The last year of life for patients dying from cancer vs. non-cancer causes: a retrospective cross-sectional survey of bereaved relatives.

PURPOSE: To compare health care experiences of patients with cancer or non-cancer diseases in their last year of life. METHODS: A cross-sectional post-bereavement survey was conducted using an adapted German version of the VOICES questionnaire (VOICES-LYOL-Cologne). Differences in the reported experiences were assessed using a two-sided Pearson's chi-square test and Mann-Whitney U test. RESULTS: We collected data from 351 bereaved relatives. More than half of non-cancer patients were not informed that their disease could lead to death (p < 0.001). When this was communicated, in 46.7% of non-cancer and 64.5% of cancer patients, it was reported by the hospital doctor (p = 0.050). In all, 66.9% of non-cancer and 41.6% of cancer patients were not informed about death being imminent (p < 0.001). On average, non-cancer patients had significantly fewer transitions and hospital stays in their last year of life (p = 0.014; p = 0.008, respectively). Non-cancer patients were treated more often by general practitioners, and cancer patients were treated more often by specialists (p = 0.002; p = 0.002, respectively). A substantially lower proportion of non-cancer patients were treated by at least one member of or in the setting of general or specialized palliative care (p < 0.001). CONCLUSIONS: Non-cancer patients experience disadvantages in communication regarding their care and in access to specialized palliative care in their last year of life compared to cancer patients. Regarding the assessment of palliative care needs and the lack of communication of an incurable disease, non-cancer patients are underserved. An early identification of patients requiring palliative care is a major public health concern and should be addressed irrespective of diagnosis. TRIAL REGISTRATION: Prospectively registered by the German Clinical Trials Register (DRKS00011925, data of registration: 13.06.2017).

Dying in hospital is worse for non-cancer patients. A regional cross-sectional survey of bereaved relatives' views.

OBJECTIVE: The aim of the study is to examine differences in hospital care between patients with cancer and non-cancer conditions in their dying phase, perceived by bereaved relatives. METHODS: A retrospective cross-sectional post-bereavement survey, with the total population of 351 deceased, 91 cancer patients and 46 non-cancer patients, who spent their last 2 days of life in hospital. A validated German version of the VOICES-questionnaire ('VOICES-LYOL-Cologne') was used. RESULTS: There were substantial differences between the two groups in the rating of sufficient practical care such as pain relief or support to eat or drink (p = 0.005) and sufficient emotional care needs (p = 0.006) and in the quality of communication with healthcare professionals (p < 0.001), with non-cancer patients scoring lowest in all these dimensions. CONCLUSION: In all surveyed dimensions on the quality of care in the dying phase, non-cancer patients' relatives rated the provided care worse than those of cancer patients. To compensate any differences in care in the dying phase between diagnosis groups, hospital care should be provided as needs-oriented and non-indication-specific.

Quality of care in the last year of life: adaptation and validation of the German "Views of Informal Carers' Evaluation of Services - Last Year of Life - Cologne".

BACKGROUND: To inform quality improvement and strengthen services provided in the last year of life, measuring quality of care is essential. For Germany, data on care experiences in the last year of life that go beyond diagnoses and care settings are still rare. The aim of this study was to develop and validate a German version of the 'Views of Informal Carers' Evaluation of Services - Short Form (VOICES-SF)' suitable to assess the quality of care and services received across settings and healthcare providers in the German setting in the last year of life (VOICES-LYOL-Cologne). METHODS: VOICES-SF was adapted and translated following the 'TRAPD' team approach. Data collected in a retrospective cross-sectional survey with bereaved relatives in the region of Cologne, Germany were used to assess validity and reliability. RESULTS: Data from 351 bereaved relatives of adult decedents were analysed. The VOICES-LYOL-Cologne demonstrated construct validity in performing according to expected patterns, i.e. correlation of scores to care experiences and significant variability based on care settings. It further correlated with the PACIC-S9 Proxy, indicating good criterion validity. The newly added scale "subjective experiences of process and outcome of care in the last year of life" showed good internal consistency for each given care setting, except for the homecare setting. Test-retest analyses revealed no significant differences in satisfaction ratings according to the length of time since the patient's death. Overall, our data demonstrated the feasibility of collecting patient care experiences reported by proxy-respondents across multiple care settings. CONCLUSION: VOICES-LYOL-Cologne is the first German instrument to analyse care experiences in the last year of life in a comprehensive manner and encourages further research in German-speaking countries. This instrument enables the comparison of quality of care between settings and may be used to inform local and national quality improvement activities. TRIAL REGISTRATION: This study was registered in the German Clinical Trials Register (DRKS00011925; Date of registration: 13/06/2017).

Minority and Majority Adolescents' Attitudes toward Mutual Acculturation and its Association with Psychological Adjustment.

Although acculturation is considered a mutual process, no measure assesses attitudes toward mutual acculturation. Through a novel four-dimensional measurement, this study addresses this research gap by assessing attitudes toward minority and majority acculturation and its relation to psychological adjustment for immigrant-background minority and non-immigrant majority adolescents in public secondary schools in three European countries: in Germany (n = 346, 46% female, Mage = 12.78 years, range 11-16), Greece (n = 439, 56% female, Mage = 12.29 years, range 11-20), and Switzerland (n = 375, 47% female, Mage = 12.67 years, range 11-15). Latent profile analyses led to three distinct acculturation profiles in all three countries: strong and mild mutual integration profiles, where both migrant and majority students are expected to integrate, and a third profile assuming lower responsibility upon the majority. Additionally, those in the strong- and mild-integration profiles reported stronger psychological adjustment than those assuming lower responsibility upon the majority, which held for all students in Switzerland and mostly for those without a migration background in Germany. The findings demonstrate the importance of a mutual acculturation framework for future research. Moreover, as most adolescents fit in with one of the mutual integration patterns, findings stress that no matter their migration background, adolescents favor mutual integration including the expectation on schools to enhance intercultural contact.

Can we determine burdensome transitions in the last year of life based on time of occurrence and frequency? An explanatory mixed-methods study.

OBJECTIVE: Burdensome transitions are typically defined as having a transition in the last three days or multiple hospitalizations in the last three months of life, which is seldom verified with qualitative accounts from persons concerned. This study analyses types and frequencies of transitions in the last year of life and indicators of burdensome transitions from the perspective of bereaved relatives. METHOD: Cross-sectional explanatory mixed-methods study with 351 surveyed and 41 interviewed bereaved relatives in a German urban area. Frequencies, t-tests, and Spearman correlations were computed for quantitative data. Qualitative data were analyzed using content analysis with provisional and descriptive coding/subcoding. RESULTS: Transitions rise sharply during the last year of life. 8.2% of patients experience a transition in the last three days and 7.8% three or more hospitalizations in the last three months of life. An empathetic way of telling patients about the prospect of death is associated with fewer transitions in the last month of life (r = 0.185, p = 0.046). Professionals being aware of the preferred place of death corresponds to fewer hospitalizations in the last three months of life (1.28 vs. 0.97, p = 0.021). Qualitative data do not confirm that burden in transitions is linked to having transitions in the last three days or multiple hospitalizations in the last three months of life. Burden is associated with (1) late and non-empathetic communication about the prospect of death, (2) not coordinating care across settings, and (3) not considering patients' preferences. SIGNIFICANCE OF RESULTS: Time of occurrence and frequency appear to be imperfect proxies for burdensome transitions. The subjective burden seems to be associated rather with insufficient information, preparation, and management of transitions.

Unsolved problems and unwanted decision-making in the last year of life: A qualitative analysis of comments from bereaved caregivers.

OBJECTIVES: Patients in their last year of life, as well as their relatives, often feel that existent care structures of the healthcare system do not adequately address their individual needs and challenges. This study analyzes unmet needs in terms of unsolved problems and unwanted decision-making in the health and social care of patients in their last year of life from the perspective of bereaved caregivers. METHODS: This qualitative study is based on free-text comments from informal caregivers of deceased patients collected as part of the Last-Year-of-Life-Study-Cologne (LYOL-C) using a postal survey. With qualitative content analysis, a category system with main and subcategories was developed in a multi-step process. RESULTS: Free-text commentaries and demographic data were collected from 240 bereaved caregivers. Particularly outside of hospice and palliative care services, study participants addressed the following unsolved problems: poor communication with medical and nursing staff, insufficient professional support for informal caregivers, inadequate psycho-social support for patients, and poor management of pain and other symptoms. Respondents often stated that their relative had to be cared for and die outside their own home, which the relative did not want. SIGNIFICANCE OF RESULTS: Our findings suggest the necessity for greater awareness of patients' and their relatives' needs in the last year of life. Addressing individual needs, integrating palliative and hospice care in acute hospitals and other healthcare structures, and identifying patients in their last year of life and their caregivers could help to achieve more targeted interventions and optimization of care.

Benefits and challenges of conversational agents in older adults : A scoping review.

BACKGROUND: Commercial conversational agents (CAs) bear the promise of low threshold accessibility for individuals with limited digital competencies. This applies not only for healthy aging older adults but also for specific subgroups such as those with life-long intellectual disabilities (ID). OBJECTIVE: This scoping review aims to synthesize the current evidence on benefits and challenges of CAs for older adults with and without ID. In doing so, we hope to inform future research as well as practical decision-making in the context of CAs as potential quality of life enhancers for older adults with various competence levels. MATERIAL AND METHODS: A literature search was conducted in form of a scoping review. A total of 841 publications were screened for benefits and challenges of CAs, resulting in an extraction of 18 articles targeting healthy aging older adults (60 years+) and 5 articles targeting older adults with ID (50 years+) for synthesis. RESULTS: The existing evidence suggests that CAs come with more benefits than challenges, e.g., general ease of use, easier information access, and feelings of companionship. Higher perceived agency due to using a CA seems to be a specific issue for older adults with ID. Challenges concern mostly learning how to use a CA and privacy concerns. CONCLUSION: The results indicate that CAs can serve as quality of life enhancers both in healthy aging adults and in older adults with ID; nevertheless, thoughtful preparation is necessary, especially in relation to learning needs, capabilities present and privacy concerns.

What are the risk factors for avoidable transitions in the last year of life? A qualitative exploration of professionals' perspectives for improving care in Germany.

BACKGROUND: Little is known about the nature of patients' transitions between healthcare settings in the last year of life (LYOL) in Germany. Patients often experience transitions between different healthcare settings, such as hospitals and long-term facilities including nursing homes and hospices. The perspective of healthcare professionals can therefore provide information on transitions in the LYOL that are avoidable from a medical perspective. This study aims to explore factors influencing avoidable transitions across healthcare settings in the LYOL and to disclose how these could be prevented. METHODS: Two focus groups (n = 11) and five individual interviews were conducted with healthcare professionals working in hospitals, hospices and nursing services from Cologne, Germany. They were asked to share their observations about avoidable transitions in the LYOL. The data collection continued until the point of information power was reached and were audio recorded and analysed using qualitative content analysis. RESULTS: Four factors for potentially avoidable transitions between care settings in the LYOL were identified: healthcare system, organization, healthcare professional, patient and relatives. According to the participants, the most relevant aspects that can aid in reducing unnecessary transitions include timely identification and communication of the LYOL; consideration of palliative care options; availability and accessibility of care services; and having a healthcare professional taking main responsibility for care planning. CONCLUSIONS: Preventing avoidable transitions by considering the multicomponent factors related to them not only immediately before death but also in the LYOL could help to provide more value-based care for patients and improving their quality of life.

The Importance of Low Daily Risk for the Prediction of Treatment Events of Individual Dairy Cows with Sensor Systems.

The prediction of health disorders is the goal of many sensor systems in dairy farming. Although mastitis and lameness are the most common health disorders in dairy cows, these diseases or treatments are a rare event related to a single day and cow. A number of studies already developed and evaluated models for classifying cows in need of treatment for mastitis and lameness with machine learning methods, but few have illustrated the effects of the positive predictive value (PPV) on practical application. The objective of this study was to investigate the importance of low-frequency treatments of mastitis or lameness for the applicability of these classification models in practice. Data from three German dairy farms contained animal individual sensor data (milkings, activity, feed intake) and were classified using machine learning models developed in a previous study. Subsequently, different risk criteria (previous treatments, information from milk recording, early lactation) were designed to isolate high-risk groups. Restricting selection to cows with previous mastitis or hoof treatment achieved the highest increase in PPV from 0.07 to 0.20 and 0.15, respectively. However, the known low daily risk of a treatment per cow remains the critical factor that prevents the reduction of daily false-positive alarms to a satisfactory level. Sensor systems should be seen as additional decision-support aid to the farmers' expert knowledge.

Perceptions of and Attitudes Toward Death, Dying, Grief, and the Finitude of Life-A Representative Survey Among the General Public in Germany.

Some end-of-life aspects have become a significant political and social issue such as elderly care and euthanasia. But hardly anything is known about how the general public in Germany thinks about death and dying more generally. Therefore, we conducted a representative online survey (N = 997) regarding 21 end-of-life aspects. Differences between subgroups were analyzed by conducting analyses of variance and Tukey honestly significance difference post hoc tests and by performing t tests. The findings revealed that the general public is open to engaging with topics of death, dying, and grief and that death education might even be promoted for children. Most participants appraised dealing with the finitude of life as part of a good life, but few have contemplated death and dying themselves so far. Attitudes and perceptions were related to age, subjective health, religious denomination, and gender. The survey provides useful implications for community palliative care, death education, and communication with dying people.

Patient-centered care during the last year of life: adaptation and validation of the German PACIC short form for bereaved persons as proxies (PACIC-S9-proxy).

BACKGROUND: Providing patient-centered care (PCC) during the last year of life (LYOL) can be challenging due to the complexity of the patients' medical, social and psychological needs, especially in case of chronic illnesses. Assessing PCC can be helpful in identifying areas for improvements. Since not all patients can be surveyed, a questionnaire for proxy informants was developed in order to retrospectively assess patient-centeredness in care during the whole LYOL. This study aimed to evaluate the feasibility and validity of an adapted version of the German Patient Assessment of Chronic Illness Care (PACIC) for surveying bereaved persons in order to assess PCC during the decedents' LYOL. METHODS: The German PACIC short form (11 items) was adapted to a nine-item version for surveying bereaved persons on the decedent's LYOL (PACIC-S9-Proxy). Items were rated on a five-point Likert scale. The PACIC adaptation and validation was part of a cross-sectional survey in the region of Cologne. Participants were recruited through self-selection and active recruitment by practice partners. Sociodemographic characteristics and missing data were analyzed using descriptive statistics. An exploratory factor analysis was conducted in order to assess the structure of the PACIC-S9-Proxy. Internal consistency was estimated using Cronbach's alpha. RESULTS: Of the 351 informants who participated in the survey, 230 (65.52%) considered their decedent to have suffered from chronic illness prior to death. 193 of these informants (83.91%) completed ≥5 items of the questionnaire and were included in the analysis. The least answered item was item (74.09%) was item 4 (encouragement to group & classes for coping). The most frequently answered item (96.89%) was item 2 (satisfaction with care organization). Informants rated the item" Given a copy of their treatment plan" highest (mean 3.96), whereas "encouragement to get to a specific group or class to cope with the condition" (mean 1.74) was rated lowest. Cronbach's alpha was 0.84. A unidimensional structure of the questionnaire was found (Kaiser-Meyer-Olkin 0.86, Bartlett's test for sphericity p < 0.001), with items' factor loadings ranging from 0.46 to 0.82. CONCLUSIONS: The nine-item questionnaire can be used as efficient tool for assessing PCC during the LYOL retrospectively and by proxies. TRIAL REGISTRATION: The study was registered in the German Clinical Trials Register ( DRKS00011925 ) on 13 June 2017.

Using Sensor Data to Detect Lameness and Mastitis Treatment Events in Dairy Cows: A Comparison of Classification Models.

The aim of this study was to develop classification models for mastitis and lameness treatments in Holstein dairy cows as the target variables based on continuous data from herd management software with modern machine learning methods. Data was collected over a period of 40 months from a total of 167 different cows with daily individual sensor information containing milking parameters, pedometer activity, feed and water intake, and body weight (in the form of differently aggregated data) as well as the entered treatment data. To identify the most important predictors for mastitis and lameness treatments, respectively, Random Forest feature importance, Pearson's correlation and sequential forward feature selection were applied. With the selected predictors, various machine learning models such as Logistic Regression (LR), Support Vector Machine (SVM), K-nearest neighbors (KNN), Gaussian Naïve Bayes (GNB), Extra Trees Classifier (ET) and different ensemble methods such as Random Forest (RF) were trained. Their performance was compared using the receiver operator characteristic (ROC) area-under-curve (AUC), as well as sensitivity, block sensitivity and specificity. In addition, sampling methods were compared: Over- and undersampling as compensation for the expected unbalanced training data had a high impact on the ratio of sensitivity and specificity in the classification of the test data, but with regard to AUC, random oversampling and SMOTE (Synthetic Minority Over-sampling) even showed significantly lower values than with non-sampled data. The best model, ET, obtained a mean AUC of 0.79 for mastitis and 0.71 for lameness, respectively, based on testing data from practical conditions and is recommended by us for this type of data, but GNB, LR and RF were only marginally worse, and random oversampling and SMOTE even showed significantly lower values than without sampling. We recommend the use of these models as a benchmark for similar self-learning classification tasks. The classification models presented here retain their interpretability with the ability to present feature importances to the farmer in contrast to the "black box" models of Deep Learning methods.

A retrospective analysis of determinants of involuntary psychiatric in-patient treatment.

BACKGROUND: The purpose of our study was to identify predictors of a high risk of involuntary psychiatric in-patient treatment. METHODS: We carried out a detailed analysis of the 1773 mental health records of all the persons treated as in-patients under the PsychKG NRW (Mental Health Act for the state of North Rhine-Westphalia, Germany) in a metropolitan region of Germany (the City of Cologne) in 2011. 3991 mental health records of voluntary in-patients from the same hospitals served as a control group. We extracted medical, sociodemographic and socioeconomic data from these records. Apart from descriptive statistics, we used a prediction model employing chi-squared automatic interaction detection (CHAID). RESULTS: Among involuntary patients, organic mental disorders (ICD10: F0) and schizophrenia and other psychotic disorders (ICD10: F2) were overrepresented. Patients treated as in-patients against their will were on average older, they were more often retired and had a migratory background. The Exhaustive CHAID analysis confirmed the main diagnosis to be the strongest predictor of involuntary in-patient psychiatric treatment. Other predictors were the absence of outpatient treatment prior to admission, admission outside of regular service hours and migratory background. The highest risk of involuntary treatment was associated with patients with organic mental disorders (ICD 10: F0) who were married or widowed and patients with non-organic psychotic disorders (ICD10: F2) or mental retardation (ICD10: F7) in combination with a migratory background. Also, referrals from general hospitals were frequently encountered. CONCLUSIONS: We identified modifiable risk factors for involuntary psychiatric in-patient treatment. This implies that preventive measures may be feasible and should be implemented to reduce the rate of involuntary psychiatric in-patient treatment. This may include efforts to establish crisis resolution teams to improve out-patient treatment, train general hospital staff in deescalation techniques, and develop special programs for patients with a migratory background.

Measuring attitudes towards the dying process: A systematic review of tools.

BACKGROUND: At the end of life, anxious attitudes concerning the dying process are common in patients in Palliative Care. Measurement tools can identify vulnerabilities, resources and the need for subsequent treatment to relieve suffering and support well-being. AIM: To systematically review available tools measuring attitudes towards dying, their operationalization, the method of measurement and the methodological quality including generalizability to different contexts. DESIGN: Systematic review according to the PRISMA Statement. Methodological quality of tools assessed by standardized review criteria. DATA SOURCES: MEDLINE, PsycINFO, PsyndexTests and the Health and Psychosocial Instruments were searched from their inception to April 2017. RESULTS: A total of 94 identified studies reported the development and/or validation of 44 tools. Of these, 37 were questionnaires and 7 alternative measurement methods (e.g. projective measures). In 34 of 37 questionnaires, the emotional evaluation (e.g. anxiety) towards dying is measured. Dying is operationalized in general items ( n = 20), in several specific aspects of dying ( n = 34) and as dying of others ( n = 14). Methodological quality of tools was reported inconsistently. Nine tools reported good internal consistency. Of 37 tools, 4 were validated in a clinical sample (e.g. terminal cancer; Huntington disease), indicating questionable generalizability to clinical contexts for most tools. CONCLUSION: Many tools exist to measure attitudes towards the dying process using different endpoints. This overview can serve as decision framework on which tool to apply in which contexts. For clinical application, only few tools were available. Further validation of existing tools and potential alternative methods in various populations is needed.

[Wearables to support self-management of older adults with chronic diseases : A qualitative study from the perspectives of patients and physicians]. / Wearables zur Unterstützung des Selbstmanagements von älteren Menschen mit chronischen Erkrankungen : Eine qualitative Studie aus der Perspektive von Patienten und Ärzten.

BACKGROUND: The use of wearable devices (WD) is discussed as an option to support elderly chronically ill people. These technologies lack essential research regarding the improvement of self-management. This study aimes to identify perspectives, expectations and their underlying background of patients and physicians with respect to the usage of WDs to enhance self-management. METHODS: In this study a total of 14 patients and physicians were surveyed using a semi-structured questionnaire design. The data were analyzed by qualitative content analysis. RESULTS: The participants have in general a positive attitude towards the use of WDs with respect to memory function, self-control, sense of security, documentation of vital parameters and communication about the disease, as well as suitability for everyday use; however, in many cases participants are concerned about the usage of WDs for a variety of reasons. They perceive the device as unnecessary or they lack technological self-confidence and felt controlled as well as data protection concerns. Participant responses show prerequisites which should be met for the usage of a WD requiring an individual needs assessment. CONCLUSION: The results show a potential of WDs to improve self-management. The usage of WD could have a positive effect on the course of the disease; however, personality and environmental factors should be taken into account to individually adjust and support the usage of WDs. Furthermore, the application of WDs should be integrated into a structured training program accompanied by healthcare professionals. For this purpose, funding and time-oriented framework conditions should be established.

Quality of life of the very old : Survey on quality of life and subjective well-being of the very old in North Rhine-Westphalia (NRW80+).

BACKGROUND: In Germany, the very old are the most rapidly growing proportion of the population. A comprehensive investigation of the conditions for a good quality of life in this group is relevant for both society and politics. OBJECTIVE: The project "Quality of life and subjective well-being of the very old in North Rhine-Westphalia" (NRW80+) at the University of Cologne surveys quality of life of the very old. Taking into account many specific methodological and theoretical challenges, it aims at setting up a specific theoretical framework and methodological approach. METHODS: Existing studies on quality of life in old age in Germany and abroad as well as models on quality of life are reviewed with respect to their relevance for the very old and their specific living conditions, needs and interests. A theoretical framework of quality of life in very old age is developed. The NRW80+ study combines three levels: the empirical level of description of life situations and conditions, the explanative level of evaluating models of quality of life and the normative level of societal and ethical standards and norms. RESULTS: Considering results of recently conducted studies with the very old, an integrative conceptual model for studying quality of life of very old persons is introduced. In the model of challenges and potentials (CHAPO), environmental and individual factors as well as life chances and life results are thereby taken into consideration from a subjective as well as an objective point of view, supplemented by the concept of successful life conduct. CONCLUSION: Starting from the CHAPO model of quality of life, the representative study NRW80+ aims at challenging methodological standards for the inclusion of the very old in social research thus providing the basis for further research as well as for sustainable social politics especially for the very old.

The German Intelligibility in Context Scale (ICS-G): reliability and validity evidence.

BACKGROUND: In 2012 the Intelligibility in Context Scale (ICS) was published as a parent-report screening assessment that considers parents' perceptions of their children's functional intelligibility with a range of communication partners that differ in levels of authority and familiarity in real-life situations. To date, the ICS has been translated into 60 languages (including German). AIMS: To evaluate the psychometric properties of the German translation of the ICS ( = ICS-G), especially its reliability and validity, using four objective measures of speech sound disorder (SSD) severity: percentage of consonants correct (PCC); percentage of initial consonants correct (PICC); percentage of vowels correct (PVC); and percentage of phonemes correct (PPC). METHODS & PROCEDURES: Children who were typically developing (TD) and children with SSD (n = 181; 90 males, 81 females; mean age = 4.18 years, SD = 0.79 years, range = 3;0-5;11 years) were recruited through 13 kindergartens and 15 speech-language pathologists (SLPs) in Germany. All children's parents completed the ICS-G. To obtain an insight into the severity of SSD (n = 30), children's speech skills were assessed with PLAKSS-II. For the analysis of test-retest reliability the ICS-G was re-administered with a subsample of parents (n = 36) after 1 week. OUTCOMES & RESULTS: The ICS-G had high internal consistency (α = .95, p < .001) and high test-retest reliability (r = .998, p < .001). The ICS-G total scores and item scores for both samples showed significant correlations, indicating good construct validity. Analyses revealed low but significant correlations with external factors (e.g., age, social class). Criterion validity was established through significant correlations between the ICS-G and scores for PCC (r = .43), PICC (r = .43), PVC (r = .62) and PPC (r = .47). The discriminatory ability of the ICS-G was indicated by significantly higher mean scores for the TD group (mean = 4.49, SD = 0.47) than the SSD group (mean = 3.97, SD = 0.63). CONCLUSIONS & IMPLICATIONS: The overall good psychometric properties of the ICS-G support its use by SLPs for clinical and research purposes with German-speaking children.

Prediction of depressive symptoms at high age (80+) by psychological, biological and functional factors.

BACKGROUND: Late-life depression (LLD) is highly prevalent, especially in people aged 80 years and older. We aimed to investigate predictors and their influence on depressive symptoms in LLD. METHODS: We analysed data from the NRW80+ study, a population-based cross-sectional study of individuals aged 80 years and older. Data from n = 926 cognitively unimpaired participants were included. We reduced 95 variables to 21 predictors of depressive symptoms by using a two-step cluster analysis (TSCA), which were assigned to one of four factors (function, values and lifestyle, autonomy and contentment, biological-somatic) according to a principal component analysis. A second TSCA with complete data sets (n = 879) was used to define clusters of participants. Using weighted mean composite scores (CS) for each factor group, binary logistic regression analyses were performed to predict depressive symptoms for each cluster and the total population. RESULTS: The second TSCA yielded two clusters (cluster 1 (n = 688), cluster 2 (n = 191)). The proportion of participants with depressive symptoms was significantly higher in cluster 2 compared to cluster 1 (39 % vs. 15 %; OR = 3.6; 95 % CI 2.5-5.1; p < .001). Participants in cluster 2 were significantly older (mean age 88 vs. 85 years; p < .001), with a higher proportion of women (56 % vs. 46 %; OR = 1.5; 95 % CI 1.1-2.0; p = .016), had a higher BMI (p = .017), lower financial resources (OR = 2.3; 95 % CI 1.6-3.5; p < .001), lower educational level (OR = 1.8; 95 % CI 1.2-2.5; p = .002), higher proportion of single, separated or widowed participants (OR = 1.9; 95 % CI 1.3-2.6; p < .001) and a smaller mean social network (p = .044) compared to cluster 1. Binary logistic regression analyses showed that the weighted mean CS including the autonomy and contentment predictors explained the largest proportion of variance (22.8 %) for depressive symptoms in the total population (Nagelkerke's R2 = 0.228, p < .001) and in both clusters (cluster 1: Nagelkerke's R2 = 0.171, p < .001; cluster 2: Nagelkerke's R2 = 0.213, p < .001), respectively. LIMITATIONS: The main limitations are the restriction to cognitively unimpaired individuals and the use of a self-rated questionnaire to assess depressive symptoms. CONCLUSIONS: Psychological factors such as autonomy and contentment are critical for the occurrence of depressive symptoms at higher age, independent of the functional and somatic status and may serve as specific targets for psychotherapy.

Resilience profiles across context: A latent profile analysis in a German, Greek, and Swiss sample of adolescents.

The present study investigated resilience profiles (based on levels of symptoms of anxiety and depression and five dimensions of protective factors) of 1,160 students from Germany (n = 346, 46.0% females, Mage = 12.77, SDage = 0.78), Greece (n = 439, 54.5% females, Mage = 12.68, SDage = 0.69), and Switzerland (n = 375, 44.5% females, Mage = 12.29, SDage = 0.88) using latent profile analyses. We also checked for measurement invariance and investigated the influence of gender and migration on class membership. A three-profile-solution was found for Switzerland (nonresilient 22.1%, moderately resilient 42.9%, untroubled 34.9%), and a four-profile-solution was the best fitting model for Germany (nonresilient 15.7%, moderately resilient 44.2%, untroubled 27.3%, resilient 12.7%) and Greece (nonresilient 21.0%, moderately resilient 30.8%, untroubled 24.9%, resilient 23.3%). Measurement invariance did not hold across the three countries. Profile differences regarding class membership predictions were detected for Germany and Greece, but none for Switzerland. Results implicate that resilience profiles are highly contextually sensitive, and resilience research findings should not be generalized considering the particularity of contexts, people, and outcomes.

A Cross-National Validation of the Shortened Version of the Adolescent Stress Questionnaire (ASQ-S) Among Adolescents From Switzerland, Germany, and Greece.

The experience of stress is receiving increasing attention in the context of adolescent mental health, which is why a valid and reliable stress assessment instrument is of great importance. For this purpose, an English-language adolescent stress questionnaire (ASQ) was developed, which assesses the subjective stress experience of adolescents in different areas of life (e.g., at home, at school, and during leisure time). However, the latest long version of the questionnaire with 56 items (ASQ-2) was found to be too extensive, so a more economical short version ASQ-S with 27 items was developed. The aim of this study was to validate a German and a Greek version of the ASQ-S. In order to investigate the psychometric properties of the German and Greek ASQ-S confirmatory factor analysis, analyses of variance and correlations were applied to sample data from Switzerland, Germany, and Greece (N = 1,071 seventh-grade students; M age = 12.53; SD = 0.76). The results yielded only poor to moderate internal reliability across all three countries and the suggested 9-dimensional factor structure could not be confirmed. Instead, a modified 6-factor structure was tested which showed acceptable model fits while demonstrating form invariance across the three countries. Furthermore, the ASQ-S scales correlated positively with depressive symptoms and anxiety and negatively with self-esteem and life satisfaction, all of which supported adequate concurrent validity. The results revealed that the utility of the ASQ-S appears to be limited when translated to other languages and should be used with caution when administered in international contexts.