Validation of the Mirror Image Comfort and Avoidance Scale in a General Population.

Background and Purpose: Mirror viewing is a central concept in body image, as many feelings and thoughts about one's body originate in the mirror. The Mirror Image Comfort and Avoidance Scale (MICAS) is a self-reported instrument to assess the experiential aspects of mirror viewing. The development of this instrument is grounded in the nursing mid-range Neurocognitive Mirror Comfort and Avoidance theory. This study aimed to validate the MICAS in a general population, explore its subscales, and note demographic differences. Methods: Waltz, Strickland, and Lenz's instrument validation framework guided the process. A survey website was used to recruit adult participants (n = 205). Convergent validation was established by assessing the relationships between mirror comfort and avoidance scores and measures of anxiety, depression, stress, self-esteem, and body appreciation. Results: Validity was obtained, and the subscales were reliable. Cronbach's α score was satisfactory for comfort at .90 and avoidance at .92. Significant associations were found between mirror comfort and avoidance and all psychological variables, indicating that mirror comfort and avoidance play a role in body image and overall well-being. Conclusions: MICAS is a nurse-developed instrument designed for research purposes to enhance our understanding of mirror viewing and formulate supportive nursing interventions to improve the mirror viewing experience.

Stress among Pediatric Occupational Therapists: A Study of Prevalence, Work and Demographic Factors.

This study aimed to evaluate the self-reported stress levels of pediatric occupational therapists, examine specific work factors and determine if demographic factors predict occupational stress. A cross-sectional survey design study, using voluntary response sampling, was conducted. The survey included demographics, the Workplace Stress Scale, and the Stress Index. The sample included 289 pediatric occupational therapists. Using descriptive analysis, a one-sample t-test, and multiple linear regressions, results indicated that pediatric occupational therapists had significantly higher stress levels than the validating sample of the Workplace Stress Scale. Self-reported work factors included too much work to do in a limited time and lack of time to plan or evaluate treatments. No demographic factors predicted work stress, while several work factors did. Occupational stress exists in pediatric occupational therapy work settings, especially in settings where high productivity is self-reported.

The Baby Bites Text Messaging Project with randomized controlled trial: texting to improve infant feeding practices.

Background: Rapid weight gain and overweight in infancy are associated with childhood obesity. Thus, effective, accessible interventions to promote healthy infant feeding practices to prevent early obesity are essential. Methods: This mixed-methods study involved diverse parents of infants in an urban, low-income pediatric clinic. Qualitative interviews explored parental attitudes towards feeding, early obesity, and communication with the pediatrician. A pilot, randomized controlled trial (RCT) informed by feedback provided by clinic parents compared text messages delivered for 12 months promoting healthy feeding practices to usual care to prevent early pediatric obesity. A computer-generated randomization schedule with balanced distribution for sex was used to place infants into groups. Weight-for-length percentiles and z-scores and feeding practices were measured at 0-2 weeks (baseline), 2-4 months, 6-9 months, and 12 months. Interviews were recorded, transcribed, and coded using thematic analysis. Weight for length percentile, Weight for length z scores, and feeding practices were compared between groups using repeated measures mixed analysis of variance (ANOVA). Results: Participants in the interviews were 15 parents of infants less than 1 month old. RCT participants were 38 parents of newborns (17 control; 21 intervention). Most parents in the qualitative evaluation viewed breastfeeding positively but also discussed barriers. Most also wanted practical information regarding infant feeding. There were no differences in weight-for-length percentile (F=0.52; P=0.60) or z-scores (F=0.7922; P=0.79), breastfeeding persistence χ2[1] =1.45, P=0.23, or age of introduction of solids in the intervention (statistical analysis not possible due to low counts) compared to the control group; however, low response to surveys limited the study's power. Conclusions: Text messaging has potential to extend the healthcare provider's communication beyond clinic. However, texting interventions should be flexible to mitigate barriers such as loss of phone service and challenges customizing messages to parent needs.

Development and Evaluation of the Atheist Identity Concealment Scale (AICS).

The Atheist Identity Concealment Scale (AICS) was developed as a tool to assess the degree to which atheists conceal their atheist identity from others. Drawing on concealable stigmatized identity (CSI) theory, the aim of this study was to provide researchers with a valid means to effectively assess atheist identity concealment. Using three separate samples of more than 500 adults in the USA, exploratory and confirmatory factor analyses were conducted which ultimately resulted in a short, robust measure comprised of eight items. Additional validity evidence was provided by examining the relationship between the AICS and several previously validated tools (i.e., outness, nonreligiosity, depression, anxiety, stress, and self-esteem).

Development and validation of the mirror image comfort and avoidance scale (MICAS).

PURPOSE: The purpose of this study was to develop an instrument to measure the experience of viewing one's reflection in the mirror for use in rehabilitation, nursing, psychology, and in research studies designed to improve the mirror-viewing experience for those who have suffered psychological or bodily trauma. A secondary purpose was to explore demographic differences in each subscale of the instrument. METHODS: The developed items went through content expert validation, exploratory and confirmatory factor analyses, and internal consistency reliability testing. RESULTS: Using an exploratory factor analysis (n = 137) and a confirmatory factor analysis (n = 142), we validated a 17-item instrument for two distinct populations: veterans (n = 108) and individuals with upper and lower limb loss (n = 210). The mirror viewing comfort subscale (9 items; α = 0.90) and the mirror avoidance subscale (8 items, α = 0.94) were deemed reliable. Strong, significant correlations between pre-and post-comfort scores (r = 0.81, p < 0.001), as well as pre-and post-avoidance scores (r = 0.94, p < 0.001) provide evidence of test-retest reliability. Demographic differences were noted in the subscales. CONCLUSIONS: This instrument contributes to a greater understanding of the experience of mirror-viewing in clinical practice. In interventional research studies to improve the mirror-viewing experience, this instrument can act as a manipulation check or outcome measure.Implications for rehabilitationIndividuals who suffer actual or perceived body disfigurement due to surgery or trauma may suffer mirror discomfort or mirror trauma when viewing their bodies in a mirror. This reaction is due to a pre-frontal cortex neurological disruption and autonomic nervous system fright/flight or faint. Psychological disorders (e.g., devastation, shame, self-revulsion, decreased body image) may ensue.Falls have occurred due to mirror trauma due to an autonomic nervous system disturbance (faint) and may result in ongoing mirror avoidance. When mirrors are needed for incision visualization, mirror avoidance has led to severe surgical site infections.Although there were many scales available in the literature to measure several aspects of the effects of actual or perceived body disfigurement, there were no scales that measured the mirror-viewing experience.Clinicians and researchers can use the Mirror Comfort and Avoidance Scale (MICAS) to assess mirror comfort and avoidance.

Efficacy of cogmed working memory training program in improving working memory in school-age children with and without neurological insults or disorders: A meta-analysis.

This meta-analysis assessed the efficacy of the Cogmed Working Memory Training program in improving near-transfer measures (verbal and visuospatial working memory) and far-transfer measures (attention, executive function, and academic achievement) in school-age children with and without neurological insults or disorders. Relevant studies were searched in databases and clinical trial registries using the keyword Cogmed. Ten published studies and unpublished data from one study met the inclusion criteria. Hedges g was calculated for each outcome measure obtained at pre-intervention, post-intervention, and 3-6 month time points. Analysis compared outcome measures in the control versus experimental groups and examined the role of moderators on treatment effects (control group intervention, intervention environment). Data revealed significant medium-size effects of the Cogmed program in improving verbal and visuospatial working memory post-intervention and for verbal working memory only at the 3-6 month time point. However, the training did not generalize to the far-transfer measures. Analyses indicated that only the type of intervention provided for the control group moderated treatment effects on verbal and visual working memory. Meta-analytic findings suggest that the Cogmed program leads to short-term improvements and in some cases, long-term improvements in working memory in school-age children; however, these effects may not generalize to far-transfer measures.

Educating Nurses on Supported Mirror Viewing for Patients After Amputation and Other Visible Disfigurements.

PURPOSE: The aim of our study was to test an educational intervention to improve nurses' confidence in supporting and frequency of offering a mirror to patients who have recently suffered visible body disfigurement. DESIGN/METHODS: Forty-eight registered nurses who worked in two acute care hospitals took part in a mixed-method one-group repeated-measures (pretest and posttest) research study. The educational intervention included a video, a presentation, and a recorded discussion. RESULTS: Study participants experienced a significant increase in confidence in supporting and frequency of offering mirrors to patients. An overarching theme from the qualitative analysis was that the nurse participants perceived assisting patients in viewing their changed bodies in mirrors as "an act of compassion." Four subthemes emerged: (a) seeing mirrors differently, (b) there is only one first time, (c) how can we do this better, and (d) "me too" stories of their own and patients' difficult mirror-viewing experiences. CONCLUSION: Education enhances nurses' frequency of offering mirrors and supporting patients in mirror viewing after visible disfigurement because of trauma or surgery. CLINICAL RELEVANCE: Education provides nurses with the necessary skills to assist patients in adapting to an altered body image.

Constraint Induced Movement Therapy Camp for Children with Hemiplegic Cerebral Palsy Augmented by Use of an Exoskeleton to Play Games in Virtual Reality.

AIM: To determine the acceptability and effects of a pediatric constraint induced movement therapy (P-CIMT) camp for children with hemiplegic cerebral palsy (hCP) augmented by use of an exoskeleton to play games in virtual reality (VR). METHOD: 31 children with hCP attended a P-CIMT camp 6 hours per day for 10 days over 2 successive weeks (60 hours) that included 30 minutes of unilateral training with the Hocoma Armeo®Spring Pediatric that combines the assistance of an exoskeleton and VR games. The primary outcome measure was the Assisting Hand Assessment (AHA); secondary outcome measures were the Melbourne Assessment of Uni-lateral Hand Function (MUUL), and the Canadian Occupational Performance Measure (COPM). Assessments were completed at pre-intervention, post-intervention, and 6 months following intervention. RESULTS: Participants demonstrated clinically and statistically significant improvement in bimanual performance (AHA) (p < .001) and COPM Performance (p < .001) and Satisfaction with performance (p < .001). Improvement in unilateral performance (MUUL) was statistically (p < .001) but not clinically significant. CONCLUSIONS: A P-CIMT camp augmented by the Hocoma Armeo®Spring Pediatric was feasible and accepted by participants. Bimanual hand function and occupational performance improved immediately following intervention, and the treatment effects persisted 6 months following intervention.

Factor Analysis of the Administrator-Research Campus Climate Collaborative (ARC3) Survey.

Sexual assault, dating violence, stalking, and sexual harassment present serious challenges to the health and well-being of college students across the United States. An estimated one in five female college students is sexually assaulted during college. Under the federal protection of Title IX, institutions of higher education are responsible for addressing sexual harassment and sexual misconduct as forms of discrimination, thus campus climate surveys are increasingly being conducted in campus settings to examine student beliefs and experiences about sexual assault, dating violence, stalking, sexual harassment, and related campus prevention and response efforts. The Administrator-Researcher Campus Climate Collaborative (ARC3) Campus Climate Survey was designed to assess a range of Title IX violations that include sexual harassment, dating violence, and sexual misconduct victimization and perpetration. This article used a sample of students drawn from seven universities to assess the psychometric properties of the ARC3 survey. Specifically, factor analysis (exploratory and confirmatory) was used to examine the factor structure of each module of the ARC3 survey. Results indicated that the majority of modules within the ARC3 survey were valid and reliable. Recommendations are provided for university administration to utilize a scorecard approach in order to get a brief but comprehensive view of campus safety status.

Vitamin D Deficiency and Sleep Quality in Minority Pregnant Women.

PURPOSE: To examine if vitamin D deficiency was associated with poor sleep quality in a sample of African American and Hispanic pregnant women. We also examined if race moderates the relationship between serum 25(OH)D levels and sleep quality among participants in this sample. STUDY DESIGN AND METHODS: Using a cross-sectional design, a sample of 115 African American and Hispanic pregnant women were enrolled from a federally qualified health center in the Midwest. Women completed questionnaires and had blood drawn for serum 25(OH)D levels between 24- and 32 weeks gestation. The questionnaires included demographic characteristics, the Pittsburgh Sleep Quality Index, and dietary vitamin D and calcium intake. RESULTS: The overall regression model indicated that the predictors explained 17% of variance in sleep quality (F(5, 103) = 4.10, p = .002, R = 0.17). Serum 25(OH)D levels were significant predictors of sleep quality after controlling for covariates (i.e., race, maternal age, prepregnancy body mass index, gestational age at data collection). Race did not moderate the association between serum 25(OH)D levels and sleep quality among women in this sample. CLINICAL IMPLICATIONS: Pregnant women should be screened for vitamin D deficiency. Women who have vitamin D deficiency should be provided vitamin D supplementation. Vitamin D supplementation may be a simple solution to enhance sleep quality at this critical time in a woman's life.

The Impact of Game Outcome on Affect of Military Wheelchair Basketball Players.

Participation in physical activity has been shown to improve components of psychological well-being (i.e., affect). Programs such as the Warrior Games have been designed to promote physical activity in wounded military personnel. However, sport competition typically yields a winner and a loser (i.e., game outcome). The experience of a win or a loss may affect how wounded athletes respond to game outcome. Therefore, the purpose of this study was to investigate the affective changes (positive affect, negative affect, tranquility, and fatigue) according to game outcome in a sample of wounded military wheelchair basketball players participating in a weekend tournament. The results indicated that the participants who experienced a win reported significantly higher positive affect and tranquility and significantly lower negative affect than those experiencing a loss. These findings have important implications for wounded veteran athletes, as well as coaches and administrative personnel.

Caught in a Web of Confusion: Assessing the Readability of University Webpages for Victims of Sexual Assault.

Assuring the effectiveness of Web sites in communicating critical information to a college student who has experienced sexual assault is important and complex. Recognizing that the average American reads at the eighth grade level, the National Institutes of Health and the American Medical Association recommend that information be written at a sixth-grade reading level. A sample of 10 U.S. institutions of higher education (IHE) Web sites made up the sample of the current study. The IHEs included were all participants in a project called "Cultivating Safe College Campuses," funded by the Department of Health and Human Services. This study aimed to gain more insight into the readability of college Web sites about sexual assault resources for the intended consumer-college students. The reading level of IHE Web sites with information about sexual assault should align with the reading level of their intended audience. The average readability of sexual assault Webpages for this study's sample of IHEs was over 13, well above the reading level of the average "first time in college" student. All IHEs should review the readability of their Web sites and revise them to use consistent and defined terms and present the material in a way that is clear and accessible for the student who has experienced trauma.

Moving Beyond Univariate Post-Hoc Testing in Exercise Science: A Primer on Descriptive Discriminate Analysis.

There has been a recent call to improve data reporting in kinesiology journals, including the appropriate use of univariate and multivariate analysis techniques. For example, a multivariate analysis of variance (MANOVA) with univariate post hocs and a Bonferroni correction is frequently used to investigate group differences on multiple dependent variables. However, this univariate approach decreases power, increases the risk for Type 1 error, and contradicts the rationale for conducting multivariate tests in the first place. PURPOSE: The purpose of this study was to provide a user-friendly primer on conducting descriptive discriminant analysis (DDA), which is a post-hoc strategy to MANOVA that takes into account the complex relationships among multiple dependent variables. METHOD: A real-world example using the Statistical Package for the Social Sciences syntax and data from 1,095 middle school students on their body composition and body image are provided to explain and interpret the results from DDA. RESULTS: While univariate post hocs increased the risk for Type 1 error to 76%, the DDA identified which dependent variables contributed to group differences and which groups were different from each other. For example, students in the very lean and Healthy Fitness Zone categories for body mass index experienced less pressure to lose weight, more satisfaction with their body, and higher physical self-concept than the Needs Improvement Zone groups. However, perceived pressure to gain weight did not contribute to group differences because it was a suppressor variable. CONCLUSION: Researchers are encouraged to use DDA when investigating group differences on multiple correlated dependent variables to determine which variables contributed to group differences.

Weight Control Behavior as an Indicator of Adolescent Psychological Well-Being.

BACKGROUND: Adolescence is a critical time for the development of psychological well-being. Weight gain and the emergence of body image concerns during this period can lead to the development of negative psychological states. To explore this issue, we examined the relationship between weight control behavior (WCB; ie, trying to lose, gain, stay the same, or do nothing about weight) and levels of depression and self-esteem. METHODS: Adolescents (508 boys, 502 girls; Mage = 12.32 ± .88 years) completed a survey that assessed WCB, depression, and self-esteem. Descriptive discriminant analysis was used to analyze WCB group differences on psychological well-being. Multivariate post hoc analysis further examined group differences. Structure coefficients indicated the relative importance of each dependent variable in boys and girls. RESULTS: Results indicated that, among both sexes, WCB was significantly related to depression and self-esteem. Individuals trying to lose weight had lower levels of psychological well-being than the other groups. CONCLUSIONS: Adolescents trying to lose weight reported the lowest psychological well-being scores whereas those not doing anything to control weight reported the highest levels of psychological well-being. These findings have important implications for screening and education programs designed to monitor and support adolescent psychological well-being.

Shared Decision-Making in Nursing Homes: Factors Associated With the Empowerment of Direct Care Workers.

OBJECTIVE: The advantages of empowering direct care workers (DCWs) within nursing homes (NHs) are well documented. Our objective is to identify factors that create DCW empowerment as this has not received adequate attention. METHOD: The data come from a larger study focused on the empowerment of DCWs in NHs. A self-administered instrument was completed by 372 DCWs within 11 NHs in the north Texas region. Cluster analysis and ordinary least squares (OLS) regression were performed. RESULTS: Feedback from nurse management to DCWs was positively associated with shared decision-making (SDM) and ranked highest followed by information exchange, trust in management, and wages linked to performance. DISCUSSION: SDM may be enhanced where nurse management shares relevant information with the DCWs, listens to their ideas, provides explanations when DCW suggestions are not used, and does so in a supportive environment. Organizational characteristics of importance include linking wages to DCW performance and providing an accessible training program.