Construction and validation of an alternate form general mental health scale for the Medical Outcomes Study Short-Form 36-Item Health Survey

Comparison of vision-related quality of life in primary open-angle glaucoma and dry-type age-related macular degeneration

PurposeTo compare quality of life (QoL) in patients with primary open-angle glaucoma (POAG) and dry-type age-related macular degeneration (AMD) with similar best-corrected visual acuity.MethodsAge-, sex-, and visual acuity-matched POAG and dry AMD patients were included in the study. Each patient performed 24-2 and 10-2 SITA standard visual field tests. Contrast sensitivity was evaluated with CSV-1000 HGT instrument. The 25 item National Eye Institute Visual Function Questionnaire (NEI-VFQ-25) was used to analyze QoL. Overall and subscale scores were converted to scores between 0 and 100, the higher scores indicating better vision-related QoL.ResultsOverall NEI-VFQ-25 scores were 86.44 and 84.66 in glaucoma and AMD groups, respectively (P=0.244). The highest scores were obtained in 'vision-related dependency' subgroup in glaucoma and 'color and peripheral vision' in AMD group, whereas the lowest scores were noted 'in peripheral vision' in both glaucoma and AMD patients. Glaucoma patients had significantly lower scores in ocular pain, color vision, and peripheral vision subgroups compared with the AMD group, whereas AMD patients had lower scores in near and distance vision activities, vision-related social activity, and dependency subgroups. Contrast sensitivity results and mean defect values showed correlation with NEI-VFQ-25 scores in both groups.ConclusionsGlaucoma and AMD patients with similar visual acuity experienced similar overall impairment in QoL. However, glaucoma patients described more difficulty with peripheral vision and ocular pain, whereas AMD patients complained more about near and distance vision and dependency items.

The Effect of Mental Distress on Women's Preventive Health Behaviors

Purpose.

To examine the relationship between mental distress and preventive health behaviors (i.e., mammograms, pap tests, physical exams) among women.

Methods.

A cross-sectional design was employed. The sample consisted of 426 women from the Appalachian region in the United States who completed a comprehensive health survey. Mental distress was assessed by the 5-item Mental Health Index (MHI). Logistic regression was used to specify the models allowing for the control of covariates (i.e., marital status, education, recipient of Medicaid).

Results.

Women who reported high mental distress were more likely to not get timely pap tests [OR = 1.64; 95% CI (1.10, 2.45); p < .05] or physical exams [OR = 1.68; 95% CI (1.07, 2.65); p < .05] than women who did not report being mentally distressed. A similar but less robust relationship was found between mental distress and timely mammograms.

Conclusions.

These findings suggest that mental distress affects the likelihood of engagement in preventive health behaviors.

Using mobile health technology to deliver decision support for self-monitoring after lung transplantation

BACKGROUND

Lung transplant recipients (LTR) experience problems recognizing and reporting critical condition changes during their daily health self-monitoring. Pocket PATH(®), a mobile health application, was designed to provide automatic feedback messages to LTR to guide decisions for detecting and reporting critical values of health indicators.

OBJECTIVES

To examine the degree to which LTR followed decision support messages to report recorded critical values, and to explore predictors of appropriately following technology decision support by reporting critical values during the first year after transplantation.

METHODS

A cross-sectional correlational study was conducted to analyze existing data from 96 LTR who used the Pocket PATH for daily health self-monitoring. When a critical value is entered, the device automatically generated a feedback message to guide LTR about when and what to report to their transplant coordinators. Their socio-demographics and clinical characteristics were obtained before discharge. Their use of Pocket PATH for health self-monitoring during 12 months was categorized as low (≤25% of days), moderate (>25% to ≤75% of days), and high (>75% of days) use. Following technology decision support was defined by the total number of critical feedback messages appropriately handled divided by the total number of critical feedback messages generated. This variable was dichotomized by whether or not all (100%) feedback messages were appropriately followed. Binary logistic regression was used to explore predictors of appropriately following decision support.

RESULTS

Of the 96 participants, 53 had at least 1 critical feedback message generated during 12 months. Of these 53 participants, the average message response rate was 90% and 33 (62%) followed 100% decision support. LTR who moderately used Pocket PATH (n=23) were less likely to follow technology decision support than the high (odds ratio [OR]=0.11, p=0.02) and low (OR=0.04, p=0.02) use groups. The odds of following decision support were reduced in LTR whose income met basic needs (OR=0.01, p=0.01) or who had longer hospital stays (OR=0.94, p=0.004). A significant interaction was found between gender and past technology experience (OR=0.21, p=0.03), suggesting that with increased past technology experience, the odds of following decision support to report all critical values decreased in men but increased in women.

CONCLUSIONS

The majority of LTR responded appropriately to mobile technology-based decision support for reporting recorded critical values. Appropriately following technology decision support was associated with gender, income, experience with technology, length of hospital stay, and frequency of use of technology for self-monitoring. Clinicians should monitor LTR, who are at risk for poor reporting of recorded critical values, more vigilantly even when LTR are provided with mobile technology decision support.

Acceptance and Use of Mobile Technology for Health Self-Monitoring in Lung Transplant Recipients during the First Year Post-Transplantation

OBJECTIVES

To describe lung transplant recipients (LTRs') acceptance and use of mobile technology for health self-monitoring during the first year post-transplantation, and explore correlates of the use of technology in the 0 to 2, >2 to ≤6, >6 to ≤12, and 0 to 12 months.

METHODS

Secondary analysis of data from 96 LTR assigned to use Pocket PATH(®), a smartphone application, for daily health self-monitoring in a randomized controlled trial. Use of Pocket PATH was categorized as low, moderate, and high use. Proportional odds models for ordinal logistic regression were employed to explore correlates of use of technology.

RESULTS

LTR reported high acceptance of Pocket PATH at baseline. However, acceptance was not associated with actual use over the 12 months (p=0.45~0.96). Actual use decreased across time intervals (p<0.001). Increased self-care agency was associated with the increased odds of higher use in women (p=0.03) and those less satisfied with technology training (p=0.02) in the first 2 months. Higher use from >2 to ≤6 months was associated with greater satisfaction with technology training (OR=3.37, p=0.01) and shorter length of hospital stay (OR=0.98, p=0.02). Higher use from >6 to ≤12 months was associated with older age (OR=1.05, p=0.02), lower psychological distress (OR=0.43, p=0.02), and better physical functioning (OR=1.09, p=0.01). Higher use over 12 months was also associated with older age (OR=1.05, p=0.007), better physical functioning (OR=1.13, p=0.001), and greater satisfaction with technology training (OR=3.05, p=0.02).

CONCLUSIONS

Correlates were different for short- and long-term use of mobile technology for health self-monitoring in the first year post-transplantation. It is important to follow up with LTR with longer hospital stay, poor physical functioning, and psychological distress, providing ongoing education to improve their long-term use of technology for health self-monitoring.

Binge drinking and subsequent depressive symptoms in young women in Australia

BACKGROUND

The long-term impact of binge drinking on subsequent depressive symptoms is unclear. The aims were to identify longitudinal patterns of binge drinking and whether binge drinking preceded depressive symptoms in the short-term (1-6 years) and long-term (10-15 years).

METHODS

Longitudinal data from 1996, 2000 and 2009 mailed surveys of 8,197 women in the 1973-78 cohort of the Australian Longitudinal Study on Women's Health. Latent class analysis was used to identify binge drinking patterns and logistic regression to estimate associations with subsequent depressive symptoms.

RESULTS

Five binge drinking trajectories were identified with predicted proportions of women who were very infrequent (24%), fluctuating infrequent (17%), frequent (17%), very frequent (26%) or extremely frequent binge drinkers (16%) between 16 and 21 years. At 22-27 years, depressive symptoms were significantly higher for extremely frequent binge drinkers (31% versus 21% in the short-term; 22% versus 16%-18% in the long-term) than for less frequent bingers. Unadjusted odds of depressive symptoms were 1.70 (95%CI:1.38;2.08) times for extremely frequent binge drinkers than very infrequent bingers and were 1.30 (95%CI:1.04;1.63) after adjusting for demographics, relationships and experience of violence. At 31-36 years, the odds of depressive symptoms were 1.34 (95%CI:1.09-1.64) times for extremely frequent than very infrequent binge drinkers, but were not significant after adjusting for relationships and violence.

CONCLUSIONS

Extremely frequent binge drinking (more than weekly) in late adolescence appears to elevate the risk of subsequent depressive symptoms in young women in their early twenties and thirties, emphasising the need for preventive strategies to curb binge drinking.

Differential Item Functioning in the SF-36 Physical Functioning and Mental Health Sub-Scales: A Population-Based Investigation in the Canadian Multicentre Osteoporosis Study

Background

Self-reported health status measures, like the Short Form 36-item Health Survey (SF-36), can provide rich information about the overall health of a population and its components, such as physical, mental, and social health. However, differential item functioning (DIF), which arises when population sub-groups with the same underlying (i.e., latent) level of health have different measured item response probabilities, may compromise the comparability of these measures. The purpose of this study was to test for DIF on the SF-36 physical functioning (PF) and mental health (MH) sub-scale items in a Canadian population-based sample.

Methods

Study data were from the prospective Canadian Multicentre Osteoporosis Study (CaMos), which collected baseline data in 1996–1997. DIF was tested using a multiple indicators multiple causes (MIMIC) method. Confirmatory factor analysis defined the latent variable measurement model for the item responses and latent variable regression with demographic and health status covariates (i.e., sex, age group, body weight, self-perceived general health) produced estimates of the magnitude of DIF effects.

Results

The CaMos cohort consisted of 9423 respondents; 69.4% were female and 51.7% were less than 65 years. Eight of 10 items on the PF sub-scale and four of five items on the MH sub-scale exhibited DIF. Large DIF effects were observed on PF sub-scale items about vigorous and moderate activities, lifting and carrying groceries, walking one block, and bathing or dressing. On the MH sub-scale items, all DIF effects were small or moderate in size.

Conclusions

SF-36 PF and MH sub-scale scores were not comparable across population sub-groups defined by demographic and health status variables due to the effects of DIF, although the magnitude of this bias was not large for most items. We recommend testing and adjusting for DIF to ensure comparability of the SF-36 in population-based investigations.

The Relationship Among Caregiver Depressive Symptoms, Parenting Behavior, and Family-Centered Care

BACKGROUND

Parental depression has been associated with adverse child outcomes. However, the specific parenting behaviors that may result in such child outcomes and the effect of family-centered care (FCC) on positive parenting behavior of depressed parents has not previously been examined.

METHODS

Data from the National Survey of Early Childhood Health was used (n = 2,068). Groups were stratified by the presence of parental depression and compared with regard to demographics and the mean number of specific positive parenting behaviors. Generalized linear models were developed based on testing whether individuals performed more or less than the median number of positive behaviors. Lastly, we tested whether depression independently predicted each outcome after adjustment for FCC, coping, social support, and ethnicity to evaluate if depression independently predicted each outcome after adjustment.

RESULTS

No difference was found in demographic variables between parents who were depressed and not depressed. Parents who were not depressed performed significantly more routines (p = .036); reported coping better with parenting (p < .001); performed significantly less punitive behaviors (p = .022); and needed/had less social support (p = .002) compared with parents who were depressed. Individual items and scale scores were associated in the expected directions. FCC was independently associated with study variables but did not moderate the effect of depression.

CONCLUSIONS

These data identify specific parenting behaviors that differ between parents who report depressive symptoms compared with parents who do not have depressive symptoms. More targeted interventions coordinated through a medical home are needed for parents with depressive symptoms to reduce the child health disparities often associated with parental depression.

Sleep Related Cognitions in Individuals with Symptoms of Insomnia and Depression

STUDY OBJECTIVES

Depression has been identified as the most common condition comorbid to insomnia, with findings pointing to the possibility that these disorders may be causally related to each other or may share common mechanisms. Some have suggested that comorbid insomnia and depression may have a different clinical course than either condition alone, and may thus require specific treatment procedures. In this report we examined the clinical characteristics of individuals referred to an academic sleep center who report comorbid symptoms of insomnia and depression and those with symptoms of insomnia outside the context of meaningful depression, and we identified differences between these groups with regard to several cognitive-related variables.

METHODS

Logistic regression analyses examined whether past week worry, dysfunctional beliefs about sleep, and insomnia symptom-focused rumination predicted group membership.

RESULTS

Individuals with comorbid symptoms of insomnia and depression reported more past-week worry, dysfunctional beliefs about sleep, and insomnia symptom-focused rumination, than those with symptoms of insomnia without significant depression symptoms. When including all three cognitive-related variables in our model, those with comorbid symptoms reported more severe insomnia symptom-focused rumination, even when controlling for insomnia and mental health severity, among other relevant covariates.

CONCLUSION

The findings contribute to our understanding of the complex nature of comorbid symptoms of insomnia and depression and the specific symptom burden experienced by those with significant depression symptoms in the presence of insomnia. The findings also highlight the need for increased clinical attention to the sleep-focused rumination reported by these patients.

A prospective 1-year study of postural tachycardia and the relationship to non-postural versus orthostatic symptoms

PURPOSE

Healthy subjects with asymptomatic postural tachycardia at baseline were evaluated over a one year period to determine whether they developed non-postural versus orthostatic symptoms that could predispose them to develop Postural Tachycardia Syndrome (POTS).

METHODS

Participants (n=30) were recruited for a 1-year follow-up (FUP) study if at baseline they demonstrated a heart rate increment of ≥30bpm on head-up tilt (HUT). At FUP, HUT was repeated and four self-report questionnaires were used to assess symptoms.

RESULTS

Heart rate (HR) increment was reduced in 19 subjects (-11.8±7.4bpm) and increased in 11 subjects (8.3±6.1bpm) at FUP versus baseline. Heart rate increment at FUP demonstrated no correlation to general fatigue (r=0.006), body vigilance (r=0.195), or the component scores for physical (r=-0.087) and mental (r=-0.137) health of the SF-36. Similarly, there was no correlation between HR increment at FUP and orthostatic scores (r=0.04). However, orthostatic scores did show a significant positive correlation with general fatigue and body vigilance scores (r=0.374, r=0.392, respectively; p<0.05).

CONCLUSIONS

Despite meeting the heart rate criteria for POTS, these findings further support that the majority of young individuals express benign orthostatic tachycardia. In addition, after one year this patient population showed no predisposition to develop non-postural or postural symptoms that could lead to the full syndrome of POTS. These data further argue for the re-evaluation of the heart rate criteria for diagnosing POTS in young populations.

HIV research trials versus standard clinics for antiretroviral-naïve patients: the outcomes differ but do the patients?

Exclusion criteria for HIV treatment-naïve drug trials can be stringent and selection bias exists, making it difficult to extrapolate results into the 'real world' clinical situation. We aim to compare the demographics, virological outcomes and psychosocial complexity in adult HIV-infected treatment-naïve patients from our cohort initiating combination antiretroviral therapy (cART) in research trials versus standard clinics. In our unit from 2006 to 2011, 1202 standard clinic and 69 research trial patients initiated cART; every eighth standard clinics patient was included to create a standard clinics:research trials patient ratio of 2:1. Notes were retrospectively reviewed for patient demographics, attendance rates and virological outcomes. Data from 221 antiretroviral-naïve patients starting cART were analysed: 152 standard clinic patients and 69 from research trials. In the research trials group, there was an overrepresentation of men (p = 0.041), men who have sex with men (p < 0.001), patients of white ethnicity (p = 0.01), employed patients (p = 0.01) and patients using excessive alcohol (p = 0.02). There was equal representation of drug use, depression and referral to psychology, psychiatry and social work in both groups. The research trials group at baseline had significantly higher CD4 counts (p < 0.001), lower viral loads (p = 0.01) and more patients achieved undetectable viral loads at three (p < 0.001), six (p < 0.001) and 24 months (p = 0.033). There is a prevailing common preconception that participants in clinical trials are uncomplicated, unlike their 'real-life' counterparts. We demonstrated important similarities in psychosocial complexity as well as differences in demographics and virological outcomes in trial and non-trial patients. Clinicians need to be aware of these discrepancies to ensure the facilitation of a heterogeneous population participating in research trials.

Gender differences in health related quality of life among people living with HIV on highly active antiretroviral therapy in Mekelle Town, Northern Ethiopia

Background. Health related quality of life (HRQOL) is an important outcome measure for highly active antiretroviral treatment program. In Ethiopia, studies revealed that there are improved qualities of life among adults living with the viruses taking antiretroviral therapy but there is no explicit data showing gender differences in health related quality of life. Aim. To assess gender differences in HRQOL and its associated factors among people living with HIV and on highly active antiretroviral therapy in public health institutions of Mekelle town, Northern Ethiopia. Methods. A comparative cross-sectional study was conducted among 494 adult people living with HIV taking ART services. Quality of life was measured using WHOQOL-HIV BREF. Result. There was a statistically significant gender difference (P < 0.05) in HRQOL among PLHIV on HAART. Females had low score in all HRQOL domains. High perceived stigma was strongly associated with poor psychological quality of domain among both female and male groups with [AOR = 2.89(1.69,4.96)] and [AOR = 2.5(1.4,4.4)], respectively. Conclusion. There was statistically significant gender difference in all quality of life domains. Public health interventions to improve HRQOL of PLHIV should take in to account the physical, psychological, social, environmental, and spiritual health of PLHIV during treatment, care, and support.

Extent and reasons for nonadherence to antihypertensive, cholesterol, and diabetes medications: the association with depressive symptom burden in a sample of American veterans

OBJECTIVE

Persons with depressive symptoms generally have higher rates of medication nonadherence than persons without depressive symptoms. However, little is known about whether this association differs by comorbid medical condition or whether reasons for nonadherence differ by depressive symptoms or comorbid medical condition.

METHODS

Self-reported extent of nonadherence, reasons for nonadherence, and depressive symptoms among 1,026 veterans prescribed medications for hypertension, dyslipidemia, and/or type 2 diabetes were assessed.

RESULTS

In multivariable logistic regression adjusted for clinical and demographic factors, the odds of nonadherence were higher among participants with high depressive symptom burden for dyslipidemia (n=848; odds ratio [OR]: 1.42, P=0.03) but not hypertension (n=916; OR: 1.24, P=0.15), or type 2 diabetes (n=447; OR: 1.15, P=0.51). Among participants reporting nonadherence to antihypertensive and antilipemic medications, those with greater depressive symptom burden had greater odds of endorsing medication nonadherence reasons related to negative expectations and excessive economic burden. Neither extent of nonadherence nor reasons for nonadherence differed by depressive symptom burden among patients with diabetes.

CONCLUSION

These findings suggest that clinicians may consider tailoring interventions to improve adherence to antihypertensive and antilipemic medications to specific medication concerns of participants with depressive symptoms.

Treatment of Moderate to Severe Alzheimer's Disease: Rationale and Trial Design

Moderate to severe Alzheimer's disease (AD) is characterized by increasing cognitive, functional, and behavioural dysfunction that results in increased caregiver burden and, eventually, complete dependence. Despite its significance as a societal health problem, there are few treatment trials of cognitive enhancers or disease modifying agents for this stage of illness. Studies suggest the cholinesterase inhibitors, especially donepezil, may provide benefit. Several studies provide support for the use of the NMDA receptor antagonist memantine as monotherapy or added to a cholinesterase inhibitor for moderate to severe AD. While there are no published guidelines for the treatment of moderate to severe AD, these studies do provide guidance for recommendations for study design and outcome measures. Such studies are urgently needed.

Long-term changes in physical capacity after colorectal cancer treatment

Older patients with colorectal cancer are faced with the dilemma of choosing between the short-term risks of treatment and the long-term risks of insufficiently treated disease. In addition to treatment-related morbidity and mortality, patients may suffer from loss of physical capacity. The purpose of this review was to gather all available evidence regarding long-term changes in physical functioning and role functioning after colorectal cancer treatment, by performing a systematic Medline and Embase search. This search yielded 27 publications from 23 studies. In 16 studies addressing physical functioning after rectal cancer treatment, a median drop of 10% (range -26% to -5%) in the mean score for this item at three months. At six months, mean score was still 7% lower than baseline (range -18% to 0%) and at twelve months 5% lower (range -13% to +5%). For role functioning (i.e. ability to perform daily activities) after rectal cancer treatment, scores were -18% (range -39% to -2%), -8% (range -23% to +6%) and -5% (range -17% to +10%) respectively. Elderly patients experience the greatest and most persistent decline in self-care capacity (up to 61% at one year). This systematic review demonstrates that both physical functioning and role functioning are significantly affected by colorectal cancer surgery. Although initial losses are recovered partially during follow-up, there is a permanent loss in both aspects of physical capacity, in patients of all ages but especially in the elderly. This aspect should be included in patient counselling regarding surgery.

A propensity-matched analysis comparing survival after primary minimally invasive esophagectomy followed by adjuvant therapy to neoadjuvant therapy for esophagogastric adenocarcinoma

OBJECTIVES

Prognosis for patients with locally advanced esophagogastric adenocarcinoma (EAC) is poor with surgery alone, and adjuvant therapy after open esophagectomy is frequently not tolerated. After minimally invasive esophagectomy (MIE); however, earlier return to normal function may render patients better able to receive adjuvant therapy. We examined whether primary MIE followed by adjuvant chemotherapy influenced survival compared with propensity-matched patients treated with neoadjuvant therapy.

METHODS

Patients with stage II or higher EAC treated with MIE (N = 375) were identified. Using 30 pretreatment covariates, propensity for assignment to either neoadjuvant followed by MIE (n = 183; 54%) or MIE as primary therapy (n = 156; 46%) was calculated, generating 97 closely matched pairs. Hazard ratios were adjusted for age, sex, body mass index, smoking, comorbidity, and final pathologic stage.

RESULTS

In propensity-matched pairs, adjusted hazard ratio for death did not differ significantly for primary MIE compared with neoadjuvant (hazard ratio, 0.83; 95% confidence interval, 0.60-1.16). Recurrence patterns were similar between groups and 65% of patients with IIb or greater pathologic stage received adjuvant therapy. Clinical staging was inaccurate in 37 out of 105 patients (35%) who underwent primary MIE (n = 18 upstaged and n = 19 downstaged).

CONCLUSIONS

Primary MIE followed by adjuvant chemotherapy guided by pathologic findings did not negatively influence survival and allowed for accurate staging compared with clinical staging. Our data suggest that primary MIE in patients with resectable EAC may be a reasonable approach, improving stage-based prognostication and potentially minimizing overtreatment in patients with early stage disease through accurate stage assignments. A randomized controlled trial testing this hypothesis is needed.

Quality of life and health care consumption in primary care patients with elevated serum calcium concentrations in - a prospective, case control, study

Background

Patients with elevated calcium concentrations have an increased morbidity due to various underlying illnesses. However, there is a lack of studies of quality of life and health care consumption in patients with hypercalcaemia per se. The study aims to investigate quality of life and health care consumption, as measured by, sick leave, drug prescriptions and the number of visits and admissions to health care centres and hospitals, in primary care patients with elevated calcium concentrations.

Methods

A prospective, case control, study in primary care centre, in Sweden. Patients with elevated, (n = 127, 28 men), and normal calcium concentrations, (n = 254, 56 men), mean age 61.4 year, were recruited in the study and followed during 10 years. Eighty-six percent of those alive at the time of follow up participated in a follow up visit. The study participants completed a quality of life survey, SF-36, which also were compared with the Swedish SF-36 national normative database.

Results

Patients with elevated calcium concentrations had significantly lower quality of life both compared with the control group (patients with normal calcium concentrations) and compared with age and gender-matched reference material from the Swedish SF-36 national normative database. The group with elevated calcium concentrations had significantly more hospitalisations (p = 0.017), subsequently cancer diagnoses (p < 0.003), sick leave (p = 0.007) and medication (p = 0.002) compared with patients with normal calcium concentrations. Men with elevated calcium concentrations had more contacts with the psychosocial team (p = 0.02) at the health care centre.

Conclusions

Elevated calcium concentrations are associated with significantly reduced quality of life and increased health care consumption and should therefore be an important warning flag that should alert the physician to further investigate and care for the patient. This is the first study in this field and the results need to be confirmed in further studies.

Sexual victimization using latent class analysis: exploring patterns and psycho-behavioral correlates

Sexual victimization is prevalent in the United States and overrepresented among adolescents. Research typically assesses victimization on a continuum of severity and rarely examines patterns of victimization within an individual. Using latent class analysis, the present study investigated whether meaningful classes of sexual victimization could be found based on the tactic used and severity of sexual behavior. Personal characteristics and psycho-behavioral outcomes were explored as they related to victimization classes. Peer sexual coercion experiences were examined among 657 racially diverse high school and college students, and four classes were identified: non-victims (54%), manipulated and forced fondle/intercourse (27%), poly-victimization (9.5%), and forced fondling (9.5%). Sexual victimization classes were significantly characterized in regards to childhood sexual abuse, gender, and age. The poly-victimization class (i.e., verbal coercion, substance facilitated, and physical force resulting in completed intercourse) showed the greatest level of psycho-behavioral consequences with significantly lower self-esteem, higher psychological distress, and more sexual risk taking than all other classes. The manipulated and forced class also showed significantly lower self-esteem than non-victims. Findings provide important implications for understanding patterns of sexual victimization and related consequences to help target interventions more effectively.

Psychological distress, cardiovascular complications and mortality among people with screen-detected type 2 diabetes: follow-up of the ADDITION-Denmark trial

AIMS/HYPOTHESIS

The aim of this study was to examine the association between psychological distress and the risk of cardiovascular disease (CVD) events and all-cause mortality in patients with screen-detected type 2 diabetes mellitus. In addition, we explored whether or not metabolic control and medication adherence could explain part of this association.

METHODS

A follow-up study was performed including 1,533 patients aged 40-69 years with screen-detected type 2 diabetes mellitus identified in general practice during 2001-2006 in the Denmark arm of the ADDITION (Anglo-Danish-Dutch Study of Intensive Treatment in People with Screen-Detected Diabetes in Primary Care) study. Mental health was measured at baseline with the Mental Health Inventory 5 (MHI-5). Psychological distress was defined as an MHI-5 score of ≤ 68 (18.2% of the population). CVD risk factors were measured at baseline and repeated at the follow-up examination. Information on death, hospital discharge diagnosis, and antihypertensive and lipid-lowering drug treatment was obtained from national registers. Cox proportional regression was used to estimate HRs for the association between psychological distress, CVD events and all-cause mortality. Age- and sex-adjusted risk difference analyses were performed to estimate differences in meeting treatment targets.

RESULTS

Patients with psychological distress had a 1.8-fold higher mortality rate (HR 1.76, 95% CI 1.23, 2.53) and a 1.7-fold higher risk of having a CVD event (HR: 1.69, 95% CI 1.05, 2.70) compared with those with an MHI-5 score of >68. Overall, psychological distress was not associated with the ability to meet treatment targets for HbA1c levels, cholesterol levels or BP, or to redeem antihypertensive or lipid-lowering drug treatment.

CONCLUSIONS/INTERPRETATION

In people detected and treated early in the diabetes disease trajectory, those with psychological distress at the time of diagnosis had a higher risk of CVD events and death than those without psychological distress.

The Influence of Religiosity and Spirituality on Psychological Well-Being Among Black Women

The influence of religiosity and spirituality on psychological well-being was examined among a sample of 167 Black American women in this web-based study. Findings suggest direct links between both religiosity and spirituality and psychological well-being. Moreover, results from bootstrapping procedures indicated that spirituality fully mediated the relation between religiosity and global mental health and between religiosity and life satisfaction. Implications of the findings are discussed.

Maternal relationship security as a moderator of home visiting impacts on maternal psychosocial functioning

There is variability in home visiting program impacts on the outcomes achieved by high risk families. An understanding of how effects vary among families is important for refining service targeting and content. The current study assessed whether and how maternal attributes, including relationship security, moderate short- and long-term home visiting impacts on maternal psychosocial functioning. In this multisite RCT of home visiting in a population-based, ethnically-diverse sample of families at risk for maltreatment of their newborns (n = 643), families were randomly assigned to home visited (HV) and control groups. HV families were to receive intensive services by trained paraprofessionals from birth-3 years. Outcome data were collected when children were 1, 2, and 3 years old and 7, 8, and 9 years old. Overall, short- and long-term outcomes for HV and control mothers did not differ significantly. Demographic attributes, a general measure of overall maternal risk, and partner violence did not moderate program impact on psychosocial functioning outcomes. Maternal relationship security did moderate program impact. Mothers who scored high on relationship anxiety but not on relationship avoidance showed the greatest benefits, particularly at the long-term follow-up. Mothers scoring high for both relationship anxiety and avoidance experienced some adverse consequences of home visiting. Further research is needed to determine mediating pathways and to inform and test ways to improve the targeting of home visiting and the tailoring of home visit service models to extend positive home visiting impacts to targeted families not benefiting from current models.

Use of the “Mental Health Inventory – 5” with Portuguese 10-15 Years Old

The present study describes the psychometric properties of the Portuguese version of the Mental Health Inventory-5 for use with young adolescents. A sample of 367 Portuguese students (aged 10-15 years) completed the Portuguese-language versions of Mental Health Inventory-5 (MHI-5; Berwick et al., 1991), Children's Hope Scale (CHS; Snyder et al., 1997), Students' Life Satisfaction Scale (SLSS; Huebner, 1991a), and Global Self-Worth Sub-scale (Harter, 1985). Analysis of readability, reliability (internal consistency and 1-year stability), factor structure, and criterion-related validity suggested that the MHI-5 can be appropriately used in this age group. Implications of the findings are discussed.

Relationship between birth spacing, child maltreatment, and child behavior and development outcomes among at-risk families

Prior research indicates that closely spaced births are associated with poor outcomes for the mother and subsequent child. Limited research has focused on outcomes for the index child (the child born immediately prior to a subsequent child in a birth interval). The objectives are to assess the association of short birth intervals in at-risk families with: (1) indicators of harsh and neglectful parenting behaviors towards the index child, including substantiated maltreatment reports across 6 years; and (2) the index child's behavior and development in first grade. This is a longitudinal study of 658 women screened to be at-risk for child maltreatment. Twenty percent of women had a rapid repeat birth (RRB), defined as the birth of a subsequent child within 24 months of the index child. Generalized estimating equations, survival analyses, and linear and logistic regression models were used to assess the associations between RRB and index child outcomes. Women with an RRB were more likely than those without an RRB to report neglectful parenting of the index child. Children of mothers with an RRB were more likely than children of mothers without an RRB to have more behavioral problems and lower cognitive functioning in first grade. This study is among the first to focus on the associations of birth spacing with maltreatment, behavior and development outcomes in the index child. Future work regarding the effects of birth spacing should include a focus on the index child.

Sexual Coercion Among Black and White Teenagers

The relations between type of sexual coercion (i.e., verbal, substance-facilitated, physical) and psychological and behavioral health were examined among Black ( n = 107) and White ( n = 114) young women. We also explored the moderating role of sexual stereotypes in understanding the relations between sexual coercion and health. Over half (53%) of the total sample reported experiencing at least one sexually coercive incident. Direct relations were found between sexual coercion type and psychological and behavioral health correlates. Specifically, for both Black and White young women, greater verbal coercion was related to increased risky sexual behaviors. Substance-facilitated sexual coercion was related to lower levels of two indicators of mental health among Black participants (i.e., psychological distress and self-esteem). Endorsement of sexual stereotypes moderated the relations between total sexual coercion experiences and self-esteem for Black young women and between total sexual coercion experiences and psychological distress for White young women.

Physical violence and health-related quality of life: Danish cross-sectional analyses

Background

The aim of this study was to evaluate the association between experienced physical violence and health-related quality of life (HRQoL) by comparing self-reported health status for individuals with and without experience of physical violence. Our hypothesis was that individuals exposed to violence would experience worse HRQoL than non-exposed individuals. We tested whether men and women and different age groups experience similar reductions in HRQoL, and the extent to which such differences might be associated with social circumstances and lifestyle conditions. Finally, we explored the HRQoL consequences of exposure to violence in a longer time perspective.

Methods

We used data from self-completed questionnaires in two Danish nationally representative, cross-sectional health interview surveys. Exposure to violence was indicated through specific survey questions (Straus’ conflict tactics scale) enquiring about different types of violence during the last 12 months. Health status of respondents was elicited by the EQ-5D and SF-36 questionnaires. The health status profiles were converted to health score indexes using the Danish algorithm for EQ-5D and the revised Brazier algorithm for SF-6D. Differences in score indexes between the exposed and non-exposed individuals were explored separately for men and women using ordinary least square regression with four age categories as explanatory variables.

Results

In the 2000 and 2005 surveys, respectively, 4.9% and 5.7% of respondents indicated that they had been exposed to physical violence within the last 12 months. Exposure to violence was more prevalent in the younger age groups and more prevalent for men than women. Respondents exposed to violence had lower score indexes on both the EQ-5D and the SF-6D compared with the non-exposed. Respondents who reported exposure to violence in both 2000 and 2005 reported lower HRQoL than individuals who only reported exposure in one of the surveys.

Conclusions

The results of this study provide evidence for an association between exposure to physical violence and reduction in health-related quality of life.

Patterns of Intimate Partner Violence in Mothers At-Risk for Child Maltreatment

Using three interviews spanning 3 years, we identified intimate partner violence (IPV) classes and determined how class membership changed over time amongst a sample of 217 mothers at-risk for child maltreatment that were enrolled in an early childhood home visitation evaluation study. Data on perpetration/victimization, IPV type (verbal, physical, and sexual abuse and injury) and severity were used to conduct latent class analyses at each time point. Latent transition analyses established the proportion of mothers who changed classes over time. A three-class solution (minimal, moderate, and high IPV) was indicated at each time point. All classes included mutual IPV. Partners used minor verbal abuse in the minimal class, minor and severe verbal abuse and minor physical abuse in the moderate class, and all IPV categories in the high class. At each transition, 40% or more moved from minimal to moderate or high IPV. This movement emphasizes the need to screen women frequently and develop interventions recognizing the dynamic nature of IPV.

Clinimetric properties of the Turkish translation of a modified neck disability index

Background

Neck pain is a common problem that can greatly affect a person's activities of daily living. Functional status questionnaires are important in assessing this effect, and are used to follow up neck pain management programs. The Neck Disability Index (NDI) is the first-created scale for neck pain-related disability and is widely translated and in common used in many countries. Our aim is investigate to clinometric properties of a Turkish version of modified NDI and to give a choice in daily practise of versions to be used.

Methods

The modified NDI was applied to 30 patients for reliability. 185 patients participated in the validity study. All patients were recruited from the outpatient clinic of our department. The scale was translated by the forward and backward translation procedure according to the COSMIN criteria. The test was repeated at 48 hours interval for reliability study. SPSS-10.0, software was used for statistical analyses. The Intraclass correlation coefficient was used for the test- retest reliability of the modified NDI. Cronbach α was used for internal consistency. Factor analysis was used for construct validity. The validity of the modified NDI with respect to the SF-36, HAD, VAS pain, VAS disability was assessed using Spearman correlations.

Results

The Intraclass correlation coefficient between first and second (within 48 hours) evaluation of test (rs) was 0.92. Questions 1,4,6,8,10 were shown to have excellent reliability. (rs > 0.9). Question 10 was the most frequently challenged question because "recreational and social activities" do not have not the same meanings in Turkey than in western countries. This required that detailed explanations be provided by the investigators. Cronbach's alpha for the total index was 0.88. A single factor accounting for 80.2% of the variance was obtained. Validity studies demonstrated good and moderate correlations (rs) among NDI, HAD, VAS, physical function subtitle of SF 36 (0.62, 0.76, 0.68).

Conclusions

The modified NDI-Turkish version is a reliable and valid test and is suitable for daily practise.

Course and prognosis of recovery for chronic non-specific low back pain: design, therapy program and baseline data of a prospective cohort study

BACKGROUND

There has been increasing focus on factors predicting the development of chronic musculoskeletal disorders. For patients already experiencing chronic non-specific low back pain it is also relevant to investigate which prognostic factors predict recovery. We present the design of a cohort study that aims to determine the course and prognostic factors for recovery in patients with chronic non-specific low back pain.

METHODS/DESIGN

All participating patients were recruited (Jan 2003-Dec 2008) from the same rehabilitation centre and were evaluated by means of (postal) questionnaires and physical examinations at baseline, during the 2-month therapy program, and at 5 and 12 months after start of therapy. The therapy protocol at the rehabilitation centre used a bio-psychosocial approach to stimulate patients to adopt adequate (movement) behaviour aimed at physical and functional recovery. The program is part of regular care and consists of 16 sessions of 3 hours each, over an 8-week period (in total 48 hours), followed by a 3-month self-management program. The primary outcomes are low back pain intensity, disability, quality of life, patient's global perceived effect of recovery, and participation in work. Baseline characteristics include information on socio-demographics, low back pain, employment status, and additional clinical items status such as fatigue, duration of activities, and fear of kinesiophobia. Prognostic variables are determined for recovery at short-term (5 months) and long-term (12 months) follow-up after start of therapy.

DISCUSSION

In a routine clinical setting it is important to provide patients suffering from chronic non-specific low back pain with adequate information about the prognosis of their complaint.

Risk factors for intimate partner violence initiation and persistence among high psychosocial risk Asian and Pacific Islander women in intact relationships

PURPOSE

The present study identifies risk factors for intimate partner violence (IPV) initiation and persistence over three years in a high psychosocial risk Asian American and Pacific Islander (AAPI) sample of women with children living in Hawaii.

METHODS

We included 378 women in a 3-year relationship with the same partner who reported IPV experiences at baseline and 3 years later. Baseline risk factors included characteristics of each woman, her partner, and their relationship. Bivariate and multivariate regression models were conducted to assess the influence of risk factors on the likelihood of experiencing IPV initiation and persistence.

FINDINGS

Of women who experienced no physical violence at baseline, 43% reported IPV initiation. Of women who did experience physical violence at baseline, 57% reported IPV persistence. Being unemployed and reporting poor mental health at baseline are important risk factors for experiencing IPV initiation. Reporting frequent physical violence at baseline increases the likelihood of experiencing IPV persistence. Asian women were significantly less likely to report IPV persistence than other groups of women.

CONCLUSIONS

Our study indicates that among a high psychosocial risk sample of AAPI women there are different risk factors for IPV initiation and persistence. Future prevention and screening efforts may need to focus on these risk factors.

Responsiveness of the QuickDASH and SF-12 in workers with neck or upper extremity musculoskeletal disorders: one-year follow-up

INTRODUCTION Questionnaires that measure functional status such as the Disability of the Arm, Shoulder and Hand (QuickDASH) and the Medical Outcomes Study 12-item Short-Form Health Survey (SF-12) can quantify the impact of health on performance. Little is known about whether these questionnaires can be used as a tool for measuring disabilities among workers. We compare the responsiveness of these two functional status questionnaires to changes in clinical outcomes of neck or upper extremity musculoskeletal disorders (UEMSD) among active workers in a longitudinal study. METHODS We evaluated the effect size (ES) and standardized response means (SRM) of the QuickDASH and the SF-12 for 148 workers who were divided into four subgroups based on the diagnosis status change between baseline and 1-year visit. RESULTS The ES and SRM for QuickDASH scores were 0.6/0.6 for the 50 subjects who became incident symptomatic neck or UEMSD cases, 1.3/1.0 for the 18 subjects who became incident clinical cases of neck or UEMSD, -1.0/-1.1 for the 46 subjects who recovered from having neck or UEMSD symptoms, and -1.1/-1.1 for the 34 subjects who recovered from being neck or UEMSD clinical cases. The correspondent ES/SRM for the QuickDASH work module were 0.4/0.3, 0.7/0.5, -0.6/-0.4, and -1.0/-0.8, respectively. The correspondent ES/SRM for the physical component scores of SF-12 (PCS12) for the four subgroups were 0.2/0.2, -0.9/-0.6, 0.3/0.2, and 0.3/0.3, respectively. CONCLUSIONS The QuickDASH scores were responsive to changes among active workers who were neck or UEMSD symptomatic or clinical case. PCS12 scores were sufficient only for use in clinical case status change.

Protecting the health of employees caring for family members with special health care needs

Over half of American workers are holding a paid job while also providing unpaid assistance and support to a family member. Research shows that family members who provide care to children or adults with special health care needs are themselves at risk of physical and mental health problems. Yet, little research has explored how the work environment mediates the effects of caregiving on caregivers' mental and physical health. With a sample of 2455 currently employed U.S. adults from the Work, Family, Community Nexus (WFCN) survey, a random-digit dial, nationally representative survey of Americans aged 18-69, we examine whether paid leave and flexibility policies mediate the relationship between caregiving and health. In Ordinary Least Squares regression models, we find that paid leave to address family members' health was associated with better mental health status as measured by the 5-item Mental Health Inventory and paid sick leave with better physical health status as measured by self-rated overall health status. A supportive supervisor was also associated with improvements in mental and physical health. For both men and women, paid leave and a supervisor's support offset some or all of the negative effects of caregiving, but for women, the buffering effects of working conditions are slightly larger. Enhancing the unpaid leave guaranteed in the U.S. Family and Medical Leave Act so that it is paid and passing national paid sick days legislation will help ensure that employed caregivers can retain their jobs, receive needed income, and meet their own mental and physical health needs.

Limitations of the Knee Society Score in evaluating outcomes following revision total knee arthroplasty

BACKGROUND

Traditionally, the results of revision total knee arthroplasty have been determined with use of surgeon-based measures such as the Knee Society rating system. Recently, outcome and quality-of-life measures have shifted toward a greater emphasis on patient-based evaluation. The aim of our study was to determine the validity and responsiveness of the Knee Society rating system compared with the Short Form-36 health survey (SF-36), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and a four-question 4-point Likert scale satisfaction questionnaire following revision total knee arthroplasty.

METHODS

A total of 152 patients underwent revision total knee arthroplasty at our institution, between August 2003 and January 2007, and had a two-year follow-up evaluation after revision surgery. The SF-36, WOMAC, Knee Society rating system, and satisfaction scores were completed preoperatively and postoperatively. Spearman correlation coefficients were calculated to determine the degree of correlation for each outcome scale. The SF-36, WOMAC, and patient satisfaction were correlated with the Knee Society rating system.

RESULTS

Both before and after surgery, the correlation among items of the Knee Society rating system displayed low to negligible levels of association. The Knee Society rating system pain score showed modest levels of convergent construct validity with the WOMAC and SF-36. However, the Knee Society functional score displayed negligible to low correlation with its WOMAC functional counterpart preoperatively. The Knee Society pain and functional scores, respectively, showed marked and moderate association with satisfaction. The change in the Knee Society pain and functional scores had moderate association with the SF-36 and WOMAC counterparts, except low correlation was displayed between the pain scores for the Knee Society rating system and the SF-36. The Knee Society rating system pain score was found to be the most responsive of the measures with a standardized response mean of 1.6, whereas the Knee Society rating system functional score was found to be the least responsive at 0.7.

CONCLUSIONS

Currently, there is no so-called gold standard that optimally reflects the status of the knee, as well as the patient, prior to and following revision total knee arthroplasty. Ideally, numerous assessment scales should be administered to the patient in order to accurately reflect the patient characteristics for the purpose of academic study, but from a practical standpoint, this may not be feasible. We encourage further research and development of a simple and concise standardized questionnaire for use before and after revision total knee arthroplasty.

A within-subject longitudinal study of the effects of positive job experiences and generalized workplace harassment on well-being

Drawing on the mobilization-minimization hypothesis, this research examines the influence of positive job experiences and generalized workplace harassment (GWH) on employee job stress and well-being over time, postulating declines in the adverse influence of GWH between Time 1 and 2 and less pronounced declines in the influence of positive job experiences over this same timeframe of approximately one year. A national sample of 1,167 workers polled via telephone at two time periods illustrates that negative job experiences weigh more heavily on mental health than do positive job experiences in the short-term. In the long-term, GWH's association with mental health and job stress was diminished. But its effects on job stress, and mental health, and physical health persist over one year, and, in the case of long-term mental health, GWH overshadows the positive mental health effects of positive job experiences. The research also argues for a reconceptualization of GWH and positive job experiences as formative latent variables on theoretical grounds.

Depression, coronary artery disease, type 2 diabetes, metabolic syndrome and quality of life in Taiwanese adults from a cardiovascular department of a major hospital in Southern Taiwan

AIMS

To examine the relationships between depression, coronary artery disease, type 2 diabetes, metabolic syndrome and quality of life in Taiwanese adults from a cardiovascular department of a major hospital in Taiwan.

BACKGROUND

Research suggests associations between depression, metabolic syndrome and quality of life. Despite this fact, few studies have investigated these relationships among Taiwanese.

DESIGN

A cross-sectional descriptive correlational design was used to conduct this study.

METHODS

A convenience sample of 140 adults participated in the study. Data were analysed with descriptive statistics, Pearson's correlations, hierarchical regression and t-tests.

RESULTS

Almost a half of the subjects (46.5%) had metabolic syndrome. The most common combination of metabolic syndrome criteria was elevated blood glucose, central obesity and high blood pressure (23.7%). A greater number of individuals had coronary artery disease (72.9%), type 2 diabetes (35%) and/or depression (21.4%). Type 2 diabetes and depression were significant predictors of overall quality of life (β = -0.16, p < 0.01 and β = -0.63, p < 0.001, respectively). In addition, there were significant differences between individuals with and without type 2 diabetes and/or depression regarding overall quality of life scores; t (138) = 3.50, p < 0.01); and t (138) = 7.80, p < 0.001), respectively.

CONCLUSIONS

Coronary artery disease, type 2 diabetes and depression were common among our sample of individuals with metabolic syndrome. Those with diabetes and/or depression had worse quality of life than those without those diseases.

RELEVANCE TO CLINICAL PRACTICE

Nurses need to be prepared to assess and intervene in preventing or treating depression among patients with chronic diseases, especially those with coronary artery disease, type 2 diabetes and metabolic syndrome. When individuals are treated for depression, they are more likely to engage in self-management of their diseases, which will prevent complications and improve their quality of life.

Forms of social support and their relationships to mental health in HIV-positive persons

A baseline assessment for an HIV health services study recruited 626 people living with HIV/AIDS (PLWHA) in New York city who participated in an interview querying social support, health status, substance use, and mental health. Data were modeled using hierarchical classes (HICLAS) analysis. HICLAS discriminated items reflecting general support and assistance vs. support from an important person in one's life who was named in addition to other family members and friends. HICLAS then identified respondents who reported that they had general support and assistance, support from an important person, both types, or neither type of support. Having one or more important persons as part of the respondent's social network was associated with more positive mental (but not physical) health than having only general support and assistance, or no support at all. Results argue for differentiating support obtained through one's relationship with an important person.

Relative effectiveness and adverse effects of cervical manipulation, mobilisation and the activator instrument in patients with sub-acute non-specific neck pain: results from a stopped randomised trial

BACKGROUND

Neck pain of a mechanical nature is a common complaint seen by practitioners of manual medicine, who use a multitude of methods to treat the condition. It is not known, however, if any of these methods are superior in treatment effectiveness. This trial was stopped due to poor recruitment. The purposes of this report are (1) to describe the trial protocol, (2) to report on the data obtained from subjects who completed the study, (3) to discuss the problems we encountered in conducting this study.

METHODS

A pragmatic randomised clinical trial was undertaken. Patients who met eligibility criteria were randomised into three groups. One group was treated using specific segmental high velocity low amplitude manipulation (diversified), another by specific segmental mobilisation, and a third group by the Activator instrument. All three groups were also treated for any myofascial distortions and given appropriate exercises and advice. Participants were treated six times over a three-week period or until they reported being pain free. The primary outcome measure for the study was Patient Global Impression of Change (PGIC); secondary outcome measures included the Short-Form Health Survey (SF-36v2), the neck Bournemouth Questionnaire, and the numerical rating scale for pain intensity. Participants also kept a diary of any pain medication taken and noted any perceived adverse effects of treatment. Outcomes were measured at four points: end of treatment, and 3, 6, and 12 months thereafter.

RESULTS

Between January 2007 and March 2008, 123 patients were assessed for eligibility, of these 47 were considered eligible, of which 16 were allocated to manipulation, 16 to the Activator instrument and 15 to the mobilisation group. Comparison between the groups on the PGIC adjusted for baseline covariants did not show a significant difference for any of the endpoints. Within group analyses for change from baseline to the 12-month follow up for secondary outcomes were significant for all groups on the Bournemouth Questionnaire and for pain, while the mobilisation group had a significant improvement on the PCS and MCS subscales of the SF-36v2. Finally, there were no moderate, severe, or long-lasting adverse effects reported by any participant in any group.

CONCLUSIONS

Although the small sample size must be taken into consideration, it appears that all three methods of treating mechanical neck pain had a long-term benefit for subacute neck pain, without moderate or serious adverse events associated with any of the treatment methods. There were difficulties in recruiting subjects to this trial. This pragmatic trial should be repeated with a larger sample size.

Television viewing by young Hispanic children: evidence of heterogeneity

OBJECTIVES

To determine if hours of daily television viewed by varying age groups of young children with Hispanic mothers differs by maternal language preference and to compare these differences with young children with white mothers.

DESIGN

Cross-sectional analysis of data collected in 2000 from the National Survey of Early Childhood Health.

SETTING

Nationally representative sample.

PARTICIPANTS

One thousand three hundred forty-seven mothers of children aged 4 to 35 months.

MAIN EXPOSURE

Subgroups of self-reported maternal race/ethnicity (white or Hispanic) and within Hispanic race/ethnicity, stratification by maternal language preference (English or Spanish).

OUTCOME MEASURE

Hours of daily television the child viewed.

RESULTS

Bivariate analyses showed that children of English- vs Spanish-speaking Hispanic mothers watched more television daily (1.88 vs 1.31 hours, P < .01). Multivariable regression analyses stratified by age revealed differences by age group. Among 4- to 11-month-old infants, those of English- and Spanish-speaking Hispanic mothers watched similar amounts. However, among children aged 12 to 23 and 24 to 35 months, those of English-speaking Hispanic mothers watched more television than children of Spanish-speaking Hispanic mothers (incidence rate ratio [IRR], 1.61; 95% confidence interval [CI], 1.17-2.22; IRR, 1.66; 95% CI, 1.10-2.51, respectively). Compared with children of white mothers, children of both Hispanic subgroups watched similar amounts among the 4- to 11-month-old group. However, among 12- to 23-month-old children, those of English-speaking Hispanic mothers watched more compared with children of white mothers (IRR, 1.57; 95% CI, 1.18-2.11). Among 24- to 35-month-old children, those of English-speaking Hispanic mothers watched similar amounts compared with children of white mothers, but children of Spanish-speaking Hispanic mothers watched less (IRR, 0.69; 95% CI, 0.50-0.95).

CONCLUSION

Television-viewing amounts among young children with Hispanic mothers vary by child age and maternal language preference, supporting the need to explore sociocultural factors that influence viewing in Hispanic children.

Reducing maternal intimate partner violence after the birth of a child: a randomized controlled trial of the Hawaii Healthy Start Home Visitation Program

OBJECTIVES

To estimate whether home visitation beginning after childbirth was associated with changes in average rates of mothers' intimate partner violence (IPV) victimization and perpetration as well as rates of specific IPV types (physical assault, verbal abuse, sexual assault, and injury) during the 3 years of program implementation and during 3 years of long-term follow-up.

DESIGN

Randomized controlled trial.

SETTING

Oahu, Hawaii.

PARTICIPANTS

Six hundred forty-three families with an infant at high risk for child maltreatment born between November 1994 and December 1995. Intervention Home visitors provided direct services and linked families to community resources. Home visits were to initially occur weekly and to continue for at least 3 years.

MAIN OUTCOME MEASURES

Women's self-reports of past-year IPV victimization and perpetration using the Conflict Tactics Scale. Blinded research staff conducted maternal interviews following the child's birth and annually when children were aged 1 to 3 years and then 7 to 9 years.

RESULTS

During program implementation, intervention mothers as compared with control mothers reported lower rates of IPV victimization (incidence rate ratio [IRR], 0.86; 95% confidence interval [CI], 0.73-1.01) and significantly lower rates of perpetration (IRR, 0.83; 95% CI, 0.72-0.96). Considering specific IPV types, intervention women reported significantly lower rates of physical assault victimization (IRR, 0.85; 95% CI, 0.71-1.00) and perpetration (IRR, 0.82; 95% CI, 0.70-0.96). During long-term follow-up, rates of overall IPV victimization and perpetration decreased, with nonsignificant between-group differences. Verbal abuse victimization rates (IRR, 1.14, 95% CI, 0.97-1.34) may have increased among intervention mothers.

CONCLUSION

Early-childhood home visitation may be a promising strategy for reducing IPV.

Outcomes after a decade of laparoscopic giant paraesophageal hernia repair

OBJECTIVE

Laparoscopic repair of giant paraesophageal hernia is a complex operation requiring significant laparoscopic expertise. Our objective was to compare our current approach and outcomes for laparoscopic repair of giant paraesophageal hernia with our previous experience.

METHODS

A retrospective review of patients undergoing nonemergency laparoscopic repair of giant paraesophageal hernia, stratified by early versus current era (January 1997-June 2003 and July 2003-June 2008), was performed. We evaluated clinical outcomes, barium esophagogram, and quality of life.

RESULTS

Laparoscopic repair of giant paraesophageal hernia was performed in 662 patients (median age 70 years, range 19-92 years) with a median percentage of herniated stomach of 70% (range 30%-100%). With time, use of Collis gastroplasty decreased (86% to 53%), as did crural mesh reinforcement (17% to 12%). Current era patients were 50% more likely to have a Charlson comorbidity index score greater than 3. Thirty-day mortality was 1.7% (11/662). Mortality and complication rates were stable with time, despite increasing comorbid disease in current era. Postoperative gastroesophageal reflux disease health-related quality of life scores were available for 489 patients (30-month median follow-up), with good to excellent results in 90% (438/489). Radiographic recurrence (15.7%) was not associated with symptom recurrence. Reoperation occurred in 3.2% (21/662).

CONCLUSIONS

With time, we have obtained significant minimally invasive experience and refined our approach to laparoscopic repair of giant paraesophageal hernia. Perioperative morbidity and mortality remain low, despite increased comorbid disease in the current era. Laparoscopic repair provided excellent patient satisfaction and symptom improvement, even with small radiographic recurrences. Reoperation rates were comparable to the best open series.

Examining the Relation Between Racial Identity Attitude Clusters and Psychological Health Outcomes in African American College Students

Using Cross’s expanded Nigrescence theory, this study examined the relation between patterns of racial identity attitudes and mental health outcomes among a sample of 317 Black American college students. Racial identity attitudes were operationalized using the Cross Racial Identity Scale, and the mental health outcomes assessed included subjective well-being, hardiness, and general psychological health. Results from a cluster analysis indicated a five-cluster solution (Low Race Salience, Multiculturalist, Self-Hatred, Immersion, and Afrocentric), which for the most part is consistent with previous research. In addition, differential associations were found between cluster groups and psychological health outcomes, where participants in the Multiculturalist cluster reported greater levels of psychological well-being and those in the Immersion cluster group reported the lowest levels. The implications for these findings with respect to future research are discussed.

The impact of psychosocial factors on neck pain and disability outcomes among primary care patients: Results from the UCLA Neck Pain Study

PURPOSE

The purpose of this study is to estimate the associations of psychosocial factors with pain and disability outcomes among neck-pain patients enrolled in a randomized clinical trial of chiropractic treatments.

METHODS

Neck-pain patients were randomized to one of 8 modes of chiropractic treatment. Health status and psychosocial variables were measured at baseline. Changes in neck pain severity and disability from baseline to 6 months were the primary outcome variables. Multivariable regression models were used to estimate effects of psychosocial variables adjusted for potential confounders.

RESULTS

Of 960 eligible patients, 336 were enrolled and 80% were followed up through 6 months. Coping strategies involving self-assurance resulted in better disability outcomes, whereas getting angry or frustrated resulted in worse pain and disability outcomes. Participants with high levels of social support from individuals were more likely to experience clinically meaningful reductions in pain and disability. No consistent relations of internal health locus of control, and physical and psychological job demands with improvements in pain and disability were detected.

CONCLUSIONS

We found some evidence that certain coping strategies and types of social support are associated with pain and disability outcomes in this population of largely subacute and chronic neck-pain patients.