Assessment of first language adds important information to the diagnosis of language disorders in multilingual children.

OBJECTIVE: 59% of Viennese day care children have a first language other than German. Lower proficiency in the second language German might be typical in multilingual settings, but might also be due to language disorder (ICD-10:F80 or comorbid). Diagnostic practise in Austria focuses on second language evaluation. This study describes a group of multilingual children with suspected language impairment at a specialized counselling hour and reflects the role of the first language in language evaluation. METHOD: Linguistic evaluation (typically developed, ICD-10:F80, comorbid language disorder) and sociodemographic parameters of 270 children (time period: 2013-2020) are investigated. Linguistic results are reported according to primary diseases. For children without primary disease the relation between the linguistic evaluation and sociodemographic parameters is assessed. RESULTS: Overall, the children had 37 different first languages (74% were bilingual, 26% multilingual). The percentage of children with typical development and comorbid language development varied according to primary disease. Children without primary disease had higher chances of typical development the older they were at the examination, the earlier they produced first words, and if there was no heredity for ICD-10:F80. CONCLUSIONS: Results suggest that evaluating the children's first language is useful since it contributes to understanding the individual language development at different linguistic levels, despite the heterogeneity of the children, and, thus, allows practitioners to recommend the best possible support.

Bilingual children acquiring Russian and German in Vienna: nonword repetition correlates with stronger but not with weaker language.

PURPOSE: Nonword repetition tests (NWRT) can be useful tools together with other assessment procedures for diagnosing a developmental learning disorder in bilingual children. Concerning typically developing children, however, the link between NWRT performance and language development is still unclear. The present study contributes to this discussion by investigating the link between language-dependent NWRT performance, language development, and language exposure. METHODS: A total of 20 simultaneously bilingual Russian-German children, aged 4-6 years, were tested with "The Russian language proficiency test for multilingual children (SRUK)" and "Patholinguistische Diagnostik bei Sprachentwicklungsstörungen (PDSS)" as well as language-specific nonwords for Russian and German. RESULTS: Most children scored within the mean range in SRUK. In PDSS they scored two standard deviations below the mean range in most of the subtests. NWRT in Russian significantly correlated with the NWRT in German and also positively correlated with both comprehension and production in Russian. In contrast, the German NWRT did not correlate with comprehension or with production in German. Moreover, the correlation between the German NWRT and the comprehension of grammatical structures in Russian was significant, and the correlations between the German NWRT and the two other Russian language development tests just failed to reach significance. CONCLUSION: High scores in both the Russian and the German NWRT offer evidence that the ability to repeat language-specific nonwords does not differ depending on language exposure. The aim to distinguish between typical and atypical language development based on NWRT can be reached only when NWRT and all possible influencing factors in typically developed children are analyzed.

Imagery Rescripting and Imaginal Exposure in Nightmare Disorder Compared to Positive Imagery: A Randomized Controlled Trial.

INTRODUCTION: Both imagery rescripting and imaginal exposure have been proven to be effective in the treatment of chronic nightmares when compared to a waitlist condition. Little is known about their comparative efficacy and their efficacy compared to an active control. OBJECTIVE: The aims of this study were to compare the two treatments to one another and to positive imagery as an active control, and to explore covariates of the treatment effect. METHODS: In this single-blinded randomized controlled trial, 96 patients with nightmare disorder (idiopathic nightmares) from an outpatient clinic were randomly assigned to a single individual treatment session of rescripting, exposure, or positive imagery and 4 weeks of practice at home. The primary outcome was nightmare distress, and the secondary outcomes were nightmare frequency, nightmare effects, self-efficacy, and general psychopathology. RESULTS: Nightmare distress was reduced in all groups (imagery rescripting: Cohen's d = -1.04, imaginal exposure: d = -0.68, positive imagery: d = -0.57), as were nightmare frequency, nightmare effects, and psychopathology. Self-efficacy was enhanced. No differential treatment effects were found on any primary or secondary measure. Treatment gains were not associated with demographic or disorder characteristics, baseline values, treatment credibility, or the number of practice sessions. CONCLUSIONS: Even short nightmare treatments are effective regardless of personal characteristics, and different interventions produce similar results. Future research should aim to clarify the mechanisms of action. Health care should make more use of these powerful and easy-to-administer nightmare treatments.

Important aspects in the assessment of bilingual children with suspected language impairment: The Vienna Model.

BACKGROUND: Due to demographic changes over the last few decades, the number of multilingual children has grown rapidly. Many of them face problems in learning their second language. Similarities between linguistic manifestations of stages of second language acquisition and an impairment of language acquisition cause a diagnostic dilemma. The Vienna Model of language assessment in multilingual children will be presented. METHODS: A key feature of our procedure is the integration of medical students as native speakers in diagnosing acquisition of the first language. A case study of a boy with Russian as first language illustrates the procedure. RESULTS: The Vienna Model of language assessment in multilingual children offers the possibility to evaluate language competence in a differentiated manner with support of medical students as native speakers. Based on the bilingual assessment on different linguistic levels the diagnosis ICD-10 F80.0 is given. The subsequent short therapy showed an improvement regarding phonological competence.

Motives, experiences and psychological strain in medical students engaged in refugee care in a reception center- a mixed-methods approach.

BACKGROUND: The UN Refugee Agency has reported that an increasing number of people are being forcibly displaced worldwide. Despite this, global health issues, especially initiatives focusing on physical and psychological conditions of refugees, are still rarely considered in medical curricula. Furthermore, there is little evidence regarding the experiences and possible related psychological strain of medical students who work with refugees. Therefore, the present study aimed to investigate motivations, learning achievements and experiences, as well as psychological strain and possible protective factors, in medical students volunteering in a reception center for refugees. METHODS: In this prospective study using a mixed-methods approach, we applied (1) qualitative content analysis of semi-standardized interviews in a pre-post design in a subsample of n = 16 students. The aims were to analyze (1a) the students' motivations and experiences in the reception center, and (1b) the students' perceived learning achievement. We further administered (2) psychometric questionnaires using a cross-sectional approach to n = 62 students in order to examine (2a) the students' psychological strain, in terms of secondary traumatization, depression, anxiety and health-related quality of life, and (2b) possible protective factors such as attachment style and sense of coherence. RESULTS: The content analysis of the students' interviews revealed three main categories before the assignment and four main categories subsequently, displaying a broad variety of perspectives. Quantitative analysis identified that 3.2% of the students showed moderate secondary traumatization, and a correlation emerged between the number of shifts and symptom severity of secondary traumatization. The students displayed significantly reduced scores for depression and anxiety, when compared to a sample of first-year medical students. Sense of coherence was identified as a protective factor concerning secondary traumatization. CONCLUSION: A rather small proportion of the medical students working in the reception center displayed explicit symptoms of psychological strain in terms of secondary traumatic stress. Due to their assignments, students were able to improve their cultural awareness, which they reported to be highly relevant for their future occupation. In view of increasing globalization, theoretical and practical courses on issues of flight and global health might therefore be implemented as an obligatory part of medical curricula.

Medical Clerkship in a State Registration and Reception Center for Forced Migrants in Germany: Students' Experiences, Teachable Moments, and Psychological Burden.

Aspects of global health are becoming increasingly relevant for doctors of future generations. However, medical curricula rarely include courses which focus on global health or forced migration. Furthermore, it remains unclear whether students are at risk to develop psychological strain, after being confronted with highly burdened or even traumatized asylum seekers. This is a prospective study using a mixed-methods approach. We included n = 22 medical students performing a medical clerkship in a state registration and reception center for refugees. By applying (1) qualitative interviews, (2) reflective diaries, and (3) psychometric questionnaires, we examined the students' experiences, teachable moments, and potential psychological burdens. In the interviews, the students emphasized the importance of cultural sensitivity during their clerkship. However, they also reported cognitive changes concerning their views of themselves and the world in general; this could indicate vicarious traumatization. The reflective diaries displayed high learning achievements. According to the psychometric questionnaires, the assignment in the reception center had not caused any significant psychological strain for the students. By completing their medical clerkship in a reception center, students were able to improve their medical, organizational, and interactional knowledge and skills. Furthermore, they reported that they had broadened their personal and cultural horizons.

Aetiology and treatment of nightmare disorder: State of the art and future perspectives.

This consensus paper provides an overview of the state of the art in research on the aetiology and treatment of nightmare disorder and outlines further perspectives on these issues. It presents a definition of nightmares and nightmare disorder followed by epidemiological findings, and then explains existing models of nightmare aetiology in traumatized and non-traumatized individuals. Chronic nightmares develop through the interaction of elevated hyperarousal and impaired fear extinction. This interplay is assumed to be facilitated by trait affect distress elicited by traumatic experiences, early childhood adversity and trait susceptibility, as well as by elevated thought suppression and potentially sleep-disordered breathing. Accordingly, different treatment options for nightmares focus on their meaning, on the chronic repetition of the nightmare or on maladaptive beliefs. Clinically, knowledge of healthcare providers about nightmare disorder and the delivery of evidence-based interventions in the healthcare system is discussed. Based on these findings, we highlight some future perspectives and potential further developments of nightmare treatments and research into nightmare aetiology.

A Comparison of Stress Perception in International and Local First Semester Medical Students Using Psychometric, Psychophysiological, and Humoral Methods.

(1) Medical doctors and medical students show increased psychological stress levels. International medical students seem to be particularly vulnerable. (2) We compared different methods of assessing stress levels in international and local first year medical students. First, study participants completed questionnaires related to stress, depression, empathy, and self-efficacy (MBI, PSQ, PHQ-9, JSPE-S, and GSE) at three separate points in time (T1 to T3). Second, their heart rate variabilities (HRVs) were recorded in an oral examination, a seminar, and in a relaxing situation. Third, hair samples were collected at the beginning and at the end of the semester to assess the cortisol concentration. (3) Included were 20 international and 20 local first semester medical students. At T1, we found considerable differences between international and local students in the JSPE-S; at T2 in the MBI factor "professional efficacy", the PHQ-9, and in the JSPE-S; and at T3 in the MBI factors "cynicism" and "professional efficacy", the PHQ-9, and in the JSPE-S. International and local students also differed concerning their HRVs during relaxation. Over the course of the semester, international students showed changes in the MBI factors "emotional exhaustion" and "professional efficacy", the PHQ-9, and the GSE. Local students showed changes in the GSE. No effects were found for students' hair cortisol concentrations. (4) All participants showed low levels of stress. However, while international students experienced their stress levels to decrease over the course of the semester, local students found their stress levels to increase.

Prevalence of and Risk Factors for Secondary Traumatization in Interpreters for Refugees: A Cross-Sectional Study.

BACKGROUND: A substantial proportion of refugees, fleeing persecution, torture, and war, are estimated to suffer from psychological traumatization. After being sheltered in reception centers, the refugees come in close contact with different occupational groups, e.g., physicians, social workers, and interpreters. Previous studies ascertained that such interpreters themselves often suffer from primary psychological traumatization. Moreover, through translating refugees' potentially traumatic depictions, the interpreters are in danger of developing a so-called secondary traumatization. OBJECTIVE: The present study aimed (1) to analyze the prevalence rates of primary traumatization in interpreters, (2) to assess the prevalence of secondary traumatization, depression, anxiety, and stress symptoms, (3) to examine the association between secondary traumatization symptoms and resilience factors in terms of sense of coherence, social support, and attachment style, and (4) to test whether these resilience factors mediate the relationship between primary and secondary traumatization. METHODS: Participating interpreters (n = 64) were assessed for past exposure to potentially traumatic events as well as symptoms of posttraumatic stress disorder (PTSD), secondary traumatization, depressive symptoms, anxiety, and subjective stress levels. Furthermore, we conducted psychometric surveys to measure interpreters' sense of coherence, degree of social support, and attachment style as potential predictors. RESULTS: (1) 9% of the interpreters fulfilled all criteria for PTSD and a further 33% had subclinical PTSD; (2) a secondary traumatization was present in 21% of the examined interpreters - of these, 6% showed very high total scores indicating a severe secondary traumatization; furthermore, we found higher scores for depression, anxiety, and stress as compared to representative population samples, especially for females; (3) a present sense of coherence, an existing social support network, and a secure or preoccupied attachment style correlated significantly with low scores for secondary traumatization; and (4) a significant correlation emerged between primary and secondary traumatization (r = 0.595, p < 0.001); a mediation analysis revealed that this effect is partially mediated by secure attachment. CONCLUSION: A substantial proportion of interpreters working with refugees suffer from primary as well as secondary traumatization. However, high scores for sense of coherence and social support, male gender, and especially a secure attachment style were identified as resilience factors for secondary traumatization. The results may have implications for the selection, training, and supervision of interpreters.

Shedding light into the black box: A prospective longitudinal study identifying the CanMEDS roles of final year medical students' on-ward activities.

INTRODUCTION: To our best knowledge, a rigorous prospective analysis of final year medical students' (FY medical students) activity profiles during workplace learning is lacking. The present study investigated the CanMEDS characteristics of all on-ward activities performed by internal medicine FY medical students. We tested the hypotheses that during FY medical student workplace training (I) routine activities are predominantly performed, while supervised, more complex activities are underrepresented with (II) FY medical students performing an insufficient number of autonomous activities and that (III) the CanMEDS roles of the Communicator and the Professional prevail. METHODS: During the second and the sixth week of their final year trimester at the University of Heidelberg Medical Hospital, N = 34 FY medical students (73% female; mean age 26.4 ± 2.4) were asked to keep a detailed record of all their on-ward activities and to document the duration, mode of action (active versus passive; independent versus supervised), estimated relevance for later practice, and difficulty-level in specially designed activity logbooks. CanMEDS roles were assigned to the documented activities via post-hoc expert consensus. RESULTS: About 4308 activities lasting a total of 2211.4 h were documented. Drawing blood (20.8%) was the most frequently documented medical activity followed by full admission procedures (9.6%). About 14.9% of the time was spent with non-medical activities. About 82.1% of all medical activities performed went unsupervised. The Communicator (42%), the Professional (38%), and the Collaborator (7%) were assigned as the top three CanMEDS roles. CONCLUSIONS: The results call for increased efforts in creating more authentic learning experiences for FY medical students shifting towards more complex, supervised tasks, and improved team integration.

Dispersion of Multi-Walled Carbon Nanotubes in Skutterudites and Its Effect on Thermoelectric and Mechanical Properties.

Filled cobalt-antimony based skutterudites have proven themselves as very promising thermoelectric materials for generator applications in an intermediate temperature range between 400 and 800 K due to their high figure of merit. Besides the functional thermoelectric properties also the skutterudites' mechanical properties play an important role to withstand external mechanical and internal thermomechanical loads during operation. Properties of interest are hardness as well as fracture toughness and resistance to fatigue. Carbon nano tubes are well known for their high tensile strength and may therefore be used to increase the mechanical strength of composite materials. Additionally, the thermoelectric properties of the composite material might benefit from the high electrical conductivity of carbon nano tubes and increased phonon scattering at interfaces between matrix and carbon nano tube. A main precondition for benefiting from embedded nano-tubes is to achieve a homogeneous distribution of the CNTs and good adhesion between carbon nano tube and matrix material. In this work we present the influence of the introduction of multi-walled carbon nano tubes on the thermoelectric and mechanical properties of p-type skutterudites Ce(0.14)La(0.06)Co(2)Fe(2)Sb(12). The influence of different carbon nano tube concentrations and preparation routes on the resulting composite material's thermoelectric, mechanical and microstructural properties is studied. A reduction of electrical and thermal conductivity as well as fracture strength is observed with increasing carbon nano tube content which is attributed to strong agglomeration of the nano tubes. The results underline the pivotal role of a homogeneous distribution of the carbon nano tubes for improving the mechanical properties of skutterudites.

Alveolar and Velarized Laterals in Albanian and in the Viennese Dialect.

A comparison of alveolar and velarized lateral realizations in two language varieties, Albanian and the Viennese dialect, has been performed. Albanian distinguishes the two laterals phonemically, whereas in the Viennese dialect, the velarized lateral was introduced by language contact with Czech immigrants. A categorical distinction between the two lateral phonemes is fully maintained in Albanian. Results are not as straightforward in the Viennese dialect. Most prominently, female speakers, if at all, realize the velarized lateral in word-final position, thus indicating the application of a phonetically motivated process. The realization of the velarized lateral by male speakers, on the other hand, indicates that the velarized lateral replaced the former alveolar lateral phoneme. Alveolar laterals are either realized in perceptually salient positions, thus governed by an input-switch rule, or in front vowel contexts, thus subject to coarticulatory influences. Our results illustrate the subtle interplay of phonology, phonetics and sociolinguistics.

Peer-led Stress Prevention Seminars in the First Year of Medical School--A Project Report.

INTRODUCTION: From the beginning of the first year of medical studies, increased psychological stress and elevated burnout prevalence rates can be registered compared to sample populations. Characterized by learning "on an equal footing", the principle of peer-assisted learning (PAL) is widely used in medical education. This report aims to showcase the development and evaluation of peer-led stress prevention seminars for first year medical students after one year of implementation. PROJECT DESCRIPTION: With each of the three sessions lasting 90 min., the stress prevention seminars took place in small groups (6-10 students) in the period from November 2013 to January 2014 and from November 2014 to December 2014 at the Medical Faculty of Heidelberg. Led by trained peers, the seminar content ranged from psycho-educational elements, i.e. time management strategy development and test anxiety assistance, to relaxation techniques. All seminar sessions were evaluated via questionnaire. All questions were answered on a Likert scale ranging from 1 to 7 (1=strongly agree; 7=strongly disagree). RESULTS: 75 students consented to participate in seminars (65% female; aged 20.5±3.3 years). The series of seminars was averagely given the school grade of 1.2±0.4 (1=very good to 6=unsatisfactory) in WS 2013/14 and 1.5±0.5 in the following year and the peer tutors' competence was evaluated as very high (1.4 to 1.5 approval rate on the Likert scale). DISCUSSION: The seminar sessions' importance to the students is underlined by their very positive evaluations. This offer seems to have benefited students especially during the demanding transitional phase at the start of their studies. Both the implementation of the preventive measure at an early stage as well as the use of PAL seem to have proven effective. CONCLUSION: PAL seems to be effective in the field of stress prevention. However, specific efficacy studies are still lacking.

[Stress in Medical Students: A Cross-Sectional Study on the Relevance of Attachment Style and Structural Integration]. / Stresserleben bei Medizinstudierenden: Welche Rolle spielen Bindungserleben und Persönlichkeitsaspekte?

INTRODUCTION: From year one of studying medicine an increase of psychological stress is found. The relationship between the occurrence of this stress and attachment patterns or structural personality functions remains unclear. The present study aimed at investigating whether a relationship between the enduring personality variables, attachment style and level of structural integration of the personality, and acute stress experience at the beginning of medical students' studies exists. MATERIAL & METHODS: In this study, all students in the first semester of medicine were invited to participate in a study to identify stress factors via questionnaire (MBI-SS, PSQ, PHQ-9, GAD-7) in the WS 2013/2014. Simultaneously, the predominant attachment style (RQ-2) and structural abilities (OPD-SFK) were evaluated. RESULTS: The study included 293 students (return: 91.3%). Securely attached students experienced significantly less stress than insecurely attached students (p=0.019). Students with a high level of structural integration showed significantly less stress burden (p<0.001) and lower exhaustion- (p<0.001) and cynicism values (p<0.001), while showing a higher experience of self-efficacy (p<0.001). The influence of attachment behavior on stress experience is mediated by the level of the structural integration of the personality. DISCUSSION: Significant correlations exist between attachment style and the level of structural integration of the personality, and burnout risk as well as stress burden. The level of structural integration of the personality mediates the relationship between the attachment-related "model of self" and stress experience, i. e. a positive "model of self" can have a stress-protective effect when good structural abilities are present. Practical implication: An insecure attachment style and a low level of structural integration may be associated with higher stress experience when transitioning to study. The results suggest that the enduring personality variable attachment style, mediated by the level of structural integration of the personality, leads to higher stress and burnout experience. Affected students could be supported by early preventive measures enabling the sustainable preparation for this transitional period. Longitudinal prospective studies are needed to explore if the assumption is applicable that pre-existing vulnerabilities in school are exacerbated at this transitional stage.

Characteristics of Disorder-Related Autobiographical Memory in Acute Anorexia Nervosa Patients.

OBJECTIVE: First studies revealed overgeneral autobiographical memories in anorexia nervosa (AN) patients. The aim of the present study was to investigate frequency, generalization and valence of autobiographical memories in AN patients in response to eating disorder-related cue words. METHOD: Autobiographical memory was examined in 21 AN patients and 21 healthy controls (HC) using a modified version of the Autobiographical Memory Test, incorporating body-related, food-related, perfectionism-related, depression-related and neutral cues. RESULTS: Anorexia nervosa patients recalled fewer and more general autobiographical memories compared with HC. For eating disorder-related cues as against neutral ones, AN patients compared with HC showed fewer memories for food-related and body-related cues, an elevated overgeneralization for food-related cues, while the valence of the retrieved memories was more negative in response to body-related cues. DISCUSSION: This study detects disorder-related autobiographical memory alterations in AN, which are intensified in response to symptom-related cues. The findings are discussed with regard to their maladaptive function in emotion regulation.