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Converging evidence of high stress levels in the nursing profession as well as their detrimental effects on the execution of nursing actions, quality indicators of care, and self-reported job satisfaction justify the need for test environments that assess stress coping competences in dealing with domain-specific stress factors. Reliable and valid information on the test takers' stress coping competence can help to identify individual deficits and supportive needs and thus, to design training measures that may contribute to job retention and a skilled workforce. This article describes the development and validation of a digital assessment that ensures authenticity by means of video-based situational judgement tests. Analyses of the performance data were conducted in four steps: (1) the scaling of the data with a partial credit model in order to identify items that are subject to measurement error, (2) differential-item-function analyses for different specializations in nursing education, (3) dimensionality tests, and (4) correlations between test performance and perceived psychological work stress in order to gauge criterion validity. The total sample consisted of n = 300 German nursing apprentices. The results show that the developed test instrument can be used for a reliable and valid measurement of coping skills of (prospective) nurses, covering two essential dimensions. Limitations of the current study and related objectives of future research are discussed together with questions of practical applicability.

The identification of effects of vocational education and training conditions on competence development in nursing education requires longitudinal studies. An important precondition is the availability of a test of nursing competence which is economical in use, measures a homogeneous construct throughout years of nursing education and across nursing specializations, and can detect increases in the required competence, hence allowing for sensitive testing. This article describes a cross-sectional study that aimed to optimize a computer-based test measuring nursing competence in care for the elderly--the TEMA test--through the selection of items on the basis of measurement error, differential item functioning, and item difficulty. Evidence of the test sensitivity of the optimized TEMA-L instrument is presented for the second and third year of nursing education. The total sample consisted of n = 133 German nursing students from clinical and geriatric nursing. The resulting instrument includes two test booklets consisting of 36 (WLE = 0.72) and 35 items (WLE = 0.70) respectively for the second and third year of training. The cross-sectional data indicate that the test likely has good properties for sensitive testing of nursing competence in a future longitudinal study. Hence, it might be used to study factors contributing to increases in nursing competence in German VET and serve as an example for similar studies in other countries. Limitations of the current study and related subjects of future research are discussed.

Valid and reliable standardized assessment of nursing competencies is needed to monitor the quality of vocational education and training (VET) in nursing and evaluate learning outcomes for care work trainees with increasingly heterogeneous learning backgrounds. To date, however, the modeling of professional competencies has not yet evolved into procedures that would meet large-scale assessment (LSA) standards in VET. To empirically test a proposed structural model for client-directed nursing competence and to estimate psychometric properties of a newly developed video- and computer-based test (CBT) to inform subsequent LSA in nursing VET, 402 final-year nursing students from 24 German schools responded to a 77 item CBT. Multi-dimensional IRT modeling was employed to test the subdomain structure and estimate students' competencies in geriatric nursing. The standardized CBT measures nursing students' client-directed care competence with acceptable precision (WLE = 0.76) and does so across the whole range of observed proficiency levels. Structural validity was supported by substantive contributions of test items from all proposed process-oriented subdomains, practice field scenarios, as well as items with and without reference to emotional demands. However, it was not possible to empirically separate the diagnostic, practical or communicative subdomains, probably reflecting parallel, recursive and hierarchical care processes in complex care situations. On average, students in our sample attained 45% of the maximum test score so it is a demanding assessment of nursing competence. An extensively piloted, valid and reliable CBT is suggested to assess nursing students' client-directed care competencies at the end of the third year of the VET program.

Objectives: The study aimed to survey current strategies against enamel demineralization during multibracket therapy (MBT) and guide a prevention concept based on existing scientific evidence. Materials and methods: The survey comprised questions on the prevention and management of white spot lesions (WSL). The questionnaire was sent via email to orthodontists working in practices and universities throughout Germany. The analysis involved descriptive statistics using the chi-square test (p < 0.05). Results: A prevention protocol was used before MBT by 80.6% of the participants. Less than a quarter of the participants regularly applied topical fluoride (gel or varnish) during MBT. According to the respondents' assessment, the prevalence of WSL during MBT is 11.6%, mainly observed in 12- to 15-year-old male patients. Orthodontists graduating after 2000 tended to recommend and apply fluoride-containing materials more often than their senior colleagues (p = 0.039). Participants from private practices applied fluoride varnish or gel more frequently than those from university clinics (p = 0.013). Fluoridation was the most common (70.7%) treatment for WSL after MBT, followed by resin infiltration (21.2%). The majority (80.9%) of the participants favor a guideline for preventing WSL. Conclusions: WSL prevention during MBT is challenging. Males in puberty are predominantly affected. Younger orthodontists are more concerned about the prevention of WSL during MBT. Clinical relevance. The non-negligible prevalence of individuals with WSL emphasizes the need for dental education and health care reform. This would help to implement standardized procedures and establish innovative applications. [ABSTRACT FROM AUTHOR]

Background: Obesity is considered an epidemic problem with an increasing number of individuals affected. The physical and psychological complaints associated with obesity point to the importance of implementing effective interventions. Innovative mHealth applications appear to be promising in helping provide a continuous and flexible support during the intervention. Since research on mHealth interventions is still relatively sparse, the main goal of the current study is to assess the effectiveness of an mHealth obesity intervention in terms of weight reduction, health behaviours as well as health-related quality of life. In addition, the study aims to investigate various psychological explicit and implicit processes associated with physical activity behaviour. Methods: The study includes quantitative and qualitative methods. Regarding the quantitative methods, the goal is to recruit up to 450 individuals at baseline in different obesity centres across Germany with some of these centres offering an mHealth intervention. All individuals who agree to take part in the mHealth intervention will be assigned to the intervention group, while all other individuals will be assigned to the control group. The mHealth obesity intervention consists of three stays at an obesity centre, with approximately six months between stays during which patients are supported by the digital platform CASPAR. The study includes three measurements with a baseline measurement and two follow-up measurements, one after six months and one after twelve months. To assess the effectiveness of the intervention, body weight, physical activity behaviour, eating behaviour as well as health related quality of life will be assessed. In addition, motivation, intentions, self-efficacy, enjoyment, and habit will be used to assess the psychological processes related with physical activity behaviour. A multivariate analysis of variance with repeated measurement and latent growth curve models will be used to compare the development of the variables within the two groups. In relation to the qualitative methods, interviews with individuals of the intervention group will be conducted to shed light on the applicability, acceptance, and usability of the mHealth intervention. Discussion: This study may provide a valuable insight into the potential of mHealth obesity interventions and the psychological processes related to physical activity behaviour. Trial registration The trial has been registered with the German Register of Clinical Studies (DRKS) on June 30, 2021 under the registration number: DRKS00024836. [ABSTRACT FROM AUTHOR]

Background: Physical activity (PA) has beneficial effects on health and health-related quality of life (HRQoL), which is a protective factor of illness and mortality. The purpose of this examination was to investigate if self-reported and device-based measures of PA were related to HRQoL in adolescents.Methods: Participants (N = 1565; 54.3% female; Mage = 14.37 years, SDage = 1.99) were recruited from 167 sample points across Germany. Adolescents self-reported their PA, supplemented by a 1-week examination of device-based PA using accelerometry. Additionally, they completed the multidimensional KIDSCREEN-27 to assess HRQoL.Results: Results showed that self-reported PA was correlated with overall HRQoL, Physical Well-Being, Psychological Well-Being, Social Support & Peers, and School Environment, whereas device-based PA was only correlated with Physical as well as Psychological Well-Being. Further, self-reported PA significantly predicted all facets of HRQoL except for Autonomy and Parent Relations, whereas device-based PA solely heightened the amount of explained variance in the Physical Well-Being subscale.Conclusions: Findings demonstrate the importance of self-reported PA as it is related to almost all facets of HRQoL. Both measures of PA are not congruent in their relationship with HRQoL and thus implications have to be carefully considered. Future studies should investigate the direct effect of PA on HRQoL and health in a longitudinal approach to account for the causality of effects. [ABSTRACT FROM AUTHOR]

Purpose: In Europe, intravenous fosfomycin (IV) is used particularly in difficult-to-treat or complex infections, caused by both Gram-positive and Gram-negative pathogens including multidrug-resistant strains. Here, we investigated the efficacy and safety of intravenous fosfomycin under real-life conditions. Methods: Prospective, multi-center, and non-interventional study in patients with bacterial infections from 20 intensive care units (ICU) in Germany and Austria (NCT01173575). Results: Overall, 209 patients were included (77 females, 132 males, mean age: 59 ± 16 years), 194 of which were treated in intensive care (APACHE II score at the beginning of fosfomycin therapy: 23 ± 8). Main indications (± bacteremia or sepsis) were infections of the CNS (21.5%), community- (CAP) and hospital-acquired pneumonia (HAP)/ventilator-associated pneumonia (VAP, 15.3%), bone and joint infections (BJI, 11%), abdominal infections (11%), and bacteremia (10.5%). Most frequently identified pathogens were S. aureus (22.3%), S. epidermidis (14.2%), Enterococcus spp. (10.8%), E. coli (12.3%) and Klebsiella spp. (7.7%). At least one multidrug-resistant (MDR) pathogen was isolated from 51 patients (24.4%). Fosfomycin was administered with an average daily dose of 13.7 ± 3.5 g over 12.4 ± 8.6 days, almost exclusively (99%) in combination with other antibiotics. The overall clinical success was favorable in 81.3% (148/182) of cases, and in 84.8% (39/46) of patients with ≥ 1 MDR pathogen. Noteworthy, 16.3% (34/209) of patients developed at least one, in the majority of cases non-serious, adverse drug reaction during fosfomycin therapy. Conclusion: Our data suggest that IV fosfomycin is an effective and safe combination partner for the treatment of a broad spectrum of severe bacterial infections in critically ill patients. [ABSTRACT FROM AUTHOR]

The article reports on the challenges for energy efficiency in Germany. Topics mentioned include the importance of the National Action Plan for Energy Efficiency (NAPE) in the country, the importance of energy conservation, and the energy saving obligations. Also mentioned are the role of renewable energy in the energy efficiency and the management of energy taxes.

Hand hygiene is a cornerstone of infection prevention. However, few data are available for school children on their knowledge of infectious diseases and their prevention. The aim of the study was to develop and apply a standardized questionnaire for children when visiting primary schools to survey their knowledge about infectious diseases, pathogen transmission and prevention measures. Enrolling thirteen German primary schools, 493 questionnaires for grade three primary school children were included for further analyses, comprising 257 (52.1%) girls and 236 (47.9%) boys with an age range of 8–11 years. Out of 489 children, 91.2% participants indicated that they knew about human-to-human transmissible diseases. Of these, 445 children responded in detail, most frequently mentioning respiratory and gastrointestinal diseases, followed by childhood diseases. Addressing putative hygiene awareness-influencing factors, it was worrisome that more than 40.0% of the children avoided visiting the sanitary facilities at school. Most of the children (82.9%) noted that they did not like to use the sanitary facilities at school because of their uncleanliness and the poor hygienic behavior of their classmates. In conclusion, basic infection awareness exists already in primary school age children. Ideas about the origin and prevention of infections are retrievable, however, this knowledge is not always accurate and adequately contextualized. Since the condition of sanitary facilities has a strong influence on usage behavior, the child's perspective should be given more consideration in the design and maintenance of sanitary facilities. [ABSTRACT FROM AUTHOR]

Disorientation may present as a warning sign of developing delirium. The most commonly used delirium assessment tool in Germany, the Confusion Assessment Method for Intensive Care Unit (CAM-ICU), does not rate "disorientation", since intubated patients cannot communicate verbally. However, the majority of German ICU patients are not orally intubated, so they could be examined for their orientation. This study was carried out to investigate whether the delirium feature "disorientation" in extubated patients yields diverging findings in comparison to the CAM-ICU and whether the sensitivity of the CAM-ICU may be improved when combined with the feature "disorientation" (CAM-IMC). A total of 86 paired assessments were completed in 50 extubated patients. Delirium was found in 19.8% (N = 17). The CAM-ICU had a sensitivity of 71% (95% confidence interval [CI] 44-90%) and a specificity of 100% (95-100%). Disorientation, if taken as the only delirium feature, had a sensitivity of 77% (50-93%) and a specificity of 93% (89-100%). The CAM-IMC reached a sensitivity of 88% (64-99%) and a specificity of 100% (95-100%). The receiver operating characteristics (ROC) analyses found an area under the curve (AUC) of 0.941 (95%CI 0.851-1.000) for the CAM-IMC, which was the highest compared to the other delirium tests (CAM-ICU, AUC 0.853 [0.720-0.986]; disorientation, AUC 0.868 [0.745-0.991]). This research emphasizes the importance of the feature "disorientation" for delirium assessments in patients able to verbally communicate and explains some controversial delirium ratings in daily practice. The CAM-IMC appears to be an attractive tool for delirium assessment in nonintubated patients and deserves further research., (© 2021. The Author(s).)