Validation of the Internal Coherence Scale (ICS) in Healthy Geriatric Individuals and Patients Suffering from Diabetes Mellitus Type 2 and Cancer.

BACKGROUND: With increased life expectancy, the coexistence of functional impairment and multimorbidity can negatively impact life quality and coherence in geriatric individuals. The self-report 10-item Internal Coherence (ICS) measures how individuals cope with and make sense of disease-specific life challenges. The aim of this study was to validate the ICS in a sample of geriatric individuals. METHODS AND PROCEDURE: In a cross-sectional study, geriatric individuals with and without chronic diseases were recruited. A factor analysis with principal component extraction (PCA) and a structural equation model (SEM) was conducted to assess the ICS factor structure in a geriatric sample. To measure convergent validity, the following scales were used: Short Health Survey (SF-12), Karnofsky Performance Index (KPI), Trait autonomic regulation (Trait aR), Sense of Coherence Scale (SOC), and Geriatric Depression Scale (GDS). RESULTS: A sample of n = 104 (70-96 years of age) patients with Diabetes Mellitus Type 2 (n = 22), cancer diseases (n = 31) and healthy controls (n = 51) completed the ICS. PCA and SEM yielded the original two-factor solution: 1. Inner resilience and coherence and 2. Thermo coherence. Overall internal consistency for this cohort was satisfying (Cronbach's α with rα = 0.72), and test-retest reliability was moderate (rrt = 0.53). ICS scores were significantly correlated to all convergent criteria ranging between r = 0.22 * and 0.49 ** (p < 0.05 *; p < 0.01 **). CONCLUSION: Study results suggest that the ICS appears to be a reliable and valid tool to measure internal coherence in a geriatric cohort (70-96 years). However, moderate test-retest reliability prompts the consideration of potential age-effects that may bias the reliability for this specific cohort.

Stability of psychological wellbeing during the COVID-19 pandemic among people with an anthroposophical worldview: the influence of wondering awe and perception of nature as resources.

Background: During the COVID-19 pandemic, differences in responses and behaviors were observed among specific groups. We aimed to address how people with an anthroposophical worldview behaved with respect to the perception of burden, fears, and wellbeing. As it is an integral part of their lifestyle and convictions, we addressed the influence of wondering awe and gratitude and perception of nature and times of mindful quietness as resources to cope. Methods: In two cross-sectional surveys with standardized instruments, participants were recruited in 2020 (n = 1,252) and 2021 (n = 2,273). Results: Psychological wellbeing was much higher than in other studied groups and populations, with slightly lower scores in 2021 compared to the 2020 sample (Eta2 = 0.020), while the perception of the COVID-19-related burden and fear of the future were low in 2020 with a slight increase in 2021 (Eta2 = 0.033 and 0.008, respectively). Their transcendence conviction was negatively related to fears of their own infection or the infection of others. Best predictors of their wellbeing were low burden and awe/gratitude, while the best predictors of their burden were low wellbeing and lack of social contacts. Conclusion: Compared to the general population in Germany, the anthroposophical lifestyle and related convictions may have buffered some of the COVID-19-related burden and helped them to stabilize their psychological wellbeing.

Assessing preferences for leisure activities of people receiving adult day services: a study protocol for concept mapping and psychometric testing.

INTRODUCTION: Leisure activities appear to be an important factor in maintaining and improving health in old age. To better understand what people want to do when visiting an adult day service (ADS), it is important to systematically assess their preferences. Currently, there is no instrument for assessing preferences for leisure activities for people receiving ADS. Accordingly, the planned study aims to develop or modify and psychometrically test an instrument to assess leisure activities preferences for use with people receiving ADS. METHODS AND ANALYSIS: A mixed-method design with a participatory research approach was chosen for this study (Preferences for Everyday Living-Deutschland, PELI-D II). In the first step of this study, leisure activities will be identified on the basis of an evidence map. In the second step, the results from the evidence map will be empirically supplemented, and leisure activities will be categorised and prioritised within a concept mapping approach by people who receive ADS. Subsequently, based on this categorisation, either an instrument that was piloted in a previous study (PELI-D I) will be modified or an instrument with a focus on preferences for leisure activities in ADS will be explored. In the last step of this study, the instrument will be psychometrically tested. Data will be analysed via content analysis as well as descriptive and inferential statistics and statistical tests. The results will be presented in various tables and graphs (eg, pattern matching). ETHICS AND DISSEMINATION: This study was approved by the ethics committee of the Witten/Herdecke University (application number 226/2020). The results will be made available to the public at (inter)national conferences, in peer-reviewed articles and in articles for practitioners.

Organizational Capacity Building in Nursing Facilities to Promote Resident Mobility: A Systematic Review.

OBJECTIVES: The objective of the present systematic review was to investigate the effects of organizational capacity building interventions on the environment, nursing staff capacity, and mobility of residents in nursing facilities. DESIGN: Systematic review. SETTING AND PARTICIPANTS: Nursing facilities, staff, and residents. METHODS: We conducted a systematic review according to the methods of the Cochrane Collaboration. The systematic review was prospectively registered in the PROSPERO database of systematic reviews (registration number CRD42020202996). We searched for studies in MEDLINE (via PubMed), CINAHL (via EBSCO), the Physiotherapy Evidence Database (PEDro), and the Cochrane Library (07/20). A narrative synthesis was conducted because of the high heterogeneity of the included studies. RESULTS: We identified 6747 records and included 14 studies in our review. We clustered the 14 interventions into 3 different categories (environmental modification, nursing staff capacity, and multifactorial interventions). Three studies assessed outcomes at the nursing staff level, and all studies reported outcomes at the resident level. We found highly heterogeneous and inconsistent effects of organizational capacity building on increasing nursing staff capacity and/or resident mobility. CONCLUSIONS AND IMPLICATIONS: The findings emphasize the need for further research focusing on an international understanding and definition of organizational capacity building. Additionally, research and intervention development for organizational capacity building interventions to promote resident mobility are needed while applying the framework of the Medical Research Council. Furthermore, studies should assess outcomes regarding the environment and nursing staff to better understand if and how environmental structures and nursing staff capacity effect resident mobility.

Dynamics of Perceived Positive Changes and Indicators of Well-Being Within Different Phases of the COVID-19 Pandemic.

Background: During the COVID-19 pandemic, people reported about fears, depressive states, and phases of loneliness. However, there have also been positively experienced changes in terms of awareness of nature, reflection of life, more intensive relationships, meaningful digital media usage to connect with others, and interest in spirituality. We were interested in the dynamics of these indicators directly after the first lockdown, the summer months and during the second wave of the pandemic with its second lockdown, and how they relate to the perceived restrictions, fears, and worries. Method: Survey with standardized questionnaires, i.e., Perceived Changes Questionnaire, WHO-Five Well-being Index, Brief Multidimensional Life Satisfaction Scale, Awe/Gratitude scale. Participants were categorized as cohort 1 (June 2020; n = 1,333), cohort 2 (July to September 2020, n = 823), and cohort three (October 2020 to January 2021, n = 625). Results: Participants perceived changes in specific attitudes and behaviors, which have impacted their well-being and life satisfaction. Compared to their experiences directly after the first wave of the pandemic (cohort 1), well-being (Hedge's g = 0.83) and life satisfaction (g = 0.63) decreased during the second wave (cohort 3) and participants' stressors increased (g = -0.94). At the same time, positive perceptions such as Nature/Silence/Contemplation (g = 0.67), Spirituality (g = 0.62), Relationships (g = 0.55), and Digital media usage declined (g = 0.31), but not Reflections on life (g = -0.03). In cohort 3, the proportion of persons relying on their faith as a strong hold was declining also in nominally religious persons. Awe/Gratitude was among the best predictors of perceived positive changes, indicating a resource which is nevertheless declining during the second wave of the pandemic (g = 0.60). Conclusions: Several perceptions, attitudes, and behaviors have changed, particularly during the second wave of the pandemic, which had a strong influence on psychological health. Although Awe/Gratitude was confirmed as the best predictor of perceived positive changes, this resource may not buffer against the negative outcomes of the pandemic but helps to recognize the still positive aspects in life. There is a need for new and not yet defined public health communities that could focus on persons which are affected in their physical, mental, social, and spiritual health and well-being due to the pandemic.

Awe/Gratitude as an Experiential Aspect of Spirituality and Its Association to Perceived Positive Changes During the COVID-19 Pandemic.

Background: While the COVID-19 pandemic has affected the lives of almost all people worldwide, many people observed also positive changes in their attitudes and behaviors. This can be seen in the context of posttraumatic growth. These perceived changes refer to five main categories: Nature/Silence/Contemplation, Spirituality, Relationships, Reflection on life, and Digital media usage. A previous study with persons recruited in June 2020 directly after the lockdown in Germany showed that the best predictors of these perceived changes related to the Corona pandemic were the ability to mindfully stop and pause in distinct situations, to be "spellbound at the moment" and to become "quiet and devout," indicating moments of wondering awe, with subsequent feelings of gratitude. Now, we intended to analyze (1) by whom and how strongly awe/gratitude was experienced during the COVID-19 pandemic, and (2) how these feelings relate to perceived changes and experienced burden, and (3) whether or not feelings of awe/gratitude contribute to participants' well-being or may buffer perceived burden in terms of a resilience factor. Methods: Online survey with standardized questionnaires [i.e., WHO-Five Well-being Index (WHO5), Life satisfaction (BMLSS), Awe/Gratitude scale (GrAw-7), and Perceived Changes Questionnaire (PCQ)] among 2,573 participants (68% women; mean age 48.7 ± 14.2 years, 74% with a Christian affiliation) from Germany recruited between June and November 2020. Results: Awe/Gratitude scored significantly higher particularly among women (Cohen's d = 0.40), older persons (d = 0.88), persons who rely on their faith as a "stronghold in difficult times" (d = 0.99), those with higher well-being (d = 0.70), and lower perceptions of loneliness (d = 0.49). With respect to perceived changes during the pandemic, more intense feelings of Awe/Gratitude were particularly related to Nature/Silence/Contemplation (r = 0.41), Spirituality (r = 0.41), and Relationships (r = 0.33). Regression analyses revealed that the best predictors of Awe/Gratitude (R 2 = 0.40) were the frequency of meditation, female gender, life satisfaction and well-being, faith as a stronghold, and perceived burden and also life reflection, while Nature/Silence/Contemplation and Relationships had a further, but weaker, impact on Awe/Gratitude as a dependent variable. Awe/Gratitude was moderately associated with well-being (r = 0.32) and would predict 9% of participants' well-being variance. The best predictors of participants' well-being were multidimensional life satisfaction and low perceived burden (related to the pandemic), and further Awe/Gratitude and Nature/Silence/Contemplation; these would explain 47% of variance in well-being scores. However, Awe/Gratitude cannot be regarded as a buffer of the negative aspects of the COVID-19 pandemic, as it is only marginally (though negatively) related to perceived burden (r = -0.15). Mediation analysis showed that Awe/Gratitude mediates 42% of the link between well-being as a predictor on Nature/Silence/Contemplation as an outcome and has a direct effect of ß = 0.15 (p < 0.001) and an indirect effect of ß = 0.11 (p < 0.001). Further, Awe/Gratitude mediates 38% (p < 0.001) of the link between Nature/Silence/Contemplation as a predictor on well-being as the outcome; the direct effect is ß = 0.18 (p < 0.001), and the indirect effect is ß = 0.11 (p < 0.001). Conclusions: The general ability to experience Awe/Gratitude particularly during the COVID-19 pandemic may sensitize to perceive the world around (including nature and concrete persons) more intensely, probably in terms of, or similar to, posttraumatic growth. As this awareness toward specific moments and situations that deeply "touch" a person was higher in persons with more intense meditation or prayer practice, one may assume that these practices may facilitate these perceptions in terms of a training. However, the experience of Awe/Gratitude does not necessarily buffer against adverse events in life and cannot prevent perceived burden due to the corona pandemic, but it facilitates to, nevertheless, perceive positive aspects of life even within difficult times. As Awe/Gratitude is further mediating the effects of Nature/Silence/Contemplation on well-being, intervention programs could help to train these perceptions, as these self-transcendent feelings are also related to prosocial behaviors with respectful treatment of others and commitment to persons in needs, and well-being.

Perceived changes of specific attitudes, perceptions and behaviors during the Corona pandemic and their relation to wellbeing.

BACKGROUND: During the COVID-19 pandemic, most people had to cope with the restrictions of the lockdown, leaving them to their fears, insecurity and isolation. On the other hand, due to the unexpected 'extra time' there was room for new experiences and for personal reflections on what is essential in life, to perceive nature and relations more consciously etc. We, therefore, intended to analyze perceived changes of attitudes and behaviors during the time of lockdown, and whether these perceptions would contribute to personal wellbeing during the pandemic. METHODS: An anonym cross-sectional online survey was performed for data collection, using standardized questionnaires, i.e., the WHO-Five Well-being Index (WHO-5), Brief Multidimensional Life Satisfaction Scale (BMLSS), Awe/Gratitude scale (GrAw-7), and the newly developed Perceived Changes Questionnaire (PCQ). RESULTS: Within the number of respondents (n = 1277), women were predominating (67.5%). Participants' mean age was 50.9 ± 14.9 years. Exploratory factor analyses showed that the 24-item Perceived Changes Questionnaire differentiated five factors that would account for 61% of variance: (1) Nature/Silence/Contemplation (Cronbach's alpha = .87), (2) Spirituality (Cronbach's alpha = .83), (3) Relationships (Cronbach's alpha = .80), (4) Reflection on life (Cronbach's alpha = .74), (5) Digital media usage (Cronbach's alpha = .74). Strongest changes were observed for Relationships and Nature/Silence/Contemplation. Perceived changes were stronger among older persons, among persons with higher wellbeing, and among those who relied on their faith as a resource. These changes were predicted best by a person's perception of wondering awe in distinct situations with subsequent feelings of gratitude. Stepwise regression analyzes revealed that participants' wellbeing was explained best by low perceived burden and high life satisfaction (R2 = .46). Awe/gratitude, perceived changes in terms of Nature/Silence/Contemplation and low Reflections of live are further variables that would predict a person's wellbeing among the COVID-19 pandemic. CONCLUSIONS: During the Corona pandemic, people tried to find ways to adapt to the outcomes of the restrictions. The perceived changes of attitudes and behaviors can be interpreted in terms of a reappraisal strategy. These can be measured with the extended version of the PCQ which was found to have good quality indices and a plausible factor structure. The reported changes contribute to persons' wellbeing only to some extend, indicating that they represent an independent quality of relevance in peoples' life.

A Randomized Controlled Trial to Investigate the Impact of Tango Argentino versus Tai Chi on Quality of Life in Patients with Parkinson Disease: A Short Report.

OBJECTIVES: Parkinson disease (PD) is a neurodegenerative disorder with increasing impairments in disease progression. The aim of the pilot study was to investigate the influence of Tango argentino on the quality of life of people with PD compared to Tai Chi. Design, Setting, Interventions: In the two-arm, randomized controlled pilot study, patients with PD received a 10-week Tango argentino or Tai Chi intervention (once per week, 60 min each). MAIN OUTCOME MEASURES: The outcome parameters were assessed at three time points (after the 1st course, after the 5th course, and after the 10th course) using standardized instruments, i.e., Parkinson's Disease Questionnaire-39 (PDQ-39), Brief Multidimensional Life Satisfaction Scale (BMLSS), Inner Congruence with Practices (ICPH). RESULTS: Overall, 14 patients and their partners received Tango argentino (9 male, 5 female; mean age: 69 ± 8 years) and 15 received Tai Chi (3 male, 12 female; mean age: 69 ± 11 years). Four patients in each group were lost during the trial. No improvements were found in both groups for all outcomes. Patients in the tango group reported better emotional well-being (p = 0.039) after 10 weeks of intervention compared to the Tai Chi group. CONCLUSIONS: Further studies are needed taking into account findings from this study to improve recruitment and attrition of patients during the trial and to justify the potential implementation of Tango argentino into clinical care.

Influence of a Multimodal and Multimodal-Aerobic Therapy Concept on Health-Related Quality of Life in Breast Cancer Survivors.

CONTEXT: Cancer-related fatigue (CRF) is one of the most burdensome symptoms in breast cancer survivors (BCSs), accompanied by reduced health-related quality of life (HRQOL). OBJECTIVES: This study investigated the influence of a multimodal therapy (MT; psychoeducation, eurythmy therapy, painting therapy, and sleep education/restriction), or a combination therapy (CT; MT plus aerobic training [AT]) on HRQOL in BCS with chronic CRF in comparison with AT alone. METHODS: One hundred and twenty-six BCSs with CRF were included in a pragmatic comprehensive cohort study and allocated either per randomization or by preference to MT, CT, or AT. The EORTC QLQ-C30 core questionnaire was used to measure HRQOL. All analyses on HRQOL parameters were done in an explorative intention. RESULTS: Patients were assigned to MT (n = 44), CT (n = 54), or AT (n = 28). CT was significantly superior to AT after 10 weeks of intervention (T1) in improving physical function. MT was found to have significant superiority over AT at T1 and T2 for physical functioning, emotional functioning, insomnia, and financial problems as well as role functioning, cognitive, social functioning, and fatigue 6 months later (T2). CONCLUSION: A multimodal approach appears to be a suitable concept for BCS with chronic CRF. A confirmatory study with larger samples should demonstrate the superiority of MT and adapted CT in HRQOL compared with the current treatment AT found in these explorative analyses.

Complementary and alternative therapies in dentistry and characteristics of dentists who recommend them.

OBJECTIVES: The aims of this study were to analyse whether dentists offer or recommend complementary and alternative medicine (CAM) remedies in their clinical routine, and how effective these are rated by proponents and opponents. A second aim of this study was to give a profile of the dentists endorsing CAM. DESIGN: A prospective, explorative, anonymised cross-sectional survey was spread among practicing dentists in Germany via congresses, dental periodicals and online (n=250, 55% male, 45% female; mean age 49.1±11.4years). RESULTS: Of a set of 31 predefined CAM modalities, the dentists integrated plant extracts from Arnica montana (64%), chamomile (64%), clove (63%), Salvia officinalis (54%), but also relaxation therapies (62%), homeopathy (57%), osteopathic medicine (50%) and dietetics (50%). The effectiveness of specific treatments was rated significantly higher (p<0.0001) by CAM proponents than opponents. However also CAM opponents classified some CAM remedies as highly effective, namely ear acupuncture, osteopathic medicine and clove. For ear acupuncture these scores did not significantly differ between both groups. With respect to the characteristic of the proponents, the majority of CAM endorsing dentists were women. The mean age (50.4±0.9 vs 47.0±0.9years) and number of years of professional experience (24.2±1.0 vs 20.0±1.0years) were significantly higher for CAM proponents than the means for opponents (p<0.0001 respectively). CAM proponents worked significantly less (p<0.0001) and their perceived workload was significantly lower (p=0.008). Their self-efficacy expectation (SEE) and work engagement (Utrecht work engagement, UWE) were significantly higher (p≤0.01 and p<0.0001) compared to dentists who abandoned these treatment options. The logistic regression model showed (exploratively) an increased association from CAM proponents with the UWES subscale dedication, with years of experience, and that men are less likely to be CAM proponents than women. CONCLUSION: Various CAM treatments are recommended by German dentists and requested by their patients, but the scientific evidence for these treatments are often low or at least unclear. CAM proponents are often female, have higher SE and work engagement.

Iyengar-Yoga Compared to Exercise as a Therapeutic Intervention during (Neo)adjuvant Therapy in Women with Stage I-III Breast Cancer: Health-Related Quality of Life, Mindfulness, Spirituality, Life Satisfaction, and Cancer-Related Fatigue.

This study aims to test the effects of yoga on health-related quality of life, life satisfaction, cancer-related fatigue, mindfulness, and spirituality compared to conventional therapeutic exercises during (neo)adjuvant cytotoxic and endocrine therapy in women with breast cancer. In a randomized controlled trial 92 women with breast cancer undergoing oncological treatment were randomly enrolled for a yoga intervention (YI) (n = 45) or for a physical exercise intervention (PEI) (n = 47). Measurements were obtained before (t 0) and after the intervention (t 1) as well as 3 months after finishing intervention (t 2) using standardized questionnaires. Life satisfaction and fatigue improved under PEI (p < 0.05) but not under YI (t 0 to t 2). Regarding quality of life (EORTC QLQ-C30) a direct effect (t 0 to t 1; p < 0.001) of YI was found on role and emotional functioning, while under PEI only emotional functioning improved. Significant improvements (p < 0.001) were observed at both t 1 and t 2 also for symptom scales in both groups: dyspnea, appetite loss, constipation, and diarrhea. There was no significant difference between therapies for none of the analyzed variables neither for t 1 nor for t 2. During chemotherapy, yoga was not seen as more helpful than conventional therapeutic exercises. This does not argue against its use in the recovery phase.