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Traditional personality disorder (PD) taxonomies have been developed for adult populations. We aimed to identify an adolescent hierarchical tree typology of PD indicators to provide classification into broad severity classes but also more fine-grained classification within those classes. A large sample of community adolescents (N = 1,940) completed a validated dimensional measure that covers a comprehensive range of pathologically formulated personality traits, the Personality Inventory for DSM-5. Latent class tree modeling suggested three classes at the first level of the tree representing high, medium, and low PD-trait levels-thus spanning the range between normal and pathological personality. These classes were divided into subclasses lower in the hierarchy, which suggested subclinical variants of patterns that are often found in clinical samples, medium levels of externalizing and internalizing behaviors, and differential profiles of thriving in the low-risk classes. The identified classes had promising initial criterion validity based on meaningful relations with self- and peer-reported measures of friendship and social functioning with peers. Our hierarchical PD tree typology may represent groups at differential risk for developing PDs and could therefore be useful for preventive purposes. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

The Severity Indices of Personality Problems (SIPP; Verheul et al., 2008) is a popular self-report questionnaire that measures severity of maladaptive personality functioning. Two studies demonstrated the utility of the short form (SIPP-SF) among older adults but validation in clinical settings is lacking. Therefore, we examined the psychometric properties of the SIPP-SF in a large sample of older adult Dutch outpatients (N = 124; age range = 60-85 years, M = 69.8, SD = 5.3). The SIPP-SF domains showed good to excellent internal reliability (Cronbach's α = .75-.91) and effectively discriminated between participants with and without a personality disorder, as assessed with the Structured Clinical Interview for DSM-IV Axis II Personality Disorders (SCID-II). Convergent validity of the SIPP-SF was examined with instruments for measuring personality pathology among older adults (Informant Personality questionnaire [HAP]; Gerontological Personality Disorders Scale [GPS]). The GPS generally correlated with the SIPP-SF domains in expected directions, with small to large effect sizes. For the HAP, only 1 scale correlated with all SIPP-SF domains. No associations were found between the SIPP-SF and psychiatric symptomatology as measured by the Brief Symptom Inventory (BSI). The SIPP-SF appears to be a promising instrument for assessing maladaptive personality functioning among older adult outpatients.

Purpose:To assess the test-retest reliability of the Special Interest Group on Amputation Medicine Mobility Scale/Dutch Working Group on Amputations and Prosthetics, better known as SIGAM/WAP mobility scale, in persons with a lower-limb amputation. Method:Longitudinal study at the outpatient departments of a rehabilitation center and a university medical center. Persons with a lower-limb amputation, wearing a prosthesis, were assessed at the end of their multidisciplinary rehabilitation treatment twice, with a 3-week interval, by the same practitioner. Test-retest reliability was quantified using the intraclass correlation coefficient for agreement. Results:Eighty persons participated (mean age +/- SD, 61 +/- 15 years; 61% men; 76% vascular cause of amputation; 70% able to walk >50m). Fifty-one of them rated themselves to be stable with respect to their mobility and their intraclass correlation coefficient was 0.90 (95% confidence intervals 0.84-0.94). Conclusions:The Special Interest Group on Amputation Medicine Mobility Scale/Dutch Working Group on Amputations and Prosthetics had, at the outpatient departments of a rehabilitation center and a university medical center, excellent test-retest reliability in persons wearing a prosthesis after a lower-limb amputation.

The authors would like to thank all the women that participated in the HealthyMoms trial and thereby contributed to the present study. We would also like to thank the involved midwifes at the maternity clinics for helping with the recruitment, and Eva Flinke and Ellinor Nilsson for their assistance in the data collection. The HealthyMoms trial is funded by the Swedish Research Council (2016-01147 to M.L.) and additionally supported by the Swedish Research Council for Health, Working Life and Welfare (Forte, 2017-00088 to P.H.); Bo and Vera Ax:son Johnsons' Foundation (to M.L.); the Strategic Research Area Health Care Science, Karolinska Institutet/Umea University (to P.H.); the Swedish Society of Medicine (to P.H.); Karolinska Institutet (to P.H.); and Lions Forskningsfond (to P.H.). M.H.L. was supported by a grant from Yrjo Jahnsson Foundation. The funders have no role in the design, conduct, data management, or interpretation of the analysis or in the decision to submit the manuscript for publication., Physical fitness is a strong marker of health, but objective fitness measurements are not always feasible. The International FItness Scale (IFIS) for self-reported fitness is a simple-to-use tool with demonstrated validity and reliability; however, validation in pregnancy needs to be confirmed. Also, its association with cardiometabolic health in pregnant women is unknown. Hence, we examined (1) the validity of the IFIS with objectively measured fitness, and (2) the associations of self-reported versus objectively measured cardiorespiratory fitness (CRF) and muscular strength with cardiometabolic risk factors in early pregnancy. Women (n = 303) from the HealthyMoms trial were measured at gestational week 14 for: CRF (6-min walk test); upper-body muscular strength (handgrip strength test); self-reported fitness (IFIS), body composition (air-displacement plethysmography); blood pressure and metabolic parameters (lipids, glucose, insulin). Higher self-reported fitness was associated with better measured fitness (ANOVA overall p < 0.01 for all fitness types), indicating the usefulness of the IFIS in pregnancy. Furthermore, higher self-reported overall fitness and CRF were associated with lower cardiometabolic risk scores (ANOVA p < 0.001), with similar results shown for measured CRF (ANOVA p < 0.001). The findings suggest that IFIS could be useful to stratify pregnant women in appropriate fitness levels on a population-based level where objective measurement is not possible., Swedish Research Council, European Commission 2016-01147, Swedish Research Council for Health, Working Life and Welfare (Forte) 2017-00088, Bo and Vera Ax:son Johnsons' Foundation, Strategic Research Area Health Care Science, Karolinska Institutet/Umea University, Swedish Society of Medicine, Karolinska Institutet, Lions Forskningsfond, Yrjo Jahnsson Foundation

Objective:Cognitive reserve (CR) capacity can be viewed as the maximum processing potential of neural systems that support adaptive cognitive performance in age-related cognitive decline. CR is a complex construct that can only be measured indirectly. Proxy measures (e.g., psychosocial/lifestyle variables) are traditionally used to reflect CR. However, strong relationships have been observed between these measures and cognitive functions (e.g., executive function [EF], processing resources [PR], fluid/crystallized abilities); therefore, the organizational structure of indicators implicated in CR remains unclear. The objective of this study was to test a hypothetical, theoretical model of CR capacity that includes both traditional CR proxy indicators and measures of cognitive function [Satz et al. (2011).Journal of Clinical and Experimental Neuropsychology,33(1), 121–130], which remain, as yet, untested.Method:Construct validity of the model was investigated in healthy older adults through exploratory and confirmatory factor analysis (EFA and CFA) using data from the Maastricht Ageing Study (MAAS). A secondary CFA was conducted to validate the model using data from the Irish Longitudinal Study on Ageing (TILDA).Results:EFA and CFA in MAAS established a two-factor model comprising EF/PR and cumulative cognitive enrichment (CCE), which was further validated in a secondary analysis in TILDA. Convergent and discriminant validity was supported in MAAS (range ofR2= .228–.635; factor correlation confidence interval (CI) = .622, .740) and TILDA (range ofR2= .172–.899; factor correlation CI = .559, .624).Conclusions:A dual model of CR elucidated the relationships between hypothesized indicators of CR capacity and revealed a two-factor structure suggesting that both control (EF/PR) and representational processes (CCE) are involved in CR capacity.

Aims To assess whether parental substance use disorder (SUD) is associated with lower cognitive ability in offspring, and whether the association is independent of shared genetic factors. Design A population family-based cohort study utilizing national Swedish registries. Linear regression with increased adjustment of covariates was performed in the full population. In addition, the mechanism of the association was investigated with children-of-sibling analyses using fixed-effects regression with three types of sibling parents with increasing genetic relatedness (half-siblings, full siblings and monozygotic twins). Setting and participants A total of 3 004 401 people born in Sweden between 1951 and 1998. Measurements The exposure variable was parental SUD, operationalized as having a parent with life-time SUD diagnosis or substance-related criminal conviction in the National Patient Register or Crime Register, respectively. Outcomes were cognitive test score at military conscription and final school grades when graduating from compulsory school. Covariates included in the analyses were sex, birth year, parental education, parental migration status and parental psychiatric comorbid diagnoses. Findings In the full population, parental SUD was associated with decreased cognitive test stanine scores at conscription [4.56, 95% confidence interval (CI) = 4.55-4.57] and lower Z-standardized school grades (-0.43, 95% CI = -0.43 to -0.42) compared to people with no parental SUD (cognitive test: 5.17, 95% CI = 5.17-5.18; grades: 0.09, 95% CI = 0.08-0.09). There was evidence of a dose-response relationship, in that having two parents with SUD (cognitive test: 4.17, 95% CI = 4.15-4.20; grades: -0.83, 95% CI = -0.84 to -0.82) was associated with even lower cognitive ability than having one parent with SUD (cognitive test: 4.60, 95% CI = 4.59-4.60; grades: -0.38, 95% CI = -0.39 to -0.380). In the children-of-siblings analyses when accounting for genetic relatedness, these negative associations were attenuated, suggestive of shared underlying genetic factors. Conclusions There appear to be shared genetic factors between parental substance use disorder (SUD) and offspring cognitive function, suggesting that cognitive deficits may constitute a genetically transmitted risk factor in SUD.

Background Empowerment helps persons with a chronic disease to self-manage their condition and increase their autonomy and participation. MSmonitor (Curavista bv) is an interactive Web-based program for self-management and multidisciplinary care in multiple sclerosis (MS). It includes, among others, short questionnaires on fatigue (Modified Fatigue Impact Scale-5 [MFIS-5]) and health-related quality of life (HRQoL, Leeds Multiple Sclerosis Quality of Life [LMSQoL]); long questionnaires on disabilities, perception of disabilities (Multiple Sclerosis Impact Profile), and HRQoL (Multiple Sclerosis Quality of Life-54); a Medication and Adherence Inventory and an Activity Diary. The combination MFIS-5, LMSQoL, and Medication and Adherence Inventory constitutes the Quick Scan. Objective This study aimed to investigate the short-term effects of MSmonitor on empowerment in patients with MS. Methods We conducted a quasi-experimental study in a general hospital. Of the 180 patients with MS, 125 were eligible, 30 used MSmonitor, and 21 participated in the study (mean age 45.4 years, SD 10.2 years). A total of 24 eligible patients who did not use MSmonitor constituted the control group (mean age 49.3 years, SD 11.4 years). At baseline and at 4 months, we assessed self-efficacy (Multiple Sclerosis Self-Efficacy Scale [MSSES]), participation and autonomy (Impact on Participation and Autonomy [IPA] questionnaire), and self-management (Partners In Health [PIH] questionnaire). Differences between time points and groups were tested with paired t tests and χ² tests. Results In the MSmonitor group, follow-up values remained unchanged for MSSES control (P=.19), MSSES function (P=.62), IPA limitations (P=.26), IPA problems (P=.40), PIH recognition and management of symptoms (P=.52), PIH adherence to treatment (P=.80), and PIH coping (P=.73), whereas the PIH knowledge score had improved (mean 27.8, SD 1.7 vs mean 28.7, SD 2.0; P=.02). The overall utilization rate of the program components was 83% and that of the Quick Scan was 95%. In the control group, all outcomes had remained unchanged. Conclusions The results suggest that for first-time users of the MSmonitor program and their health care providers, it may not be justified to expect a short-term improvement in empowerment in terms of self-efficacy, self-management, autonomy, or participation. Furthermore, a lack of effect on empowerment is not because of nonusage of the program components.

BackgroundDutch teachers in secondary vocational schools suffer from stress and burnout complaints that can cause considerable problems at work. This paper presents a study design that can be used to evaluate the short-term and long-term effectiveness of mindfulness-based stress reduction (MBSR), a person-focused intervention, both within and outside of the context of an additional organisational health intervention.MethodsThe proposed study comprises a cluster randomised controlled trial that will be conducted in at least three secondary vocational schools, to which teachers will be recruited from three types of courses: Care, Technology, and Economy. The allocation of the intervention programme to the participating schools will be randomised. The teachers from each school will be assigned to intervention group 1 (IG 1), intervention group 2 (IG 2), or the waiting list group (WG). IG 1 will receive MBSR training and IG 2 will receive MBSR training combined with an additional organisational health intervention. WG, that is the control group, will receive MBSR training one year later. The primary outcome variable of the proposed study is mindfulness, which will be measured using the Dutch version of the Five Facet Mindfulness Questionnaire (FFMQ-NL). In the conceptual model, the effects of teachers’ mindfulness resulting from the intervention programmes (MBSR training and MBSR training combined with an additional organisational health intervention) will be related to salient (secondary outcome) variables: mental health outcomes (e.g., burnout, work engagement), work performance, work-related perceptions (job demands and job resources), and personal competencies (e.g., occupational self-efficacy). Data will be collected before (T0) and immediately after the MBSR training (T1), and 3 (T2) and 9 months (T3) after the training. The power analysis revealed a required sample size of 66 teachers (22 in each group).DiscussionThe proposed study aims to provide insight into (1) the short-term and long-term effects of MBSR on teachers’ mental health, (2) the possible enhancing effects of the additional organisational health intervention, and (3) the teachers’ experiences with the interventions (working mechanisms, steps in the mindfulness change process). Strengths of this study design are the use of both positive and negative outcomes, the wide range of outcomes, both outcome and process measures, longitudinal data, mixed methods, and an integral approach. Although the proposed study protocol may not address all weaknesses of current studies (e.g., self-selection bias, self-reporting of data, the Hawthorne effect), it is innovative in many ways and can be expected to make important contributions to both the scientific and practical debate on how to beat work-related stress and occupational burnout, and on how to enhance work engagement and work performance.Trial registrationDutch Trial Register (www.trialregister.nl):NL5581. Registered on 6 July 2016.

Objective: To describe the prevalence of comorbidity and its relationship with demographic and clinical characteristics in persons wearing a prosthesis after lower-limb amputation.Design: Cross-sectional study.Subjects/patients: Persons wearing a prosthesis after lower-limb amputation (n = 171; mean age 65 years (standard deviation 12); 72% men) at the end of outpatient rehabilitation treatment.Methods: Comorbidity was assessed with the Functional Comorbidity Index: a list of 18 items addressing the presence of specific comorbid conditions impacting on functional status. Comorbidities in medical records were assessed independently by 2 assessors. Associations with demographic and clinical characteristics were analysed using linear or logistic regression.Results: The median (interquartile range) number of comorbidities was 3 (2; 4). Three or more comorbidities were present in 103 of 171 (60%) participants. Diabetes was present in 71 (41%), cardiac disease in 60 (35%), and lumbago/degenerative disc disease in 39 (23%) participants. The prevalence of comorbidities was higher in women and those with vascular cause of amputation.Conclusion: There is a high prevalence of comorbidity at the end of outpatient rehabilitation treatment in persons wearing a prosthesis after a lower-limb amputation, especially in women and those with vascular cause of amputation.

Interpersonal problems are key transdiagnostic constructs in psychopathology. In the past, investigators have neglected the importance of operationalizing interpersonal problems according to their latent structure by using divergent representations of the construct: (a) computing scores for severity, agency, and communion (“dimensional approach”), (b) classifying persons into subgroups with respect to their interpersonal profile (“categorical approach”). This hinders cumulative research on interpersonal problems, because findings cannot be integrated both from a conceptual and a statistical point of view. We provide a comprehensive evaluation of interpersonal problems by enlisting several large samples (Ns = 5,400, 491, 656, and 712) to estimate a set of latent variable candidate models, covering the spectrum of purely dimensional (i.e., confirmatory factor analysis using Gaussian and nonnormal latent t-distributions), hybrid (i.e., semiparametric factor analysis), and purely categorical approaches (latent class analysis). Statistical models were compared with regard to their structural validity, as evaluated by model fit (corrected Akaike’s information criterion and the Bayesian information criterion), and their concurrent validity, as defined by the models’ ability to predict relevant external variables. Across samples, the fully dimensional model performed best in terms of model fit, prediction, robustness, and parsimony. We found scant evidence that categorical and hybrid models provide incremental value for understanding interpersonal problems. Our results indicate that the latent structure of interpersonal problems is best represented by continuous dimensions, especially when one allows for nonnormal latent distributions., General Scientific Summary This study suggests that interpersonal problems are best characterized by continuous differences in severity and interpersonal style (i.e., agency and communion), and not by “types” of people.

BACKGROUND: Follow-up of stroke survivors is important to objectify activity limitations and/or participations restrictions. Responsive measurement tools are needed with a low burden for professional and patient.AIM: To examine the concurrent validity, floor and ceiling effects and responsiveness of both domains of the Late-Life Function and Disability Index Computerized Adaptive Test (LLFDI-CAT) in first-ever stroke survivors discharged to their home setting.DESIGN: Longitudinal study.SETTING: Community.POPULATION: First ever stroke survivors.METHODS: Participants were visited within three weeks after discharge and six months later. Stroke Impact Scale (SIS 3.0) and Five-Meter Walk Test (5MWT) outcomes were used to investigate concurrent validity of both domains, activity limitations, and participation restriction, of the LLFDI-CAT. Scores at three weeks and six months were used to examine floor and ceiling effects and change scores were used for responsiveness. Responsiveness was assessed using predefined hypotheses. Hypotheses regarding the correlations with change scores of related measures, unrelated measures, and differences between groups were formulated.RESULTS: The study included 105 participants. Concurrent validity (R) of the LLFDI-CAT activity limitations domain compared with the physical function domain of the SIS 3.0 and with the 5MWT was 0.79 and -0.46 respectively. R of the LLFDI-CAT participation restriction domain compared with the participation domain of the S1S 3.0 and with the 5MWT was 0.79 and -0.41 respectively. A ceiling effect (15%) for the participation restriction domain was found at six months. Both domains, activity limitations and participation restrictions, of the LLFDI-CAT, scored well on responsiveness: 100% (12/12) and 91% ( I 2/11) respectively of the predefined hypotheses were confirmed.CONCLUSIONS: The LLFDI-CAT seems to be a valid instrument and both domains are able to detect change over time. Therefore, the LLFD-CAT is a promising tool to use both in practice and in research.CLINICAL REHABILITATION IMPACT: The LLFDI-CAT can be used in research and clinical practice.

Objective: To identify the frequency, nature and profile of complaints for trauma patients with and without mild traumatic brain injury (mTBI), and to assess their relation to anxiety and depression.Methods: A prospective cohort study in a level-one trauma centre was conducted. Mild traumatic brain injury patients and trauma controls were approached for participation. Two weeks after injury, The Head Injury Symptom Checklist (HISC) and the Hospital Anxiety and Depression Scale (HADS) were administered.Results: Two-hundred seventy two patients with mTBI and 125 TC patients completed the questionnaires. Differences were demonstrated between the two trauma populations on frequency and nature of reported complaints. Ordinal common factor analysis on the mTBI scores yielded three factors: mental distress, physical discomfort, and sensory disbalance, which were all significantly correlated to anxiety and depression scores. Discriminant analyses identified a subset of complaints which could allocate almost 80% of patients to the correct group.Conclusions: Patients with mTBI showed a different pattern of complaints than orthopaedic control patients. A mental distress factor consisting of both somatic and cognitive complaints proved to be most discriminating and showed high correlations with anxiety and depression. (C) 2016 Elsevier Ltd. All rights reserved.

This study presents a French translation and validation of the Durand Adaptive Psychopathic Traits Questionnaire (DAPTQ; Durand, 2017), an instrument for assessing adaptive traits known to correlate with the psychopathic personality. The first sample, which included individuals from France and Canada (N = 135, 52% in France, M-age = 26.98, SD = 9.24), completed the DAPTQ in French, alongside measures of empathy, positive and negative affects, satisfaction with life, and self-esteem. The second sample included bilingual (French and English) individuals from France and Canada (N= 141, 52% in France, M-age = 29.73, SD = 9.09) who completed both versions of the DAPTQ (French and English), alongside measurements of perceived stress, trait anxiety, and creativity. The results support the DAPTQ-French version good internal consistency (alpha = .89/.87), convergent validity, and concurrent validity. Correlation between the DAPTQ total and subscales across versions (French-English) showed strong associations (r = .84 to .96). These findings support the cross-cultural equivalence of the DAPTQ and its effectiveness as a valid assessment method of adaptive traits in the field of psychopathy.

BACKGROUND: It is well known that sports participation is positively associated with psychosocial health in children, but details about this association over time are lacking. This study aimed to explore longitudinal associations between several characteristics of sports participation and three aspects of psychosocial health (internalizing problems, externalizing problems and prosocial behaviour) in Dutch children aged 10-12 years.METHODS: Data from 695 fourth-grade primary school children were included at baseline; 10-13 months later, 487 children (response rate 70.1%) were retained. At both time points, children reported on their sports participation (Move and Sports Monitor Questionnaire - Youth Aged 8-12 Years) and psychosocial health (Strength and Difficulties Questionnaire). Longitudinal associations between several characteristics of sports participation and the three aspects of psychosocial health were analysed using linear mixed models, both clustering the repeated measures within children and clustering the children within schools. In addition to crude analyses, analyses were performed adjusting for sex, age, BMI, household composition, SES and frequency of sports participation.RESULTS: Membership in a sports club, moderate or high frequency of sports participation, performing team sports, performing outdoor sports, performing contact sports and involvement in competition were longitudinally associated with fewer internalizing problems. The longitudinal association of higher frequency of sports participation with fewer internalizing problems was stronger as a child's BMI increased. The association of performing team sports with fewer internalizing problems was only observed for boys. Membership in a sports club and moderate or high frequency of sports participation were also longitudinally associated with better prosocial behaviour. These associations with prosocial behaviour were stronger for girls. None of the characteristics of sports participation examined were longitudinally associated with externalizing problems.CONCLUSIONS: This study shows that from a longitudinal perspective, fewer internalizing problems and better prosocial behaviour were seen in children who were active in sports. Fewer internalizing problems were also associated with the kind of sports participation; for example, with performing outdoor sports. No associations were found for externalizing problems. Future research should preferably take the form of an intervention to investigate whether the observed statistical associations are of a causal nature.

© 2018 Taylor & Francis The categorical model of personality disorder classification in the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (5th ed. [DSM–5]; American Psychiatric Association, 2013) is highly and fundamentally problematic. Proposed for DSM–5 and provided within Section III (for Emerging Measures and Models) was the Alternative Model of Personality Disorder (AMPD) classification, consisting of Criterion A (self-interpersonal deficits) and Criterion B (maladaptive personality traits). A proposed alternative to the DSM–5 more generally is an empirically based dimensional organization of psychopathology identified as the Hierarchical Taxonomy of Psychopathology (HiTOP; Kotov et al., 2017). HiTOP currently includes, at the highest level, a general factor of psychopathology. Further down are the five domains of detachment, antagonistic externalizing, disinhibited externalizing, thought disorder, and internalizing (along with a provisional sixth somatoform dimension) that align with Criterion B. The purpose of this article is to discuss the potential inclusion and placement of the self-interpersonal deficits of the DSM–5 Section III Criterion A within HiTOP.

BACKGROUND: Retirement is a life transition involving an obligatory change in how people use their time. Because there are strong associations between use of time and health, different changes in time use following retirement may have different impacts on mental health. METHODS: 105 participants were followed from 6 months before retirement to 12 months after retirement. At each time-point, use of time was quantified using a validated computerised 24-hour recall. Depression, anxiety and stress were assessed using the Depression, Anxiety and Stress Scales (DASS21), well-being with the Short Warwick-Edinburgh Mental Well-being Scale (SWEMWBS), life satisfaction with the Australian Unity Personal Well-being Index (AUPWI), and self-esteem with the Rosenberg Self-Esteem Scale. Time-use data were analysed using compositional data analysis, which treats the 24-h day as a holistic "activity composition" rather than as individual activity domains. Time flow analytics were used to map patterns of change in time use from pre-retirement to post-retirement. Regression analysis was used to determine whether changes in the activity composition were significantly associated with changes in mental health. Compositional isotemporal substitution models were used to illustrate dose-response relationships between changes in time use and conditional changes in mental health for individual activity domains, such as sleep, screen time and physical activity. RESULTS: Following retirement, time no longer spent in work flowed mainly to household chores, sleep, screen time and quiet time (e.g. reading). Mental health improved overall. Changes in the activity composition were significantly related to conditional changes in DASS21 total score, depression, stress, and self-esteem, but not to anxiety, well-being or life satisfaction. Replacing work time with physical activity or sleep was associated with positive changes in mental health. Effect sizes for 60-minute substitutions ranged from -0.15 to +0.31. CONCLUSION: Following retirement, replacing work with physical activity, and to a lesser extent sleep, is associated with better mental health. ispartof: PLOS ONE vol:13 issue:6 ispartof: location:United States status: published

Experiential avoidance, cognitive defusion, and mindfulness have all been associated with psychological disorders and well-being. This study investigates whether they predict psychological distress, i.e., symptoms of burnout, depression, stress and anxiety, in parents of children with chronic conditions. We hypothesized that these factors would exhibit a large degree of common variance, and that when compared to mindfulness and defusion, experiential avoidance on its own would predict a larger proportion of unique variance. 75 parents of children with chronic conditions having burnout symptoms who participated in an intervention study completed measures of burnout, stress, anxiety, depression, experiential avoidance, cognitive defusion, and mindfulness at the beginning of the intervention study (baseline). We ran several regression analyses to assess the predictive ability of these different constructs. Experiential avoidance on its own accounted for 28–48% of the variance in different psychological symptoms. Cognitive defusion and mindfulness did not make a significant contribution to explaining burnout, stress and anxiety, but cognitive defusion contributed to explaining depression. The results confirmed our hypothesis, supporting research on the importance of psychological flexibility as a central factor in understanding the occurrence of psychological distress. peerReviewed

STUDY DESIGN: A prospective cohort study, with assessments before, at 3 months after, and at 12 months after total knee arthroplasty (TKA).OBJECTIVES: To determine and compare the responsiveness and reliability of the Patient-Specific Functional Scale (PSFS) in patients undergoing a TKA.BACKGROUND: Reliable and valid measurement instruments are important to measure functional status. The PSFS is frequently used in several patient populations, but its methodological characteristics in a population of patients with TKA in the perioperative phases of surgery are unknown.METHODS: The PSFS, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and global perceived effect (GPE) were administered at 3 time points in 150 patients undergoing a TKA. Correlations, effect sizes, and standardized response Means were calculated. The PSFS was administered twice to assess its reliability in terms of intraclass correlation coefficients and limits of agreement.RESULTS: The correlation coefficients between the PSFS and WOMAC at 3 months and 1 year were 0.41 and 0.48, respectively; those between the PSFS and GPE were -0.37 and -0.55, respectively. The effect sizes of the PSFS at 3 months and 1 year were 1.71 and 2.89, respectively; those of the WOMAC were 1.45 and 1.64, respectively. The standardized response means of the PSFS at 3 months and 1 year were 0.96 and 1.48, respectively; those of the WOMAC were 1.28 and 1.37, respectively. The intraclass correlation coefficients ranged between 0.73 and 0.86. The systematic error was between 0.12 and 0.54. The limits of agreement ranged from +/- 2.17 to +/- 2.72.CONCLUSION: The reliability of the PSFS is good. Its responsiveness is high, especially in the long term. However, the PSFS cannot be used interchangeably with the WOMAC in the immediate postoperative period.

OBJECTIVE: Performing minimally invasive surgery puts high demands on a surgeon's cognitive and psychomotor abilities. Assessment of these abilities can be used to predict a surgeon's learning curve, to create individualized training programs, and ultimately in selection programs for surgical training. The aim of this study was to examine the influence of cognitive and psychomotor ability on the training duration and learning rate.DESIGN: A prospective quasiexperimental field study regarding the influence of cognitive and psychomotor ability, baseline measures of time to complete task, damage to tissue, and efficiency of movement, age, and gender on the number of sessions needed to reach a predefined performance level on a laparoscopy simulator. The same variables were investigated as predictors of the learning rate.SETTING: The study was performed at the Experimental Center for Technical Medicine at the University of Twente, The Netherlands.PARTICIPANTS: In all, 98 novices from the Master program of Technical Medicine followed a proficiency-based basic laparoscopic skills training.RESULTS: Perceptual speed (PS) predicted training duration (hazard ratio = 1.578; 95% CI = 1.084, 2.300; p = 0.017). Cognitive (b = 0.721, p = 0.014) and psychomotor ability (b = 0.182, p = 0.009) predicted the learning rate of time to complete the task. Also, the learning rate for participants with higher levels of PS was lower (b = 0.167, p = 0.036). Psychomotor ability also predicted the learning rate for damage to tissue (b = 0.194, p = 0.015) and efficiency of movement (b = 0.229, p = 0.004). Participants with better psychomotor ability outperformed other participants across all sessions on all outcome measures.CONCLUSIONS: PS predicted training duration in a basic laparoscopic skills training and the learning rate for the time to complete the task. Psychomotor ability predicted the learning rate for laparoscopic skill acquisition in terms of time to complete task, damage to tissue, and efficiency of movements. These results indicate early automation of basic laparoscopic skill. Careful selection of the cognitive abilities tests is advised for use in training programs and to identify individuals who need more training. ((C) 2015 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.)

BackgroundIt is well known that the prevalence of overweight and obesity is considerably higher among youth from lower socio-economic families, but there is little information about the role of some energy balance-related behaviors in the association between socio-economic status and childhood overweight and obesity. The objective of this paper was to assess the possible mediation role of energy balance-related behaviors in the association between parental education and children’s body composition.MethodsData were obtained from the cross sectional study of the “EuropeaN Energy balance Research to prevent excessive weight Gain among Youth” (ENERGY) project. 2121 boys and 2516 girls aged 10 to 12 from Belgium, Greece, Hungary, the Netherlands, Norway, Slovenia and Spain were included in the analyses. Data were obtained via questionnaires assessing obesity related dietary, physical activity and sedentary behaviors and basic anthropometric objectively measured indicators (weight, height, waist circumference). The possible mediating effect of sugared drinks intake, breakfast consumption, active transportation to school, sports participation, TV viewing, computer use and sleep duration in the association between parental education and children’s body composition was explored via MacKinnon’s product-of-coefficients test in single and multiple mediation models. Two different body composition indicators were included in the models, namely Body Mass Index and waist circumference.ResultsThe association between parental education and children’s body composition was partially mediated by breakfast consumption, sports participation, TV viewing and computer use. Additionally, a suppression effect was found for sugared drinks intake. No mediation effect was found for active transportation and sleep duration. The significant mediators explained a higher proportion of the association between parental education and waist circumference compared to the association between parental education and BMI.ConclusionsTailored overweight and obesity prevention strategies in low SES preadolescent populations should incorporate specific messages focusing on the importance of encouraging daily breakfast consumption, increasing sports participation and decreasing TV viewing and computer use. However, longitudinal research to support these findings is needed.

While the term ‘‘psychopathy’’ is embedded with negativity, evidence points to the existence of another form of psychopathy, which involves adaptive traits such as stress and anxiety immunity, remarkable social skills, noteworthy leadership ability, and an absence of fear. The newly developed Durand Adaptive Psychopathic Traits Questionnaire (DAPTQ) aims to assess adaptive traits known to correlate with the psychopathic personality. Validation of the questionnaire among 765 individuals from the community gave support to a 10-factor solution: Leadership, Logical Thinking, Composure, Creativity, Fearlessness, Money Smart, Focus, Extroversion, Consequentialism, and Management. The DAPTQ and its 10 subscales demonstrated good internal consistency reliability in a community sample (0.64 - 0.88). Good convergent and divergent validity was confirmed by administering the DAPTQ alongside established measures of the psychopathic personality. Subscales validation against well-established personality assessments further confirms the DAPTQ’s strength. These findings support the potential of the DAPTQ as an instrument for measuring psychopathy-associated adaptive traits. Limitations of the present study and potential directions for future research are also discussed. Further studies are needed to validate the DAPTQ and its subscales against a wider range of personality traits and behaviors.

There is growing consensus that the dimensional structure of early personality pathology can be organized within a similar framework as in adults (De Clercq, De Fruyt, Van Leeuwen, & Mervielde, 2006; Tromp & Koot, 2008). From this perspective, the Dimensional Personality Symptom Itempool (DIPSI) was recently expanded from a 4- to a 5-dimensional trait structure (Verbeke & De Clercq, 2014), including Disagreeableness, Emotional Instability, Introversion, Compulsivity, and Oddity. This developmental maladaptive trait structure is in need of further research, however, before it can be accepted as a valid framework for describing early manifestations of personality dysfunction. By use of exploratory structural equation modeling (ESEM) analyses, the current study explored the fit of the 5-factor DIPSI framework across 4 different samples (N = 1456), and replicated 5 higher-order factors that demonstrated scalar invariance across age and metric invariance across informants and clinical status. These results underscore the robustness of 5 underlying dimensions of personality pathology at a young age and highlight adequate psychometric properties of the proposed DIPSI measure for describing childhood personality pathology precursors. (PsycINFO Database Record

This study reports on the development of the Multicultural Personality Questionnaire-Short Form among 511 participants. Using a split-sample scale validation design, Study 1 (N = 260) employed a principal component analysis and rigorous item selection criteria to extract a 40-item short form (MPQ-SF) from the original 91-item Multicultural Personality Questionnaire (MPQ; van der Zee & van Oudenhoven, 2000, 2001). In Study 2 (N = 251), the MPQ-SF was subjected to confirmatory factor analysis and resulted in a reasonably good fit to the data (comparative fit index =.94; root mean squared error of approximation =.066). Satisfactory coefficient alphas and high correlations with the original scales were found. Moreover, relationships with related scales were largely in the predicted direction. Specific directions for follow-up research are posited.

Objectives: To determine whether sacral neuromodulation (SNM) for urinary symptoms or fecal incontinence gives improvement of female sexual function and whether improvement is due to physiological or psychological factors. Methods: Between 2002 and 2008, 8 patients had an array of questionnaires before and after SNM implantation. The questionnaires were: the Questionnaire for Screening for Sexual Dysfunctions, the Golombok Rust Inventory of Sexual Satisfaction, the Symptom Checklist-90, the Maudsley Marital Questionnaire and the McGill-Mah Orgasm Questionnaire. Three of these 8 patients underwent vaginal plethysmography before and after implantation. Results: No statistically significant changes were found, although there seems to be a trend toward improvement in orgasm scores. In plethysmography all 3 patients showed increased vaginal pulse amplitude with the stimulator turned on with both erotic and non-erotic stimuli. Conclusions: This study does not show a clear effect of SNM on sexual function, although there seems to be an improvement in orgasm scores. The lack of response on psychological questionnaires and the increase in vaginal pulse amplitude after SNM implantation indicate that there might be a physiological response.

The first aim of this study was to translate the Neck Pain and Disability Scale (NPAD) from English into Dutch producing the NPAD-Dutch Language Version (DLV). The second aim was to analyze test-retest reliability and agreement of the NPAD-DLV and the Neck Disability Index (NDI)-DLV. The NPAD was translated according to established guidelines. Thirty-four patients (mean age 37.5 years, 68% female) with chronic neck pain (CNP), within an outpatient rehabilitation setting, participated in this study. The NPAD-DLV and the NDI-DLV were filled out twice with a mean test-retest interval of 18 days. The intraclass correlation coefficient of the NPAD-DLV was 0.76 (95% confidence interval (CI) 0.57-0.87) and of the NDI-DLV 0.84 (95% CI 0.69-0.92). The limits of agreement of the NPAD-DLV and the NDI-DLV were, respectively, +/- 20.9 (scale 0-100) and +/- 6.5 (scale 0-50). The reliability of the NPAD-DLV and the NDI-DLV was acceptable for patients with CNP. The variation ('instability') in the NPAD-DLV total scores was relatively large and larger than the variation of the NDI-DLV.

The increased popularity of mindfulness-based interventions and the growing body of empirical evidence confirming the positive effects of these interventions on well-being warrant more research to determine if the effects are indeed related to learning mindfulness. The present study extends previous studies, by examining whether and how changes in five core aspects of mindfulness are related to changes in the report of negative and positive affect during an 8-week course of mindfulness-based cognitive therapy. The study was performed in 64 individuals from the community with mild to moderate psychological problems. Data were collected by self-report questionnaires before and directly after the training. Results showed significant decreases in negative affect and increases in positive affect. We also found significant increases in four of the five aspects of mindfulness. Importantly, changes in mindfulness were significantly associated with improved affect, with a distinct pattern found for positive and negative affect. Hereby, our findings extend previous research by showing that learning distinct aspects of mindfulness is differently related to an improved positive affect and a decreased negative affect. Future randomized controlled trials with a larger sample and longer follow-up period are needed to replicate these findings.

Background Reliable and valid measures of total sedentary time, context-specific sedentary behaviour (SB) and its potential correlates are useful for the development of future interventions. The purpose was to examine test-retest reliability and criterion validity of three newly developed questionnaires on total sedentary time, context-specific SB and its potential correlates in adolescents, adults and older adults. Methods Reliability and validity was tested in six different samples of Flemish (Belgium) residents. For the reliability study, 20 adolescents, 22 adults and 20 older adults filled out the age-specific SB questionnaire twice. Test-retest reliability was analysed using Kappa coefficients, Intraclass Correlation Coefficients and/or percentage agreement, separately for the three age groups. For the validity study, data were retrieved from 62 adolescents, 33 adults and 33 older adults, with activPAL™ as criterion measure. Spearman correlations and Bland-Altman plots (or non-parametric approach) were used to analyse criterion validity, separately for the three age groups and for weekday, weekend day and average day. Results The test-retest reliability for self-reported total sedentary time indicated following values: ICC = 0.37-0.67 in adolescents; ICC = 0.73-0.77 in adults; ICC = 0.68-0.80 in older adults. Item-specific reliability results (e.g. context-specific SB and its potential correlates) showed good-to-excellent reliability in 67.94 %, 68.90 % and 66.38 % of the items in adolescents, adults and older adults respectively. All items belonging to sedentary-related equipment and simultaneous SB showed good reliability. The sections of the questionnaire with lowest reliability were: context-specific SB (adolescents), potential correlates of computer use (adults) and potential correlates of motorized transport (older adults). Spearman correlations between self-reported total sedentary time and the activPAL™ were different for each age group: ρ = 0.02-0.42 (adolescents), ρ = 0.06-0.52 (adults), ρ = 0.38-0.50 (older adults). Participants over-reported total sedentary time (except for weekend day in older adults) compared to the activPAL™, for weekday, weekend day and average day respectively by +57.05 %, +46.29 %, +53.34 % in adolescents; +40.40 %, +19.15 %, +32.89 % in adults; +10.10 %, −6.24 %, +4.11 % in older adults. Conclusions The questionnaires showed acceptable test-retest reliability and criterion validity. However, over-reporting of total SB was noticeable in adolescents and adults. Nevertheless, these questionnaires will be useful in getting context-specific information on SB. Electronic supplementary material The online version of this article (doi:10.1186/s12966-015-0277-2) contains supplementary material, which is available to authorized users.

Background Screen-related behaviours are highly prevalent in schoolchildren. Considering the adverse health effects and the relation of obesity and screen time in childhood, efforts to affect screen use in children are warranted. Parents have been identified as an important influence on children’s screen time and therefore should be involved in prevention programmes. The aim was to examine the mediating role of family-related factors on the effects of the school-based family-focused UP4FUN intervention aimed at screen time in 10- to 12-year-old European children (n child–parent dyads = 1940). Methods A randomised controlled trial was conducted to test the six-week UP4FUN intervention in 10- to 12-year-old children and one of their parents in five European countries in 2011 (n child–parent dyads = 1940). Self-reported data of children were used to assess their TV and computer/game console time per day, and parents reported their physical activity, screen time and family-related factors associated with screen behaviours (availability, permissiveness, monitoring, negotiation, rules, avoiding negative role modeling, and frequency of physically active family excursions). Mediation analyses were performed using multi-level regression analyses (child-school-country). Results Almost all TV-specific and half of the computer-specific family-related factors were associated with children’s screen time. However, the measured family-related factors did not mediate intervention effects on children’s TV and computer/game console use, because the intervention was not successful in changing these family-related factors. Conclusion Future screen-related interventions should aim to effectively target the home environment and parents’ practices related to children’s use of TV and computers to decrease children’s screen time. Trial registration The study is registered in the International Standard Randomised Controlled Trial Number Register (registration number: ISRCTN34562078 ).

Background The Southampton Hand Assessment Procedure (SHAP) is currently used in the adult population for evaluating the functionality of impaired or prosthetic hands. The SHAP cannot be used for children because of the relatively larger size of the objects used to perform SHAP tasks and unknown clinimetric properties. The aims of this study were to adapt the SHAP for use in children (SHAP-C), to determine norm values for the SHAP-C, and to analyze the reliability of the SHAP-C. Methods The SHAP-C was adapted based on the SHAP protocol. Some objects were downsized, and the timing of tasks was performed by the rater instead of the participant. Intra- and inter-rater reliability were assessed in 24 children (5 [0.54] y/o) with unimpaired hands. The repeatability coefficients (RCs) were calculated. An RC ≤ 75% of the mean SHAP-C task values was considered good reliability. Results Participants were able to perform all SHAP-C tasks. The means of the SHAP-C tasks ranged from 0.75 to 1.21 seconds for abstract objects and from 0.64-19.13 seconds for activities of daily living. The RCs of a single assessor did not exceed 75% in 17/26 SHAP-C tasks, displaying a relatively good intra-rater reliability, whereas the RCs for the inter-rater reliability exceeded 75% in 22/26 SHAP-C tasks, thus displaying poor reliability. Conclusion In this first study that adjusted the SHAP for pediatric use, we found that all SHAP-C objects and tasks could be performed by children. The intra-rater reliability was better than the inter-rater reliability. Although the SHAP-C appears to be a promising instrument, the protocol requires further modifications to provide reliable measurements in children.

Background Parents and their parenting practices play an important role in shaping their children’s environment and energy-balance related behaviours (EBRBs). Measurement of parenting practices can be parent- or child-informed, however not much is known about agreement between parent and child perspectives. This study aimed to assess agreement between parent and child reports on parental practices regarding EBRBs across different countries in Europe and to identify correlates of agreement. Methods Within the ENERGY-project, a cross-sectional survey was conducted among 10–12 year old children and their parents in eight European countries. Both children and parents filled in a questionnaire on 14 parental practices regarding five different EBRBs (i.e. soft drink, fruit juice and breakfast consumption, sports activity and watching TV) and socio-demographic characteristics. Children’s anthropometric measurements were taken at school. We calculated percentages of agreement between children and their parents and weighted kappa statistics (for ordinal variables) per practice and country and assessed factors associated with agreement using multilevel linear regression. Results Reports of 6425 children and their parents were available for analysis. Overall mean agreement between parent and child reports was 43% and varied little among countries. The lowest agreement was found for questions assessing joint parent–child activities, such as sports (27%; Kappa (κ) = 0.14) or watching TV (30%;κ = 0.17), and for parental allowance of the child to have soft drinks (32%;κ = 0.24) or fruit juices (32%;κ = 0.19), or to watch TV (27%;κ = 0.17). Having breakfast products available at home or having a TV in the child’s bedroom were the only practices with moderate to good agreement (>60%;κ = 0.06 and 0.77, respectively). In general, agreement was lower for boys, younger children, younger parents, parents with less than 14 years of education, single parents, parents with a higher self-reported body mass index and parents who perceived their child to be underweight. Conclusions Parents and children perceive parental practices regarding dietary, physical activity and sedentary behaviours differently in all parts of Europe, with considerable variation across specific practices and countries. Therefore, future studies should assess both, parents and children’s view on parental practices. Electronic supplementary material The online version of this article (doi:10.1186/1471-2458-14-918) contains supplementary material, which is available to authorized users.

Background To explore differences in personal and home environmental factors that are regarded as determinants of energy balance-related behaviors (EBRBs) according to parental education and ethnic background among 10–12 year old schoolchildren across Europe. Methods A school-based survey among 10–12 year olds was conducted in eight countries across Europe. A range of personal and home environment variables relevant for soft drink consumption, daily breakfast, sport participation and TV time was assessed by means of child report. Personal factors included attitude, health beliefs, and preference/liking. Home environment factors included parental subjective norm, modeling, support, practices and home availability. Children were classified based on parental education (i.e., low vs. high) and ethnic background (i.e., native vs. non-native). Data from 6018 children originating from 83 schools were included in the analyses. Results Multilevel logistic regression analyses showed that the majority of the factors tested –and especially home environment variables- were more favorable among children from higher educated parents and from native ethnicity. None of the personal and home environment factors was found to be more favorable among children from lower educated parents or non-native ethnicity. Conclusions The present study indicates that schoolchildren from lower educated and non-native parents across Europe have EBRB-related beliefs and are exposed to home environments that are less favorable for engagement in healthy EBRBs.

Background Hostility is a significant predictor of mortality and cardiovascular events in patients with coronary heart disease ( CHD ), but the mechanisms that explain this association are not well understood. The purpose of this study was to evaluate potential mechanisms of association between hostility and adverse cardiovascular outcomes. Methods and Results We prospectively examined the association between self‐reported hostility and secondary events (myocardial infarction, heart failure, stroke, transient ischemic attack, and death) in 1022 outpatients with stable CHD from the Heart and Soul Study. Baseline hostility was assessed using the 8‐item Cynical Distrust scale. Cox proportional hazard models were used to determine the extent to which candidate biological and behavioral mediators changed the strength of association between hostility and secondary events. During an average follow‐up time of 7.4±2.7 years, the age‐adjusted annual rate of secondary events was 9.5% among subjects in the highest quartile of hostility and 5.7% among subjects in the lowest quartile (age‐adjusted hazard ratio [ HR ]: 1.68, 95% confidence interval [ CI ]: 1.30 to 2.17; P HR : 1.58, 95% CI : 1.19 to 2.09; P =0.001). This association was mildly attenuated after adjustment for C‐reactive protein ( HR : 1.41, 95% CI , 1.06 to 1.87; P =0.02) and no longer significant after further adjustment for smoking and physical inactivity ( HR : 1.25, 95% CI : 0.94 to 1.67; P =0.13). Conclusions Hostility was a significant predictor of secondary events in this sample of outpatients with baseline stable CHD . Much of this association was moderated by poor health behaviors, specifically physical inactivity and smoking.

Objective: To assess the reliability of the Test of Wheeled Mobility (TOWM) and the Wheelie test.Design: Cohort study.Setting: Gymnasium.Participants: Manual wheelchair users (N=30, age 23-53y) with a spinal cord injury.Intervention: Participants performed the 30 skills of the TOWM and the 8 skills of the Wheelie test twice. Ability, time, and anxiety scores were assessed on field. Quality scores were assessed by video analysis.Main Outcome Measures: Test-retest reliability was evaluated for the ability, time, anxiety, and quality scores of both tests. Intrarater and interrater reliability were determined on the basis of quality scores of 20 participants. Intraclass coefficient and nonparametric statistics were applied, as well as standard error of measurement, method error (ME), coefficient variation of ME, minimal detectable change (95% confidence), and technical error of measurement.Results: Test-retest reliability: no significant differences between t1 and t2 in the ability, quality, and time scores, except for anxiety scores. Standard error of measurement, ME, coefficient variation of ME, and minimal detectable change (95% confidence) values were low for the ability and quality total score and higher for the time and anxiety total score. Intrarater and interrater reliability interclass correlation coefficients of both tests ranged between .91 and .99. Interrater relative technical error of measurement for the TOWM and the Wheelie test total quality score was 3.7% and 6.3%, respectively, and intrarater relative technical error of measurement was 4.3% and 6.1%, respectively. Interclass correlation coefficients per individual tasks ranged between .88 and 1.00, except for "level propulsion forward," which showed low interclass correlation coefficient scores (interrater: .49; intrarater: .44; test-retest: .43).Conclusions: Based on ability and quality total scores, the TOWM and the Wheelie test are reliable when assessing the wheeled mobility of manual wheelchair users with spinal cord injury. The quality criteria of 1 task from the TOWM and 3 tasks from the Wheelie test need to be refined. Archives of Physical Medicine and Rehabilitation 2013;94:761-70 (C) 2013 by the American Congress of Rehabilitation Medicine

Objective: To investigate associations of family-related factors with children's breakfast consumption and BMI-z-score and to examine whether children's breakfast consumption mediates associations between family-related factors and children's BMI-z-score. Subjects: Ten-to twelve-year-old children (n = 6374; mean age = 11.6 +/- 0.7 years, 53.2% girls, mean BMI-z-score = 0.4 +/- 1.2) and one of their parents (n = 6374; mean age = 41.4 +/- 5.3 years, 82.7% female, mean BMI = 24.5 +/- 4.2 kg/m(2)) were recruited from schools in eight European countries (Belgium, Greece, Hungary, the Netherlands, Norway, Slovenia, Spain, and Switzerland). The children self-reported their breakfast frequency per week. The body weight and height of the children were objectively measured. The parents responded to items on family factors related to breakfast (automaticity, availability, encouragement, paying attention, permissiveness, negotiating, communicating health beliefs, parental self-efficacy to address children's nagging, praising, and family breakfast frequency). Mediation analyses were performed using multi-level regression analyses (child-school-country). Results: Three of the eleven family-related variables were significantly associated with children's BMI-z-score. The family breakfast frequency was negatively associated with the BMI-z-score; permissiveness concerning skipping breakfast and negotiating about breakfast were positively associated with the BMI-z-score. Children's breakfast consumption was found to be a mediator of the two associations. All family-related variables except for negotiating, praising and communicating health beliefs, were significantly associated with children's breakfast consumption. Conclusions: Future breakfast promotion and obesity prevention interventions should focus on family-related factors including the physical home environment and parenting practices. Nevertheless, more longitudinal research and intervention studies to support these findings between family-related factors and both children's breakfast consumption and BMI-z-score are needed.

Impairments in social behavior are frequently found in moderate to severe traumatic brain injury (TBI) patients and are associated with an unfavorable outcome with regard to return to work and social reintegration. Neuropsychological tests measuring aspects of social cognition are thought to be sensitive to these problems. However, little is known about the effect of general cognitive problems on these tests, nor about their sensitivity to injury severity and frontal lesions. In the present study 28 chronic TBI patients with a moderate to severe TBI were assessed with tests for social cognition (emotion recognition, Theory of Mind, and empathy), and for general, non-social cognition (memory, mental speed, attention, and executive function). The patients performed significantly worse than healthy controls on all measures, with the highest effect size for the emotion recognition test, the Facial Expressions of Emotion-Stimuli and Tests (FEEST). Correlation analyses yielded no significant (partial) correlations between social and non-social cognition tests. Consequently, poor performance on social cognition tests was not due to general cognitive deficits. In addition, the emotion recognition test was the only measure that was significantly related to post-traumatic amnesia (PTA) duration, Glasgow Coma Scale (GCS) score, and the presence of prefrontal lesions. Hence, we conclude that social cognition tests are a valuable supplement to a standard neuropsychological examination, and we strongly recommend the incorporation of measurements of social cognition in clinical practice. Preferably, a broader range of social cognition tests would be applied, since our study demonstrated that each of the measures represents a unique aspect of social cognition, but if capacity is limited, at least a test for emotion recognition should be included.

Fliess-Douer O, Vanlandewijck YC, Van Der Woude LHV. Most essential wheeled mobility skills for daily life: an international survey among paralympic wheelchair athletes with spinal cord injury. Arch Phys Med Rehabil 2012;93:629-35.Objectives: To create a hierarchical list of the most essential wheeled mobility (WM) skills for everyday life of wheelchair users with a spinal cord injury (SCI), and to compare perceptions of WM gained during and after clinical rehabilitation.Design: Cross-sectional study using survey questionnaires.Setting: The Beijing Paralympic games, at the international zone of the Olympic village and in different sports venues.Participants: A sample of men (N=49) and women (N=30) elite manual wheelchair user athletes with SCI (paraplegia, n=64; tetraplegia, n=15).Interventions: Not applicable.Main Outcome Measure: A survey with 24 predefined skills was distributed during the Beijing Paralympic games. Respondents were asked to rate the essentiality of each skill (I, not essential; 5, extremely essential); to state where, when, and with whom they have learned to perform each skill; and to mark the level of WM, which they gained during and after clinical rehabilitation, on 3 different WM visual analog scales (scores 1-10).Results: Rated as the most essential skill was transfer into and out of a car (mean +/- SD, 4.7 +/- 0.7). Rated as the least essential skill was the 1-handed wheelie (mean SD, 1.9 +/- 1.3). Of the respondents, 57% have learned the most essential skills in clinical rehabilitation, while 40% claimed to have learned those skills afterward in a community setting. Three percent have never learned to perform the most essential skills. Of the very essential skills, 40% were self-taught. Mean score +/- SD for the extent to which WM skills were gained in rehabilitation was 5.4 +/- 2.5.Conclusions: The main survey outcome is a sorted list of WM skills according to their essentiality for daily life of hand-rim wheelchair users with SCI. It is recommended to incorporate the skills that were graded as very essential and extremely essential during inpatient rehabilitation and in postrehabilitalion WM workshops.

Research on the Psychopathic Personality Inventory-Revised (PPI-R) has revealed two factors: Fearless Dominance, and Self-Centered Impulsivity. This study examined the validity of these PPI-R factors in a community sample (N = 675). First, confirmatory factor analyses did not support the two-factor structure. Second, the PPI-R factors showed good convergent and discriminant validity with two other self-report measures of psychopathy, that is, the Youth Psychopathic Traits Inventory and Levenson's Self-Report of Psychopathy. Third, PPI-R factors exhibited good external validity in relation to various theoretically relevant correlates. The results indicate that the PPI-R factors have good convergent, discriminant, and external validity, but confirmatory factor analysis raises concerns about the robustness of the two-factor structure. Keywords psychopathy, self-report measures, validity, community, Psychopathic Personality Inventory–Revised, Levenson’s Self-Report Measure for Psychopathy, Youth Psychopathic Traits Inventory ispartof: Assessment vol:17 issue:3 pages:334-346 ispartof: location:United States status: published

Cowan RE, Nash MS, de Groot S, van der Woude LH. Adapted manual wheelchair circuit: test-retest reliability and discriminative validity in persons with spinal cord injury. Arch Phys Med Rehabil 2011;92:1270-80.Objective: To assess the test-retest reliability and discriminative validity of a 14-item manual wheelchair circuit adapted from previous research (AMWC).Design: Two AMWC trials per subject completed within 15 days.Setting: Two clinical research and 3 rehabilitation centers.Participants: Convenience sample of individuals with spinal cord injury (N=50) from centers in the United States (n=38) and the Netherlands (n=12). Mean age +/- SD was 46 +/- 13 years, and mean injury duration +/- SD was 12 +/- 11 years. Fifteen had cervical injuries, and 42 were men.Interventions: An existing 8-task manual wheelchair circuit was modified to remove the need for a wheelchair treadmill and expanded to 14 tasks to attenuate floor and ceiling effects: 5 original tasks-figure-of-8, .012-m doorstep crossing, .10-m platform, 15-m sprint, and making a level transfer; 3 modified tasks-3% and 6% ramp, and 3-minute overground wheeling; and 6 new tasks-.04-m doorstep crossing, propelling over artificial grass, opening/closing a door, 3% side slope, holding a wheelie for 10 seconds, and propelling in a wheelie.Main Outcome Measures: Reliability of the primary outcomes, sum ability score (sum of all tasks; 0-14 [no.]) and sum performance time (figure-of-8 + sprint + grass; 0-360 [s]), was determined by intraclass correlation coefficients (ICCs) for the whole sample and paraplegia (PP) and tetraplegia (TP) subsets. Independent t tests compared PP and TP trial 1 sum ability score and sum performance time.Results: Sum ability and sum performance time ICCs exceeded-.90 for the full sample and the PP/TP subsets. Sum ability was higher for PP than TP (PP, 12.9 +/- 1.2; TP, 9.8 +/- 2.8; PConclusions: AMWC primary outcomes, sum ability score and sum performance time, are reliable and discriminate between TP and PP.

The present study examined the structure of a Dutch adaptation of the 40-item Narcissistic Personality Inventory (Raskin & Terry, 1988) in a community sample (n = 460) and a student sample (n = 515). Altering the response format of the NPI to a Likert-scale had no apparent effect on the responses. Confirmatory factor analyses supported neither the four-factor structure reported by Emmons (1984), nor the seven-factor structure reported by Raskin and Terry (1988). Instead, exploratory factor analyses supported either a single-factor solution (general narcissism), or a two-factor solution (Authority/Power and Self-Admiration). The validity of the NPI was supported by its relations with sex, age, personality, self-esteem, shame, guilt and social desirability.

Context Anxiety is common in patients with coronary heart disease (CHD), but studies examining the effect of anxiety on cardiovascular prognosis and the role of potential mediators have yielded inconsistent results. Objectives To evaluate the effect of generalized anxiety disorder (GAD) on subsequent cardiovascular events and the extent to which this association is explained by cardiac disease severity and potential behavioral or biological mediators. Design Prospective cohort study (Heart and Soul Study). Setting Participants were recruited between September 11, 2000, and December 20, 2002, from 12 outpatient clinics in the San Francisco Bay Area and were followed up until March 18, 2009. Participants One thousand fifteen outpatients with stable CHD followed up for a mean (SD) of 5.6 (1.8) years. Main Outcome Measures We determined the presence of GAD using the Diagnostic Interview Schedule. Proportional hazards models were used to evaluate the association of GAD with subsequent cardiovascular events and the extent to which this association was explained by potential confounders and mediators. Results A total of 371 cardiovascular events occurred during 5711 person-years of follow-up. The age-adjusted annual rate of cardiovascular events was 9.6% in the 106 participants with GAD and 6.6% in the 909 participants without GAD ( P = .03). After adjustment for demographic characteristics, comorbid conditions (including major depressive disorder), cardiac disease severity, and medication use, GAD remained associated with a 62% higher rate of cardiovascular events (hazard ratio, 1.62; 95% confidence interval, 1.11-2.37; P = .01). Additional adjustment for a variety of potential behavioral and biological mediators had little effect on this association (hazard ratio, 1.74; 95% confidence interval, 1.13-2.67; P = .01). Conclusions In outpatients with CHD, a robust association between GAD and cardiovascular events was found that could not be explained by disease severity, health behaviors, or biological mediators. How GAD leads to poor cardiovascular outcomes deserves further study.

This study presents evidence on the reliability and construct validity of the Dutch version of the Youth Psychopathic traits Inventory (YPI), a self-report instrument for psychopathic traits in adolescent boys and girls In a sample of 776 Dutch non-referred adolescents, the YPI Was found to have good internal consistency. Furthermore, exploratory Principal Components Analysis (PCA) indicated a three-factor structure for the YPI, including a Giandiose-manipulative, Callous-unemotional, and Impulsive-irresponsible dimension Good internal consistency was demonstrated for all dimensions in boys as well as girls, except for the Callous-unemotional dimension Results further indicated strong correlations between psychopathic traits and dominant and hostile inter personal style The Grandiose-manipulative dimension predicted dominant interpersonal behavior in boys, but not in 911 IS In girls. a dominant interpersonal style was predicted by the Impulsive-irresponsible dimension. Psychopathic traits, mainly the impulsive-irresponsible dimension, were related to a higher frequency of self-reported drug and alcohol use in boys and girls.