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Krankheitsängste in verschiedenen Populationen und die Effektivität ambulanter Verhaltenstheraphie
(2023)
Teacher self-efficacy is highly relevant for effective teaching, student academic development, and teachers’ wellbeing, as theoretical work (Bandura, 1997; Tschannen-Moran et al., 1998) and empirical studies (i.e., Burić & Kim, 2020; Klassen & Chiu, 2010; van Uden et al., 2013) have shown associations with effective classroom management, student support, student motivation, and teachers’ job satisfaction. Given the importance of teacher self-efficacy for teaching and learning, it is interesting to note that existing research is limited in several aspects – first, longitudinal studies on the relations between teacher self-efficacy and student academic outcomes are widely missing; second, empirical studies often assess teacher self-efficacy as a one-dimensional construct, neglecting its multidimensional character; third, studies often only focus on either the students’ or the teachers’ perspective on teaching and thus do not include simultaneously multiple sources of information on teaching practices as a consequence of teacher self-efficacy; fourth, research often does not systematically consider the effects of teacher self-efficacy on students’ academic outcomes at both the group and individual level. Against this backdrop, this dissertation presents three longitudinal studies that aim to contribute to a more detailed perspective on teacher self-efficacy by examining systematically and longitudinally the relations between multiple dimensions of teacher self-efficacy and theoretically aligned teaching quality facets as perceived by teachers and students, as well as their relations to students’ motivational-affective outcomes – more concretely, their relations to students’ interest, enjoyment, and self-efficacy in a multi-level analysis approach. Study 1 examines the longitudinal relations between teacher self-efficacy for classroom management and student-perceived monitoring and social relatedness, and investigates whether the two student-reported teaching dimensions explain the relations between teacher self-efficacy for classroom management and student enjoyment using multi-level analyses. Study 2 examines longitudinally how teacher self-efficacy for student engagement relates to student interest through student- and teacher-perceived emotional support. Also, including student and teacher perspectives on teaching, Study 3 examines the longitudinal relations between specific facets of teacher self-efficacy for classroom management and classroom discipline, teacher self-efficacy for instructional strategies and cognitive activation, teacher self-efficacy for student engagement and competence support, teacher self-efficacy for emotional support and social relatedness, as well as teacher self-efficacy for student-oriented teaching and learning goal-oriented instruction with students’ enjoyment and self-efficacy. Furthermore, in Studies 2 and 3 the cross-level mediation effects of longitudinal relations with teacher self-efficacy on student motivational-affective characteristics via teaching practices are examined in order to address the lack of empirical studies disentangling the relations for specifically individual- vs. group-level effects. The limitations and implications are discussed in terms of their theoretical and practical relevance for school practice, teacher education, and teacher training.
We live in an aging society. The change in demographic structures poses a number of challenges, including an increase in age-associated diseases. Delirium, dementia, and depression are considered to be of particular interest in the field of aging and mental health. A common theory regarding healthy aging and mental health is that the highest satisfaction and best performance is achieved when a person's abilities match the demands of their environment. In this context, the person's environment includes both the physical and the social environment. Based on this assumption, this dissertation focuses on the investigation of non-pharmacological interventions that modify environmental factors in order to facilitate the prevention and treatment of mental disorders in older patients and their caregivers. The first part of this dissertation consists of two publications and deals with the prevention of postoperative delirium in elderly patients. The PAWEL study investigated the use of a multimodal, non-pharmacological intervention in the routine care of patients aged 70 years or older undergoing elective surgery. The intervention included an interdepartmental delirium prevention team, daily use of seven manualized “best practice” procedures, structured staff training on delirium, and the adaptation of the hospital environment to the patients’ needs. The second part of the dissertation used a meta-analysis to investigate whether technology-based interventions are a suitable form of support for informal caregivers of people with dementia. Subgroup analyses were conducted to examine the effect of different types of technology on caregiver burden and depressive symptoms. The following main results were found: The PAWEL study showed that the use of a multimodal, non-pharmacological intervention resulted in a significantly lower incidence rate of postoperative delirium and reduced days with delirium in the intervention group compared to the control group. However, this difference could not be observed in the group of patients undergoing elective cardiac surgery. The results of the meta-analysis showed that technology-based interventions offer a promising alternative to traditional “face-to-face” services. Significant effect sizes could be found in relation to both the burden and the depressive symptoms of caregiving relatives. These results provide further important information on the significant impact of non-pharmacological interventions that modify environmental factors on mental health, and support the consideration of such interventions in the prevention and treatment of mental disorders in both older patients and their caregivers.
In modern times of evolving globalization and continuous technological developments, organizations are required to respond to ever-changing demands. Therefore, to be successful in today’s highly uncertain environments, organizations need employees to actively search for opportunities, anticipate challenges, and act ahead. In other words, employee proactivity in the workplace represents a highly valuable resource in nowadays organizations. Empirical studies conducted as part of this thesis advance the research on the outcomes of proactivity from the individual perspective. The main contribution of this thesis pertains to revealing several important individual and contextual conditions under which engaging in proactivity will have negative and positive effects on employees’ well-being and their consequent behaviours, as well as shedding light on the unique psychological mechanisms through which these effects unfold. From a practical standpoint, this research underscores the importance of creating work environments that support employees’ autonomous motivation for proactivity and urge organizations and managers to be mindful about the pressures they place on employees to be proactive at work. Besides, this thesis stimulates research efforts aimed at further extending our knowledge of when and how individual proactive behaviours at work will do more good than harm for those who enact them.
Learning to read in German
(2021)
In the present dissertation, the development of eye movement behavior and the perceptual span of German beginning readers was investigated in Grades 1 to 3 (Study 1) and longitudinally within a one-year time interval (Study 2), as well as in relation to intrinsic and extrinsic reading motivation (Study 3). The presented results are intended to fill the gap of only sparse information on young readers’ eye movements and completely missing information on German young readers’ perceptual span and its development. On the other hand, reading motivation data have been scrutinized with respect to reciprocal effects on reading comprehension but not with respect to more immediate, basic cognitive processing (e.g., word decoding) that is indicated by different eye movement measures. Based on a longitudinal study design, children in Grades 1–3 participated in a moving window reading experiment with eye movement recordings in two successive years. All children were participants of a larger longitudinal study on intrapersonal developmental risk factors in childhood and adolescence (PIER study). Motivation data and other psychometric reading data were collected during individual inquiries and tests at school. Data analyses were realized in three separate studies that focused on different but related aspects of reading and perceptual span development. Study 1 presents the first cross-sectional report on the perceptual span of beginning German readers. The focus was on reading rate changes in Grades 1 to 3 and on the issue of the onset of the perceptual span development and its dependence on basic foveal reading processes. Study 2 presents a successor of Study 1 providing first longitudinal data of the perceptual span in elementary school children. It also includes information on the stability of observed and predicted reading rates and perceptual span sizes and introduces a new measure of the perceptual span based on nonlinear mixed-effects models. Another issue addressed in this study is the longitudinal between-group comparison of slower and faster readers which refers to the detection of developmental patterns. Study 3 includes longitudinal reading motivation data and investigates the relation between different eye movement measures including perceptual span and intrinsic as well as extrinsic reading motivation. In Study 1, a decelerated increase in reading rate was observed between Grades 1 to 3. Grade effects were also reported for saccade length, refixation probability, and different fixation duration measures. With higher grade, mean saccade length increased, whereas refixation probability, first-fixation duration, gaze duration, and total reading time decreased. Perceptual span development was indicated by an increase in window size effects with grade level. Grade level differences with respect to window size effects were stronger between Grades 2 and 3 than between Grades 1 and 2. These results were replicated longitudinally in Study 2. Again, perceptual span size significantly changed between Grades 2 and 3, but not between Grades 1 and 2 or Grades 3 and 4. Observed and predicted reading rates were found to be highly stable after first grade, whereas stability of perceptual span was only moderate for all grade levels. Group differences between slower and faster readers in Year 1 remained observable in Year 2 showing a pattern of stable achievement differences rather than a compensatory pattern. Between Grades 2 and 3, between-group differences in reading rate even increased resulting in a Matthew effect. A similar effect was observed for perceptual span development between Grades 3 and 4. Finally, in Study 3, significant relations between beginning readers’ eye movements and their reading motivation were observed. In both years of measurement, higher intrinsic reading motivation was related to more skilled eye movement patterns as indicated by short fixations, longer saccades, and higher reading rates. In Year 2, intrinsic reading motivation was also significantly and negatively correlated with refixation probability. These correlational patterns were confirmed in cross-sectional linear models controlling for grade level and reading amount and including both reading motivation measures, extrinsic and intrinsic motivation. While there were significant positive relations between intrinsic reading motivation and word decoding as indicated by the above stated eye movement measures, extrinsic reading motivation only predicted variance in eye movements in Year 2 (significant for fixation durations and reading rate), with a consistently opposite pattern of effects as compared to intrinsic reading motivation. Finally, longitudinal effects of Year 1 intrinsic reading motivation on Year 2 word decoding were observed for gaze duration, total reading time, refixation probability, and perceptual span within cross-lagged panel models. These effects were reciprocal because all eye movement measures significantly predicted variance in intrinsic reading motivation. Extrinsic reading motivation in Year 1 did not affect any eye movement measure in Year 2, and vice versa, except for a significant, negative relation with perceptual span. Concluding, the present dissertation demonstrates that largest gains in reading development in terms of eye movement changes are observable between Grades 1 and 2. Together with the observed pattern of stable differences between slower and faster readers and a widening achievement gap between Grades 2 and 3 for reading rate, these results underline the importance of the first year(s) of formal reading instruction. The development of the perceptual span lags behind as it is most apparent between Grades 2 and 3. This suggests that efficient parafoveal processing presupposes a certain degree of foveal reading proficiency (e.g., word decoding). Finally, this dissertation demonstrates that intrinsic reading motivation—but not extrinsic motivation—effectively supports the development of skilled reading.
Hintergrund. Personen, die mit der chronischen Erkrankung HIV leben (PWH), müssen ihr Leben lang die sog. antiretrovirale Therapie (ART) einnehmen, um einen Ausbruch der Erkrankung in das Vollbild AIDS (Akquiriertes Immun-Defizienz-Syndrom) zu vermeiden. Gleichzeitig ist die ART und HIV selbst assoziiert mit dem Auftreten zusätzlicher Erkrankungen (Komorbiditäten) kardiovaskulärer oder psychologischer Natur. Die Prävalenz von Komorbiditäten und schlechter Lebensqualität ist im Vergleich zu HIV-negativen Personen deutlich höher.
Methoden. Es wurden zwei Metaanalysen zu sportlicher Betätigung, PWH und (1) kardiovaskulären und (2) psychologischen Parametern sowie eine Querschnittsstudie (HIBES-Studie, HIV-Begleiterkrankungen und Sport) durchgeführt. Für die Auswertung der metaanalytischen Daten wurde der Review Manager 5.3, für die Auswertung der Daten der HIBES-Studie das Analyseprogramm „R“ verwendet. In den Metaanalysen wurden, neben den Hauptanalysen verschiedener Parameter, erstmals spezifische Subgruppenanalysen durchgeführt. Die HIBES-Studie untersuchte Unterschiede zwischen kumulativen (2-3 verschiedenen Sportarten pro Woche) und einfachen (eine Sportart pro Woche) Freizeitsport und analysiert die Zusammenhänge von Parametern des Freizeitsports (Trainingshäufigkeit, -Minuten und –Intensität), Komorbiditäten und der Lebensqualität.
Ergebnisse. Ausdauer- und Krafttraining haben einen mittel-starken bis starken positiven Effekt auf die maximale Sauerstoffaufnahme (SMD= 0.66, p< .00001), den 6-Minuten-Walk-Test (6MWT) (SMD= 0.59, p= .02), die maximale Watt Zahl (SMD= 0.80, p= .009). Kein Effekt wurde bei der maximalen Herzfrequenz und dem systolischen sowie diastolischen Blutdruck gefunden. Subgruppenanalysen zu ≥3 Einheiten/Woche, ≥150 Min./Woche ergaben hohe Effektstärken in der maximalen Watt Zahl und 6MWT. Ausdauer- und Krafttraining zusammen mit Yoga haben einen starken Effekt auf Symptome der Depression (SMD= -0.84, p= .02) und Angststörungen (SMD= -1.23, p= .04). Die Subanalyse der Depression zu professioneller Supervision und sportlicher Betätigung wiesen einen sehr starken Effekt (SMD= -1.40, p= .03). Die HIBES-Studie wies ein sehr differenziertes Bild im Sportverhalten von PWH in Deutschland auf. 49% der Teilnehmer übten mehr als eine Sportart pro Woche aus. Es wurden keine Unterschiede zwischen kumuliertem (CTE) und einfachem Sport (STE) in der Lebensqualität gefunden. Die Freizeitsportparameter (Häufigkeiten/Woche, Minuten/Woche, Intensität/Woche) waren in der CTE-Gruppe deutlich höher als in der STE-Gruppe. Trainingsminuten und die -Intensität zeigten beim Vorhandensein einer Komorbidität einen großen Zusammenhang mit der Lebensqualität. Die Minuten und die Intensität des durchgeführten Sportes zeigten einen prädiktiven Zusammenhang mit der Lebensqualität.
Konklusion: Sportliche Betätigung verbessert die maximale Sauerstoffaufnahme und Symptome der Depression und Angststörungen. Die Aussagekraft der Subanalysen ist aufgrund der geringen Studienzahl, vorsichtig zu interpretieren. Erhöhte Trainingsparameter finden sich eher bei PWH, die mehr als eine Sportart pro Woche treiben. Daher kann kumulierter Sport als mediierender Faktor zur Steigerung der Lebensqualität interpretiert werden; zumindest bei PWH mit einer psychologischen Komorbidität.
Die Auswirkungen der reformierten Psychotherapierichtlinie auf die ambulante Patentenversorgung
(2020)
The PhD thesis entitled “Actions through the lens of communicative cues. The influence of verbal cues and emotional cues on action processing and action selection in the second year of life” is based on four studies, which examined the cognitive integration of another person’s communicative cues (i.e., verbal cues, emotional cues) with behavioral cues in 18- and 24-month-olds. In the context of social learning of instrumental actions, it was investigated how the intention-related coherence of either a verbally announced action intention or an emotionally signaled action evaluation with an action demonstration influenced infants’ neuro-cognitive processing (Study I) and selection (Studies II, III, IV) of a novel object-directed action. Developmental research has shown that infants benefit from another’s behavioral cues (e.g., action effect, persistency, selectivity) to infer the underlying goal or intention, respectively, of an observed action (e.g., Cannon & Woodward, 2012; Woodward, 1998). Particularly action effects support infants in distinguishing perceptual action features (e.g., target object identity, movement trajectory, final target object state) from conceptual action features such as goals and intentions. However, less is known about infants’ ability to cognitively integrate another’s behavioral cues with additional action-related communicative cues. There is some evidence showing that in the second year of life, infants selectively imitate a novel action that is verbally (“There!”) or emotionally (positive expression) marked as aligning with the model’s action intention over an action that is verbally (“Whoops!”) or emotionally (negative expression) marked as unintentional (Carpenter, Akhtar, & Tomasello, 1998; Olineck & Poulin-Dubois, 2005, 2009; Repacholi, 2009; Repacholi, Meltzoff, Toub, & Ruba, 2016). Yet, it is currently unclear which role the specific intention-related coherence of a communicative cue with a behavioral cue plays in infants’ action processing and action selection that is, whether the communicative cue confirms, contrasts, clarifies, or is unrelated to the behavioral cue. Notably, by using both verbal cues and emotional cues, we examined not only two domains of communicative cues but also two qualitatively distinct relations between behavioral cues on the one hand and communicative cues on the other hand. More specifically, a verbal cue has the potential to communicate an action intention in the absence of an action demonstration and thus a prior-intention (Searle, 1983), whereas an emotional cue evaluates an ongoing or past action demonstration and thus signals an intention-in-action (Searle, 1983). In a first research focus, this thesis examined infants’ capacity to cognitively integrate another’s intention-related communicative cues and behavioral cues, and also focused on the role of the social cues’ coherence in infants’ action processing and action selection. In a second research focus, and to gain more elaborate insights into how the sub-processes of social learning (attention, encoding, response; cf. Bandura, 1977) are involved in this coherence-sensitive integrative processing, we employed a multi-measures approach. More specifically, we used Electroencephalography (EEG) and looking times to examine how the cues’ coherence influenced the compound of attention and encoding, and imitation (including latencies to first-touch and first-action) to address the compound of encoding and response. Based on the action-reconstruction account (Csibra, 2007), we predicted that infants use extra-motor information (i.e., communicative cues) together with behavioral cues to reconstruct another’s action intention. Accordingly, we expected infants to possess a flexibly organized internal action hierarchy, which they adapt according to the cues’ coherence that is, according to what they inferred to be the overarching action goal. More specifically, in a social-learning situation that comprised an adult model, who demonstrated an action on a novel object that offered two actions, we expected the demonstrated action to lead infants’ action hierarchy when the communicative (i.e., verbal, emotional) cue conveyed similar (confirming coherence) or no additional (un-related coherence) intention-related information relative to the behavioral cue. In terms of action selection, this action hierarchy should become evident in a selective imitation of the demonstrated action. However, when the communicative cue questioned (contrasting coherence) the behaviorally implied action goal or was the only cue conveying meaningful intention-related information (clarifying coherence), the verbally/emotionally intended action should ascend infants’ action hierarchy. Consequently, infants’ action selection should align with the verbally/emotionally intended action (goal emulation). Notably, these predictions oppose the direct-matching perspective (Rizzolatti & Craighero, 2004), according to which the observation of another’s action directly resonates with the observer’s motor repertoire, with this motor resonance enabling the identification of the underlying action goal. Importantly, the direct-matching perspective predicts a rather inflexible action hierarchy inasmuch as the process of goal identification should solely rely on the behavioral cue, irrespective of the behavioral cue’s coherence with extra-motor intention-related information, as it may be conveyed via communicative cues. As to the role of verbal cues, Study I used EEG to examine the influence of a confirming (Congruent) versus contrasting (Incongruent) coherence of a verbal action intention with the same action demonstration on 18-month-olds’ conceptual action processing (as measured via mid-latency mean negative ERP amplitude) and motor activation (as measured via central mu-frequency band power). The action was demonstrated on a novel object that offered two action alternatives from a neutral position. We expected mid-latency ERP negativity to be enhanced in Incongruent compared to Congruent, because past EEG research has demonstrated enhanced conceptual processing for stimuli that mismatched rather than matched the semantic context (Friedrich & Friederici, 2010; Kaduk et al., 2016). Regarding motor activation, Csibra (2007) posited that the identification of a clear action goal constitutes a crucial basis for motor activation to occur. We therefore predicted reduced mu power (indicating enhanced motor activation) for Congruent than Incongruent, because in Congruent, the cues’ match provides unequivocal information about the model’s action goal, whereas in Incongruent, the conflict may render the model’s action goal more unclear. Unexpectedly, in the entire sample, 18-month-olds’ mid-latency ERP negativity during the observation of the same action demonstration did not differ significantly depending on whether this action was congruent or incongruent with the model’s verbal action intention. Yet, post hoc analyses revealed the presence of two subgroups of infants, each of which exhibited significantly different mid-latency ERP negativity for Congruent versus Incongruent, but in opposing directions. The subgroups differed in their productive action-related language skills, with the linguistically more advanced infants exhibiting the expected response pattern of enhanced ERP mean negativity in Incongruent than Congruent, indicating enhanced conceptual processing of an action demonstration that was contrasted rather than confirmed by the verbal action context. As expected, central mu power in the entire sample was reduced in Congruent relative to Incongruent, indicating enhanced motor activation when the action demonstration was preceded by a confirming relative to a contrasting verbal action intention. This finding may indicate the covert preparation for a preferential imitation of the congruent relative to the incongruent action (Filippi et al., 2016; Frey & Gerry, 2006). Overall, these findings are in line with the action-reconstruction account (Csibra, 2007), because they suggest a coherence-sensitive attention to and encoding of the same perceptual features of another’s behavior and thus a cognitive integration of intention-related verbal cues and behavioral cues. Yet, because the subgroup constellation in infants’ ERPs was only discovered post hoc, future research is clearly required to substantiate this finding. Also, future research should validate our interpretation that enhanced motor activation may reflect an electrophysiological marker of subsequent imitation by employing EEG and imitation in a within-subjects design. Study II built on Study I by investigating the impact of coherence of a verbal cue and a behavioral cue on 18- and 24-month-olds’ action selection in an imitation study. When infants of both age groups observed a confirming (Congruent) or unrelated (Pseudo-word: action demonstration was associated with novel verb-like cue) coherence, they selectively imitated the demonstrated action over the not demonstrated, alternative action, with no difference between these two conditions. These findings suggest that, as expected, infants’ action hierarchy was led by the demonstrated action when the verbal cue provided similar (Congruent) or no additional (Pseudo-word) intention-related information relative to a meaningful behavioral cue. These findings support the above-mentioned interpretation that enhanced motor activation during action observation may reflect a covert preparation for imitation (Study I). Interestingly, infants did not seem to benefit from the intention-highlighting effect of the verbal cue in Congruent, suggesting that the verbal cue had an unspecific (e.g., attention-guiding) effect on infants’ action selection. Contrary, when infants observed a contrasting (Incongruent) or clarifying (Failed-attempt: model failed to manipulate the object but verbally announced a certain action intention) coherence, their action selection varied with age and also varied across the course of the experiment (block 1 vs. block 2). More specifically, the 24-month-olds made stronger use of the verbal cue for their action selection in block 1 than did the 18-month-olds. However, while the 18-month-olds’ use of the verbal cue increased across blocks, particularly in Incongruent, the 24-month-olds’ use of the verbal cue decreased across blocks. Overall, these results suggest that, as expected, infants’ action hierarchy in Incongruent (both age groups) and Failed-attempt (only 24-month-olds) drew on the verbal action intention, because in both age groups, infants emulated the verbal intention about as often as they imitated the demonstrated action or even emulated the verbal action intention preferentially. Yet, these findings were confined to certain blocks. It may be argued that the younger age group had a harder time inferring and emulating the intended, yet never observed action, because this requirement is more demanding in cognitive and motor terms. These demands may explain why the 18-month-olds needed some time to take account of the verbal action intention. Contrary, it seems that the 24-month-olds, although demonstrating their principle capacity to take account of the verbal cue in block 1, lost trust in the model’s verbal cue, maybe because the verbal cue did not have predictive value for the model’s actual behavior. Supporting this interpretation, research on selective trust has demonstrated that already infants evaluate another’s reliability or competence, respectively, based on how that model handles familiar objects (behavioral reliability) or labels familiar objects (verbal reliability; for reviews, see Mills, 2013; Poulin-Dubois & Brosseau-Liard, 2016). Relatedly, imitation research has demonstrated that the interpersonal aspects of a social-learning situation gain increasing relevance for infants during the second year of life (Gellén & Buttelmann, 2019; Matheson, Moore, & Akhtar, 2013; Uzgiris, 1981). It may thus be argued that when the 24-month-olds were repeatedly faced with a verbally unreliable model, they de-evaluated the verbal cue as signaling the model’s action intention and instead relied more heavily on alternative cues such as the behavioral cue (Incongruent) or the action context (e.g., object affordances, salience; Failed-attempt). Infants’ first-action latencies were higher in Incongruent and Failed-attempt than in both Congruent and Pseudo-word, and were also higher in Failed-attempt than in Incongruent. These latency-findings thus indicate that situations involving a meaningful verbal cue that deviated from the behavioral cue are cognitively more demanding, resulting in a delayed initiation of a behavioral response. In sum, the findings of Study II suggest that both age groups were highly flexible in their integration of a verbal cue and behavioral cue. Moreover, our results do not indicate a general superiority of either cue. Instead, it seems to depend on the informational gain conveyed by the verbal cue whether it exerts a specific, intention-highlighting effect (Incongruent, Failed-attempt) or an unspecific (e.g., attention-guiding) effect (Congruent, Pseudo-word). Studies III and IV investigated the impact of another’s action-related emotional cues on 18-month-olds’ action selection. In Study III, infants observed a model, who demonstrated two actions on a novel object in direct succession, and who combined one of the two actions with a positive (happy) emotional expression and the other action with a negative (sad) emotional expression. As expected, infants imitated the positively emoted (PE) action more often than the negatively emoted (NE) action. This preference arose from an increase in infants’ readiness to perform the PE action from the baseline period (prior to the action demonstrations) to the test period (following the action demonstrations), rather than from a decrease in readiness to the perform the NE action. The positive cue thus had a stronger behavior-regulating effect than the negative cue. Notably, infants’ more general object-directed behavior in terms of first-touch latencies remained unaffected by the emotional cues’ valence, indicating that infants had linked the emotional cues specifically to the corresponding action and not the object as a whole (Repacholi, 2009). Also, infants’ looking times during the action demonstration did not differ significantly as a function of emotional valence and were characterized by a predominant attentional focus to the action/object rather than to the model’s face. Together with the findings on infants’ first-touch latencies, these results indicate a sensitivity for the notion that emotions can have very specific referents (referential specificity; Martin, Maza, McGrath, & Phelps, 2014). Together, Study III provided evidence for selective imitation based on another’s intention-related (particularly positive) emotional cues in an action-selection task, and thus indicates that infants’ action hierarchy flexibly responds to another’s emotional evaluation of observed actions. According to Repacholi (2009), we suggest that infants used the model’s emotional evaluation to re-appraise the corresponding action (effect), for instance in terms of desirability. Study IV followed up on Study III by investigating the role of the negative emotional cue for infants’ action selection in more detail. Specifically, we investigated whether a contrasting (negative) emotional cue alone would be sufficient to differentially rank the two actions along infants’ action hierarchy or whether instead infants require direct information about the model’s action intention (in the form of a confirming action-emotion pair) to align their action selection with the emotional cues. Also, we examined whether the absence of a direct behavior-regulating effect of the negative cue in Study III was due to the negative cue itself or to the concurrently available positive cue masking the negative cue’s potential effect. To this end, we split the demonstration of the two action-emotion pairs across two trials. In each trial, one action was thus demonstrated and emoted (PE, NE action), and one action was not demonstrated and un-emoted (UE action). For trial 1, we predicted that infants, who observed a PE action demonstration, would selectively imitate the PE action, whereas infants, who observed a NE action demonstration would selectively emulate the UE action. As to trial 2, we expected the complementary action-emotion pair to provide additional clarifying information as the model’s emotional evaluation of both actions, which should either lead to adaptive perseveration (if infants’ action selection in trial 1 had already drawn on the emotional cue) or adaptive change (if infants’ action selection in trial 1 signaled a disregard of the emotional cue). As to trial 1, our findings revealed that, as expected, infants imitated the PE action more often than they emulated the UE action. Like in Study III, this selectivity arose from an increase in infants’ propensity to perform the PE action from baseline to trial 1. Also like in Study III, infants performed the NE action about equally often in baseline and trial 1, which speaks against a direct behavior-regulating effect of the negative cue also when presented in isolation. However, after a NE action demonstration, infants emulated the UE action more often in trial 1 than in baseline, suggesting an indirect behavior-regulating effect of the negative cue. Yet, this indirect effect did not yield a selective emulation of the UE action, because infants performed both action alternatives about equally often in trial 1. Unexpectedly, infants’ action selection in trial 2 was unaffected by the emotional cue. Instead, infants perseverated their action selection of trial 1 in trial 2, irrespective of whether it was adaptive or non-adaptive with respect to the model’s emotional evaluation of the action. It seems that infants changed their strategy across trials, from an initial adherence to the emotional (particularly positive) cue, towards bringing about a salient action effect (Marcovich & Zelazo, 2009). In sum, Studies III and IV indicate a dynamic interplay of different action-selection strategies, depending on valence and presentation order. Apparently, at least in infancy, action reconstruction as one basis for selective action performance reaches its limits when infants can only draw on indirect intention-related information (i.e., which action should be avoided). Overall, our findings favor the action-reconstruction account (Csibra, 2007), according to which actions are flexibly organized along a hierarchy, depending on inferential processes based on extra-motor intention-related information. At the same time, the findings question the direct-matching hypothesis (Rizzolatti & Craighero, 2004), according to which the identification (and pursuit) of action goals hinges on a direct simulation of another’s behavioral cues. Based on the studies’ findings, a preliminary working model is introduced, which seeks to integrate the two theoretical accounts by conceptualizing the routes that activation induced by social cues may take to eventually influence an infant’s action selection. Our findings indicate that it is useful to strive a differentiated conceptualization of communicative cues, because they seem to operate at different places within the process of cue integration, depending on their potential to convey direct intention-related information. Moreover, we suggest that there is bidirectional exchange within each compound of adjacent sub-processes (i.e., between attention and encoding, and encoding and response), and between the compounds. Hence, our findings highlight the benefits of a multi-measures approach when studying the development of infants’ social-cognitive abilities, because it provides a more comprehensive picture how the concerted use of social cues from different domains influences infants’ processing and selection of instrumental actions. Finally, this thesis points to potential future directions to substantiate our current interpretation of the findings.. Moreover, an extension to additional kinds of coherence is suggested to get closer to infants’ everyday-world of experience.
Early numeracy is one of the strongest predictors for later success in school mathematics (e.g., Duncan et al., 2007). The main goal of first grade mathematics teachers should therefore be to provide learning opportunities that enable all students to develop sound early numeracy skills. Developmental models, or learning progressions, can describe how early numerical understanding typically develops. Assessments that are aligned to empirically validated learning progressions can support teachers to understand their students learning better and target instruction accordingly. To date, there have been no progression-based instruments made available for German teachers to monitor their students’ progress in the domain of early numeracy. This dissertation contributes to the design of such an instrument. The first study analysed the suitability of early numeracy assessments currently used in German primary schools at school entry to identify students’ individual starting points for subsequent progress monitoring. The second study described the development of progression-based items and investigated the items in regards to main test quality criteria, such as reliability, validity, and test fairness, to find a suitable item pool to build targeted tests. The third study described the construction of the progress monitoring measure, referred to as the learning progress assessment (LPA). The study investigated the extent to which the LPA was able to monitor students’ individual learning progress in early numeracy over time. The results of the first study indicated that current school entry assessments were not able to provide meaningful information about the students’ initial learning status. Thus, the MARKO-D test (Ricken, Fritz, & Balzer, 2013) was used to determine the students’ initial numerical understanding in the other two studies, because it has been shown to be an effective measure of conceptual numerical understanding (Fritz, Ehlert, & Leutner, 2018). Both studies provided promising evidence for the quality of the LPA and its ability to detect changes in numerical understanding over the course of first grade. The studies of this dissertation can be considered an important step in the process of designing an empirically validated instrument that supports teachers to monitor their students’ early numeracy development and to adjust their teaching accordingly to enhance school achievement.
This doctoral dissertation aims at elucidating the development of hot and cool executive functions in middle childhood and at gaining insight about their role in childhood overweight. The dissertation is based on three empirical studies which have been published in peer-reviewed journals. Data from a large 3-year longitudinal study (the “PIER-study”) was used.
The findings presented in the dissertation demonstrated that both hot and cool EF abilities increase during middle childhood. They also supported the notion that hot and cool EF facets are distinguishable from each other in middle childhood, that they have distinct developmental trajectories, and different predictors.
Evidence was found for associations of hot and cool EF with body weight in middle childhood, which is in line with the notion that they might play a role in the self-regulation of eating and the multifactorial etiology of childhood overweight.
Wie stark eine Person in ihrer alltäglichen Umgebung auf Anzahlen achtet (Spontane Fokussierung auf Anzahligkeit, kurz SFON) ist individuell sehr unterschiedlich. Zwar liegen bereits hinreichende Belege für einen Zusammenhang zwischen SFON und Zählfertigkeiten, Subitizing und basalen sowie höheren arithmetischen Fertigkeiten im Kindergarten und der frühen Grundschulzeit vor, die Einordnung der relativen Bedeutsamkeit von SFON gegenüber bereits bekannten und gut belegten Prädiktoren fehlt jedoch. Daneben lag der bisherige Schwerpunkt vorrangig auf Zählfertigkeiten. Offen bleiben die Kompetenzen des Kindes in der Mengenerfassung und -verarbeitung sowie die bereits im Vorschulalter vorhandene Kenntnis arabischer Ziffern.
Die Daten dieser Arbeit wurden im Rahmen einer großen epidemiologischen Studie (SCHUES) erhoben. Eine Stichprobe von 1868 Kindergartenkindern (964 Jungen und 904 Mädchen) konnte zwölf Monate vor ihrem Schuleintritt erstmalig untersucht werden. Die Kinder waren hier im Mittel 63 Monate alt. 1704 Kinder konnten erneut rund neun Monate später (im Mittel drei Monate vor Schulbeginn) getestet werden. Das mittlere Alter der Kinder lag bei 72 Monaten. Die erfassten numerisch-mathematischen Fertigkeiten lassen sich in drei Teilbereiche gliedern: Zählfertigkeiten, Ziffernkenntnis und Rechnen/Mengenerfassung. Daneben wurden SFON, die nonverbale und verbale Intelligenz, die phonologische Schleife, der visuell-räumliche Notizblock sowie die zentrale Exekutive und die Aufmerksamkeit zu beiden Messzeitpunkten erhoben.
Die SFON-Tendenz zeigte eine mäßige, numerisch-mathematische Fertigkeiten eine mäßige bis hohe Stabilität über die Zeit. Der an bisher deutlich kleineren Stichproben gefundene Zusammenhang zwischen der SFON-Tendenz und den numerisch-mathematischen Fertigkeiten konnte in der vorliegenden Arbeit repliziert werden. Eine Vorhersage auffälliger als auch sehr guter numerisch-mathematischer Leistungen gelang jedoch weder quer- noch längsschnittlich mit ausreichend hoher Genauigkeit. Auch der bereits in der Literatur beschriebene reziproke Zusammenhang zwischen SFON und numerisch-mathematischen Fertigkeiten konnte durch die vorliegende Arbeit an einer großen Stichprobe repliziert werden. Darüber hinaus wurden Hinweise auf die kausale Struktur des Zusammenhangs gewonnen: Die Ergebnisse zeigten, dass numerisch-mathematische Fertigkeiten SFON besser vorhersagen konnten als andersherum. Die Ergebnisse der Pfadanalysen zeigten weiterhin, dass SFON neben den bedeutsamen Konstrukten des Arbeitsgedächtnisses, der Intelligenz und der Aufmerksamkeit einen eigenständigen Beitrag für die Entwicklung numerischer als auch mathematischer Fertigkeiten leistet. Auch auf die weitere numerische und mathematische Entwicklung bis kurz vor Schuleintritt hat SFON einen bedeutsamen Einfluss. Dieser vollzieht sich jedoch indirekt über das numerisch-mathematische Vorwissen.
On being and belonging
(2019)
Die Unzufriedenheit mit Gewicht und Figur gilt als bedeutsamer Risikofaktor für die Entstehung von gestörtem Essverhalten und Essstörungen im Vollbild und steht mit reduziertem psychischem Wohlbefinden in Zusammenhang. Aufgrund der hohen klinischen Relevanz wurden Gewichts- /Figursorgen v. a. bei weiblichen Jugendlichen und jungen Erwachsenen vielfach untersucht. Muskelsorgen – als männliches Äquivalent betrachtet – stießen erst im Verlauf der letzten 20 Jahren auf vermehrtes Interesse in der psychologischen Forschung. Die aktuellen westlichen Schönheitsideale legen jedoch die Relevanz von Gewicht, Figur und Muskulosität in Bezug auf aussehensbezogene Sorgen bei beiden Geschlechtern nahe. In der vorliegenden Dissertation wurden deshalb die folgenden Fragestellungen thematisiert: (1) Auftreten: Wie sind Gewichts- /Figursorgen und Muskelsorgen bei weiblichen und männlichen Jugendlichen und jungen Erwachsenen ausgeprägt? Wie verändern sie sich über 20 Monate? Welche Profile lassen sich bezüglich ihres Auftretens definieren? (2) Einflussfaktoren: Welchen Einfluss haben Alter, Gewichtsstatus, negative Affektivität und Internalisierung des Schönheitsideals auf Gewichts- /Figursorgen und Muskelsorgen? (3) Folgen: Welchen Einfluss haben Gewichts-/Figursorgen und Muskelsorgen auf essensbezogene Sorgen, restriktives Essverhalten, Binge Eating, zwanghaftes Bewegungsverhalten, Verhaltensweisen zum Muskelaufbau und negative Affektivität?
Es konnte gezeigt werden, dass mehr Mädchen von aussehensbezogenen Sorgen betroffen sind und diese im Mittel höher ausgeprägte Gewichts-/Figursorgen zeigen, während Jungen höher ausgeprägte Muskelsorgen berichten. Eine differenzierte Analyse verschiedener Subgruppen legt jedoch nahe, dass es in Gruppen mit ausgeprägten aussehensbezogenen Sorgen keine Geschlechtsunterschiede bezüglich Gewichts-/Figursorgen und Muskelsorgen gibt. Dieser Befund unterstreicht die Relevanz beider Aspekte bei beiden Geschlechtern und legt eine entsprechende Erfassung in zukünftigen Studien nahe. Des Weiteren ergaben sich Ansatzpunkte für die Notwendigkeit der Prävention bei Mädchen mit Übergewicht/Adipositas im späten Jugend- und frühen Erwachsenenalter ebenso wie bei Jungen mit Untergewicht sowie Übergewicht/Adipositas. Neben Gewichts-/Figursorgen sollte bei weiblichen Jugendlichen und jungen Erwachsenen auch die Internalisierung des schlanken Ideals thematisiert werden, um der Entstehung von auffälligem Ess- und Bewegungsverhalten vorzubeugen. Bei beiden Geschlechtern zeigte sich außerdem die Internalisierung des athletischen Ideals als relevanter Ansatzpunkt für die Vorbeugung von Verhaltensweisen zum Muskelaufbau. Darüberhinaus konnten bei beiden Geschlechtern sowohl für Gewichts-/Figursorgen, als auch für Muskelsorgen Zusammenhänge mit potentiell gesundheitsschädlichen Verhaltensweisen gezeigt werden.
Zusammenfassend gelang in der vorliegenden Arbeit eine differenzierte Analyse von Auftreten, Einflussfaktoren und Folgen von Gewichts-/Figursorgen und Muskelsorgen bei Jugendlichen und jungen Erwachsenen. Mittels, großteils prospektiver, latenter Modelle und manifester Pfadanalysen konnten bisherige Befunde überprüft und erste Befunde zu den Forschungslücken in Bezug auf Muskelsorgen bei weiblichen Jugendlichen und jungen Erwachsenen berichtet werden.
Funktionelle Bauchschmerzen des Kindes betreffen die ganze Familie, wobei die Literatur insbesondere die Rolle der Eltern hervorhebt. Bisher wurden die Eltern jedoch primär als „critical behavioral agents“ (Palermo & Eccleston, 2009) gesehen, die einen Einfluss auf die Bauchschmerzen und Beeinträchtigung des Kindes ausüben. Untersuchungen der psychosozialen Auswirkungen der Bauchschmerzen und der Beeinträchtigung des Kindes auf die Eltern wurden bislang vernachlässigt (Palermo & Eccleston, 2009). Die Dissertation hatte daher zum Ziel, die Rolle der Eltern bei funktionellen Bauchschmerzen umfassend zu betrachten, indem sowohl schmerzbezogene Reaktionen der Eltern, als auch die psychosoziale Belastung der Eltern berücksichtigt und systematisch in Zusammenhang zu den Bauchschmerzen und der Beeinträchtigung des Kindes untersucht wurden. Zum anderen sollten durch Interventionsstudien Aussagen über die Veränderbarkeit spezifischer Belastungsmerkmale der Eltern und über das Wechselspiel zwischen der Ebene der Eltern und der Ebene des Kindes ermöglicht werden. Anhand von vier Studien sollten die Fragen beantworten werden 1) welche Faktoren die ärztliche Inanspruchnahme beeinflussen und welche besondere Relevanz dabei die Bewertungsprozesse der Eltern besitzen, 2) wie die psychosoziale Belastung der Eltern charakterisiert ist und durch welche Faktoren sie beeinflusst wird, 3) welche Veränderungen im Rahmen einer kindzentrierten verhaltenstherapeutischen Intervention auf Seiten der Eltern zu beobachten sind und 4) wie sich diese Veränderungen seitens der Eltern und seitens des Kindes gegenseitig beeinflussen.
Datenbankbasierte epidemiologische Untersuchung über die Versorgung demenzerkrankter Patienten
(2016)
Hintergrund:
Demenz wird von der Weltgesundheitsorganisation als ein in der Regel chronisch oder progressiv verlaufendes Syndrom definiert, das von einer Vielzahl von Hirnerkrankungen verursacht wird, welche das Gedächtnis, das Denkvermögen, das Verhalten und die Fähigkeit, alltägliche Tätigkeiten auszuführen, beeinflussen. Weltweit leiden 47,5 Millionen Menschen unter Demenz und diese Zahl wird sich voraussichtlich bis zum Jahr 2050 verdreifachen.
In den vorliegenden Studien wurden zum Einem die Faktoren, welche mit dem Risiko einhergehen eine Demenz zu entwickeln, analysiert. Zum Anderen wurde die Persistenz der medikamentösen Behandlung von depressiven Zuständen mit Antidepressiva sowie die Persistenz der medikamentösen Behandlung von Verhaltensstörungen, therapiert mit Antipsychotika, bei Demenzpatienten untersucht.
Durchführung:
Alle drei Studien basieren auf den Daten der IMS Disease Analyzer-Datenbank.
Die Daten der Disease Analyzer-Datenbank werden über standardisierte Schnittstellen direkt monatlich aus dem Praxiscomputer generiert. Die Daten werden vor der Übertragung verschlüsselt und entsprechen in Umfang und Detaillierungsgrad der Patientenakte.
Risikofaktoren für eine Demenzdiagnose
Methode:
Insgesamt wurden in die Studie 11.956 Patienten mit einer Erstdiagnose (Indexdatum) einer Demenz (ICD 10: F01, F03, G30) zwischen Januar 2010 und Dezember 2014 eingeschlossen. 11.956 Kontrollpatienten (ohne Demenz) wurden den Patienten nach Alter, Geschlecht, Art der Krankenversicherung und Arzt zugeordnet. In beiden Fällen wurden die Praxisaufzeichnungen dazu verwendet, sicherzustellen, dass die Patienten vor dem Indexdatum jeweils 10 Jahre kontinuierlich beobachtet worden waren. Insgesamt wurden 23.912 Personen betrachtet.
Mehrere Erkrankungen, die möglicherweise mit Demenz assoziiert sind, wurden anhand von allgemeinärztlichen Diagnosen bestimmt (ICD-10-Codes): Diabetes (E10-E14), Hypertonie (I10), Adipositas (E66), Hyperlipidämie (E78), Schlaganfall (einschließlich transitorische ischämische Attacke, TIA) (I63, I64, G45), Parkinson-Krankheit (G20, G21), intrakranielle Verletzung (S06), koronare Herzkrankheit (I20-I25), leichte kognitive Beeinträchtigung (F06) und psychische und Verhaltensstörungen durch Alkohol (F10). Das Vorhandensein mehrerer Medikamente, wie z. B. Statine, Protonenpumpenhemmer und Antihypertensiva (einschließlich Diuretika, Beta-Blocker, Calciumkanalblocker, ACE-Hemmer und Angiotensin-II), wurde ebenfalls bemessen.
Ergebnisse:
Das Durchschnittsalter für die 11.956 Demenzpatienten und die 11.956 der Kontrollkohorte war 80,4 (SD 5,3) Jahre. 39,0% der waren männlich. In dem multivariaten Regressionsmodell, wurden folgende Variablen mit einem erhöhten Risiko von Demenz in einem signifikanten Einfluß assoziiert: milde kognitive Beeinträchtigung (MCI) (OR: 2,12), psychische und Verhaltensstörungen durch Alkohol (1,96), Parkinson-Krankheit (PD) (1,89), Schlaganfall (1,68), intrakranielle Verletzung (1,30), Diabetes (1,17), Fettstoffwechselstörung (1,07), koronare Herzkrankheit (1,06). Der Einsatz von Antihypertensiva (0,96), Statinen (OR: 0,94) und Protonen-Pumpen-Inhibitoren (PPI) (0,93) wurden mit einem verringerten Risiko der Entwicklung von Demenz.
Schlussfolgerung:
Die gefundenen Risikofaktoren für Demenz stehen in Einklang mit der Literatur. Nichtsdestotrotz bedürfen die Zusammenhänge zwischen der Verwendung von Statinen, PPI und Antihypertensiva und einem verringerten Demenzrisiko weiterer Untersuchungen.
Persistenz der Behandlung mit Antidepressiva bei Patienten mit Demenz
Methode:
Patienten wurden ausgewählt, wenn bei ihnen im Zeitraum zwischen Januar 2004 und Dezember 2013 eine Demenzdiagnose (ICD 10: F01, F03, G30) und eine erste Verordnung eines trizyklischen Antidepressivums oder selektiven Serotonin-
Wiederaufnahmehemmers (SSRI) oder Serotonin-Noradrenalin-Wiederaufnahmehemmers (SSNRI) vorlagen. Ausgewählte Patienten wurden über einen Zeitraum von bis zu zwei Jahre nach dem Indexdatum beobachtet. Das letzte Nachbeobachtungsdatum eines Patienten war der 31. Dezember 2014. Insgesamt standen 12.281 Patienten für die Persistenzanalyse zur Verfügung. Der Hauptzielparameter war die Abbruchrate der Antidepressivabehandlung innerhalb von sechs Monaten nach dem Indexdatum. Behandlungsabbruch wurde definiert als ein Zeitraum von 90 Tagen ohne diese Therapie.
Als demographische Daten wurden Alter, Art der Krankenversicherung (privat oder gesetzlich), Art der Praxis (Neurologe oder Allgemeinmediziner) und Praxisregion (Ost- oder Westdeutschland) erhoben. Die folgenden Demenzdiagnosen wurden berücksichtigt: Alzheimer-Krankheit (G30), vaskuläre Demenz (F01) und nicht näher bezeichnete Demenz (F03). Darüber hinaus wurde der Charlson-Komorbiditäts-Index als allgemeiner Marker für Komorbidität verwendet. Darüber hinaus wurden die folgenden Diagnosen als Komorbiditäten in die Studie aufgenommen: Depression (ICD 10: F32-33), Delir (F05), Typ-2-Diabetes mellitus (E11, E14), Hypertonie (I10), koronare Herzkrankheit (I24, I25), Schlaganfall (I63, I64), Myokardinfarkt (I21-23) und Herzinsuffizienz (I50).
Ergebnisse:
Nach sechs Monaten Nachbeobachtung hatten 52,7 % (von 12,281 Demenzpatienten) der mit Antidepressiva behandelten Demenzpatienten die Medikamenteneinnahme abgebrochen. Die multivariaten Regressionsanalysen zeigten ein signifikant geringeres Risiko für einen Behandlungsabbruch bei mit SSRRI oder SSNRI behandelten Patienten verglichen mit Patienten, die trizyklische Antidepressiva einnahmen. Es zeigte sich ein signifikant geringeres Risiko eines Behandlungsabbruchs bei jüngeren Patienten.
Schlussfolgerung:
Die Ergebnisse zeigen eine unzureichende Persistenz mit Antipsychotika bei Demenzpatienten unter Alltagsbedingungen. Es muss eine Verbesserung erreicht werden, um die in den Richtlinien empfohlene Behandlung sicherzustellen.
Persistenz der Behandlung mit Antipsychotika bei Patienten mit Demenz
Methode:
Diese Studie umfasste Patienten im Alter ab 60 Jahren mit Demenz beliebigen Ursprungs, die zwischen Januar 2009 und Dezember 2013 (Indexdatum) zum ersten Mal Antipsychotikaverordnungen (ATC: N05A) von deutschen Psychiatern erhielten. Der Nachbeobachtungszeitraum endete im Oktober 2015. Die Demenz wurde auf Grundlage der ICD-10-Codes für vaskuläre Demenz (F01), nicht näher bezeichnete Demenz (F03) und Alzheimer-Krankheit (G30) bewertet.
Der Hauptzielparameter war die Behandlungspersistenzrate über einen Zeitraum von mehr als 6 Monaten nach dem Indexdatum. Die Persistenz wurde als Therapiezeit ohne Absetzen der Behandlung, definiert als mindestens 180 Tage ohne Antipsychotikatherapie, geschätzt. Alle Patienten wurden für eine Dauer von bis zu zwei Jahren ab ihrem Indexdatum beobachtet.
Gleichzeitig auftretende Erkrankungen wurden anhand von Diagnosen (ICD-10-Codes) von Depression (F32, F33), Parkinson-Krankheit (G20), psychischer Störungen aufgrund bekannter physiologischer Erkrankungen (F06) und Persönlichkeits- und Verhaltensstörungen aufgrund physiologischer Erkrankungen (F07) bestimmt. Als demographische Daten wurden Alter, Geschlecht und Art der Krankenversicherung (privat/gesetzlich) erhoben.
Ergebnisse:
12,979 Demenzpatienten mit einem Durchschnittsalter von 82 Jahre (52.1% leben in Pflegeheimen) wurden in diese Studie analysiert. Nach zwei Jahren Nachbeobachtung hatten 54,8 %, 57,2 %, 61,1 % bzw. 65,4 % der Patienten zwischen 60-69, 70-79, 80-89 bzw. 90-99 Jahren Antipsychotikaverordnungen erhalten (p<0,001). 82,6 % der in Pflegeheimen lebenden Patienten und 76,2 % der Patienten in häuslicher Pflege setzten ihre Behandlung ebenfalls länger als 6 Monate fort; nach zwei Jahren lag der Anteil bei 63,9 % (in Pflegeheimen) bzw. 55,0 % (in häuslicher Pflege) (p<0,001).
Schlussfolgerung:
Die Studie zeigt, dass der Anteil der mit Antipsychotika behandelten Demenzpatienten sehr hoch ist. Weitere Studien, einschließlich qualitativer Untersuchungen, sind nötig, um die Gründe für dieses Verschreibungsverhalten zu verstehen und zu erklären.
Rechenstörungen im Kindes- und Jugendalter: psychische Auffälligkeiten und kognitive Defizite
(2012)
Zur Entwicklung geistiger Fähigkeiten in der gymnasialen Oberstufe : Potsdamer Längsschnittstudie
(1992)
Strategisches Lernen
(2000)