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Purpose Measuring self-management behaviors in adolescents and young adults with chronic health conditions has become a priority in health care, yet there is a paucity of instruments that capture these behaviors. The purpose of this psychometric study was to evaluate the reliability and validity of the 17-item generic Adolescent/Young Adult Self-Management and Independence Scale II (AMIS II). Method Data were collected from 201 adolescents/young adults (AYA) with spina bifida and 129 of their parents. Exploratory factor analysis, confirmatory factor analysis, Cronbach alpha, frequencies, Pearson correlations, and intraclass correlations were used to evaluate the data. Results The exploratory factor analysis of parent data supported two related self-management factors (Condition Self-Management and Independent Living Self-Management). Confirmatory factor analysis of AYA data confirmed these two factors and an overall scale with good fit statistics (GFI and CFI = 0.86-0.95; RMSEA = 0.057). Internal reliabilities ranged from α= 0.72-0.89. Intraclass correlation analysis supported the stability of the instrument (ICC parent report = 0.82, AYA report = 0.84). Concurrent validity was supported with low to moderate correlations to six related but distinct variables. Conclusion Psychometric analysis supports this expanded measure of self-management for AYA with spina bifida. Evaluation of this instrument in AYA with other chronic health conditions is underway.

Background and Objective In previous studies, we showed that irradiation with 405 nm or 470 nm light suppresses up to 92% methicillin-resistant Staphylococcus aureus (MRSA) growth in vitro and that the remaining bacteria re-colonize. In this study, the aim was to develop a protocol that yields 100% MRSA growth suppression. Materials and Methods We cultured 3 × 106 and 5 × 106 CFU/ml USA300 strain of MRSA and then irradiated each plate with varying fluences of 1–60 J/cm2 of 405 nm or 470 nm light, either once or twice at 6 hours intervals. Next, we plated 7 × 106 CFU/ml and irradiated it with 45, 50, 55, or 60 J/cm2 fluence, once, twice, or thrice at the same 6 hours intervals. In a third experiment, the same culture density was irradiated with 0, 165, 180, 220, or 240 J/cm2, either once, twice, or thrice. Results Irradiation with either wavelength significantly reduced the bacterial colonies regardless of bacterial density (P

Background:Increasing physical activity (PA) levels in older adults represents an important public health challenge. The purpose of this study was to evaluate the feasibility of combining individualized motivational messaging with pedometer walking step targets to increase PA in previously inactive and insufficiently active older adults.Methods:In this 12-week intervention study older adults were randomized to 1 of 4 study arms: Group 1—control; Group 2—pedometer 10,000 step goal; Group 3—pedometer step goal plus individualized motivational feedback; or Group 4—everything in Group 3 augmented with biweekly telephone feedback.Results:81 participants were randomized into the study, 61 participants completed the study with an average age of 63.8 ± 6.0 years. Group 1 did not differ in accumulated steps/day following the 12-week intervention compared with participants in Group 2. Participants in Groups 3 and 4 took on average 2159 (P < .001) and 2488 (P < .001) more steps/day, respectively, than those in Group 1 after the 12-week intervention.Conclusion:In this 12-week pilot randomized control trial, a pedometer feedback intervention partnered with individually matched motivational messaging was an effective intervention strategy to significantly increase PA behavior in previously inactive and insufficiently active older adults.

The purpose of this study was to investigate the effect of wavelength and methicillin-resistant Staphylococcus aureus (MRSA) density on the bactericidal effect of 405 and 470 nm light.It is recognized that 405 and 470 nm light-emitting diode (LED) light kill MRSA in standard 5 × 10(6) colony-forming units (CFU)/mL cultures; however, the effect of bacterial density on the bactericidal effect of each wavelength is not known.In three experiments, we cultured and plated US300 MRSA at four densities. Then, we irradiated each plate once with either wavelength at 0, 1, 3, 45, 50, 55, 60, and 220 J/cm(2).Irradiation with either wavelength reduced bacterial colonies at each density (p0.05). More bacteria were cleared as density increased; however, the proportion of colonies cleared, inversely decreased as density increased--the maximum being 100%, 96%, and 78% for 3 × 10(6), 5 × 10(6), and 7 × 10(6) CFU/mL cultures, respectively. Both wavelengths had similar effects on the sparser 3 × 10(6) and 5 × 10(6) CFU/mL cultures, but in the denser 7 × 10(6) CFU/mL culture, 405 nm light cleared more bacteria at each fluence (p0.001). To determine the effect of beam penetration, denser 8 × 10(6) and 12 × 10(6) CFU/mL culture plates were irradiated either from the top, the bottom, or both directions. More colonies were eradicated from plates irradiated from top and bottom, than from plates irradiated from top or bottom at the same sum total fluences (p0.001).The bactericidal effect of LED blue light is limited more by light penetration of bacterial layers than by bacterial density per se.

Purpose To determine whether a pressure ulcer prevention bundle was associated with a significant reduction in pressure ulcer development in infants in the pediatric intensive care unit. Design and Methods Quasi-experimental design involving 399 infants 0 to 3 months of age at a large tertiary care medical center. Results The implementation of the care bundle was associated with a significant drop in pressure ulcer incidence from 18.8 to 6.8%. Practice Implications Pressure ulcers can be prevented in the most vulnerable patients with the consistent implementation of evidence-based interventions and system supports to assist nurses with the change in practice.

Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disease involving nerve cells that control voluntary muscle movement (Rowland LP, Shneider NA, N Engl J Med 344(22):1688-1700, 2001). The aim of this study were to determine the pattern of neurodegenerative change in (1) isometric tongue strength (ITS) and spontaneous saliva swallow (SSS) pressure, (2) saliva weight, and (3) forced vital capacity (FVC) in patients with ALS who present with primary spinal versus primary bulbar symptoms. Twenty-three consecutive patients (age = 48-80 years, mean = 59.5 years) were enrolled. Data were collected over three visits (12-week interval) for each group: 9 patients with bulbar symptoms and 14 with spinal symptoms. A significant difference was noted in SSS and ITS in the group with bulbar symptoms from Trial 1 to II and from Trial II to III. SSS and ITS showed a significant difference when comparing Trial I to III but not when comparing Trial I to II for the spinal symptom group, indicating that this group experienced a slower decline in SSS. Saliva production did not show a significant change in the bulbar symptom group but did in the spinal group. FVC was significantly different when comparing Trial I to III and Trial II to III for both groups. FVC, SSS, and ITS may be complimentary measures used as a gauge of an ALS patient's ability to efficiently take oral nutrition and to support required alterations in diet consistency.

Increasingly, children spend much of their day in the care of adults other than their parents, such as child care providers. Consequently, it is important to analyze nonparental adults’ use of strategies suggested to foster language development, such as contingent responsiveness, during interactions with young children. This study examined child caregivers’ contingent responsiveness behaviors that followed toddlers’ communicative attempts within unstructured, semistructured, and structured daycare contexts. Child caregiver behaviors were coded as (a) no response (appropriate), (b) no response (inappropriate), (c) noncontingent response (appropriate), (d) noncontingent response (inappropriate), (e) contingent response and termination of the interaction (appropriate), (f) contingent response and termination of the interaction (inappropriate), and (g) contingent response leading to maintenance of the communicative interaction. Important similarities and differences in child caregivers’ contingent responsiveness behaviors for the three contexts suggest a need to prepare child caregivers to use strategies such as contingent responsiveness across contexts to facilitate language development.

Objective: The purpose of this secondary analysis was to examine if play styles used by mothers when their infants are 6 months or older are exhibited by mothers who play with their 3–4 month old infants.Method: Sixteen healthy, mostly Caucasian, maternal-infant dyads participated in a repeated measures design study that consisted of two, 3-minute play episodes separated by an interval ranging from 2 to 10 minutes in length. Digital video recordings of the first and second play episodes were analyzed and coded using three specific play styles cited in the literature (attention-supporting, attention-directing and control play). Duration of time spent in each play style was determined and descriptive statistics were used to summarize the percentage of time the mothers exhibited each style across the two play episodes. Dependent t-tests were used to examine differences in the amount of time spent in each play style across episode one and two.Results: Mothers exhibited attention-supporting play for the longes...

Accessibility of early intervention program literature was examined through readability analysis of documents given to families who have a child served by the Birth to 3 program. Nine agencies that serve families in Birth to 3 programs located in a county in the Midwest provided the ( n = 94) documents. Documents were included in the analysis if they conveyed information about the nature of the program, the financial obligations of the family, intervention planning, and programmatic consent. The analysis indicated that a majority of the documents were written above the recommended fifth-grade reading level. Action steps to improve the accessibility of early intervention documents are discussed.

This study examined objectively determined walking profiles of older adults across a wide range of sociocultural backgrounds. All individuals (N = 415; 131 men age 70.5 ± 9.2 yr and 284 women age 71.5 ± 9.0 yr) underwent physiological measurements, completed pen-and-paper surveys, and wore a pedometer for 7 consecutive days. The total sample accumulated a mean of 3,987 ± 2,680 steps/day. Age (r = –.485, p < .001) and body-mass index (BMI; r = –.353, p < .001) were negatively associated with steps per day. Multivariate analysis revealed that race/ethnic category (F = 3.15, df = 3), gender (F = 2.46, df = 1), BMI (F = 6.23, df = 2), income (F = 9.86, df = 1), education (F = 43.3, df = 1), and retirement status (F = 52.3, df = 1) were significantly associated with steps per day. Collectively these categories accounted for 56% of the variance in walking activity in this independently living, community-dwelling older adult sample. Sedentary characteristics highlighted within, and step-per-day values specific to, older adults have implications for planning targeted physical activity interventions related to walking activity in this population.

Knowledge of cross-informant rating concordance is critical for the assessment of child and adolescent problems in clinical and research settings. We explored parent-youth rating concordance for hair pulling variables, functional impairment, and anxiety symptoms in a sample of child and adolescent hair pullers (n = 133) satisfying conservative diagnostic criteria for trichotillomania (TTM). Whole group analyses reveal significant parent-youth agreement on all study variables. Split group analyses, however, reveal superior parent-youth concordance for the adolescent (15–17 years old) versus younger (10–12 years old) hair pullers for awareness of hair pulling and anxiety scale scores. These results highlight the need for both parent and youth ratings when assessing younger children with TTM.

This article describes the development and initial psychometric properties of the Milwaukee Inventory for Styles of Trichotillomania-Child Version (MIST-C), a self-report scale designed to assess styles of hair pulling in children and adolescents diagnosed with trichotillomania (TTM). Using Internet sampling procedures, the authors recruited 164 parent–child dyads, the children of whom met modified diagnostic criteria for TTM. The MIST-C was administered in the context of a larger survey examining functional impairment experienced by children with TTM. Results of an exploratory factor analysis on MIST-C items revealed a two-factor solution. Factors 1 (“focused” pulling scale) and 2 (“automatic” pulling scale) consisted of 21 and 4 items, respectively, with both scales demonstrating acceptable internal consistency and good construct and discriminant validity. The development of the MIST-C provides researchers with a reliable and valid assessment of “automatic” and “focused” pulling, and provides a means by which to examine the developmental trajectory and treatment implications of these pulling styles.

Background: Although walking is the most commonly reported physical activity by older adults, there is a paucity of data determining the relationship between objectively determined walking behavior and glucose dynamics in older adults. Objective: This study was designed to investigate the relationship between objectively determined walking behavior and glucose control in a multiethnic sample of older adults. Methods: Data were collected on 142 older adults (age 72.1 ± 9.2 years; body mass index (BMI) 29.4 ± 6.3; 37 males, 105 females). Anthropometric measures, fasting plasma glucose (FG), and glycosylated hemoglobin A1c (HbA1c) were assessed; race/ethnicity was self-reported. The study participants wore a pedometer for 7 consecutive days. Results: The average number of steps/day reported by the entire group was 3,939 ± 232. White participants (n = 48) were older (p = 0.019), taller (p = 0.002), had lower waist circumference (WC) (p = 0.021), HbA1c (p = 0.001) and FG (p = 0.007), and did not differ in average steps/day (p = 0.162) or BMI (p = 0.280) as compared with nonwhite participants (n = 94). Individuals with HbA1c values 1c and/or FG values. Age, race/ethnicity, WC, BMI, log base 10 of steps/days, and type 1 and 2 diabetes medications accounted for 37.5% of the variance in inverse HbA1c (p < 0.001), with significant or near significant individual model contributions consisting of WC (beta = –0.316, B = –0.001, SE = 0.000, p = 0.047), BMI (beta = 0.310, B = 0.001, SE = 0.001, p = 0.050), diabetic medication (beta = –0.473, B = –0.035, SE = 0.006, p < 0.001), and log base 10 of steps/day (beta = 0.198, B = 0.019, SE = 0.010, p = 0.056). Interpretations of transformed data illustrate that greater WC and being on diabetic medications are associated with higher HbA1c levels. Further, there is a trend to suggest that fewer accumulated steps/day and lower BMI are associated with higher HbA1c concentrations. Conclusions: This study demonstrated that objectively determined walking behavior and indicators of obesity were modest predictors of chronic glucose control, after accounting for glucose-altering medications, in this multicultural sample of older adults. Further, when comparing individuals with good glucose control to those with less favorable glucose control, walking an additional 0.5–0.75 miles was associated with better glucose control.

The purpose of the present study is to investigate evidence of the validity of Survey of Attitudes Toward Statistics Scale (SATS) scores and their relationship with scores from two other measures of attitudes toward statistics, the Attitude Toward Statistics Scale (ATS) and the Statistics Attitude Survey. The pre- and postcourse responses of 342 graduate and undergraduate students enrolled in inferential statistics courses at a large midwestern university were analyzed. Internal consistency reliability estimates were greater than .90 for total scores and greater than .70 for subscale scores for all instruments. Regression analyses confirmed the importance of SATS subscale scores over and above demographic variables in a theoretical model predicting statistics course achievement. Factor analyses suggested that both the ATS and the SATS have two domains, which is contrary to the four-factor solution proposed by the developers of the SATS.

This report describes patterns of cigarette smoking and interest in smoking cessation programs among employees in a public worksite (n = 6,000) and a private worksite (n = 14,000). Of the 622 employees who attended an employee assistance program (EAP) orientation, 110 (18%) were current smokers. A significantly greater proportion of public employees smoked cigarettes, smoked more heavily, and evaluated their health more poorly compared to private employees. Smokers in both sites were over-represented in unskilled positions. Regardless of worksite, respondents who smoked had similar desires to quit or cut down and were annoyed by the comments of others, felt guilty about smoking, awakened with a desire to smoke, and felt they had a smoking problem. Overall, more than one third of individuals were interested in joining a smoking cessation program. Occupational health nurses may use these findings to design and implement smoking cessation interventions in their workplaces.

The authors report on the development and assessment of an instrument to measure baseline campus cigarette use and outcomes from prevention programs, including those using a social norms approach combined with environmental policy change. They administered the 37-item College Tobacco Survey (CTS) to a convenience sample of 1,279 college students in freshmen-level classes at a large urban university. Factor analysis of 15 belief items revealed 3 factors: Peer Environment, Personal Effects, and Campus Policy Endorsement. The findings support the survey's reliability and validity. The authors discuss potential uses of the survey in terms of social norms and environmental prevention programs.

Racine, Wisconsin, located on Lake Michigan, experiences frequent recreational water quality advisories in the absence of any identifiable point source of pollution. This research examines the environmental distribution of Escherichia coli in conjunction with the assessment of additional parameters (rainfall, turbidity, wave height, wind direction, wind speed and algal presence) in order to determine the most probable factors that influence E. coli levels in surface waters. Densities of E. coli were highest in core samples taken from foreshore sands, often exceeding an order of magnitude greater than those collected from submerged sands and water. Simple regression and multivariate analyses conducted on supplementary environmental data indicate that the previous day's E. coli concentration in conjunction with wave height is significantly predictive for present-time E. coli concentration. Genetic fingerprinting using repetitive element anchored PCR and cellular fatty acid analysis were employed to assess the presence of clonal isolates which indicate replication from a common parent cell. There were relatively few occurrences of clonal patterns in isolates collected from water, foreshore and submerged sands, suggesting that accumulation of E. coli, rather than environmental replication, was occurring in this system. Non-point source pollution, namely transport of accumulated E. coli from foreshore sands to surface waters via wave action, was found to be a major contributor to poor recreational water quality at the Lake Michigan beaches involved in this study.

Objective We explored the factor structure of the Massachusetts General Hospital Hairpulling Scale (MGH-HPS), a self-report measure for trichotillomania (TTM). Methods Self-reported hairpullers who responded to an Internet-based survey ( N =990) completed the MGH-HPS, demographic items, and other survey instruments. Principal axis exploratory factor analysis with Promax rotation of scores was conducted. Results A two-factor solution was revealed, with “Severity” and “Resistance and Control” as separate factors. Conclusion The MGH-HPS consists of two separate factors. Factor scores can be utilized to track naturalistic TTM symptom changes, improve patient characterization and treatment matching, and clarify the timing and mechanism of action for different treatment modalities.

To determine whether a pressure ulcer prevention bundle was associated with a significant reduction in pressure ulcer development in infants in the pediatric intensive care unit.Quasi-experimental design involving 399 infants 0 to 3 months of age at a large tertiary care medical center.The implementation of the care bundle was associated with a significant drop in pressure ulcer incidence from 18.8 to 6.8%.Pressure ulcers can be prevented in the most vulnerable patients with the consistent implementation of evidence-based interventions and system supports to assist nurses with the change in practice.

Background:To examine the effectiveness of the American College of Sports Medicine (ACSM) and the American Heart Association (AHA) resistance training (RT) guidelines to improve physical function and functional classification in older adults with reduced physical abilities.Methods:Twenty-five at-risk older adults were randomized to a control (CON = 13) or 8-week resistance training intervention arm (RT = 12). Progressive RT included 8 exercises for 1 set of 10 repetitions at a perceived exertion of 5–6 performed twice a week. Individuals were assessed for physical function and functional classification change (low, moderate or high) by the short physical performance battery (SPPB) and muscle strength measures.Results:Postintervention, significant differences were found between groups for SPPB—Chair Stand [F(1,22) = 9.14, P < .01, η = .29] and SPPB—Total Score [F(1,22) = 7.40, P < .05, η = .25]. Functional classification was improved as a result of the intervention with 83% of participants in the RT group improving from low to moderate functioning or moderate to high functioning. Strength significantly improved on all exercises in the RT compared with the CON group.Conclusions:A RT program congruent with the current ASCM and AHA guidelines is effective to improve overall physical function, functional classification, and muscle strength for older adults with reduced physical abilities.

Improved access to the Internet along with technological advances in hardware and software are prompting social scientists to move their research pursuits from the laboratory into cyberspace. While evidence suggests that online research is equivalent if not superior to traditional offline (i.e., paper-pencil [PP]) methods (Buchanan & Smith, 1999; Campos et al., 2011; Lonsdale et al., 2006; Meyerson & Tryon, 2003; Naus et al., 2009; Preckel & Thiemann, 2003), caution is urged in summarily generalizing research methods and results from one format to another. To address one of the key limitations of Internet research (i.e., measurement error), scholars have begun to examine the reliability and validity of online test formats. In studies of matched or paired samples who completed electronic and PP measures of various psychological constructs (e.g., personality, burnout, intellectual giftedness), results suggest comparable psychometric properties, factor structure, and outcomes across the data collection methods (Buchanan & Smith, 1999; Campos et al., 2011; Lonsdale et al., 2006; Meyerson & Tryon, 2003; Naus et al., 2009; Preckel & Thiemann, 2003).

Background The number of days of pedometer or accelerometer data needed to reliably assess physical activity (PA) is important for research that examines the relationship with health. While this important research has been completed in young to middle-aged adults, data is lacking in older adults. Further, data determining the number of days of self-reports PA data is also void. The purpose of this study was to examine the number of days needed to predict habitual PA and sedentary behaviour across pedometer, accelerometer, and physical activity log (PA log) data in older adults. Methods Participants (52 older men and women; age = 69.3 ± 7.4 years, range= 55-86 years) wore a Yamax Digiwalker SW-200 pedometer and an ActiGraph 7164 accelerometer while completing a PA log for 21 consecutive days. Mean differences each instrument and intensity between days of the week were examined using separate repeated measures analysis of variance for with pairwise comparisons. Spearman-Brown Prophecy Formulae based on Intraclass Correlations of .80, .85, .90 and .95 were used to predict the number of days of accelerometer or pedometer wear or PA log daily records needed to represent total PA, light PA, moderate-to-vigorous PA, and sedentary behaviour. Results Results of this study showed that three days of accelerometer data, four days of pedometer data, or four days of completing PA logs are needed to accurately predict PA levels in older adults. When examining time spent in specific intensities of PA, fewer days of data are needed for accurate prediction of time spent in that activity for ActiGraph but more for the PA log. To accurately predict average daily time spent in sedentary behaviour, five days of ActiGraph data are needed. Conclusions The number days of objective (pedometer and ActiGraph) and subjective (PA log) data needed to accurately estimate daily PA in older adults was relatively consistent. Despite no statistical differences between days for total PA by the pedometer and ActiGraph, the magnitude of differences between days suggests that day of the week cannot be completely ignored in the design and analysis of PA studies that involve < 7-day monitoring protocols for these instruments. More days of accelerometer data were needed to determine typical sedentary behaviour than PA level in this population of older adults.

Background Spina bifida affects one out of every 1200 to 1400 live births each year in the United States. Secondary conditions related to the level of the SB lesion (LOL) such as incontinence, skin breakdown, obesity, pain, and orthopedic problems (e.g., scoliosis) are common. The purpose of this presentation is to address the following questions: 1) What is the frequency of key secondary conditions (bowel/bladder status, skin breakdown, UTIs, pain, overweight, scoliosis, latex allergy)? 2) Are select secondary conditions related to LOL, school, peer or employment activities? 3) How satisfied are participants with their bowel/bladder program and is satisfaction related to clinical variables?

Bazett-Jones DM, Cobb SC, Joshi MN, Cashin SE, Earl JE. Normalizing hip muscle strength: establishing body-size-independent measurements. Objective To investigate the effectiveness of computing body-size-independent hip strength measures using muscle-specific allometric scaling and ratio standard normalization methods. Design Cross-sectional study. Setting University laboratory. Participants A convenience sample of healthy participants (N=113; 42 men, 71 women). Interventions Not applicable. Main Outcome Measures Anthropometric measurements of the leg and thigh were obtained, and maximal hip strength was tested (medial and lateral rotation, abduction, adduction, flexion, extension). Strength was measured isometrically as force (kg) and then converted to torque (Nm). Results The allometric scaling analysis resulted in exponents for normalizing body mass (BM) in each muscle group assessed. In addition, a 6-muscle average exponent was also computed (bavg) for force (men, .554; women, .335) and torque (men, .792; women, .482). The nonsignificant results of the linear regression analysis revealed that normalizing hip strength to BM bavg (hip strength/BM bavg ) effectively removed the influence of BM on force and torque. However, sex should be factored into analyses of allometric scaling because men have higher b-values than women for both force and torque. The linear regression analyses also demonstrated that force normalized to BM ( P =.162–.895) and torque normalized to BM × Height ( P =.146–.889) were body-size-independent measures. Force normalized to BM 0.67 ( P =.001–.191) and body mass index (BMI) ( P = P =.004–.415) and BMI ( P Conclusions Normalizing force and torque to BM bavg is the most effective method of removing body-size dependence and allowing comparisons of persons with differing body sizes.

This study examined the predictive validity of accelerometers (ACC) to estimate physical activity intensity (PAI) across age and differences in intensity predictions when expressed in relative and absolute PAI terms. Ninety adults categorized into 3 age groups (20–29, 40–49, and 60–69 yr) completed a treadmill calibration study with simultaneous ACC (7164 Actigraph) and oxygen-consumption assessment. Results revealed strong linear relations between ACC output and measured PAI (R2 = .62–.89) across age and similar ACC cut-point ranges across age delineating absolute PAI ranges compared with previous findings. Comparing measured metabolic equivalents (METs) with estimated METs derived from previously published regression equations revealed that age did not affect predictive validity of ACC estimates of absolute PAI. Comparing ACC output expressed in relative vs. absolute terms across age revealed substantial differences in PAI ACC count ranges. Further work is warranted to increase the applicability of ACC use relative to PAI differences associated with physiological changes with age.

Adolescents with spina bifida (SB) vary in their ability to adapt to the disease, and it is likely that numerous risk and protective factors affect adaptation outcomes. The primary aim was to test neuropsychological impairment, exemplified herein by executive dysfunction, as a risk factor in the Ecological Model of Adaptation for Adolescents with SB. Specific hypotheses were that: (1) executive functioning predicts the adaptation outcome of functional independence in adolescents with SB; (2) executive functioning mediates the impact of neurological severity on functional independence; and (3) family and adolescent protective factors are related to functional independence and moderate the relationship between executive functioning and functional independence. Forty-three adolescents aged 12–21 years completed neuropsychological measures and an interview that assessed risk, adolescent and family protective factors, and functional independence. Age, level of lesion, executive functioning, and the protective factor adolescent activities were significantly correlated with the functional independence outcome. In hierarchical regression analysis, the model accounted for 61% of the variance in functional independence outcomes. Executive functioning mediated the impact of neurological severity on functional independence. (JINS, 2008, 14, 793–804.)

Previous research has examined possible phenomenological differences between "focused" (i.e., with a compulsive quality) and "automatic" (i.e., with decreased awareness) pulling associated with trichotillomania (TTM), but these constructs have not been assessed using psychometrically sound measures. In the current study, differences in TTM severity, phenomenology, comorbid psychiatric symptoms, and functional impact were examined across individuals with varying combinations of "focused" and "automatic" pulling styles. Participants aged 18 and older were recruited via an internet-based survey. Those meeting inclusion criteria and completing the Milwaukee Inventory for Subtypes of Trichotillomania-Adult Version (MIST-A; n=1545) were classified as either high- or low-focused and either high- or low-automatic based on scores obtained from the focused and automatic scales of the MIST-A using a median split procedure. Results showed some significant differences between pulling styles. For example, "high-automatic" pullers reported more severe TTM and greater stress than "low-automatic" pullers, and "high-focused" pullers reported more severe TTM, greater stress and depression, and greater functional impact than "low-focused" pullers. Subsequent analyses suggest that, in comparison to individuals experiencing low levels of both automatic and focused pulling, those experiencing high levels of each pulling style reported greater severity, psychological impact, and functional impact. Clinical and research implications, study limitations, and future areas of research are discussed.

Childhood overweight has increased in the United States. Success of weight-loss programs has been limited (Barlow, S.E., & Dietz, W.H. (1998). Obesity evaluation and treatment: Expert committee recomendations. Pediatrics, 102, e29.). The purpose of this investigation was to systematically examine the effectiveness of weight-loss interventions for children. For this meta-analysis, seven weight-loss intervention studies were coded and quality index scores calculated. The interventions had a significant positive effect on weight-loss average d = 0.95, with a 95% confidence interval of 0.79 to 1.11. Limited interventional studies with effective long-term maintenance of weight loss in children are available in the literature. However, there are effective methods for weight loss in children.

This report describes patterns of cigarette smoking and interest in smoking cessation programs among employees in a public worksite (n = 6,000) and a private worksite (n = 14,000). Of the 622 employees who attended an employee assistance program (EAP) orientation, 110 (18%) were current smokers. A significantly greater proportion of public employees smoked cigarettes, smoked more heavily, and evaluated their health more poorly compared to private employees. Smokers in both sites were over-represented in unskilled positions. Regardless of worksite, respondents who smoked had similar desires to quit or cut down and were annoyed by the comments of others, felt guilty about smoking, awakened with a desire to smoke, and felt they had a smoking problem. Overall, more than one third of individuals were interested in joining a smoking cessation program. Occupational health nurses may use these findings to design and implement smoking cessation interventions in their workplaces.

Purpose: This study tests the effectiveness of the theoretically driven BACE (i.e., Balancing Arousal Controls Excesses) intervention in decreasing agitation in residents of long-term care with moderate or severe dementia. Design and Methods: A pretest–posttest double-blinded experimental design with random assignment was used with a sample of 78 participants. The BACE intervention controls the daily activity schedule so that there is a balance between a person’s high-arousal and low-arousal states. The outcome measure was observed agitation. Results: When time spent in arousal imbalance at pretest was controlled for, a repeated measures analysis of covariance revealed a statistically significant Group 3 Time interaction, F(1, 69) = 4.26, p = .043, with a partial g 2 = .06. The average change in agitation for the treatment group was a decrease of 8.43 points (SD = 12.01) from pretest to posttest, an effect size of .7. Implications: The results of this study support the theory that balancing arousal states by using an individualized approach is effective in decreasing agitation levels of people with dementia.

People with dementia have complex and unique social, environmental, and communication needs arising from impaired cognition. One response to dissatisfaction with the medical model of care in nursing homes has been the creation of more homelike and social options for care in the community. These options include community-based residential facilities and a variety of more independent senior dwellings. Staying in residential settings longer may be associated with benefits, including decreased financial burden and improved quality of life. However, with the boundaries between these place types often less than clearly drawn, it has become increasingly difficult to anticipate the specific services and environmental features provided by each. It is also difficult to effectively match facilities to the specific needs of older persons with dementia. Even social workers responsible for placements, especially in urban areas, may not be able to visit all local residential options. To better understand these new venues for dementia care, this study explored the range of services and settings available to people with dementia in three different place types in five Wisconsin counties: nursing homes, community-based residential facilities, and independent senior housing.

Background Little is known physical health (PH), mental health (MH) and health-related quality of life (HRQOL) adaptation outcomes in AYA with SB, and the factors associated with them. The purpose of this presentation is to 1) describe the PH (functional status [FS], self-management, secondary conditions), MH (depression, overall selfworth, and internal/external behavior problems [IBP, EBP]), and HRQOL outcomes; and 2) delineate the direct and indirect relationships of risk and protective variables in the Ecological Model of Secondary Conditions and Adaptation in SB associated with these outcomes. This model includes SB Context (SES, shunt status and level of lesion [LOL]), neuropsychological risk [NPR], and protective processes (adolescent resilience and family resourcefulness).