[German Prevention Programs for Eating Disorders - A Systematic Review]. / Deutschsprachige Präventionsprogramme für Essstörungen ­ Ein systematisches Review.

In the past years a considerable amount of primary and secondary prevention programs for eating disorders was developed in German speaking countries. However, up to now there has been no systematic review of contents and evaluation studies. The main objective of the present systematic review is to identify and outline German prevention programs for eating disorders. This should facilitate the selection of appropriate and effective interventions for medical experts, other professionals and teachers. A systematic literature research was conducted and 22 German-language primary and secondary prevention programs were identified. Half of them were evaluated. The programs were conducted either in school, on the internet or in a group setting. The findings show that throughout almost all programs a reduction in weight and shape concerns and drive for thinness as well as an increase of (body) self-esteem could be observed in either the total sample or the high-risk sample. However, programs were inconsistently effective in reducing disordered eating behavior in the target population. All studies were effective in reducing at least one risk factor. Overall, higher effect sizes were found for secondary prevention programs than for primary prevention programs. Lastly, limitations of the studies and suggestions for future prevention efforts are discussed.

Health and health risk behaviour of adolescents-Differences according to family structure. Results of the German KiGGS cohort study.

OBJECTIVE: This study's aim was to investigate the association between family structure and different health-related outcomes in adolescence (self-rated health, emotional and behavioural problems, health-related quality of life, regular smoking, and heavy episodic drinking). Furthermore, we analysed the extent to which socio-economic status, family cohesion and the pre-transition health status explain family structure-related health disparities. METHODS: We used longitudinal data from the first two waves of the German KiGGS cohort study carried out by the Robert Koch Institute (baseline: 2003-2006, follow-up: 2009-2012). The sample comprised 4,692 respondents aged 11 to 17 years. Using data from both waves, effects of family structure on health status at follow-up were calculated applying linear and logistic regression models. RESULTS: We found that adolescents continuously living with both birth parents were in good health. Adolescents whose parents separated after the baseline survey, reported poorer health and were more likely to smoke. The transition from stepfamily to single parent family was also associated with a higher risk of regular smoking. Lower health-related quality of life as well as higher scores for emotional and behavioural problems occurred in almost all non-nuclear family structures, although not all effects were statistically significant. No significant effects of family structure on heavy episodic drinking were found. While family cohesion mediated the effects of family structure on adolescents' health, the mediating effect of socio-economic status was small. After controlling for pre-transition health, the effects were even lower. CONCLUSIONS: Because the direct effects of family structure on adolescents' health were small and family cohesion was found to be an important mediator in the association between family structure and adolescents' health, prevention programmes and interventions should be directed towards the parent-adolescent relationship rather than just the family structure, in order to minimize the psychosocial stress of adolescents during the period of family transition.

DNA double-strand breaks in blood lymphocytes induced by two-day 99mTc-MIBI myocardial perfusion scintigraphy.

OBJECTIVES: To investigate DNA double-strand breaks (DSBs) in blood lymphocytes induced by two-day 99mTc-MIBI myocardial perfusion scintigraphy (MPS) using y-H2AX immunofluorescence microscopy and to correlate the results with 99mTc activity in blood samples. METHODS: Eleven patients who underwent two-day MPS were included. DSB blood sampling was performed before and 5min, 1h and 24h after the first and second radiotracer injections. 99mTc activity was measured in each blood sample. For immunofluorescence microscopy, distinct foci representing DSBs were quantified in lymphocytes after staining for the phosphorylated histone variant y-H2AX. RESULTS: The 99mTc-MIBI activity measured on days one and two was similar (254±25 and 258±27 MBq; p=0.594). Compared with baseline DSB foci (0.09±0.05/cell), a significant increase was found at 5min (0.19±0.04/cell) and 1h (0.18±0.04/cell) after the first injection and at 5min and 1h after the second injection (0.21±0.03 and 0.19±0.04/cell, respectively; p=0.003 for both). At 24h after the first and second injections, the number of DSB foci had returned to baseline (0.06±0.02 and 0.12±0.05/cell, respectively). 99mTc activity levels in peripheral blood samples correlated well with DSB counts (r=0.451). CONCLUSIONS: DSB counts reflect 99mTc-MIBI activity after injection for two-day MPS, and might allow individual monitoring of biological effects of cardiac nuclear imaging. KEY POINTS: • Myocardial perfusion scintigraphy using 99mTc induces time-dependent double-strand breaks (DSBs) • γ-H2AX immunofluorescence microscopy shows DSB as an early response to radiotracer injection • Activity measurements of 99mTc correlate well with detected DSB • DSB foci induced by 99mTc return to baseline 24h after radiotracer injection.

[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.

[Brief Instruments in German for the Assessment of Disordered Eating]. / Deutschsprachige Kurzskalen zur Erfassung auffälligen Essverhaltens.

The development of brief instruments is an important area in the clinical and psychological assessment in the past years. Brief instruments reveal many advantages due to their efficiency and shortness for the users. However, the psychometric standards of development and validation were often neglected during the construction of short forms. The current overview presents 6 brief instruments for the assessment of disordered eating and eating disorders in German: Eating Attitudes Test 8 (EAT-8), Eating Disorder Examination-Questionnaire 8 (EDE-Q8) and the child version (ChEDE-Q8), ICD-10-Symptom-Rating subscale eating disorders (ISR-E), SCOFF questionnaire, and Short Evaluation of Eating Disorders (SEED). Furthermore, recent validation studies were summarized. Users should be aware about the fact that every brief instrument is validated for specific purpose and population. Therefore, aim of the present overview is to help the reader choosing the appropriate brief instrument for the intended purpose and population.

[Psychiatric and Somatic Comorbidities of Eating Disorders and Obesity in Female Adolescent and Adult Inpatients]. / Häufigkeit von Komorbiditäten bei der stationären Behandlung von Essstörungen und Adipositas bei Mädchen und jungen Frauen.

Objective The main aim of this study was to determine the prevalence of somatic and psychiatric comorbidities in female inpatients diagnosed with an eating disorder or obesity. Methods Statutory health insurance data (11 - 25 years, N = 1269) was analysed. Results The most frequent comorbidities for both groups were affective, neurotic, stress-related and somatoform as well as personality disorders and diseases of the digestive system. Conclusion Close to half of the patients diagnosed with an eating disorder suffered from psychiatric comorbidities. The majority of obese patients were diagnosed with somatic comorbidities.

Screening disordered eating in a representative sample of the German population: Usefulness and psychometric properties of the German SCOFF questionnaire.

The prevention of eating disorders and the identification of high-risk individuals are essential for the public health sector. There is need for sensitive and specific screening instruments of disordered eating that can be applied in universal samples as an initial step into disease prevention. The SCOFF is a screening instrument for disordered eating, frequently used in international and cross-cultural contexts to detect individuals at risk. The objective of this research is to evaluate whether the SCOFF can be used as a screening tool for disordered eating in universal samples. This is the first study which examined the psychometric properties of the German version of the SCOFF in a general population sample. A representative sample (N=2527) of the German population, aged 14-95years, was recruited. Psychometric properties were determined including reliability, concurrent and construct validity, and factor structure. The prevalence of disordered eating was assessed. The prevalence of disordered eating in the general population was 10%. Using the established cutoff point of ≥2, values for diagnostic accuracy were 26% (sensitivity), 97% (specificity), 80% (positive predictive value), and 74% (negative predictive value). Factorial analyses revealed an excellent model fit of a unidimensional model. Due to its low sensitivity and a high percentage of false negatives, there are limitations in using the German version of the SCOFF in general population samples with wide age ranges.

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.

Supervisors' perspective on medical thesis projects and dropout rates: survey among thesis supervisors at a large German university hospital.

OBJECTIVES: To identify underlying causes for failure of medical thesis projects and the constantly high drop-out rate in Germany from the supervisors' perspective and to compare the results with the students' perspective. SETTING: Cross-sectional survey. Online questionnaire for survey of medical thesis supervisors among the staff of Charité-Universitätsmedizin Berlin, Germany. Published, earlier longitudinal survey among students for comparison. PARTICIPANTS: 1069 thesis supervisors participated. DATA EXTRACTION AND SYNTHESIS: Data are presented using descriptive statistics, and the χ2 test served to compare the results among supervisors with the earlier data from the longitudinal survey of doctoral students. PRIMARY AND SECONDARY OUTCOMES: Not applicable. This survey is an observational study. RESULTS: Of 3653 potential participants, 1069 (29.3%) supervising 3744 doctoral candidates participated in the study. Supervisors considered themselves to be highly motivated and to offer adequate supervision. On the other hand, 87% stated that they did not feel well prepared for thesis supervision. Supervisors gave lack of timeliness of doctoral students and personal differences (p=0.024 and p=0.001) as the main reasons for terminating thesis projects. Doctoral students predominantly mentioned methodological problems and difficult subjects as critical issues (p=0.001 and p<0.001). Specifically, students felt ill prepared for the statistical part of their research-49.5% stated that they never received statistical assistance, whereas 97% of supervisors claimed to help their students with statistical analysis. CONCLUSIONS: The authors found that both thesis supervisors and medical students feel ill prepared for their roles in the process of a medical dissertation. Contradictory reasons for terminating medical thesis projects based on supervisors' and students' self-assessment suggest a lack of communication and true scientific collaboration between supervisors and doctoral students as the major underlying issue that requires resolution.

Psychometric properties of a short version of the Eating Attitudes Test (EAT-8) in a German representative sample.

PURPOSE: Disordered eating is common for all ages and sexes in the general population. However, only some individuals are known to develop clinically relevant eating disorders. There is a critical need of efficient, reliable and valid screening instruments to measure disordered eating for the general population. The Eating Attitudes Test was shortened into an 8-item-version to screen individuals at high risk of developing clinical eating disorders in a general population sample. METHODS: Psychometric properties (Cronbach's α, construct and concurrent validity and factor structure), cutoff scores (with sensitivity, specificity, positive and negative predictive value) and norms were determined in a representative sample of the German population (N=2527). Factorial validity was investigated using item response modeling. RESULTS: Results confirmed reliability and validity of the questionnaire. Internal consistency and convergent validity were good. Analysis revealed different cutoff points for male and female participants. Values for sensitivity and specificity were satisfying and the positive predictive value was higher compared to other short screening instruments for disordered eating. Factorial analysis revealed a one-factor solution with an excellent model fit. The elimination of one item was discussed. Gender- and age-specific norms are reported. CONCLUSIONS: Overall results indicated that the EAT-8 is an efficient instrument suitable for screening purposes in large general population samples.

The Impact of Different Levels of Adaptive Iterative Dose Reduction 3D on Image Quality of 320-Row Coronary CT Angiography: A Clinical Trial.

PURPOSE: The aim of this study was the systematic image quality evaluation of coronary CT angiography (CTA), reconstructed with the 3 different levels of adaptive iterative dose reduction (AIDR 3D) and compared to filtered back projection (FBP) with quantum denoising software (QDS). METHODS: Standard-dose CTA raw data of 30 patients with mean radiation dose of 3.2 ± 2.6 mSv were reconstructed using AIDR 3D mild, standard, strong and compared to FBP/QDS. Objective image quality comparison (signal, noise, signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), contour sharpness) was performed using 21 measurement points per patient, including measurements in each coronary artery from proximal to distal. RESULTS: Objective image quality parameters improved with increasing levels of AIDR 3D. Noise was lowest in AIDR 3D strong (p ≤ 0.001 at 20/21 measurement points; compared with FBP/QDS). Signal and contour sharpness analysis showed no significant difference between the reconstruction algorithms for most measurement points. Best coronary SNR and CNR were achieved with AIDR 3D strong. No loss of SNR or CNR in distal segments was seen with AIDR 3D as compared to FBP. CONCLUSIONS: On standard-dose coronary CTA images, AIDR 3D strong showed higher objective image quality than FBP/QDS without reducing contour sharpness. TRIAL REGISTRATION: Clinicaltrials.gov NCT00967876.

[Factoranalytic Structure of a Short Version of the Eating Attitudes Test (EAT-13) and Prevalences of Disordered Eating in a Representative German Sample.] / Faktoranalyse einer Kurzversion des Eating Attitudes Tests (EAT-13) und Prävalenzen gestörten Essverhaltens in einer repräsentativen deutschen Bevölkerungsstichprobe.

Early detection of disordered eating behavior is a first hint to prevent clinically relevant eating disorders. Screening instruments are aimed at detecting disordered eating behavior at an early stage, to identify risk groups and as necessary initiate treatment. The EAT-13 is an economic screening instrument (13 items), that allows identification of risk groups in big unselected samples with help of determination of sum score. Factorial validity of the EAT-13 and the suitability for different ages were determined in a representative sample of the German population (N=2 508). Furthermore prevalence of disordered eating behavior was assessed in the sample. Results show that the EAT-13 is a reliable and economic screening instrument that is eligible to select risk groups. An inspection of criterion validity shall be conducted in further studies.

Contrast agent bolus tracking with a fixed threshold or a manual fast start for coronary CT angiography.

OBJECTIVES: Comparison of bolus tracking with a fixed threshold versus a manual fast start for coronary CT angiography. METHODS: We retrospectively analysed 320-row coronary CT angiography of 50 patients with suspected or known coronary artery disease. Twenty-five examinations were initiated by a bolus tracking method (group 1), 25 examinations with a manual fast surestart (group 2). RESULTS: Mean attenuation values in the ascending aorta were 519 ± 111 Hounsfield units (HU) in group 1 and 476 ± 65 HU in group 2 (p = 0.10). Assessable vessel lengths were 171 ± 44 mm vs 172 ± 29 mm for the right coronary artery (p = 0.91), 11 ± 4 mm vs 12 ± 4 mm for the left main (p = 0.9), 163 ± 28 mm vs 151 ± 26 mm for the left anterior descending coronary artery (p = 0.11) and 125 ± 41 mm vs 110 ± 37 mm for the left circumflex coronary artery (p = 0.18). Image quality for all coronary arteries was not significantly different between the groups (p > 0.41). The attenuation ratio between the left and right ventricle was 2.8 ± 0.7 vs 3.6 ± 1.0 (p = 0.003). Significantly less contrast agent was used in group 2 (64 ± 6 ml vs 80 ± 0 ml; p < 0.001). CONCLUSIONS: Bolus tracking with a fixed threshold and with a manual fast start are both suitable methods; the fast start allowed a reduction of contrast agent volumes. KEY POINTS: Fixed threshold bolus tracking is suitable for coronary 320-row CT angiography. Manual fast start bolus tracking can reduce contrast agent volumes. Manual fast start and fixed threshold initiation achieve good image quality. Fixed threshold bolus tracking achieves a more reliable contrast bolus position.