THE INFLUENCE OF VISUAL FIXATION ON HOP TEST PERFORMANCE.

BACKGROUND: It has been recognized that anterior cruciate ligament (ACL) injuries typically occur when athletes are attending to a secondary task or object, including teammates, opponents, and/or a goal. Commonly applied tests after ACL injury include a series of hop tests to determine functional status, yet do not control for visual fixation. PURPOSE: To examine the influence of visual fixation during two functional hop tests in healthy individuals. STUDY DESIGN: Repeated measures. METHODS: Participants performed the crossover triple hop for distance (XHOP) on the left lower limb, and the medial triple hop for distance (MHOP) on the right. For the hop test only conditions, participants were not instructed where to fix their vision while performing the hop test. The visual fixation condition required participants to fix their vision on an alternating plus/minus sign at the center of a display monitor located in front of the participant while performing each hop test, respectively. A retest session occurred 48-72 hours after the initial test session in order to examine reliability. RESULTS: Thirty-four healthy adults (age: 24.0 ± 3.9 years) completed testing procedures, performing the XHOP and MHOP under standard and visual fixation conditions. Of those participants, twelve completed a retest session for reliability analysis. Hop distance was not altered by the addition of visual fixation (p = 0.27), with trivial effect sizes found across conditions (d = 0.02 - 0.07); however, the addition of visual fixation slightly improved within- and between-session intrarater reliability, standard error of measurement, and minimal detectable change of the MHOP. CONCLUSION: Hop distance during the XHOP and MHOP was not influenced by visual fixation. Measurement of both the XHOP and MHOP was reliable, but lacked precision. Measurement properties for the MHOP including within- and between-session reliability, standard error of measurement, and minimal detectable change improved slightly with the addition of visual fixation compared to normal MHOP procedures. LEVEL OF EVIDENCE: 2b.

INCORPORATING A DUAL-TASK ASSESSMENT PROTOCOL WITH FUNCTIONAL HOP TESTING.

BACKGROUND: Hop tests are commonly used within a testing battery to assess readiness for return to sport after anterior cruciate ligament (ACL) injury, yet athletes still experience a high rate of re-injury. Simultaneous performance of a secondary task requiring cognitive processing or decision-making may test the athlete under more realistic contexts. PURPOSE: To examine a clinically feasible, dual-task assessment paradigm applied during functional hop tests in healthy individuals. STUDY DESIGN: Repeated measures. METHODS: Participants performed the crossover triple hop for distance (XHOP) and medial triple hop for distance test (MHOP) under three separate conditions: standard procedures and two dual-task protocols including the backward digit span memory task and a visuospatial recognition task. The visuospatial task involved briefly displaying an image consisting of 18 randomly placed red and blue circles on a screen, where the participant was asked to identify the number of red circles in each image. The backward digit span task was applied by introducing a sequence of random numbers to the participants, who were required to repeat the sequence in reverse order. Each motor and cognitive task was performed independently and simultaneously, in accordance with the dual-task paradigm. RESULTS: Thirty-four healthy participants (age: 24.0 ± 3.9 years) completed testing procedures. No differences in hop distance were observed with the simultaneous application of a cognitive task, with the exception of the backward digit span memory task resulting in decreased hop distance (p = 0.04, d = 0.14). There were no differences in cognitive accuracy according to hop test type, although the effect size was greater for the XHOP (p = 0.08, d = 0.49) compared to the MHOP (p = 1.0, d = 0.07). The dual-task protocol revealed good-excellent within- (ICC3,1 = 0.85 - 0.99) and between-session (ICC3,k = 0.94 - 0.99) intrarater reliability for hop distance across all dual-task conditions. The addition of a cognitive task to the XHOP and MHOP resulted in a lower standard error of measurement and decreased minimal detectable change, as compared to standard testing procedures. CONCLUSION: The simultaneous application of a cognitive task did not alter hop distance, with the exception of the backward digit span memory task resulting in decreased hop distance with a trivial effect size. There were no differences in cognitive accuracy according to task type (sitting, XHOP, MHOP). All combinations of dual-task assessment demonstrated good-excellent within- and between-session intrarater reliability among healthy individuals, but measurement precision was deficient. LEVEL OF EVIDENCE: 2b.

Multilevel Analysis of Child and Adolescent Subjective Well-Being Across 14 Countries: Child- and Country-Level Predictors.

This study tests an ecological, relationship-based model of children's subjective well-being with 9- to 14-year-old children (n = 25,906) from 14 countries across Africa, Asia, Europe, North America, and South America. Children completed the Children's Worlds survey, a self-report measure of contextual and well-being indicators. Multilevel modeling was used to predict children's well-being (life satisfaction and self-image) at two levels, child (age, gender, home context, family relationships, peer relationships, school context, teacher relationships, and neighborhood quality), and country (gross domestic product and income inequality). Findings indicated that intercepts varied significantly across countries. The majority of variance in children's well-being was attributed to child-level rather than country-level factors. Country-level factors did not strongly predict well-being but marginally improved model fit.

Neural and psychological characteristics of college students with alcoholic parents differ depending on current alcohol use.

A significant proportion of college students are adult children of an alcoholic parent (ACoA), which can confer greater risk of depression, poor self-esteem, alcohol and drug problems, and greater levels of college attrition. However, some ACoA are resilient to these negative outcomes. The goal of this study was to better understand the psychobiological factors that distinguish resilient and vulnerable college-aged ACoAs. To do so, scholastic performance and psychological health were measured in ACoA college students not engaged in hazardous alcohol use (resilient) and those currently engaged in hazardous alcohol use (vulnerable). Neural activity (as measured by functional magnetic resonance imaging) in response to performing working memory and emotion-based tasks were assessed. Furthermore, the frequency of polymorphisms in candidate genes associated with substance use, risk taking and stress reactivity were compared between the two ACoA groups. College ACoAs currently engaged in hazardous alcohol use reported more anxiety, depression and posttraumatic stress symptoms, and increased risky nicotine and marijuana use as compared to ACoAs resistant to problem alcohol use. ACoA college students with current problem alcohol showed greater activity of the middle frontal gyrus and reduced activation of the posterior cingulate in response to visual working memory and emotional processing tasks, which may relate to increased anxiety and problem alcohol and drug behaviors. Furthermore, polymorphisms of cholinergic receptor and the serotonin transporter genes also appear to contribute a role in problem alcohol use in ACoAs. Overall, findings point to several important psychobiological variables that distinguish ACoAs based on their current alcohol use that may be used in the future for early intervention.

Measuring secondary traumatic stress symptoms in military spouses with the posttraumatic stress disorder checklist military version.

Little research to date has examined secondary traumatic stress symptoms in spouses of military veterans. This study investigated the presence and severity of posttraumatic stress symptoms in a sample of 227 Army National Guard veterans and secondary traumatic stress symptoms among their spouses. The veterans completed the posttraumatic stress disorder (PTSD) Checklist Military Version (PCL-M) (Weathers et al., 1993) to determine the probable prevalence rate of posttraumatic stress symptoms. A modified version of the PCL-M was used to assess secondary traumatic stress symptoms in the spouses. A confirmatory factor analysis showed that the modified version of the PCL-M used to assess secondary traumatic stress symptoms in spouses fits using the same four-factor PTSD structure as the PCL-M for veterans. This study provides initial evidence on the underlying symptom structure of secondary traumatic stress symptoms among spouses of traumatic event victims.

Assessing posttraumatic stress disorder with or without reference to a single, worst traumatic event: examining differences in factor structure.

The authors examined the effects of a methodological manipulation on the Posttraumatic Stress Disorder (PTSD) Checklist's factor structure: specifically, whether respondents were instructed to reference a single worst traumatic event when rating PTSD symptoms. Nonclinical, trauma-exposed participants were randomly assigned to 1 of 2 PTSD assessment conditions: referencing PTSD symptoms to their worst trauma (trauma-specific group, n = 218) or to their overall trauma history in general (trauma-general group, n = 234). A 3rd group of non-trauma-exposed participants (n = 464) rated PTSD symptoms globally from any stressful event. Using confirmatory factor analysis, the authors show that the 4-factor PTSD model proposed by D. W. King, G. A. Leskin, L. A. King, and F. W. Weathers (1998; separating effortful avoidance and emotional numbing) demonstrated the best model fit for trauma-general and non-trauma-exposed participants. The 4-factor PTSD model proposed by L. J. Simms, D. Watson, and B. N. Doebbeling (2002; emphasizing a general dysphoria factor) demonstrated the best model fit for trauma-specific participants. Measurement invariance testing revealed that non-trauma-exposed participants were different from both trauma-exposed groups on factor structure parameters, but trauma groups were not substantially different from each other.

Accuracy of automated blood pressure monitors.

PURPOSE: The purpose of this study is to determine if automated and aneroid manometers are as accurate a means of determining blood pressure as the mercury manometer. Obtaining vital signs for patients is considered standard of care, yet many dental offices do not routinely perform this health service because of technique inconsistencies and time constraints. The use of automatic blood pressure monitors addresses both concerns. The mercury column manometer, the control in this study, has long been considered the most accurate and preferred instrument for obtaining blood pressure measurements. METHODS: During this study, 94 participants (19 years of age and older) consented to having blood pressure taken by each of 4 different monitors. These included the mercury column manometer and stethoscope, the aneroid manometer and stethoscope, the automatic arm blood pressure monitor, and the automatic wrist blood pressure monitor. Each of 3 investigators was assigned to and calibrated for a specific monitoring device. All measurements were taken from the left arm with 5 minutes allowed between measurements. Identical stethoscopes were used with the manual monitors. Strict adherence to the manufacturers' directions and patient preparation was followed for all monitors. Investigators were not aware of readings obtained by other investigators during testing. Eighty-three subjects completed all tests. RESULTS: Review and analysis of data indicates little difference for pulse readings between the automated and digital methods. Systolic readings by automated wrist manometers were the most unreliable. Automated arm monitors tended to provide higher measures than the mercury standard on average, and demonstrated significantly different diastolic readings in one age group compared to the control. All monitors exhibited low reliability for participants over age 50 compared to the control. CONCLUSION: This study demonstrates there is inaccuracy in the use of automated blood pressure monitors and traditional aneroid manometers when compared to the gold standard mercury column manometer for subjects of all ages and blood pressure ranges.

Differences in posttraumatic stress disorder diagnostic rates and symptom severity between Criterion A1 and non-Criterion A1 stressors.

This study addresses the ongoing controversy regarding the definition of DSM-IV posttraumatic stress disorder's (PTSD) traumatic stressor criterion (A1). A sample of 119 college students completed the PTSD Symptom Scale separately in relation to both Criterion A1 and non-Criterion A1 stressful events, using a mixed between-groups (administration order) and within-subjects (stressor type) design. Contrary to what was expected, analyses revealed that non-Criterion A1 events were associated with greater likelihood of "probable" PTSD diagnoses and a greater PTSD symptom frequency than Criterion A1 events. Symptom frequency relationships, however, were moderated by the order in which the measures were administered. The non-Criterion A1 PTSD scores were only higher when non-Criterion A1 measures were presented first in the administration order. Similar patterns of differences in PTSD scores between stressor types were also found across the three PTSD symptom criteria. Implications are discussed as to the ongoing controversy of the PTSD construct.