Correlations of Physical and Psychological Health in Parents of Individuals With Autism Spectrum Disorder.

BACKGROUND: Individuals with autism spectrum disorder (ASD) have social communication difficulties and restricted, repetitive, and/or sensory behaviors or interests. The prevalence of ASD is now 1 in 36 individuals. Parents of individuals with ASD face challenges that can affect their physical and psychological well-being. OBJECTIVE: With the long-term goal to tailor an exercise program, the purpose of this study was 2-fold: (1) establish the baseline physical and mental health of parents of individuals with ASD and (2) estimate the relationship of physiologic variables with psychological variables of health for parents of individuals with ASD. METHODS: This descriptive, cross-sectional study (N = 44) explored physical health measures and the correlation between physical and psychological health, using measures of anxiety, stress, parenting depression, and positive thinking for parents who care for individuals with ASD. RESULTS: The common characteristics that these parents shared was high body fat and low physical activity. Body fat was negatively correlated to total step count (r = -0.428, P < .05), grip strength (r = -0.319, P < .5), and total distance walked in the week (r = -0.661, P < .01), and positively correlated to 5-times sit to stand (r = 0.337, P < .05). Low activity correlated to increased parenting stress of advocating for child's needs (r = -0.310, P = .043). CONCLUSIONS: Understanding relationships between physical and psychological health informs effective interventions and support systems for parents. Parents need supports to be able to prioritize exercise. Future studies should include a larger sample to verify these effects.

Body Mass Index and Gut Microbiome: A Cluster-Randomized, Controlled, Pilot Feasibility Study.

Background: Prebiotic fiber has been examined as a way to foster gut bacteria less associated with obesity. Tests of prebiotic fiber in reducing obesity have been conducted mainly in animals, adults, and Caucasians when the highest obesity rates are in African American and Latinx youth. Response to prebiotic fiber is determined by the pre-existing intestinal microbiota. The type of microbiota varies based on diet and physical activity (PA), so it is important to examine acceptability and response to prebiotic fiber in those most at risk for obesity. Methods: This cluster-randomized, controlled feasibility trial included an online program designed to improve diet and PA along with administration of a prebiotic fiber for 12 weeks in 123 students of 4th and 5th grade where 98% were eligible for free or reduced-fee lunch. Of these 56% were male; 71% Latinx; 15% African American; and 14% other. Results: Decrease in body fat (BF) was associated with higher pretest BF. Lower body mass index (BMI) was associated with decrease in fecal Tenericutes and increase in Actinobacteria. Conclusions: Prebiotic fiber can be helpful in supporting healthy weight, so inclusion in culturally congruent foods usually eaten by children from groups at high risk for obesity should be considered following additional studies. Determining those most responsive to prebiotic fibers can also permit individual recommendations for greater inclusion in usual diet choices. Clinical Trial Registration Number NCT05671731.

Physical Activity, Inflammation, and Physical Function in Older Adults: Results From the Health & Retirement Study.

Physical function declines with aging due to physical and biological changes. The biological process of aging has been associated with increases in systemic inflammation and a greater risk for chronic conditions. In older adults, physical activity aids in maintenance of function. However, the influence of inflammatory biomarkers and adiposity on physical activity and physical function needs to be further explored. METHODS: A cross-sectional secondary data analysis from Wave 13 of the Health & Retirement Study (HRS) core biennial data and Venous Blood Study (VBS) was conducted. Structural equation modeling was used to establish the model and test the relationships. RESULTS: Chronic low-level inflammation was moderately negatively correlated with physical activity (r = -0.326) and function (r = -0.367). Latent regressions showed that higher physical activity is associated with better physical function (unstandardized estimate = 0.600, p < .001) while inflammation negatively affects physical function (unstandardized estimate = -0.139, p < .001), and adiposity was not a predictor in the model (p = 0.055). CONCLUSION: For older adults, preserving physical function by participation in physical activity and decreasing chronic inflammation are key preventive health strategies for older adults to maintain independence, with a need to further explore pro and anti-inflammatory biomarkers.

Learning a Healthy Rhythm: An Intervention to Increase Children's Resources for Stress Management.

This article describes a pilot test of a community engaged, culturally relevant, arts-based intervention. The purpose was to increase children's personal protective buffering resources. Protective buffering resources help children cope with stressful stimuli, reduce activation of their systemic stress response, mitigate allostatic load, and promote optimal health. The "Learning a Healthy Rhythm" intervention included a stress management component and an ongoing Afro-Latino percussion program for 18 children ages 9-11. The stress management component included educational content about stress, self-assessment of stress symptoms, and stress management techniques. A mixed-method intervention evaluation design was used. Qualitative data, quantitative data, and biometrics including hair cortisol were collected. Six intervention parameters were evaluated: effectiveness, fidelity, feasibility, acceptability, necessity, and safety. Positive results were obtained for all parameters. Reduction in physiological and subjective measures of stress was evident. This stress management intervention was well-received and supported by participants.

Using Bayesian methods to clarify the role of trauma-related cognitions on the course of posttraumatic stress in nonspecific trauma-focused therapy.

OBJECTIVE: There is strong empirical evidence that a reduction of trauma cognitions lessens PTSD symptoms, but there are discrepancies, including evidence that baseline negative posttrauma cognitions are associated with more, less, or are not associated with changes in PTSD symptoms. Discrepancies may be a function of power, sample size, analytic method, or measure. METHODS: The rate of PTSD symptoms change across 16 trauma-focused treatment sessions in a community clinic (n = 56) was estimated using a Bayesian mixed-effects model with repeated measures nested within participants. Number of treatment sessions was the level-1 predictor variable with baseline levels of trauma-related cognitions (overaccommodation, assimilation, accommodation, and optimism) as time-invariant level-2 predictors. The relations between baseline trauma-related cognitions and PTSD symptoms change across sessions were assessed by cross-level interactions. RESULTS: PTSD symptoms declined over treatment (b = -1.57, 95% CrI [-1.89, -1.25]). Higher levels of overaccommodation and assimilation were associated with attenuated (b = .38, 95% CrI [.03, .73]) and greater (b = -.36, 95% CrI [-.69, -.02]) rates of symptom reduction, respectively. The relations between PTSD symptom reduction and accommodation (b = -.12, 95% CrI [-.43, .20]) and optimism (b = -.13, 95% CrI [-.45, .20]) were uncertain. CONCLUSIONS: There may be a nuanced role of trauma-related cognitions on PTSD symptoms during treatment. More research is needed to examine theoretically grounded trauma-related cognitions that align with the different treatments for PTSD, particularly in reference to the current diagnostic criteria for PTSD. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Identification of research priorities in CHD: empowering patients and families through participation in the development of formal research agendas.

BACKGROUND: Conquering CHD, formerly known as the Pediatric Congenital Heart Association (PCHA), is the leading congenital heart disease (CHD) patient advocacy organisation in the United States of America, and places high priority on patient engagement in the research process. Participatory design is an approach to problem-solving that utilises the knowledge and opinions of groups of people to generate plans and new ideas. Utilising this mode of patient engagement, patients and families engaged with Conquering CHD assisted in developing a list of research priorities which was then distributed to the larger membership with instructions to rank the priorities in order of importance. Upon completion, these items were compared to the current scientific literature to assess correlation with current publications. This cross-sectional study and literature review aimed to assess the priorities of patients and families in CHD research and to determine the reflection of these areas in the current body of scientific literature. METHODS: This cross-sectional study utilised a survey asking participants to rank the importance of research items within categories including "Technology Advances," "Genetic and Cellular Research," "Broad Understanding of CHD," and "Psychosocial Outcomes" which was distributed through social media and email to 43,168 accounts across all platforms. Respondents were asked to place each item in a ranked order in each category, with the value "1" representing the most preferred for each participant. Anyone engaged with Conquering CHD was eligible to complete the study, including patients and families. Subsequently, a literature review of the largest medical databases including PubMed, Scopus, and ScienceDirect was undertaken to determine the number of articles published per each topic which was then assessed to determine if there is a correlation between patient-ranked priorities and the current body of literature. RESULTS: The study generated a total response of 527 participants. Regarding "Technology Advances," valve replacement was the preferred topic (mean rank 2.07, IQR 2). Stem cell research was the favoured topic in "Genetic and Cellular Research" (mean rank 2.53, IQR 2). Access to care was the priority in the "Broadening Understanding of CHD" (mean rank 1.24, IQR 1). Pertaining to "Psychosocial Outcomes", psychological/emotional effects was the highest ranked topic (mean rank 1.46, IQR 1). The literature review returned a total of 135,672 articles in the areas of interest. For "Valve Replacement", 8361 articles resulted reflecting a proportion of 0.097 of total articles. For "Stem Cell Research", 9921 articles resulted reflecting a proportion of 0.115 of total articles. For "Access to Care", 7845 articles resulted reflecting a proportion of 0.091 of total articles. For "Psychological/Emotional Effects", 6422 articles resulted reflecting a proportion of 0.074 of total articles. A Spearman's correlation demonstrated no correlation between the preferred domain of CHD research and the number of articles published for that domain (rs = 0.02, p = 0.94). CONCLUSIONS: This process demonstrates the effectiveness of participatory design, using a patient and family network to determine the research items of concern to those affected by CHD. The cross-sectional survey was effective in assessing patient and family priorities but was limited by access to reliable internet and delivery only in English. Though the study had a large response rate, it was limited to patients already engaged with Conquering CHD. For these reasons, it may not completely reflect the opinions of the total population affected by CHD. However, this offers valuable insight into patient-determined priorities and reveals that the current scientific literature does not correlate with these items. These data serve to inform individual and institutional research agendas to better reflect the needs and desires of this population.

Nasogastric bridles are associated with improved tube-related outcomes in children.

OBJECTIVE: To compare tube-related outcomes in children with standard tape vs nasal bridle securement of nasogastric tubes (NGTs). STUDY DESIGN: This was a single-center, retrospective, correlational study of outcomes from the time of NGT placement until full oral feeds or durable-tube placement. Outcomes of interest included NGT dislodgments, length of stay, emergency department (ED) encounters, radiographic exposures, and adverse skin outcomes. Negative binomial regression and logistic regression were used to analyze differences between groups. RESULTS: Five hundred eighty-two children had NGTs secured traditionally (43% female; age at therapy initiation of 2.6 months [SD 8.1]), and 173 received nasal bridles (55.5% female; age at therapy initiation of 8.4 months [SD 11.8]). Children with bridled NGTs were 16.67 times less likely to experience one or more dislodgments (odds ratio [OR] = 0.06; 95% CI, 0.04-0.09); 2.5 times less likely to have one more ED visit (OR = 0.4; 95% CI, 0.19-0.82), and 4.76 times less likely to require one more radiographic exposure (OR = 0.21; 95% CI, 0.14-0.33) than unbridled children (all P values < 0.02). The mean initial hospital length of stay was 28 and 54 days in the bridled-NGT and standard-care groups, respectively (P < 0.001). Overall, 62.4% children with bridled NGTs and 77.1% children with unbridled NGTs progressed to full oral feedings and discontinued therapy (P < 0.001). Adverse skin outcomes were rare in both groups. CONCLUSION: Children with bridled NGTs experienced fewer dislodgments, hospital days, ED encounters, and radiographic exposures than unbridled NGTs. Most children in both groups progressed to full oral feedings.

Predicting Duration of Outpatient Physical Therapy Episodes for Individuals with Spinal Cord Injury Based on Locomotor Training Strategy.

OBJECTIVE: To characterize individuals with spinal cord injuries (SCI) who use outpatient physical therapy or community wellness services for locomotor training and predict the duration of services, controlling for demographic, injury, quality of life, and service and financial characteristics. We explore how the duration of services is related to locomotor strategy. DESIGN: Observational study of participants at 4 SCI Model Systems centers with survival. Weibull regression model to predict the duration of services. SETTING: Rehabilitation and community wellness facilities at 4 SCI Model Systems centers. PARTICIPANTS: Eligibility criteria were SCI or dysfunction resulting in motor impairment and the use of physical therapy or community wellness programs for locomotor/gait training. We excluded those who did not complete training or who experienced a disruption in training greater than 45 days. Our sample included 62 participants in conventional therapy and 37 participants in robotic exoskeleton training. INTERVENTIONS: Outpatient physical therapy or community wellness services for locomotor/gait training. MAIN OUTCOME MEASURES: SCI characteristics (level and completeness of injury) and the duration of services from medical records. Self-reported perceptions of SCI consequences using the SCI-Functional Index for basic mobility and SCI-Quality of Life measurement system for bowel difficulties, bladder difficulties, and pain interference. RESULTS: After controlling for predictors, the duration of services for the conventional therapy group was an average of 63% longer than for the robotic exoskeleton group, however each visit was 50% shorter in total time. Men had an 11% longer duration of services than women had. Participants with complete injuries had a duration of services that was approximately 1.72 times longer than participants with incomplete injuries. Perceived improvement was larger in the conventional group. CONCLUSIONS: Locomotor/gait training strategies are distinctive for individuals with SCI using a robotic exoskeleton in a community wellness facility as episodes are shorter but individual sessions are longer. Participants' preferences and the ability to pay for ongoing services may be critical factors associated with the duration of outpatient services.

A multidimensional zero-inflated graded response model for ordinal symptom data.

Zero responses and their equivalents-for example, never, none, not at all-are commonly observed on measures of psychopathology inquiring about symptom frequencies, particularly when these measures are administered to community samples. Measurement researchers typically accommodate multivariate zero inflation by including a nonpathological class of respondents who endorse zero for all symptoms. While this latent class approach accounts for test-level zero inflation (i.e., a proportion of individuals who do not experience any of the symptoms), it may be overly restrictive on questionnaires comprising items of differing severity. For example, an item about suicidal ideation is likely to exhibit a much higher degree of zero inflation than an item about low energy. Existing models do not account for this variability. We propose a multidimensional zero-inflated graded response model (MZI-GRM) as a more flexible approach for modeling zero inflation on questionnaires. According to the model, two distinct but correlated latent variables underlie ordinal item responses; one represents susceptibility to the construct, whereas the other represents severity. As a motivating example, we show how the MZI-GRM can be fit to data from the PHQ-9, a common depression screener. Results suggest that the MZI-GRM is better able to capture zero inflation across items than existing alternative models. Further, we find support for a multidimensional model that allows distinct but correlated latent variables to underlie each response process. Some items better measure susceptibility to depression (symptom presence), whereas others better capture severity of depression (symptom frequency). Implications for scale development and scoring are discussed. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Probiotic interventions to reduce antepartum Group B streptococcus colonization: A systematic review and meta-analysis.

OBJECTIVE: To systematically review and meta-analyse studies of the efficacy of probiotics to reduce antenatal Group B Streptococcus (GBS) colonisation. PARTICIPANTS: Antenatal participants with known positive GBS colonisation or unknown GBS status. INTERVENTION: Probiotic interventions containing species of Lactobacillus or Streptococcus. DESIGN: Systematic review and meta-analysis. MEASUREMENTS AND FINDINGS: The systematic review included 10 studies. Five articles contained in vitro studies of probiotic interventions to determine antagonistic activity against GBS. Six clinical trials of probiotics to reduce antenatal GBS were systematically reviewed and meta-analysed. The meta-analysis revealed that the use of an antenatal probiotic decreased the probability of a positive GBS result by 44% (OR = 0.56, 95% CI = 8.7%, 194.1%, p = 0.02) (n = 709). However, only one clinical trial of 10 had a low risk of bias. KEY CONCLUSIONS: The probiotic interventions subjected to in vitro testing showed antagonistic activity against GBS through the mechanisms of acidification, immune modulation, and adhesion. The findings of the meta-analysis of the clinical trials revealed that probiotics are a moderately effective intervention to reduce antenatal GBS colonisation. More well-controlled trials with diverse participants and with better elucidation of variables influencing GBS colonisation rates are needed. IMPLICATIONS FOR PRACTICE: Probiotic interventions appear to be a safe and effective primary prevention strategy for antenatal GBS colonisation. Application of this low-risk intervention needs more study but may reduce the need for intrapartum antibiotic prophylaxis in countries or regions where antenatal GBS screening is used. Midwives can be instrumental in conducting and supporting larger well-controlled clinical trials.

Complementary and Alternative Medicine Mind-Body Approaches Used Among Racially and Ethnically Diverse Adolescents.

PURPOSE: The aim of this paper is to examine complementary and alternative medicine (CAM) use among racially and ethnically diverse adolescents. Greater understanding of CAM use among this group is warranted to better inform health care providers in delivering a culturally relevant health promotion approach. DESIGN AND METHODS: A secondary data analysis was conducted using the 2012 Child Complementary and Alternative Medicine Supplement of the National Health Interview Survey (CAM-NHIS) data, which was collected from a national sample of adolescents aged 12-17 years. A logistic regression test was employed to investigate the predictors associated with CAM use among racially and ethnically diverse adolescents. RESULTS: While Black and Hispanic adolescents were the least likely to use CAM compared to their White counterparts, families with higher incomes, higher education attainment, and adolescents who experienced pain were more likely to use CAM. CONCLUSIONS: Findings suggest the need for future research to gain a greater understanding of CAM use among racially and ethnically diverse adolescents, and insights into how health disparities impact CAM use. Greater understanding of how CAM use intersects with health beliefs and outcomes is also warranted. PRACTICE IMPLICATIONS: Based on the CAM-NHIS survey, few racially and ethnically diverse adolescents have reported use of CAM. Development of culturally appropriate instruments and methods to assess CAM use among racially and ethnically diverse adolescents may yield specific data for this population. Informed health care providers can advocate for improved access to CAM for minority adolescents and alter disparate use.

Comparing Interprofessional Socialization in Mixed-Discipline and Nursing Student-Only Cohorts.

BACKGROUND: A challenge to substantiating the value of interprofessional education (IPE) has been the limited number of studies that assess the effectiveness of IPE interventions compared with education interventions in which professions were learning separately from one another. PURPOSE: The purpose was to compare interprofessional socialization (IS) in mixed-discipline and single-discipline-only student cohorts to determine if mixed-discipline cohorts demonstrate greater improvement in IS compared with single-discipline cohorts. METHODS: Interprofessional socialization was measured using the Interprofessional Socialization and Valuing Scale in 166 university students who completed a semester-long online palliative care course. RESULTS: Statistically significant increases in IS were seen with all participants, both those in discipline-specific as well as mixed-discipline cohorts and in all IS subscales. No difference was observed between a cohort of nursing student-only learners versus a cohort of mixed-discipline students. CONCLUSION: The study demonstrates that IS can be significantly increased whether students participate with single discipline peers or in mixed-discipline settings.

A Systematic Review and Meta-Analysis of Risk Factors for Postpartum Depression Among Latinas.

OBJECTIVES: The purpose of this article was to describe the findings from a systematic review, quality review, and meta-analysis of risk factors for postpartum depression among adult Latinas in the United States. METHODS: Databases were searched from inception to May 2020 for studies published in English related to Latina/Hispanic mothers and risk factors of postpartum depression. Of 115 abstracts screened, 10 met the inclusion criteria for the review and meta-analysis. Eleven risk factors from these studies were included: acculturation, age, economic stress, education, marital status, number of children, prenatal depression, recent and remote intimate partner violence (IPV), general social support, and partner/father's social support. RESULTS: Partner/father's social support had a large effect size. Prenatal depression and recent IPV had medium effect sizes, while education, economic stress, general social support and remote IPV had small effect sizes. Negligible effect sizes were found for age, marital status, number of children, and acculturation. CONCLUSIONS: Prenatal depression, IPV, social support (general and from partner/father), economic stress and education are risk factors that should be screened for when working with perinatal Latinas. Future directions for clinical practice and research are discussed.

Change in Event Centrality and Posttraumatic Stress Disorder Symptoms During Intensive Treatment.

Event centrality, defined as the extent to which a traumatic event becomes a core component of a person's identity (Berntsen & Rubin, 2006), is both a correlate and predictor of posttraumatic stress disorder (PTSD) symptoms, over and above event severity. These findings suggest that decreasing the perceived centrality of a traumatic event to one's identity might result in decreases in PTSD symptom severity. To date, few studies have examined how centrality is affected by PTSD treatment. The present study tested the hypotheses that change in centrality would be associated with both change in PTSD symptom severity and discharge PTSD symptom severity in an exposure-based PTSD partial hospitalization program (N = 132; 86.0% White; 85.2% female; M age = 36 years). At discharge (i.e., after approximately 6 weeks of treatment), both PTSD symptoms and centrality had significantly decreased, ds = .70 and .98, respectively, with large effect sizes. Decreases in Centrality of Events Scale (CES) scores at posttreatment, baseline CES scores, and baseline PTSD Checklist for DSM-5 (PCL-5) scores were associated with change (i.e., decrease) in PCL-5 scores, p < .001, as well as with posttreatment PCL-5 scores, p < .001. Decreases in CES scores over time, baseline CES scores, and baseline PCL-5 scores explained 31% of the variance in PCL-5 change and 34% of the variance in posttreatment PCL-5 scores. The results indicate the potential importance of decreasing the centrality of a traumatic event in PTSD treatment and recovery.

Swim Program Pilot for Children with Autism: Impact on Behaviors and Health.

The purpose of this mixed methods pre-/post-pilot intervention study was to assess parental psychological health and child challenging behaviors before and after a swimming program for children with autism. Participants were 10 parent-child dyads. Child's challenging behaviors were lower in the post testing (Cohen's d = 0.07-0.45). Mean scores were improved for parent perception of general health (Cohen's d = 0.22). Three themes emerged from the post swim program focus group: (a) Parent satisfaction with instructors with sub themes (i) firmness (ii) creativity, and (iii) promotion of social interaction and sharing, (b) improved child sleeping, and (c) family dynamics with sub themes (i) siblings wanted to swim and (ii) parents' fear of drowning. Preliminary results point to improved child behaviors and parent perception of general health. Future studies can focus on expanding the swim program to include all family members.

Engaging Parents in Education for Discharge (ePED): Evaluating the Reach, Adoption & Implementation of an Innovative Discharge Teaching Method.

PURPOSE: This paper describes the evaluation of the implementation of an innovative teaching method, the "Engaging Parents in Education for Discharge" (ePED) iPad application (app), at a pediatric hospital. DESIGN AND METHODS: The Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework was used to guide the evaluation. Three of the five RE-AIM elements are addressed in this study: Reach, Adoption, and Implementation. RESULTS: The Reach of the ePED was 245 of 1015 (24.2%) patient discharges. The Adoption rate was 211 of 245 (86%) patients discharged in the five months' study period. High levels of fidelity (89.3%) to Implementation of the ePED were attained: the Signs and Symptoms domain had the highest (93%) and Thinking Forward about Family Adjustment screen had the lowest fidelity (83.3%). Nurse themes explained implementation fidelity: "It takes longer", and "Forgot to do it." CONCLUSIONS: The ePED app operationalized how to have an engaging structured discharge conversation with parents. While the Reach of the ePED app was low under the study conditions, the adoption rate was positive. Nurses were able to integrate a theory-driven practice change into their daily routine when using the ePED app. IMPLICATIONS FOR PRACTICE: The rates of adoption and implementation fidelity support the feasibility of future hospital wide implementation to improve patient and family healthcare experience. Attention to training of new content and the interactive conversation approach will be needed to fully leverage the value of the ePED app. Future studies are needed to evaluate the maintenance of the ePED app.

Systematic review of psychometric properties of instruments measuring patient preferences for engagement in health care.

AIM: To identify, critically appraise, and summarize instruments that measure patients' preferences for engagement in health care. DESIGN: Psychometric systematic literature review. DATA SOURCES: PubMed, Embase, CINAHL, and PsycINFO were searched from inception to March 2019. REVIEW METHODS: Three reviewers independently evaluated the 'methodological quality' and the 'measurement properties' of the included instruments using the Consensus-based Standards for the Selection of Health Measurement Instruments (COSMIN) checklist and Terwee's quality criteria. Each instrument was given a Grading of Recommendations Assessment, Development and Evaluation (GRADE) score. The review was registered at PROSPERO (registry number CRD42018109253). RESULTS: A total of 16 studies evaluating 8 instruments measuring patients' preferences for engagement in health care were included. All instruments were downgraded for their 'methodological quality' or 'measurement properties', or a combination of both. Common concerns were lack of theoretical basis, absence of patient input during development, incorrect usage and reporting of validity measures and absence of a priori hypotheses to test validity. CONCLUSIONS: There were no identified instruments that demonstrated adequate evidence for all measurement properties. The Patient Preferences for Patient Participation Scale (4Ps) and 10-item Decisional Engagement Scale (DES-10) had the highest overall GRADE scores; however, each had some underlying developmental or methodological issues. IMPACT: Assessing how patients prefer to engage in their care is a critical first step to truly individualize engagement interventions to meet patient expectations. Systematic reviews of measures of patient experience with engagement in health care have been undertaken but none are available on measures of patient preferences for engagement. The results highlight the need to further develop and test instruments that measure patients' preferences for engagement in health care within a framework for consumerism. Involving the consumer in the instrument development process will ensure that engagement strategies used by healthcare providers are relevant and individualized to consumer preferences.

Validity and Reliability of the Antepartum Gastrointestinal Symptom Assessment Instrument.

OBJECTIVE: To examine the psychometric properties of the nine-item Antepartum Gastrointestinal Symptom Assessment (AP-GI-SA) instrument. DESIGN: Single-group prospective design. SETTING: Urban prenatal clinic serving a diverse population. PARTICIPANTS: Convenience sample of 45 pregnant women. METHODS: Participants completed the AP-GI-SA before a scheduled prenatal care appointment. We used Bayesian structural equation modeling to evaluate the construct validity of the scale and assessed known-groups validity. We assessed reliability through maximal reliability coefficient estimate and measured internal consistency with Cronbach's alpha coefficient. RESULTS: Participants completed the instrument in 2 minutes or less. Construct validity was supported by confirmatory factor analysis (posterior predictive p value = 0.49, gamma-hat = 0.970, and root mean square error of approximation = 0.065), which indicated that the single-factor model is a plausible data-generative model for GI symptoms. The maximal reliability coefficient of 0.75 and Cronbach's alpha coefficient of 0.67 supported reliability. Average AP-GI-SA scores were the highest for women in the third trimester. Of all nine GI symptoms, heartburn in the third trimester received the highest score. CONCLUSION: Our findings provide preliminary support for the validity and reliability of the AP-GI-SA. The instrument may be used as a measure in intervention studies where GI symptoms of pregnancy are an outcome. The AP-GI-SA could also be useful in clinical settings to quickly evaluate GI symptoms.

Using the Engaging Parents in Education for Discharge (ePED) iPad Application to Improve Parent Discharge Experience.

PURPOSE: The purpose of this study was to evaluate the use of the Engaging Parents in Education for Discharge (ePED) iPad application on parent experiences of hospital discharge teaching and care coordination. Hypotheses were: parents exposed to discharge teaching using ePED will have 1) higher quality of discharge teaching and 2) better care coordination than parents exposed to usual discharge teaching. The secondary purpose examined group differences in the discharge teaching, care coordination, and 30-day readmissions for parents of children with and without a chronic condition. DESIGN/METHODS: Using a quasi-experimental design, ePED was implemented on one inpatient unit (n = 211) and comparison group (n = 184) from a separate unit at a pediatric academic medical center. Patient experience outcome measures collected on day of discharge included Quality of Discharge Teaching Scale-Delivery (QDTS-D) and care coordination measured by Care Transition Measure (CTM). Thirty-day readmission was abstracted from records. RESULTS: Parents taught using ePED reported higher QDTS-D scores than parents without ePED (p = .002). No differences in CTM were found between groups. Correlations between QDTS-D and CTM were small for ePED (r = 0.14, p 0.03) and non-ePED (r = 0.29, p < .001) parent groups. CTM was weakly associated with 30-day readmissions in the ePED group. CONCLUSION: The use of ePED by the discharging nurse enhances parent-reported quality of discharge teaching. PRACTICE IMPLICATIONS: The ePED app is a theory-based structured conversation guide to engage parents in discharge preparation. Nursing implementation of ePED contributes to optimizing the patient/family healthcare experience.