Baseline participation in a health examination survey of the population 65 years and older: who is missed and why?

BACKGROUND: Public health monitoring depends on valid health and disability estimates in the population 65+ years. This is hampered by high non-participation rates in this age group. There is limited insight into size and direction of potential baseline selection bias. METHODS: We analyzed baseline non-participation in a register-based random sample of 1481 inner-city residents 65+ years, invited to a health examination survey according to demographics available for the entire sample, self-report information as available and reasons for non-participation. One year after recruitment, non-responders were revisited to assess their reasons. RESULTS: Five groups defined by participation status were differentiated: participants (N = 299), persons who had died or moved (N = 173), those who declined participation, but answered a short questionnaire (N = 384), those who declined participation and the short questionnaire (N = 324), and non-responders (N = 301). The results confirm substantial baseline selection bias with significant underrepresentation of persons 85+ years, persons in residential care or from disadvantaged neighborhoods, with lower education, foreign citizenship, or lower health-related quality of life. Finally, reasons for non-participation could be identified for 78% of all non-participants, including 183 non-responders. CONCLUSION: A diversity in health problems and barriers to participation exists among non-participants. Innovative study designs are needed for public health monitoring in aging populations.

Cognitive Function in Adolescent Patients with Anorexia Nervosa and Unipolar Affective Disorders.

Studies have shown impairments in cognitive function among adult patients with anorexia nervosa (AN) and affective disorders (AD). The association between cognitive dysfunctions, AN and AD as well as the specificity for these psychiatric diagnoses remains unclear. Therefore, we examined cognitive flexibility and processing speed in 47 female adolescent patients with AN, 21 female adolescent patients with unipolar affective disorders and 48 female healthy adolescents. All participants completed a neuropsychological test battery. There were no significant group differences regarding cognitive function, except for psychomotor processing speed with poorer performance in patients with AN. A further analysis revealed that all groups performed with the normal range, although patients with AN were over represented in the poorest performing quartile. We found no severe cognitive impairments in either patient group. Nevertheless, belonging to the AN group contributed significantly to poor performances in neuropsychological tasks. Therefore, we conclude that the risk for cognitive impairments is slightly higher for patients with AN.

'We can do only what we have the means for' general practitioners' views of primary care for older people with complex health problems.

BACKGROUND: Due to demographic change, general practitioners (GPs) are increasingly required to care for older people with complex health problems. Little is known about the subjective appraisals of GPs concerning the demanded changes. Our objective is to explore how general practitioners view their professional mandates and capacities to provide comprehensive care for older people with complex health problems. Do geriatric training or experience influence viewpoints? Can barriers for the implementation of changes in primary care for older people with complex health problems be detected? METHODS: Preceding a controlled intervention study on case management for older patients in the primary care setting (OMAHA II), this qualitative study included 10 GPs with differing degrees of geriatric qualification. Semi structured interviews were conducted and audio-taped. Full interview transcripts were analyzed starting with open coding on a case basis and case descriptions. The emerging thematic structure was enriched with comparative dimensions through reiterated inter-case comparison and developed into a multidimensional typology of views. RESULTS: Based on the themes emerging from the data and their presentation by the interviewed general practitioners we could identify three different types of views on primary care for older people with complex health problems: 'maneuvering along competence limits', 'Herculean task', and 'cooperation and networking'. The types of views differ in regard to role-perception, perception of their own professional domain, and action patterns in regard to cooperation. One type shows strong correspondence with a geriatrician. Across all groups, there is a shared concern with the availability of sufficient resources to meet the challenges of primary care for older people with complex health problems. CONCLUSIONS: Limited financial resources, lack of cooperational networks, and attitudes appear to be barriers to assuring better primary care for older people with complex health problems. To overcome these barriers, geriatric training is likely to have a positive impact but needs to be supplemented by regulations regarding reimbursement. Most of all, general practitioners' care for older people with complex health problems needs a conceptual framework that provides guidance regarding their specific role and contribution and assisting networks. For example, it is essential that general practice guidelines become more explicit with respect to managing older people with complex health problems.

Clinically relevant depressive symptoms in young stroke patients - results of the sifap1 study.

BACKGROUND: Although post-stroke depression is widely recognized, less is known about depressive symptoms in the acute stage of stroke and especially in young stroke patients. We thus investigated depressive symptoms and their determinants in such a cohort. METHODS: The Stroke in Young Fabry Patients study (sifap1) prospectively recruited a large multinational European cohort (n = 5,023) of patients with a cerebrovascular event aged 18-55. For assessing clinically relevant depressive symptoms (CRDS, defined by a BDI-score ≥18) the self-reporting Beck Depression Inventory (BDI) was obtained on inclusion in the study. Associations with baseline parameters, stroke severity (National Institutes of Health Stroke Scale, NIHSS), and brain MRI findings were analyzed. RESULTS: From the 2007 patients with BDI documentation, 202 (10.1%) had CRDS. CRDS were observed more frequently in women (12.6 vs. 8.2% in men, p < 0.001). Patients with CRDS more often had arterial hypertension, diabetes mellitus, and hyperlipidemia than patients without CRDS (hypertension: 58.0 vs. 47.1%, p = 0.017; diabetes mellitus: 17.9 vs. 8.9%, p < 0.001; hyperlipidemia: 40.5 vs. 32.3%, p = 0.012). In the subgroup of patients with ischemic stroke or TIA (n = 1,832) no significant associations between CRDS and cerebral MRI findings such as the presence of acute infarcts (68.1 vs. 65.8%, p = 0.666), old infarctions (63.4 vs. 62.1%, p = 0.725) or white matter hyper-intensities (51.6 vs. 53.7%, p = 0.520) were found. CONCLUSION: Depressive symptoms were present in 10.1% of young stroke patients in the acute phase, and were related to risk factors but not to imaging findings.

[Case management studies for individuals 65 years and older in Germany: Systematic review of the currently published state of research]. / "Case-management"-Studien für Personen ab 65 Jahren in Deutschland : Systematische Übersicht zum aktuell publizierten Forschungsstand.

BACKGROUND: The aim of this systematic review was to provide an overview on the current state of published research on case management (CM) according to the definition of the German Association of Care and Case Management (DGCC) for individuals 65 years and older in Germany. MATERIAL AND METHODS: A systematic literature search was carried out for CM studies according to the DGCC in Germany since 2000 including individuals aged 65 years and older. RESULTS: Of the 249 abstracts retrieved a total of 14 evaluation and intervention studies of 10 different projects fulfilled the inclusion criteria. According to the results of the five evaluation studies, CM was feasible and barriers to implementation as well as satisfaction and positive effects of CM were described. The quality and outcome criteria of the intervention studies were heterogeneous. The results of the intervention studies can be interpreted as CM having positive effects on, for example hospital admissions and mortality. CONCLUSION: Only few and qualitatively heterogeneous studies are currently available on the intervention effects of CM in Germany among this age group. So far robust scientific evidence of this method in Germany seems to be lacking.

[Quality of life and health - individual perspectives of nursing home residents who were able to answer questions - a qualitative research]. / Lebensqualität und Gesundheit - Subjektive Perspektiven von selbstauskunftsfähigen Pflegeheimbewohnern - eine qualitative Studie.

BACKGROUND: A fundamental aim of social science and for practitioners is the improvement of the quality of life of inpatients residing in long term care homes. Health, as a vital part of quality of life, gains in subjective importance with rising age. AIM: This paper aims to analyse the aspects of «Intact mental abilities¼ and "Mobility" thorough in terms of the subjective quality of life of nursing home residents. MATERIALS AND METHOD: nine male and 33 female inpatients of eight independent nursing homes within Berlin and surrounding regions have been interviewed using narrative guidance questions. The interviewees were selected by the interviewer participating in their day to day life and through the means of direct conversations with the respective persons. The following analysis is based on Bohnsack's documentary method. RESULTS: Findings suggest that it is important for the interviewees to retain their mental abilities up until old age to be capable of acting autonomously and independently controlling their own life. The respondents not only perceive the loss of their own cognitive abilities as problematic, but also that of their cohabitants, as such impedes social contacts. Another key component of well-being deems to be the ability "to walk", in other words, mobility is basis for retaining self-determination and facilitates to participate in activities within the nursing homes. CONCLUSION: Nursing home residents should receive tailored support in cognitive abilities. In addition, interested residents should receive enhanced information about the disease of dementia. The mobility should be largely preserved more close to everyday life movement offers available towards the residents.

MRI in acute cerebral ischemia of the young: the Stroke in Young Fabry Patients (sifap1) Study.

OBJECTIVE: We focused on cerebral imaging findings in a large cohort of young patients with a symptomatic ischemic cerebrovascular event (CVE) to extract relevant pathophysiologic and clinical information. METHODS: We analyzed the scans of 2,979 patients (aged 18-55 years) enrolled in the sifap1 project with clinical evidence of ischemic stroke (IS) or clinically defined TIA in whom MRI, including diffusion-weighted imaging, was obtained within 10 days of the CVE. Age groups were categorized as 18-34, 35-44, and 45-55 years. We compared age- and sex-specific proportions of infarct features, white matter hyperintensities, and old microbleeds. RESULTS: Acute infarcts were identified in 1,914 of 2,264 patients (84.5%) with IS and 101 of 715 patients (14.1%) with TIA. Among patients with IS, younger age was significantly associated with acute infarcts in the posterior circulation, while anterior circulation infarcts and acute lacunar infarcts were more frequent in older age groups. One or more old infarcts were present in 26.8% of IS and 17.1% of TIA patients. This rate remained high even after excluding patients with a prior CVE (IS, 21.7%; TIA, 9.9%). The prevailing type of old infarction was territorial in patients younger than 45 years and lacunar in those aged 45 years or older. The frequency of white matter hyperintensities (46.4%) and their severity was positively associated with age. Old microbleeds were infrequent (7.2%). CONCLUSIONS: Young adults show a high frequency of preexisting and clinically silent infarcts and a relative preference for acute ischemia in the posterior circulation. Findings suggesting small-vessel disease become apparent at age 45 years and older.

Headache as a symptom at stroke onset in 4,431 young ischaemic stroke patients. Results from the "Stroke in Young Fabry Patients (SIFAP1) study".

Headache as symptom of stroke is linked to gender, history of migraine, younger age, cerebellar stroke, and low blood pressure. These associations have been controversial, large scale studies are missing. We used the stroke in young fabry patients study to examine the association of demographic, clinical and imaging factors with the occurrence of headache in 4,431 young ischaemic stroke patients (18-55 years; mean: 44.7 years) with an ischemic cerebrovascular event (CVE) (ischemic stroke-IS 75.9%, TIA 24.1%). Headache in males occurred more frequently in bilateral localisation (right/left/bilateral: 27.5, 24.6, 39.2%, p < 0.01), but not in females (40.3, 34.7, 39.6%). Headache occurrence was more often associated in both genders with IS or TIA in the posterior cerebral territory (male: 33.2%, p < 0.05; female: 51.0%, p < 0.01) and vertebrobasilar arteries (male: 44.8%, p < 0.001; female: 51.2%, p < 0.001). The larger the size of the most prominent lesion the more likely patients were complaining headache during the IS (≤1 cm vs. >half lobe: 19.5 vs. 28.4% in male, p < 0.001; 28.9 vs. 39.1% in female, p < 0.01). Binary logistic regression analyses revealed lower age (p < 0.001), female sex (p < 0.001), larger size of the largest lesion (p < 0.001), and localization in the vertebrobasilar territory (p < 0.001) as predictors for headache during CVE. Headache at stroke onset is more common during IS in females, younger patients, with greater size of the acute lesion, and affected in posterior cerebral artery or vertebrobasilar system. Headache is a leading symptom in specific combination of stroke factors. These factors should be taken into account when patients report headache during IS or TIA.

Quality of life in nursing homes: results of a qualitative resident survey.

PURPOSE: The growing importance of residential nursing care has been accompanied by an increasing demand for instruments measuring quality of life in nursing homes. Quality of life is a complex construct with both subjective and objective aspects that does not lend itself to being determined by a single measure. The aim of this study was therefore to identify dimensions of life that nursing home residents perceive as having a particular impact on their overall quality of life. METHODS: Data were obtained from 9 men and 33 women from eight nursing homes by means of semi-structured narrative interviews. The interviews were analyzed using the documentary method. RESULTS: Ten central dimensions of subjective quality of life were derived from the interview data: social contacts, self-determination and autonomy, privacy, peace and quiet, variety of stimuli and activities, feeling at home, security, health, being kept informed, and meaningful/enjoyable activity. Some of these dimensions are multifaceted and have further subdimensions. CONCLUSION: The aspects emerging as relevant to residents' subjective quality of life extend far beyond care- and health-related aspects. Nevertheless, some of the quality of life dimensions reconstructed are within the direct influence of the home (e.g., variety of stimuli and activities or being kept informed) and can possibly be improved by attending to the residents' objective situation.

Acute cerebrovascular disease in the young: the Stroke in Young Fabry Patients study.

BACKGROUND AND PURPOSE: Strokes have especially devastating implications if they occur early in life; however, only limited information exists on the characteristics of acute cerebrovascular disease in young adults. Although risk factors and manifestation of atherosclerosis are commonly associated with stroke in the elderly, recent data suggests different causes for stroke in the young. We initiated the prospective, multinational European study Stroke in Young Fabry Patients (sifap) to characterize a cohort of young stroke patients. METHODS: Overall, 5023 patients aged 18 to 55 years with the diagnosis of ischemic stroke (3396), hemorrhagic stroke (271), transient ischemic attack (1071) were enrolled in 15 European countries and 47 centers between April 2007 and January 2010 undergoing a detailed, standardized, clinical, laboratory, and radiological protocol. RESULTS: Median age in the overall cohort was 46 years. Definite Fabry disease was diagnosed in 0.5% (95% confidence interval, 0.4%-0.8%; n=27) of all patients; and probable Fabry disease in additional 18 patients. Males dominated the study population (2962/59%) whereas females outnumbered men (65.3%) among the youngest patients (18-24 years). About 80.5% of the patients had a first stroke. Silent infarcts on magnetic resonance imaging were seen in 20% of patients with a first-ever stroke, and in 11.4% of patients with transient ischemic attack and no history of a previous cerebrovascular event. The most common causes of ischemic stroke were large artery atherosclerosis (18.6%) and dissection (9.9%). CONCLUSIONS: Definite Fabry disease occurs in 0.5% and probable Fabry disease in further 0.4% of young stroke patients. Silent infarcts, white matter intensities, and classical risk factors were highly prevalent, emphasizing the need for new early preventive strategies. Clinical Trial Registration Information- URL: http://www.clinicaltrials.gov.Unique identifier: NCT00414583.

Validation of a new patient-generated questionnaire for quality of life in an urban sample of elder residents.

PURPOSE: To provide evidence for the validity of the Fragebogen zur Lebensqualität multimorbider älterer Menschen (FLQM; English: Quality of life in elders with multimorbidity), a new tool for the assessment of life-satisfaction as a subjective indicator of quality of life in old age. METHODS: The FLQM measures overall life-satisfaction based on those self-generated domains in life that are most important to the respondent. Construct validity (correlations with convergent and divergent scales) and differential validity (subgroup differences with respect to age and limitations in everyday functioning) were analyzed in an urban sample of older adults (n = 299; 54.6% male; Mean (age) = 75.65 years, SD = 6.57). RESULTS: Correlations of FLQM with measures of similar constructs were close (r = 0.35-0.50; p < 0.001). There were no age-group differences. However, subjects with self-reported impairment in functioning scored significantly lower on the FLQM. Also, the relationship between FLQM and self-rated health was close (r = 0.44; p < 0.001). CONCLUSIONS: The FLQM is a valid assessment of older peoples' life-satisfaction. The focus on domains of utmost individual importance seems to link the FLQM to self-rated health more closely than other ratings of global life-satisfaction. Further investigation into the qualitative information obtained by the FLQM is desirable in order to explain individual compositions of life-satisfaction and overall quality of life.

Encouraging experience with intracardiac transplantation of unselected autologous bone marrow cells concomitant with coronary artery bypass surgery after myocardial infarction.

BACKGROUND: Chronic heart failure after myocardial infarction is still a serious problem without a fundamental therapy. Experimental transplantation of bone marrow cells (BMC) into infarcted myocardium resulted in regeneration and functional improvement. OBJECTIVE: Clinical investigation of safety and efficacy of intracardiac transplantation of unselected autologous BMC. METHOD: 22 patients scheduled for elective and isolated coronary artery bypass grafting (CABG) with a reduced LVEF due to myocardial infarction were included. Intraoperatively, sternal bone marrow blood was aspirated, and a sterile buffy coat was prepared and applicated. 19 age, LVEF and coronary disease matched patients served as controls. Heart function, geometry, and scar proportion were assessed by echocardiography and Gadolinium-MRI at the time of the operation and 6 months thereafter. RESULTS: Transplanted patients received a mean number of 360 × 106 BMC. We did not notice any significant differences in early or late complications in the transplant group as compared to controls. At six months follow up only the transplanted patients showed a significant improvement of NYHA classes from 2.7 to 1.5 and of LVEF from 36 to 43 %, (p < 0.05). Furthermore, only CABG concomitant with BMC-TX led to a significant reduction of left ventricular end diastolic diameter (LVEDD) from 59 to 54 mm and of scar proportion of the infarcted segments from 2.53 to 2.42, (p < 0.05). CONCLUSION: Intracardiac transplantation of unselected, autologous BMC is safe and feasible. In adjunct with coronary revascularization it leads to an improvement of ventricular geometry and function. Moreover, it reduces myocardial scar proportion and heart failure symptoms.

Operationalizing multimorbidity and autonomy for health services research in aging populations--the OMAHA study.

BACKGROUND: As part of a Berlin-based research consortium on health in old age, the OMAHA (Operationalizing Multimorbidity and Autonomy for Health Services Research in Aging Populations) study aims to develop a conceptual framework and a set of standardized instruments and indicators for continuous monitoring of multimorbidity and associated health care needs in the population 65 years and older. METHODS/DESIGN: OMAHA is a longitudinal epidemiological study including a comprehensive assessment at baseline and at 12-month follow-up as well as brief intermediate telephone interviews at 6 and 18 months. In order to evaluate different sampling procedures and modes of data collection, the study is conducted in two different population-based samples of men and women aged 65 years and older. A geographically defined sample was recruited from an age and sex stratified random sample from the register of residents in Berlin-Mitte (Berlin OMAHA study cohort, n = 299) for assessment by face-to-face interview and examination. A larger nationwide sample (German OMAHA study cohort, n = 730) was recruited for assessment by telephone interview among participants in previous German Telephone Health Surveys. In both cohorts, we successfully applied a multi-dimensional set of instruments to assess multimorbidity, functional disability in daily life, autonomy, quality of life (QoL), health care services utilization, personal and social resources as well as socio-demographic and biographical context variables. Response rates considerably varied between the Berlin and German OMAHA study cohorts (22.8% vs. 59.7%), whereas completeness of follow-up at month 12 was comparably high in both cohorts (82.9% vs. 81.2%). DISCUSSION: The OMAHA study offers a wide spectrum of data concerning health, functioning, social involvement, psychological well-being, and cognitive capacity in community-dwelling older people in Germany. Results from the study will add to methodological and content-specific discourses on human resources for maintaining quality of life and autonomy throughout old age, even in the face of multiple health complaints.

Protocol and methodology of the Stroke in Young Fabry Patients (sifap1) study: a prospective multicenter European study of 5,024 young stroke patients aged 18-55 years.

BACKGROUND: Stroke in the young has not been thoroughly investigated with most previous studies based on a small number of patients from single centers. Furthermore, recent reports indicate that Fabry disease may be a significant cause for young stroke. The primary aim of our study was to determine the prevalence of Fabry disease in young stroke patients, while the secondary aim was to describe patterns of stroke in young patients. METHODS: We initiated the Stroke in Young Fabry Patients (sifap1) study as a multinational prospective European study of stroke patients aged 18-55 years and collected a broad range of clinical, laboratory, and radiological data using stringent standardized methods. All patients were tested for Fabry disease and blood was stored for future genetic testing. RESULTS: We managed to enroll 5,024 eligible young stroke patients in 15 countries and 47 centers across Europe between April 2007 and January 2010. The median number of patients included per center was 98 with a range between 8 and 315. The average duration of patient recruitment per center was 22 months, ranging between 5 and 33 months. The database was closed in July 2010. This paper describes protocol and methodology of the sifap1 study. CONCLUSION: The sifap1 study included the largest series of young stroke patients so far and will allow for analyses on a large number of aspects of stroke in the young.

[Psychometric properties of the Eating Disorder Inventory (EDI-2) in adolescents]. / Psychometrische Gütekriterien des Eating Disorder Inventory (EDI-2) bei Jugendlichen.

The present study examines the psychometric properties of the German version of the Eating Disorder Inventory EDI-2 (1997) in 371 adolescents aged 13 to 18 years. Internal consistency, convergent and divergent validity were examined and a confirmatory factor analysis was conducted. Internal consistency was high for the group of patients and satisfactory for both control groups. Associations with other clinical instruments point in the expected direction and support the external validity of the EDI-2. The EDI-2 differentiated very well between the group of eating disorder patients (n=71) and the female (n=150) and male control groups (n=150). A discriminant analysis demonstrated that 86.0% of the cases were correctly classified, and a confirmatory factor analysis largely supported the six-factor structure generated by the German version of the EDI-2 (Thiel et al., 1997).

Individualized measurement of quality of life in older adults: development and pilot testing of a new tool.

We describe theoretical background, development, and piloting of a measure for quality of life in older adults that specifically takes into account the subjective perspective. Although quality of life is usually subjectively assessed, normative thresholds for "the good life" are most often set by a third party. The new tool FLQM asks for respondents to name, rate, and weight those domains in life that are most important for their life-satisfaction solely from their own point of view. Construct validity was pilot-tested in two samples of elders (N1 = 44; N2 = 90). Correlations were in the medium range in both studies and support the questionnaire's validity. There were no age or gender differences on total score. However, in Study 1 as well as in Study 2 older subjects named significantly fewer domains than did younger participants. Further, in Study 1 the overall number of distinct domains generated by the participants diminished with age-the "interindividual pool of domains" shrank. Implications of this age-associated narrowing of domainscope are discussed on a background of adaptation theories. Concluding, the new questionnaire seems apt to assess older peoples' quality of life even in a physically very ill population, but needs further testing, especially regarding its reliability. This is currently being undertaken in a larger longitudinal sample to assure psychometric properties.

Effect of the first night shift period on sleep in young nurse students.

In young hospital nurses being exposed to a night shift work schedule for the first time in their occupational life, sleep quality is investigated quantitatively. A main sleep period and supplementary sleep periods were defined and analyzed to investigate sleep behavior and quality. A total of 30 young nurses (26 women, 4 men), mean age 20.2 +/- 2.1 years participated. A 3 week nursing school period was followed by a 3 week work period with a 3-5 night shift sub-period and recovery days. Sleep-wake behavior was assessed with an actigraph, sleep diaries, Epworth sleepiness scale (ESS), and quality of life was assessed with a standard questionnaire (SF-36). Comparing the school period with the work shift period when excluding recovery days after night shift period significant increase of total sleep time within 24 h was found during the work days (ANOVA P < 0.05). During the night shift sub-period, there was just a small decline of the main sleep period at day (n.s.) which was not compensated by supplementary sleep episodes. The supplementary sleep during work day varied between 11 min (school period) and 18 min after recovery days from night shift (n.s.). Young healthy nurses tolerate the first night shift exposure very well, according to objective and subjective parameters related to quality of sleep. An increased sleep need during work days lead to longer total sleep time, but do not lead to longer supplementary sleep episodes. Young nurses tolerate the first rotating shift period and the first night shift period very well.

Sleep quality in professional ballet dancers.

Ballet dancers are competitive athletes who undergo extreme physical and mental stress and work according to an irregular schedule, with long days of training, rehearsal, and performance. Their most significant potential risks entail physical injury and altered sleep. The elaborate training requirements for ballet dancers do not allow regular chronobiological patterns or a normal sleep-wake rhythm. Our aim was to investigate the sleep-wake rhythm and sleep quality during rehearsal phases prior to a ballet premiere. We used wrist actigraphy and sleep diaries for a period of 67 days before the ballet premiere performance to study 24 classical ballet dancers. We likewise applied the Epworth Sleepiness Score (ESS), Pittsburgh Sleep Quality Index (PSQI), SF-12 Quality of life Assessment, and d2 Test of Attention to assess quality of sleep, aspects of cognitive performance, and health status. We found significant reduction in sleep duration, from 418+/-43 min to 391+/-42 min, and sleep efficiency, from 81+/-4% to 79+/-5%, over the 67-day course of the rehearsal. We also found a decline in time in bed and an increase in wakefulness after sleep onset. Sleep onset latency did not change. However, the changes in sleep as documented by actigraphy were not reflected by the subjective data of the sleep diaries and sleep scores. As a result of the facts that total sleep efficiency and sleep duration values were already lower than usual for the dancers' age group at the beginning of the study and that mental acuity, concentration, and speed were likewise impaired, we observed exacerbated health deterioration in terms of sleep deprivation in ballet dancers during preparation for a premier. We conclude that individual activity-rest schedules, including daytime naps, may be helpful, especially during the stressful training and rehearsal experienced prior to ballet premieres.

The German version of the Anorectic Behavior Observation Scale (ABOS).

OBJECTIVE: To assess the performance of the German version of the Anorectic Behavior Observation Scale (ABOS) as a parent-report screening instrument for eating disorders (ED) in their children. METHODS: Parents of 101 ED female patients (80 with Anorexia Nervosa; 21 with Bulimia Nervosa) and of 121 age- and socioeconomic status (SES)-matched female controls completed the ABOS. RESULTS: Confirmatory factor analysis supported the original three-factor structure model of the ABOS. Cronbach's alpha coefficients indicated good internal consistency for the three factors and the total score in the total sample. The best cut-off point (100% sensitivity and specificity) in the German version was >or=23. CONCLUSION: The ABOS may be a useful additional instrument for assessing ED.