Rationale and Design of Distance-Based Training to Persuade Local Health Department Employees that Addressing Social Determinants of Health Is Their Job, Too.

Public health workers in local health departments frequently rate skills needed to address social determinants of health among their top training needs. These workers have the ability to impact social determinants of health, but many may believe this responsibility is not part of their job description or that they do not have the necessary skills or resources. Guided by the Elaboration Likelihood Model of Persuasion and employing the case study method of instruction, the Region 2 Public Health Training Center designed a 45-minute, self-paced, online training module, titled Strategies to Advance Health Equity: How Health Departments Can Promote Living Wages, to persuade public health workers that addressing social determinants of health, especially those related to income disparities, is part of their day-to-day responsibilities. This article describes the module design, promising preliminary assessment data, and the formal evaluation plan.

Posttraumatic Growth as a Response to Natural Disasters in Children and Adolescents.

PURPOSE OF REVIEW: This review examines factors thought to be associated with posttraumatic growth (PTG) (demographic variables, exposure, and family and social processes) among youth exposed to natural disasters, describes the relationship between PTG and posttraumatic stress, and discusses psychological processes (rumination and coping) linked to PTG. RECENT FINDINGS: Guided by PTG theory and the literature on PTG in adults, research has revealed relationships between PTG and child, environmental, and family and social factors among youth though the results are mixed. Youth's subjective exposure to disasters, their level of posttraumatic stress following the disaster, and the type of psychological processes they employ to cope with the disaster appear to be associated with PTG. Research has garnered preliminary support for PTG in children exposed to natural disasters but additional research is needed to fully explicate these relationships and to understand how these relationships change over time.

Diet and lifestyle impact the development and progression of Alzheimer's dementia.

Dementia is a growing public health concern, with an estimated prevalence of 57 million adults worldwide. Alzheimer's disease (AD) accounts for 60-80% of the cases. Clinical trials testing potential drugs and neuroprotective agents have proven futile, and currently approved drugs only provide symptomatic benefits. Emerging epidemiological and clinical studies suggest that lifestyle changes, including diet and physical activity, offer an alternative therapeutic route for slowing and preventing cognitive decline and dementia. Age is the single most common risk factor for dementia, and it is associated with slowing cellular bioenergetics and metabolic processes. Therefore, a nutrient-rich diet is critical for optimal brain health. Furthermore, type 2 diabetes (T2D) is a risk factor for AD, and diets that reduce the risk of T2D may confer neuroprotection. Foods predominant in Mediterranean, MIND, and DASH diets, including fruits, leafy green vegetables, fish, nuts, and olive oil, may prevent or slow cognitive decline. The mechanisms by which these nutrients promote brain health, however, are not yet completely understood. Other dietary approaches and eating regimes, including ketogenic and intermittent fasting, are also emerging as beneficial for brain health. This review summarizes the pathophysiology, associated risk factors, and the potential neuroprotective pathways activated by several diets and eating regimes that have shown promising results in promoting brain health and preventing dementia.

Profiles of service utilization and the resultant economic impact in preschoolers with attention deficit/hyperactivity disorder.

OBJECTIVE: To examine whether preschool children with Attention deficit/hyperactivity disorder (ADHD) utilize more speech and language therapy (ST), occupational therapy (OT), and physical therapy (PT) services and are more likely to be placed in special education (SPED) classrooms as compared to their peers. Corresponding financial consequences were also examined. METHODS: The amount of ST, OT, and PT, as well as SPED placements, was examined in 3- and 4-year-old children with and without ADHD (n = 109 and n = 97, respectively) during the baseline portion of an ongoing, 5-year longitudinal study. Costs for individual services and aggregate cost were determined per child and compared across groups. RESULTS: Preschool children with ADHD were more likely to receive individual and multiple services. Higher rates of service utilization translated into increased costs for each individual service with the exception of PT. CONCLUSIONS: A comprehensive understanding of service utilization in the early years of development is important in addressing the increased service use in the preschool years and assist in guiding allocation of resources.

Nutritional Needs of the Older Adult.

Older adults are particularly vulnerable to compromised nutritional status. With advancing age, the consumption of a high-quality, nutritionally dense diet is increasingly essential to optimize health and well-being. Proportionally, macronutrient needs for older adults are similar to younger adults, however overall calorie requirements tend to decline with age. Unique factors influencing food intake should be considered and individualized guidance should be designed to help overcome medical, physical, and social barriers to a healthy diet. The goal for nutrition intervention should ultimately be to promote health and quality of life across the continuum of the aging process.

A Case Study Examining Fixed Versus Randomized Criteria for Treating a Child With Conduct Problems and Callous-Unemotional Traits.

Children with conduct problems and callous unemotional traits (CPCU) seem to show a decreased response to behavioral treatment (Hawes, Price, & Dadds, 2014). It was hypothesized that children with CPCU may respond differently to behavior therapy when the target behavior criteria are fixed a priori versus when the target behavior criteria are randomly determined post hoc. A single-case study experiment was conducted as an initial step toward investigating this hypothesis. The study was conducted using a daily report card implemented in the context of an intensive behavioral summer treatment program. Results indicated that rates of negative behaviors were higher when rewards were delivered using randomly determined levels of target behaviors as compared to using fixed levels of target behaviors. Results suggest the importance of providing children with CPCU specific and predictable treatment goals when using contingency management procedures. Additional research that examines how children with CPCU react to components of behavioral treatment may help improve their response to behavior therapy.

The effects of multidimensional home-based exercise on functional performance in elderly people.

BACKGROUND: This study tested the hypothesis that a home-based exercise program would improve functional performance in elderly people. METHODS: We conducted a 6-month, single-blinded, randomized controlled trial. 72 community dwelling men and women (aged >/=70 years) with self-reported and laboratory-based functional impairment were recruited for the study. Participants were randomly assigned to either a home-based progressive strength, balance, and general physical activity intervention or an attention-control group that received home-based nutrition education. Functional performance was measured in the laboratory using the Physical Performance Test (PPT) and the Established Populations for Epidemiologic Studies of the Elderly (EPESE) short physical performance battery. Physiologic capacity was measured by strength (one repetition maximum), dynamic balance (tandem walk), gait speed (2-meter walk), and cardiovascular endurance (6-minute walk). RESULTS: 70 participants (97%) completed the 6-month trial. Compliance with study interventions within each group ranged from 75% in controls to 82% in exercisers. PPT increased by 6.1 +/- 13.4% in exercisers and decreased by 2.8 +/- 13.6% in controls (p =.02). EPESE improved by 26.2 +/- 37.5% in exercisers and decreased by 1.2 +/- 22.1% in controls (p =.001). Dynamic balance improved by 33.8 +/- 14.4% in exercisers versus 11.5 +/- 23.7% in controls (p =.0002). There were no differences between groups in the change in strength, gait speed, or cardiovascular endurance. CONCLUSIONS: Minimally supervised exercise is safe and can improve functional performance in elderly individuals. The improvements in functional performance occurred along with improvements in balance but without a significant change in muscle strength or endurance.

Higher dietary variety is associated with better nutritional status in frail elderly people.

OBJECTIVE: A narrow range of food choices may lead to dietary inadequacies, a particular concern in elderly people. We hypothesized that consumption of a more diverse diet would predict better nutritional status in frail elderly persons. SUBJECTS: Subjects included 98 frail nursing home residents (36 men, 62 women), mean age 87.1+/-5.5 (72 to 98) years. METHODS: 3-day dietary variety scores ranging from 23 to 48 and fruit and vegetable variety scores ranging from 5 to 20 were calculated from weighed 3-day food records as the number of different food or fruit and vegetable choices consumed. A higher score indicates a more varied diet. Nutritional status was assessed by weight, height, body mass index (BMI), skinfold thickness, circumference measures, calculated mean arm muscle area, total body water, computerized tomography of the thigh, and total body potassium, as well as nutritional analysis, biochemical measures, and subject medical history. STATISTICAL METHODS: Univariate regression analyses were performed to investigate the relationship between clinical and nutrition variables. Multiple linear regressions were used to develop models relating dietary variety scores to possible etiologic factors as well as indicators of nutritional status. Models were controlled for age, BMI, and energy intake when appropriate. RESULTS: Mean dietary variety score was 35.2+/-4.5, and mean fruit and vegetable variety score was 11.3+/-3.0. Higher dietary variety score was associated with higher energy intake (beta = 20.5, P < .001) and both high dietary variety score and fruit and vegetable variety score were positively associated with intake for many nutrients (P < or = .05). High dietary variety score was related to high fruit and vegetable variety score and total intake of fruits and vegetables. In men, higher dietary variety score and fruit and vegetable variety score were associated with higher high-density lipoprotein (beta = 1.02), lower very-low-density lipoprotein (beta = -3.58) and triglycerol (beta = -3.51), and higher blood folate (beta = 4.72) concentrations in women (P < or = .05). In women, high dietary variety score was associated with higher BMI (beta = 0.34, P < .001) and higher total body potassium (beta = 1.30, P = .02); high fruit and vegetable variety score was associated with higher BMI (beta = 0.41), mid-arm circumference (beta = 0.34), and mid-arm muscle area (beta = 2.94) (P < or = .03). Dietary variety score was higher (mean 37.6+/-5.38 vs 34.6+/-4.14) in those who received assistance with feeding (beta = 2 .67, P = .01). History of cancer (beta = -2.04) and gastrointenstinal cancer (beta = -3.54) were associated with low dietary variety score (P < or = .05). CONCLUSIONS: The results of this study suggest that a highly varied diet in elderly nursing home residents is associated with better nutritional status as assessed by nutrient intake, biochemical measures, and body composition measures. Dietary variety score is a straightforward tool for screening and identifying people at nutritional risk, as well as a mechanism for monitoring response to nutritional, medical, and environmental interventions. Preventive measures to improve dietary variety, as measured by the dietary variety score, should be evaluated and introduced before nutrition and health complications arise.

A pilot study of stimulant medication for adults with attention-deficit/hyperactivity disorder (ADHD) who are parents of adolescents with ADHD: the acute effects of stimulant medication on observed parent-adolescent interactions.

OBJECTIVE: This study explores the use of stimulant medication for parents with attention-deficit/hyperactivity disorder (ADHD) who also have adolescents with ADHD. METHODS: Five parents, diagnosed with ADHD, had their dose of lisdexamfetamine (LDX) titrated to optimal effect. Next, parents and their adolescents completed two interactions, once when parents were on placebo and once when parents were on optimal dose of LDX, to assess acute effects of parental medication on parenting during a neutral discussion (NeuDiss), a problem discussion (ProbDiss), and a homework task (HW). RESULTS: Parents demonstrated a significant decrease in the ratio of commands to total verbalizations during the NeuDiss on LDX compared with placebo. Although no other statistically significant effects emerged at the p<0.05 level, moderate to large effects of medication on some aspects of parenting related to the amount and timing of speech (i.e., total verbalizations, total commands, ratio of commands to total verbalizations, and responsiveness) emerged and varied by task. Parental stimulant medication did not appear to impact the content of parents' speech (i.e., use of negative talk or praise). CONCLUSIONS: These results add to a growing literature suggesting that treatment for parental ADHD may impact parenting performance, and suggest that attention to parental ADHD in treatment for adolescents with ADHD may possibly enhance family functioning.

Position of the Academy of Nutrition and Dietetics: food and nutrition for older adults: promoting health and wellness.

It is the position of the Academy of Nutrition and Dietetics that all Americans aged 60 years and older receive appropriate nutrition care; have access to coordinated, comprehensive food and nutrition services; and receive the benefits of ongoing research to identify the most effective food and nutrition programs, interventions, and therapies. Health, physiologic, and functional changes associated with the aging process can influence nutrition needs and nutrient intake. The practice of nutrition for older adults is no longer limited to those who are frail, malnourished, and ill. The population of adults older than age 60 years includes many individuals who are living healthy, vital lives with a variety of nutrition-related circumstances and environments. Access and availability of wholesome, nutritious food is essential to ensure successful aging and well-being for the rapidly growing, heterogeneous, multiracial, and ethnic population of older adults. To ensure successful aging and minimize the effects of disease and disability, a wide range of flexible dietary recommendations, culturally sensitive food and nutrition services, physical activities, and supportive care tailored to older adults are necessary. National, state, and local strategies that promote access to coordinated food and nutrition services are essential to maintain independence, functional ability, disease management, and quality of life. Those working with older adults must be proactive in demonstrating the value of comprehensive food and nutrition services. To meet the needs of all older adults, registered dietitians and dietetic technicians, registered, must widen their scope of practice to include prevention, treatment, and maintenance of health and quality of life into old age.

Exploring the gender gap in referrals for children with ADHD and other disruptive behavior disorders.

OBJECTIVE: The current study examined the impact of the gender of children with ADHD on teachers' perceptions toward inattentive, hyperactive, or oppositional behaviors, and how these perceptions relate to teachers' ratings of children's impairment and referral recommendations. METHOD: Teachers read eight vignettes depicting boys and girls with different subtypes of ADHD, as well as one depicting comorbidity (ADHD + ODD). Teachers then completed measures of impairment, and responded to questions about what services they would likely refer for the child and why. RESULTS: Teachers rated girls as being significantly more impaired and more in need of services than boys. Regardless of gender, teachers overwhelmingly reported preferring the use of behavior modification for the described child. Also, children who were described with symptoms of ADHD-predominately inattentive subtype were rated as being the least impaired, while girls described as hyperactive and impulsive were rated by teachers as being the most impaired. CONCLUSION: The current study adds to previous literature on gender bias in ADHD referrals by providing evidence for the differential referral of ADHD boys and girls to treatment based on presentation of symptoms.

Moderating effects of neurocognitive abilities on the relationship between temperament and global functioning.

Clear links between temperament, psychopathology, and neuropsychological functioning exist; however the interrelations among temperament and neuropsychology, and their impact on functioning in typically developing children is not as well understood. This study examined the degree to which neuropsychological functioning, as measured by the NEPSY, moderates the impact of temperament on global functioning, as measured by the Children's Global Assessment Scale (CGAS), in 74 typically developing preschoolers. Temperament was assessed via parent ratings on the Children's Behavior Questionnaire (CBQ) and teacher ratings on the Temperament Assessment Battery for Children--Revised (TABC-R). Moderation analyses revealed significant interactions between verbal-executive skills and both child emotionality and lack of task persistence in predicting global functioning. The interaction patterns were mostly consistent across measures and indicated that when lower neurocognitive scores were coupled with higher levels of expressed negative emotions and more difficulties in task persistence, global functioning was at its lowest. In contrast better neurocognitive functioning mitigated the impact of high expressed emotions on global functioning. These findings support past literature and indicate that emotional and cognitive functioning interact to effect young children's global functioning.