Caregiver Nutritional Health Outcomes of the Simple Suppers Study: Results from a 10 Week, Two-Group Quasi-Experimental Family Meals Intervention.

Individuals from racial minority backgrounds, especially those in low income situations, are at increased risk for obesity. Family meals positively impact child nutritional health; however, there is limited evidence examining the impact on caregivers, particularly racial minority and income-restricted individuals. The objective of this intervention study was to determine the effect of Simple Suppers, a 10 week family meals program, on caregiver diet and nutrition outcomes. Intervention versus waitlist control participants were compared from baseline (T0) to post-intervention (T1). In addition, intervention participants were assessed at a 10 week follow-up time point (T2). This study was a two-group quasi-experimental intervention trial. Lessons (10 total) were delivered on a weekly basis for 90 min. Data were collected from intervention and waitlist control participants at T0 and T1, and intervention participants at T2. After baseline (T0) data collection, families enrolled in the immediate upcoming session of Simple Suppers (intervention group) or waited for 10 weeks (waitlist control group) to begin the program. Participants were caregivers of children ages 4-10 years. This study was conducted in a faith-based community center for underserved families in Columbus, Ohio. Primary outcomes were: diet quality assessed by Healthy Eating Index (HEI) total and component scores, and total energy intake (kcal/day); body mass index (BMI) (kg/m2), waist circumference (cm), systolic and diastolic blood pressure (BP) (mmHG); and self-efficacy for having healthy meals and menu planning (both scalar). The impact of the intervention (T0:T1) was assessed using generalized mixed-effects linear regression models. Maintenance of change in study outcomes among intervention participants (T1:T2) was examined with paired t-tests. 109 caregivers enrolled in this study. The retention rate at T1 was 90% (i.e., 98 participants). 56 of 68 intervention participants completed T2, resulting in a retention rate of 82%. Almost all (99%) were female, 61% were Black, and 50% were between 31 and 40 years old. In total, 40% had low income and 37% had low or very low food security. At T1, intervention vs. waitlist controls had a lower daily energy intake (p = 0.04), but an HEI-2010 component score for fatty acids (adequacy) that was lower indicating a lower dietary intake of fatty acids (p = 0.02), and a component score for empty calories (moderation) that was significantly lower indicating a higher intake of empty calorie foods (p = 0.03). At T1, intervention vs. waitlist controls also had a lower BMI (p < 0.001) and systolic BP (p = 0.04), and higher self-efficacy (p = 0.03). There were no group differences in other outcomes. At T2, intervention participants maintained the changes in daily energy intake, BMI, systolic BP, and self-efficacy that improved during the intervention period. There was no change (improvement) in the component score for fatty acids; however, the component score for empty calories significantly improved (p = 0.02). Engagement in the Simple Suppers program led to improvements in caregivers' daily caloric intake, weight status, systolic blood pressure, and self-efficacy for family meals. Future research should further explore the dietary and nutritional health benefits of family meals among caregivers at the highest risk for obesity.

Child diet and health outcomes of the simple suppers program: a 10-week, 2-group quasi-experimental family meals trial.

BACKGROUND: Racial minority children, particularly from low-income households, are at risk for obesity. Family meals have a protective effect on child nutritional health. However, the current evidence is limited in racial and socioeconomic diversity. The objective of this study was to evaluate the impact of a family meals intervention, Simple Suppers, on improvements in diet and health outcomes from baseline (T0) to post-intervention (T1) in intervention compared to waitlist control participants, and determine retention of change in outcomes among intervention participants at 10-week follow-up (T2). METHODS: Simple Suppers was a 10-week family meals intervention implemented as a 2-group quasi-experimental trial. Ten 90-min lessons were delivered weekly. Data were collected at T0 and T1, and from intervention participants at T2. Participants were racially diverse 4-10 year-old children from low-income households. Setting was a faith-based community center. Main outcomes were daily servings of fruit, vegetables, and sugar-sweetened beverages and diet quality; z-scores for body mass index (BMI), waist circumference, systolic and diastolic blood pressure (BP); weight status categories; food preparation skills; and family meals (frequency of dinner, breakfast, TV viewing during meals, meals in dining area). Generalized linear mixed models (GLMMs) and mixed-effects ordinal regression models were used to assess intervention impact (T0:T1). Paired t-tests examined retention of change among intervention participants (T1:T2). RESULTS: One hundred forty children enrolled and 126 completed T1 (90% retention); 71 of 87 intervention participants completed T2(79% retention). Mean (SD) age was 6.9(1.9) yr, 62% female, 60% Black, and 42% low-income. Intervention vs waitlist controls had higher food preparation skills (p < 0.001) and lower TV viewing during meals (p = 0.04) at T1.There were no group differences in dietary intake or quality or z-scores for BMI, waist circumference, or BP, however intervention versus waitlist controls experienced a greater change toward healthy weight (p = 0.04) At T2, intervention participants demonstrated a retention of improved food preparation skills. CONCLUSIONS: Simple Suppers led to improvements in children's weight status, food preparation skills, and TV viewing during meals, but not diet or z-scores for BMI, waist circumference, or BP. Future research should examine the preventive effects of healthy family mealtime routines in children at greatest risk for obesity. TRIAL REGISTRATION: NCT02923050; Simple Suppers Scale-up (S3); Retrospectively registered on Oct 2016; First participant enrolled on Jan 2015.

Participation in structured programming may prevent unhealthy weight gain during the summer in school-aged children from low-income neighbourhoods: feasibility, fidelity and preliminary efficacy findings from the Camp NERF study.

OBJECTIVE: Evaluate the feasibility, fidelity and preliminary efficacy of Camp NERF to prevent unhealthy weight gain and promote healthy behaviours in children during the summer. DESIGN: Camp NERF was an 8-week, multicomponent, theory-based programme coupled with the US Department of Agriculture's Summer Food Service Program. Twelve eligible elementary-school sites were randomized to one of three treatment groups: (i) Active Control (non-nutrition, -physical activity (PA), -mental health); (ii) Standard Care (nutrition and PA); or (iii) Enhanced Care (nutrition and PA, plus cognitive behavioural techniques) programming. Efficacy was determined by assessing mean change by group in child outcomes using hierarchical linear regression models. SETTING: Low-income, urban neighbourhoods in Columbus, OH, USA.ParticipantsEconomically disadvantaged, racial minority children of elementary school age (kindergarten-5th grade). RESULTS: Eighty-seven child-caregiver dyads consented; eighty-one completed pre- and post-intervention assessments resulting in a 93·10 % retention rate. Delivery of the intended lesson occurred 79-90 % of the time. Of the children, 56·98 % (n 49) were female; 89·53 % (n 77) were Black. Overall mean change in BMI Z-score from baseline to post-intervention was -0·03 (se 0·05); change in BMI Z-score did not differ significantly between treatment group. Change in nutrition, PA, mental health or psychosocial outcomes did not differ between groups. CONCLUSIONS: Results from the current study demonstrate feasibility and fidelity, yet no intervention effect of Camp NERF. Instead, findings suggest that participation in structured programming of any type (health behaviour-related or not) may prevent unhealthy summer weight gain. Additional studies are needed to confirm findings. Results have implications for child nutrition policy addressing the issue of summer health.

Testing of a tethered personal health record framework for early end-of-life discussions.

OBJECTIVES: The process of planning for end-of life decisions, also known as advance care planning (ACP), is associated with numerous positive outcomes, including improved patient satisfaction with care and improved patient quality of life in terminal illness. In this study, we sought to test a novel personal health record (PHR)-delivered ACP framework through a small-scale randomized trial of usual care practices versus PHR-delivered ACP. STUDY DESIGN: Randomized controlled pilot intervention. METHODS: A novel PHR-ACP tool was tested using data and feedback collected in a randomized controlled pilot intervention (n = 50). Participants in the control group received standard care for ACP conversations while participants randomized to the intervention group received a novel ACP framework through the electronic health record. RESULTS: The pilot study testing the ACP framework found that its use resulted in improved ACP documentation rates (P = .001) and quality (P = .007) compared with usual care. CONCLUSIONS: Tethered PHR use as an initial ACP communication tool can improve outpatient documentation rates and quality. Future studies obtaining patient feedback on a revised framework and testing in a larger setting are needed to determine reproducibility of findings.

Early predictors of phonological and morphosyntactic skills in second graders with cochlear implants.

PURPOSE: Newborn hearing screening has made it possible to provide early treatment of hearing loss to more children than ever before, raising expectations these children will be able to attend regular schools. But continuing deficits in spoken language skills have led to challenges in meeting those expectations. This study was conducted to (1) examine two kinds of language skills (phonological and morphosyntactic) at school age (second grade) for children with cochlear implants (CIs); (2) see which measures from earlier in life best predicted performance at second grade; (3) explore how well these skills supported other cognitive and language functions; and (4) examine how treatment factors affected measured outcomes. METHODS: Data were analyzed from 100 second-grade, monolingual English-speaking children: 51 with CIs and 49 with normal hearing (NH). Ten measures of spoken language and related functions were collected: three each of phonological and morphosyntactic skills; and four of other cognitive and language functions. Six measures from preschool and seven from kindergarten served as predictor variables. The effects of treatment variables were examined. RESULTS: Children with CIs were more delayed acquiring phonological than morphosyntactic skills. Mean length of utterance at earlier ages was the most consistent predictor of both phonological and morphosyntactic skills at second grade. Early bimodal stimulation had a weak, but positive effect on phonological skills at second grade; sign language experience during preschool had a negative effect on morphosyntactic structures in spoken language. CONCLUSIONS: Children with CIs are delayed in language acquisition, and especially so in phonological skills. Appropriate testing and treatments can help ameliorate these delays.

Outcomes of an Oral Care Protocol in Postmechanically Ventilated Patients.

BACKGROUND: Oral care is standard practice to prevent hospital-associated infections while patients are intubated and in the intensive care unit. Following extubation and transfer, infections remain an important risk for patients, but less attention is paid to oral care. Few studies have assessed the impact of oral care in recently extubated acutely ill patients. AIMS: To develop an evidence-based oral care protocol for hospitalized patients and determine the impact of this protocol on health outcomes in recently extubated patients. METHODS: In this randomized controlled trial, subjects were randomized to usual care or an intervention protocol that included tooth brushing, tongue scraping, flossing, mouth rinsing, and lip care. Major outcome measures were the revised THROAT (R-THROAT; oral cavity assessment) and overall prevalence of methicillin-sensitive Staphylococcus aureus and methicillin-resistant S. aureus on oral cultures. RESULTS: Seventy-four subjects were randomized. As measured by the R-THROAT, oral cavity health improved over time in both groups, but the intervention group demonstrated significantly more improvement than the control group (R-THROAT score improved by 1.97 intervention vs. 0.87 control; p = .04). Two categories, tongue and mouth comfort, demonstrated the most significant improvement. There was no difference in MSSA/MRSA colonization between the groups at the conclusion of the study. Overall, subjects in the intervention group were more satisfied with their protocol than subjects in the usual care group. LINKING EVIDENCE TO ACTION: This study offers an important evaluation of an oral care protocol after extubation. Results demonstrated improvement in the oral cavity assessment with the designed oral care protocol. Patients expressed a preference for the intervention protocol, which included a battery-operated toothbrush, higher-quality toothpaste and mouth rinse, tongue scraper, floss, and lip balm. The implementation of an oral care protocol specifically addressing patients in the immediate postintubation is essential.

Nurses' Attitudes Regarding the Safe Handling of Patients Who Are Morbidly Obese: Instrument Development and Psychometric Analysis.

BACKGROUND AND PURPOSE: Nurses' attitudes play an important role in the consistent practice of safe patient handling behaviors. The purposes of this study were to develop and assess the psychometric properties of a newly developed instrument measuring attitudes of nurses related to the care and safe handling of patients who are obese. METHODS: Phases of instrument development included (a) item generation, (b) content validity assessment, (c) reliability assessment, (d) cognitive interviewing, and (e) construct validity assessment through factor analysis. RESULTS: The final data from the exploratory factor analysis produced a 26-item multidimensional instrument that contains 9 subscales. CONCLUSIONS: Based on the factor analysis, a 26-item instrument can be used to examine nurses' attitudes regarding patients who are morbidly obese and related safe handling practices.

Association between Prediagnostic Allergy-Related Serum Cytokines and Glioma.

Allergy is inversely related to glioma risk. To determine whether prediagnostic allergy-related serum proteins are associated with glioma, we conducted a nested case-control study of seven cytokines (IL4, IL13, IL5, IL6, IL10, IFNG, TGFB2), two soluble cytokine receptors (sIL4RA, sIL13RA2) and three allergy-related transcription factors (FOXP3, STAT3, STAT6) using serum specimens from the Janus Serum Bank Cohort in Oslo, Norway. Blood donors subsequently diagnosed with glioma (n = 487) were matched to controls (n = 487) on age and date of blood draw and sex. We first estimated individual effects of the 12 serum proteins and then interactions between IL4 and IL13 and their receptors using conditional logistic regression. We next tested equality of case-control inter-correlations among the 12 serum proteins. We found that TGFB2 is inversely related to glioblastoma (Odds Ratio (OR) = 0.87, 95% Confidence Interval (CI)) = 0.76, 0.98). In addition, ≤ 5 years before diagnosis, we observed associations between IL4 (OR = 0.82, 95% CI = 0.66, 1.01), sIL4RA (OR = 0.80, 95% CI = 0.65, 1.00), their interaction (OR = 1.06, 95% CI = 1.01, 1.12) and glioblastoma. This interaction was apparent > 20 years before diagnosis (IL4-sIL4RA OR = 1.20, 95% CI = 1.05, 1.37). Findings for glioma were similar. Case correlations were different from control correlations stratified on time before diagnosis. Five years or less before diagnosis, correlations among case serum proteins were weaker than were those among controls. Our findings suggest that IL4 and sIL4RA reduce glioma risk long before diagnosis and early gliomagenesis affects circulating immune function proteins.

Association Between Prediagnostic Serum 25-Hydroxyvitamin D Concentration and Glioma.

There are no previous studies of the association between prediagnostic serum vitamin D concentration and glioma. Vitamin D has immunosuppressive properties; as does glioma. It was, therefore, our hypothesis that elevated vitamin D concentration would increase glioma risk. We conducted a nested case-control study using specimens from the Janus Serum Bank cohort in Norway. Blood donors who were subsequently diagnosed with glioma (n = 592), between 1974 and 2007, were matched to donors without glioma (n = 1112) on date and age at blood collection and sex. We measured 25-hydroxyvitamin D [25(OH)D], an indicator of vitamin D availability, using liquid chromatography coupled with mass spectrometry. Seasonally adjusted odds ratios (ORs) and 95% confidence intervals (95% CIs) were estimated for each control quintile of 25(OH)D using conditional logistic regression. Among men diagnosed with high grade glioma >56, we found a negative trend (P = .04). Men diagnosed ≤ 56 showed a borderline positive trend (P = .08). High levels (>66 nmol/L) of 25(OH)D in men >56 were inversely related to high grade glioma from ≥2 yr before diagnosis (OR = 0.59; 95% CI = 0.38, 0.91) to ≥15 yr before diagnosis (OR = 0.61; 95% CI = 0.38,0.96). Our findings are consistent long before glioma diagnosis and are therefore unlikely to reflect preclinical disease.

Cigarette smoking following lung transplantation: effects on allograft function and recipient functional performance.

PURPOSE: Despite mandatory tobacco abstinence following lung transplantation (LTX), some recipients resume smoking cigarettes. The effect of smoking on allograft function, exercise performance, and symptomatology is unknown. METHODS: A retrospective review was conducted of LTX recipients who received allografts over an 8-year interval and who were subjected to sequential posttransplant pulmonary function testing (PFT), 6-minute walk (6MW) testing, and assessments of exertional dyspnea (Borg score). Using post-LTX PFT results, recipients were determined to have either bronchiolitis obliterans syndrome (BOS), a manifestation of chronic allograft rejection, or normal pulmonary function (non-BOS). With respect to post-LTX pulmonary function, 6MW distances, and Borg scores, comparisons were made between these recipient groups and those who resumed smoking. RESULTS: Of 34 LTX recipients identified, 13 maintained normal lung function (non-BOS), while 16 demonstrated a decline in their PFT values consistent with BOS. Five recipients began smoking at median postoperative day 365 and smoked 1 pack per day for a mean of 485.6 days. Smokers developed a deterioration of their PFT values that was similar to those with BOS (P = .47) and tended to be worse than those in the non-BOS group (P = .09). All smokers experienced a decline in 6MW distances similar to those with BOS and non-BOS but reported less exertional dyspnea (lower Borg scores) than those with BOS. CONCLUSION: Recipients of LTX who resume cigarette smoking demonstrate a decline in pulmonary function similar to those afflicted with chronic allograft rejection but do not experience a decrement in their functional performance or increased dyspnea.

Women with breast cancer: self-reported distress in early survivorship.

PURPOSE/OBJECTIVES: To identify and compare levels of distress and sources of problems among patients with breast cancer in early survivorship. DESIGN: Descriptive, cross-sectional. SETTING: A National Cancer Institute-designated comprehensive cancer center. SAMPLE: 100 breast cancer survivors were selected to represent four time points in the cancer trajectory. METHODS: Distress was self-reported using the Distress Thermometer and its 38-item problem list. Analysis of variance and chi-square analyses were performed as appropriate. MAIN RESEARCH VARIABLES: Distress scores, problem reports, and time groups. FINDINGS: Participants scored in range of the cutoff of more than 4 (range = 4.1-5.1) from treatment through three months post-treatment. At six months post-treatment, distress levels were significantly lower. Significant differences were found between groups on the total problem list score (p = 0.007) and emotional (p = 0.01) and physical subscale scores (p = 0.003). CONCLUSIONS: Comparison of groups at different points in the cancer trajectory found similar elevated levels from diagnosis through three months. Distress remained elevated in early survivorship but significantly decreased at six months post-treatment. IMPLICATIONS FOR NURSING: Interventions to reduce or prevent distress may improve outcomes in early survivorship.

Relationships of PROP Taste Phenotype, Taste Receptor Genotype, and Oral Nicotine Replacement Use.

INTRODUCTION: Recommended dosage of oral nicotine replacement therapy (NRT) product is often not achieved in smoking cessation attempts. n-6-propylthiouracil (PROP) bitter taste phenotype may be a potential risk factor for non-adherence to oral NRT products due to their bitter taste. There is limited literature on this phenotype in the context of smoking and none in relation to oral NRT pharmacotherapy. METHODS: The association of PROP taste phenotype with NRT usage and sensory response to products was examined. In a cross-over experimental design, 120 participants received a 1 week supply of nicotine inhalers and 1 week of nicotine lozenges with random assignment to order. Mixed effects linear model analyses were conducted. RESULTS: PROP taste phenotype and taste receptor genotype were not associated with NRT usage or sensory response to NRT, after adjusting for other factors. However, PROP non-tasters used a higher number of lozenges per day (continuous exposure) than nicotine cartridges (intermittent exposure). Unexpectedly, half of baseline PROP non-tasters shifted to taster phenotype 2 weeks after smoking cessation or reduction. Menthol cigarette smokers identified higher NRT strength of sensation scores than nonmenthol smokers. Taste receptor genotype was related to PROP taste phenotype (Kendall τ = .591, p = .0001). CONCLUSIONS: A nonsignificant relationship of PROP phenotype and NRT usage may be associated with NRT under-dosing and limited variance in the outcome variable. PROP non-tasters' greater use of lozenges is consistent with nicotine exposure being less aversive to non-tasters. Further research of this and other factors impacting NRT usage are warranted to effectively inform smoking cessation pharmacotherapy.

Pilot study of an oral care protocol on poststroke survivors.

PURPOSE: The pilot study purpose was to determine the effects of a new standardized oral care protocol (intervention) to usual care practices (control) in poststroke patients. DESIGN: This study is a randomized controlled clinical trial. METHOD: Fifty-one subjects were enrolled. Subjects in the intervention group received oral care twice a day including tooth brushing, tongue brushing, flossing, mouth rinse, and lip care while control patients received usual oral care. FINDINGS: Subjects in the control and intervention groups showed improvement in their oral health assessments, swallowing abilities and oral intake. There were no significant differences between the two groups. Although not statistically significant, overall prevalence of methicillin-resistant Staphylococcus aureus and methicillin-sensitive Staphylococcus aureus colonization in the control group almost doubled (from 4.8% to 9.5%), while colonization in the intervention group decreased (from 20.8% to 16.7%). CONCLUSIONS/CLINICAL RELEVANCE: These findings demonstrate the importance of oral care in the poststroke patient with dysphagia.

Piloting "sodabriety": a school-based intervention to impact sugar-sweetened beverage consumption in rural Appalachian high schools.

BACKGROUND: Sugar-sweetened beverages (SSBs) are the largest source of added sugar in the US diet. In adolescents aged 12-19, these drinks account for 13% to 28% of total daily calories. Compared with other adolescents, those residing in Appalachia have the highest consumption rates of SSBs. METHODS: Using a Teen Advisory Council (TAC), a student-designed and student-led intervention was conducted at 2 high schools in a rural Appalachian county. Using repeated-measures models design with Bonferroni correction, data were collected on daily and weekly consumption of SSBs and of water at baseline, immediately post-intervention, and 30 days post-intervention. Vending machine surveys were completed. RESULTS: The 186 participants reported purchasing SSBs from school vending machines (41.4%), cafeteria (36.5%), and school stores (7.7%). Daily SSB servings decreased from an average of 2.32 (SD = 2.14) to 1.32 (SD = 1.29) (p < .001). Weekly consumption decreased from an average of 4.30 (SD = 2.40) days/week to 2.64 (SD = 1.91) (p < .001). Water consumption increased 19% from baseline to immediately post-intervention. CONCLUSIONS: Student-directed efforts to support behavioral change are feasible and effective at affecting individual lifestyle behaviors. Small and manageable changes may lead to net improvements in lifestyle behaviors.

Workplace bullying in the OR: Results of a descriptive study.

This study describes the incidence of workplace bullying among perioperative RNs, surgical technologists, and unlicensed perioperative personnel in two academic medical centers. The study sought to determine whether the demographic variables of gender, ethnicity, hospital, years of experience on the unit, years in the profession, and job title predict the experience of workplace bullying; whether a relationship exists between workplace bullying and emotional exhaustion; and whether bullying is associated with perceptions of patient safety in the OR. The cross-sectional design included perioperative nurses, surgical technologists, and unlicensed perioperative personnel (N = 167). Fifty-nine percent of the study participants reported witnessing coworker bullying weekly, and 34% reported at least two bullying acts weekly. Having one's opinion ignored is the most common bullying act, with 28% of respondents experiencing being ignored. Differences in the experience of bullying can be found between hospitals and among ethnicities. Emotional exhaustion also was correlated with bullying. The participants did not perceive bullying as affecting patient safety.

Comparing the effects of teen mentors to adult teachers on child lifestyle behaviors and health outcomes in Appalachia.

Childhood obesity prevalence rates in the United States are the highest in the rural Appalachian areas. Teens mentoring younger children to reverse obesity health risks are an understudied approach. This randomized-controlled trial compared the effects of two curriculum delivery methods and assessed the mediating effects of the number of sessions attended on the outcomes. The control group received the 8-week Just for Kids! curriculum via an adult teacher in a classroom and the experimental group received the same curriculum via individual teen mentoring. Data collected at baseline and postintervention were analyzed using multilevel linear models. Each of the outcomes (e.g., body mass index, blood pressure, current lifestyle behaviors) were modeled separately. Only the mentored children demonstrated improved current lifestyle behaviors (e.g., physical activity and dietary patterns) and health outcomes. Teen mentoring was an effective and efficacious approach to impact the lifestyle patterns and health outcomes of children in a school setting.

Playground characteristics to encourage children to visit and play.

BACKGROUND: The research sought to find the salient perceived characteristics of playgrounds for African-American children and their parents, and to test effects of changes in those characteristics on playground choice. METHODS: Thirty-one African-American children and their parents sorted 15 photographs of playgrounds for similarity. Nonmetric multidimensional scaling on the similarity scores and correlations between the resulting dimensions and judged characteristics of each playground revealed salient perceived characteristics. Study 2 had 40 African-American children and their parents view pairs of photographs, manipulated on the salient characteristics, and pick the one to play on (child question) or for the child to play on (parent question). A third study inventoried and observed children's activities in 14 playgrounds. RESULTS: Study 1 found seats, fence, playground type, and softness of surface as salient perceived characteristics of the playground. Study 2 found that participants were more likely to pick playgrounds with equipment and playgrounds with a softer surface. Study 3 found higher levels of physical activity for playground settings with equipment. CONCLUSIONS: The findings confirm correlational findings on the desirability of equipment and safety. Communities need to test the effects of changes in playgrounds.

Measuring what matters: effectively predicting language and literacy in children with cochlear implants.

OBJECTIVES: To evaluate how well various language measures typically used with very young children after they receive cochlear implants predict language and literacy skills as they enter school. METHODS: Subjects were 50 children who had just completed kindergarten and were 6 or 7 years of age. All had previously participated in a longitudinal study from 12 to 48 months of age. 27 children had severe-to-profound hearing loss and wore cochlear implants, 8 had moderate hearing loss and wore hearing aids, and 15 had normal hearing. A latent variable of language/literacy skill was constructed from scores on six kinds of measures: (1) language comprehension; (2) expressive vocabulary; (3) phonological awareness; (4) literacy; (5) narrative skill; and (6) processing speed. Five kinds of language measures obtained at six-month intervals from 12 to 48 months of age were used as predictor variables in correlational analyses: (1) language comprehension; (2) expressive vocabulary; (3) syntactic structure of productive speech; (4) form and (5) function of language used in language samples. RESULTS: Outcomes quantified how much variance in kindergarten language/literacy performance was explained by each predictor variable, at each earlier age of testing. Comprehension measures consistently predicted roughly 25-50 percent of the variance in kindergarten language/literacy performance, and were the only effective predictors before 24 months of age. Vocabulary and syntactic complexity were strong predictors after roughly 36 months of age. Amount of speech produced in language samples and number of answers to parental queries explained moderate amounts of variance in performance after 24 months of age. Number of manual gestures and nonspeech vocalizations produced in language samples explained little to no variance before 24 months of age, and after that were negatively correlated with kindergarten performance. The number of imitations produced in language samples at 24 months of age explained about 10 percent of variance in kindergarten performance, but was otherwise not correlated or negatively correlated with kindergarten outcomes. CONCLUSIONS: Before 24 months of age, the best predictor of later language success is language comprehension. In general, measures that index a child's cognitive processing of language are the most sensitive predictors of school-age language abilities.

Emergent literacy in kindergartners with cochlear implants.

OBJECTIVE: A key ingredient to academic success is being able to read. Deaf individuals have historically failed to develop literacy skills comparable with those of their normal-hearing (NH) peers, but early identification and cochlear implants (CIs) have improved prospects such that these children can learn to read at the levels of their peers. The goal of this study was to examine early, or emergent, literacy in these children. METHOD: Twenty-seven deaf children with CIs, who had just completed kindergarten were tested on emergent literacy, and on cognitive and linguistic skills that support emergent literacy, specifically ones involving phonological awareness, executive functioning, and oral language. Seventeen kindergartners with NH and eight with hearing loss, but who used hearing aids served as controls. Outcomes were compared for these three groups of children, regression analyses were performed to see whether predictor variables for emergent literacy differed for children with NH and those with CIs, and factors related to the early treatment of hearing loss and prosthesis configuration were examined for children with CIs. RESULTS: The performance of children with CIs was roughly 1 SD or more below the mean performance of children with NH on all tasks, except for syllable counting, reading fluency, and rapid serial naming. Oral language skills explained more variance in emergent literacy for children with CIs than for children with NH. Age of first implant explained moderate amounts of variance for several measures. Having one or two CIs had no effect, but children who had some amount of bimodal experience outperformed children who had none on several measures. CONCLUSIONS: Even deaf children who have benefitted from early identification, intervention, and implantation are still at risk for problems with emergent literacy that could affect their academic success. This finding means that intensive language support needs to continue through at least the early elementary grades. Also, a period of bimodal stimulation during the preschool years can help boost emergent literacy skills to some extent.

Shared decision making and other variables as correlates of satisfaction with health care decisions in a United States national survey.

OBJECTIVE: The purpose of this study was to examine the relationship between shared decision-making (SDM) and satisfaction with decision (SWD) within a larger survey of patient decision-making in health care consultations. METHODS: A randomly selected age-proportionate national sample of adults (aged 21-70 years) stratified on race, ethnicity, and gender (N=488) was recruited from a health research volunteer registry and completed an online survey with reference to a recent health consultation. Measures included the shared decision making-9 questionnaire (SDM-Q-9), Satisfaction With Decision (SWD) scale, sociodemographic, health, and other standardized decision-making measures. Forward selection weighted multiple regression analysis was used to model correlates of SWD. RESULTS: After controlling for sociodemographic variables, SDM-Q-9 total score was associated with SWD, adjusted R(2)=.368, p<.001. Three of nine SDM-Q-9 items accounted for significant proportions of variance in SWD. CONCLUSION: SDM was positively associated with SWD and was strongest for three areas of SDM: patients being helped in a health care consultation with understanding information, with treatment preference elicitation, and with weighing options thoroughly. PRACTICE IMPLICATIONS: By identifying variables such as SDM that are associated with SWD, health care interventions can better target modifiable factors to enhance satisfaction and other outcomes.