Electronic Version of the Family Quality of Life Survey (eFQOLS): Reliability and Validity for Families of Individuals With Disabilities and Chronic Health Conditions.

This study tested the psychometric properties of an electronic Family Quality of Life Survey (eFQOLS) when used with families of individuals with disabilities and/or chronic health conditions. Data gathered from 272 family caregivers using the eFQOLS were subjected to reliability analysis, correlation analysis, and confirmatory factor analysis to test the internal consistency of the scales, as well as criterion and construct validity of the internal structure of the scale. Testing factor structures of the item-level domain models indicated that initiative and stability had low factor loadings in many domains. As a result, these items were deleted from the subscales. The subscale-level FQOL factor structure demonstrated a good fit after two adjustments. The internal consistency of the 27-item total FQOL scale was excellent (α = .93), while that of the subscales ranged from moderate to strong (α = .69 to .90). The eFQOLS had a moderate degree of construct validity, good criterion validity, and reliability when used with diverse families across the lifespan. Additional research is needed to continue refining the survey with a more heterogenous sample.

Developing Workforce Skills and Capacity in Telehealth: What LEND Trainees Need to Know.

INTRODUCTION: The COVID-19 pandemic significantly impacted the way health-related services are delivered, rapidly shifting from in-person to telehealth visits. To ensure that future healthcare providers are fully prepared to deliver services to families of youth with neurodevelopmental disabilities (NDD), understanding telehealth's advantages and barriers is vital. To this end, data were gathered to inform the development of a nationally available telehealth curriculum aimed at training future healthcare professionals from the Leadership Education in Neurodevelopmental Disabilities (LEND) network. METHODS: Surveys were sent out nationally to current LEND trainees, practicing healthcare professionals, and family members of youth with NDD in November of 2020. Multiple choice and free response questions were completed and analyzed. A total of N = 208 surveys were completed (88 LEND trainees, 94 practicing professionals, 23 family members). RESULTS: Most survey respondents reported having positive experiences with telehealth. LEND trainees and current healthcare professionals cited increased access to care and engagement as the top benefit of telehealth. Most family members reported using telehealth services (78%) and felt it was superior to in-person visits in terms of location of visit, scheduling, and meeting transportation needs. Trainees and professionals agreed the top barriers to telehealth for families were lack of broadband access and complexity of implementation and use. LEND trainees agreed telehealth basics should be included in LEND curriculum. DISCUSSION: Trainees, professionals, and family members all agreed that knowing the basics of telehealth is essential for effective telehealth service delivery. Emerging healthcare professionals need to understand how those they will be serving engage with technology, their levels of experience in this area, and effective strategies for engaging children and youth with NDD through telehealth. This will bridge the engagement gap many families of children with disabilities face when not meeting in person. Findings from this study contributed to the design of learning materials that currently support LEND trainees across the country in developing these skills.

Using a LIFE Framework to Develop MCH Leaders.

INTRODUCTION: The Maternal Child Health (MCH) Bureau created MCH Leadership Competencies to support current and future leaders by defining the knowledge and skills necessary to lead in this field. The Michigan-LEND (MILEND) training program developed a 'LIFE. framework', an acronym that stands for Leadership, Interdisciplinary, Family-Professional Partnerships, and Equity, to codify the 12 MCH leadership competencies into an easy to remember and easy to apply structure. This manuscript addresses the question, Does the LIFE framework align with the 12 MCH Leadership Competencies? Our hypothesis is that MI-LEND trainees will demonstrate improvement in their self-assessment of the 12 MCH leadership competencies after completing the MI-LEND program which uses the LIFE framework. METHODS: Data were collected from 24 MI-LEND long-term trainees (> 300 hours) who completed a 100-itemleadership self-assessment questionnaire based on the MCH Navigator at the beginning and the end of the training year. Non-parametric sign tests were used to test the median difference, item by item for each of the questions under each competency. Parametric paired-sample t-tests were used to analyze mean difference, competency by competency when the assumption of normality was met. RESULTS: All basic and advanced-level competencies had a statistically significant improvement between the beginning and end of the training year. The greatest changes were seen in Family-Professional Partnerships, Policy, Interdisciplinary Team Building, MCH Knowledge Base and Critical Thinking - all areas emphasized in the L.I.F.E. DISCUSSION: While the LIFE framework may oversimplify MCH Leadership Competencies, it is an effective mnemonic tool to organize and articulate MCH leadership competencies and could foster consistency across MCH programs.

Evaluating the Benefits of a Family Support Program on the Health and Well-Being of Aging Family Caregivers of Adults with Intellectual and Developmental Disabilities.

Providing care to a family member with intellectual and developmental disabilities (I/DD) takes a toll on the health of the caregiver and the family, especially as they age. Research shows that peer mediated family support programs can improve caregiver health and well-being. To date, most family support programs have focused on family caregivers of children and youth with I/DD. The purpose of this study was to examine the benefits of participating in the Michigan Older Caregivers of Emerging Adults with Autism and Neurodevelopmental Disabilities (MI-OCEAN) family support program grounded in the Family Quality of Life (FQOL) framework. Specifically, we examined the effect of participation on health care utilization, caregiver well-being, and perceptions of global FQOL for older caregivers of adults with I/DD. Quantitative analysis of data gathered from 82 caregivers (age 50 and older) indicated that study participation was associated with increased use of Medicaid and improved caregiver well-being (reduced burden, stress, depression; increased health satisfaction and FQOL). Future research is needed to examine the long-term impact of the family support programs in improving the health and well-being of older caregivers of adults with I/DD.

Asking the Right Questions About Secondhand Smoke.

INTRODUCTION: Despite knowledge about major health effects of secondhand tobacco smoke (SHS) exposure, systematic incorporation of SHS screening and counseling in clinical settings has not occurred. METHODS: A three-round modified Delphi Panel of tobacco control experts was convened to build consensus on the screening questions that should be asked and identify opportunities and barriers to SHS exposure screening and counseling. The panel considered four questions: (1) what questions should be asked about SHS exposure; (2) what are the top priorities to advance the goal of ensuring that these questions are asked; (3) what are the barriers to achieving these goals; and (4) how might these barriers be overcome. Each panel member submitted answers to the questions. Responses were summarized and successive rounds were reviewed by panel members for consolidation and prioritization. RESULTS: Panelists agreed that both adults and children should be screened during clinical encounters by asking if they are exposed or have ever been exposed to smoke from any tobacco products in their usual environment. The panel found that consistent clinician training, quality measurement or other accountability, and policy and electronic health records interventions were needed to successfully implement consistent screening. CONCLUSIONS: The panel successfully generated screening questions and identified priorities to improve SHS exposure screening. Policy interventions and stakeholder engagement are needed to overcome barriers to implementing effective SHS screening. IMPLICATIONS: In a modified Delphi panel, tobacco control and clinical prevention experts agreed that all adults and children should be screened during clinical encounters by asking if they are exposed or have ever been exposed to smoke from tobacco products. Consistent training, accountability, and policy and electronic health records interventions are needed to implement consistent screening. Increasing SHS screening will have a significant impact on public health and costs.

An exploratory study of seasonality and preschoolers' physical activity engagement.

BACKGROUND: While there is an emerging body of literature showing variations in physical activity between seasons, further investigation is needed to better understand this association in preschool-age children. This study was designed to examine seasonal variation from fall to winter in physical activity among preschoolers. METHODS: Forty-six preschool children from 2 preschools in a large Midwestern Metropolitan area completed weekly habitual physical activity measures in both fall and following winter. The habitual physical activity was quantified with the GT1M Actigraph uniaxial accelerometer. To determine seasonal differences in physical activity, a series of paired sample t tests were conducted. RESULTS: Although overall physical activity level declined in winter, the magnitude of seasonality effects seem varied in terms of contexts. Compared with the decline during after-school time and during weekends, the differences in physical activity across the 2 seasons were much less evident during the time attending preschool and during weekdays. CONCLUSION: Seasonality in physical activity can be moderated by other contextual factors, such as preschool policies and curriculum. Preschools may serve as a major battlefield for fighting against physical inactivity and obesity during childhood due to their practical controllability.

Screening for diabetes in an African American community: identifying characteristics associated with abnormal blood glucose readings.

OBJECTIVE: To identify characteristics associated with abnormal blood glucose readings among African Americans and to determine the potential value of a more targeted approach to community-based screenings for type 2 diabetes. METHODS: Data were collected from 7113 participants with no previous diagnosis of diabetes at mobile screening events in Detroit, Michigan. Data collected included gender, race, age, self-reported height and weight, total diabetes risk score, blood pressure, and random capillary blood glucose. RESULTS: Nearly 9% of participants had abnormal random plasma glucose readings (RPG>or=160 mg/dL). Results indicated that higher age, elevated blood pressure, and body mass index (BMI) were significantly associated with abnormal glucose readings. CONCLUSION: These findings suggest that community-based screenings for diabetes that are targeted to adults aged more than 50 years who have high blood pressure or a BMI of at least 25 may enhance detection of abnormal glucose levels among African Americans.

Tobacco manufacturers' defence against plaintiffs' claims of cancer causation: throwing mud at the wall and hoping some of it will stick.

BACKGROUND: In the late 1990s and the early part of this decade, the major US cigarette manufacturers admitted, to varying degrees, that smoking causes cancer and other diseases. OBJECTIVE: To examine how tobacco manufacturers have defended themselves against charges that their products caused cancer in plaintiffs in 34 personal injury lawsuits, all but one of which were litigated between the years 1986 and 2003. METHODS: Defence opening and closing statements, trial testimony, and depositions for these cases were obtained from the Tobacco Deposition and Trial Testimony Archive (http://tobaccodocuments.org/datta/). All available defence-related transcripts from these cases were reviewed and a content analysis was conducted to identify common themes in the defendants' arguments. RESULTS: After review of the transcripts, defendants' arguments were grouped into seven categories: (1) there is no scientific proof that cigarette smoking causes lung cancer; (2) the plaintiff did not have lung cancer as claimed; (3) the plaintiff had a type of lung cancer not associated with cigarette smoking; (4) the plaintiff had cancer that may have been associated with cigarette smoking or smokeless tobacco use, but tobacco products were not to blame in this particular case; (5) the plaintiff had cancer that may have been associated with cigarette smoking, but the defendant's cigarette brands were not to blame; (6) the defendant's cigarettes (or smokeless tobacco) may have played a role in the plaintiff's illness/death, but other risk factors were present that negate or mitigate the defendant's responsibility; and (7) the defendant's cigarettes may have been a factor in the plaintiff's illness/death, but the plaintiff knew of the health risks and exercised free will in choosing to smoke and declining to quit. Use of the argument that smoking is not a proven cause of lung cancer declined in frequency during and after the period when tobacco companies began to publicly admit that smoking causes disease. Corresponding increases occurred over time in the use of other arguments (namely, presence of other risk factors and "free will"). CONCLUSIONS: Despite the vast body of literature showing that cigarette smoking causes cancer, and despite tobacco companies' recent admissions that smoking causes cancer, defendants used numerous arguments in these cases to deny that their products had caused cancer in plaintiffs. The cigarette companies, through their public admissions and courtroom arguments, seem to be saying, "Yes, smoking causes lung cancer, but not in people who sue us".

Prevalence of parents' perceptions of sensory processing disorders among kindergarten children.

This study is the first to systematically examine estimated rates of sensory processing disorders using survey data. Parents of incoming kindergartners from one suburban U.S. public school district were surveyed using the Short Sensory Profile, a parent-report screening tool that evaluates parents' perceptions of functional correlates of sensory processing disorders (McIntosh, Miller, Shyu, & Dunn, 1999a). A total of 703 completed surveys were returned, which represents 39% of the kindergarten enrollment (n = 1,796) in the district for the 1999-2000 school year. Of the 703 children represented by the surveys, 96 children (13.7% of 703) met criteria for sensory processing disorders based upon parental perceptions. A more conservative prevalence estimate of children having sensory processing disorders based on parental perceptions was calculated by assuming that all non-respondents failed to meet screening criteria. This cautious estimate suggests that based on parents' perceptions, 5.3% (96 of 1796) of the kindergarten enrollment met screening criteria for sensory processing disorders. These percentages are consistent with hypothesized estimates published in the literature. Findings suggest a need for rigorous epidemiological studies of sensory processing disorders.

Violence against women with physical disabilities.

This study explored risk factors for violence among a sample of adult women with physical disabilities. Fifty-six percent (100) of the 177 women participating in the study indicated a positive history of abuse. Of the women who reported abuse, most reported multiple abuse situations and abusers who were typically their male partners. In addition, only a small proportion of women sought and received adequate help. Women who indicated that they did not seek help were asked why this was the case. Their responses included: feeling that they could handle it themselves, having other sources of support available, being unaware of where to go, feeling embarrassed, feeling guilty about being a burden or that it was their fault, fear that abuser would come after them, fear of not being believed, and, to a lesser extent, concern that the shelter would lack appropriate accommodations. These findings highlight the importance of intervention strategies including advocacy activities for women with disabilities, activities with schools, activities to deter and prevent partner and caregiver violence, community awareness activities, and dissemination activities.

Genetic heterogeneity in attention-deficit hyperactivity disorder (ADHD): gender, psychiatric comorbidity, and maternal ADHD.

The authors examined the siblings of 140 attention-deficit hyperactivity disorder (ADHD) and 120 control probands and classified families as antisocial if the proband had conduct disorder or a parent had antisocial personality. Partial support was found for the hypothesis that the ADHD gender effect would be limited to antisocial families. Boys had an increased risk for ADHD compared with girls, but only among siblings from antisocial families. The effect size for predicting ADHD in siblings of probands was greater for maternal compared with paternal ADHD, but only for families exhibiting antisocial disorders. Strong support was found for the hypothesis that, compared with siblings from nonantisocial families, those from antisocial families would have more psychopathology (ADHD, depression, substance use, and conduct disorders). The presence of antisocial disorders signals a distinct subtype of ADHD.