Testing a Model of Resilience in Family Members of Relatives with Traumatic Brain Injury vs Spinal Cord Injury: Multigroup Analysis.

OBJECTIVE: To test a model comprising explanatory (neurologic impairment, coping, personality) and mediating (resilience, self-efficacy, hope, social support) variables on psychological adjustment and burden among family caregivers of individuals with traumatic brain injury (TBI) vs spinal cord injury (SCI). DESIGN: Structural equation modeling with multigroup analysis. SETTING: Six rehabilitation centers across New South Wales and Queensland, Australia. PARTICIPANTS: A total of 181 family members (N=181; 131 TBI, 50 SCI). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Connor-Davidson Resilience Scale, Eysenck Personality Questionnaire, Ways of Coping Questionnaire, General Self-Efficacy Scale, Herth Hope Scale, Medical Outcome Study Social Support Survey; and 4 measures of psychological adjustment including: Caregiver Burden Scale, Medical Outcomes Survey Short Form-36 (SF-36), General Health Questionnaire-28, and Positive and Negative Affect Scale. RESULTS: The model for the aggregated sample demonstrated a very good model fit (χ2=47.42, df=39, ρ=0.167, normed fit index=.962, incremental fit index=.993, Tucker-Lewis index=.985, comparative fit index=.993, root-mean-squared error of approximation=.035). Multi-group analysis found significant commonalities in the pattern of relationships among variables across the 2 groups. In the only differences found, neuroticism was significantly more influential on burden in family members supporting individuals with TBI than family members of individuals with SCI. Furthermore, problem-focused coping was statistically more influential on positive affect in family members of individuals with TBI when compared with family members of individuals with SCI. CONCLUSIONS: The study found significant similarities in the patterns of resilience and psychological adjustment among family caregivers of individuals with TBI and SCI.

Factors predicting the mental health of adolescents attending a faith-based Australian school system: a multi-group structural equation analysis.

Background: Adolescents attending Seventh-day Adventist schools (Adventist) in Australia tend to experience good health and exhibit better health behaviors than national norms, however few studies have investigated factors predicting their mental health.Aims: The aim of this study was to explore the complex network of factors that predict the mental health status (MHS) of adolescents attending Adventist schools in Australia.Methods: A survey instrument was used to collect data from 1527 secondary school students attending Adventist schools across Australia. Structural equation modeling was employed to examine concomitantly the direct and indirect effects of childhood experiences, present attitudes and selected health behaviors on MHS.Results: Childhood family dynamics had the strongest association with MHS (ßtotal = 0.33) followed by a sense of meaning and purpose (ßtotal = 0.27), perceived social misfit status (ßtotal = -0.19), and school academic performance (ßtotal = 0.18). Multi-group analysis found significant pathway differences in the model for gender with regards to the association of meaning and purpose, physical activity and sleep quantity with MHS.Conclusions: The outcomes of the study highlight the importance of early positive childhood family dynamics and the discovery of meaning and purpose during adolescence to promote positive mental health among adolescents.

The association between self-rated health and social environments, health behaviors and health outcomes: a structural equation analysis.

BACKGROUND: The factors shaping the health of the current generation of adolescents are multi-dimensional and complex. The purpose of this study was to explore the determinants of self-rated health (SRH) of adolescents attending a faith-based school system in Australia. METHODS: A total of 788 students attending 21 Seventh-day Adventist schools in Australia responded to a health and lifestyle survey that assessed SRH as well as potential determinants of SRH including the health outcomes mental health, vitality, body mass index (BMI), select health behaviors, social factors and personal demographics. Structural equation modeling was used to analyze the data and examine the direct and indirect effects of these factors on SRH. RESULTS: The structural model developed was a good fit with the data. The health outcome mental health had the strongest association with SRH (ß = 0.17). Several upstream variables were also associated with higher SRH ratings. The health behavior sleep hours had the strongest association with SRH (ßtotal = 0.178) followed by fruit/vegetable consumption (ßtotal = 0.144), physical activity (ßtotal = 0.135) and a vegetarian diet (ßtotal = 0.103). Of the demographic and social variables measured, adverse childhood experiences (ACEs) had the strongest association with SRH (ßtotal = - 0.125), negatively influencing SRH, and gender also associated with an increase in SRH (ßtotal = 0.092), with the influence of these factors being mediated through other variables in the model. CONCLUSIONS: This study presents a conceptual model that illustrates the complex network of factors concomitantly associated with SRH in adolescents. The outcomes of the study provide insights into the determinants of adolescent SRH which may inform priority areas for improving this construct.

The impact of neurobehavioral impairment on family functioning and the psychological well-being of male versus female caregivers of relatives with severe traumatic brain injury: multigroup analysis.

OBJECTIVE: To examine the differential effect of neurobehavioral impairments (cognitive, behavioral, and social) on family functioning, family roles, and psychological distress in male versus female caregivers of relatives with severe traumatic brain injury (TBI). DESIGN: Structural equation modeling with multigroup analysis conducted in a cross-sectional sample to test an established theoretical model. PARTICIPANTS: An aggregated sample of 122 caregivers (46 male, 76 female) of people with severe TBI. The sample comprised 64 spouses and 58 parents (29 parental couples) of 93 persons with TBI. MEASURES: Neurobehavioral Problem Checklist; Family Assessment Device; and Brief Symptom Inventory. RESULTS: Structural equation modeling showed that the proposed model had acceptable fit indices for the combined sample. Multigroup analysis indicated that both male and female caregivers (i) responded similarly to the neurobehavioral impairments experienced by the injured relative and (ii) reported behavior having a direct effect on family functioning, which, in turn, increased psychological distress. However, the effect of disrupted family functioning was more influential on the level of distress in male caregivers than in female caregivers. CONCLUSION: Evidence was found for gender-specific pathways underlying the psychological distress of male versus female caregivers. Such findings can assist in tailoring family support strategies so that they cater for caregivers of both genders.

Testing the stability of a family resilience model at 2 and 5 years after traumatic brain injury or spinal cord injury: A longitudinal study.

BACKGROUND: Recent studies have tested models of resilience and caregiver adjustment in individuals with traumatic brain injury (TBI) or spinal cord injury (SCI). Few studies have examined the role of adaptive variables over time. OBJECTIVE: Conduct a longitudinal study to test a model of caregiver resilience with caregiver outcomes at 2- and 5-years post-injury. METHOD: Caregivers of relatives with TBI or SCI were surveyed at 2 years (Time 1) and 5 years (Time 2) post-injury. Stability of the resilience model across the 2 time-points was tested using structural equation modeling with multi-group analysis. Measures included resilience related variables (Connor-Davidson Resilience Scale, General Self-Efficacy Scale, Herth Hope Scale, Social Support Survey) and outcome variables (Caregiver Burden Scale, General Health Questionnaire-28, Medical Outcome Study Short Form -36 [SF-36] and Positive and Negative Affect Scale). RESULTS: In total, 100 caregivers were surveyed at both 2 and 5 years (TBI =77, SCI =23). Scores for resilience (Time 1, 75.9 SD 10.6; Time 2, 71.5 SD 12.6) and self-efficacy (Time 1, 32.51 SD 3.85; Time 2, 31.66 SD 4.28) showed significant minor declines, with other variables remaining stable. The resilience model for the pooled responses (Time 1+ Time 2) demonstrated a good fit (Goodness of Fit Index [GFI] = 0.971; Incremental Fit Index [IFI] = 0.986; Tucker-Lewis Index [TLI] = 0.971; Comparative Fit Index [CFI] = 0.985 and Root Mean Square Error of Approximation [RMSEA] = 0.051). Multi-group analysis then compared Time 1 to Time 2 responses and found that a variant (compared to invariant) model best fitted the data, with social support having stronger associations with mental health and positive affect at Time 2 than Time 1. Hope reduced from Time 1 to Time 2. CONCLUSIONS: The model suggests that resilience-related variables can play an important role in positive caregiver adjustment over time.

Enhancing the knowledge, attitudes, and skills of preceptors: an Australian perspective.

Within the context of nursing education in Australia, the registered nurse (RN) preceptor plays an invaluable role with nursing students; however, many are not specifically trained for this role. This study explored the perceptions of practicing preceptors from one health care facility after completion of a specially designed preceptor program. Results indicated that the participants perceived that the program had increased their knowledge of teaching and learning and increased their skills as preceptors. Further results suggested that when the RN preceptor's knowledge of the teaching and learning process increased, it led to an increase in the RN preceptor's generic preceptor skills. This increased the RN preceptor's confidence, leading to a more positive attitude toward student nurses and a positive effect on preceptor functioning, enhancing the preceptor's ability to include students more in daily nursing tasks.

Differential pathways of psychological distress in spouses vs. parents of people with severe traumatic brain injury (TBI): multi-group analysis.

PRIMARY OBJECTIVE: A contemporary model of psychological stress based on an amalgamation of Conservation of Resources theory and the McMaster Model of Family Functioning was devised to compare the effects of neurobehavioural impairments on family functioning and psychological distress in spouses and parents caring for relatives with TBI. METHOD: Participants were 64 spouses and 58 parents. They completed the Neurobehavioral Problem Checklist, Family Assessment Device and the Brief Symptom Inventory. Structural equation modelling (SEM) was used to test the model for the combined (spouses and parents) sample. Multi-group analysis was then employed for examining differences in structural weights for spouses and parents. MAIN RESULTS: SEM supported the model for the combined sample. Multi-group analysis showed for spouses cognitive and behavioural impairments significantly disrupted family functioning, which in turn increased psychological distress. In contrast, cognitive and behavioural impairments did not significantly disrupt family functioning in parents. For parents, however, cognitive impairments increased psychological distress. Furthermore, parents who reported disrupted family functioning also experienced higher levels of psychological distress. The effect of cognitive impairments was statistically more influential on the level of distress in parents when compared to spouses. CONCLUSIONS: Understanding these differences can assist in better targeting family support interventions.

Reducing catheter-associated urinary tract infections in hospitals: study protocol for a multi-site randomised controlled study.

INTRODUCTION: Despite advances in infection prevention and control, catheter-associated urinary tract infections (CAUTIs) are common and remain problematic. A number of measures can be taken to reduce the risk of CAUTI in hospitals. Appropriate urinary catheter insertion procedures are one such method. Reducing bacterial colonisation around the meatal or urethral area has the potential to reduce CAUTI risk. However, evidence about the best antiseptic solutions for meatal cleaning is mixed, resulting in conflicting recommendations in guidelines internationally. This paper presents the protocol for a study to evaluate the effectiveness (objective 1) and cost-effectiveness (objective 2) of using chlorhexidine in meatal cleaning prior to catheter insertion, in reducing catheter-associated asymptomatic bacteriuria and CAUTI. METHODS AND ANALYSIS: A stepped wedge randomised controlled trial will be undertaken in three large Australian hospitals over a 32-week period. The intervention in this study is the use of chlorhexidine (0.1%) solution for meatal cleaning prior to catheter insertion. During the first 8 weeks of the study, no hospital will receive the intervention. After 8 weeks, one hospital will cross over to the intervention with the other two participating hospitals crossing over to the intervention at 8-week intervals respectively based on randomisation. All sites complete the trial at the same time in 2018. The primary outcomes for objective 1 (effectiveness) are the number of cases of CAUTI and catheter-associated asymptomatic bacteriuria per 100 catheter days will be analysed separately using Poisson regression. The primary outcome for objective 2 (cost-effectiveness) is the changes in costs relative to health benefits (incremental cost-effectiveness ratio) from adoption of the intervention. DISSEMINATION: Results will be disseminated via peer-reviewed journals and presentations at relevant conferences.A dissemination plan it being developed. Results will be published in the peer review literature, presented at relevant conferences and communicated via professional networks. ETHICS: Ethics approval has been obtained. TRIAL REGISTRATION NUMBER: 12617000373370, approved 13/03/2017. Protocol version 1.1.

The effectiveness of the Complete Health Improvement Program (CHIP) in Australasia for reducing selected chronic disease risk factors: a feasibility study.

AIM: To examine the effectiveness within the Australasian context of the Complete Health Improvement Program (CHIP) lifestyle intervention, which has been shown to produce meaningful reductions in selected chronic disease risk factors in the United States. METHODS: Changes in body weight, blood pressure, blood lipid profile and fasting plasma glucose were assessed in 836 self-selected participants (age=55.9 plus or minus 12.7 yrs, 35% male/65% female) from 18 sites throughout New Zealand (N=731) and Australia (N=105). RESULTS: In the 30 days of the program, significant overall reductions (p<0.001) were recorded in the participants' body mass (-3.8%; 87.1 plus or minus 22.4 versus 83.9 plus or minus 21.5 kg), systolic blood pressure (-5.6%; 135 plus or minus 19 versus 127 plus or minus 17 mmHg), diastolic blood pressure (-4.6%; 80 plus or minus 12 versus 76 plus or minus 12 mmHg), total cholesterol (-14.7%; 5.17 plus or minus 1.08 versus 4.41 plus or minus 0.96 mmol/L), low-density lipoprotein cholesterol (-17.9%; 3.17 plus or minus 0.95 versus 2.60 plus or minus 0.83 mmol/L), triglycerides (-12.5%; 1.51 plus or minus 0.98 versus 1.32 plus or minus 0.71 mmol/L) and fasting plasma glucose (-5.6%; 5.55 plus or minus 1.49 versus 5.24 plus or minus 1.11 mmol/L). Participants at program entry with the highest classifications of total cholesterol, low-density lipoprotein, triglycerides and fasting plasma glucose experienced over 20% reductions in these measures in 30 days. CONCLUSIONS: Significant reductions in selected chronic disease risk factors were observed in 30 days using the CHIP intervention and the improvements were comparable to that observed in cohorts from the United States. The results of this feasibility study indicate that lifestyle interventions like CHIP may be useful for combating the burgeoning epidemic of chronic disease and further research is warranted.

Effectiveness of a volunteer-delivered lifestyle modification program for reducing cardiovascular disease risk factors.

Lifestyle modification has been demonstrated to effectively reduce the risk factors associated with cardiovascular disease, but there is a perception that it is costly to administer and resource. The present study examined the results achieved by a 30-day lifestyle modification program (Coronary Health Improvement Project) delivered by volunteers in a community setting. Changes in selected biometric measures of 5,070 participants in the Coronary Health Improvement Project programs delivered throughout North America (January 2006 to October 2009), were assessed. Overall, significant reductions (p < 0.001) were recorded in body mass (-3.2%), systolic and diastolic blood pressure (-4.9% and -5.3%, respectively), total cholesterol (-11.0%), low-density lipoprotein cholesterol (-13.0%), triglycerides (-7.7%), and fasting plasma glucose (-6.1%). Stratification of the data revealed more dramatic responses in those presenting with the greatest risk factor levels. Those presenting with cholesterol levels >280 mg/dl recorded an average reduction of 19.8%. A mean decrease of 16.1% in low-density lipoprotein levels was observed among those who entered the program with a low-density lipoprotein level >190 mg/dl. Individuals who presented with triglycerides >500 mg/dl recorded a mean reduction of 44.1%. The Framingham assessment forecast that approximately 70 cardiac events would be averted during the subsequent decade in the cohort because of the program. In conclusion, significant reductions in cardiovascular disease risk factors can be achieved in a 30-day lifestyle intervention delivered by volunteers, providing a cost-effective mode of administering lifestyle medicine.