[Psychometric quality of the "Eating Attitudes Test" (German version EAT-26D) for measuring disordered eating in pre-adolescents and proposal for a 13-item short version]. / Eignung des "Eating Attitudes Test" EAT-26D zur Erfassung riskanten Essverhaltens bei 11- bis 13-Jährigen und Vorschlag für eine Kurzversion mit 13 Items.

To detect risky eating behavior questionnaires should be economic but at the same time they should fulfill the psychometric quality criteria. Available instruments are too long for the target group (e. g. EDE-Q, 28 items), restricted on primary symptoms (short version of EDI, 23 items) and with minor reliability (e. g. SCOFF and WC-Scale, 5 items each). Using the German version of the Eating Attitudes Test (EAT-26D, which comprises 26 items) in a community sample of 1 331 11-13 year old girls and 906 boys from Thuringia, Germany, we measured a internal consistency of Cronbachs' Alpha=0.85 for girls and 0.78 for boys. In a principal factor analysis, we could replicate the 6-factorial structure of previous studies. A confirmatory factor analysis verified the suitability of the EAT-26D for both, girls and boys. Reducing the EAT-26D on the 3 core-factors leads to an economic 13 item short version with an internal consistency of 0.87 for girls and 0.80 for boys.

[Screening of disordered eating in 12-Year-old girls and boys: psychometric analysis of the German versions of SCOFF and EAT-26]. / Screening riskanten Essverhaltens bei 12-jährigen Mädchen und Jungen: psychometrischer Vergleich der deutschsprachigen Versionen von SCOFF und EAT-26.

To detect eating disorders and risky eating behaviour at an early stage, screening tests should be economic, i. e. as short as possible but at the same time they should fulfil the psychometric quality criteria. We compared the German version of the Eating Attitudes Test (EAT-26D, which comprises 26 items) and the German version of the SCOFF test (which contains only 5 Yes-no questions) in a community sample of 425 12-year-old girls and 382 boys from Thuringia, Germany. Although the EAT-26D reached higher psychometric properties, the SCOFF has been proved as a useful screening tool with a test-retest reliability of r (tt)=0.73 and a maximum accuracy of 82% (area under the ROC curve). With the EAT-26D (20 point cut-off) as a reference the sensitivity of the SCOFF was 79%, specificity 74%, positive predictive value 25%, and the negative predictive value, which is more relevant for screenings, was 97%. The criterion validity reached r=0.53.

Real-world effectiveness of a German school-based intervention for primary prevention of anorexia nervosa in preadolescent girls.

OBJECTIVE: Anorexia nervosa ('AN') is notoriously difficult to treat, has high mortality rates, and has a prevalence peak in 15-year-old girls. We developed a German school-based intervention program ('PriMa') for the primary prevention of AN in preadolescent girls and assessed the effects in a sample of Thuringian girls. METHOD: Intervention involved nine guided lessons with special posters and group discussions. A parallel controlled trial with pre-post measurements and a three-month follow-up was conducted in 92 Thuringian schools (n=1553 girls) in 2007 and 2008. Primary outcomes were conspicuous eating behavior, body self esteem, and AN-related knowledge. RESULTS: After adjusting for the girls' ages and the type of school, we observed significant improvements in the areas of knowledge (d=.24) and body self esteem (d=.29), but not for eating behavior. CONCLUSION: The PriMa intervention provides an efficient and practical model to increase AN-related protection factors.

The impact of optimism on anxiety, depression and quality of life in urogenital cancer patients.

OBJECTIVE: The purpose of the present study was to examine the relationship between optimism and anxiety, depression and health-related quality of life (HRQOL). A further aim was to investigate the predictive value of optimism for anxiety, depression and HRQOL, quantified with and without controlling the corresponding base level. METHODS: A total of 427 urogenital cancer patients were asked to complete the Life Orientation Test (LOT), the Hospital Anxiety and Depression Scale (HADS) and the health survey SF-8 during their stay in the hospital (T1), two weeks later (T2) and three months later. RESULTS: Finally, 275 patients (64.4%) completed all questionnaires. Optimism at T1 was significantly associated with anxiety (r=-0.35), depression (r=-0.41) and HRQOL (physical: r=0.29; mental: r=0.27) and can predict outcome variables three months later. After controlling for the base levels of anxiety, depression and HRQOL, the predictive value of optimism remained significant but small. The incrementally variance explained by the LOT varied between 2.1% in anxiety and 8.2% in physical HRQOL. CONCLUSION: Especially patients with a low level of optimism and a high level of pessimism are at risk for higher levels of anxiety and depression in addition to lowered HRQOL.

[Fatigue and its determinants in radio-oncology]. / Fatigue und deren Determinanten in der Radioonkologie.

BACKGROUND: Fatigue is a common symptom among cancer patients, influencing their quality of life. The primary goal of his study was to identify parameters influencing fatigue, both prior to radiotherapy (RT) and changes in fatigue during RT. METHODS: 239 patients could be assessed prior to RT, 208 patients were reassessed at the end of RT. Measures comprised the Multidimensional Fatigue Inventory (MFI-20), the Resilience Scale (RS) and the SF-12 as a measure of health related Quality of Life (QoL). RESULTS: The sample revealed higher scores in the MFI and in the RS as well as lower scores in the SF-12 than normative samples. Fatigue increased significantly during RT. Fatigue at the beginning of RT was best predicted by the patients' resilience scores, changes of fatigue scores during RT depended on the patients' initial fatigue scores, the decrease in haemoglobin and the patients' experience with RT. CONCLUSIONS: Fatigue appears to be an important problem among cancer patients receiving RT. Resilience proved to powerfully predict the patients' fatigue at the beginning of RT. This result confirms other studies showing resilience to be an important psychological predictor of QoL and coping in cancer patients. The change of fatigue during RT is mainly related to disease- and treatment-related factors.

The need for psychosocial support and its determinants in a sample of patients undergoing radiooncological treatment of cancer.

OBJECTIVE: The primary goal of this study was to examine the need for psychosocial support in a consecutive sample of cancer patients undergoing radiotherapy (RT). Out of an initial sample of 250 patients, 239 patients could be assessed at the beginning of their RT. Two hundred eight patients were reassessed at the end of RT 4-8 weeks later. METHODS: Measures comprised the Hornheide Screening Instrument, the Multidimensional Fatigue Inventory, the Resilience Scale, and the Short Form 12 as a measure of health-related quality of life (QoL). Medical and radiological data were continuously registered. RESULTS: Within the sample, the need for psychosocial support as reflected in the screening instrument was high (>70%). Patients with the need for psychosocial support revealed significantly higher fatigue scores than patients who where not identified as needing psychosocial support. Furthermore, a negative correlation of the need for psychosocial support and QoL as well as resilience could be observed. QoL turned out to be the strongest predictor for the need of psychosocial support. CONCLUSION: The study confirmed that the need for psychosocial support is an important aspect in the treatment of cancer patients undergoing RT, which appeared to be powerfully predicted by the patients' health-related QoL. Fatigue turned out to be an important illness- and treatment-related factor that affects QoL. Psychological interventions for cancer patients should explicitly focus on decreasing patients' fatigue and increasing their resilience, thus improving their QoL.

Primary prevention of eating disorders: characteristics of effective programmes and how to bring them to broader dissemination.

OBJECTIVE: Based upon the observation of advances in the primary prevention of eating disorders (ED), it is summarized that school-based programmes, focusing on risk factors for females with interactive elements, dissonance induction and booster sessions yield significant effects even under strong methodological conditions. However, beyond the presented research findings it remains often unclear, if and how programmes can be brought to a broader dissemination within a community, region or country. METHOD: Introducing the programme PriMa (German school-based programme for the primary prevention of anorexia nervosa (AN) for girls up to the age of 12), we describe the process of programme evaluation (including 1.006 girls from 42 schools in Thuringia, Germany, who participated in a controlled study using a pre-post-design and a 3 months follow-up), programme implementation and development of follow-up programmes, including an intervention for boys and flanking secondary preventive actions (such as a telephone hotline). RESULTS: Using standardized measures, the girls in the intervention group of PriMa reported significant improvements in body self esteem, figure dissatisfaction, knowledge and eating attitudes. The teachers, who conducted the programme, felt well qualified and were evaluated significantly positive by their students. Based upon the PriMa evaluation, we established a comprehensive health promotion programme at 60 Thuringian schools within the last 3 years, which could function as a model of a fruitful cooperation between a governmental institution (Thuringian Ministry of Culture) and a research institution (University Hospital Jena). CONCLUSIONS: Existing programmes have the potential for effective prevention of ED. To confirm these effects under 'real world conditions' within a given community will still be a great challenge that often requires methodological and organizational concessions and compromises.

The influence of resilience on fatigue in cancer patients undergoing radiation therapy (RT).

PURPOSE: The primary goal of the study was to determine if resilience influences fatigue in a consecutive sample of cancer patients treated with radiotherapy (RT) at the beginning and at the end of the treatment. METHODS: Out of an initial sample of 250 patients, 239 could be assessed at the beginning of their RT. Two hundred and eight patients were reassessed at the end of RT 4-8 weeks later. Measures comprised the Resilience Scale (RS), the Multidimensional Fatigue Inventory (MFI), and the SF-12 as a measure of health related Quality of Life (QoL). Medical data were continuously registered. RESULTS: As hypothesized, the sample revealed higher scores in the MFI and lower scores in the SF-12 than normative samples. Resilience scores were higher than in the norm population. Fatigue increased during RT. Using multiple regression analyses, fatigue scores at the beginning of treatment were shown to be higher in inpatients and patients undergoing palliative treatment. Initial fatigue was best predicted by the patients' initial resilience scores. Changes of fatigue scores during RT depended on initial scores, decrease in Hb and the patients' experience with RT. Resilience could not be determined as a predictor of changes in fatigue during RT. CONCLUSIONS: The study confirmed that fatigue is an important problem among RT patients. Resilience turned out to powerfully predict the patients' fatigue at least early in RT. This result is in line with other studies, showing resilience to be an important psychological predictor of QoL and coping in cancer patients. On the other hand, resilience seems to have little influence on treatment related fatigue during RT.

Co-morbidity and functional deficits independently contribute to quality of life before chemotherapy in elderly cancer patients.

UNLABELLED: GOAL OF THE WORK: The quality of life (QoL) of patients with cancer is a major area of concern for both patients and their physicians. The independent contribution of functional impairment and co-morbidity to QoL is unclear. MATERIALS AND METHODS: We investigated initial global QoL in 477 patients: 195 cancer patients aged 60 years or older (group A), 152 cancer patients below the age of 60 years (group B), admitted as inpatients for chemotherapy initiation and 130 patients aged 60 years or older admitted for non-cancer-related disorders (group C). Global QoL was assessed by the EORTC-QLQ-C30 subscale, functional status by the Karnofsky Performance Scale (KPS) and the Instrumental Activities of Daily Living (IADL) scale, and co-morbidity by the Cumulative Illness Rating Scale (CIRS). RESULTS: In multivariate analyses, global QoL is significantly associated with KPS, IADL and co-morbidity in group A (r (2) = 0.27), with KPS and IADL in group B (r (2) = 0.23), and with age, KPS and IADL in group C (r (2) = 0.38). CONCLUSIONS: IADL contributes to global QoL in addition to the known effect of KPS. In addition, co-morbidity independently influences global QoL in elderly cancer patients.

[The Resilience Scale (RS): a statistical comparison of the short and long version based on a patient population]. / Die Resilienzskala (RS): Ein statistischer Vergleich der Kurz- und Langform anhand einer onkologischen Patientenstichprobe.

The use of short and reliable questionnaires in psychological and medical studies is increasingly demanded due to economic, but also ethical reasons. The expectation of low dropout rates within longitudinal studies is an important issue with respect to the validity and quality of clinical studies. In this article, differences of the Resilience Scale (RS) in a short (11 items) and a long version (25 items) are described related to 212 patients treated in a radiooncological unit before receiving radiotherapy. It can be demonstrated that the long and the short version of the Resilience Scale did not appear to differ clinically relevant (differences of means = - 0.080, median = - 0.042, effect size = 0.11). Effect sizes and correlations of the resilience of the patients and other illness- and treatment-related variables such as the need for psychosocial support and fatigue did not change depending on the use of the short or long version of the questionnaire. Therefore, it can be concluded that the short version of the Resilience Scale turns out to be a useful and valid instrument that can be recommended for its use in psychological and medical research.