Prüfungsangst ist in der heutigen Gesellschaft und in den Lerneinrichtungen, wie Schule und Universität, ein sehr relevantes Thema. So gibt jeder sechste Student im Erststudium an, sich mit Lern- und Leistungsproblemen sowie mit Prüfungs- angst auseinanderzusetzen (17. Sozialerhebung des Deutschen Studentenwerks, 2003). Es ist von einem Zusammenhang zwischen Prüfungsangst und Lernstrate- gien auszugehen. Die Vermittlung von Lernstrategien kann zur Prävention von Prüfungsangst beitragen. Ziel der vorliegenden Arbeit war es, bei Studierenden den Zusammenhang zwi- schen der Ausprägung von Prüfungsangst und der Nutzung von Lernstrategien zu untersuchen. Zudem wurde das Ausmaß der Nutzung verschiedener Lernstrate- gien in Abhängigkeit von der Semesterzahl, der Studienrichtung und dem Ge- schlecht untersucht und der Bedarf bei Studierenden hinsichtlich der Vermittlung von Lernstrategien erfasst. Ergänzend wurde der Zusammenhang von Lernstra- tegien und subjektiv wahrgenommenem Studienerfolg beschrieben. Im Rahmen einer Fragebogenuntersuchung im Sommersemester 2008 wurden Studierende der Humanmedizin und des Lehramtes der Universität Würzburg zum Einsatz von Lernstrategien, der Ausprägung von Prüfungsangst, ihrem Be- darf hinsichtlich der Vermittlung von Lernstrategien und ihrem subjektivem Studi- enerfolg befragt. Es wurden Studierende der ersten beiden Semester und ab dem achten Semester untersucht. Die Stichprobe umfasst 345 Studierende. Im Bezug auf die Strategienutzung und das Geschlecht der Studierenden konnten die Ergebnisse aus der Literatur weitgehend repliziert werden. So konnte bestätigt werden, dass Frauen in stärkerem Ausmaß Lernstrategien einsetzen als Männer. Bei der Untersuchung einzelner Lernstrategien konnte gezeigt werden, dass Frauen erwartungsgemäß vermehrt die Lernstrategien „Wiederholen“ „Organisati- on“ und „Lernen mit Studienkollegen“ einsetzen, während Männer vermehrt die Lernstrategie „Kritisches Prüfen“ nutzen. Entgegen den Ergebnissen aus der Lite- ratur zeigte sich in der untersuchten Stichprobe kein Unterschied in der Nutzung der Lernstrategien „Elaboration“ und „Kritisches Prüfen“ zwischen Studierenden in höheren und niedrigeren Semestern. - 94 - Bezüglich des Bedarfs hinsichtlich der Vermittlung von Lernstrategien zeigte sich, dass Studierende in den Anfangssemestern und Studierende mit Prüfungsangst einen stärkeren Bedarf bekunden. Lehramtsstudierende äußern in allen unter- suchten Semestern einen starken Bedarf. Insbesondere für die genannten Grup- pen von Studierenden sollten Angebote zur Vermittlung von Lernstrategien ge- macht werden. Bei der Untersuchung der Zusammenhänge zwischen Studienerfolg und Prü- fungsangst konnte gezeigt werden, dass Studierende mit starker Prüfungsangst ihren Studienerfolg schlechter einschätzen als Studierende mit geringer Prü- fungsangst. Auf Basis dieser Ergebnisse erscheint es sinnvoll, in der Praxis für Medizinstudie- rende vor allem in den Anfangssemestern gezielt Beratungs- und Lehrangebote anzubieten, da sie diesbezüglich einen stärkeren Bedarf bekundet haben. Für Lehramtsstudierende sollte hingegen eine Lernstrategievermittlung über das ge- samte Studium angeboten werden. / Test anxiety is a relevant and highly complex issue in academic setting and in the contemporary society. If you take into account the many uses of tests and exams in our culture it´s not surprising that testing situations may evoke anxiety and people tend to connect self-worth with test performance. One out of six first year students declares to struggle with problems in learning and performance as well as fear of exams (17. social census of the German student association, 2003). It has to be assumed that a connection between performance anxiety and learning strategies exists. The incorporation of study skills training into cognitive behavioral programs for anxiety reduction brings about enhanced anxiety-reducing effects and shows additional effects on academic performance. The aim of this paper was to research the coherence between the occurence of performance anxiety and the use of learning strategies. Furthermore, the extend of use of different learning stratgies was analysed in reference to the year of study, course and gender and it has been researched to which extend the students are in demand for assistance on learning strategies. Additionally, the connection between learning strategies and study success as subjectively perceived has been described. The University of Wuerzburg (Germany) started a pilot project in fall 2007 comprising lectures and peer coaching with the aim to optimize learning skills and exam preparation to prevent test anxiety by modifying risk factors for test anxiety before the onset of related problems. The pilot project comprises both lectures and peer coaching. Peer coaching allows an expert training of issues discussed in lectures. In the course of a questionnaire in the summer semester of 2008 students of the medical school and educational studies of the university of Wuerzburg have been questioned about learning strategies, the extend of exam anxiety, their need for information on learning strategies and the subjective perception of study success. The students questioned were formed of first and second semester studends and students of the eight semester upwards. The random sample was embraced 345 students. In reference to the use of strategies and the gender of the students, the results from existing literature could be widely replicated. Thus, it could be confirmed that women tend to use learning strategies to a higher extend than men. In the course of the research on specific learning strategies it could be proven that as expected women tend to use more often the learning strategies of ‚repitition‘, ‚organisation‘ and ‚studying with fellow students‘, whereas men tend to use the strategy of ‚critical control/check‘. However, in contrast to results shown in literature on the topic, it has proven that there is no difference in the use of the learning stratgies ‚elaboration‘ and ‚critical control/check‘ depending on the semester. Concerning the need to teach information on learning strategies it has shown that students of the lower semesters and students with exam anxiety show a higher need. Students of educational studies show throughout all semesters a higher need. In particular for the student groups mentioned a possibility to receive information on learning strategies should be facilitated. In the course of the research on the connection of study success and exam anxiety it could be shown that students with a higher degree of exam anxiety rate their study success lower than students with a lower degree of exam anxiety. On the basis of this results it appears to be useful to offer therapeutic strategies and learning and preparation skils to medical students in their first semester as this group has shown a higher demand. For education students however the offer should be available throughout their studies.

Primärprävention hat sich insbesondere im Bereich der infektiösen Erkrankungen als erfolgreich erwiesen. Auch für die chronischen Krankheitsbilder gilt es, effektive Präventionsmaßnahmen zu entwickeln. Obwohl es zahlreiche Hinweise aus der wissenschaftlichen Literatur gibt, dass bestimmte Verhaltensweisen, z.B. das Ernährungsverhalten oder die körperliche Aktivität, einen beträchtlichen Anteil an der Entstehung von Krankheitsbildern wie Herz-Kreislauf-Erkrankungen oder Krebs haben, ist das darin vorhandene präventive Potential bislang nur wenig ausgeschöpft worden. Ein Grund hierfür könnte in der mangelnden wissenschaftlichen Glaubwürdigkeit der postulierten Maßnahmen liegen. Die vorliegende Arbeit befasst sich mit den Forschungsschritten, die notwendig sind, um zu belastbaren, wissenschaftlich fundierten Aussagen zu kommen, aus denen sich Empfehlungen zum Ernährungsverhalten ableiten lassen. Dazu wurden drei Komponenten dieses Prozesses beleuchtet: 1. Methodische Aspekte Einleitend wird auf methodische Vorrausetzungen eingegangen, die zur Gewinnung valider Daten notwendig sind, angefangen bei Erhebungsinstrumenten bis hin zur Anwendung adäquater Studiendesigns. Beispielhaft werden methodische Arbeiten vorgestellt, die im Rahmen der EPIC-Potsdam Studie entstanden sind und sich auf die Validierung von Ernährungserhebungsinstrumenten und Blutdruckmessungen beziehen. 2. Ergebnisse epidemiologischer Studien Grundvoraussetzung zur Entwicklung primärpräventiv wirksamer Empfehlungen ist die Generierung epidemiologischer Daten, die einen Zusammenhang zwischen Ernährungs-verhalten und dem Auftreten der untersuchten Erkrankung aufzeigen. Als Beispiel werden analytisch-epidemiologische Studienergebnisse aus dem Bereich des metabolischen Syndroms präsentiert und diskutiert. 3. Konzeptionelle Überlegungen Abschließend werden Aspekte der Interpretation einzelner Studienergebnisse sowie der zusammenfassenden Interpretation aller zu einem Thema vorliegenden Daten diskutiert. Die Synthese von Evidenz wird insbesondere auf dem Hintergrund der Konzepte des sog. evidenz-basierten Vorgehens betrachtet. Zusammenfassend lässt sich feststellen, dass der aufgezeigte Prozess hin zu evidenz-basierten Ernährungsempfehlungen begonnen hat und in den nächsten Jahren erste Erkenntnissen zu erwarten sind, die eine fundierte Einschätzung der Ernährung im Rahmen der Primärprävention erlauben. / Primary prevention has been proven to be a successful approach, especially in the area of infectious diseases. Nowadays the challenge is to develop effective preventive measures for chronic disease prevention. However, despite numerous signs from the scientific literature that life-style factors such as dietary behaviour or physical activity levels contribute substantially to the development of diseases like cardio-vascular disease or cancer, the preventive potential has not been fully exploited so far. One reason for that might be the lack of credibility of the postulated measures. This thesis deals with the necessary research steps needed for the development of scientifically based dietary recommendations. Three aspects of this process were highlighted: 1. Methodological aspects The introductory part points out the prerequisites for obtaining valid data, beginning with the assessments instruments and ending with the appropriate study design. As an example, validation studies on dietary assessment and blood pressure measurement that were undertaken for the EPIC-Potsdam study are presented. 2. Results from epidemiological studies Basic requirement for the development of primary prevention measures are epidemiological data demonstrating an association between dietary behaviour and disease occurrence. To exemplify this, analytical epidemiological study results obtained from studies on the metabolic syndrome are presented and discussed. 3. Conceptual considerations Finally, aspects of interpretation of single study results as well as of summarizing all data on a certain topic are discussed. Background of the considerations on the synthesis of evidence is the so-called evidence based approach. In summary, the outlined process leading towards evidence based dietary recommendations has begun, and during the upcoming years first results from this process are to be expected. These will then allow to derive a sound appraisal of the role of nutrition for primary prevention.

Background: The prognostic significance of chest pain is well established in patients with coronary artery disease, but still ill defined in primary prevention. Therefore, the aim of our analysis was to assess the prognostic value of different forms of chest pain in a large cohort of primary care subjects under the conditions of contemporary modalities of care in primary prevention, including measurement of serum levels of the biomarker NT-pro-BNP. Design: We carried out a post-hoc analysis of the prospective DETECT cohort study. Methods: In a total of 5570 unselected subjects, free of coronary artery disease, within the 55,518 participants of the cross-sectional DETECT study, we assessed chest pain history by a comprehensive questionnaire and measured serum NT-pro-BNP levels. Three types of chest pain, which were any chest pain, exertional chest pain and classical angina, were defined. Major adverse cardiovascular events (MACEs = cardiovascular death, myocardial infarction, coronary revascularization procedures) were assessed during a 5-year follow-up period. Results: During follow-up, 109 subjects experienced a MACE. All types of reported chest pain were associated with an approximately three-fold increased risk for the occurrence of incident MACEs, even after adjusting for cardiovascular risk factors. Any form of reported chest pain had a similar predictive value for MACEs as a one-time measurement of NT-pro-BNP. However, adding a single measurement of NT-pro-BNP and the information on chest pain resulted in reclassification of approximately 40% of subjects, when compared with risk prediction based on established cardiovascular risk factors. Conclusions: In primary prevention, self-reported chest pain and a single measurement of NT-pro-BNP substantially improve cardiovascular risk prediction and allow for risk reclassification of approximately 40% of the subjects compared with assessing classical cardiovascular risk factors alone.

Background: Several selected population-based studies have emphasized the significance of resting heart rate as an independent cardiovascular risk factor. However, there are no data available for using resting heart rate as a cardiovascular risk predictor in contemporary primary care. Thus, the aim of our analysis was to examine the clinical value of the measurement of resting heart rate in a large, unselected population-based cohort of primary care subjects under the conditions of contemporary primary prevention. Design: Prospective, population-based cohort study. Methods: We examined a subgroup of 5320 unselected primary care subjects free of coronary artery disease from the nationwide, longitudinal Diabetes Cardiovascular Risk Evaluation Targets and Essential Data for Commitment of Treatment (DETECT) cohort study, which was conducted from 2003 to 2008. Results: During the follow-up time of 5 years, 258 events were reported. Elevated resting heart rate was not associated with an increased risk for cardiovascular events (HR = 0.75, p = 0.394), cardiovascular mortality (HR = 0.71, p = 0.616) or major cardiovascular events (HR = 0.77, p = 0.376). By cross-sectional analysis, elevated heart rate clustered with markers of the metabolic syndrome, like increased blood pressure (systolic: OR = 5.54, p < 0.0001; diastolic: OR = 3.82, p < 0.0001), elevated fasting plasma glucose levels (OR = 8.84, p < 0.0001), hypertriglyceridaemia (OR = 22.16, p = 0.001), and obesity (body mass index OR = 0.89, p < 0.0001). Assessment of resting heart rate in clinical practice had minimal and non-significant additional prognostic value compared to established cardiovascular risk factors as judged by C statistics (C = 0.001, p = 0.979). Conclusion: The measurement of resting heart rate in the daily routine of primary care does not provide incremental prognostic information for cardiovascular risk stratification.

Background: Several selected population-based studies have emphasized the significance of resting heart rate as an independent cardiovascular risk factor. However, there are no data available for using resting heart rate as a cardiovascular risk predictor in contemporary primary care. Thus, the aim of our analysis was to examine the clinical value of the measurement of resting heart rate in a large, unselected population-based cohort of primary care subjects under the conditions of contemporary primary prevention. Design: Prospective, population-based cohort study. Methods: We examined a subgroup of 5320 unselected primary care subjects free of coronary artery disease from the nationwide, longitudinal Diabetes Cardiovascular Risk Evaluation Targets and Essential Data for Commitment of Treatment (DETECT) cohort study, which was conducted from 2003 to 2008. Results: During the follow-up time of 5 years, 258 events were reported. Elevated resting heart rate was not associated with an increased risk for cardiovascular events (HR = 0.75, p = 0.394), cardiovascular mortality (HR = 0.71, p = 0.616) or major cardiovascular events (HR = 0.77, p = 0.376). By cross-sectional analysis, elevated heart rate clustered with markers of the metabolic syndrome, like increased blood pressure (systolic: OR = 5.54, p < 0.0001; diastolic: OR = 3.82, p < 0.0001), elevated fasting plasma glucose levels (OR = 8.84, p < 0.0001), hypertriglyceridaemia (OR = 22.16, p = 0.001), and obesity (body mass index OR = 0.89, p < 0.0001). Assessment of resting heart rate in clinical practice had minimal and non-significant additional prognostic value compared to established cardiovascular risk factors as judged by C statistics (C = 0.001, p = 0.979). Conclusion: The measurement of resting heart rate in the daily routine of primary care does not provide incremental prognostic information for cardiovascular risk stratification.

Background: The prognostic significance of chest pain is well established in patients with coronary artery disease, but still ill defined in primary prevention. Therefore, the aim of our analysis was to assess the prognostic value of different forms of chest pain in a large cohort of primary care subjects under the conditions of contemporary modalities of care in primary prevention, including measurement of serum levels of the biomarker NT-pro-BNP. Design: We carried out a post-hoc analysis of the prospective DETECT cohort study. Methods: In a total of 5570 unselected subjects, free of coronary artery disease, within the 55,518 participants of the cross-sectional DETECT study, we assessed chest pain history by a comprehensive questionnaire and measured serum NT-pro-BNP levels. Three types of chest pain, which were any chest pain, exertional chest pain and classical angina, were defined. Major adverse cardiovascular events (MACEs = cardiovascular death, myocardial infarction, coronary revascularization procedures) were assessed during a 5-year follow-up period. Results: During follow-up, 109 subjects experienced a MACE. All types of reported chest pain were associated with an approximately three-fold increased risk for the occurrence of incident MACEs, even after adjusting for cardiovascular risk factors. Any form of reported chest pain had a similar predictive value for MACEs as a one-time measurement of NT-pro-BNP. However, adding a single measurement of NT-pro-BNP and the information on chest pain resulted in reclassification of approximately 40% of subjects, when compared with risk prediction based on established cardiovascular risk factors. Conclusions: In primary prevention, self-reported chest pain and a single measurement of NT-pro-BNP substantially improve cardiovascular risk prediction and allow for risk reclassification of approximately 40% of the subjects compared with assessing classical cardiovascular risk factors alone.