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This paper analyses wave 4 the Tsogolo la Thanzi survey of n = 1349 Malawian women aged 16–26 to explore the prevalence and predictors of self-reported fertility impairments (difficulties conceiving and/or difficulties carrying a pregnancy to term) and help-seeking strategies. Using descriptive statistics, logistic regression models, and graphic displays, the correlates of self-reporting an impairment and patterns of help-seeking strategies are examined. Nearly 13% (n = 117) of those who had ever tried to conceive reported experiencing a fertility impairment. Age was positively associated with reporting an impairment, while there was a negative association with education and with parity. Of women who reported an impairment, 85.5% sought help. Visiting a hospital or clinic was the most common response, followed closely by going to a traditional healer. Around one-quarter employed multiple help-seeking strategies, highlighting the need for various help-seeking behaviours to be viewed in tandem rather than in isolation. [ABSTRACT FROM AUTHOR]

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Children with a significant cognitive and motor developmental delay (SDD) are vulnerable for the development of (future) behavioral and mental health problems. To support children within this target group, knowledge on their social-emotional development is necessary. Therefore, in this paper, an explorative assessment of the changes in the social-emotional functioning of children with SDD over a two-year period was done. Yearly semi-structured interviews with one or more primary caregiver(s) of 25 children were conducted and analyzed on 13 domains of social-emotional functioning, according to an adapted version of the Scale for Emotional Development - Revised (SED-R). This study showed a lot of variation in individual and group patterns of change across the two-year period. Charting the social-emotional development in this target group is challenging and requires further in-depth analysis of individual trajectories as well as more fine-grained and long-term data collection. [ABSTRACT FROM AUTHOR]

Purpose: A screening instrument (0–100 points) to predict return-to-work (RTW) problems was developed. We tested the predictive validity in patients with mental diseases (MD) and musculoskeletal diseases (MSD). Materials and methods: A prospective multicenter study with questionnaires at admission and 3 months after rehabilitation was conducted. Patients with MD and MSD were included. The outcome was occurrence of RTW problems during the follow-up. Receiver operating characteristic analyses were performed. Sensitivity, specificity, and predictive values were calculated for each disease group using the threshold of 27 points. Results: There were 401 patients with MD (n = 250) and MSD (n = 151) included in the study, and 31.8% and 46.4% reported RTW problems during the follow-up, respectively. The area under curve was 0.885 (0.838–0.920) and 0.899 (0.841–0.943). The sensitivity rates were 87.1% and 87.5% and the specificity rates were 79.9% and 88.4% for MD and MSD, respectively. The post-test probability of experiencing RTW problems was 78.9% for MD and 77.8% for MSD. Analyses including only employed patients showed similar results. Conclusions: The screening predicts short-term RTW problems after rehabilitation in patients with mental or MSD regardless of employment. The threshold of 27 points was confirmed as reasonable, but alternatives in the range of 20–30 points can also be recommended. The SIMBO is a short and economic screening predicting future problems during the return to work (RTW) in patients with mental or musculoskeletal diseases. The SIMBO can be recommended to detect the initial RTW chance at the beginning of the rehabilitation process. This paper implied that there are mainly generic factors predicting the success of an RTW. Based on this it is possible to use one screening for different disease groups. [ABSTRACT FROM AUTHOR]

A good deal of research purports that bilingualism has a positive effect on some aspects of cognitive functioning. However, this effect is not consistent, and little research examines trajectories of cognitive skill development in bilingual children. Moreover, it remains unclear whether different types of bilingualism impact how cognitive abilities unfold. The reported study investigates children's data from three linguistic groups (179 sequential bilingual, 96 simultaneous bilingual and 57 monolingual German-speaking children) and examines differences (1) regarding cognitive outcome measures pertaining to selective attention, visuospatial thinking and abstract thinking and (2) searches for substantial developmental trajectory differences regarding said measures. Children were tested at 3 points in time; at age 4;10, 6;2 and 7;4. Results indicate no significant linguistic group differences in selective attention, visuospatial thinking and abstract thinking when controlling for gender, language comprehension of the child, and families' socioeconomic status. Moreover, the three linguistic groups did not differ in developmental trajectories. Theoretical and practical implications are discussed. [ABSTRACT FROM AUTHOR]

This study aimed to analyse outcomes with hearing aid (HA) use and to determine whether common audiological tests, including pure-tone audiometry or word recognition test, correlate with HA wearers' subjective benefit. A retrospective chart review. A total of 129 patients who adopted new HAs between January 2011 and December 2018 were enrolled. Outcome measures including pure tone thresholds, word recognition score (WRS), and self-reported questionnaires were obtained 1, 4, and 12 months post fit. The mean aided threshold and WRS at each post-fit visit significantly improved from the unaided condition. Self-reported outcomes confirmed by the Hearing Handicap Inventory for the Elderly (HHIE) scores significantly improved compared to the unaided condition at 1- and 4-month follow-up. Results of the regression analysis indicated that the aided WRS score is a significant factor at all post-fit visits that explains less than 10% of the variance in HHIE scores. Aided WRS is the factor most associated with subjectively reported HA outcomes, both in the short- and long term. Therefore, aided WRS should be considered as a useful tool for evaluating HA benefits, even after the prolonged use of HAs. [ABSTRACT FROM AUTHOR]

We assessed fidelity of delivery and participant engagement in the implementation of a community paramedic coach-led Care Transitions Intervention (CTI) program adapted for use following emergency department (ED) visits. The adapted CTI for ED-to-home transitions was implemented at three university-affiliated hospitals in two cities from 2016 to 2019. Participants were aged ≥60 years old and discharged from the ED within 24 hours of arrival. In the current analysis, participants had to have received the CTI. Community paramedic coaches collected data on program delivery and participant characteristics at each transition contact via inventories and assessments. Participants provided commentary on the acceptability of the adapted CTI. Using a multimethod approach, the CTI implementation was assessed quantitatively for site- and coach-level differences. Qualitatively, barriers to implementation and participant satisfaction with the CTI were thematically analyzed. Of the 863 patient participants, 726 (84.1%) completed their home visits. Cancellations were usually patient-generated (94.9%). Most planned follow-up visits were successfully completed (94.6%). Content on the planning for red flags and post-discharge goal setting was discussed with high rates of fidelity overall (95% and greater), while content on outpatient follow-up was lower overall (75%). Differences in service delivery between the two sites existed for the in-person visit and the first phone follow-up, but the differences narrowed as the study progressed. Participants showed a 24.6% increase in patient activation (i.e., behavioral adoption) over the 30-day study period (p < 0.001). Overall, participants reported that the program was beneficial for managing their health, the quality of coaching was high, and that the program should continue. Not all participants felt that they needed the program. Community paramedic coaches reported barriers to CTI delivery due to patient medical problems and difficulties with phone visit coordination. Coaches also noted refusal to communicate or engage with the intervention as an implementation barrier. Community paramedic coaches delivered the adapted CTI with high fidelity across geographically distant sites and successfully facilitated participant engagement, highlighting community paramedics as an effective resource for implementing such patient-centered interventions. [ABSTRACT FROM AUTHOR]

Predicting emergence from prolonged disorders of consciousness (PDOC) is important for planning care and treatment. We used machine learning to examine which variables from routine clinical data on admission to specialist rehabilitation units best predict emergence by discharge. A multicentre national cohort analysis of prospectively collected clinical data from the UK Rehabilitation Outcomes (UKROC) database 2010–2018. Patients (n = 1170) were operationally defined as "still in PDOC" or "emerged" by their total UK Functional Assessment Measure (FIM + FAM) discharge score. Variables included: Age, aetiology, length of stay, time since onset, and all items of the Neurological Impairment Scale, Rehabilitation Complexity Scale, Northwick Park Dependency Scale, and the Patient Categorisation Tool. After filtering, prediction of emergence was explored using four techniques: binary logistic regression, linear discriminant analysis, artificial neural networks, and rule induction. Triangulation through these techniques consistently identified characteristics associated with emergence from PDOC. More severe motor impairment, complex disability, medical and behavioural instability, and anoxic aetiology were predictive of non-emergence, whereas those with less severe motor impairment, agitated behaviour and complex disability were predictive of emergence. This initial exploration demonstrates the potential opportunities to enhance prediction of outcome using machine learning techniques to explore routinely collected clinical data. Predicting emergence from prolonged disorders of consciousness is important for planning care and treatment. Few evidence-based criteria exist for aiding clinical decision-making and existing criteria are mostly based upon acute admission data. Whilst acknowledging the limitations of using proxy data for diagnosis of emergence, this study suggests that key items from the UKROC dataset, routinely collected on admission to specialist rehabilitation some months post injury, may help to predict those patients who are more (or less) likely to regain consciousness. Machine learning can help to enhance our understanding of the best predictors of outcome and thus assist with clinical decision-making in PDOC. [ABSTRACT FROM AUTHOR]

The aim of this classic grounded theory study was to develop a substantive theory explaining variations in patients' expectations of physiotherapists when contacting a clinic. The study was nested in a survey cohort study, and data constituted a single open-ended question: State what you expect the physiotherapist to help you with. Responses were obtained from patients before attending the clinic. Statements were analysed using classic grounded theory with open, selective, and theoretical coding. The authors concurrently used memos and constant comparison until theoretical saturation was achieved, categories were identified, and a theoretical model was developed. Based on 292 statements from patients primarily suffering from musculoskeletal problems, the theory grounded in data Expectations as a continuum was developed. Four typologies created the theory: (1) Doing something, so it is again possible to..., (2) Finding out what is wrong with me, (3) Relieving/getting rid of symptoms, and (4) Help to self-help. The theory Expectations as a continuum illuminates that patients' expectations range from helplessness to being competent to act and reflect the social cognitive theories health locus of control and self-efficacy. Patients' abilities for self-management are different, and physiotherapists should carefully adjust the requirements for self-management. [ABSTRACT FROM AUTHOR]

This study aimed to examine the impact of reallocating time spent in waking movement behaviours at baseline on indicators of psychological distress at 24-month follow-up using isotemporal substitution regression models among a sample of Spanish adolescents. The DADOS (Deporte, ADOlescencia y Salud) study is a 3-year longitudinal observational research project carried out between years 2015–2017. The analyses included 197 adolescents (91 girls) aged 13.9 ± 0.3 years at baseline. Waking movement behaviours were assessed by a wrist-worn GENEActiv triaxial accelerometer and expressed as minutes/day of light physical activity (LPA), moderate-vigorous physical activity (MVPA) and time spent in sedentary behaviour (SB). The Behaviour Assessment System for Children and Adolescents (level 3 for adolescents) was used to assess psychological distress indicators (i.e., anxiety, social stress, and risk of depression). Results showed significant associations only for girls. The substitution of 10 min/day of SB or LPA at baseline with 10 min/day of MVPA was associated with lower levels of anxiety (both p ≤ 0.01) and social stress (both p < 0.05) at follow-up. The substitution of 10 min/day of SB with 10 min/day of LPA was associated with higher levels of anxiety at follow-up (p = 0.01). These findings highlight the need of specific physical activity recommendations for mental health paying special attention to sex-differences. [ABSTRACT FROM AUTHOR]

Digital media initiated a paradigm shift of the doctor-patient relationship in which prospective patients "shop" for physicians as they do other goods and services: using search engines' results, aggregated review websites, and star ratings as cues. These are processed centrally or peripherally in accordance with the Elaboration Likelihood Model (ELM). Electronic word of mouth (EWOM) in conjunction with a pediatrician's digital brand management strategy impacts practice revenue through patient recruitment and retention. This exploratory study found that a pediatrician's placement on a review website and overall digital brand image leads to increased or decreased trust in expertise, competence, and likability. [ABSTRACT FROM AUTHOR]

Children with neuromotor delays are at risk for reaching and object exploration impairments, which may negatively affect their cognitive development and daily activity performance. This study evaluated the effectiveness of the Sitting Together And Reaching To Play (START-Play) intervention on reaching-related exploratory behaviors in children with neuromotor delays. In this randomized controlled clinical trial, 112 children (Mean = 10.80, SD = 2.59 months old at baseline) with motor delays were randomly assigned to receive START-Play intervention or usual care-early intervention. Performance for ten reaching-related exploratory behaviors was assessed at baseline and 1.5, 3, 6, 12 months post-baseline. Piecewise linear mixed-effects modeling was used to evaluate short- and long-term effects of the intervention. Benefits of START-Play were observed for children with significant motor delays, but not for those with mild delays. START-Play was especially beneficial for children with significant motor delays who demonstrated early mastery in the reaching assessment (i.e., object contact ≥65% of the time within 3 months after baseline); these children showed greater improvements in manual, visual, and multimodal exploration, as well as intensity of exploration across time. START-Play advanced the performance of reaching-related exploratory behaviors in children with significant motor delays. [ABSTRACT FROM AUTHOR]

The SPOT-MAS assay "Screening for the Presence Of Tumor by Methylation And Size" detects the five most common cancers in Vietnam by evaluating circulating tumor DNA in the blood. Here, we validated its performance in a prospective multi-center clinical trial, K-DETEK. Our analysis of 2795 participants from 14 sites across Vietnam demonstrates its ability to detect cancers in asymptomatic individuals with a positive predictive value of 60%, with 83.3% accuracy in detecting tumor location. We present a case report to support further using SPOT-MAS as a complementary method to achieve early cancer detection and provide the opportunity for early treatment. [ABSTRACT FROM AUTHOR]

1: To determine whether Total UK FIM + FAM scores can identify patients in VS/MCS. 2: Using the identified cut-off points, to examine outcomes from specialist rehabilitation. Part 1: Retrospective analysis of a consecutive clinical cohort (n = 388) presenting to a single specialist PDOC evaluation programme 2007–2021. FIM + FAM scores were analysed by PDOC diagnosis to define cut-off points for vegetative (VS) and minimally conscious states (MCS). Part 2: Multicentre cohort analysis of prospectively-collected clinical outcomes data from the UK Rehabilitation Outcomes Collaborative database of adults in PDOC registered 2011–2020 (n = 2384 in 68 centres). Cut-off points of ≤31 and 32–35 in FIM + FAM total scores respectively identified patients in VS/MCS-Minus and MCS-Plus. Approximately 365 PDOC patients are admitted to specialist rehabilitation units in England each year. By discharge, 43% have emerged into consciousness and demonstrate a wide range of disability. A few reached full independence, but the majority remained severely dependent. Nevertheless, those who emerged generated mean net life-time savings of over £436,000 (£400 million for this cohort). In absence of a dedicated PDOC registry, FIM + FAM scores can identify patients in VS/MCS at population level. Identifying those who emerge and providing timely rehabilitation generates cost-savings well-exceeding the cost of the evaluation/rehabilitation programme. The UK National Health Service currently collects no systematic data to identify patients in PDOC, so we have no accurate information on how many patients there are, where they are managed or what their outcomes are. In the absence of more direct data, total FIM + FAM scores of < =31 and 32–35 respectively can be used to identify patients in vegetative and minimally conscious states. Of the 365 or so patients admitted to specialist rehabilitation units per year, 43% emerge into consciousness leaving about 150 patients per year in PDOC states that are likely to be permanent. Identifying those who emerge and providing timely rehabilitation generates cost-savings that pay for the entire PDOC evaluation/rehabilitation programme many times over. [ABSTRACT FROM AUTHOR]

Objectives: Studies have shown that grit—defined as perseverance and passion for achieving one's long-term goals—is associated with improved health outcomes, including lower levels of psychological distress. However, the psychometric properties of the original Grit Scale (Grit-O Scale) has not been validated among sexual minority men (SMM). The present study aimed to validate the Grit-O Scale among a sample of older SMM and assess the relationships between the Grit-O Scale factors and symptoms of psychological distress. Method: We used data from a single visit of participants in the Multicenter AIDS Cohort Study (MACS) Healthy Aging longitudinal study. The sample included 981 older SMM (mean age = 61, SD = 8.5) with and without HIV. We conducted confirmatory factor analysis (CFA) to identify the two factors of the Grit-O Scale: consistency of interest and perseverance of effort. We also conducted a latent profile analysis (LPA) to identify distinct profiles of psychological distress from self-reported scales of depression, anxiety, and perceived stress. Results:The Grit-O Scale showed acceptable reliability estimates for the items with Cronbach's alpha reliability coefficients ranging from 0.77 to 0.82. The CFA identified the two factors of the Grit-O Scale with acceptable model fit (root mean square error of approximation = 0.058 [95% CI = 0.050, 0.067], comparative fit index = 0.95, Tucker-Lewis Index = 0.93, standardized root mean square residual = 0.07). The LPA yielded three mutually exclusive profiles of psychological distress (profile 1: low stress, anxiety, and depression; profile 2: high stress and depression and low anxiety; and profile 3: high stress, anxiety, and depression). In adjusted multinominal logistic regression analysis, we found that both higher levels of consistency of interest and perseverance of effort factors of the Grit-O Scale were significantly associated with decreased odds of being in profiles 2 and 3 compared with being in profile 1. Conclusion: Our findings support the use of the Grit-O Scale among older SMM. Grit factors could explain variability in the negative psychological symptoms among older SMM and warrant further investigation. Supplemental data for this article is available online at http://dx.doi.org/10.1080/13607863.2022.2032594 [ABSTRACT FROM AUTHOR]

There is a general lack of information about how insufficient physical activity impacts blood pressure and physical fitness in Latin-American ethnic minorities. To describe the interactions between insufficient physical activity, blood pressure, and physical fitness outcomes in Latin-American schoolchildren of different ethnicity. This was a prospective, international, multi-center, and cross-sectional study of three Latin-American countries involving schoolchildren from seven ethnic groups of Colombia (Tikuna, Nasa, Embera), Brazil (African, Mulato), and Chile (Mapuche), and also European schoolchildren from Brazil and Chile. Data were categorized based on whether participants were physically active (PA) or insufficient physical activity (iPA) using the WHO physical activity recommendations. The main outcomes were systolic (SBP), diastolic (DBP), and mean arterial (MAP) blood pressure, and scores for physical and cardiorespiratory fitness (CRF, by estimated V ˙ O2max), handgrip muscle strength (HGS), and standing long jump (SLJ). Secondary outcomes were anthropometric measures (weight, height, body mass index [BMI], waist circumference [WC], waist-to-height ratio), and body fat percentage (BF%, limited data by country). Primary and secondary outcomes were ranked. For both PA and iPA categories, significant interactions between ethnic groups were found concerning SBP/DBP (F(37.7), ES 0.08; F(51.5), ES 0.08), V ˙ O2max (F(37.7), ES 0.08; F(51.5), ES 0.08), HGS (F(33.8), ES 0.07; F(5.03), ES 0.04), and SLJ (F(64.3), ES 0.14; F(64.3), 0.14). In the iPA category, Mapuche schoolchildren were classified 1st (119.5; 81.5) with highest SBP/DBP and highest MAP (94.6 mmHg); Embera schoolchildren were classified 1st with lowest V ˙ O2max (33.7 mL/kg/min); and European schoolchildren were classified 1st (19.9 kg) with lowest HGS and SLJ (121.4 m) physical fitness. Under conditions of insufficient physical activity conditions, Mapuche schoolchildren had the most detrimental blood pressure, whereas Embera, Tikuna, and European schoolchildren had the lowest levels of physical fitness. These results serve to highlight the need for the early and appropriate promotion of physical activity based on ethnic differences in Latin-American schools. [ABSTRACT FROM AUTHOR]

This prospective one-year cohort study aimed to assess the feasibility and outcomes of a routine psychosocial screening at patients' admittance to specialist inpatient palliative care. Patients admitted to an academic palliative care ward were routinely screened for self-reported distress and psychological morbidity, psychosocial stress factors, and subjective need for help from psychosocial professions. Cognitive impairments were the most common patient barrier to screening. Screenings were completed in 138 of 428 patients (32%). Based on established cutoffs, distress was indicated in 89%, depression in 51%, and anxiety in 50% of these patients. The burden on next-of-kin emerged as the most prevalent stress factor (73%). One-half of the patients disclosed a subjective need for help (53%). Possible depression (p =.023), anxiety (p <.001), and subjective need for help (p <.001) correlated positively with a higher amount of time spent by psychologists and creative arts-based therapists with small to moderate effects. Patients who completed the screening were attributed with a higher amount of time by social workers than patients who did not (p =.004), but there were no relationships between screening results and social work. Results suggest the potential of screenings for the allocation of specialist psychosocial care during specialist palliative care; however, barriers to screening do exist. [ABSTRACT FROM AUTHOR]

Follow-up care (FU-care) and self-management are recognized as important to ensure prolonged effects of rehabilitation. Objectives of this study were to explore current FU-care and self-management after specialized rehabilitation for patients with rheumatic and musculoskeletal diseases. This multicentre cohort study included 523 patients who self-reported need and plans for FU-care and plans for self-management activities (SMAs) at rehabilitation discharge. The FU-care received and adherence to SMA were self-reported after 4-, 8-, and 12-months. Predictors for received FU-care and adherence to SMA were explored in multiple logistic regression models. Plans for FU-care were significantly associated with received FU-care. Younger age, better coping skills, and performing regular social activities and hobbies were significant predictors for received FU-care. Throughout the follow-up year, 221 (51%) participants had adherence to their SMA plans. Older age, regular physical activity, more severe pain, and performing regular social activities and hobbies were significant predictors for adherence to SMA. Participants with SMA adherence more often reported planned FU-care, and more frequently received the FU-care they needed. Planning FU-care should be integrated in specialized rehabilitation. Patients with poor coping skills and sedentary lifestyle may need more support over longer time to implement behavioral changes for healthy self-management. Planning follow-up should be integrated in specialized rehabilitation as it supports self-management and receiving follow-up at home. Patients with sedentary lifestyle, poor coping skills, and depression may need more support over longer time to implement healthy self-management. Structure and routines in daily life enhance self-management. [ABSTRACT FROM AUTHOR]

Little is known about the experiences of people living with open surgical wounds. These wounds are common and predominantly affect young and actively working people. The aim of this qualitative study was to explore the meaning of living with open surgical wounds. A qualitative exploratory study was conducted. We collected data using two individual interviews with each of ten participants (aged between 18–73 years) who had open surgical wounds. Our analytical approach was based on qualitative content analysis. Methods are reported using COREQ guidelines. We found that the meaning of living with open surgical wounds is shaped by five subthemes: "enduring healing", "life disruption", "adapting to a new reality", "striving for healing" and "returning to normal life;" all under an overarching theme of "negotiating a new normality". Participants' well-being and everyday living are greatly impacted by open surgical wounds. Findings from this study emphasize that open surgical wounds are a long-term condition with a typical "chronicity" trajectory; this brings a new perspective to previous findings of studies on living with complex wounds. This study has also highlighted areas for further research, related to improving individuals' experience of living with open surgical wounds. [ABSTRACT FROM AUTHOR]

To study the impact of cardiovascular diseases (CVDs) on hearing deterioration among ageing adults in a longitudinal setting. Furthermore, to describe the pure tone threshold changes at the 0.125–8 kHz frequency range over 13 years. A population-based follow-up study. A random sample of 850 adults, of whom 559 participated in the follow-up study. Otological examination, a structured interview, and pure tone audiometry were conducted. Multivariate regression models were used to estimate the effect of CVD (participants had at least one cardiovascular condition) on hearing deterioration of the better ear hearing level (BEHL), defined as a change in the pure-tone average (PTA) of the frequencies 0.5, 1, 2, and 4 kHz and separately at the lower (0.125, 0.25, and 0.5 kHz) and higher (4, 6, and 8 kHz) frequencies. In the multivariable-adjusted analysis, the BEHL change at 13 years was 0.7 dB greater among participants with CVD (p = 0.3). The mean BEHL change during the 13-year follow-up was 12.0 dB (95% CI 11.4–12.6) among all participants. No significant association between CVD and hearing threshold changes was found. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this study was to test the diagnostic validity of the Primary Care PTSD screen (PC-PTSD) in a generalizable college sample and to examine potential differences in its predictive efficacy according to sex and racial/ethnic identity. An exploratory aim was to determine whether PC-PTSD symptom items differentially predicted PTSD diagnostic status. Participants: Data from 475 undergraduates were analyzed. Methods: Logistic regressions were conducted to examine the relationship between different PC-PTSD endorsement thresholds and probable PTSD among various subsamples. Follow-up tests of diagnostic accuracy were performed. Results: Results of this study indicated that the PC-PTSD identified PTSD among college students with poor accuracy. Furthermore, the PC-PTSD did not demonstrate equal predictive validity across neither sex nor racial/ethnic identity. Endorsement of reexperiencing symptoms appeared to be the strongest predictor of PTSD. Conclusions: Results highlight the clear need for a validated PTSD screener effective for a diverse college population. [ABSTRACT FROM AUTHOR]

To explore whether the personal assistance (PA) activities provided by the Swedish Act concerning Support and Service for Persons with Certain Functional Impairment in 2010 and 2015 promote participation in society according to Article 19 of the United Nations' Convention on the Rights of Persons with Disabilities (UNCRPD). Register data and data from two questionnaires were used (N = 2565). Descriptive statistics and chi-square (McNemar's test) were used to describe the basic features of the data. Mixed binominal logistic regression was used to examine correlation between gender and hours of PA between 2010 and 2015. Despite an increase in the number of PA hours, more care activities and a reduction of most PA activities representing an active life were found. The result was especially evident for women, older people, and for a particular person category. The results offer evidence of a shift to a medical model and indicate a risk of social exclusion due to fewer activities representing an active life. An increase on average of 16 h of PA over the period studied does not guarantee access to an active life and may indicate a marginal utility. The noted decline of PA for participation in society enhances the importance of monitoring content aspects to fulfil Article 19 of the UNCRPD. Personal assistance (PA) in Sweden is a supportive measure for persons with disabilities; however, there are few studies to show whether PA activities are fulfilling disability rights of participation in society. The results show that PA activities are used more for medical care and home-based services over the five-year period. The study highlights the importance of monitoring aspects of content to ensure that the activities of PA comply with the policy objectives of the LSS legislation and Article 19 of the United Nations' Convention on the Rights of Persons with Disabilities (UNCRPD), i.e., full participation in society. Monitoring efforts should include individualised planning and follow-up, moreover, ensure compliance with social service capacity at PA providers. [ABSTRACT FROM AUTHOR]

Purpose: Voice feminization for transgender women remains a challenge. The fundamental frequency of the voice (fo) is one of the main parameters contributing to the perception of gender. One of the aims of voice therapy is to help transgender women acquire a new vocal motor behavior to increase their fo. We hypothesized that ambulatory biofeedback could help extend the new vocal behavior to daily life. Materials and methods: This prospective case study assessed the impact of two weeks of ambulatory vibrotactile biofeedback (VTBF) applied to one transgender woman, following two weeks of voice therapy (three 60-minute sessions). The VTBF was activated when the participant's voice was lower than 150 Hz for more than 500 ms and was accompanied by two 60-minute counseling sessions. Results: The results showed that mean fo monitored in daily activities tended to increase following the two weeks of voice therapy (Δ = 8 Hz or 1 semitone) and then increased significantly immediately after the two weeks of VTBF (Δ = 13 Hz or 1.5 semitones). The increase in mean fo from day to day and the decrease in the activation percentage from the first to the second week of VTBF (Δ = 6%) indicated a gradual integration of the motor behavior, making it possible to achieve the targeted female frequency. Conclusions: The results suggest that ambulatory VTBF helped the participant to generalize the techniques acquired during the voice therapy sessions to real-life communication situations. These results are promising for therapeutic programs that integrate tools that can be used outside the clinical context. Design: Prospective case study. [ABSTRACT FROM AUTHOR]

Examine prospective relationships between erectile dysfunction (ED) drugs and CD4 and CD8 T-cells, and immune markers among men who have sex with men (MSM). Data from Multicenter AIDS Cohort Study, an observational prospective cohort study, with semiannual follow-ups conducted in four U.S. centers from 1998 onwards was used. Marginal structural models using g-computation were fitted to estimate the mean differences for the effects of self-reported ED drug use on CD4 and CD8 T-cell outcomes and immune biomarkers. Total of 1,391 men with HIV (MWH) and 307 men without HIV (MWOH) was included. Baseline mean CD4 cell count among MWH and MWOH was 499.9 and 966.7 cells/μL, respectively. At baseline, 41.8% of MWH were virally suppressed. ED drug users reported a mean of 44.4 months of exposure to ED drugs. ED drug use was associated with increased CD4 cell outcomes among MWH but not MWOH. Mean differences in CD4 cell counts after 1 year of ED drug use was 57.6 cells/μL and increased to 117.7 after 10 years among MWH. CD8 counts were higher in ED drug users among MWH over 10 years than non-users; no consistent differences were found among MWOH. ED drug use appeared to reduce immune marker levels, such as IL-6 and increase markers, such as IL-10. We observed similar effects of ED drug use on biomarker levels among MWOH. Long-term use of ED drugs do not adversely affect immune function among MWH or MWOH. Future studies on the relationships between different types of ED drugs and effects on T-cell subtypes are warranted. [ABSTRACT FROM AUTHOR]

The use of mesh for vaginal repairs is currently problematic and as a consequence, there is increased interest in native tissue repair. We describe the follow-up data of a sub-analysis of a prospective and multi-center study focusing on the combination of pectopexy and native tissue repair. Patients were followed up for 12–18 months after surgery (+ SD: 15). Two-hundred and sixty-four patients attended the clinics for physical examination and were integrated into the follow-up. Cystocele repair was performed laparoscopically in 84 patients and vaginally in 52 patients. Posterior repair was performed vaginally in 40 patients and laparoscopically in 53 patients. Clinical success rate, patient recommendations and patient satisfaction rates were similar in both groups. The laparoscopic anterior repair resulted in an 89% cure or anatomical improvement rate; this compared to 94.2% for the vaginal approach. In the posterior group, laparoscopy resulted in a 94.3% cure or improvement rate compared to 97.5% in the second group. The outcomes of both strategies showed satisfactory results in our study. Consequently, surgeons may choose between the two strategies according to their preference and skill. The two approaches only differed with regard to vaginal scarring. We suggest future research investigating the long-term impact of scarring. [ABSTRACT FROM AUTHOR]

Lower limb exoskeletons are a recent intervention promoted to improve gait disorders. Available research has focused on clinical outcomes; however, little is known about therapists' experiences using the device in practice. We explored the implementation of an exoskeleton at a tertiary rehabilitation center. In this longitudinal qualitative study we conducted semi-structured interviews with 10 therapists. One group of therapists was formally trained using the device, whereas the other group only had clinical exposure to the device. The interviews were transcribed, coded, and analyzed for themes. Three main themes emerged: (1) A steep learning curve described challenges in learning to use the exoskeleton. (2) One step at a time illustrated the complex process of incorporating the exoskeleton in daily work. (3) Not a magic bullet revealed the tensions using this emergent technology in practice. The exoskeleton represents one of the most complicated and labor-intensive interventions provided by therapists. Implementation requires substantial resources, raising questions regarding its efficacy and cost-effectiveness relative to other approaches. Until more evidence becomes available around the use and effectiveness of this rapidly evolving technology, therapists must contend with a high degree of uncertainty. Using a lower limb exoskeleton may reduce physical demands on therapists in high-intensity rehabilitation programs that involve repetitive, effortful movements. However, a number of potential barriers to implementing the exoskeleton into practice need to be taken into consideration, including calibration time, intensive training required to become qualified to administer the intervention, the cost of the device, and comfort and safety of the device affecting user acceptance and uptake. Therapists also need to manage patient expectations related to outcomes related to use of exoskeletons. [ABSTRACT FROM AUTHOR]

The goal of the present study was to investigate the relationship between speech production (SP) and speech perception in children with Speech Sound Disorder (SSD) from both typical speech production (TSP) and child's own atypical speech production (ASP). Ten children with SSD were evaluated by a speech production task (naming test) and two speech perception tasks (phonological contrast identification) using the PERCEFAL instrument. In the identification task, the acoustic stimulus, from typical and child's own atypical speech productions, was presented to each child, and they needed to choose the corresponding stimulus between two pictures displayed on the computer screen. The percentages of errors on speech production (SP) task, on the identification task from TSP and ASP were calculated for each child. ANOVA showed a significant difference between speech production and speech perception. Post hoc analysis demonstrated a greater mean of errors in the ASP compared to the mean of errors in the TSP and SP performances. Only SP and ASP performances presented a significant correlation (r = 0.65). Errors involving manner and manner+place were most recurring in SP. TSP seems to precede SP; that is, children with SSD perceive more speech from typical production than they are able to produce. The significant correlation between ASP and SP suggests that the evaluation of these skills accesses the children's equivalent underlying phonological representation. A more accurate production, such as typical production, may have cues that help children with SSD to identify phonological contrasts, even if their underlying representations are overly broad or not established. [ABSTRACT FROM AUTHOR]

Idea density has been shown to influence comprehension time for text in various populations. This study aims to explore the influence of spoken idea density on attainment in young, healthy subjects using demographic characteristics. Students watched two online lectures and answered 10 multiple choice questions on them. Students received one more idea dense (MID) and one less idea dense (LID) lecture on two different subjects. Seventy-five students completed the study achieving a higher median score after a less idea-dense lecture (LID = 7(3), MID = 6(3), p = 0.04). Artificial neural network models revealed the first language as the main predictor of exam performance. The odds ratio (OR) of obtaining ≥70% after a more idea-dense lecture was six-time higher for the first language versus second language English speakers (OR = 5.963, 95% CI 1.080–32.911, p = 0.041). The odds ratio was not significant when receiving a less dense lecture (OR = 2.298, 95% CI 0.635–8.315, p = 0.205). Second-language speakers benefited from receiving a lower idea density, achieving a 10.8% score increase from high to low density, versus a 3.2% increase obtained by first language speakers. The propositional idea density of lectures directly influences students' comprehension, and disproportionately for second language speakers; revealing the possibility of reduced spoken idea density in levelling the attainment differential between first and second language speakers. [ABSTRACT FROM AUTHOR]

To compare stroke-specific health related quality of life in two country-regions with organisational differences in subacute rehabilitation services, and to reveal whether organisational factors or individual factors impact outcome. A prospective multicentre study with one-year follow-up of 369 first-ever stroke survivors with ischaemic or haemorrhagic stroke, recruited from stroke units in North Norway (n = 208) and Central Denmark (n = 161). The 12-domain Stroke-Specific Quality of Life scale was the primary outcome-measure. The Norwegian participants were older than the Danish (Mage= 69.8 vs. 66.7 years, respectively), had higher initial stroke severity, and longer stroke unit stays. Both cohorts reported more problems with cognitive, social, and emotional functioning compared to physical functioning. Two scale components were revealed. Between-country differences in the cognitive-social-mental component showed slightly better function in the Norwegian participants. Depression, anxiety, pre-stroke dependency, initial stroke severity, and older age were substantially associated to scale scores. Successful improvements in one-year functioning in both country-regions may result from optimising long-term rehabilitation services to address cognitive, emotional, and social functioning. Stroke-Specific Quality of Life one-year post-stroke could be explained by individual factors, such as pre-stroke dependency and mental health, rather than differences in the organisation of subacute rehabilitation services. The stroke-specific health related quality of life (SS-QOL) assessment tool captures multidimensional effects of a stroke from the perspective of the patient, which is clinically important information for the rehabilitation services. The cognitive-social-mental component and the physical health component, indicate specific functional problems which may vary across and within countries and regions with different organisation of rehabilitation services. For persons with mild to moderate stroke, longer-term functional improvements may be better optimised if the rehabilitation services particularly address cognitive, emotional, and social functioning. [ABSTRACT FROM AUTHOR]

The Arthritis Self-Efficacy Scale-8 (ASES-8) is one of the most commonly used scales to measure patient-reported arthritis-specific self-efficacy. However, evidence about the validity and reliability of ASES-8 in an Arabic-speaking arthritis population is lacking. This study aimed to cross-culturally adapt and assess aspects of validity and reliability of the Arabic version of the ASES-8. The ASES-8 was translated into the Arabic language using the back-translation method, and administered to 67 patients with rheumatoid arthritis (RA). Construct validation methods used exploratory factor analysis and correlating the ASES-8 scores with disease-related variables expected to be related to the arthritis self-efficacy construct. An internal consistency test was conducted. Floor and ceiling effects were considered present if more than 15% of patients achieved high (=10) and low (=1) scores on the Arabic ASES-8 for both the scale and item scores. Exploratory factor analysis demonstrated a one-factor solution (factor loadings: 0.54–0.81). ASES-8 scores were correlated with all measures assessed (r = −0.24 to −0.57 and r = 0.06–0.66), demonstrating construct validity. Internal consistency was acceptable for measures of Cronbach's alpha (0.86–0.88). The scale did not exhibit ceiling or floor effects. The Arabic version of ASES-8 is valid and reliable for evaluating self-efficacy in patients with rheumatoid arthritis. The Arthritis Self-Efficacy Scale (ASES-8) questionnaire was translated and adapted for use in Arabic language. This questionnaire is a valid and reliable instrument for evaluating self-efficacy among Arabic individuals with rheumatoid arthritis. This will support greater use of this tool worldwide in clinical and research practices that include Arabic people. [ABSTRACT FROM AUTHOR]

Children with Down syndrome (DS) may have limited opportunities to engage in self-directed mobility and play due to motor delays. A recent modified ride-on car innovation is the sit-to-stand (STS) model, which incorporates functional standing and walking training with the experience of powered mobility. This study aimed to: (1) describe total dosage and daily usage of three modified ride-on car modes (seated, standing, and power-push) by young children with DS; (2) examine the ability of young children with DS to independently activate the modified ride-on car in seated and standing modes; (3) describe the age of onset of selected motor milestones of the sample in comparison to DS norms. Eight young children with DS (8.6 ± 2.0 months) used three modes of the modified ride-on car over a 9-month intervention. All eight children independently activated the modified ride-on car in seated and standing modes. Most motor milestones were achieved earlier in this sample than expected for DS norms, including the onset of independent walking. The developmentally progressive nature of the intervention and high dosage may have been instrumental in encouraging the onset of independent activation and earlier motor milestones. Young children with Down syndrome were able to achieve independent activation in seated and standing modified ride-on cars. Developmentally progressive modified ride-on car interventions may facilitate motor skill development, but future work utilizing a randomized control group is needed to examine the potential motor developmental benefits of the STS model and power-push mode. The developmentally progressive nature of the intervention may have been instrumental in encouraging the onset of independent switch activation in both seated and standing modes, as well as the high dosage and adherence rates compared to previous studies. [ABSTRACT FROM AUTHOR]

The aim of this study was to test the effectiveness of an occupational therapy program to promote well-being in people with experiences of mental illness. The method was a multicentre collaborative study. The intervention group participated in an occupational therapy program to promote well-being in addition to the standard program of day hospital/psychiatric occupational therapy, while the control group only participated in the standard program only. Results showed that the intervention group had effects on three factors, including "Positive emotions," "Willingness to ask for help," and "Achievement." The effectiveness of this program needs to be further tested in a randomized controlled trial. [ABSTRACT FROM AUTHOR]

People undergoing investigations for suspected cancer have to undergo a number of investigations before they know their full diagnosis and treatment plan. We examined predictors of distress among patients undergoing staging investigations for suspected colorectal or lung cancer. Patients were prospectively recruited to two multi-centre trials comparing WB-MRI with standard scans. Patients completed a questionnaire, administered at trial recruitment, measuring demographic and psychological variables (n = 129, 66 colorectal, 63 lung; median age 66.4, range: 31–89). Predictors of distress were analysed using logistic regression. Forty percent of patients reported high distress (a score of 4 or higher on the GHQ-12). Higher deprivation and greater intolerance of uncertainty (IU) predicted high distress in both unadjusted (low deprivation: OR 0.352, 95% CIs 0.144 to 0.860, p = 0.022; IU: OR 1.972, 95% CIs: 1.357 to 2.865, p < 0.001) and adjusted analyses (low deprivation: OR 0.243, 95% CIs 0.083 to 0.714, p = 0.010; IU: OR 2.231, 95% CIs 1.429 to 3.485, p < 0.001). Age, gender, presence of comorbid illness, cancer type, probable knowledge of cancer diagnosis, and a final diagnosis of cancer did not predict high distress. Future research should examine how to reduce distress in patients undergoing investigations for cancer, particularly among those who find uncertainty difficult to manage. [ABSTRACT FROM AUTHOR]

Objectives: To compare post-concussion symptoms (PCS) and return to normal activities between mild Traumatic Brain Injury (mTBI) patients with or without concomitant injuries at 7-and 90 days post-mTBI.Methods: Design: Sub-analysis of a multicentre prospective cohort study. Participants and setting: patients with mTBI from 7 Canadian Emergency Departments. Procedure: Research assistants conducted telephone follow-ups using the Rivermead Postconcussion Symptoms Questionnaire (RPQ) at 7-, 30- and 90 days post-mTBI. Main outcome: Presence of PCS (RPQ: ≥3 symptoms) at 90 days. Secondary outcomes: RPQ score ≥21, prevalence of individual RPQ symptoms and patients' return to normal activities, at 7- and 90-days. Adjusted risk ratios (RR) were calculated.Results: 1725 mTBI patients were included and 1055 (61.1%) had concomitant injuries. Patients with concomitant injuries were at higher risk of having ≥3 symptoms on the RPQ (RR:1.26 [95% CI 1.01–1.58]) at 90 days. They were also at higher risk of experiencing specific symptoms (dizziness, fatigue, headaches and taking longer to think) and of non-return to their normal activities (RR:2.11 [95% CI 1.30–3.45]).Conclusion: Patients with concomitant injuries have slightly more PCS and seemed to be at higher risk of non-return to their normal activities 90 days, compared to patients without concomitant injuries. [ABSTRACT FROM AUTHOR]

Concussion education strategies that improve knowledge and attitudes long term are needed. This exploratory study piloted an interactive concussion education program, adopting concepts from the learning sciences and attitude change literature, for the underserved and high-risk population of motorsports. Forty UK motorsport drivers (ages 16–20 years) participated. The workshop group received a two-phased workshop-based program. The comparison group received a concussion leaflet. Participants completed an adapted version of the Rosenbaum Concussion Knowledge and Attitudes Survey (RoCKAS-ST) at pre-, post- and 2-month follow-up. Within-group analysis for the workshop group explored the differential effect of the individual difference variable, Need for Cognition (NfC), and effectiveness was explored through post-workshop questionnaires and interviews. Unlike the comparison group, the workshop group showed a significant improvement in knowledge over time (F(2,58) = 45.49, p <.001, η2p =.61). Qualitative data indicated workshop-program participants developed safer attitudes toward concussion following programming. Preliminary evidence suggested individuals' responses to concussion education aligned with differences in NfC. This study piloted the first concussion education program for motorsport drivers and explored whether aligning educational provision with the NfC construct may help to improve program effectiveness. Findings are relevant to addressing the public health issue of concussion through educational approaches. [ABSTRACT FROM AUTHOR]

Prehospital prediction models to estimate the likelihood of several types of stroke (large vessel occlusion [LVO], intracranial hemorrhage [ICH], and subarachnoid hemorrhage [SAH], and other types of stroke) should be useful to transfer those with suspected stroke to appropriate facilities. We recently reported Japan Urgent Stroke Triage (JUST) score with 21 items had excellent predictive abilities, and we further tried to simplify the score with parsimonious items and comparable predictive abilities. We conducted historical and prospective multicenter cohort studies at 8 centers from June 2015 to March 2018. We developed the prediction rules with select variables from JUST score for LVO, ICH, SAH and other types of stroke in 2236 patients with suspected stroke in historical derivation cohort. We validated the developed prediction rules in 964 patients in prospective validation cohort. There were 1150 stroke, including 235 LVO, 352 ICH, 107 SAH and 456 other types of stroke in the derivation cohort. We developed the scores with 7 items (high blood pressure, arrhythmia, conjugate deviation, headache, dysarthria, disturbance of consciousness, paralysis of upper limbs) and the developed scores had area under the receiver-operating curve (AUC) of 0.84 for any type of stroke, 0.89 for LVO, 0.79 for ICH, and 0.90 for SAH in the derivation cohort. There were 490 stroke, including 102 LVO, 138 ICH, 28 SAH and 222 other types of stroke in the validation cohort. The scores well discriminated these strokes in the validation cohort (AUC of 0.76 for any type of stroke; 0.81 for LVO, 0.73 for ICH, and 0.85 for SAH). The simplified 7-item JUST (JUST-7) score had good predictive ability and can help healthcare providers to estimate the likelihood of different types of stroke and decide the referral hospital. [ABSTRACT FROM AUTHOR]

Employment of young adults with chronic physical conditions entering the labor market after finishing post-secondary education remains behind compared to typically developing peers. The aim of this study is to evaluate changes in their paid employment levels after following a vocational rehabilitation intervention ('At Work'). Participants aged between 16 and 27 years (n = 90) were recruited via rehabilitation physicians and a jobcoach agency and participated in a vocational rehabilitation program. Cochran's Q and McNemar tests served to test the development of intervention participants' paid employment over time. Chi-square tests were used to compare intervention participants' paid employment level with national reference data selected on age and having a self-reported chronic physical condition. Paid employment level of the intervention cohort significantly increased from 10.0% at baseline to 42.4% at 2-years follow-up (p < 0.001). At 2-years follow-up, their employment rates approached the employment rates of national reference data (42.4% versus 52.9%, p = 0.17). Starting from a disadvantaged position, the paid employment rate of the intervention cohort substantially increased over time, approaching the employment rate of reference data. 'At Work' seems to be appropriate for supporting this specific group who face obstacles to enter the labor market, to find competitive employment. 'At Work' is a vocational rehabilitation intervention for young adults with chronic physical conditions who experience problems with finding and maintaining competitive employment after finishing post-secondary education. The 'At Work' intervention entails a combination of group sessions and individual coaching sessions based on the supported employment methodology. Paid employment rates of the intervention cohort substantially increased on the short- and long term, and approached employment rates of reference data of persons with chronic physical conditions. The 'At Work' intervention seems appropriate to support young adults with chronic physical conditions who experience barriers for work participation, to enter the labor market and find competitive and sustainable employment. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the effect of adding cognitive strategy training to task-specific training (TST), called Cognitive Oriented Strategy Training Augmented Rehabilitation (COSTAR), compared with TST on activity and participation for chronic stroke survivors in an outpatient occupational therapy setting Materials and methods: We conducted an exploratory, single-blind, randomized controlled trial. Participants were randomized to TST or COSTAR protocol. Our primary outcomes measured activity and participation after stroke: the Stroke Impact Scale (SIS), Canadian Occupational Performance Measure (COPM), and Performance Quality Rating Scale (PQRS). Results: Forty-four participants were randomized. The COSTAR group had an attrition rate of 50% and an average of 9.8 of 12 sessions were completed; the TST group had an attrition rate of 25% and an average of 10.7 sessions were completed. Generally both groups improved on the majority of primary and secondary outcomes. There is little evidence to support a beneficial effect of COSTAR over TST for improvement of primary measures of activity performance or secondary measures. Conclusion: Negligible findings may be attributed to an inadvertent treatment group equivalency. Further, the research design did not allow for adequate measurement of the effect of each intervention on participants' ability to generalize learned skills. Stroke rehabilitation is largely based upon the principles of task-specific training, which is associated with improvements in upper extremity motor performance; however, TST requires a heavy dosage and lacks generalization to untrained activities. Cognitive strategy use has been associated with improved generalization of treatment to untrained activities and novel contexts however, it is often not used in TST protocols. The results of this preliminary study found no clear advantage between task-specific training and strategy-adapted task-specific training on trained and untrained activities when both interventions targeted activity performance. Task-specific training, if focused at the activity performance level rather than the impairment reduction level, may have a stronger effect on improving in individual's ability to participate in everyday life activities even without the use of cognitive-strategies. Incorporating cognitive strategy-use into TST would likely produce the greatest effect on generalization and transfer of the treatment effects to other activities and contexts rather than solely on activity performance of trained activities. [ABSTRACT FROM AUTHOR]

To create longitudinal trajectories and reference percentiles for frequency of participation in family and recreational activities for children with cerebral palsy (CP) by Gross Motor Function Classification System (GMFCS) level. 708 children with CP 18-months to 12-years of age and their families participated in two to five assessments using the GMFCS and Child Engagement in Daily Life Measure. Data were analyzed using mixed-effects models and quantile regression. Longitudinal trajectories depict the relatively stable level of frequency of participation with considerable individual variability. Average change in the frequency of participation scores of children from 2-12 years of age by GMFCS level varied from 3.7 (GMFCS level I) to – 9.0 points (GMFCS level V). A system to interpret the magnitude of change in percentiles over time is presented. Longitudinal trajectories and reference percentiles can inform therapists and families for collaboratively designing services and monitoring performance to support children's participation in family and recreational activities. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the effects of intrathecal baclofen therapy (ITB) on health-related quality of life for children with cerebral palsy and neurological conditions. Method: This study is part of a longitudinal, multicentre audit. The primary outcome measure, the Caregiver Priorities and Child Health Index of Life with Disabilities, was completed at baseline, 6 and 12 months post ITB implant. Results: Forty subjects with cerebral palsy and other neurological conditions demonstrated significant improvement in aspects of health-related quality of life following ITB therapy, mean change 42.3 (SD 14.9) at baseline to 53.3 (SD 14.7) at 12 months (p<.001). Conclusion: Evidence to demonstrate the utility of ITB in pediatric populations beyond spasticity and dystonia reduction is limited. Our findings suggest that ITB improves aspects of quality of life, comfort, and ease of caregiving in children with cerebral palsy and other neurological conditions. [ABSTRACT FROM AUTHOR]

The purposes of the current study were to explore the applicability of the Health Action Process Approach (HAPA) model for interpreting changes in physical exercise behavior and to examine the key determinants of changes in physical exercise. The participants were 639 rural middle school students in Sichuan province, China, who did not perform physical exercise. Three surveys and two interventions were completed in the same participants within 1.5 years. The HAPA model elements and physical exercise were estimated by a self-reported questionnaire. The results showed that 158 students (24.7%) formed a habit of physical exercise. The structural equation model for the pre-intention stage and behavior stage showed acceptable goodness of fit. Outcome expectancies (β=0.136, P=0.014) and action self-efficacy (β=0.314, P=0.001) directly predicted intention of physical exercise, the latter directly predicted physical exerciseplanning (β=0.537, P<0.001), andplanning subsequently predicted physical exercise (β=0.324, P<0.001). Maintenance self-efficacy indirectly predicted physical exercise through planning (95%CI: 0.014, 0.053). The findings suggested that the HAPA model was a very useful tool for predicting changes in physical exercise behavior, as this model explains the process of changing physical exercise habits and reveals the weak link in such behavioral changes among Chinese rural adolescents. [ABSTRACT FROM AUTHOR]

This mix-methods study sought to assess the effect of semi-structured and unstructured reflective journaling (RJ) on 97 undergraduate students' perceptions of their metacognitive awareness, classified into two main components: knowledge of cognition and regulation of cognition. Students' entries were analyzed based on a guiding scheme. The Metacognitive Awareness Inventory (MAI) was administered to the participants before (pretest) and after (posttest) a 13-week intervention. Multiple levels of reflective engagement were evident in the semi-structured RJ entries, whereas the unstructured entries were largely descriptive, and mainly related to students' short-term learning experiences. Semi-structured RJ was found effective in nurturing students' perceptions of their regulation of cognition. The present study adds to past work by showing how prompting questions might enable students to perceive themselves as self-regulated learners. [ABSTRACT FROM AUTHOR]

Background: Following hospital discharge, stroke survivors may experience a decline in mobility, outings, and community participation. The aim of this study was to examine the relationship between demographic and clinical measures, and the level of participation by community-dwelling stroke survivors. Methods: A prospective, multicenter, observational study was conducted. Participants were 83 community-dwelling stroke survivors with participation goals who were undergoing post-inpatient rehabilitation in Australia. Predictors collected at baseline, early after hospital discharge were demographic (age, gender, living situation, home access) and clinical measures (walking capacity, driving status, baseline outings). The outcome of interest was community participation 6 months later, measured over 7 days as number of outings (collected in a self-report diary). An outing was any excursion beyond the perimeter of the participants' dwelling into a public street. Results: Number of outings 6 months after admission to the study (mean 8.5/week, SD 5.3) was predicted by number of outings at baseline, walking capacity, and age. Driving status did not predict number of outings. Conclusion: The strongest predictors of community participation were the number of outings early post-inpatient rehabilitation, walking capacity, and age. The only significant modifiable predictor was walking capacity. [ABSTRACT FROM AUTHOR]

It has been suggested that interprofessional tracheostomy teams improve safety, enhance outcomes and promote excellence. This study evaluated the effect of a Tracheostomy Review Service (TRS) on patient outcomes and staff attitudes. The TRS reviewed patients with a tracheostomy tube (TT) in situ on our wards. Data was collected via medical record audit. Two years of retrospective data (n = 39) was compared with 12 months of prospective data (n = 28) for: length of cannulation (LOC); length of ward-based cannulation (LOWBC); length of stay (LOS); ICU LOS (ICU-length of stay); the frequency and time to trial one way valve (PMV); and tracheostomy-related adverse events (AE). Staff were also surveyed regarding their knowledge and confidence in tracheostomy management. No significant difference was seen in LOC, LOWBC, LOS, ICU-LOS, and AE. A significant increase was seen in the frequency of PMV use (pre-TRS 74%; post-TRS 100%). Staff reported an improvement in knowledge and confidence in more complex areas of tracheostomy management. Limited measureable improvements in patient outcomes were seen following the implementation of a TRS. Limitations of this study include a small sample size and heterogeneous patient characteristics. [ABSTRACT FROM AUTHOR]

Research question: 1. Does activity participation improve over time in the first year after stroke? 2. What is the association of depressive symptoms on retained activity participation 12-months post-stroke adjusting for neurological stroke severity and age? 3. Is an improvement in activity participation associated with a decrease in depressive symptoms between 3- and 12-months post-stroke? Design: Longitudinal observational study of activity participation and depressive symptoms in ischemic stroke survivors. Participants: A total of 100 stroke survivors with mild neurological stroke severity. Methods: A total of 100 stroke survivors were recruited from five metropolitan hospitals and assessed at 3- and 12-months post-stroke using measures of activity participation (Activity Card Sort-Australia (ACS-Aus)) and depressive symptoms (Montgomery–Asberg Depression Rating Scale Structured Interview Guide (MADRS-SIGMA)). Results: There was a significant association between time (pre-stroke to 3-months post-stroke) and current activity participation (−5.2 activities 95% CI −6.8 to −3.5, p < 0.01) and time (pre-stroke to 12-months) and current activity participation (−2.1 activities 95% CI −3.7 to −0.5, p = 0.01). At 12-months post-stroke, a one-point increase in depressive symptoms was associated with a median decrease of 0.3% (95% CI −1.4% to −0.1%, p = 0.02) of retained overall activity participation, assuming similar neurological stroke severity and age. A decrease in depressive symptoms between 3- and 12-months post-stroke was associated with an improvement of 0.31 (95% CI −0.5 to −0.1, p = 0.01) in current activity participation. Conclusions: Activity participation improves during the first year of recovery post-stroke in stroke survivors with mild neurological stroke severity and is associated with depressive symptoms over time and at 12-months post-stroke. Improvements in participation occur in the first 3-months post-stroke and continue to a lesser degree in the first year after stroke. Depressive symptoms are associated with lower participation at 12-months. A multidimensional approach targeting depressive symptoms and increasing participation in the early months post-stroke and throughout the first-year after stroke is recommended to increase overall recovery following stroke. A focus on increasing leisure activity participation is recommended to improve depressive symptoms. [ABSTRACT FROM AUTHOR]

The mechanism by which sleep problems adversely impacts adolescent health is poorly understood. Distress tolerance—a multifactorial trait indicative of one's ability to withstand negative emotions and persist toward long-term goals—is implicated in numerous emotional psychopathologies and an important target for research and practice. We hypothesized that the adverse psychobiological effects of sleep problems could disrupt the development of distress tolerance during adolescence. This longitudinal study examined whether sleep problems predicted changes in four facets of distress tolerance during adolescence: (1) absorption—feeling attention is captured by negative emotions, (2) appraisal—experiencing distress as unacceptable, (3) regulation—engaging in behaviors to terminate distress, and (4) tolerance—low perceived ability to tolerate distress. High school students (M baseline age = 15.5 years, N = 2,309, 56.1% female), completed self-report measures of sleep problems and distress tolerance at baseline and 1-year follow-up. In linear regression models adjusting for baseline distress tolerance, sleep problems predicted poorer distress tolerance at 1-year follow-up for each distress tolerance facet (βs = –0.10 to –0.24, ps ≤ 0.02). After additionally controlling for sociodemographics and emotional psychopathology, sleep problems were associated with poorer distress tolerance for absorption (β = -0.13, p = 0.004) and appraisal (β = –0.09, p = 0.049) facets, but not regulation or tolerance (ps ≥ 0.35) facets. Interventions targeting healthy sleep habits warrant consideration for improving adolescent development of certain facets of distress tolerance, and in turn various positive health outcomes improved by distress tolerance. [ABSTRACT FROM AUTHOR]

Background: Rapid testing and counseling (RTC) procedures have become a relevant strategy to decrease the health impact of HIV/STIs. It's known that individuals who use substances have an increased risk for HIV/STIs. In Mexico about a third of the individuals with substance use disorders (SUDs) receive treatment at the Community-Based Residential Care Facilities (C-BRCF), but procedures in this setting to link individuals to HIV/STIs care haven't been developed. The primary aim, is to test the acceptability of RTC procedure in individuals who receive treatment in the C-BRCF for SUDs. Methods: A multi-site, observational, prospective study will recruit participants in C-BRCF for SUDs. After discharge from the facilities, participants will receive six monthly follow-up calls. Six hundred participants will be inquired about their substance-use, condom-use, number of sexual-partners and assistance to sexual-health-services (including confirmatory testing). Primary outcome will be assessed by measuring the proportion of participants who accept the STIs testing, expecting that at least 70% of the accept to undergo in the RTC procedure. Conclusion: Mexico is struggling to reach the first goal of the 90-90-90 UNAIDS global goal, the detection of the 90% of HIV positive cases. The results of this study will provide significant data about a strategy to reach a key population. Abbreviations: SUDs: substance use disorders; STIs: sexually transmitted infections; CODs: co-occurring disorders; UEC-INPRFM: clinical trials unit in addiction and mental health-national institute of psychiatry ramón de la fuente muñiz [ABSTRACT FROM AUTHOR]

Purpose: This first psychometric evaluation of the Patient Categorisation Tool examined its properties as an instrument to measure complexity of needs in a mixed population of patients presenting for specialist neurorehabilitation. Materials/methods: Analysis of a large multicentre cohort of patients (n = 5396) from the national clinical dataset representing 63 specialist rehabilitation services across England. Structural validity was examined using exploratory and confirmatory factor analysis. Concurrent and criterion-validity were tested through a priori hypothesized relationships with other validated measures of resource requirements and dependency. Results: All but two items loaded strongly onto a single principal component with Cronbach's alpha 0.88. A total score of ≥30 identified patients with complex (category A) needs with sensitivity 76% and specificity 75%. However, confirmatory factor analysis provided a better fit when the scale was split into two subscales – a 'Cognitive/psychosocial' and a 'Physical' sub-scale (alpha 0.83 and 0.84, respectively). Moderate convergent and discriminant correlations were consistent with hypothesized relationships. Conclusions: The findings provide some overall support for the Patient Categorisation Tool as a unidimensional tool for measuring complexity of needs for neurorehabilitation, but the subscales may be more suitable for certain groups of patients. Further analysis is now required to evaluate its performance in different conditions. A psychometrically robust tool for measuring the complexity of rehabilitation needs has potential value, both at an individual level for treatment planning, and at a population level for planning and commissioning rehabilitation services. The Patient Categorisation Tool now forms part of the United Kingdom national clinical dataset mandated by the National Health Service in England This psychometric analysis from a large national multicentre cohort representing a diverse range of conditions, provides evidence for its validity as a means to identity patients with complex rehabilitation needs requiring specialist rehabilitation. [ABSTRACT FROM AUTHOR]

A new modality - the small group learning approach, was developed for social group work courses for social work students in Hong Kong. A research study, aimed at understanding the students' level of satisfaction with the new approach and exploring its effectiveness regarding enhancing students' learning in social group work, was conducted for three cohorts of students in the academic years from 2013-14 to 2015-16. The findings indicated that its effectiveness was influenced by the quality of the tutors and the level of co-operation of the students. Strategies for improving the design and the implementation of the approach will be discussed [ABSTRACT FROM AUTHOR]

Background: The long-term effects of marijuana on cognition, particularly in the context of HIV is not clear, as extant research shows mixed findings. Objective: To determine associations between current and cumulative exposure to marijuana and changes in cognitive processing speed and flexibility in 788 HIV-seropositive (HIV+) and 1,132 HIV-seronegative (HIV−) men followed for up to 17 years in the Multicenter AIDS Cohort Study. Results: Among HIV+ men only, current daily marijuana use compared to none-use, was significantly associated with a greater annual percentage decline in cognitive processing speed assessed with the Trail Making Test A (TMTA) (β=−0.41, 95% confidence interval (CI): −0.88, −0.03, p=0.03)] and Symbol Digit Modalities Test (SDMT) (β= −0.14, 95% CI: −0.28, −0.01, p=0.04). Further, monthly marijuana use was associated with greater annual percentage decline in cognitive flexibility assessed with the Trail Making Test B (TMTB) (β= −0.70, 95% CI: −1.34, −0.05; p=0.03] and cognitive processing speed (SDMT) (β= −0.21, 95% CI: −0.40, −0.01, p=0.03). Among the HIV− men only, each 5-marijuana use-years (equivalent to 5-years of daily marijuana use) was significantly associated with a 0.17 annual percentage decline in cognitive processing speed only (TMTA) (β= −0.18, 95% CI: −0.36, −0.01; p=0.04). Conclusions: Our findings suggest that marijuana use, particularly current use, may be associated with worse cognitive processing speed, but the magnitude of the estimates was not clinically meaningful. [ABSTRACT FROM AUTHOR]