Reliability and validity of the Taiwanese version of the collaborative practice assessment tool: A pilot study.

Objectives: To promote teamwork communication and collaboration between health-care professionals, educators emphasized proper training programs to develop interprofessional collaborative practice (IPCP) among postgraduate (PG) trainees. A literature review indicated that the faculty necessarily measured the competency in IPCP with structured and applicable assessment tools in collocation to training programs domestically. A cross-sectional psychometric study was conducted to construct a reliable assessment tool for measuring PG learning outcome in Taiwan through a bidirectional translation. The study aimed to assess the interprofessional team behavior of trainees using the Taiwanese version of the collaborative practice assessment tool (T-CPAT). Materials and Methods: The study recruited 43 participants to undergo a PG training program in a single institute and to complete T-CPAT. Data were analyzed using SPSS 22.0 software. We employed descriptive analysis of demographic variables. The validity of T-CPAT was analyzed by experts in different specialties and its availability was assessed by item-level analysis. Furthermore, the T-CPAT reliability was tested using Cronbach's α. Results: The average score was 305.2 (standard deviation = 38.08), and the expert validity of the T-CPAT was 0.96. In the item-level analysis, there were no failure items in T-CAPT. Cronbach's α reached 0.94 (95% confidence interval = 0.90-0.96). Conclusion: The study demonstrated good reliability and validity for the T-CPAT. Thus, the T-CPAT can be used to accurately measure and assess the competence of IPCP in PG trainees in general medicine in Taiwan. The results were deemed sufficient to provide faculties with related arrangements for future teaching plans.

Scale Development and Model Validation for the Process of Exercise Engagement for People with Prediabetes.

PURPOSE: This study had two objectives: 1) to develop a scale for the process of exercise engagement (SPEE) for prediabetic individuals (PDIs); 2) to validate a structural model for the process of exercise engagement for PDIs. METHODS: A cross-sectional survey with simple random sampling was conducted from September 2013 to December 2015 (in Taiwan). A total of 310 PDIs were enrolled for scale development and model validation via item analysis, factor analyses, and structural equation modeling. The Kuo model was used as the basis for developing the Chinese version of the SPEE for PDIs. RESULTS: The SPEE contains five subscales with a total of twenty-one items that account for 54.9% to 65.9% of the total variance explained for assessing participants' process of engagement during exercise. For Kuo model validation, the model measures indicated goodness of fit between the Kuo model and sample data. Analysis further revealed a direct effect between the creating health blueprints (CHB) stage and the spontaneous regular exercise (SRE) stage (ß=.60). CONCLUSION: The SPEE includes five subscales for assessing the psychological transition and behavioral expression at each stage of the process of exercise engagement for PDIs. The SPEE for people with prediabetes provides deeper insights into the factors of behavioral change stages that are required to initiate long-term health care outcomes and avoid developing diabetes. These insights are significant as they allow for patient-specific mapping and behavior modification to effect exercise.

Effects of individual characteristics on insomnia severity trajectory among nurses: A prospective longitudinal study.

AIMS: To examine the longitudinal effects of individual characteristics on the change pattern of insomnia and the association of occupational stress with insomnia over time in newly graduated nurses. BACKGROUND: The association between individual factors and insomnia in nurses is inconclusive. Longitudinal research on insomnia in newly graduated nurses is limited. METHODS: This prospective longitudinal study included 200 participants generating 800 observations of insomnia severity during their first year of nursing. We employed growth mixture modelling for data analyses. Both time-varying covariate (occupational stress) and time-invariant covariates (nurses' characteristics) were entered into the model simultaneously. RESULTS: Nurses had a homogeneous insomnia trajectory during the whole year of survey. The educational level significantly predicted the growth rate of insomnia severity among nurses. Occupational stress at each time point was significantly associated with worse insomnia across time points (all p < .001). CONCLUSIONS: Nurses with a baccalaureate degree were more resilient to the development of severe insomnia. Additional studies have an opportunity to investigate the reason for the effects of the educational level on the pattern of insomnia. IMPLICATIONS FOR NURSING MANAGEMENT: Considering nurses' occupational stress and educational level would lead more effective management of stress and insomnia in newly graduated nurses.

An objective structured teaching exercise for faculty training and assessment of teaching ability in interprofessional collaborative practice and education.

OBJECTIVE: Improving clinical teachers' ability to teach interprofessional collaborative practice warrants development in current faculty training programs; in particular, current education training emphasizes experiential learning and multiple teaching strategies. The purpose of this study was to establish a teaching model to apply interdisciplinary collaborative care and to improve clinical teachers' execution of interprofessional practices. MATERIALS AND METHODS: Health-care faculty members were studied; this study assessed a teacher education curriculum for interprofessional education (IPE) and applied an objective structured teaching exercise (OSTE) to evaluate IPE execution by clinical teachers. RESULTS: The OSTE improved clinical teachers' IPE execution, verifying the necessity for multistrategy teaching in faculty training programs. CONCLUSIONS: This study provides different types of interprofessional faculty training and assessments. Development of an OSTE requires long-term planning, and IPE should also be incorporated into formal programs.

Obstacle crossing in 7-9-year-old children with Down syndrome.

This study aimed to investigate obstacle crossing in 7-9-year-old children with Down syndrome (DS). Fifteen children with DS, age- and gender-matched with 15 typically developing (TD) children, were recruited to walk and cross obstacles with heights of 10%, 20% and 30% of their leg lengths. End-point and kinematic variables of obstacle crossing were obtained using a three-dimensional motion analysis system. The results showed that children with DS tend to adopt a lower speed and larger step width when they perceive instability. Moreover, unlike TD children, children with DS adopt a pelvic strategy (i.e., greater pelvic leading-side listing and forward rotation) to achieve a higher leading toe clearance with a longer step length, presumably for safety reasons. This pelvic strategy increased the frontal plane motion of the whole leg and trunk, and thus possibly stability, during obstacle crossing. However, this strategy may be inefficient. Trailing toe clearance did not differ significantly between two groups. The results of this study suggest that children with DS tend to use inefficient and conservative strategies for obstacle crossing. Knowledge of both end-point and kinematic control of obstacle crossing in children with DS is useful for understanding the mechanisms of obstacle-related falls. Moreover, obstacle crossing can be used as a task-oriented rehabilitation program for children with DS.

Mixed picture of readiness for adoption of evidence-based prevention programs in communities: exploratory surveys of state program delivery systems.

An emerging literature highlights the potential for broader dissemination of evidence-based prevention programs in communities through existing state systems, such as the land grant university Extension outreach system and departments of public education and health (DOE-DPH). This exploratory study entailed surveying representatives of the national Extension system and DOE-DPH, to evaluate dissemination readiness factors, as part of a larger project on an evidence-based program delivery model called PROSPER. In addition to assessing systems' readiness factors, differences among US regions and comparative levels of readiness between state systems were evaluated. The Extension web-based survey sample N was 958 and the DOE-DPH telephone survey N was 338, with response rates of 23 and 79 %, respectively. Extension survey results suggested only a moderate level of overall readiness nationally, with relatively higher perceived need for collaborative efforts and relatively lower perceived resource availability. There were significant regional differences on all factors, generally favoring the Northeast. Results from DOE-DPH surveys showed significantly higher levels for all readiness factors, compared with Extension systems. Overall, the findings present a mixed picture. Although there were clear challenges related to measuring readiness in complex systems, addressing currently limited dissemination resources, and devising strategies for optimizing readiness, all systems showed some readiness-related strengths.

Immediate efficacy of laterally wedged insoles with arch support on walking in persons with bilateral medial knee osteoarthritis.

OBJECTIVE: To investigate the immediate efficacy of laterally wedged insoles with arch support (LWAS) on gait in persons with bilateral medial knee osteoarthritis (OA). DESIGN: A prospective case-control intervention study. SETTING: A gait laboratory with a 6-camera motion analysis system and 2 forceplates. PARTICIPANTS: Fifteen women with bilateral medial knee OA and 15 healthy control subjects (N=30). INTERVENTIONS: LWAS. MAIN OUTCOME MEASURES: Subjective knee pain and objective biomechanical indices, namely, joint angles and moments in the frontal plane, frontal plane ground reaction force and lever arm, as well as medial/lateral center of mass and center of pressure during gait. RESULTS: When wearing the LWAS, knee pain during gait in persons with medial knee OA decreased (P=.01). Peak internal knee abductor moments were also reduced (P<.001) with increasing foot progression angles, laterally shifted center of pressure, and a shortened frontal plane lever arm (all P<.05). However, ankle invertor moments were increased (P<.05) when wearing the LWAS. CONCLUSIONS: Although peak internal knee abductor moment and knee pain were immediately reduced during gait when wearing the LWAS, increased ankle invertor moments were found, suggesting that the LWAS should be used with caution. Strengthening and monitoring the condition of the ankle invertor muscles may be necessary if the LWAS is used as an intervention for persons with bilateral medial knee OA.

Media as social influence: racial differences in the effects of peers and media on adolescent alcohol cognitions and consumption.

Racial differences in the effects of peer and media influence on adolescents' alcohol cognitions and consumption were examined in a large-scale panel study. With regard to peer influence, results from cross-lagged panel analyses indicated that the relation between perceived peer drinking and own drinking was significant for both Black and White adolescents, but it was stronger for the White adolescents. With regard to media influence, structural modeling analyses indicated that exposure to drinking in movies was associated with more alcohol consumption 8 months and 16 months later. These effects were mediated by increases in the favorability of the adolescents' drinker prototypes, their willingness to drink, and their tendency to affiliate with friends who were drinking. Multiple group analyses indicated that, once again, the effects (both direct and indirect) were much stronger for White adolescents than for Black adolescents. The results suggest media influence works in a similar manner to social influence and that Whites may be more susceptible to both types of influence.

Early experience with racial discrimination and conduct disorder as predictors of subsequent drug use: a critical period hypothesis.

A critical period hypothesis linking early experiences with both racial discrimination and conduct disorder (CD) with subsequent drug use was examined in a panel of 889 African American adolescents (age 10.5 at time 1) and their parents. Analyses indicated that these early experiences did predict use by the adolescents at time 3 (T3)-5 years later. These relations were both direct and indirect, being mediated by an increase in affiliation with friends who were using drugs. The relations existed controlling for parents' reports of their use, discrimination experiences, and their socioeconomic status (SES). The impact of these early experiences on African American families is discussed.

Rural-urban differences in substance use among African-American adolescents.

PURPOSE: To examine substance use differences among African-American adolescents living in rural and more urban areas in Iowa and Georgia and factors thought to be related to those differences. Specifically, negative affect and perceived availability were examined as mediators of the relation between community size and alcohol, tobacco, and drug use. METHODS: In-home interviews with the adolescents (Time 1: N = 897, Mean age = 10.5) assessed their use, perceived substance availability, and negative affect across 3 waves. Their parents' use was also assessed. Census data were used to determine community size (rural or= 2,500). FINDINGS: Perceived substance availability and use were both higher among the more urban adolescents. As expected, negative affect was a primary antecedent to use at each wave. Structural Equation Modeling indicated that the relation between population and use was mediated by perceived availability of the substances. Additional multigroup analyses indicated that the relations between negative affect and use were significantly stronger among the urban adolescents at all waves. CONCLUSIONS: Results suggest that stress or negative affect is an important antecedent to use among African-American adolescents, especially when it occurs at an early age, but living in rural areas may be a buffer for both problems, in part, because exposure to this type of risk is lower in these environments.

Relationships among sexual satisfaction, marital quality, and marital instability at midlife.

Sexual satisfaction, marital quality, and marital instability have been studied over the life course of couples in many previous studies, but less in relation to each other. On the basis of the longitudinal data from 283 married couples, the authors used autoregressive models in this study to examine the causal sequences among these 3 constructs for husbands and wives separately. Results of cross-lagged models, for both husbands and wives, provided support for the causal sequences that proceed from sexual satisfaction to marital quality, from sexual satisfaction to marital instability, and from marital quality to marital instability. Initially higher levels of sexual satisfaction resulted in an increase in marital quality, which in turn led to a decrease in marital instability over time. Effects of sexual satisfaction on marital instability appear to have been mediated through marital quality.