[General Self-Efficacy Scale (GSE) in Simple Language: Internal Consistency, Standard Values and Correlations with Demographic Variables in a Representative German Sample]. / Skala Selbstwirksamkeitserwartung in Leichter Sprache (SWE-LS): interne Konsistenz, Normwerte und Zusammenhänge mit demografischen Variablen in einer repräsentativen Stichprobe.

BACKGROUND: Approximately 6,2 million people with limited literacy live in Germany. They are unable to communicate in written language beyond single sentences and thus experience limited social participation in many everyday areas. In addition, they are also excluded from participation in survey-based social science research. METHOD: In order to enable persons with limited literacy to participate in written surveys, existing questionnaires need to be converted to easy language and their psychometric quality needs to be reexamined. We went through this process for the Self-Efficacy Expectancy (SWE) questionnaire and tested the new scale in easy language (SWE-LS) on a representative sample of the German population aged 14 years and older (N=2,531). RESULTS: The SWE-LS scale showed good internal consistency (Cronbach's-Alpha=0,84) and adequate item difficulty and discriminatory power. We found correlations consistent with expectations for the demographic variables surveyed. Thus, men and persons with higher education and higher income showed significantly higher self-efficacy expectations. The effect was also evident for East Germans versus West Germans, married persons living together versus separated, unmarried, or persons living as singles. DISCUSSION: Compared to the original SWE scale, the SWE-LS scale in easy language has no methodological disadvantages. The additional effort of linguistic adaptation and renewed psychometric testing is thus directly offset by enabling participation in survey-based research by over 12% of the adult population. A systematic translation of particularly frequently used questionnaires or those that do not concern fundamental research but research areas in which demographic variables themselves are part of the research object would be desirable.

[Relationship Between Social Integration, Global Self-Esteem, and Physical and Mental Health in a Representative German Sample]. / Zusammenhang von sozialer Teilhabe, globalem Selbstwert sowie physischer und psychischer Gesundheit in einer repräsentativen deutschen Stichprobe.

INTRODUCTION: Beyond participation as a civil right, social participation has already been considered from legal, ethical, socio-psychological and political perspectives as an important component of the self- and external evaluation of a person as a valuable member of a society. Thus, social psychological studies frequently showed the importance of the sense of belonging as a central psychological component of social participation for both personal and social self-esteem. From a medical-psychological perspective, the association of global self-esteem and self-efficacy with health is well established. However, it is an open question whether social participation is directly related to psychological and physical well-being or whether this relationship is mediated via global self-esteem. MATERIAL AND METHODS: Based on a nationwide representative survey in Germany (N=2.531; age 14-93, M=48.58; 55.4% women), the variables social participation (KsT-5), global self-esteem (SISE), and physical and mental health (EQ5D) were measured using standardized questionnaires to examine a potential mediation. RESULTS: As expected, significant positive correlations between social participation, global self-esteem and physical and mental health were found with medium ranged effect sizes. However, global self-esteem only partially mediated the association between social participation and health, i. e. a direct significant association between social participation and health could be proven. DISCUSSION: The results underline the direct relevance of social participation for physical and mental health. This opens a hitherto hardly used perspective for health promotion in interaction with socio-political challenges in the topics of integration, inclusion and the sense of belonging.

Autogenic Training for Reducing Chronic Pain: a Systematic Review and Meta-analysis of Randomized Controlled Trials.

BACKGROUND: Autogenic training (AT) is frequently used as therapeutic approach in multimodal pain therapy. The aim of this systematic review and meta-analysis is to investigate the efficacy of AT in individuals suffering from chronic pain in comparison to passive and active control groups. METHODS: A comprehensive literature search in Medline, Web of Science, PsycInfo, and PubPsych and manual searches (last search April 7, 2021) were conducted to locate randomized controlled trials (RCTs). Treatment guidelines and references of relevant articles and previous reviews were checked. ProQuest Dissertations and Theses Full Text database, DART-Europe E-theses Portal, Networked Digital Library of Theses and Dissertations (NDLTD), and the Theses Database of the German National Library were screened to identify any unpublished material. RESULTS: A total of 13 eligible studies (k = 15 comparisons) including 576 participants were identified. Random-effects meta-analyses revealed a significantly positive, moderate effect of AT on the primary outcome pain compared to passive control groups (g = 0.58, 95% CI [0.36; 0.79], k = 9, I2 = 0%). In comparison with other psychological interventions, no difference was found (g = - 0.05, 95% CI [- 0.30; 0.20], k = 6, I2 = 0%). Sensitivity analyses proved the robustness of findings. Overall risk-of-bias judgment was 'some concerns' in the majority of studies. CONCLUSIONS: Beneficial effects of AT on pain reduction were demonstrated, but findings are prone to bias. Furthermore, high methodological quality RCTs are needed to strengthen the promising evidence of AT for individuals with chronic pain.

[Short Scale Measuring Perceived Social Participation: Factorial Structure, Internal Consistency, Content Validity, Convergent Validity and Standard Values in a Representative German Sample]. / Kurz-Skala zur Erfassung wahrgenommener sozialer Teilhabe (KsT-5): faktorielle Struktur, interne Konsistenz, inhaltliche und konvergente Validität sowie Normwerte in einer repräsentativen Stichprobe.

Social participation is politically as well as socially and psychologically relevant for the coexistence of people in our society and the well-being of the individual. In light of the German Federal Participation Act and the partial equalization of the terms "(Social) Participation" and "Inclusion", social participation in recent years has frequently been restricted to people with disabilities with regard to the "International Classification of Functioning, Disability and Health (ICF)" of the World Health Organization and the UN Convention on the Rights of Persons with Disabilities. The question of participation, however, affects all people and is not only dependent on the degree of functional capacity or disability, but also on social inclusion, financial possibilities, regional affiliation, education, self-esteem and is correlated with health. In the present study, a new short scale of 5 items (KsT-5) for measuring the aspects "belonging", "self-efficacy", "need for recognition", "self-esteem" and "integration in the social environment" was tested on a German representative general population sample (N=2531) with regard to their psychometric quality criteria. It showed a good fit with a one-factor solution, a satisfactory internal consistency of Cronbach's α=0,73 and McDonald's ω=0,73 as well as good convergent validity over positive correlations with self-esteem and psychological as well as physical health. This study provides norm values of the new KsT-5 stratified according to gender and age as a prerequisite for use in future studies.

Self-Esteem as a Potential Mediator of the Association Between Social Integration, Mental Well-Being, and Physical Well-Being.

Previous research points to a significant impact of social integration and self-esteem on well-being. The present study examined whether self-esteem constitutes one pathway from social integration in the classroom to mental and physical well-being of students and accordingly serves as a mediator. Therefore, 163 students (mean age: 12.98 years, age range: 9-17 years, 57.9% male) of three German secondary schools were examined regarding their experience of social integration, self-esteem, and mental as well as physical well-being. Results revealed that self-esteem mediated the effect of social integration on mental and physical well-being. This finding elucidates one pathway from social integration to well-being and points to the importance of improving both self-esteem and social integration for the promotion of well-being among adolescents.

[Inclusive Research: Validation of the General Self-Efficacy Scale in Simple Language in a Sample of Students with Special Educational Needs]. / Inklusive Forschung: Validierung der Skala zur Allgemeinen Selbstwirksamkeitserwartung (SWE) in Leichter Sprache an einer Stichprobe von Schülerinnen und Schülern mit sonderpädagogischem Förderbedarf.

BACKGROUND: Approximately 7% of pupils in Germany have special educational needs. This is accompanied by a general reduction in social participation, partly due to a reduction in language comprehension. The endeavour for social inclusion therefore includes the provision of text information in simple language. Since written surveys play an important role in social science and clinical research, this also applies to psychometric questionnaires. OBJECTIVE: Comparison of psychometric quality of the original scale measuring self-efficacy (German version: SWE, English version: GSE) and a version of the same scale translated into simple language (SWE-LS). METHODS: Both versions of the SWE were completed by N=94 pupils aged between 12 and 19 years with special educational needs from 7 special schools in Thuringia. Internal consistency and convergent validity of both scales were measured. RESULTS: Both scale versions achieved satisfactory internal consistency (SWE:=0.74, SWE-LS:=0.78). However, the mean scale values differ significantly. The convergent validity was r=0.69, whereby 3 items did not correlate significantly (-0.010.21). The proportion of missing values is significantly higher for the original SWE with 16% listwise and 6.7% pairwise than for the SWE-LS with 3.2 and 0.5%, respectively. DISCUSSION: Overall, the SWE-LS translated into simple language has a better psychometric quality than the original scale. The lower proportion of missing values also speaks for the use of the SWE-LS. CONCLUSION: The translation of standardised questionnaires into simple language offers the possibility of also including groups of participants who have so far been excluded or who have only been surveyed indirectly (e. g. through caregivers). The cost of translation is comparable to that of translation into other languages. In the case of simple language, however, a back translation and thus a verification of the validity of the content are not possible.

I Can Stand Learning: A Controlled Pilot Intervention Study on the Effects of Increased Standing Time on Cognitive Function in Primary School Children.

Sedentarism is considered an independent cardiovascular risk factor. Thus, the present study investigated the effects of employing standing desks in classrooms on cognitive function. The intervention class (IG; n = 19) was supplied with standing desks and balance pads for 11 weeks. The control class (CG; n = 19) received lessons as usual. Standing time was assessed objectively (accelerometers) and subjectively (self-report sheets, external classroom observers). The impact of standing on the digit span task and Eriksen flanker task was analysed. The standing time of the IG was higher during the school day in comparison to the CG (lesson: p = 0.004; break: p = 0.003). The intra-class correlation coefficient between self-reports and external observation was high (ICC = 0.94). The IG improved slightly on the Digit Span Task compared to CG. Employing standing desks for at least 1 h per school day serves as a feasible and effective opportunity to improve cognitive function.

[Implementation of Evidence-Based Prevention Programs for Eating Disorders: PriMa and Torera in Daily School Life]. / Implementation evidenzbasierter Präventionsprogramme für Essstörungen: PriMa und Torera im Schulalltag.

BACKGROUND: Prevalence rates for eating disorders remained stable over the years despite the implementation of numerous prevention strategies. This may be due to discrepancies between research and practice and scientific findings are not fully applied to the care of risk groups. The school-based programs PriMa and Torera for primary prevention of eating disorders have been delivered in Thuringian schools since 2004. A current survey provides information on barriers and facilitators for a long-term implementation in the school routine. OBJECTIVES AND METHODS: Using the "Consolidated Framework for Implementation Research", factors which impact the implementation process are discussed. RESULTS: Impeding factors for a long-term implementation are missing framework conditions, staff turnover and a lack of financial support from politicians. Possible solutions could be the establishment of extra time in the curriculum, the employment of individuals responsible for prevention and a close network between all people involved. CONCLUSION: According to the Society for Prevention Research, discussing implementation factors builds the last part of comprehensive program evaluations. We illustrate the barriers for the integration of evidence-based prevention programs in daily school life. It is important to implement new structures prior to the implementation of resource-intensive new prevention programs in order to increase the effectiveness of said programs and enable long-term implementation.

Long-term effectiveness of a school-based primary prevention program for anorexia nervosa: A 7-to 8-year follow-up.

PURPOSE: This is the first study to evaluate the long-term effectiveness of a school-based prevention program in Germany. The aim is to determine the long-term effects of the primary prevention program PriMa (Primary prevention of anorexia nervosa in preadolescent girls) on disordered eating and body self-esteem from childhood to young adulthood. METHODS: PriMa was conducted and successfully evaluated in a quasi-experimental pre-post design with a control group from 2007 to 2008 consisting of 11-13year old girls (N=1508) from Thuringian schools in Germany. Seven to eight years after the intervention, the same cohort (mean age 19.8years) was invited to complete an online survey. Disordered eating (EAT-26), body self-esteem (FBeK) and BMI were assessed via self-report. The response rate at seven-to-eight-year follow-up was very low (7%). Data of N=100 girls were analyzed. RESULTS: Concerning changes in disordered eating, results revealed no significant long-term effect of PriMa seven to eight years after the intervention. During this time, disordered eating remained stable without a significant increase or decrease. Regarding changes in body self-esteem, group courses differed significantly from each other. The results revealed a significant main effect of group, indicating significant differences in changes of body self-esteem between the intervention and the control group. Following the analysis of these changes of body self-esteem over time, it was found that the intervention group revealed an increase of body self-esteem after program participation and remained stable over time. By contrast, the control group revealed a decrease of body self-esteem over time. CONCLUSIONS: Long-term intervention effects of PriMa could be found for body self-esteem but not for disordered eating. The findings suggest that PriMa prevented a decrease of body self-esteem from childhood to young adulthood. For a broader dissemination it is necessary to implement prevention programs consistently in school settings. In order to maintain the prevention effects, it would be interesting to investigate the effects of booster sessions which refresh the programs content on a regular basis. Furthermore, the results of this study revealed the implementation difficulties of primary prevention programs especially concerning the retention of the sample size.

[Influence of Attachment Style on the Outcome of Bariatric Surgery - A Pilot Study]. / Die Bedeutung des Bindungsstils für den Erfolg bariatrischer Operationen ­ Eine Pilotstudie.

Background: Bariatric surgery can lower body weight and comorbidities. Different factors might influence the outcome of this treatment. This pilot study examines whether patients' attachment style can influence surgical outcome. Methods: The sample consisted of 32 patients (f=24; m=8; BMI preoperative=47,8 kg/m2±5,2; age=53±9,84) who underwent a laparoscopic sleeve gastrectomy. The following variables were assessed pre- and postoperatively via questionnaires: quality of life (BAROS), self esteem (SES), depression, anxiety, psychological distress (SCL-90R), feelings of hunger, cognitive control, irritated eating behaviour (FEV) and weight related variables (BMI, EWL%, EBL%, TBL). Attachment style was determined postoperatively using the BPQE. Results: None of the participating patients suffered from a binge eating disorder. There was no significant difference of the BMI at any time between the 12 securely attached (SA) patients and the 19 insecurely attachted (IA) patients. Compared to the SA patients IA patients preoperatively showed lower outcomes in variables concerning eating behaviour and mental health. Comparing the 2 groups postoperatively the IA patients achieved lower levels in variables concerning mental health than SA patients and did not reach the preoperative values of the SA patients. Both groups benefited from surgery related to weight loss, mental health and eating behaviour. There was no difference found in the development from pre- to postoperative between SA and IA patients. Discussion & Conclusion: Patients profit by a bariatric intervention independent of their attachment style. By evaluating the attachment style, it could be possible to individually optimize pre- and postoperative patients support in order to gain more effective surgery results. Follow up studies extended to multi-site assessment are required.

Recommendations to enhance constructivist-based learning in Interprofessional Education using video-based self-assessment.

INTRODUCTION: Interprofessional collaboration is crucial to the optimization of patient care. AIM: This paper aims to provide recommendations for implementing an innovative constructivist educational concept with the core element of video-based self-assessment. METHODOLOGY: A course for students in medicine, physiotherapy, and nursing was developed through interprofessional, cross-institutional collaboration. The course consisted of drawing on prior knowledge about the work done by each professional group in regard to a specific clinical scenario and an interprofessional treatment situation, filming a role play of this treatment situation, and a structured self-assessment of the role play. We evaluated the preparation and implementation of the three courses conducted thus far. Concrete recommendations for implementation were made based on evaluation sheets (students), open discussions (tutors, instructors, institutions) and recorded meeting minutes (project managers, project participants). RESULTS: Basic recommendations for implementation include: selecting appropriate criteria for self-assessment and a simulated situation that offers members of each professional group an equal opportunity to act in the role play. In terms of administrative implementation we recommend early coordination among the professions and educational institutions regarding the target groups, scheduling and attendance policy to ensure participant recruitment across all professions. Procedural planning should include developing teaching materials, such as the case vignette and treatment scenario, and providing technical equipment that can be operated intuitively in order to ensure efficient recording. CONCLUSION: These recommendations serve as an aid for implementing an innovative constructivist educational concept with video-based self-assessment at its core.

Deviation between self-reported and measured occupational physical activity levels in office employees: effects of age and body composition.

OBJECTIVES: Whether occupational physical activity (PA) will be assessed via questionnaires or accelerometry depends on available resources. Although self-reported data collection seems feasible and inexpensive, obtained information could be biased by demographic determinants. Thus, we aimed at comparing self-reported and objectively measured occupational sitting, standing, and walking times adjusted for socio-demographic variables. METHODS: Thirty-eight office employees (eight males, 30 females, age 40.8 ± 11.4 years, BMI 23.9 ± 4.2 kg/m(2)) supplied with height-adjustable working desks were asked to report sitting, standing, and walking times using the Occupational Sitting and Physical Activity Questionnaire during one working week. The ActiGraph wGT3X-BT was used to objectively measure occupational PA during the same week. Subjectively and objectively measured data were compared computing the intra-class correlation coefficients, paired t tests and Bland-Altman plots. Furthermore, repeated-measurement ANOVAs for measurement (subjective vs. objective) and socio-demographic variables were calculated. RESULTS: Self-reported data yielded a significant underestimation of standing time (13.3 vs. 17.9%) and an overestimation of walking time (12.7 vs. 5.0%). Significant interaction effects of age and measurement of standing time (F = 6.0, p = .02, ηp(2) = .14) and BMI group and measurement of walking time were found (F = 3.7, p = .04, ηp(2) = .17). Older employees (>39 years) underestimated their standing time, while underweight workers (BMI < 20 kg/m(2)) overestimated their walking time. CONCLUSIONS: Self-reported PA data differ from objective data. Demographic variables (age, BMI) affect the amount of self-reported misjudging of PA. In order to improve the validity of self-reported data, a correction formula for the economic assessment of PA by subjective measures is needed, considering age and BMI.

[Relationship between Stress and Resources in Patients Waiting for Organ Transplantation: Comparison of Patients with Renal and Liver Insufficiency]. / Zusammenhang zwischen Belastungsfaktoren und Ressourcen bei Patienten auf der Warteliste für ein Spenderorgan: Nieren- und leberinsuffiziente Patienten im Vergleich.

INTRODUCTION: Patients on the waiting list for organ transplantation are exposed to different stress factors and use individual resources for coping. The present study examines these factors in the context of health-related quality of life in different patient groups (patients with renal vs. liver insufficiency) and attachment pattern. MATERIAL & METHODS: The following variables were measured by questionnaire in a clinical sample of 103 patients waiting for a liver or kidney transplant in Thuringia: Physical complaints (GBB), Depression and Anxiety (HADS-D), Coping (EFK), Self-efficacy expectations (SWE), Resilience (RS-13), Social support (F-SozU-K-14), Health-related quality of life (SF-8) and Attachment style (BFPE). RESULTS: Patients with liver insufficiency have a higher level of anxiety and show more often an insecure attachment style as renal failure patients. Differences between secure and insecure attached patients waiting for a kidney transplant are found in physical complaints, depression, depressive coping and self-efficacy, resilience, social support, active coping and mental health, in favor of secure attachment. Insecure attachment in patients with liver insufficiency leads to a less frequent usage of active coping strategies. Furthermore, the variables anxiety, depression, resilience, social support and dysfunctional coping mediate the relationship between attachment and mental health completely. DISCUSSION: RESULTS suggest that psychological interventions should specifically consider the variables anxiety, depression, resilience, self-efficacy, social support, coping and attachment. CONCLUSION: The gained insights of this study make it possible to derive implications for interventions to reduce risk factors for the development of co-morbid mental disorders and to strengthen protective factors and thus improve the well-being and quality of life of patients.

Groundwater nitrate contamination: factors and indicators.

Identifying significant determinants of groundwater nitrate contamination is critical in order to define sensible agri-environmental indicators that support the design, enforcement, and monitoring of regulatory policies. We use data from approximately 1200 Austrian municipalities to provide a detailed statistical analysis of (1) the factors influencing groundwater nitrate contamination and (2) the predictive capacity of the Gross Nitrogen Balance, one of the most commonly used agri-environmental indicators. We find that the percentage of cropland in a given region correlates positively with nitrate concentration in groundwater. Additionally, environmental characteristics such as temperature and precipitation are important co-factors. Higher average temperatures result in lower nitrate contamination of groundwater, possibly due to increased evapotranspiration. Higher average precipitation dilutes nitrates in the soil, further reducing groundwater nitrate concentration. Finally, we assess whether the Gross Nitrogen Balance is a valid predictor of groundwater nitrate contamination. Our regression analysis reveals that the Gross Nitrogen Balance is a statistically significant predictor for nitrate contamination. We also show that its predictive power can be improved if we account for average regional precipitation. The Gross Nitrogen Balance predicts nitrate contamination in groundwater more precisely in regions with higher average precipitation.

[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.