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Context: The relationship between physical activity (PA) and fear of pain with movement (ie, kinesiophobia) during concussion recovery is unknown. Kinesiophobia may limit PA, while PA after concussion may reduce kinesiophobia. Our purpose was to examine the correlation between PA and self-reported kinesiophobia during concussion recovery for adolescents with and without persistent symptoms. Design: Prospective cohort study of children ages 10–18 years within 14 days of concussion. Methods: Participants rated kinesiophobia using the Tampa Scale of Kinesiophobia (TSK) at initial (≤14 d postconcussion) and return to play (RTP) assessments, and wore activity monitors between assessments. Our primary outcome was TSK score change from initial to RTP assessments. We grouped participants based on whether they experienced persistent symptoms (symptoms ≥28 days) or not (symptoms <28 days) and calculated correlation coefficients (Pearson r for normally distributed and Spearman rho for nonnormally distributed variables) between PA variables and TSK change scores. Results: Among the 41 participants enrolled, 44% developed persistent symptoms (n = 18; age = 14.5 [2.0] y; 50% female; symptom duration = 57.3 [6.2] d; RTP = 66.8 [6.4] d) and 56% did not (n = 23; age = 14.9 [1.8] y; 48% female; symptom duration = 15.2 [1.5] d; RTP = 21.7 [1.9] d). For the persistent symptoms group, greater TSK change scores (mean = −2.5 [5.7] point change) were significantly and moderately correlated with higher daily step count (r = −.60, P =.008) and exercise frequency (r = −.63, P =.005), but were not correlated with exercise duration (ρ = −.12, P =.65). Among the no persistent symptoms group, TSK change scores (mean = −6.0 [5.0] point change) were not correlated with step count (r = −.18, P =.41) or exercise duration (ρ =.10, P =.67), and the correlation with frequency was low and not significant (r = −.34, P =.12). Conclusions: Regular PA during concussion recovery, regardless of duration or intensity, may help reduce kinesiophobia for those experiencing persistent symptoms. [ABSTRACT FROM AUTHOR]

Sever's disease (calcaneal apophysitis) is a common condition in youth athletes, including those who participate in barefoot sports. Health care professionals often recommend that young athletes with Sever's disease wear heel cups in their shoes while active, but barefoot athletes are unable to use heel cups. To compare the efficacy of 2 braces used by barefoot athletes with Sever's disease. Randomized controlled clinical trial. Pediatric sports medicine clinic. A total of 43 barefoot athletes aged 7 to 14 years were enrolled, and 32 completed the study (age = 10.3 ± 1.6 years; 29 girls, 3 boys). Participants were randomized to the Tuli's Cheetah heel cup (n = 16) or Tuli's The X Brace (n = 16) group for use during barefoot sports over the 3-month study period. Participants completed self-reported assessments after diagnosis (baseline) and 1, 2, and 3 months later. The primary outcome was the Oxford Ankle Foot Questionnaire for Children (OxAFQ-C) physical score (3 months postenrollment). The secondary outcomes were OxAFQ-C school or play and emotional scores and the visual analog scale pain score. The percentage of time wearing the brace during barefoot sports was not different between the Cheetah heel cup and The X Brace groups (82% versus 64% of the time in sports; P =.08). At 3 months, we observed no differences for the OxAFQ-C physical (0.79 versus 0.71; P =.80; Hedges g = 0.06), school or play (0.94 versus 1.00; P =.58; Hedges g = 0.26), or emotional (1.00 versus 1.00; P =.85; Hedges g = 0.21) score. Visual analog scale pain scores during activities of daily living and sports were lower (better) at the 2- and 3-month time points than at baseline (P <.001). Both groups demonstrated improvements in ankle and foot function across time, but no between-groups differences were seen at 3 months. Given these results, barefoot athletes with Sever's disease may consider using either brace with barefoot activity to help improve pain and functional status. [ABSTRACT FROM AUTHOR]

Clinical reaction-time (RT) measures are frequently used when examining patients with concussion but do not correlate with functional movement RT. We developed the Standardized Assessment of RT (StART) to emulate the rapid cognitive demands and whole-body movement needed in sport. To assess StART differences across 6 cognitive-motor combinations, examine potential demographic and health history confounders, and provide preliminary reference data for healthy collegiate student-athletes. Prospective, cross-sectional study. Clinical medicine facilities. A total of 89 student-athletes (56 [62.9%] men, 33 [37.1%] women; age = 19.5 ± 0.9 years, height = 178.2 ± 21.7 cm, mass = 80.4 ± 24 kg; no concussion history = 64 [71.9%]). Student-athletes completed health history questionnaires and StART during preseason testing. The StART consisted of 3 movements (standing, single-legged balance, and cutting) under 2 cognitive states (single task and dual task [subtracting by 6's or 7's]) for 3 trials under each condition. The StART trials were calculated as milliseconds between penlight illumination and initial movement. We used a 3 × 2 repeated-measures analysis of variance with post hoc t tests and 95% CIs to assess StART cognitive and movement differences, conducted univariable linear regressions to examine StART performance associations, and reported StART performance as percentiles. All StART conditions differed (P ≤.03), except single-task standing versus single-task single-legged balance (P =.36). Every 1-year age increase was associated with an 18-millisecond (95% CI = 8, 27 milliseconds) slower single-task cutting RT (P <.001). Female athletes had slower single-task (15 milliseconds; 95% CI = 2, 28 milliseconds; P =.02) and dual-task (28 milliseconds; 95% CI = 2, 55 milliseconds; P =.03) standing RT than male athletes. No other demographic or health history factors were associated with any StART condition (P ≥.056). The StART outcomes were unique across each cognitive-motor combination, suggesting minimal subtest redundancy. Only age and sex were associated with select outcomes. The StART composite scores may minimize confounding factors, but future researchers should consider age and sex when providing normative data. [ABSTRACT FROM AUTHOR]

OBJECTIVES: To prospectively investigate the recovery of athlete-reported symptoms and the condition-specific health-related quality of life (HRQoL) following sport-related concussion. DESIGN: Prospective matched-cohort study. METHODS: We recruited amateur athletes who were diagnosed with sport-related concussion by emergency department physicians. Study participants were assessed at 3 time points following sport-related concussion. At each assessment, participants completed 5 condition-specific HRQoL patient-reported outcome measures to evaluate participants' perceptions of the effects of specific concussion-related symptoms on their HRQoL. We performed log-linear analyses to assess the proportion of concussed participants with clinically impaired condition-specific HRQoL compared with the proportion of participants in the control group with clinically impaired condition-specific HRQoL. RESULTS: Fifty participants with sport-related concussion and 50 control participants matched by sex, age, and activity completed the study. Upon return to sporting activity, there was a significantly greater proportion of participants in the concussion group who perceived that headache, neck pain, and dizziness had an adverse effect on their HRQoL compared with the control group. Two weeks after return to sporting activity, there was still a significantly greater proportion of participants in the concussion group who perceived that headache (χ²1 = 9.0; odds ratio [OR] = 4.4; 95% confidence interval [CI]: 1.5, 15.2; P = .003) and dizziness (χ²1 = 9.5; OR = 13.5; 95% CI: 1.8, 604.9; P = .006) had an adverse effect on their HRQoL compared with the proportion of clinically impaired participants in the control group. CONCLUSION: Of concussed participants, 1 in 4 perceived that headache and dizziness had adverse effects on their HRQoL after returning to sporting activity following sport-related concussion compared with nonconcussed, control participants. [ABSTRACT FROM AUTHOR]

Objective: To determine the test-retest correlation of an objective eye-tracking device among uninjured youth athletes. Design: Repeated-measures study. Setting: Sports-medicine clinic. Participants: Healthy youth athletes (mean age = 14.6 ± 2.2 years; 39% women) completed a brief, automated, and objective eye-tracking assessment. Independent variables: Participants completed the eye-tracking assessment at 2 different testing sessions. Main outcome measures: During the assessment, participants watched a 220-second video clip while it moved around a computer monitor in a clockwise direction as an eye tracker recorded eye movements. We obtained 13 eye movement outcome variables and assessed correlations between the assessments made at the 2 time points using Spearman's Rho (rs). Results: Thirty-one participants completed the eye-tracking evaluation at 2 time points [median = 7 (interquartile range = 6-9) days between tests]. No significant differences in outcomes were found between the 2 testing times. Several eye movement variables demonstrated moderate to moderately high test-retest reliability. Combined eye conjugacy metric (BOX score, rs = 0.529, P = 0.008), the variance of the ratio for both eye movements in the horizontal (rs = 0.497, P = 0.013) and vertical (rs = 0.446; P = 0.029) movement planes along the top/bottom of the computer screen, and the variance of the left and right eye movement along the bottom segment of the computer screen (rs = 0.565; P = 0.004) each demonstrated moderate between-test correlations. Conclusions: Automated and quantitative eye movement and conjugacy metrics provide relatively stable measurements among a group of healthy youth athletes. Thus, their inclusion as a visual tracking metric may be complementary to other visual examination techniques when monitoring concussion recovery across time. [ABSTRACT FROM AUTHOR]

Context: The tandem gait test is a method for assessing dynamic postural control and part of the Sport Concussion Assessment Tool, versions 3 and 5. However, its reliability among child and adolescent athletes has yet to be established. Objective: To examine the test-retest reliability of the single-task and dual-task tandem gait test among healthy child and adolescent athletes. Design: Descriptive laboratory study. Setting: Sports injury-prevention center. Patients or Other Participants: Uninjured and healthy athletes between the ages of 9 and 18 years. Intervention(s): Tandem gait measures repeated 3 times across the period of approximately 1 month. Main Outcome Measure(s): Participants completed the tandem gait test under single-task and dual-task (ie, while simultaneously executing a cognitive task) conditions. Our primary outcome measure was completion time during the single-task and dual-task conditions. We also assessed cognitive accuracy and response rate while participants completed the dual-task tandem gait test. Results: Thirty-two child and adolescent athletes completed the study (mean age = 14.3 ± 2.4 years; females = 16). Single- task tandem gait times were similar across the 3 testing sessions (14.4 ± 4.8, 13.5 ± 4.2, and 13.8 ± 4.8 seconds; P = .45). Dual-task tandem gait times steadily improved across the test timeline (18.6 ± 6.9, 16.6 ± 4.5, and 15.8 ± 4.7 seconds; P = .02). Bivariate correlations indicated moderately high to high agreement from test 1 to test 2 (single-task r= .627; dual-task r= 0.655) and from test 2 to test 3 (single-task r = 0.852; dual-task r = 0.775). Both the single-task (intraclass correlation coefficient; ICC [3,1] = 0.86; 95% confidence interval [CI] = 0.73, 0.93) and dual-task (ICC [3,1] = 0.84; 95% CI = 0.69, 0.92) conditions demonstrated high reliability across testing sessions. Conclusions: Tandem gait outcome measures demonstrat¬ed high test-retest reliability in both the single- and dual-task conditions. The overall reliability was within the acceptable range for clinical practice, but improvements across tests suggested a moderate practice effect. Tandem gait represents a reliable, dynamic, postural-control test that requires minimal space, cost, and time. [ABSTRACT FROM AUTHOR]

Context: Concussions affect a large number of US athletes each year. Returning an athlete to activity once selfreported symptoms have resolved can be problematic if unrecognized neurocognitive and balance deficits persist. Pairing cognitive and motor tasks or cognitive and quietstance tasks may allow clinicians to detect and monitor these changes postconcussion. Objective: To prospectively examine adolescent athletes' gait and quiet-stance performance while concurrently completing a cognitive task acutely after concussion and after symptom resolution. Design: Case-control study. Setting: Sport concussion clinic. Patients or Other Participants: Thirty-seven athletes (age = 1±.2 ± 3.1 years; 54% female) were diagnosed with a concussion, and their performance was compared with that of a group of 44 uninjured control participants (age = 15.0 ± 2.0 years; 57% female). Intervention: Participants diagnosed with a concussion completed a symptom inventory and single- and dual-task gait and quiet-stance evaluations within 21 days of injury and then again after symptom resolution. Gait and postural-control measurements were quantified using an inertial sensor system and analyzed using multivariate analyses of covariance. Main Outcome Measure(s): Post-Concussion Symptom Scale, single-task and dual-task gait measures, quiet-stance measures, and cognitive task performance. Results: At the initial postinjury examination, single-task gait stride length (1.1± ± 0.14 versus 1.25 ± 0.13 m, P = .003) and dual-task gait stride length (1.02 ± 0.13 m versus 1.10 ± 0.13 m, P = .011) for the concussion group compared with the control group, respectively, were shorter. After symptom resolution, no single-task gait differences were found, but the concussion group demonstrated slower gait velocity (0.78 ± 0.15 m/s versus 0.92 ± 0.14 m/s, P = .005), lower cadence (92.5 ± 12.2 steps/min versus 99.3 ± 7.8 steps/min, P , .001), and a shorter stride length (0.99 ± 0.15 m versus 1.10 ± 0.13 m, P = .003) during dual-task gait than the control group. No between-groups differences were detected during quiet stance at either time point. Conclusions: Acutely after concussion, single-task and dual-task stride-length alterations were present among youth athletes compared with a control group. Although single-task gait alterations were not detected after symptom resolution, dual-task gait differences persisted, suggesting that dual-task gait alterations may persist longer after concussion than singletask gait or objective quiet-stance alterations. Dual-task gait assessments may, therefore, be a useful component in monitoring concussion recovery after symptom resolution. [ABSTRACT FROM AUTHOR]

Aims To determine if urine C-peptide/creatinine ratio is a useful tool for monitoring β-cell function in new-onset Type 1 diabetes. Methods Data were obtained from a prospective immunomodulation study in people with Type 1 diabetes ≤ 3 months from diagnosis, with a standard mixed-meal tolerance test and measurement of urine C-peptide/creatinine ratio carried out at 0, 3, 6, 9 and 12 months. The change in the insulin-dose-adjusted HbA1c level was also correlated with the change in serum/urine C-peptide level during the 12-month follow-up period. Results A significant reduction in urine C-peptide/creatinine ratio, measured after a mixed-meal, was reached at 9 months (−45.4%), whilst the reduction in stimulated serum C-peptide level reached significance after 3 months (−54.7%) in placebo-treated participants. Neither change in stimulated serum C-peptide nor change in urine C-peptide level correlated with each other, and nor did change in insulin-dose-adjusted HbA1c level in the first 6 months, but all measures correlated significantly in the second half of the 12-month follow-up period. Conclusion Mixed-meal-stimulated urine C-peptide/creatinine ratio was similar to, although less sensitive than, stimulated serum C-peptide level in monitoring β-cell function during the first year after diagnosis. Because the former is significantly less invasive, it warrants inclusion in further studies in Type 1 diabetes and may represent an attractive alternative outcome measure in cohort studies and in children. [ABSTRACT FROM AUTHOR]

Recent work has identified deficits in dual-task gait balance control for up to 2 months after adolescent concussion; however, how resumption of preinjury physical activities affects recovery is unknown. Purpose: The objective of this study is to examine how return to activity (RTA) affects recovery from concussion on measures of symptom severity, cognition, and balance control during single-task and dual-task walking. Methods: Nineteen adolescents with concussion who returned to preinjury activity within 2 months after injury and 19 uninjured, matched controls completed symptom inventories, computerized cognitive testing, and single-task and dual-task gait analyses. Concussion participants were assessed at five time points: within 72 h, 1 wk, 2 wk, 1 month, and 2 months postinjury. Control participants were assessed at the same time points as their matched concussion counterparts. RTA day was documented as the postinjury day in which physical activity participation was allowed. The effect of returning to physical activity was assessed by examining the percent change on each dependent variable across time before and directly after the RTA. Data were analyzed by two-way mixed effects ANOVAs. Results: After the RTA day, concussion participants significantly increased their total center-of-mass medial/lateral displacement (P = 0.009, ƞp2 = .175) and peak velocity (P = 0.048, ƞp2 = 0.104) during dual-task walking when compared with pre-RTA data, whereas no changes for the concussion group or between groups were detected on measures of single-task walking, forward movement, or cognition. Conclusions: Adolescents with concussion displayed increased center-of-mass medial/lateral displacement and velocity during dual-task walking after RTA, suggesting a regression of recovery in gait balance control. This study reinforces the need for a multifaceted approach to concussion management and continued monitoring beyond the point of clinical recovery. [ABSTRACT FROM AUTHOR]

Background: Age has been described as a factor that affects recovery after concussion. The recommended management protocol is to treat adolescents in a more cautious manner than adults. However, few studies have prospectively and longitudinally assessed the way these age groups perform on motor tasks after concussion. Purpose: To examine dual-task gait balance control deficits after concussion in a group of adolescents and young adults in reference to matched control subjects within 72 hours of injury and throughout 2 months after injury. Study Design: Cohort study; Level of evidence, 2. Methods: Adolescents and young adults who sustained a concussion and individually matched controls completed a whole-body motion gait analysis while simultaneously performing a cognitive task. Subjects with concussion reported to the laboratory within 72 hours after injury and at the following time points: 1 week, 2 weeks, 1 month, and 2 months after injury. Control subjects completed the same protocol at similar time points. Gait balance control measurements included whole-body center-of-mass (COM) medial-lateral displacement/velocity and anterior velocity. Results: A total of 38 subjects with concussion, 19 young adults (mean ± SD age, 20.3 ± 2.4 years) and 19 adolescents (mean ± SD age, 15.1 ± 1.1 years), and 38 individually matched control subjects were tested. Within 72 hours of injury, adolescents displayed significantly greater COM medial-lateral displacement (P = .001) and peak velocity (P = .001) relative to their control group, and the young adult concussion group displayed significantly less peak COM anterior velocity than their control group (P = .01). Across the 2 months of testing, adolescents with concussion displayed significantly greater total COM medial-lateral displacement than did adolescent controls (P = .001), while young adults with concussion did not significantly differ from their matched controls (P = .07). Conclusion: An examination of gait balance control during dual-task walking revealed that after concussion, in reference to matched controls, adolescents demonstrated greater gait balance control deficits than did young adults initially and throughout the 2-month postinjury period, supporting the recommendation of conservative management for adolescents after concussion. [ABSTRACT FROM AUTHOR]

Primary objective: To evaluate excitability and inhibition of the motor cortex acutely and longitudinally following mild traumatic brain injury (mTBI). Research design: A longitudinal paired case-control design was used to examine cortical excitability and inhibition in 15 adults who had sustained an mTBI (mean age = 20.8 ± 1.2 years) and 15 matched control participants (mean age = 21.1 ± 1.3 years). Methods and procedures: Participants visited the lab within 72 hours of injury and again at 1, 2, 4 and 8 weeks post-injury. During each visit, transcranial magnetic stimulation was used to examine resting motor threshold (RMT), motor evoked potential peak-to-peak amplitude (MEPamp) and cortical silent period (CSP) duration of the first dorsal interosseous muscle. Main outcomes and results: There were no differences between groups in RMT ( p = 0.10) or MEPamp ( p = 0.22) at 72 hours post-injury or across the 2-month testing period ( p ≥ 0.68), indicating similar cortical excitability. However, the CSP duration was higher in individuals with mTBI, indicating greater intra-cortical inhibition compared with the control group at 72 hours post-injury ( p = 0.03) and throughout the 2 months of recovery ( p = 0.009). Conclusions: mTBI appeared to have little effect on cortical excitability, but an acute and long-lasting effect on intra-cortical inhibition. [ABSTRACT FROM AUTHOR]

In spite of the experiential advantage, people consume material items in the pursuit of happiness. We conducted three studies to determine if people commit forecasting errors when deciding between purchasing life experiences and material items. Study 1a showed that people expect life experiences to result in more well-being, whereas material items are forecasted to be a better use of money. However, Study 1b demonstrated that people enjoy greater well-being from life experiencesandconsider them to be a better use of money. Study 2, a four-week longitudinal study, corroborated this economic misforecast. Study 3 demonstrated that seeking to make good use of one’s money, compared to prioritizing happiness, is more important during material consumption, and when people attempt to maximize economic value, instead of their happiness, they are more likely to consume material items. We suggest that prioritizing value may encourage people to prefer material items instead of life experiences. [ABSTRACT FROM PUBLISHER]

Background: Head trauma in adolescents has been linked with deficits in attention and executive function that can compromise the performance of everyday tasks. Although previous research has examined this issue using computerized neuropsychological testing, little work has been done using laboratory-based measurements of attention and executive function in this population. A longitudinal analysis of recovery patterns of these measures among adolescents is central to understanding the effects of concussions across the age spectrum. Purpose: This study prospectively and longitudinally examined laboratory-based measures of attention and executive function in concussed adolescents sequentially during a 2-month period after injury. Methods: Two measures of attention and executive function, the Attentional Network Test and the Task-Switching Test, were administered to 20 concussed adolescents within 72 h post-injury as well as at 1 wk, 2 wk, 1 month, and 2 months post-injury. Twenty healthy, matched control subjects were similarly assessed at the same time intervals. Data were analyzed by two-way, mixed-effects ANOVA to determine the effect of group and time on the dependent variables. Results: Compared with control subjects, the concussed group exhibited a significantly greater switch cost on the Task-Switching Test (P = 0.038, mean difference value = 38 ms) and a significantly greater reaction time for the Attentional Network Test conflict effect component (P = 0.015, mean difference value = 34 ms) for up to 2 months after injury. Conclusions: Concussed adolescents have difficulty recovering executive function after injury and may require extended recuperation time before full recovery is achieved. Evaluations focusing on attention and executive function can be useful additions in the assessment and follow-up after head injury. [ABSTRACT FROM AUTHOR]

Objectives To identify factors associated with failure to follow up with a general practitioner ( GP) after discharge from the ED or emergency medicine unit ( EMU). Methods This prospective cohort study enrolled adult patients discharged from the ED who were requested to see their GP to complete their medical care. Participants were contacted by phone after 2 weeks to determine GP follow-up status. Variables associated with failure to follow up were determined using multivariate logistic regression. Results Of 247 participants enrolled, 217 had complete outcome data. After controlling for the confounding effect of other variables, four variables remained significantly associated with follow-up status. Compared with participants who did follow up, those who failed to follow up were less likely to have an EMU admission ( OR 0.46, 95% CI 0.22-0.93, P < 0.03), a regular GP ( OR 0.16, 95% CI 0.08-0.35, P < 0.001), health insurance ( OR 0.41, 95% CI 0.20-0.82, P < 0.01) or awareness of the reason why they were supposed to follow up ( OR 0.25, 95% CI 0.11-0.54, P < 0.001). The most common reason for failure to follow up (65%) was that the participant did not consider it necessary. Conclusion Participants who were aware of the reason for follow up with a GP, who were admitted to EMU, had health insurance or had a regular GP were more likely to comply with follow-up advice. This highlights that good patient communication is important for successful follow up, and that alternative avenues for completion of management need to be explored for patients without health insurance or a regular GP. [ABSTRACT FROM AUTHOR]

Primary objective: To verify criterion validity of measures from a functional cognitive task (FCT) carried out with patients with severe traumatic brain injury (sTBI) at 2-5 years post-injury. Methods and procedures: Forty-six patients with sTBI took part in a long-term outcome study where the FCT and the Neurobehavioural Rating Scale-Revised (NBRS-R) were administered and the FIM™ instrument was rated. The FCT is a telephone information gathering task for evaluating functional cognitive skills. Results: Ten of 16 measures of the FCT were significantly correlated with similar or related concepts from the NBRS-R. The FIM™ cognitive score and the individual items of this score were significantly correlated with 13 of the FCT measures and with the percentage of amount of information gathered. Internal consistency was good for 13 of 16 measures. Overall, patients generally had mild difficulty on the FCT concepts. Conclusion: The FCT can be used with patients with sTBI to evaluate certain aspects of functional cognition. It has good criterion validity and internal consistency, but additional research is required to further measure reliability and its applicability to other severity of TBI and to other phases of recovery. [ABSTRACT FROM AUTHOR]

Purpose: To explore changes in daily activities associated with high-intensity volunteering, this study assessed activities in a sample of 180 new Experience Corps (EC) volunteers serving low reading students in urban schools.Methods: Level of activity in 15 areas (visiting friends, reading, watching TV, etc.) was obtained at the beginning of this high-commitment volunteer experience and after 9 months of service. Latent class analyses were used to identify activity patterns, and regression analyses were used to identify factors associated with changes in activities.Results: At pre-test, 37% were classified in the low-activity group and were more likely to be first time volunteers, older, non-White, and have less education. At post-test, only 17% were classified as low activity. An increase in activity was more likely to occur for those who were low activity before joining the volunteer program.Implications: These findings demonstrate that increase in activity does occur for less active older adults who join a volunteer program. [ABSTRACT FROM PUBLISHER]

Factors that may contribute to preschool-aged children’s appraisals of their parent’s violent conflicts in families experiencing recent intimate partner violence (IPV) were evaluated for 116 mother–child dyads. Mothers and children were interviewed using empirically-validated measures to assess level of violence, maternal and child mental health, and children’s appraisals of conflict. Results suggest that preschool-aged children are able to meaningfully respond to statements about their parents’ conflicts. Both mothers’ and children’s reports of violence were significantly associated with children’s appraisals of Threat, but not with appraisals of Self-blame. Girls reported significantly higher levels of Self-blame than did boys. Children’s cognitive appraisals of Threat and Self-blame did not vary by age or ethnicity. These findings suggest that interventions designed for young children might specifically target their cognitive appraisals to help them regulate their feelings of being threatened and to provide for their safety. [ABSTRACT FROM AUTHOR]

In observational studies on cancer patients, progression of performance status over time can be described by using a multistate model in which state-to-state transitions represent changes in a patient's health condition. Although a patient experiences transitions in continuous time, assessments on the patient are often made at irregularly spaced time points. In this paper, the authors formulate a Markov 4-state model for examining longitudinal data on performance status collected under intermittent observation. The cohort consisted of 11,342 patients diagnosed with cancer in Ontario, Canada, from 2007 to 2009. The authors extend the model to estimate the predicted probability of reaching the absorbing state, death, over various time intervals. The authors also illustrate what happens to the estimated transition intensities if the true observational scheme is overlooked. Methods for multistate analysis should be used by epidemiologists, since they prove particularly useful for examining the complexities of disease processes. [ABSTRACT FROM PUBLISHER]

Objectives: An important challenge faced by emergency physicians (EPs) is determining which patients should be admitted to an intensive care unit (ICU) and which can be safely admitted to a regular ward. Understanding risk factors leading to undertriage would be useful, but these factors are not well characterized. Methods: The authors performed a secondary analysis of two prospective, observational studies of patients admitted to the hospital with clinically suspected infection from an urban university emergency department (ED). Inclusion criteria were as follows: adult ED patient (age 18 years or older), ward admission, and suspected infection. The primary outcome was transfer to an ICU within 48 hours of admission. Using multiple logistic regression, independent predictors of early ICU transfer were identified, and the area under the curve for the model was calculated. Results: Of 5,365 subjects, 93 (1.7%) were transferred to an ICU within 48 hours. Independent predictors of ICU transfer included respiratory compromise (odds ratio [OR] = 2.5, 95% confidence interval [CI] = 1.4 to 4.3), congestive heart failure (CHF; OR = 2.2, 95% CI = 1.4 to 3.6), peripheral vascular disease (OR = 2.0, 95% CI = 1.1 to 3.7), systolic blood pressure (sBP) < 100 mm Hg (OR = 1.9, 95% CI = 1.2 to 2.9), heart rate > 90 beats/min (OR = 1.8, 95% CI = 1.1 to 2.8), and creatinine > 2.0 (OR = 1.8, 95% CI = 1.1 to 2.8). Cellulitis was associated with a lower likelihood of ICU transfer (OR = 0.33, 95% CI = 0.15 to 0.72). The area under the curve for the model was 0.73, showing moderate discriminatory ability. Conclusions: In this preliminary study, independent predictors of ICU transfer within 48 hours of admission were identified. While somewhat intuitive, physicians should consider these factors when determining patient disposition. ACADEMIC EMERGENCY MEDICINE 2010; 17:1080-1085 © 2010 by the Society for Academic Emergency Medicine [ABSTRACT FROM AUTHOR]