Using measures of agreement to develop a taxonomy of passivity in dementia.

A comprehensive taxonomy categorizing passive behaviors in people with dementia was developed and revised through the use of expert raters. The taxonomy was first derived from the synthesis of 15 empirical studies that addressed this phenomenon, then was rated by an expert panel of six nurse-scientists with expertise in dementia and neuroscience research. This article describes the application of two measures of agreement, multiple rater kappa and proportion of agreement for multiple raters, calculated using Stata and SPSS, to evaluate and revise the taxonomy. The method proved useful for estimating the content validity of the taxonomy and provided evidence of stronger agreement among raters for the revised and final forms of the taxonomy. Nurse researchers will find this methodology to be an efficient, practical approach to applying measures of agreement for a variety of purposes, including taxonomy development.

Changes in physical activity beliefs and behaviors of boys and girls across the transition to junior high school.

PURPOSE: This longitudinal study investigated gender-specific changes in physical activity beliefs and behaviors across the elementary to junior high school transition. METHODS: Physical activity beliefs and behaviors were measured in a cohort of 132 racially diverse youth during the year prior to and following the transition. Questionnaires assessed variables hypothetically linked to activity. Physical activity was monitored with the Child/Adolescent Activity Log. RESULTS: Gender differences in physical activity beliefs emerged. Across the transition, boys reported decreased efficacy, social support, and expectations (norms) to be physically active. Although girls also reported decreased social support for physical activity, they further reported exposure to fewer active role models and were less likely to perceive that the benefits of regular activity out-weighed the barriers following the transition. Gender differences in activity levels were apparent, with girls being less active than boys. Despite changes in physical activity beliefs across the school transition, no significant changes in actual level of activity occurred over this period. Although beliefs were significantly related to behaviors in the domain of physical activity, pretransition activity level was the best predictor of posttransition activity level. CONCLUSIONS: These data indicate that physical activity beliefs of adolescents change over the school transition. These changes are significantly, but not highly, related to level of physical activity. Future research should explore the influences of activity-related affect and social and physical contexts on physical activity across adolescence.

Effect of pelvic muscle exercise on transient incontinence during pregnancy and after birth.

OBJECTIVE: To test the effect of pelvic muscle exercise on postpartum symptoms of stress urinary incontinence and pelvic muscle strength in primigravidas during pregnancy and postpartum. METHODS: A prospective trial randomized women into treatment (standardized instruction in pelvic muscle exercise) or control (routine care with no systematic pelvic muscle exercise instruction). Urinary incontinence symptoms were measured by questionnaire. Pelvic muscle strength was quantified by an instrumented gynecologic speculum. Time points were 20 and 35 weeks' gestation and 6 weeks, 6 months, and 12 months postpartum. RESULTS: Outcomes are reported for 46 women with vaginal or cesarean birth and for a subsample of 37 women with vaginal birth. Longitudinal analyses are reported for cases with complete data across time points. Diminished urinary incontinence symptoms were seen in the treatment group, with significant treatment effects demonstrated at 35 weeks' gestation (F [1,43] = 4.36, P = .043), 6 weeks postpartum (F [1,43] = 4.94, P = .032), and 6 months postpartum (F [1,43] = 4.29, P = .044). A repeated measures analysis of variance showed a significant interaction between time and treatment for urinary incontinence (F [4, 41] = 2.83, P = .037). A significant effect of initial pelvic muscle strength was demonstrated; ie, pelvic muscle strength at 20 weeks' gestation predicted significantly 12-months postpartum strength (F [1, 13] = 8.12, P = .014). Group differences in pelvic muscle strength were observed (the treatment group had greater strength at 6 weeks and at 6 months postpartum than did controls), but these differences were not statistically significant. CONCLUSION: Practice of pelvic muscle exercise by primiparas results in fewer urinary incontinence symptoms during late pregnancy and postpartum.

Preventive oral health behaviors among African-Americans and whites in Detroit.

OBJECTIVE: This study compared the preventive oral health behaviors of African-Americans and whites. METHODS: Face-to-face interviews were conducted with a probability sample of 384 African-American and 358 white adults living in the greater Detroit area. Questions focused on brushing, flossing, and dental visits. RESULTS: More than 95 percent of both groups reported brushing daily; however, whites were more likely to brush all teeth, including parts that do not show. Frequency of flossing did not differ between groups. African-Americans, however, were less likely to floss all of their teeth. Whites were more likely than African-Americans to get dental check-ups at least once a year and much less likely to indicate they had never had a dental check-up. African-Americans tended to have less education and lower family income than whites and were more likely than whites to have Medicaid. Race differences in brushing thoroughness and annual check-ups were greatly reduced when income, education, and insurance were controlled statistically. CONCLUSIONS: African-Americans are less likely than whites to brush thoroughly, floss thoroughly, and get dental check-ups. These differences are partly traceable to differences in socioeconomic status and access to professional oral health care.

Usefulness of multiple equations for predicting preventive oral health behaviors.

Canonical correlation analyses of a previous dental survey suggested that dental checkups, flossing, and tooth brushing could all be predicted from a single equation. Most theories and research about the influence of beliefs on behavior, however, suggest different behaviors will be best predicted by different behavior-specific measures. The current survey investigated influences on brushing, flossing, and dental checkups in a probability sample of adults in the Detroit tri-county area. Both behavior-specific variables, such as perceived benefits and costs of flossing, and general variables, such as gender, were included as predictors. Canonical correlation analysis indicated three equations were needed to predict the three oral health behaviors. Flossing frequency, for example, was best predicted by confidence in flossing ability and beliefs about the benefits of and barriers to flossing. The results suggest that even these closely related behaviors are best predicted using separate equations that include mostly behavior-specific predictors.

Equivalence of the original and revised dental anxiety scales.

PURPOSE: The Corah Dental Anxiety Scale (DAS) was introduced in 1969 as a brief, valid, and reliable instrument to measure anxiety about dental visits. Since then, changes in language usage and dental practice have rendered the scale outdated. In 1994, Ronis introduced the Dental Anxiety Scale-Revised (DAS-R), a version of the DAS revised to acknowledge the roles of dental hygienists and female dentists in the dental office. The current study was conducted to determine whether the original and revised scales are equivalent. METHODS: The study tested the equivalence of the two scales by including both in a questionnaire filled out by 141 male and female college students. Psychometric equivalence was examined by comparing the means, and reliabilities (alphas) of the two scales and by correlating the two scales with each other. RESULTS: Mean scores, variances, and reliabilities of the two versions of the scale did not differ. The Pearson correlation between the two scales was .98. CONCLUSIONS: It appears that the DAS-R is psychometrically equivalent to the DAS and can be used in its place whenever more up-to-date wording is desired.