College students with food allergy: From hypervigilance to disclosure fatigue.

PURPOSE: The purpose of this study was to explore the impact of food allergy (FA) on the daily lives of young adults who recently transitioned to attending college away from home. DESIGN AND METHODS: We conducted in-depth qualitative interviews using a grounded theory approach to data collection, data analysis, and theory development. For recruitment, we posted a flier on a FA Facebook group and reposted approximately monthly for one year. We completed and recorded 16 interviews that ranged in duration from 30 to 90 min. The interviews were transcribed, coded, and analyzed with the intention of developing mid-range theory. RESULTS: Several interrelated themes were identified during the analytical process, including hypervigilance, misunderstood risk, and stigma management. Notably, a series of cascading effects eventually lead to what we call "disclosure fatigue," where students with FA tire of talking about their invisible disability with people who misunderstand it, and they eventually develop strategies to avoid conversations. The consequences include a narrowing of social networks and activities and even risky food behaviors. CONCLUSIONS: Research is needed in other settings, for other conditions, to consider and ameliorate the negative health consequences associated with disclosure fatigue. PRACTICE IMPLICATIONS: In addition to focusing on physical aspects of FA, including avoiding exposure, healthcare practitioners in pediatric settings should emphasize social aspects of FA that gain influence during the transition out of high school and away from home. Disclosure fatigue provides one explanation for why individuals with FA may choose to ignore best practices and engage in risky food behaviors.

Dosage and Efficacy in Behavioral Interventions With Community Dwelling Older Adults: Lifestyle Redesign Revisited.

Objectives: Behavioral interventions with community dwelling older adults often utilize multiple modes of treatment, which contributes to variation in participation and high rates of nonadherence. The objective of this report was to assess the treatment efficacy of one such study. Methods: We conducted an as-treated analysis of the Well Elderly II trial, where 322 individuals underwent 6 months of individual and group treatment and participated in community outings. We utilized inferential and graphical methods to assess the relationship between treatment received and depression change. Results: Individual treatment and community outings had similar small indirect effects on depressive symptoms, but a selection effect was present for individual treatment, where individuals with high baseline depression scores were the most likely to participate. Discussion: The results provide nuance that is unavailable using intent-to-treat. Future research should expand on our methods for as-treated analyses after intent-to-treat has shown aggregate improvements.

Comparing life review writing with active control groups: Results of a feasibility study.

INTRODUCTION: Life review writing can be used to improve depressive symptoms in well older adults, but it is unclear whether the reminiscing, writing, or socialising is associated with the improvements. This study assessed the feasibility of a controlled trial comparing life review writing with two active control groups designed to isolate the acts of (a) engaging in a meaningful leisure activity and (b) socialising. METHODS: Twenty-four participants from a 100-bed assisted living facility were enrolled in the study. Participants ranged in age from 70 to 98 years (M = 83.9, SD = 7.6). Eight 1-hour weekly sessions were held, with participants assigned to one of three groups: (a) life review writing, (b) painting, or (c) coffee from around the world. At baseline, participants completed a demographic and health questionnaire, the Mini-Cog, and the Geriatric Depression Scale Short Form (GDS-15). The GDS-15 was administered again at weeks 4 and 8, along with the health questionnaire at post-test. RESULTS: Nearly 25% (N = 24) of the facility's residents attended at least one session, with an average attendance rate of 66.4%, or 5.3 sessions. However, to achieve this participation rate, our original plan to employ random assignment had to be abandoned. The groups were a partial success insofar as we successfully isolated engaging in a meaningful activity in the painting group, but the writing group engaged in less reminiscing than hoped. At post-test, seven participants reported health, mood, and social life benefits. GDS-15 scores fluctuated over time, with no significant improvement from pre- to post-test. CONCLUSION: The residents' low willingness to be randomised creates a serious selection bias, but randomising volunteers into different activities runs counter to client-centred therapy. To scrutinise the mechanisms of change of life review writing, we recommend comparing two writing groups: one that reminisces and one that does not.

Fine Motor Activities in Elementary School Children: A Replication Study.

IMPORTANCE: The educational landscape is continually changing in response to legislation and the adoption of new standards, such as the Common Core. Currently, little is known about how these changes have influenced the school day. OBJECTIVE: To examine the motor and technology requirements of kindergarten, second-, and fourth-grade general education classrooms. DESIGN: For 6 full school days, we made unobtrusive observations of and took notes that described classroom activities throughout the day. Data were coded by a committee, allocating each minute of the day into 1 of 10 activity categories. SETTING: Kindergarten, second-, and fourth-grade classrooms. PARTICIPANTS: Three general education classrooms with approximately 20 students in each class. RESULTS: Students spent between 37.1% and 60.2% of the school day performing fine motor activities, with handwriting accounting for 3.4%-18.0% of the day. Time spent using technology was relatively sparse in kindergarten (4.8%) and second grade (3.1%) compared with fourth grade (14.3%). Transitions between activities (18.9%-23.4% of time spent) exceeded time spent handwriting. CONCLUSION AND RELEVANCE: This article provides an updated estimate of motor demands throughout the school day. Estimates of fine motor activities were consistent with previous research, but the focus on handwriting appears to have substantially diminished. WHAT THIS ARTICLE ADDS: Within the context of their own school, occupational therapists may find transitions to be a good opportunity for providing services within the classroom. In addition, handwriting practice outside of school may be more necessary in the current educational climate than in previous years.

Examining Clinical Meaningfulness in Randomized Controlled Trials: Revisiting the Well Elderly II.

OBJECTIVE: Randomized controlled trial (RCT) interventions often rely on p values, where statistical significance is assumed to provide evidence of an intervention effect. This study provides a secondary data analysis of the Well Elderly II RCT using multiple approaches that examine clinical meaningfulness. METHOD: We reanalyzed the Well Elderly II RCT using effect size, standard deviation, standard error of measurement, minimal difference, a fragility index, an assessment of poor scores at baseline, and an analysis with a small subgroup of participants removed. RESULTS: Although some participants improved on several scales, most stayed the same, and a small subset declined. Omitting a small subgroup of participants led to nonsignificant p values. CONCLUSION: There is evidence that disparities in baseline scores and regression to the mean may have created the appearance of an intervention effect. Our methods of considering clinical meaningfulness suggest improved approaches to analyzing RCT data.

Health Differences in Didactic Versus Clinical Stage Graduate Allied Health Students.

AIMS: Graduate education in the healthcare professions can be stressful and mentally taxing. The objective of this study was to identify differences in health and health-related behaviors among graduate allied health students based on sex and curriculum stage (i.e., didactic or clinical education). METHODS: Participants (n=77) were assessed for body fat, BMI, resting metabolic rate (RMR), and peripheral arterial-venous O2 (AVO2), as well as a series of cognitive tasks and self-reported health and health-related behaviors. Independent sample t-tests and tests of proportions were used to assess differences between groups. RESULTS: There was no evidence that the didactic and clinical students were meaningfully different upon entering their programs. Didactic students reported significantly higher tension/anxiety, depression, anger, confusion, fatigue, total mood disturbance, trait mental fatigue, total intensity of mental work performed, and time spent sitting (p<0.05). Didactic students also reported significantly lower RMR (p=0.033), but not after normalizing for fat-free mass. Males reported lower intensity of mental work performed on non-work days compared to females (p=0.009). CONCLUSIONS: Findings indicate students in didactic stages have worse mood and decreased health relative to their counterparts in clinical stages. Opportunities exist to integrate physical and mental health-related education, resources, and self-management programming into graduate allied health curricula to improve wellness among students.

Predictors of employment status among adults with Autism Spectrum Disorder.

BACKGROUND: In the United States, adults with Autism Spectrum Disorder (ASD) experience high rates of unemployment and underemployment in relation to adults with other disabilities and the general population. Yet there is little research examining their employment experiences and the predictors of employment status. OBJECTIVE: The purpose of this study was to examine the employment characteristics and histories of both employed and unemployed adults with ASD, and the factors that contributed to their employment status. METHODS: This cross-sectional study used an online survey and the Short Effort Reward Imbalance (ERI) Scale to gather data. Multivariate logistic regression analyses were used to examine predictors of employment status and self-reported health. RESULTS: Of the 254 adults with ASD who participated in this study, 61.42% were employed and 38.58% were unemployed. Over half of the participants reported job imbalance on the Short ERI Scale and the vast majority did not receive any job assistance. Participants who disclosed their ASD diagnosis to their employer were more than three times as likely to be employed than those who did not disclose. Education level was also a significant predictor of employment status. CONCLUSIONS: This study suggests disability disclosure and education level are factors that contribute to employment status.

Test-Retest Reliability of the Child Occupational Self-Assessment (COSA).

We examined the test-retest reliability of the Child Occupational Self-Assessment (COSA). Fifty-two children ages 6-12 yr completed the COSA on two separate occasions 7-14 days apart. Participant data were analyzed using intraclass correlation coefficients (ICCs). Test-retest reliability was good for total Competence and Value scores (ICC2,1=.72-.77) and poor to good across category scores (ICC2,1=.44-.78). These findings suggest that the children's perceptions of their abilities and the value they placed on their everyday activities as reflected in the test items were fairly consistent over a short period of time.

Effectiveness of a 10-week tier-1 response to intervention program in improving fine motor and visual-motor skills in general education kindergarten students.

OBJECTIVE: This study examined the efficacy of a 10-wk Tier 1 Response to Intervention (RtI) program developed in collaboration with classroom teachers to improve the fine motor and visual-motor skills of general education kindergarten students. METHOD: We recruited 113 students in six elementary schools. Two general education kindergarten classrooms at each school participated in the study. Classrooms were randomly assigned to the intervention and control groups. Fine motor skills, pencil grip, and visual-motor integration were measured at the beginning of the school year and after the 10-wk intervention. RESULTS: The intervention group demonstrated a statistically significant increase in fine motor and visual-motor skills, whereas the control group demonstrated a slight decline in both areas. Neither group demonstrated a change in pencil grip. CONCLUSION: This study provides preliminary evidence that a Tier 1 RtI program can improve fine motor and visual-motor skills in kindergarten students.

Test-retest reliability of the sensory profile caregiver questionnaire.

OBJECTIVE: We examined the test-retest reliability and internal consistency of the Sensory Profile Caregiver Questionnaire (SP). METHOD: Fifty-five primary caregivers of children 36-72 mo old participated in the study. Participants completed the SP on two separate occasions 7-14 days apart. Participant data were analyzed using intraclass correlation coefficients (ICCs) and Cronbach's α coefficients. RESULTS: Test-retest reliability was good across quadrant scores (ICC([2, 1]) = .80-.90) and moderate to good across factor (ICC([2, 1]) = .69-.88) and section scores (ICC([2, 1]) = .50-.87). Internal consistency was high across quadrant (αs = .89-.95) and factor scores (αs = .82-.93) and moderate to high across section scores (αs = .67-.93). CONCLUSION: This study suggests the SP has acceptable test-retest reliability and internal consistency and supports the use of quadrant scores over factor and section scores to analyze children's sensory processing patterns.