Stigma and self-stigma among women within the context of the german "zero alcohol during pregnancy" recommendation: A qualitative analysis of online forums and blogs.

BACKGROUND: In many countries, including Germany, it is recommended to abstain from alcohol during pregnancy to avoid harm to the baby. In this qualitative research study, analysis of online forums was conducted to explore women's perception of the German "zero alcohol during pregnancy" recommendation with regard to stigma and self-stigma. METHODS: We used a grounded theory approach to analyze online forum discussions on alcohol use during pregnancy. Data consisted of 9 discussion threads from 5 different forums and blogs involving 115 participants in total. We used key concepts developed during analysis and the theory of stigma to interpret the posts. RESULTS: We identified five key themes: (1) Low alcohol health literacy as a breeding ground for stigmatization; (2) The widespread assumption that maternal abstinence is a prerequisite for being considered a "good mother"; (3) Interpersonal role conflicts and a guilty conscience as a result of stigmatization or self-stigmatization; (4) Paying little attention to the role of psychosocial factors in alcohol consumption, especially regarding partner responsibility during pregnancy.; (5) Understanding the "zero alcohol during pregnancy" recommendation as a complete ban, associated with loss of autonomy. CONCLUSION: The current method of communicating the "zero alcohol during pregnancy" recommendation may have unintended consequences. Specifically, misconceptions about the harm associated with low alcohol consumption and setting high expectations of motherhood are factors that can contribute to stigma or self-stigma and potentially undermine self-efficacy, help-seeking behavior, and overcoming the barriers to alcohol health literacy.

Researching Alcohol Consumption During Pregnancy. Opportunities and Challenges With Two Methods of Data Acquisition.

Qualitative research methods, primarily interviews, have become more common in the field of addiction research. Other data sources were often neglected, although sources such as social media can offer insights into the realities of people, since social media also plays a relevant role in today's living environments. This article examines the use of online forums as an underutilized data source in contrast to telephone interviews, to identify methodological opportunities and challenges. We analyzed nine discussion threads and seven interviews about 'alcohol consumption during pregnancy'. Discursive comparison of the results was performed with a focus on sampling issues, comparability and risks for participants and researchers. Key issues were present in both data sources. People with different opinions were openly hostile in forums, while tolerance was more often expressed in interviews. The interviews showed a rather mild communication style, which could be attributed to social desirability. In the forum discussions, the participants often expressed themselves very directly. To comprehensively grasp the subject matter of the research, it is important to recognize the types of communication promoted by different data sources. These results have implications for research about female substance use. Knowledge of the issues will bestow a valuable contribution to researchers working in the field of substance use to help develop appropriate research approaches, as they engage in research into this highly stigmatized and controversial area.

S3 Guideline "Smoking and Tobacco Dependence: Screening, Diagnosis, and Treatment" - Short Version.

INTRODUCTION: In addition to the prevention of tobacco consumption, the establishment and assurance of high-quality treatment for harmful use and dependence on tobacco products remains an important health-related task in Germany. Regular updating of the Association of the Scientific Medical Societies (AWMF) S3 guideline "Smoking and Tobacco Dependence: Screening, Diagnosis, and Treatment" (Tobacco Guideline) offers a sustainable and reputable source of knowledge on smoking cessation. METHODS: Under the auspices of the German Society for Psychiatry, Psychotherapy, Psychosomatics, and Neurology (DGPPN) and the German Society for Addiction Research and Addiction Therapy (DG-Sucht), the Tobacco Guideline was revised in 2019-2020 by 63 experts, who were involved in the development process of the text, in 11 working groups. Undue influence of conflicts of interest on the guideline could be minimized through careful conflict of interest management. Delegates from 50 professional societies discussed the 80 guideline recommendations and voted online. RESULTS: In addition to recommendations for screening and diagnostics, the Tobacco Guideline takes a positive stance towards the use of low-threshold counseling and support services. If, due to the severity of the tobacco-related disorder, brief counseling, telephone counseling, or internet- or smartphone-based methods are not sufficiently effective, individual or group behavioral therapy, possibly in combination with medication, is indicated. If nicotine replacement therapy is not effective, varenicline or bupropion should be offered. Alternative strategies with a lower level of recommendation are hypnotherapy, mindfulness-based treatments, or medication with cytisine. In adolescents and pregnant women, the use of medication should be limited to well-specified exceptions and nicotine replacement. The mean agreement with the recommendations reached a value of 98%. A general overview of the treatment recommendations of the Tobacco Guideline is provided by three clinical algorithms.

German Guidelines on Screening, Diagnosis, and Treatment of Alcohol Use Disorders: Update 2021.

INTRODUCTION: Alcohol consumption in Germany is associated with considerable health and economic consequences. In addition to prevention, the early detection and differential treatment of those affected play an important role. The guideline "Screening, Diagnosis, and Treatment of Alcohol Use Disorders" forms the basis of this care for people suffering from alcohol use disorders. Regular updates integrate the current state of research evidence and clinical expertise. METHODS: Under the auspices of the German Society for Psychiatry, Psychotherapy, Psychosomatics, and Neurology and the German Society for Addiction Research and Addiction Therapy e.V. (DG-Sucht), the 2019-2020 S3 guideline on alcohol was revised by eight working groups. Thirty-five professional societies participated in a structured consensus process to deliberate the recommendations. Potential conflicts of interest were examined in advance, documented, and taken into account during the voting on the recommendations. RESULTS: The guideline provides recommendations on screening and brief interventions for different groups of people, as well as on treatment of individuals in the acute and post-acute phases of withdrawal. Special emphasis was placed on the treatment of comorbid somatic and psychological disorders. In addition, recommendations for specific groups of people (e.g., children and adolescents, pregnant women) have been made and adapted to the German care landscape.

[Opinions on Alcohol Consumption During Pregnancy and The Role of The Medical Staff as an Expert in This Regard - A Grounded Theory Analysis of Online Forum Discussions]. / Meinungen zum Alkoholkonsum in der Schwangerschaft und zur diesbezüglichen ExpertInnenrolle von medizinischem Fachpersonal.

BACKGROUND: Alcohol consumption during pregnancy carries many risks for the unborn child. Despite preventive measures, some pregnant women consume alcohol. The aim of this study is to identify possible reasons for consumption during pregnancy and also to shed light on the attribution of an expert role to medical professionals by those affected. METHODS: In this study, 9 discussion threads from online forums on the topic of alcohol consumption during pregnancy with a total of 115 discussion participants were analyzed using grounded theory. The discursive validation of the results took place in the research team. RESULTS: It turned out that the individual definition of the mother role has an influence on consumer behavior. Women who are very concerned about the child's well-being occasionally used alcohol in stressful situations or on social occasions, but often reported a guilty conscience after the consumption. Women who gave more weight to their own needs were more likely to consume for pleasure or because they felt they were being patronized by prohibitions. An equitable doctor-patient relationship and detailed, non-directive information were identified as beneficial factors for ascribing the expert role to the gynecologist. On the other hand, a paternalistic attitude and the issuing of bans proved to be a hindrance. DISCUSSION: All women showed a high need for information about alcohol consumption during pregnancy. The doctor-patient relationship seems to play an important role in conveying information. In addition, it became clear that the desire for support in women striving for abstinence is not being sufficiently fulfilled. CONCLUSION: Alcohol consumption during pregnancy should be addressed regularly in the care of all pregnant women. In addition to information on consumption risks, information on support offers is relevant.

Hepatic shear wave elastography in children under free-breathing and breath-hold conditions.

OBJECTIVES: To compare hepatic 2D shear wave elastography (2D SWE) in children between free-breathing and breath-hold conditions, in terms of measurement agreement and time expenditure. METHODS: A cohort of 57 children (12.7±4.3 years) who underwent standardized 2D SWE between May and October 2015 were retrospectively evaluated. Liver elastograms were obtained under free-breathing and breath-hold conditions and time expenditure was measured. Median stiffness, interquartile range (IQR), and IQR/median ratio were calculated based on 12, six, and three elastograms. Results were compared using Pearson correlation coefficient, intraclass correlation coefficient (ICC), Bland-Altman analysis, and Student's t. RESULTS: Median liver stiffness under free-breathing and breath-hold conditions correlated strongly (7.22±4.5kPa vs. 7.21±4.11kPa; r=0.97, P<0.001). Time to acquire 12 elastograms with free-breathing was lower than that with breath-holding (79.3±32.5sec vs. 143.7±51.8sec, P<0.001). Results for median liver stiffness based of 12, six, and three elastograms demonstrated very high agreement for free-breathing (ICC 0.993) and for breath-hold conditions (ICC 0.994). CONCLUSIONS: Hepatic 2D SWE performed with free-breathing yields results similar to the breath-hold condition. With a substantially lower time requirement, which can be further reduced by lowering the number of elastograms, the free-breathing technique may be suitable for infants and less cooperative children not capable of breath-holding. KEY POINTS: • Hepatic 2D SWE performed with free-breathing yields results similar to breath-hold condition. • Benefit of the free-breathing approach is the substantially lower time requirement. • Lowering the number of elastograms can further reduce time expenditure. • Free-breathing 2D SWE is suitable in children with suspected liver disease.

Prevalence of pathological internet use in a representative German sample of adolescents: results of a latent profile analysis.

BACKGROUND: Pathological internet use is of increasing significance in several industrial nations. SAMPLING AND METHODS: We surveyed a representative German quota sample of 1,723 adolescents (aged 14-17 years) and 1 caregiver each. We conducted a latent profile analysis to identify a high-risk group for pathological internet use. RESULTS: Overall, 3.2% of the sample formed a profile group with pathological internet use. In contrast to other published studies, the results of the latent profile analysis were verified not only by self-assessments of the youth's but also by external ratings of the caregivers. In addition to the pathological internet use, the high-risk group showed lower levels of family functioning and life satisfaction as well as more problems in family interactions. CONCLUSIONS: The results showed a considerable prevalence of pathological internet use in adolescents and emphasized the need for preventive and therapeutic approaches.

Psychometric validation of a German version of the compulsive Internet use scale.

Excessive Internet use and Internet addiction are currently increasing in many industrial nations. Verified and validated measuring instruments could contribute to a better understanding of this still quite recent development. The aim of this survey was to investigate the psychometric properties of a German version of the Compulsive Internet Use Scale (CIUS). We surveyed a representative German quota sample of 1,723 adolescents aged between 14 and 17 years, as well as one parent each, with standardized questionnaires. In addition, adolescents and parents were asked whether the media use by the youth was considered problematic or excessive, and whether it led to arguments at home. We conducted confirmatory factor analyses (CFA) with maximum likelihood estimation to examine the factorial validity of the German CIUS, as well as reliability and correlation analyses. The results of the CFA indicate good psychometric properties for the German version of the CIUS. They appear in line with the findings for the original version of the questionnaire. Furthermore, the CIUS showed high internal consistency, and we found significant correlations between the "CIUS-summary score" and different ratings of problems with the media usage by the youth and the parents. The German version of the CIUS seems to be a valid and suitable diagnostic tool for measuring problematic to pathological Internet use.

Assessment of problematic internet use by the Compulsive Internet Use Scale and the Internet Addiction Test: a sample of problematic and pathological gamblers.

This study aims to analyze psychometric properties and validity of the Compulsive Internet Use Scale (CIUS) and the Internet Addiction Test (IAT) and, second, to determine a threshold for the CIUS which matches the IAT cut-off for detecting problematic Internet use. A total of 292 subjects with problematic or pathological gambling (237 men, 55 women) aged 14-63 years and with private Internet use for at least 1 h per working or weekend day were recruited via different recruitment channels. Results include that both scales were internally consistent (Cronbach's α=0.9) and had satisfactory convergent validity (r=0.75; 95% CI 0.70-0.80). The correlation with duration of private Internet use per week was significantly higher for the CIUS (r=0.54) compared to the IAT (r=0.40). Among all participants, 25.3% were classified as problematic Internet users based on the IAT with a cut-off≥40. The highest proportion of congruent classified cases results from a CIUS cut-off ≥18 (sensitivity 79.7%, specificity 79.4%). However, a higher cut-off (≥21) seems to be more appropriate for prevalence estimation of problematic Internet use.

The interdependence of family functioning and problematic internet use in a representative quota sample of adolescents.

Few studies have been carried out investigating the interdependence of family structures or interactions and excessive adolescent Internet use. In this study, we surveyed a representative German quota sample of 1,744 adolescents aged between 14 and 17 years with standardized questionnaires. Adolescents assessed their perceived own functioning in the family with the Self-Rating Scale (FB-S) of the German version of the Family Assessment Measure III, and reported on problematic Internet use with the Compulsive Internet Use Scale (CIUS). To predict problematic Internet use (CIUS summary score), we conducted a multiple stepwise linear regression analysis with the seven FB-S scales, the FB-S overall index, and gender and age as explanatory variables. For the full sample, a model with only one predictor (FB-S overall index) that summarizes the quality of family functioning produced a corrected coefficient of determination of 0.239 and explained variance of nearly 24%. t Test results for unpaired samples showed significant differences in the mean values of the FB-S scales and the FB-S overall index for comparisons of both sexes, as well as of a lower age group and higher age group. The prediction of problematic Internet use between both sexes and both age groups showed comparable findings (males: corrected coefficient of determination=0.288; females: corrected coefficient of determination=0.183; lower age group: corrected coefficient of determination=0.231; higher age group: corrected coefficient of determination=0.251), each with a single predictor (FB-S overall index). The results emphasize the importance of family functioning for the occurrence of problematic Internet use in adolescents.

Age-related distribution of vertebral bone-marrow diffusivity.

PURPOSE: To determine age-related diffusivity changes of the lumbar bone marrow by measurement of apparent diffusion coefficient (ADC) values. MATERIALS AND METHODS: The local ethics committee approved this study and written informed consent was obtained. The study group comprised 88 individuals including 75 healthy volunteers and 13 patients (48 female, 40 male; mean age 36 years, range 0-84 years). The pediatric cases were recruited from patients. Echo-planar diffusion weighted imaging (DWI) was performed with b-values of 50, 400 and 800 s/mm(2). ADC-values were calculated and measured in the 1st and 2nd vertebral body of the lumbar spine. Correlation between age and ADC-values was analyzed with Spearman's rho test. RESULTS: The ADC values of the vertebral bone marrow of the lumbar spine showed a significant negative correlation with age (rho=-0.398, p=0.001). The mean ADC values (×10(-3)mm(2)/s) in the age groups 0-29 years (mean age 18.0 years, n=42) and 30-88 years (mean age 51.6 years, n=46) were 0.54 ± 0.07 and 0.47 ± 0.08, respectively (p<0.001, T-test). No significant differences were found between children and young adults. CONCLUSION: Bone marrow ADC values of the lumbar spine show a linear decrease with growing age and thereby reflect the gradual changes of cell composition occurring during marrow conversion.

[Psychopathology and achievement motivation in adolescents with pathological internet use]. / Psychische Befindlichkeit und Leistungsmotivation bei Jugendlichen mit pathologischem Internetgebrauch.

In Germany, the internet is used by 69.4% of the population or 49 million people, and 100% of adolescents (between 14 to 19 years of age) spend time in the internet at least occasionally. An excessive use of the internet may lead to negative psychosocial consequences and changes in behaviour. This phenomenon is named "pathological internet use". Until now, there are only few studies published that investigate mental well being in German adolescents with pathological internet use. 16 participants of an outpatient treatment program for pathological internet use and 16 healthy adolescents were compared on self-reported levels of psychopathology (SPS-J), achievement motivation (FLM 7-13) and personal experience of attention deficit (FEDA). There were no differences in age, gender, intelligence or education between the two groups. Pathological internet users exhibited significantly elevated scores on self-esteem problems and the summary score of the SPS-J and significantly lower scores on FLM 7-13-dimensions "achievement ambition" and "perseverance/diligence" compared to controls. The results revealed that adolescents with pathological internet use report a higher level of psychopathology and lower levels of achievement motivation and drive. These findings should be taken into account when conceptualizing treatments for pathological internet users.