Predictive value of physical fitness on self-rated health: A longitudinal study.

BACKGROUND: The self-rated health of adolescents and young adults is important for estimating future morbidities and mortality. Little is known about how physical fitness in younger populations predicts self-rated health. This longitudinal study (2003-2017) aims to explore the effects of physical fitness on self-rated health on the basis of the German population-based study KiGGS and its in-depth study, MoMo. METHODS: Self-rated health was assessed using a one-item scale, and physical fitness was measured with seven test items covering the dimensions of coordination, muscular fitness, and cardiorespiratory fitness. Longitudinal analyses were conducted using the structural equation modeling approach in Mplus 8.0 using the maximum likelihood estimator. RESULTS: The longitudinal samples of the KiGGS/MoMo study (T1, n = 2376; T2, n = 2821; and T3, n = 2047) had a mean age of 8.5, 14.8, and 20.0 years at T1, T2, and T3, respectively. All measurement and structural models had excellent model fits. While the results of the latent regression analysis indicated moderate-to-high stability for the coordination and muscular fitness dimensions, only low-to-moderate stability coefficients were found for cardiorespiratory fitness and self-rated health. Furthermore, small significant cross-lagged regression coefficients revealed that coordination and muscular fitness predicted self-rated health at later measurement points. CONCLUSION: To the best of our knowledge, this is the first longitudinal study to demonstrate the positive predictive value of two dimensions of physical fitness, coordination and muscular fitness, on self-rated health at a later stage. The public health implications are highlighted.

Accuracy of self-monitoring: does experience, ability or case difficulty matter?

CONTEXT: The ability to self-monitor one's performance in clinical settings is a critical determinant of safe and effective practice. Various studies have shown this form of self-regulation to be more trustworthy than aggregate judgements (i.e. self-assessments) of one's capacity in a given domain. However, little is known regarding what cues inform learners' self-monitoring, which limits an informed exploration of interventions that might facilitate improvements in self-monitoring capacity. The purpose of this study is to understand the influence of characteristics of the individual (e.g. ability) and characteristics of the problem (e.g. case difficulty) on the accuracy of self-monitoring by medical students. METHODS: In a cross-sectional study, 283 medical students from 5 years of study completed a computer-based clinical reasoning exercise. Confidence ratings were collected after completing each of six cases and the accuracy of self-monitoring was considered to be a function of confidence when the eventual answer was correct relative to when the eventual answer was incorrect. The magnitude of that difference was then explored as a function of year of seniority, gender, case difficulty and overall aptitude. RESULTS: Students demonstrated accurate self-monitoring by virtue of giving higher confidence ratings (57.3%) and taking a shorter time to work through cases (25.6 seconds) when their answers were correct relative to when they were wrong (41.8% and 52.0 seconds, respectively; p< 0.001 and d > 0.5 in both instances). Self-monitoring indices were related to student seniority and case difficulty, but not to overall ability or student gender. CONCLUSIONS: This study suggests that the accuracy of self-monitoring is context specific, being heavily influenced by the struggles students experience with a particular case rather than reflecting a generic ability to know when one is right or wrong. That said, the apparent capacity to self-monitor increases developmentally because increasing experience provides a greater likelihood of success with presented problems.

Assessing clinical reasoning (ASCLIRE): Instrument development and validation.

Clinical reasoning is an essential competency in medical education. This study aimed at developing and validating a test to assess diagnostic accuracy, collected information, and diagnostic decision time in clinical reasoning. A norm-referenced computer-based test for the assessment of clinical reasoning (ASCLIRE) was developed, integrating the entire clinical decision process. In a cross-sectional study participants were asked to choose as many diagnostic measures as they deemed necessary to diagnose the underlying disease of six different cases with acute or sub-acute dyspnea and provide a diagnosis. 283 students and 20 content experts participated. In addition to diagnostic accuracy, respective decision time and number of used relevant diagnostic measures were documented as distinct performance indicators. The empirical structure of the test was investigated using a structural equation modeling approach. Experts showed higher accuracy rates and lower decision times than students. In a cross-sectional comparison, the diagnostic accuracy of students improved with the year of study. Wrong diagnoses provided by our sample were comparable to wrong diagnoses in practice. We found an excellent fit for a model with three latent factors-diagnostic accuracy, decision time, and choice of relevant diagnostic information-with diagnostic accuracy showing no significant correlation with decision time. ASCLIRE considers decision time as an important performance indicator beneath diagnostic accuracy and provides evidence that clinical reasoning is a complex ability comprising diagnostic accuracy, decision time, and choice of relevant diagnostic information as three partly correlated but still distinct aspects.

Demands and stress before and during the COVID-19 pandemic of parents to children with autism spectrum disorder.

Introduction: Parents to children with Autism Spectrum Disorder (ASD) face diverse daily demands that can lead to stress. The aim of this study was to examine to which extent stress in parents to children with ASD can be explained by daily demands before and during the COVID-19 pandemic (after lockdowns; first half of 2022), and whether there are differences between the two time periods in this regard. Methods: Data from parents to children with ASD living in Germany from two independent questionnaire studies (before the pandemic: N = 168, during the pandemic: N = 105) were matched for comparability. Simple and multiple linear regression analyses were used to answer the research question. Results: Parental stress as well as all demands examined showed higher levels during the COVID-19 pandemic than before. Significant predictors of parental stress before and during the COVID-19 pandemic were (1) the daily demands to deal with the child's problem behavior, (2) the restriction of one's personal way of life, and (3) the challenge to cooperate with the partner. During the COVID-19 pandemic, the child's problem behavior was particularly relevant. It was also found that the demand to deal with stigmatizing reactions did not explain parental stress during the COVID-19 pandemic whereas before the pandemic it had been a significant predictor. Discussion: Although parental stress and the demands of daily life increased during the pandemic, most of the stress can be explained by the same demands. It is suggested that the increased levels may be due to an increase in the child's ASD symptomatology, which is why it is advisable to install therapeutic and care structures that prepare children with ASD for future crises.

What factors affect team members' evaluation of collaboration in medical teams?

Introduction: Perceived teamwork quality is associated with numerous work-related outcomes, ranging from team effectiveness to job satisfaction. This study explored what situational and stable factors affect the perceived quality of teamwork during a specific team task: when a medical team comprising a senior (supervisor) and a junior (trainee) physician diagnoses a patient. Methods: During a field study in an emergency department, multisource data describing the patients, the diagnosing physicians, and the context were collected, including physicians' ratings of their teamwork. The relationships between perceived teamwork quality and situational (e.g., workload) and stable (e.g., seniority) factors were estimated in a latent regression model using the structural equation modeling (SEM) approach. Results: Across the N = 495 patients included, SEM analyses revealed that the patient-specific case clarity and urgency influenced the perceived teamwork quality positively, whereas the work experience of the supervisor influenced the perceived teamwork quality of both supervisor and trainee negatively, albeit to different degrees. Discussion: Our findings shed light on the complex underpinnings of perceived teamwork quality, a performance-relevant factor that may influence work and organizational effectiveness in healthcare settings.

Development of coordination and muscular fitness in children and adolescents with parent-reported ADHD in the German longitudinal MoMo Study.

This study examined the development of muscular fitness and coordination in children and adolescents with and without attention deficit hyperactivity disorder (ADHD) over a period of 11 years. Data was collected in three measurement waves as part of the longitudinal, representative Motorik-Modul (MoMo) study in Germany (2003-2006, 2009-2012, 2014-2017). The overall sample comprised 2988 participants (253 with ADHD, 65% males; 2735 non-ADHD, 47% males; mean age 9 years). Structural equation modeling was conducted, and the estimated models had a good fit. No differences in muscular fitness were observed between participants with and without ADHD. Participants with ADHD had a lower coordinative performance at first measurement than those without ADHD. The difference in coordinative performance persisted throughout the study period.

Psychometrics of the Iowa and Berlin Gambling Tasks: Unresolved Issues With Reliability and Validity for Risk Taking.

The Iowa Gambling Task (IGT) is one of the most prominent paradigms employed for the assessment of risk taking in the laboratory, and it was shown to distinguish between various patient groups and controls. The present study was conducted to test the psychometric characteristics of the original IGT and of a new gambling task variant for assessing individual differences. Two studies were conducted with adults of the general population (n = 220) and with adolescents (n = 389). Participants were also tested on multiple measures of working memory capacity, fluid intelligence, personality traits associated with risk-taking behavior, and self-reported risk taking in various domains. Both gambling tasks had only moderate retest reliability within the same session. Moderate relations were obtained with cognitive ability. However, card selections in the gambling tasks were not correlated with personality or risk taking. These findings point to limitations of IGT type gambling tasks for the assessment of individual differences in risky decision making.

The Potential of Collective Intelligence in Emergency Medicine: Pooling Medical Students' Independent Decisions Improves Diagnostic Performance.

BACKGROUND: Evidence suggests that pooling multiple independent diagnoses can improve diagnostic accuracy in well-defined tasks. We investigated whether this is also the case for diagnostics in emergency medicine, an ill-defined task environment where diagnostic errors are rife. METHODS: A computer simulation study was conducted based on empirical data from 2 published experimental studies. In the computer experiments, 285 medical students independently diagnosed 6 simulated patients arriving at the emergency room with dyspnea. Participants' diagnoses (n = 1,710), confidence ratings, and expertise levels were entered into a computer simulation. Virtual groups of different sizes were randomly created, and 3 collective intelligence rules (follow-the-plurality rule, follow-the-most-confident rule, and follow-the-most-senior rule) were applied to combine the independent decisions into a final diagnosis. For different group sizes, the performance levels (i.e., percentage of correct diagnoses) of the 3 collective intelligence rules were compared with each other and against the average individual accuracy. RESULTS: For all collective intelligence rules, combining independent decisions substantially increased performance relative to average individual performance. For groups of 4 or fewer, the follow-the-most-confident rule outperformed the other rules; for larger groups, the follow-the-plurality rule performed best. For example, combining 5 independent decisions using the follow-the-plurality rule increased diagnostic accuracy by 22 percentage points. These results were robust across case difficulty and expertise level. Limitations of the study include the use of simulated patients diagnosed by medical students. Whether results generalize to clinical practice is currently unknown. CONCLUSION: Combining independent decisions may substantially improve the quality of diagnoses in emergency medicine and may thus enhance patient safety.

Sex differences in face cognition.

Although there is abundant evidence for female superiority in Face Cognition (FC), a number of questions regarding sex differences remain to be addressed. Here we report a reanalysis of data on the level of latent factors, modeled on the basis of an extensive test battery applied to three samples of over 800 adults in all. In independent samples the measurement structure of FC was invariant for both sexes, indicating that the measurement of the construct does not depend on the context variable sex, and investigating mean performance differences will not be biased by measurement issues - a neglected aspect in previous studies. We confirmed female superiority for face perception (FP) and face memory (FM). For the first time we could show that these sex differences prevailed after accounting for sex differences in broadly measured general cognitive functioning and in object perception. Across adult age, sex differences in FM increased due to the rapid decline of this ability in men, whereas performance in women remained stable across adult age. Self-reported social involvement and things-oriented activities moderated sex-differences in FM. Results show that sex differences are salient at the level of specific FC constructs and that they can be partially explained by social involvement.