The influence of movement-related costs when searching to act and acting to search.

Real-world search behavior often involves limb movements, either during search or after search. Here we investigated whether movement-related costs influence search behavior in two kinds of search tasks. In our visual search tasks, participants made saccades to find a target object among distractors and then moved a cursor, controlled by the handle of a robotic manipulandum, to the target. In our manual search tasks, participants moved the cursor to perform the search, placing it onto objects to reveal their identity as either a target or a distractor. In all tasks, there were multiple targets. Across experiments, we manipulated either the effort or time costs associated with movement such that these costs varied across the search space. We varied effort by applying different resistive forces to the handle, and we varied time costs by altering the speed of the cursor. Our analysis of cursor and eye movements during manual and visual search, respectively, showed that effort influenced manual search but did not influence visual search. In contrast, time costs influenced both visual and manual search. Our results demonstrate that, in addition to perceptual and cognitive factors, movement-related costs can also influence search behavior.NEW & NOTEWORTHY Numerous studies have investigated the perceptual and cognitive factors that influence decision making about where to look, or move, in search tasks. However, little is known about how search is influenced by movement-related costs associated with acting on an object once it has been visually located or acting during manual search. In this article, we show that movement time costs can bias visual and manual search and that movement effort costs bias manual search.

"University students' economic situation during the COVID-19 pandemic: A cross-sectional study in Germany".

The COVID-19 pandemic caused a major economic downturn that disproportionally affected university students. This empirical research investigated effects and risk factors of the pandemic on students' economic situation with focus on financial distress and financial limitations. Data was collected using an online survey in May and June 2020 from students (n = 917) enrolled at universities in Germany. 80.6% were enrolled in bachelor programs (n = 738), the mean semester was 3.8 (standard deviation (SD = 2.0) and students' mean age was 23.1 years (SD = 4.1). 51.8% (n = 472) were female and 47.4% (n = 432) male. 56.7% (n = 506) of students worked before the pandemic. More than one third reported a decrease in income (36.5%; n = 334) and an increase in financial constraints (38.7%; n = 354). A multivariate logistic regression analysis showed that students with regular income were less likely to experience financial distress compared to those without (odds ratio (OR) = 0.456; p = 0.014). Furthermore, working part-time as associated with a higher financial distress compared to those without part-time employment (OR = 1.811; p = 0.003). Students who worked part-time before the pandemic also had a higher probability of increased financial restriction (or constraint) compared to those who did not work part-time (OR = 2.094; p < 0.001). University students were disproportionally affected by the economic consequences of the COVID-19 pandemic, which increased students' economic uncertainty. To offset such problems, financial aid schemes for students need to be made available to alleviate distress and to allow students to focus on their studies but should not compound problems by leading to financial hardship at a later point in time.

Researcher Choices for Infant Sleep Assessment: Parent Report, Actigraphy, and a Novel Video System.

Incorporating infant sleep, either as a predictor or as an outcome variable, into interdisciplinary work has become increasingly popular. Sleep researchers face many methodological choices that have implications for the reliability and validity of the data. Here, the authors directly investigated the impact of design and measurement choices in a small, longitudinal sample of infants. Three sleep measurement techniques-parent-reported sleep diaries, actigraphy (Micromini Sleep Watch), and a commercial videosomnography (Nanit)-were included, using actigraphy as the baseline. Nine infants' sleep (4 girls) was measured longitudinally using all three measurement techniques. Nanit provided summary statistics, using a proprietary algorithm, for nightly sleep parameters. The actigraphy data were analyzed with both the Sadeh Infant and Sadeh algorithms. The extent to which measurements converged on sleep start and end time, number of wake episodes, sleep efficiency, and sleep duration was assessed. Measures were positively correlated. Difference scores revealed similar patterns of greater sleep estimation in parent reports and Nanit compared with actigraphy. Bland-Altman plots revealed that much of the data were within the limits of agreement, tentatively suggesting that Nanit and actigraphy may be used interchangeably. Graphs display significant variability within and between individual infants as well as across measurement techniques. Potential confounding variables that may explain the discrepancies between parent report, Sadeh Infant, Sadeh, and Nanit are discussed. The findings are also used to speak to the advantages and disadvantages of design and measurement choices. Future directions focus on the unique contributions of each measurement technique and how to capitalize on them.

"If you can, change this system" -Pregnant asylum seekers' perceptions on social determinants and material circumstances affecting their health whilst living in state-provided accommodation in Germany - a prospective, qualitative case study.

BACKGROUND: Pregnant women and new mothers seeking asylum are highly vulnerable and have special needs, yet there is dearth of research related to this group in Germany. This paper reports on material circumstances and behavioural factors as social determinants of asylum seekers' health during pregnancy and early motherhood. The study aim was to gain in-depth insights into these women's experiences and perceived needs with a focus on material circumstances whilst living in state-provided accommodation in one federal state in Southern Germany. METHODS: A qualitative, prospective approach was taken with individual semi-structured interviews of participants during pregnancy and up to the six-week postnatal assessment, aiming at interviewing each woman twice during pregnancy and once after giving birth. Two female interviewers performed interviews assisted by female professional interpreters on the telephone. Interviews were recorded digitally and transcribed verbatim. An inductive approach was taken to perform content analysis of interview material. RESULTS: 21 interviews were performed with nine women seeking asylum in pregnancy and early motherhood. Content analysis of women's perceived health-related needs revealed significant health challenges due to considerable constraints in two major themes each with associated categories: a) material circumstances and b) behavioural factors. Participants' experiences of living conditions included significant challenges in terms of housing and neighbourhood quality e.g. poor hygiene standards with fear of disease and restless sleep due to threats of violence. Consumption potential was severely limited because of a minimal living allowance. Food was a major preoccupation for all participants. Catering services in state-provided accommodation were perceived as unsatisfactory and neglecting religious practices. Institutional food provided adequate calorific intake but participants reported loss of appetite due to bland food, limited variety, little choice and unfamiliar tastes. Self-catering was prohibited further exacerbating this problem. CONCLUSIONS: Pregnant asylum seekers and new mothers living in state-provided accommodation experienced major restrictions related to material circumstances in this study. Key results identified housing and neighbourhood quality, consumption potential and nutrition as social determinants of health which women perceived to adversely affect their health, especially during pregnancy and early motherhood.

Psychosocial health of asylum seeking women living in state-provided accommodation in Germany during pregnancy and early motherhood: A case study exploring the role of social determinants of health.

BACKGROUND: Pregnant women and new mothers seeking asylum are subject to major challenges that may affect their health and increase their vulnerability. The study aim was to investigate asylum seeking women's experiences and perceived needs during pregnancy and early motherhood whilst living in state-provided accommodation in one federal state in Southern Germany, with a particular focus on psychosocial factors. METHODS: In this exploratory case study, individual semi-structured interviews were conducted with participants in pregnancy and up to the six-week postnatal assessment. Two female interviewers performed interviews assisted by female professional interpreters. Interviews were recorded digitally and transcribed verbatim. An inductive approach was taken to content analysis of interview material. RESULTS: 21 interviews were performed with nine women seeking asylum in pregnancy and early motherhood. Women shared experiences and perceived consequences on their psychosocial health. The following five key themes were identified during content analysis: a) psychosocial stressors, b) stressful living circumstances, c) stressful relationships, d) social support and e) coping styles. Psychosocial factors were a significant source of mental stress for participants, especially due to future uncertainties linked with the asylum seeking process. Living circumstances were also marked by stressors including a lack of privacy, verbal and physical threats and experiences of powerlessness. Further strain and emotional pressure were caused by stressful relationships with the unborn child's father. Social support and personal coping styles provided relief for some participants. CONCLUSIONS: This study provides in-depth insights into the experiences and perceived needs of pregnant asylum seekers and new mothers living in state-provided accommodation. Key results identified psychosocial factors such as future uncertainties, stressful living circumstances and stressful relationships, as social determinants of health that were perceived to adversely affect women's health. Adequate social support and individual coping styles increased resilience and counterbalanced psychosocial stressors during the asylum seeking process.

Patients with somatoform disorders: More frequent attendance and higher utilization in primary Out-of-Hours care?

BACKGROUND: One significant health policy challenge in many European countries at present is developing strategies to deal with the increase in patient attendance at Out-of-Hours care (OOHC), whether this is at OOHC-Centres in primary care settings or hospital emergency departments (ED). FAs (FAs) presenting in OOHC are a known challenge and previous studies have shown that FAs present more often with psychological problems and psychiatric comorbidities rather than severe physical complaints. FAs may be also contributing to the rising workload in OOHC-Centres in primary care. The aim of this study was to determine attendance frequencies and health problem presentation patterns for patients with and without somatoform disorders (ICD-10 F45 diagnoses) in OOHC-Centres in primary care. Some of these somatoform disorders may have a psychiatric character. Moreover, we wanted to compare health care utilization patterns (pharmacotherapy and hospitalizations) between these patients groups. METHODS: Routine OOHC data from a large German statutory health insurance company in the federal state of Baden-Wuerttemberg were evaluated. 3,813,398 health insured persons were included in the data set from 2014. The data were initially made available for our study group in order to evaluate a comprehensive evaluation programme in German primary care, the "Hausarztzentrierte Versorgung" (HZV), loosely translated as "family doctor coordinated care". We used the ICD-10 codes F45.0-F45.9 in regular care to identify patients with somatoform disorders and compared their health care utilization patterns (attendance rates, diagnoses, prescriptions, hospitalization rates) in OOHC to patients without somatoform disorders. Attendance rates were calculated with multivariable regression models in order to adjust for age, gender, comorbidities and for participation in the HZV intervention. RESULTS: 350,528 patients (9.2%) of the 3,813,398 insured persons had an F45-diagnosis. In comparison with the whole study-sample, patients with an F45-diagnosis were on average seven years older (51.7 vs. 44.0 years; p<0,0001) and the percentage of women was significantly higher (70.1% vs 53.3%; p<0,0001). In OOHC, as opposed to normal office hours, the adjusted rate of patients with an F45-diagnosis was 60.6% higher (adjusted for age, gender and co-morbidity) than in the general study-sample. Accordingly, in OOHC, prescriptions for antidepressants, hypnotics, anxiolytics but also opioids were significantly higher than in the general study population i.e. those without F45- diagnoses. However, an F45 diagnosis was only made in 3.45% of all F45 patients seen in OOHC in 2014. CONCLUSIONS: Patients with somatoform disorders were more FAs in both regular office hours and in OOHC in primary care settings. In OOHC, they are normally not identified as such because the somatoform illness is secondary to other acutely presenting symptoms such as pain. While it is acknowledged that it is difficult to make an exact diagnosis in this complex group of somatoform disorders in an OOHC setting, it is still important to develop continuing education programmes for medical staff working in OOHC, to support effective recognition and response to the specific needs of this complex patient group.

Prescribing differences in family practice for diabetic patients in Germany according to statutory or private health insurance: the case of DPP-4-inhibitors and GLP-1-agonists.

BACKGROUND: The objective of this study was to analyze prescription decisions for family practice (FP) patients with Diabetes mellitus type 2 (DM2) using the case of the incretin mimetics Dipeptidyl peptidase-4 (DDP-4) inhibitors and Glucagon-like peptide-1 (GLP-1) agonists dependent on patients' health insurance status (statutory or private) in Germany. This study is important since the scientific debate is still open with regard to DPP-4-inhibitors and GLP-1-agonists, where some critics are raising questions on potential long-term risks for patients. METHODS: Data for this analysis were sourced from the German health services research register CONTENT (CONTinuous morbidity registration Epidemiologic NeTwork), in which FP health services information, generated by family practitioners, is continuously collated, e.g. patients' health insurance status, morbidity and pharmacotherapy. Patients with Diabetes mellitus type 1 (DM1) were excluded from the study. RESULTS: From the family practices collaborating in the CONTENT research network, there were 7298 patients treated with pharmacotherapeutic agents for DM2 between 01.09.2009 and 31.08.2014. 586 (8.03 %) of these patients had private insurance. Prescriptions for the incretin mimetics were 40.6 % higher (9.7 vs. 6.9 %; p < 0.0001) for patients with private insurance compared to patients with statutory health insurance. This finding was confirmed with multivariable analyses. CONCLUSIONS: There was a statistically significant difference found in prescription patterns according to the patient's health insurance status for the incretin mimetics in this sample population of German patients with DM2. Obviously, these differences result from the eligibility for reimbursement according to patients' health insurance status. Whether incretin mimetics pose specific long term risks for particular patients is yet to be determined.

Use of home remedies: a cross-sectional survey of patients in Germany.

BACKGROUND: Reliable information regarding patient knowledge of home remedies and the types of health problems patients use them for is scarce. Nevertheless, anecdotal evidence indicates that home remedies are used by patients for managing minor health problems and that this can be sufficient for symptom management while the body recovers from minor health problems. The aim of the presented study was to explore patient use of home remedies in Germany. METHODS: A questionnaire was developed and pretested in a pilot study phase. The revised questionnaire was comprised of questions about general knowledge and experienced efficiency of home remedies, the use of home remedies for common health problems and socio-demographic data. Patients were recruited via randomly selected addresses of general practitioners (GPs) in three regions of Germany (Heidelberg, Erfurt and Hanover and surrounding areas). The questionnaire was handed out in the waiting area of GP practices. The data was analyzed descriptively. RESULTS: 480 of 592 patients from 37 GP practices were included, according to a response rate of 81%. Based on the survey results, home remedies were widely known and used by about 80% of our respondents (on average 22 different home remedies were used per person). The most frequently used home remedies were steam-inhalation, hot lemon drink, honey, chamomile tea and chicken soup. 80% of respondents tried home remedies before pharmaceutical options. Information about home remedies was most commonly gained from family members, rather than from written guides, media or GPs. CONCLUSIONS: These results provide an initial overview on the use of home remedies from the patient's perspective in a German context. Bearing in mind the high use of home remedies that was reported by patients in the study, it is highly likely that GPs in Germany may need to advise patients on their use of home remedies during consultations. To this end, given the scarcity of reliable information on home remedies, further research is needed.

Malnutrition and infectious disease morbidity among children missed by the childhood immunization program in Indonesia.

Although it has been thought that child immunization programs may miss the children who are in greatest need, there are little published quantitative data to support this idea. We sought to characterize malnutrition and morbidity among children who are missed by the childhood immunization program in Indonesia. Vaccination and morbidity histories, anthropometry, and other data were collected for 286,500 children, aged 12-59 months, in rural Indonesia. Seventy-three point nine percent of children received complete immunizations (3 doses of diphtheria-pertussis-tetanus, 3 doses of oral poliovirus, and measles), 16.8% had partial coverage (1-6 of 7 vaccine doses), and 9.3% received no vaccines. Of children with complete, partial, and no immunization coverage, respectively, the prevalence of severe underweight (weight-for-age Z score < -3) was 5.4, 9.9, and 12.6%, severe stunting (height-for-age Z score < -3) was 10.2, 16.2, and 21.5%, and current diarrhea was 3.8, 7.3, and 8.6% (all p < 0.0001), respectively. In families where the child had complete, partial, and no immunizations, the history of infant mortality was 6.4, 11.4, and 16.5%, and under-five child mortality was 7.3, 13.4, and 19.2% (both p < 0.0001). Expanded programmatic coverage is needed to reach children who are missed by childhood immunizations in rural Indonesia, as missed children are at higher risk of morbidity and mortality.