School and Behavioral Outcomes Among Inner City Children: Five-Year Follow-Up.

Educational achievement is a key determinant of future life chances, but children growing up in poverty tend to do worse by many academic measures. Family, school, and neighborhood contextual characteristics may affect academic outcomes. In an attempt to explore neighborhood and individual level factors, we performed multilevel analyses to explain child's behavioral problems, repeat grade, average math and reading scores. Outcome measures were associated with specific neighborhood characteristics, above and beyond the effect of student/family level factors. The findings warrant further consideration of ecological interventions aiming to improve academic and behavioral outcomes of children living in poverty.

Rasch Analysis and Differential Item Functioning of a Social Support Measure in Jail Inmates With HIV Infection.

The protective effects of social support on health have been documented in a variety of groups. For HIV-infected persons released from correctional settings, strong social support may be particularly important for obtaining effective postrelease medical treatment and supportive services. Researchers and program evaluators seeking to improve access and adherence to postrelease HIV medical care in this population need accurate measures for the level and type of social support, but current measures have not been fully validated for incarcerated individuals with HIV infection. We used the Rasch model to test the Medical Outcomes Study (MOS) social support survey. Data for the analysis were collected as part of the EnhanceLink project in the five urban jails where the MOS was administered. Findings indicate that the MOS survey items may not capture the entire variability of person abilities. Respondents showed problems in discriminating among response options, indicating potential systematic bias. In addition, while there was no significant gender difference, overall levels of social support differed by gender. Further research is warranted to develop more effective social support measurement tools that can better guide interventions for persons transitioning from jail and prison to the community.

Community-based fortified dietary intervention improved health outcomes among low-income African-American women.

Poor dietary exposure disproportionately affects African-Americans and contributes to the persistence of disparities in health outcomes. In this study, we hypothesized that fortified dietary intervention (FDI) will improve measured dietary and related health outcomes and will be acceptable among low-income African-American women living in Tampa, FL. These objectives were tested using a prospective experimental study using pretest and posttest design with a control group, using a community-based participatory research approach. The intervention (FDI) was designed by the community through structural modification of a preexisting, diet-based program by the addition of a physical and mental health component. Paired sample t tests were used to examine preintervention and postintervention changes in study outcomes. A total of 49 women participated in the study, 26 in the FDI group and 23 controls. Two weeks postintervention, there were significant improvements in waist circumference and health-related quality of life related to physical health (P< .0001), physical fitness subscores (P= .002), and nutritional subscores (P= .001) in the FDI group. Among overweight/obese women, improvement in health-related quality of life related to physical health, a significant decrease in depressive score, and a reduction in waist circumference were noted. In the control group, a decrease in waist circumference was observed. Implementation of the FDI through a community-based participatory research approach is feasible and effective among low-income African-American women in general and overweight/obese women in particular. Social reengineering of a nutritional intervention coupled with community-based approach will enhance health outcomes of low-income women.

A review of the foot function index and the foot function index - revised.

BACKGROUND: The Foot Function Index (FFI) is a self-report, foot-specific instrument measuring pain and disability and has been widely used to measure foot health for over twenty years. A revised FFI (FFI-R) was developed in response to criticism of the FFI. The purpose of this review was to assess the uses of FFI and FFI-R as were reported in medical and surgical literature and address the suggestions found in the literature to improve the metrics of FFI-R. METHODS: A systematic literature search of PubMed/Medline and Embase databases from October 1991 through December 2010 comprised the main sources of literature. To enrich the bibliography, the search was extended to BioMedLib and Scopus search engines and manual search methods. Search terms included FFI, FFI scores, FFI-R. Requirements included abstracts/full length articles, English-language publications, and articles containing the term "foot complaints/problems." Articles selected were scrutinized; EBM abstracted data from literature and collected into tables designed for this review. EBM analyzed tables, KJC, JM, RMS reviewed and confirmed table contents. KJC and JM reanalyzed the original database of FFI-R to improve metrics. RESULTS: Seventy-eight articles qualified for this review, abstracts were compiled into 12 tables. FFI and FFI-R were used in studies of foot and ankle disorders in 4700 people worldwide. FFI Full scale or the Subscales and FFI-R were used as outcome measures in various studies; new instruments were developed based on FFI subscales. FFI Full scale was adapted/translated into other cultures. FFI and FFI-R psychometric properties are reported in this review. Reanalysis of FFI-R subscales' confirmed unidimensionality, and the FFI-R questionnaires' response categories were edited into four responses for ease of use. CONCLUSION: This review was limited to articles published in English in the past twenty years. FFI is used extensively worldwide; this instrument pioneered a quantifiable measure of foot health, and thus has shifted the paradigm of outcome measure to subjective, patient-centered, valid, reliable and responsive hard data endpoints. Edited FFI-R into four response categories will enhance its user friendliness for measuring foot health.

Dimensionality, hierarchical structure, age generalizability, and criterion validity of the GAIN's Behavioral Complexity Scale.

This study used Rasch measurement model criteria and traditional psychometric strategies to examine key psychometric properties of the Behavioral Complexity Scale (BCS), a widely used measure of externalizing disorders that focuses on attention deficit, hyperactivity, and conduct disorders. With a sample of 7,435 persons being screened for substance use disorders, the BCS was found to (a) be unidimensional, (b) have a hierarchical severity structure, (c) be generalizable to both youths and adults, and (d) meet hypothesized correlations with criterion variables. The BCS performed well as a unidimensional measure. The Rasch severity hierarchy of attention deficit to hyperactivity to conduct disorders provided a perspective that suggested that a dimensional measure could be used as an alternative and, in some ways, as an improvement to categorical diagnosis and common dimensional approaches. The finding of 3 low-severity conduct disorder items also supported a revision of categorical criteria, especially in substance use disorders.

Systems of care, featherless bipeds, and the measure of all things.

For more than 20 years, the system of care philosophy has comprised a central strategy of service reform in children's mental health at the federal, state, tribal, and local levels. System of care terminology has become widely used in many different service sectors but often without a shared understanding of what a system of care is. This manuscript, the feature article for this special issue of Evaluation and Program Planning, briefly traces the history of the system of care movement, discusses the more widely used definitions in the field of children's mental health, and offers an expanded version of the definition that takes into account the complex nature of systems of care. This manuscript was the product of a process used by the Case Studies of System Implementation research team to identify established system of care communities for inclusion in the research study. The purpose of this manuscript is to describe the process the research team engaged in while developing the revised definition and to open a public dialogue about how to characterize the essential properties of a system of care.