The bidirectional relationship of obesity and labor market status - Findings from a German prospective panel study.

BACKGROUND: Given the inconsistent findings regarding associations between obesity and unemployment, our analysis is one of the few that explores bidirectional changes in obesity and unemployment. In our prospective study, we address factors associated with the a. transition into and transition out of obesity, including unemployment, and b. transition into and out of unemployment, including obesity. SUBJECTS AND METHODS: The Labor Market and Social Security-Panel (PASS) consists of two independent, nationally representative German subsamples: residents receiving unemployment benefits (50%) and a representative sample of residents (50%). The sample contains N = 11 361 observations between two measurement points three years apart of N = 8440 individuals participating in two or three waves between 2009 and 2015. We analyzed potential predictors of the transition in and out of obesity and unemployment, including health-related quality of life (HrQoL) and physical activity, using logistic regression models. RESULTS: 1. Transition into obesity: Unemployed participants had a higher probability of exhibiting a body mass index (BMI) ≥ 35 kg/m2 three years later (transition into obesity classes II and III; Exp(B) = 1.5). 2. Transition out of obesity: Unemployment did not predict transition out of obesity. Physical activity at least once weekly increased the probability of no longer having a BMI ≥ 35 kg/m2 three years later (Exp(B) = 2.0). 3. Transition into unemployment: Obesity was not associated with becoming unemployed three years later. Participants with a lower mental HrQoL were more likely to become unemployed (Exp(B) = 0.98). 4. Transition out of unemployment: Unemployed individuals reporting a BMI of 30-34.9 kg/m2 were less likely to leave unemployment (Exp(B) = 0.67). A better physical HrQoL was associated with a higher probability of leaving unemployment (Exp(B) = 1.01). CONCLUSIONS: Obesity does not predict future unemployment, but unemployed individuals with obesity have a lower probability of labor market re-entry. Unemployment increases obesity risk. Interactions between obesity and possible confounding variables and their effect on unemployment warrants further examination.

Toward a Dimensional Assessment of Externalizing Disorders in Children: Reliability and Validity of a Semi-Structured Parent Interview.

OBJECTIVE: This study assesses the reliability and validity of the DSM-5-based, semi-structured Clinical Parent Interview for Externalizing Disorders in Children and Adolescents (ILF-EXTERNAL). METHOD: Participant data were drawn from the ongoing ESCAschool intervention study. The ILF-EXTERNAL was evaluated in a clinical sample of 474 children and adolescents (aged 6-12 years, 92 females) with symptoms of attention-deficit/hyperactivity disorder (ADHD). To obtain interrater reliability, the one-way random-effects, absolute agreement models of the intraclass correlation (ICC) for single ICC(1,1) and average measurements ICC(1,3) were computed between the interviewers and two independent raters for 45 randomly selected interviews involving ten interviewers. Overall agreement on DSM-5 diagnoses was assessed using Fleiss' kappa. Further analyses evaluated internal consistencies, item-total correlations as well as correlations between symptom severity and the degree of functional impairment. Additionally, parents completed the German version of the Child Behavior Checklist (CBCL) and two DSM-5-based parent questionnaires for the assessment of ADHD symptoms and symptoms of disruptive behavior disorders (FBB-ADHS; FBB-SSV), which were used to evaluate convergent and divergent validity. RESULTS: ICC coefficients demonstrated very good to excellent interrater reliability on the item and scale level of the ILF-EXTERNAL [scale level: ICC(1,1) = 0.83-0.95; ICC(1,3) = 0.94-0.98]. Overall kappa agreement on DSM-5 diagnoses was substantial to almost perfect for most disorders (0.38 ≤ κ ≤ 0.94). With some exceptions, internal consistencies (0.60 ≤ α ≤ 0.86) and item-total correlations (0.21 ≤ r it ≤ 0.71) were generally satisfactory to good. Furthermore, higher symptom severity was associated with a higher degree of functional impairment. The evaluation of convergent validity revealed positive results regarding clinical judgment and parent ratings (FBB-ADHS; FBB-SSV). Correlations between the ILF-EXTERNAL scales and the CBCL Externalizing Problems were moderate to high. Finally, the ILF-EXTERNAL scales were significantly more strongly associated with the CBCL Externalizing Problems than with the Internalizing Problems, indicating divergent validity. CONCLUSION: In clinically referred, school-age children, the ILF-EXTERNAL demonstrates sound psychometric properties. The ILF-EXTERNAL is a promising clinical interview and contributes to high-quality diagnostics of externalizing disorders in children and adolescents.

[Assessment of the maturity of juvenile and young adult offenders according to §105 of German juvenile law: a developmental psychology perspective]. / Die Reifebeurteilung Heranwachsender nach § 105 JGG und der Umgang mit jungen erwachsenen Straftäterinnen und Straftätern aus entwicklungspsychologischer Sicht.

Assessment of the maturity of juvenile and young adult offenders according to §105 of German juvenile law: a developmental psychology perspective Abstract. Since 1953, according to § 105 of the German JGG (Jugendgerichtsgesetz/Juvenile Court Act), it has been possible to convict offenders aged 18.0 y-20y 11 mo either as juveniles or as adults, depending on their developmental status. Yet unambiguous criteria defining the individual stages of development are available neither to judges nor to experts. Thus, for this age group this may lead judges to make arbitrary decisions impairing the right of equal treatment before the law in Germany. In the absence of clear criteria for assessing maturity, experts nearly always recommend judging such offenders as juveniles. Recent findings from the neurosciences and developmental psychology show that not only juveniles but adolescents and young adults up to the age of 25y usually have significant potential for development. After an overview of the legal practices pertaining to juveniles in Germany and throughout Europe, we propose alternatives for the individual assessment of maturity.

Acute inflammation and psychomotor slowing: Experimental assessment using lipopolysaccharide administration in healthy humans.

Data from clinical and cross-sectional studies suggest that inflammation contributes to psychomotor slowing and attentional deficits found in depressive disorder. However, experimental evidence is still lacking. The aim of this study was to clarify the effect of inflammation on psychomotor slowing using an experimental and acute model of inflammation, in which twenty-two healthy volunteers received an intravenous injection of lipopolysaccharide (LPS, dose: 0.8 â€‹ng/kg body weight) and of placebo, in a randomized order following a double-blind within-subject crossover design. A reaction time test and a go/no-go test were conducted 3 â€‹h after the LPS/placebo injection and interleukin (IL)-6 and tumor necrosis factor (TNF)-α concentrations were assessed. No effect of experimental inflammation on reaction times or errors for either test was found. However, inflammation was related to worse self-rated performance and lower effort put in the tasks. Exploratory analyses indicated that reaction time fluctuated more over time during acute inflammation. These data indicate that acute inflammation has only modest effects on psychomotor speed and attention in healthy subjects objectively, but alters the subjective evaluation of test performance. Increased variability in reaction time might be the first objective sign of altered psychomotor ability and would merit further investigation.

Towards a comprehensive assessment of school absenteeism: development and initial validation of the inventory of school attendance problems.

School attendance problems (SAPs) become manifest in many ways and are associated with multiple risk factors, calling for comprehensive assessment methods. This study documents the development of the inventory of school attendance problems (ISAP), which assesses both the quality and the function of a broad spectrum of SAPs by first asking students with SAPs to rate the intensity of symptoms prior to or at school and then to rate their impact on school attendance. An empirically generated pool of 124 items was analyzed (explorative factor analysis) using a clinical sample of N = 245 students with SAPs (53.5% male; Mage: 14.4). The Youth Self Report (YSR), a German version of the School Refusal Assessment Scale (SRAS), and the extent of school absenteeism were used to determine construct validity. The resulting 48 items loaded on 13 factors. The 13 scales assess internalizing and externalizing symptoms (Depression, Social Anxiety, Performance Anxiety, Agoraphobia/Panic, Separation Anxiety, Somatic Complaints, Aggression, School Aversion/Attractive Alternatives) as well as emotional distress due to problems in the school or family context (Problems with Teachers, Dislike of the Specific School, Problems with Peers, Problems Within the Family, Problems with Parents). All scales showed good internal consistencies. Their correlations with the YSR and the SRAS indicated convergent and discriminant validity. Positive associations between most of the scales and the extent of school absenteeism were obtained. Although preliminary, these results support the usefulness of the ISAP for a comprehensive assessment of SAPs in clinical settings.

[Economic evaluation of a manual-based, multimodal cognitive behavioural therapy for school avoiding children with psychiatric disorder]. / Ökonomische Evaluation eines manualbasierten Therapiekonzeptes für psychisch kranke Kinder und Jugendliche mit schulvermeidendem Verhalten.

Objective: Untreated school refusal increases the risk of a premature discontinuation of the educational career. The aim of this study is the economic evaluation of a manual-based treatment for school refusal in comparison to the standard treatment. Method: Within the cost-minimisation analysis, resource use is measured retrospectively for six months using the CSSRI questionnaire. Unit costs for most health care services are derived from published standard prices. Costs are calculated from the societal perspective based on prices compiled in 2011. The cost comparison during the one-year intervention period applies a difference in differences Approach. Results: The most common diagnoses among the 112 participants are phobic and emotional disorders. The average cost per patient during the intervention period amounts to 7197 € (95 %-CI: 4746 € ­ 10 079 €) for the manual group and 9294 € (95 %-CI: 6313 € ­ 12 878 €) for the control group. The difference in adjusted costs of 1453 € in favour of the manual group is not statistically relevant. Conclusions: The manual-based treatment is equivalent if not slightly advantageous compared to the standard treatment considering the clinical outcomes and cost of illness.

[The School Refusal Assessment Scale: Psychometric properties and validation of a modified version]. / Die Einschätzungsskala der Schulverweigerung: Psychometrische Gütekriterien und Validierung einer modifizierten Version.

Objective: Psychometric properties of the original and a modified version of the «Einschätzungsskala der Schulverweigerung¼ (German version of the School Refusal Assessment Scale, SRAS; Kearney & Silverman, 1993; Overmeyer et al., 1994) were analyzed in order to identify alternative ways to revise the SRAS/ESV compared to the existing revision SRAS-R (Kearney, 2002). The SRAS/ESV consists of a parent and a child version and measures four functions of school refusal (avoidance of negative affect related to school settings, escape from aversive social or evaluative situations, attention-getting behavior, positive tangible reinforcement). Method: Data from N = 124 (parent version) respectively N = 156 (child version) patients of a specialized psychiatric outpatient unit for children and adolescents with school-avoiding behavior were obtained. Analyzes included characteristics of items and scales, face-, factorial-, and construct-validity (correlations with other questionnaires, e. g., YSR, CBCL were analyzed). Results: Many items seem to measure overall anxiety instead of the functional aspects of school refusal, one item measures expansive behavior. Four factors were obtained, but they did not reflect the assumed structure of the ESV (e. g., overlap of the two avoidance-related scales). Post-hoc-analyzes with a modified version (elimination of several items with problematic content validity) suggested three factors, convergent and discriminative validity of the modified version was confirmed. Because only some of the afore-mentioned problems have been addressed in the revised version (SRAS-R; Kearney, 2002), a new revision and extension of the German version of the questionnaire covering more aspects of school avoidance behavior (e. g., bullying, depression, somatic complaints, psychosocial factors) is discussed.

Assessment of potential cardiovascular risks of methylphenidate in comparison with sibutramine: do we need a SCOUT (trial)?

With the recent approval of methylphenidate (MPH) for treating attention-deficit/hyperactivity disorder (ADHD) in adults, the number of patients exposed will increase tremendously. The ongoing debate on the cardiovascular safety of MPH has triggered two large retrospective cohort studies in children and adolescents as well as in young to middle-aged adults. These studies looked into serious cardiovascular events (sudden cardiac death, acute myocardial infarction and stroke) as primary endpoints and concluded that MPH was safe after a mean duration of 2.1 years of follow-up in children and adolescents and mean duration of 0.33 years of current use in adults. The results are encouraging with respect to the short- and medium-term use of MPH. Without the inherent limitations of retrospective cohort studies, a prospective randomized, double-blind, placebo-controlled, multicenter trial in individuals stratified for cardiovascular risk factors would allow for an optimized risk assessment. With many millions of patients treated per year and drawing parallels to the lately discovered risks of sibutramine, another sympathomimetic with an overlapping mode of action and similar side effects on heart rate and blood pressure, we hypothesize that such a trial might be a dedicated risk mitigation strategy for public health. A critical assessment of cardiovascular side effects of MPH appears particularly warranted, because ADHD is associated with obesity, smoking and poor health in general. We summarize recent findings with the focus on cardiovascular risks of MPH in humans; we additionally analyze the limited number of rodent studies that have addressed cardiovascular risks of MPH.

Behavioral Assessment of Core ADHD Symptoms Using the QbTest.

OBJECTIVE: Hyperactivity, one of the core symptoms of ADHD, has been mostly neglected in neuropsychological assessment of childhood ADHD. The neuropsychological Quantified behavior Test (QbTest) separately assesses all three core symptoms of ADHD on a behavioral level. Factor structure of the QbTest and its concurrent and discriminant validity are presented. METHOD: An exploratory factor analysis (n = 828 children) was performed. In a second sample (n = 102 children) a Multi-Trait-Multi-Method (MTMM) approach was used for validity analyses. RESULTS: A three factorial model explained 76 % of the total variance, with the resulting QbTest factors significantly influenced by age and gender. The MTMM approach yielded promising results for discriminant, yet inconsistent findings for concurrent validity between the QbTest and another attention test as well as for Conners' Parent and Teacher Rating Scales. CONCLUSION: Results indicate that the QbTest may be helpful for the behavioral assessment of childhood ADHD, yet further studies on its psychometric quality and clinical utility are needed.

Medical and psychosocial implications of adolescent extreme obesity - acceptance and effects of structured care, short: Youth with Extreme Obesity Study (YES).

BACKGROUND: Prevalence rates of overweight and obesity have increased in German children and adolescents in the last three decades. Adolescents with extreme obesity represent a distinct risk group. On the basis of data obtained by the German Child and Youth Survey (KiGGS) and the German district military offices we estimate that the group of extremely obese adolescents (BMI ≥ 35 kg/m2) currently encompasses approximately 200.000 adolescents aged 14 to 21 yrs. Conventional approaches focusing on weight reduction have largely proven futile for them. In addition, only a small percentage of adolescents with extreme obesity seek actively treatment for obesity while contributing disproportionately strong to health care costs. Because of somatic and psychiatric co-morbidities and social problems adolescents with extreme obesity require special attention within the medical care system. We have initiated the project "Medical and psychosocial implications of adolescents with extreme obesity--acceptance and effects of structured care, short: 'Youths with Extreme Obesity Study (YES)'", which aims at improving the medical care and social support structures for youths with extreme obesity in Germany. METHODS/DESIGN: We focus on identification of these subjects (baseline examination) and their acceptance of diagnostic and subsequent treatment procedures. In a randomized controlled trial (RCT) we will investigate the effectiveness of a low key group intervention not focusing on weight loss but aimed at the provision of obesity related information, alleviation of social isolation, school and vocational integration and improvement of self-esteem in comparison to a control group treated in a conventional way with focus on weight loss. Interested individuals who fulfill current recommended criteria for weight loss surgery will be provided with a structured preparation and follow-up programs. All subjects will be monitored within a long-term observational study to elucidate medical and psychosocial outcomes. Our aim is to evaluate realistic treatment options. Therefore inclusion and exclusion criteria are minimized. We will recruit adolescents (age range 14-21 years) with extreme obesity (BMI ≥ 35 kg/m2) (extreme group) within 24 months (120 per centre, 5 centres) as well as obese adolescents being at risk for developing extreme obesity (BMI ≥ 30-34.9 kg/m2) (at risk group). Follow-up evalutations will be performed biannually after inclusion for several years depending on additional funding. In sum, we aim at establishing evaluated health care structures for extremely obese adolescents. DISCUSSION: The results of YES will be of importance for a frequently neglected group of individuals, for whom current medicine has little to offer in terms of structured access to empirically evaluated therapeutic programs. Thus, the results will be both a help for the adolescents within the study and for others in the future given that the trial will lead to a positive finding. Moreover, it will help practitioners and therapists to deal with this neglected group of individuals. TRIAL REGISTRATION: Project registration numbers for each subproject: 1.) ClinicalTrials.gov: NCT01625325, NCT01703273, NCT01662271, NCT01632098; 2.) Germanctr.de: DRKS00004172, DRKS00004195, DRKS00004198, DRKS00004197.

Bibliometric assessment of publication output of child and adolescent psychiatric/psychological affiliations between 2005 and 2010 based on the databases PubMed and Scopus.

We aimed to determine the quantitative scientific publication output of child and adolescent psychiatric/psychological affiliations during 2005-2010 by country based on both, "PubMed" and "Scopus" and performed a bibliometric qualitative evaluation for 2009 using "PubMed". We performed our search by affiliation related to child and adolescent psychiatric/psychological institutions using "PubMed". For the quantitative analysis for 2005-2010, we counted the number of abstracts. For the qualitative analysis for 2009 we derived the impact factor of each abstract's journal from "Journal Citation Reports". We related total impact factor scores to the gross domestic product (GDP) and population size of each country. Additionally, we used "Scopus" to determine the number of abstracts for each country that was identified via "PubMed" for 2009 and compared the ranking of countries between the two databases. 61 % of the publications between 2005 and 2010 originated from European countries and 26 % from the USA. After adjustment for GDP and population size, the ranking positions changed in favor of smaller European countries with a population size of less than 20 million inhabitants. The ranking of countries for the count of articles in 2009 as derived from "Scopus" was similar to that identified via the "PubMed" search. The performed search revealed only minor differences between "Scopus" and "PubMed" related to the ranking of countries. Our data indicate a sharp difference between countries with a high versus low GDP with regard to scientific publication output in child and adolescent psychiatry/psychology.

Primary prevention of childhood obesity: an interdisciplinary analysis.

The primary prevention of childhood obesity requires combined efforts by stakeholders at various societal levels, based on the knowledge from multiple disciplines. The goal of the present study was therefore to analyze current preventive approaches and delineate implications for future prevention research and practice by integrating knowledge from genetics, law, economics, psychology, and social ethics. Inconclusive evidence on the etiology of obesity, a complex, multifactorial condition, likely complicates prevention, leading to a lack of specificity regarding target groups, focus, and techniques. It is recommended to increase the specificity of prevention by explicitly considering risk factor evidence, including evidence on genetic factors. Because the institutional and legal framework of primary obesity prevention in children is insufficient in many countries, considering the risk factors for childhood obesity is also crucial for establishing a basis for legal regulations. Companies from sectors concerned with food intake and physical activity may be involved in preventive action, e.g., for initiating self-defeating sanctions. Long-term behavior change may be enhanced through the systematic application of behavior modification techniques within primary prevention programs. Overall, an interdisciplinary perspective furthers understanding of the complexity of this condition and can inform public health strategies on the primary prevention of childhood obesity.

[Primary prevention of adult obesity. an interdisciplinary analysis]. / Primäre Prävention der Adipositas bei Erwachsenen : Eine interdisziplinäre Analyse.

The primary prevention of adult obesity requires combined efforts by stakeholders at various societal levels, based on the knowledge from multiple disciplines. The goal of the present study was, therefore, to analyze current preventive approaches and delineate implications for future prevention research and practice by integrating knowledge from genetics, law, economics, psychology, and social ethics (Figure 1). Inconclusive evidence on the etiology of obesity, a complex, multifactorial condition, likely complicates prevention, contributing to a lack of specificity regarding target groups, focus, and techniques of prevention. Given the urgency and significance of the "obesity problem" that requires immediate and effective solutions, it is recommended that the various existing and developing prevention programs are evaluated to ensure orientation at current risk factor research. Results from genetic risk factor research can be used as a rationale to increase specificity of preventive measures regarding identification of high-risk groups, timing, and goals of prevention. Further, it is important to evaluate prevention programs for systematic application of behavior modification techniques and consideration of individual risk factors and resources to ensure promotion of long-term behavior change that leads to weight maintenance and a reduction of incidence rates of obesity in adults (Figure 3). Although the primary prevention of childhood obesity may lead to a reduction of incidence rates of obesity in adults, high rates of adult-onset obesity and the related medical and psychosocial sequelae in adulthood underscore the necessity of preventive efforts for adults. Concerning the environmental basis of obesity prevention, in many countries, the institutional and legal framework of preventive approaches requires further examination in order to improve funding, coordination between multiple stakeholders, and implementation of prevention in the health-care system. Evidence on risk factors for obesity is also crucial to inform network approaches and to justify restrictive legal options for the purpose of prevention. Here, self-defeating sanctions of the relevant industries may be a viable first step toward obesity prevention. As taxes or subsidies are limited in feasibility (Figure 2), relevant industries could be involved in the design and promotion of "healthy" products, stimulating greater request of such products. Network approaches appear suited to involve companies and other relevant stakeholders of prevention efforts on adult obesity. Yet these approaches require greater societal conscience about the severity of the obesity problem in adults and its multifactorial etiology. Recognizing the multifactorial etiology of obesity and acknowledging that weight regulation is only somewhat within personal responsibility may therefore lead to destigmatize obese individuals as the focus is shifted away from blaming them toward a more realistic understanding of this condition. Responsibility for the development of obesity and the prevention of weight gain is in multiple areas: law, policy, industry, health-care institutions, medical professions, and the individual - all should contribute to obesity prevention. Overall, the current analysis shows that an interdisciplinary perspective furthers understanding of the complexity of this condition and can inform public-health strategies on the prevention of adult obesity.

Eating Pattern Inventory for Children: a new self-rating questionnaire for preadolescents.

A questionnaire on psychological dimensions of eating behavior in children is presented. Existing questionnaires for children specifically focus on symptoms of eating disorders only, whereas for adults, questionnaires assessing general psychological dimensions of eating behavior are also available. The development of the Eating Pattern Inventory for Children (EPI-C) was based on a sample of 373 fourth-grade students. Factor and item analysis led to a psychometrically sound 20-item questionnaire with the dimensions dietary restraint, external eating, parental pressure to eat, and emotional eating. These factors explain 62% of the total item variance. Subscale scores and emerging eating patterns were associated with children's body weight suggesting initial evidence of its validity. The EPI-C is proposed for research on eating behavior in clinical and non-clinical preadolescent samples.

Data adaptive interim modification of sample sizes for candidate-gene association studies.

OBJECTIVES: The use of conventional Transmission/Disequilibrium tests in the analysis of candidate-gene association studies requires the precise and complete pre-specification of the total number of trios to be sampled to obtain sufficient power at a certain significance level (type I error risk). In most of these studies, very little information about the genetic effect size will be available beforehand and thus it will be difficult to calculate a reasonable sample size. One would therefore wish to reassess the sample size during the course of a study. METHOD: We propose an adaptive group sequential procedure which allows for both early stopping of the study with rejection of the null hypothesis (H0) and for recalculation of the sample size based on interim effect size estimates when H0 cannot be rejected. The applicability of the method which was developed by Müller and Schäfer [Biometrics 2001;57:886-891] in a clinical context is demonstrated by a numerical example. Monte Carlo simulations are performed comparing the adaptive procedure with a fixed sample and a conventional group sequential design. RESULTS: The main advantage of the adaptive procedure is its flexibility to allow for design changes in order to achieve a stabilized power characteristic while controlling the overall type I error and using the information already collected. CONCLUSIONS: Given these advantages, the procedure is a promising alternative to traditional designs.