 months after (T1). The distress of patients with neuro-oncological disease decreased significantly after 6 months (p < 0.01). Most patients (87%) showed moderate to high resilience. Although significant correlations with distress are measurable at the T0 time point (ρ = -0.318 **, p < 0.01), no significant correlations were observed at T1. Thus, resilience seems to significantly impact distress in the acute phase of the neuro-oncological disease. For clinical practice, our findings suggest that resilience-focused screening can provide useful information about patients at risk of experiencing distress.

A Serious Game for the Prevention of Obesity in School Children-Impact of Parent's Involvement: A Randomized Controlled Trial.

Serious games convey information and use interactive components to reinforce and train behaviours. A serious game addressing nutrition, physical activity and stress coping-the Kids Obesity Prevention Program (KOP)-was previously evaluated for efficacy in children. This study aimed at evaluating the KOP-game regarding: (i) its acceptance and efficacy with respect to parents of primary school children receiving the same game intervention as the children; and (ii) whether the children could benefit by parental involvement. A randomized controlled trial with two groups of children aged 9 to 12 years was conducted which included a 6-month follow-up period. All children played the game twice in two weeks. In the family-intervention group, the parents additionally played the game. The primary outcome was the gain in knowledge in parents and children measured with a pretested questionnaire. The secondary outcomes were knowledge maintenance as well as several behavior changes. Parents and children in both groups improved and maintained their knowledge equally. The KOP-game increases knowledge of nutrition in children independently of the involvement of their parents. KOP games are well accepted in children; further research should examine the structured involvement of parents.