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Purpose: To compare (1) fluid, food and nutrient intake obtained with a paper versus an online version of a 7-day food record and (2) user's acceptability of both versions of the food record. Methods: A cross-over study was carried out in 2010 in France. A total of 246 participants aged 18-60 years reported their food and fluid intake using both versions of the 7-day food record, separated by a 7- to 14-day washout period. To help participants in estimating consumed portions, both versions of the food record were supported by a photographic booklet of standard portions and containers. At the end of the study protocol, participants completed a questionnaire designed to assess the acceptability of the two questionnaires. Results: The reported water intake of fluids was significantly higher with the online version compared with the paper version (respectively 1348 ± 36 and 1219 ± 34 mL/day, p < 0.0001). No difference was found between methods in terms of energy intake and the consumption of most food categories, macro- and micronutrients. Furthermore, 77 % of the participants preferred the online method to the paper version. Conclusions: Fluid intake, but not food intake, reported with the online 7-day food record was higher in comparison with the paper version. In addition, the online version was preferred by users. In population surveys, the online record is therefore a relevant alternative, and even a preferred alternative in the case of fluid intake, to the paper record. [ABSTRACT FROM AUTHOR]

This paper addresses the challenges and solutions in developing a holistic prevention mobile health application (mHealth app) for Germany's healthcare sector. Despite Germany's lag in healthcare digitalization, the app aims to enhance primary prevention in physical activity, nutrition, and stress management. A significant focus is on user participation and usability to counter the prevalent issue of user attrition in mHealth applications, as described by Eysenbach's 'law of attrition'. The development process, conducted in a scientific and university context, faces constraints like limited budgets and external service providers. The study firstly presents the structure and functionality of the app for people with statutory health insurance in Germany and secondly the implementation of user participation through a usability study. User participation is executed via usability tests, particularly the think-aloud method, where users verbalize their thoughts while using the app. This approach has proven effective in identifying and resolving usability issues, although some user feedback could not be implemented due to cost-benefit considerations. The implementation of this study into the development process was able to show that user participation, facilitated by methods like think-aloud, is vital for developing mHealth apps. Especially in health prevention, where long-term engagement is a challenge. The findings highlight the importance of allocating time and resources for user participation in the development of mHealth applications. [ABSTRACT FROM AUTHOR]

The use of mobile health apps to improve diet and nutrition behaviors has increased in recent years. Several studies have described the benefits and advantages of this technology as a complement to interventions for improving nutrition behaviors and nutrition‐related health outcomes, including obesity indices and clinical parameters. Few of these works have developed clinical mobile health apps for children, and although parents play a critical role in children's nutrition behaviors, work targeting parents is scarce. The work presented in this paper describes the development of the PersuHabit app, a stand-alone mobile health app targeting parents to promote the intake of fruits and vegetables (FVs) and reduce the intake of ultra-processed foods (UPF) in children aged 6 to 10 years. The paper also presents the execution of an exploratory pilot study to assess the feasibility, acceptability, and preliminary effects of the PersuHabit app. The results are presented and discussed, and actions for further improvement of the PersuHabit app are identified. [ABSTRACT FROM AUTHOR]

Background This paper explores the role of providing structure for students within a new blended-learning family medicine curriculum at Saarland University. This study intends to clarify the role of different structural elements for different learning approaches (deep vs. structured vs. surface learning). Methods This study is based on a mixed-methods approach. Fifth year medical students' (n = 84) learning approaches, measured by a shortened version of the ASSIST questionnaire, were correlated with students' academic performance in state exams and the family medicine exam. Based on learning approaches and age, participants were purposefully sampled into two semi-structured group interviews with seven participants each. Results Although surface approach learning weakly correlated with lower performance in the first state exam (rho = 0.231), surface approach learning did not correlate with lower performance in the family medicine assessment. Based on qualitative results, the structural design of the curriculum seemed to have a high impact on students' satisfaction and motivation to learn. The reduction of extraneous cognitive load was identified as effective in motivating students to study. Deep-learning students highlighted the positive effects of curriculum activities that foster germane cognitive load through schema- based learning. Conclusions Especially for surface approach learners it may be important to provide structured guidance and provide a clear alignment of course content in a blended-learning curriculum, even in higher education. Deep and structured approach learners also benefit from a clear course structure that keeps extraneous cognitive load low and fosters schema acquisition. [ABSTRACT FROM AUTHOR]

Introduction: Though text messages are increasingly used in health promotion, the current understanding of text message-based interventions to increase screening mammography in low-income African American women is limited. This study aimed to assess the feasibility and acceptability of a text message-based intervention to increase screening mammography in low-income African American women. Materials and Methods: A 15-item, self-administered, paper-based survey on cell phone ownership, text messaging practices and preferences for future breast health information was administered to 120 female patients at an urban family medicine office. Descriptive analyses and demographic correlates of text messaging practices and preferences were examined. Results and Discussion: The majority of respondents (95%) were cell phone owners of whom 81% reported texting. Prior receipt of a text message from a doctor's office was reported by 51% of cell phone owners. Mammography appointment reminders were the most desired content for future breast health text messages. Age (≥ 70 years old) was found to have a significant negative relationship with text messaging practices and perceptions. Implications: The use of text messages to promote mammography was found to be acceptable in this patient population. In addition to age, variables such as the frequency, timing and subject content of text messages also influence their acceptability. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this paper was to examine changes in situational temptations to smoke among women in early to late pregnancy enrolled in a texting trial to help them quit smoking. We compared changes between (1) intervention arms, (2) those who quit, (3) those who reduced by 50% or more, and (4) those who reduced by less than 50%. We also examined cravings overtime in the intervention arm and the relationship between real-time cravings assessed via text message and situational temptations. Methods: This was a secondary analysis of the Baby Steps trial, a randomized controlled trial testing the efficacy of a text-based scheduled gradual reduction (SGR) intervention on cessation. We used t-tests to examine changes across intervention arms and repeated measured proc mixed to explore changes in situational temptations and cravings. Results: Among all women, situational temptations decreased from early to late pregnancy for the positive, negative, and habitual subscales, (ps < 0.001). We found no difference in situational temptations across arms. We found a positive relationship between negative situational temptation and average craving during the Weeks 2 and Weeks 3 of the intervention. Negative ST increased by 0.11 for each unit increase of craving at Week 2. Conclusions: As women progress through pregnancy their temptation to smoke reduces. A different relationship might exist, however with negative affect situations in which women reported higher craving but not in response to other temptations. Future work might have a particular focus on the intersection of negative affect with cravings and temptations to promote cessation during pregnancy. Clinical Trial: NCT01995097. [ABSTRACT FROM AUTHOR]

There has been an increasing attention to the study of stress. Particularly, college students often experience high levels of stress that are linked to several negative outcomes concerning academic functioning, physical, and mental health. In this paper, we introduce the EuStress Solution, that aims to create an Information System to monitor and assess, continuously and in real-time, the stress levels of the students in order to predict burnout. The Information System will use a measuring instrument based on wearable device and machine learning techniques to collect and process stress-related data from the students without their explicit interaction. In the present study, we focus on heart rate and heart rate variability indices, by comparing baseline and stress condition. We performed different statistical tests in order to develop a complex and intelligent model. Results showed the neural network had the better model fit. [ABSTRACT FROM AUTHOR]

Background and Objective: Psychotropic drug use is high in nursing homes in Belgium. A practice improvement initiative (including education, professional support and the transition towards person-centred care) achieved significant reductions in psychotropic drug use. The initiative outline was transcribed into a general intervention template, and consequently implemented in five nursing homes (in mixed locations and with a mixed character) in preparation for a future broader roll-out in Belgium. The impact of the intervention on the use of psychotropic drugs in these five nursing homes is reported in this paper. Methods: The general intervention template was fitted into the individual nursing home setting. Education for the nursing home personnel on psychotropic drugs and non-pharmacological alternatives, as well as details for a transition to person-centred care was provided. Psychotropic drug use was recorded using a dynamic cohort study design with cross-sectional observations (November 2016–November 2017). Results: At baseline, participants' (n = 677) mean age was 85.6 years (range 54–109 years), with 72.6% female. Mean medication intake was 8.5 (range 1–22), predominantly central nervous system drugs (Anatomic Therapeutic Chemical classification N, 88.8%). Long-term (> 3 months) psychotropic drug use (62.0%) and concomitant psychotropic drug use (31.5% taking two or more medications) were high. After 12 months, the prevalence of long-term psychotropic drug use decreased significantly (from 62.0 to 52.9%, p < 0.001), likewise the combined use of psychotropic drugs (from 31.5 to 24.0%, p = 0.001). The decrease in the prevalence of antidepressant and hypnosedative use was significant (respectively, from 32.2 to 23.4%, p < 0.001, and from 35.3 to 28.7%, p = 0.006) in contrast to antipsychotic use (from 17.1 to 15.9%, p = 0.522). Conclusions: The stand-alone adaptation of the previously reported initiative using a general template was possible. This intervention resulted in a significant decrease in psychotropic drug use (predominantly hypnosedatives and antidepressants) among nursing home residents after 12 months. [ABSTRACT FROM AUTHOR]

Intraclass correlation coefficients (ICCs) are frequently employed in health science research, often to assess intrarater and interrater reliability. In many cases, insufficient details are provided about these ICCs and there seem to be misunderstandings about their selection and how they should be interpreted. This paper is intended primarily to provide a clear, accessible description of ICCs, including how they should be selected, interpreted, and reported. Emphasis is given to areas where researchers seem to encounter the greatest conceptual difficulties and to exhibit the greatest misconceptions. Two extended examples are used to support the points being made. Major additional aims of this paper are to raise the awareness of authors, reviewers, and editors concerning the importance of using appropriate ICCs, and to encourage them to ensure that complete and accurate information about ICCs is reported in journal articles. Failure to do so perpetuates a risk that incorrect decisions might be made about matters that are of crucial importance for people's health. [ABSTRACT FROM AUTHOR]

The main aim of this paper is to classify mental functions by the Wechsler Adult Intelligence Scale-Revised tests with a mixed method based on wavelets and partial correlation. The Wechsler Adult Intelligence Scale-Revised is a widely used test designed and applied for the classification of the adults cognitive skills in a comprehensive manner. In this paper, many different intellectual profiles have been taken into consideration to measure the relationship between the mental functioning and psychological disorder. We propose a method based on wavelets and correlation analysis for classifying mental functioning, by the analysis of some selected parameters measured by the Wechsler Adult Intelligence Scale-Revised tests. In particular, 1-D Continuous Wavelet Analysis, 1-D Wavelet Coefficient Method and Partial Correlation Method have been analyzed on some Wechsler Adult Intelligence Scale-Revised parameters such as School Education, Gender, Age, Performance Information Verbal and Full Scale Intelligence Quotient. In particular, we will show that gender variable has a negative but a significant role on age and Performance Information Verbal factors. The age parameters also has a significant relation in its role on Performance Information Verbal and Full Scale Intelligence Quotient change. [ABSTRACT FROM AUTHOR]

The purpose of this study was to review the evidence on the effect of initiation of breastfeeding early after birth and of exclusive breastfeeding during the first month in reducing neonatal mortality and morbidity. We searched Cochrane and PubMed databases for all available papers addressing our review questions and identified eleven papers. Data were extracted using a standard abstraction form. Evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation system. Meta-analysis was done using STATA 11.0. Early initiation of breastfeeding was associated with a reduced risk of neonatal mortality. Initiating breastfeeding after the first hour doubled the risk of neonatal mortality. Exclusively breastfed neonates had a lower risk of mortality and infection-related deaths in the first month than partially breastfed neonates. Exclusively breastfed neonates also had a significantly lower risk of sepsis, diarrhea and respiratory infections compared with those partially breastfed. The pooled evidence indicates that substantial benefits in reducing neonatal mortality and morbidity can be achieved with effective promotion of early initiation of breastfeeding and exclusive breastfeeding during the first month of life. [ABSTRACT FROM AUTHOR]

The nominal group technique (NGT) is a method to elicit healthcare priorities. Yet, there is variability on how to conduct the NGT, and limited guidance on how to analyse a diverse sample of multiple groups. This paper addresses some of this ambiguity, and explores whether different approaches to analysis provide the same outcome/s. Conceptual papers and empirical studies were identified via PubMed and informed an adapted version of the NGT. Twenty-six nominal groups were conducted, which provided in-depth knowledge on how to best conduct this method. Pilot group data were used to compare different analysis methods and to explore how this impacted on reported outcomes. Data analyses for large data-sets are complex; thematic analysis is needed to be able to conduct across group comparisons of participant priorities. Consideration should be given not just to the strength, i.e. sum of votes, or relative importance of the priority, but to the voting frequency, i.e. the popularity of the idea amongst participants; our case study demonstrated that this can affect priority rankings for those ideas with the same score. As a case study, this paper provides practical information on analysis for complex data sets. Researchers need to consider more than one analysis process to ensure that the results truly reflect participant priorities. A priority that has a high score may not necessarily reflect its popularity within the group; the voting frequency may also need to be considered. [ABSTRACT FROM AUTHOR]

According to the wisdom literature, learning from important and meaningful life experiences can foster wisdom. Leading others is one such experience. This paper explores empirically whether and how learning acquired from leadership experience can foster wisdom, which is defined as a real-life process encompassing three core components: cognitive integration, embodiment in actions, and positive effects for oneself and others. This paper consists of two studies. Study 1 investigated the learning acquired from leadership experience and its relationship with wisdom. Eight leaders in higher education in Taiwan participated in five interviews spanning 2 years which explored the lessons learned from their leadership experience. Analysis of the interviews found that leaders acquired rich and multidimensional learning from their leadership experience and that components of wisdom were involved in their learning and their application of the lessons learned. Study 2 examined whether the results of Study 1 could be generalized to a wider population of higher education leaders. An inventory of learning and wisdom compiled from Study 1 was administered to 94 Taiwanese higher education leaders twice within 8 months. Multivariate statistical analysis showed that leaders' responses to items of both acquired learning and components of wisdom increased in 8 months and that these increases were strongly correlated. Results suggest that learning from important and meaningful life experiences can foster wisdom. [ABSTRACT FROM AUTHOR]

This paper examined the prevalence of depressive symptomotology among women of Mexican ancestry (N = 205), over the age of 18, of diverse incomes and nativity. We examined differences in rates of diagnosis by Spanish/English preference and the sensitivity and specificity of three common measures: the Patient Health Questionnaire (PHQ9), the Kessler Psychological Distress Scale (K-10), and depression questions from the Composite International Diagnostic Interview, Short Form (MDD CIDI-SF); PHQ9 was used as the 'gold standard' measure. Results indicated 18-32 % of participants met criteria for depression with higher rates found among Spanish preference participants. The K-10 had significantly higher sensitivity (0.81) but lower specificity (0.79) than the MDD CIDI-SF items (0.57 and 0.89, respectively). This study suggests that the K-10 and MDD CIDI-SF measures are complementary to each other for screening of depressive symptomatology. Implications for cultural and linguistic assessment of depression are further discussed. [ABSTRACT FROM AUTHOR]

Objectives Group prenatal care results in improved birth outcomes in randomized controlled trials, and better attendance at group prenatal care visits is associated with stronger clinical effects. This paper's objectives are to identify determinants of group prenatal care attendance, and to examine the association between proportion of prenatal care received in a group context and satisfaction with care. Methods We conducted a secondary data analysis of pregnant adolescents (n = 547) receiving group prenatal care in New York City (2008-2012). Multivariable linear regression models were used to test associations between patient characteristics and percent of group care sessions attended, and between the proportion of prenatal care visits that occurred in a group context and care satisfaction. Results Sixty-seven groups were established. Group sizes ranged from 3 to 15 women (mean = 8.16, SD = 3.08); 87 % of groups enrolled at least five women. Women enrolled in group prenatal care supplemented group sessions with individual care visits. However, the percent of women who attended each group session was relatively consistent, ranging from 56 to 63 %. Being born outside of the United States was significantly associated with higher group session attendance rates [B(SE) = 11.46 (3.46), p = 0.001], and women who received a higher proportion of care in groups reported higher levels of care satisfaction [B(SE) = 0.11 (0.02), p < 0.001]. Conclusions Future research should explore alternative implementation structures to improve pregnant women's ability to receive as much prenatal care as possible in a group setting, as well as value-based reimbursement models and other incentives to encourage more widespread adoption of group prenatal care. [ABSTRACT FROM AUTHOR]

113 parents of children aged 5-13 with ASD completed online surveys assessing co-parenting quality, parenting stress, and child feeding challenges. Results indicated that food selectivity was both the most frequently reported type of challenging feeding behavior and the most often reported as problematic but was also the only type of challenging feeding behavior that was not associated with parenting stress. Greater parenting stress was reported when co-parenting agreement and support were lower. Child disruptive behavior at mealtime was the only feeding challenge associated with quality of co-parenting. This paper points to the importance of addressing feeding challenges in addition to selectivity, such as disruptive mealtime behaviors, and doing so within the context of the family and home environment. [ABSTRACT FROM AUTHOR]

Sex differences in typical development can provide context for understanding ASD. Baron-Cohen (Trends Cogn Sci 6(6):248-254, 2002) suggested ASD could be considered an extreme expression of normal male, compared to female, phenotypic profiles. In this paper, sex-specific M-CHAT scores from N = 53,728 18-month-old toddlers, including n = 185 (32 females) with ASD, were examined. Results suggest a nuanced view of the 'extreme male brain theory of autism'. At an item level, almost every male versus female disadvantage in the broader population was consistent with M-CHAT vulnerabilities in ASD. However, controlling for total M-CHAT failures, this male disadvantage was more equivocal and many classically ASD-associated features were found more common in non-ASD. Within ASD, females showed relative strengths in joint attention, but impairments in imitation. [ABSTRACT FROM AUTHOR]

Purpose: Oxysterols are cholesterol-oxygenated derivatives generated in the organism and also present in foods because of cholesterol oxidation during processing and storage. They are the natural ligands of liver X receptors (LXRs) and are generally recognized as hypocholesterolemic and anti-inflammatory molecules although this latter property is still controversial. Most oxysterol studies have been performed in macrophages, whereas the effects of oxysterols in neutrophils are poorly known. In this study, human neutrophils were exposed to two different oxysterols, 7-keto-cholesterol (7-k-chol) and 25-hydroxy-cholesterol (25-OH-chol), and their possible participation in inflammatory process was evaluated. Methods: Human neutrophils were incubated with 7-k-chol and 25-OH-chol, and ROS production, translocation of the NADPH oxidase cytosolic components, hemoxygenase-1 (HO-1) expression and lysozyme secretion were analyzed. Results: An increase in ROS production was observed within a short period of time (minutes) with both molecules. These oxysterols also stimulated the cellular membrane translocation of the NADPH oxidase cytosolic components, p47phox and p67phox. On the other hand, HO-1 expression, a cytoprotector enzyme, is inhibited in human neutrophils upon oxysterols treatment. Moreover, both oxysterols were associated with high lysozyme enzyme secretion at 5 and 18 h of incubation. Conclusions: The present paper describes for the first time that two oxysterols (7-k-chol and 25-OH-chol) enhance the ROS production within a short period of time in human neutrophils, stimulate the translocation of the cytosolic components of NADPH oxidase to the cellular membrane and increase lysozyme secretion. These data suggest that both oxysterols are able to activate pro-inflammatory effects in human neutrophils which contrasts with the role assigned to the oxysterols when they act through LXR at long time of incubation. [ABSTRACT FROM AUTHOR]

Early, accurate identification of ADHD would improve outcomes while avoiding unnecessary medication exposure for non-ADHD youths, but is challenging, especially in primary care. The aim of this paper is to test the Strengths and Difficulties Questionnaire (SDQ) using a nationally representative sample to develop scoring weights for clinical use. The British Child and Adolescent Mental Health Survey ( N = 18,232 youths 5-15 years old) included semi-structured interview DSM-IV diagnoses and parent-rated SDQ scores. Areas under the curve for SDQ subscales were good (0.81) to excellent (0.96) across sex and age groups. Hyperactivity/inattention scale scores of 10+ increased odds of ADHD by 21.3×. For discriminating ADHD from other diagnoses, accuracy was fair (<0.70) to good (0.88); Hyperactivity/inattention scale scores of 10+ increased odds of ADHD by 4.47×. The SDQ is free, easy to score, and provides clinically meaningful changes in odds of ADHD that can guide clinical decision-making in an evidence-based medicine framework. [ABSTRACT FROM AUTHOR]

Background: Non-suicidal self-injury (NSSI) is a serious and relatively prevalent problem in adolescence. Although several studies have identified risk factors for the aetiology and maintenance of NSSI, little is known about the impact of individual and contextual variables in such pervasive behaviors among adolescents. Objective: This paper aims to test whether specific internal traits characterized by shame, self-criticism and fear of self-compassion impact on NSSI, through their effect in daily peer hassles and depression. Methods: Participants are 782 adolescents with 12-18 years-old from middle and secondary schools (years of education's mean = 9.46). This study has a cross-sectional design. Self-report measures include external shame, self-criticism, fear of self-compassion, daily peer hassles, depressive symptoms and NSSI. Results: External shame, hated self and fear of self-compassion indirectly predict NSSI, through their effect in daily peer hassles and depression. The most pathological form of self-criticism (hated self) is strongly associated with NSSI. Conclusions: These findings contribute to clarification of the paths through which the belief that one is seen negatively by others, the hostile self-to-self relationship and the inability to direct compassion for self may increase NSSI. Daily peer hassles and current depressive symptoms seem to play an important role in the association between internal traits and NSSI. Preventive and intervention actions for reducing NSSI in adolescence should address not only interpersonal difficulties but also self-to-self relationship. [ABSTRACT FROM AUTHOR]

Objective This research aims to identify predictors of attrition in a longitudinal birth cohort study in Australia and assess differences in baseline characteristics and responses in subsequent follow-up phases between contactable non-responders and uncontactable non-responders deemed 'lost to follow-up (LTF)'. Methods 3368 women recruited from three public hospitals in Southeast Queensland and Northern New South Wales during antenatal visits in 2006-2011 completed a baseline questionnaire to elicit information on multiple domains of exposures. A follow-up questionnaire was posted to each participant at 1 year after birth to obtain mother's and child's health and development information. Multivariate logistic regression was used to model the association between exposures and respondents' status at 1 year. The effect of an inverse-probability-weighting method to adjust for non-response was studied. Results Overall attrition at 1-year was 35.4 %; major types of attrition were 'contactable non-response' (27.6 %) and 'LTF' (6.7 %). These two attrition types showed different responses at the 3-year follow-up and involved different predictors. Besides shared predictors (first language not English, higher risk of psychological distress, had smoked during pregnancy, higher levels of family conflict), distinguishable predictors of contactable non-responders were younger age, having moved home in the past year and having children under 16 in the household. Attrition rates increased substantially from 20 % in 2006 to 54 % in 2011. Conclusions This observed trend of increased attrition rates raises concern about the use of traditional techniques, such as 'paper-based' questionnaires, in longitudinal cohort studies. The supplementary use of electronic communications, such as online survey tools and smart-device applications, could provide a better alternative. [ABSTRACT FROM AUTHOR]

Objectives The literature exploring the relationship between food insecurity and obesity for preschool-aged children is inconclusive and suffers from inconsistent measurement. This paper explores the relationships between concurrent household and child food insecurity and child overweight as well as differences in these relationships by child gender using a sample of 2-5 year old children. Methods Using measured height and weight and responses to the Household Food Security Survey Module collected from a sample of 438 preschool-aged children (mean age 39 months) and their mothers, logistic regression models were fit to estimate the relationship between household and child food insecurity and child BMI. Separate models were fit for girls and boys. Results Twenty-seven percent of children from food insecure households and 25 % of child food insecure children were overweight or obese (BMI ≥ 85 %). There were no statistically significant associations between either household or child food insecurity and BMI for the full sample. For girls, but not boys, household food insecurity was associated with BMI z-scores ( β = 0.23, p = 0.01). Conclusions Although food insecurity and overweight were not significantly associated, a noteworthy proportion of food insecure children were overweight or obese. Programs for young children should address food insecurity and obesity simultaneously by ensuring that young children have regular access to nutrient-dense foods. [ABSTRACT FROM AUTHOR]

The increasing use of wearable actimetry devices in cohort studies can provide a deep and objective insight in physical activity (PA) patterns. For reliable and reproducible pattern recognition, and to minimize the influence of specific device characteristics, there is a need for a generic method to identify relevant PA events in sensor data sets on the basis of comprehensive features such as PA duration and intensity. The objectives of this paper are to present a method to identify universal event detection thresholds for such parameters, and to attempt to find stable meta-clusters of PA behaviour. PA events of 5, 10, 20 and 30 min with low, medium and high intensity thresholds found in literature and intensity deciles were computed for a random sample ( N = 100) of the NHANES 2005-06 accelerometer data set ( N = 7457). On the basis of all combinations of the above, activity events were detected, and parameters mean duration, mean intensity and event regularity were computed. Results were clustered using x-Means clustering and visualized for 5-, 10-, 20-, and 30-min events. Stable clustering results are obtained with intensity thresholds up to the 8th decile and for event durations up to 10 min. Two stable meta-clusters were detected: 'irregularly active' (intensity at 52nd percentile) and 'regularly active' (intensity at 42nd percentile). Distinct generic thresholds could be identified and are proposed. They may prove useful for further investigations of similar actimetry data sets, minimising the influence of specific device characteristics. The results also confirm that distinct PA event patterns - including event regularity - can be identified using wearable sensor devices, especially when regarding low-intensity, short-term activities which do not correspond to current PA recommendations. Further research is necessary to evaluate actual associations between sensor-based PA parameters and health outcome. The author identified generic intensity and duration thresholds for analysing objective PA data from wearable devices. This may contribute to further analyses of PA patterns along with their relations with health outcome parameters. [ABSTRACT FROM AUTHOR]

This paper presents a robust device for automated screening of pediatric heart diseases based on our unique processing method in murmur characterization; the Arash-Band method. The present study modifies the Arash-Band method and employs output of the modified method in conjunction with the two other original techniques to extract indicative feature vectors for the screening. The extracted feature vectors are classified by using the support vector machine method. Results show that the proposed modifications significantly enhances performance of the Arash-Band in terms of the both accuracy and sensitivity as the corresponding effect sizes are sufficiently large. The proposed algorithm has been incorporated into an Android-based tablet to constitute an intelligent phonocardiogram with the automatic screening capability. In order to obtain confidence interval of the accuracy and sensitivity, an inferable statistical test is applied on our database containing the phonocardiogram signals recorded from 263 of the referrals to a hospital. The expected value of the accuracy/sensitivity is estimated to be 87.45 % / 87.29 % with a 95 % confidence interval of (80.19 % - 92.47 %) / (76.01 % - 95.78 %) exhibiting superior performance than a pediatric cardiologist who relies on conventional or even computer-assisted auscultation. [ABSTRACT FROM AUTHOR]

Problem behaviours in children with Autism Spectrum Disorder (ASD) are a major source of parenting stress, as they restrict family capacity to maintain quality domestic and social life. It is therefore critical to support parents to manage the problem behaviours of their child with ASD. Recent mindfulness intervention studies have successfully addressed this issue. The current pilot study pursues this line of enquiry and extends the scope of mindfulness intervention by training parents to become a mindfulness teacher of their own child with ASD and problem behaviours, so together they can work on enhancing the quality of their domestic and social life. A total of six dyads of mothers (CA range 34-48 years) and children with ASD and problem behaviours (CA range 8-15 years) participated in a two-stage mindfulness intervention. Mothers attended an 8-week mindfulness program to attain fluency in the theory and practice of mindfulness meditation (Stage 1). Based on this fluency they then taught mindfulness activities to their child (Stage 2). This paper reports on the effects of the mindfulness intervention provided for mothers (Stage 1) and children (Stage 2) as demonstrated by the level of mindfulness, parenting stress, and family quality of life for mothers, and problem behaviours for children. The results highlight overall improvements in the targeted areas. Some benefits, issues, and challenges of mindfulness training for parents and their children with ASD are discussed. [ABSTRACT FROM AUTHOR]

Identification of patients with poor chronic disease self-management skills can facilitate treatment planning, determine effectiveness of interventions, and reduce disease complications. This paper describes the use of a Rasch model, the Rating Scale Model, to examine psychometric properties of the 50-item Health Problem-Solving Scale (HPSS) among 320 African American patients with high risk for cardiovascular disease. Items on the positive/effective HPSS subscales targeted patients at low, moderate, and high levels of positive/effective problem solving, whereas items on the negative/ineffective problem solving subscales mostly targeted those at moderate or high levels of ineffective problem solving. Validity was examined by correlating factor scores on the measure with clinical and behavioral measures. Items on the HPSS show promise in the ability to assess health-related problem solving among high risk patients. However, further revisions of the scale are needed to increase its usability and validity with large, diverse patient populations in the future. [ABSTRACT FROM AUTHOR]

Effective care coordination is a key quality and safety strategy for populations with chronic conditions, including children with medical complexity (CMC). However, gaps remain in parent report of the need for care coordination help and receipt of care coordination help. New models must close this gap while maintaining family-centered focus. A three-armed randomized controlled trial conducted in an established medical home utilized an advanced practice registered nurse intervention based on Presler's model of clinic-based care coordination. The model supported families of CMC across settings using telephone only or telephone and video telehealth care coordination. Effectiveness was evaluated from many perspectives and this paper reports on a subset of outcomes that includes family-centered care (FCC), need for care coordination help and adequacy of care coordination help received. FCC at baseline and end of study showed no significant difference between groups. Median FCC scores of 18.0-20.0 across all groups indicated high FCC within the medical home. No significant differences were found in the need for care coordination help within or between groups and over time. No significant difference was found in the adequacy of help received between groups at baseline. However, this indicator increased significantly over time for both intervention groups. These findings suggest that in an established medical home with high levels of FCC, families of CMC have unmet needs for care coordination help that are addressed by the APRN telehealth care coordination model. [ABSTRACT FROM AUTHOR]

As one migrates from an area of low to high incidence of breast cancer their personal risk of developing breast cancer increases. This is however not equally distributed across all races and ethnicities. This paper specifically examines Filipino migrants. A literature review was conducted to summarize breast cancer incidence, screening practices and trends in treatment amongst Filipino migrants. In addition, a retrospective cohort study was conducted specifically examining the age in which Filipino women were diagnosed with breast cancer compared to Asian and Caucasian counterparts. Filipino women are diagnosed with breast cancer at a statistically significant younger age (53.2) compared to their Asian (55.1) and Caucasian (58.4) counterparts. In addition, they are at an increased risk of developing more aggressive breast cancer with noteworthy disparities in the care they are receiving. The evidence suggest this group is worthy of special focus when diagnosing and treating breast cancer. [ABSTRACT FROM AUTHOR]

Caring for children with mental and behavioral health conditions can lead to family strain. Research indicates that Latino children are less likely to adhere to recommended treatment for their mental health diagnoses, increasing the potential for family strain. Little research has focused on understanding the different predictors of family strain among white and Latino families of children with mental health or behavioral health diagnoses. This paper uses a model of family strain to understand how stressors, resources, and perceptions predict family strain for white and Latino parents of children with a mental or behavioral health condition. Data from a telephone survey of 268 parents of children with a mental or behavioral health condition were analyzed to understand predictors of strain using the Family Strain Index scale. Findings indicate that family strain does differ between white and Latino families. Latino families' strain was predicted by age of parent (β = −0.381, P < 0.001), perceptions of treatment quality (β = 0.306, P < 0.001), and child's current symptom burden (β = −0.390, P < 0.001). White family strain was related to their child's health status (β = −0.240, P < 0.001), symptom burden (β = −0.339, P < 0.001), and parent's level of education (β = −0.315, P < 0.001). [ABSTRACT FROM AUTHOR]

IntroductionPostthrombotic syndrome (PTS) is a complication of deep vein thrombosis (DVT) characterized by chronic pain, swelling, and heaviness, and may result in ulceration. Elastic compression stockings (ECS) worn daily after DVT have been shown to reduce the incidence and severity of PTS. The aim of our study was to investigate practices and perceptions of physicians regarding adjunct therapies to anticoagulation in patients diagnosed with lower extremity DVT.MethodsA national online survey was conducted of Canadian emergency medicine staff physicians and residents (n=471) to investigate their attitudes toward the prescription of ECS post-diagnosis of DVT. A paper survey of patients in a thrombosis clinic (n=58) was also administered to better understand the patient experiences with ECS.ResultsThe majority of staff physician (62%) and resident (69%) respondents were unsure of whether ECS were effective in preventing PTS and managing venous symptoms. Only 6% of staff physicians and 7% of residents routinely prescribed ECS for above-knee DVTs. More than 78% of respondents were unsure about the optimal timing of initiation of ECS and duration of therapy. Although all patients noted symptomatic relief with ECS, only 50% were prescribed stockings by an emergency or family doctor, and 69% of those patients wore the stockings on a daily basis. Staff physicians most frequently identified poor fit as the reason for lack of patient compliance, whereas patients most frequently cited cost.ConclusionsOur findings suggest that there is variability in practice among Canadian emergency medicine physicians and trainees and a need for widespread education regarding the latest evidence of the benefit of ECS after DVT. [ABSTRACT FROM PUBLISHER]

Autism spectrum disorders (ASD) have a high degree of heritability, but there is still much debate about specific causal genes and pathways. To gain insight into patterns of transmission, research has focused on the relatedness of quantitative autism traits (QAT) between family members, mostly using questionnaires. Yet, different kinds of bias may influence research results. In this paper, we focus on possible informant effects and, taking these into account, on possible intergenerational transmission of QAT. This study used multiple informant data retrieved via the Social Responsiveness Scale from 170 families with at least one member with ASD. Using intraclass correlations (ICCs) and mixed model analyses, we investigated inter-informant agreement and differences between parent and teacher reports on children and between self- and other-reports on adults. Using structural equation modelling (SEM), we investigated the relatedness of QAT between family members in ASD families. Parent-teacher agreement about social responsiveness was poor, especially for children with ASD, though agreement between parents was moderate to strong for affected and unaffected children. Agreement between self- and other-report in adult men was good, but only moderate in women. Agreement did not differ between adults with and without ASD. While accounting for informant effects, our SEM results corroborated the assortative mating theory and the intergenerational transmission of QAT from both fathers and mothers to their offspring. [ABSTRACT FROM AUTHOR]

Given the pivotal role of African American caregiver's perceptions of childhood obesity in rural areas, the inclusion of caregiver's perceptions could potentially reduce childhood obesity rates. The objective of the current study was to explore childhood obesity perceptions among African Americans in a rural Georgia community. This concurrent mixed methods study utilized two theoretical frameworks: Social Cognitive Theory and Social Ecological Model. Using a convenience sample, caregivers ages 22-65 years completed a paper-based survey (n = 135) and a face-to-face interview (n = 12) to explore perceptions of obesity risk factors, health complications, weight status, built environment features, and obesity prevention approaches. Descriptive statistics were generated and a six-step process was used for qualitative analysis. Participants commonly cited behavioral risk factors; yet, social aspects and appearance of the community were not considered contributing factors. Chronic diseases were reported as obesity health complications. Caregivers had a distorted view of their child's weight status. In addition, analysis revealed that caregivers assessed child's weight and height measurements by the child's appearance or a recent doctor visit. Environmental barriers reported by caregivers included safety concerns and insufficient physical activity venues and programs. Also, caregivers conveyed parents are an imperative component of preventing obesity. Although this study found caregivers were aware of obesity risk factors, health complications, built environment features, and prevention approaches their obesity perceptions were not incorporated into school or community prevention efforts. Findings suggest that children residing in rural areas are in need of tailored efforts that address caregiver perceptions of obesity. [ABSTRACT FROM AUTHOR]

Food insecurity is steadily increasing in developed countries. Traditional interventions adopted to tackle food insecurity, like food banks, address the urgent need for food. By contrast, alternative interventions, such as community gardens and kitchens, are oriented towards social integration and the development of mutual aid networks. The objective of this paper is to examine whether the populations served by traditional and alternative interventions in food security differ according to measures of vulnerability. We studied newly registered participants to food security interventions. Participants were selected from a random sample of food security community organizations in a two-stage cluster sampling frame. The categorizing variable was participation in a community organization providing either traditional interventions or alternative interventions. Seven measures of vulnerability were used: food security; perceived health; civic participation; perceived social support of the primary network, social isolation, income and education. Regression multilevel models were used to assess associations. 711 participants in traditional interventions and 113 in alternative interventions were enrolled in the study. Between group differences were found with respect to food insecurity, health status perception, civic participation, education and income, but not with respect to social isolation or perceived social support from primary social network. Traditional and alternative food security interventions seem to reach different populations. Participants in traditional interventions were found to have less access to resources, compared to those in alternative interventions. Thus, new participants in traditional interventions may have higher levers of vulnerability than those in alternative interventions. [ABSTRACT FROM AUTHOR]

Objective:Reactive oxygen species (ROS) are significantly upregulated after spinal cord injury (SCI). MicroRNAs (miRNAs) are reported to be widely involved in regulating gene expression. This paper aims to explore the correlation between ROS-induced cell apoptosis and abnormal miRNA expression after SCI.Methods:To profile the expression of miRNAs after SCI, miRNA microarray was applied and the result was verified by reverse transcription quantitative PCR (RT-qPCR). ROS production following H2O2 stimulation was examined using dihydroethidium staining and flow cytometry. The levels of miR-200c after H2O2 treatment were determined using RT-qPCR. Cell viability and apoptosis were examined in murine BV-2 cells transfected with miR-200c mimics, inhibitor or negative control. Immunofluorescence and western blot were used to further explore the effects of miR-200c on Fas-associated phosphatase-1 (FAP-1) expression.Results:MiR-200c was showed to be significantly increased after SCI by miRNA microassay and RT-qPCR. ROS production enhanced miR-200c expression in a dose-dependent manner and induced significant apoptosis in BV-2 cells. The upregulation of miR-200c reduced cell viability and induced BV-2 cell apoptosis. MiR-200c negatively regulated the expression of FAP-1, thereby inducing FAS signaling-induced apoptosis. RT-qPCR analysis showed that the FAP-1-targeting small interfering RNA (siRNA) did not affect the level of miR-200c in murine BV-2 cells. In addition, suppression of FAP-1 by siRNA promoted apoptosis, even in cells that were co-transfected with the miR-200c inhibitor.Conclusions:The current data suggested that miR-200c contributes to apoptosis in murine BV-2 cells by regulating the expression of FAP-1. This proposes a therapeutic target for enhancing neural cell functional recovery after SCI. [ABSTRACT FROM AUTHOR]

This paper investigates the relationship between socio-economic status and emotional well-being of orphans in Mangaung, South Africa. Five hundred orphans aged 7-11 years participated in the cross-sectional study between 2009 and 2012. Data was collected by trained fieldworkers, who conducted face-to-face interviews and questionnaires with the orphans, their teachers and caregivers, and the heads of the households where the orphans resided. The caregivers, children and teachers all completed the Strengths and Difficulties Questionnaire in order to measure the orphans' mental health, while heads of household provided information about socio-economic indicators. STATA version 12 was used to perform multivariate data analyses to identify socio-economic factors associated with the mental health of orphans. Food security, access to medical services and a male caregiver were factors associated with better emotional well-being of orphans, whereas other variables such as household asset index and monthly household expenditure were not linked with the orphans' mental health. Two of the three variables (food security and access to medical services) associated with better emotional well-being of orphans are also government interventions to assist orphans. Further research is needed to determine whether other government programs also impact the emotional well-being of orphans. [ABSTRACT FROM AUTHOR]

Purpose: Previous studies regarding the association between carrot intake and prostate cancer risk have reported inconsistent results. We conducted a meta-analysis to summarize evidence on this association and to quantify the potential dose-response relationship. Method: A systematic literature search of papers published in August 2013 was conducted using PubMed, EMBASE, Scopus, Web of Science, the Cochrane register, and the Chinese National Knowledge Infrastructure databases, and the references of the retrieved articles were screened. The summary risk estimates with 95 % confidence intervals (CIs) for the highest versus the lowest intake of carrots were calculated. A dose-response meta-analysis was also conducted for the studies reporting categorical risk estimates for a series of exposure levels. Results: We found a significantly decreased risk of prostate cancer associated with the intake of carrots (odds ratio 0.82, 95 % CI 0.70-0.97). In addition, the dose-response meta-analysis indicated that for each serving per week, or 10 g per day increment of carrot intake, the risk estimate of prostate cancer was 0.95 (0.90-0.99) or 0.96 (0.94-0.99). There was no evidence of significant publication bias based on Begg's funnel plot ( P = 1.000) or Egger's test ( P = 0.804). Conclusion: Carrot intake might be inversely associated with prostate cancer risk. Because of the limited number of cohort studies and substantial heterogeneity observed between studies in this meta-analysis, further well-designed prospective studies are warranted to confirm the findings from our study. [ABSTRACT FROM AUTHOR]

Objectives: Little is known about how lithium should be dosed to achieve therapeutic but safe serum concentrations in older adults. In this paper, we investigate how the lithium dose-concentration ratio changes across the lifespan. Methods: This was a cross-sectional analysis of 63 current lithium users aged 20-95 years using data from McGLIDICS (the McGill Geriatric Lithium-Induced Diabetes Insipidus Clinical Study). Participants underwent blood and urine tests, including serum lithium concentrations. Multivariate analyses were conducted to evaluate potential correlates of the lithium dose-concentration ratio. Results: We found that between the ages of 40-95 years, the total daily dose of lithium required to achieve a given serum concentration decreases threefold (500 vs. 1,500 mg for 1.0 mmol/L). Greater age, once-daily dosing, and lower renal function (estimated glomerular filtration rate) were independently associated with a lower lithium dose-concentration ratio. Conclusions: The lithium dose required to achieve a given serum lithium concentration decreases threefold from middle to old age, with this trend continuing into the ninth and tenth decades of life. In order to avoid lithium toxicity in aging patients, continued serum concentration monitoring and judicious dose reduction may be required, particularly in those patients with reduced renal function. [ABSTRACT FROM AUTHOR]

Will a pastor refer to a mental health center? If they feel qualified to intervene themselves, they may not. Because pastors often provide grief counseling, it is important to understand the decisions they make when intervening with depressed individuals. A random sample of 204 Protestant pastors completed surveys about their treatment practices for depression. Fisher's exact analyses revealed that more pastors with some secular education yet no degree felt that they were the best person to treat depression than pastors who had no secular education or pastors who had at least a secular bachelor's degree. However, the level of theological education did not influence beliefs about the pastor being the best person to treat depression. In addition, neither secular nor theological education level influenced pastors' views on referring people to mental health centers for depression treatment. Based on findings, this paper discusses implications for best practices in training pastors on depression and other mental health topics. [ABSTRACT FROM AUTHOR]

Introduction: The objectives of this paper are to assess collateral blood flow in posterior circulation occlusion by MRI-based approaches (fluid-attenuated inversion recovery (FLAIR) vascular hyperintensities (FVHs), collateralization on dynamic 4D angiograms) and investigate its relation to ischemic lesion size and growth. Methods: In 28 patients with posterior cerebral artery (PCA) and 10 patients with basilar artery (BA) occlusion, MRI findings were analyzed, with emphasis on distal FVH and collateralization on dynamic 4D angiograms. Results: In PCA occlusion, distal FVH was observed in 18/29 (62.1 %), in BA occlusion, in 8/10 (80 %) cases. Collateralization on dynamic 4D angiograms was graded 1 in 8 (27.6 %) patients, 2 in 1 (3.4 %) patient, 3 in 12 (41.4 %) patients, and 4 in 8 (27.6 %) patients with PCA occlusion and 0 in 1 (10 %) patient, 2 in 3 (30 %) patients, 3 in 1 (10 %) patient, and 4 in 5 (50 %) patients with BA occlusion. FVH grade showed neither correlation with initial or follow-up diffusion-weighted image (DWI) lesion size nor DWI-perfusion-weighted imaging (PWI) mismatch ratio. Collateralization on dynamic 4D angiograms correlated inversely with initial DWI lesion size and moderately with the DWI-(PWI) mismatch ratio. The combination of distal FVH and collateralization grade on dynamic 4D angiograms correlated inversely with initial as well as follow-up DWI lesion size and highly with the DWI-PWI mismatch ratio. Conclusions: In posterior circulation occlusion, FVH is a frequent finding, but its prognostic value is limited. Dynamic 4D angiograms are advantageous to examine and graduate collateral blood flow. The combination of both parameters results in an improved characterization of collateral blood flow and might have prognostic relevance. [ABSTRACT FROM AUTHOR]

Cardiovascular disease (CVD) is the leading cause of death for Hispanic women in the United States. In 2001, the Illinois Department of Public Health received funding from the Centers for Disease Control and Prevention to implement the enhanced WISEWOMAN program (IWP) to address the disproportionate CVD risk among uninsured and underinsured women enrolled in the Illinois Breast and Cervical Cancer Early Detection Program. This paper presents the results of the Spanish-language arm of the IWP. Spanish speaking IWP participants were recruited from two sites, and randomized into either the minimum intervention (MI) or the enhanced intervention (EI) group. Both groups received CVD risk factor screening and educational handouts. The EI group also received an integrated 12-week nutrition and physical activity lifestyle change intervention. Of the 180 Spanish-speaking immigrants in this sample, 90 (50 %) received the EI and 90 (50 %) received the MI. At baseline there were no significant differences between group demographics or clinical values. At post-intervention, the EI group showed improvements in fat intake, fiber intake, moderate intensity physical activity, and total physical activity. At 1 year only the change in fiber intake remained. A significant improvement was also seen in body mass index (BMI) at the 1-year follow-up. The IWP Spanish-language arm was moderately successful in addressing risk factors for CVD in this population. The behavior changes that sustained up to a year were an increase in fiber intake and a decrease in BMI. [ABSTRACT FROM AUTHOR]