Psychophysiological Health Research Articles

Occupation and life satisfaction among individuals with mental illness: the mediation role of self-reported psychophysiological health.

BackgroundUnemployment can diminish physical, psychological and social health. In this context, research shows that people with mental illness have even more difficulties finding occupation. Thus, some countries, such as Sweden, strive after creating job opportunities for this specific group. We investigated the effect of having an occupation on life satisfaction among individuals with mental illness and whether self-reported physical and psychological health mediated the relationship between being (un)employed and life satisfaction.MethodTwo-hundred eighty-seven individuals (148 males, 134 females, and 5 missing information) with mental illness, who received support and services from Swedish Municipalities in Blekinge, self-reported occupation, life satisfaction, and physical and psychological health.ResultsParticipants who reported having an occupation reported also significantly higher levels of life satisfaction, physical health, and psychological health compared to those without occupation. Nevertheless, these differences were rather small (Eta2 < 0.06). Moreover, the indirect effect of having an occupation on life satisfaction through physical and psychological health was significant. Finally, the total indirect effect of physical and psychological health (i.e., psychophysiological health) accounted for 53% of the total effect of having an occupation on life satisfaction.ConclusionFor individuals with mental illness there seems to be an almost equal importance of indirect and direct effects of having an occupation on their levels of life satisfaction. More specifically, while there are differences in life satisfaction within this population in relation to having an occupation, having an occupation leads to the sense of good psychophysiological health, which in turn helps individuals with mental illness to feel satisfied with their lives.

Full Spectrum Phosphors for White LEDs and Virtual Windows for Light and Health Applications

Light and health is a topic of significant importance and requires fundamental studies of human interactions with light. This talk will present a review of some of the on-going studies on light and health by holistically exposing the humans to the outdoor conditions, while they are confined in indoor spaces. The designs of a new lighting-display fusion system along with examples of emerging commercial products will be discussed. Full spectrum lighting is a critical component of such systems. Results of phosphor blends based on well known thiogallates and sulfide phosphors for designing full spectrum lighting that could replicate sunlight quality will be presented. The synchronous modulation of phosphor based full spectrum light sources with electronic display playing real time outdoor videos creates a new tool for systematically studying the cognitive psycho-physiological health of human beings under different environmental conditions.

Selection and biomedical support for gifted children simultaneously involved in education and sports

Introduction. The paper reviews scholarly literature on selection criteria and medical and biological support for children talented in sports in their ‘dual career’ development. The authors substantiate the need for updating these criteria based on digital methods for functional status assessment. The paper aims to identify contradictions and inconsistencies in the current system of selection and medical and biological support for children talented in sports. These contradictions are considered as factors that determine functional status, psychophysiological health and educational and sports achievements. Materials and Methods. Theoretical analysis of scholarly works on the procedure and nature of selection and support for gifted children at sports schools was conducted. The authors used the following research methods: the axiomatic method, reviewing, analysis and generalization. Results. The theoretical analysis of scholarly and methodological works reveals the need to update the procedure of selecting children for sports schools based on an integrated (genetic, psychological and educational) conclusion on the correspondence of the individual indicators of children to selection criteria in each sports discipline. Generalization and the axiomatic method allowed the authors to formulate the main conceptual provisions of their approach to the research problem. In order to ensure sustainable health and a high level of general and specific reserve capabilities responsible for learning and sports activities (dual career development), it is necessary:  to engage professionals whose expertise includes advanced interdisciplinary knowledge and understanding of key aspects of sports science in professional training and continuing professional development of physical education teachers, coaches, sports psychologists, psychophysiologists, and physiologists;  to supplement medical and biological support by monitoring the mental sphere of young athletes experiencing an increased stress associated with a dual career (a combination of general education and sports training) for maintaining mental health and preventing professional burnout;  to attract targeted funding for school-based research investigations, to engage experts in fundamental areas of science (physiologists, geneticists, biochemists, psychophysiologists) and sports practitioners. Conclusions. The achievements of related sciences and transition to new digital distance technologies for assessing the functional and psychophysiological status in sports schools will provide systemic and dynamic monitoring, the results of which will be useful for promising coaches and athletes and local authorities, conducting Olympic selection in the Russian Federation. The authors conclude that in order to achieve the strategic goal outlined in the ‘The strategy of training prospective Olympic athletes in the Russian Federation until 2025’, the involvement of local authorities responsible for physical education and sports is required.

There’s no place like home? The physiological and psychological effects of going outside from the indoor home environment to urban environments, a field experiment on women from two ethnic groups

Background: Previous field studies evaluated the effects of visit to different outdoor urban environments on short-term psychological, cognitive and physiological responses. Less is known on the effect of going outside from the indoor home environment to these urban environments. Aim: To evaluate whether visits to different urban and ethnic environments, in comparison to home indoor environment, leads to short-term responses and whether these are independent of ethnicity. Methods: The participants, 20-35 year-old healthy women (N=72, 48 Arab and 24 Jewish), started the experiment at their home and visited six different outdoor urban environments in predominantly ethnic Arab or Jewish cities, in Israel. First they visited intra-ethnic city and afterward inter-ethnic city environments. In each city they visited an urban park, a residential neighborhood and the city center. In each environment (including home) the following measures were evaluated: mood (measured as positive and negative emotions, cheerfulness, relaxed, natural and discomfort feelings), working memory (measured with backwards digit-span task) and autonomic nervous system (assessed using heart rate variability (HRV)). Several potential mediators were measured: carbon monoxide (CO), heat, noise, social aspects, and the self-perceived restoration scale. Results: Going outside from home, to both intra and inter-ethnic parks, was associated with beneficial psychological, physiological, and cognitive responses, and the strongest effects were found for the intra-ethnic park. The results for the other urban environments were different between Jewish and Arab women. The self-perceived restoration, the social aspects and reduced CO, heat and noise exposures during the visits did not explain the observed changes between the outdoor environments and home. Conclusions: Visits to urban parks compared to the home demonstrated short-term beneficial changes in the outcomes that could not be attributed to the investigated mediators. Women should be encouraged to go outdoors and specifically visit parks to improve their psycho-physiological health.

Influence of monotony of work on psychophysiological health of drivers of electric rolling stock of railway transport

The article presents the results of the author's research that determines the degree of influence of monotonous (monotonous) labor processes on the drivers (and their assistants) of traction rolling stock of railway transport. Information is collected in order to develop a set of measures to overcome the monotony of work, improve the quality of working life and psychophysiological health of employees, and as a result, ensure traffic safety, improving the safety system for drivers and improving the quality of passenger transport.

ПСИХОЛОГІЧНІ РЕСУРСИ РЕАЛІЗАЦІЇ ПРОФЕСІЙНОГО СЦЕНАРІЮ ПСИХОЛОГА ДЖОРДАНА ПЕТЕРСОНА КРІЗЬ ПРИЗМУ ПСИХОЛОГІЧНОГО ВИГОРАННЯ

The article updates and partly characterizes the main substantive features and semantic content of the concepts of «psychological burnout», «life scenario», «psychological resources», «stress response» in the context of the professional scenario of psychologist Jordan Peterson. It is found that the research of psychological burn-out of the practical psychologist in modern domestic and foreign psychology is marked by a variety of approaches, analysis of innovative technologies, methods, and tools aimed at expanding its professional consciousness. The factors, causes, stages, indicators of the development of psychological burnout of a person, which negatively affect its psycho-physiological health, are conducted on the basis of the facts of professional activity and the life scenario of J. Peterson.

The Effects of Aromatherapy on Postpartum Women: A Systematic Review.

The postpartum period is the most crucial but also the most fragile stage of most pregnancies. The health benefits of aromatherapy have recently become more widely accepted among medical experts. Although a number of studies have examined these health benefits, no systematic reviews have been conducted to assess the effects of aromatherapy on the psycho-physiological health of postpartum women. This systematic review was conducted to evaluate the effectiveness of aromatherapy interventions on the psycho-physiological health of postpartum women, to determine the methods that were used to measure intervention effectiveness, and to identify the types of interventions that were used. We searched for studies that evaluated the effects of aromatherapy on postpartum women published in the Chinese or English languages before March 2018. We used online databases such as the Taiwan Journal Index, Centre for European Policy Studies, Cumulative Index for Nursing and Allied Health Literature, Cochrane Library, PubMed, and Social Sciences Citation Index. The search keywords used were "women," AND "postpartum," OR "postnatal" AND "aromatherapy," OR "aroma," OR "essential oils." Only randomized controlled trials including humans as study participants were included. The methodological quality of the trials was assessed using the modified Jadad scale. The quality of the full-text studies was assessed by three reviewers. The 15 studies that were included in this systematic review were performed in Iran, England, and the United States and included 2,131 participants in total. The numbers of participants in each study ranged between 35 and 635. The review found that the effective duration of aromatherapy varied according to the essential oils that were selected. The visual analog scale was the most frequently used measure of postpartum pain. Most of the studies found that the aromatherapy intervention improved postpartum physiological and psychological health, with positive effects shown on anxiety, depression, distress, fatigue, mood, nipple fissure pain, physical pain, post-cesarean-delivery pain, post-cesarean-delivery nausea, postepisiotomy pain, postepisiotomy recovery, sleep quality, and stress. Most of the studies reported no serious intervention-related side effects. This systematic review may serve as a reference for healthcare workers in caring for postpartum women. Aromatherapy may be applied as a noninvasive complementary intervention to promote physio-psychological comfort in postpartum women.

Current Development Status of Forest Therapy in China.

As a result of rapid urbanization and urban sprawl, natural ecosystems are shrinking or are fragmented, affecting people’s health and quality of life. Modern people prefer to live in large cities rather than rural areas because of greater convenience and more comfortable living conditions. As a consequence, people are suffering from many psycho-physiological health problems and have a longing for natural environments to escape the concrete jungle. Forest therapy has emerged as a preventive and alternative therapy to cope with stress and enhance people’s health and wellbeing as a result of spending time in a green and healthy environment. Here, we review the activities related to forest therapy in China and discuss the commonalities and differences between the forest therapy types. Furthermore, we summarize the current achievements of forest therapy in basic research and the development of the forest therapy industry. We also describe the challenges that forest therapy has been facing. Finally, we provide suggestions for further development in research and industry.

AGE-RELATED FEATURES OF NEURODYNAMIC INDICATORS IN NATIVE ADOLESCENT FEMALES OF RUSSIA’S NORTHEAST

An increase in mental and emotional stress in modern school makes relevant the issue of preserving the psychophysiological health of northerners. Aim. The purpose of the article is to reveal the age-related features of neurodynamic indicators in 120 adolescent females aged from 12 to 15 years from the indigenous peoples of the Northeast of Russia. Materials and methods. Neurodynamic indicators were determined by the time parameters of sensorimotor reactions with the help of NS-PsychoTest (NeuroSoft, Ivanovo). The dynamics of attention was studied using proofreading method modified by VN Amatuni. Results. The study showed regular ontogenetic changes in strength, mobility and balance of nervous processes, differentiating inhibition, attention properties and short-term visual memory in females. When studying the attention, we observed an increase in the pace of work, improvement of quality and performance with age. The decrease in the functional asymmetry of attention also indicates positive trends in the change of attention as a result of growth and development of females. Conclusion. Native females of the Northeast of Russia aged from 12 to 15 years are characterized by a lower mobility and imbalance in the nervous system compared with the middle latitude values. This should be taken into account when choosing a strategy for the education of northern children in educational institutions.

Using Physical Activity to Enhance Health Outcomes Across the Life Span.

Physical activity has been widely recognized as one of the primary determinants that proliferates positive psychophysiological health in individuals. Despite the numerous benefits of engaging in physical activity, a majority of the global population continues to be physically inactive or sedentary. The aim of this brief commentary is to capture the benefits of engaging in regular physical activity across the life span. In particular, this paper will highlight the benefits of engaging in regular physical activity with respect to age, gender, atypical populations, and lifestyle. Future research and recommendations have also been addressed.

Clinical Practice Guidelines for Yoga and Other Alternative Therapies for Patients with Mental Disorders.

Demand of complementary and alternative (CAM) treatments has been increasing over a period of time. Some studies have reported that up to 56% of patients with depression have used CAM methods while they have been used in other psychiatric disorders with or without conventional treatment. In ancient India and till the middle ages before British rule in India, yoga and Ayurveda were the sciences for health and disease. Modern medicine as described during British period gradually replaced these sciences in India. In other words, in olden times, yoga and Ayurveda were practiced as a way of life. Although yoga has its roots in Vedic and Upanishadic writings, it was 100 years BC that Patanjali emphasized on different aspects of yogic practices and advocated their role in day-to-day practice as well as healthy lifestyle. The scientist-sage Patanjali, in his Yoga Sutras (4), described Ashtanga Yoga meaning the eight-fold path of yoga and the way it should be practiced to live healthy lifestyle and prevent the diseases. It is thought that yoga is a spiritual science partly it is true but the latest advances have proven that we not only achieve an ideal state of psychophysiological health by practice of yoga, it helps in improving the individuals spiritual status and optimal functioning of body and mind. Yoga as a therapy has been used since 1400 BC described in Charak Samhita and has been popular in India since then. Yoga as therapy has gained its status in India and internationally after reported benefits of regular practice in stress reduction regulating of emotions improving mood, general well-being, and cognitive functioning. Utility of Pranayam has been proven in respiratory and cognitive functioning, while Yoga Asanas have their impact in physical flexibility, muscular strength, and neuromuscular performance. In health sciences, there has been a recent focus on research in Yoga therapy in various conditions including psychiatric disorders [Table 1]. In mental health, the major focus has been on research in depressive disorder and anxiety states with proven reports of its utility. Research is also being focused on posttraumatic stress disorders and substance use disorder. Some work has gone on in its utility in attention deficit disorders, autism, and obsessive–compulsive disorders. In some places, yoga therapy is being used as an adjunctive therapy. It also works as a preventive therapy where patients are having high risk for mental disorders. Table 1 Evidence base of efficacy of yoga in major depressive disorder

Актуальність знань з анатомії, фізіології та гігієни в професійній діяльності майбутнього педагога

One of the leading directions in modern public policy is to preserve and strengthen the health of the younger generation. In this regard, the urgency of the problem of physical, social and psychophysiological health of children, adolescents and young people in Ukraine is growing. It is necessary to increase the number of teachers, defectology teachers, educators who possess general knowledge of anatomy, physiology and hygiene of children and adolescents in health and disease. One of the promising and necessary areas for improving and optimizing the training of students is a well-thought-out teaching of the discipline. The article considers the role of the teacher in the formation of subject competences in the study of anatomy, physiology and hygiene as a basis for studying the educational components of the biological cycle. The analysis of the last researches, publications of modern methodical approaches to teaching of anatomy, physiology, hygiene for future teachers, teachers-defectologists, educators is carried out. The article highlights the peculiarity of teaching the educational component as a component of ecological and valeological preparation of students for health activities in educational organizations. The competencies of first-year students in the study of the educational component are analyzed. Knowledge of the anatomical and physiological features of children and adolescents is necessary for any teacher and educator for the proper, systematic organization of educational and upbringing work in school and kindergarten.

Full Spectrum Phosphors for White LEDs and Virtual Windows for Light and Health Applications

Light and health is a topic of significant importance and requires fundamental studies of human interactions with light. This paper presents a review of some of the on-going studies on light and health by holistically exposing the humans to the outdoor conditions, while they are confined in indoor spaces. The designs of a new lighting-display fusion system along with examples of emerging commercial products have been presented. Full spectrum lighting is a critical component of such systems. A new simple approach for creating phosphor blends based on well known thiogallates and sulfide phosphors for designing full spectrum lighting that could replicate sunlight quality has been described. The synchronous modulation of phosphor based full spectrum light sources with electronic display playing real time outdoor videos creates a new tool for systematically studying the cognitive psycho-physiological health of human beings under different environmental conditions.

Health Psychological Case Study of High Intensity, Low Impact, Physical Training Program

This case study reports on the health psychological evaluation of an integrated, high intensity, lo impact, physical training program for a 31 year old, male accountancy teacher. High intensity components consisted of running, cycling and the Canadian Airforce 5BX program. Low impact components comprised walking and Chi-gung inspired Pilates. Squash and swimming were also occasional activities. The pre-test and post-test, process and outcome evaluative, research design included qualitative and quantitative components in the form of psychometric testing, diarizing of physical activity, experiential descriptions of the various components and program outcome evaluation. Quantitative findings indicated significant improvements in psychophysiological coherence, mood, resilience and general health. Qualitative experiential descriptions provided further evidence of health psychological growth.&amp;nbsp; Integrative findings emphasize the importance of physical training programs based on client individual preferences.&amp;nbsp; The client reported that he found the program to be enjoyable, flexible, invigorating and readily adaptable to suit the needs of various individuals who face time and space constraints in their daily lives.&amp;nbsp; With minimal innovation for greater complexity, control and/or challenges, such programs may readily yield enjoyable flow experiences.

Effects of Music Therapy in Frail Elderlies: Controlled Crossover Study

Background: Music therapy (MT) may exert beneficial preventive effects in frail elderly individuals in psychophysiological health. Objectives: One hundred and fifteen frail elderly individuals (65–89 years old) participated. Methods: Subjects were randomly divided into 2 groups for a controlled crossover trial. The MT-first group participated in group sessions of 45–50 min conducted by a certified music therapist for 12 weeks, followed by a 12-week waiting period. The waiting-first group participated in the reverse order. Cognitive function was assessed by the Verbal Fluency Test (VFT) and Yamaguchi Kanji Symbol Substitution Test (YKSST). Physical function was assessed by the Timed Up and Go test (TUG). Psychophysical health was assessed by the Geriatric Depression Scale 15-item version (GDS-15), General Health Questionnaire 12-item version (GHQ-12), Instrumental Activity of Daily Living (IADL) scale, and Life Space Assessment (LSA) scale. We also evaluated the outcome of MT using the Clinical Global Impressions of Improvement (CGI-I) scale. Results: After 12 weeks of MT, significant improvements were observed in TUG, GDS-15, and GHQ-12 scores. However, no improvements were noted in other scores. CGI-I scores revealed the significant benefits of MT. Conclusions: MT may improve physical function, depressive mood, and quality of life in frail elderly individuals.

Exercise Addiction and Psychophysiological Health in Korean Collegiate Students

This study was carried out with collegiate students who took part in an exercise program for 1 year. An exercise addiction (EA) questionnaire was used to classify EA and non-EA (NEA) groups. Exercise dependence (ED), compulsive exercise (CE), and obligatory exercise (OE) questionnaires were used to validate the EA results. A total of 38 male and 37 female college students were selected as the subjects for this study to investigate the effects of EA on psychophysiological health. The psychophysiological health variables were composed of depression, stress, body composition, and muscular joint health. This study showed that EA was significantly associated with ED (r = 0.746; P = 0.001), CE (r = 0.644; P = 0.001), and OE (r = 0.731; P = 0.001), respectively. Although there were no significant differences between EA groups and NEA groups for both males and females on depression (Z = − 0.813; P = 0.416 and Z = − 0.148; P = 0.882, respectively), physical stress (Z = − 0.777; P = 0.437 and Z = −0.074; P = 0.941, respectively), and emotional stress (Z = − 1.035; P = 0.300 and Z = − 0.573; P = 0.567, respectively), the elbow and knee joint functions of EA males were significantly higher compared with those of NEA males. However, the variables of body composition in EA females were not significantly different from those of NEA females. Being addicted to exercise for 1 year resulted in negative effects on the psychological health in both genders, while it had a negative effect on physical health for women only.

The effects of a psychological intervention directed at optimizing immune function: study protocol for a randomized controlled trial

BackgroundPrevious research has provided evidence for the link between psychological processes and psychophysiological health outcomes. Psychological interventions, such as face-to-face or online cognitive behavioral therapy (CBT) and serious games aimed at improving health, have shown promising results in promoting health outcomes. Few studies so far, however, have examined whether Internet-based CBT combined with serious gaming elements is effective in modulating health outcomes. Moreover, studies often did not incorporate psychophysiological or immunological challenges in order to gain insight into physiological responses to real-life challenges after psychological interventions. The overall aim of this study is to investigate the effects of a psychological intervention on self-reported and physiological health outcomes in response to immune and psychophysiological challenges.Methods/designIn a randomized controlled trial, 60 healthy men are randomly assigned to either an experimental condition, receiving guided Internet-based (e-health) CBT combined with health-related serious gaming elements for 6 weeks, or a control condition receiving no intervention. After the psychological intervention, self-reported vitality is measured, and participants are given an immunological challenge in the form of a Mycobacterium bovis Bacillus Calmette-Guérin (BCG) vaccination. One day after the vaccination, participants are asked to perform several psychophysiological tasks in order to explore the effects of the psychological intervention on participants’ stress response following the immune challenge. To assess the delayed effects of vaccination on self-reported and physiological health outcomes, a follow-up visit is planned 4 weeks later. Total study duration is approximately 14 weeks. The primary outcome measure is self-reported vitality measured directly after the intervention. Secondary outcome measures include inflammatory and endocrine markers, as well as psychophysiological measures of heart rate and skin conductance in response to the psychophysiological tasks after the BCG vaccination.DiscussionThe innovative design features of this study – e.g., combining guided e-health CBT with health-related serious gaming elements and incorporating immunological and psychophysiological challenges – will provide valuable information on the effects of a psychological intervention on both self-reported and physiological health outcomes. This study will offer further insights into the mechanisms underlying the link between psychological factors and health outcomes and is anticipated to contribute to the optimization of health care strategies.Trial registrationNederlands Trial Register, NTR5610. Registered on 4 January 2016.

Vaginal orgasm is associated with indices of women's better psychological, intimate relationship, and psychophysiological function

A recent study by Therrien and Brotto (2016) examined the associations of orgasm during intercourse, concordance of laboratory genital and subjective arousal, and demographic variables in a group of sexually dysfunctional women. The authors claimed that their results cast doubt on the large body of multi-method multi-national research demonstrating that women's orgasm from penile-vaginal intercourse, and specifically vaginal orgasm are associated with a broad range of indices of women's better psychological, intimate relationship, and psychophysiological health. The problems with Therrien and Brotto's (2016) conclusions are discussed, and include that they did not even measure vaginal orgasm (they measured orgasm during intercourse, which can in some cases consist of orgasm elicited by clitoral masturbation during intercourse), and the non-generalisability of their findings from a sexually dysfunctional sample to the general population of women. Evidence is also presented against their claims that findings regarding orgasm during intercourse have not been investigated by other researchers, and their denial of differences between vaginal orgasm and clitoral orgasm. Denial of the myriad benefits of vaginal orgasm undermines women's sexual and general health potential, and serves only the demands of political correctness.

The Intersection of Intimate Partner Violence and Traumatic Brain Injury: A Call for Interdisciplinary Research

An emerging body of research suggests that survivors of intimate partner violence (IPV) are at a high risk for sustaining traumatic brain injury (TBI). However, most scholars and practitioners working on the problem of IPV have not examined how TBI could be related to their familiar subject of study. Concomitantly, little work in the brain injury field has been done to examine TBI in the context of IPV. In this paper, we encourage cross-collaboration among these fields. To that end, we consider the relationship between IPV and TBI; the difficulty in detecting and measuring the IPV-related TBI and ethical concerns that may arise when addressing this issue. Our work emphasizes the need to recognize the complex interplay among psycho-physiological health and socio-cultural contexts. As such, we present a socio-ecological perspective of IPV-related TBI to provide a contextual framework to guide future interdisciplinary research. Finally, we outline directions for future research.

Exploratory factor analysis of a 16D Health-Related Quality of Life instrument with adolescents seeking help for early psychiatric symptoms

Background: Health-related quality of life (HRQoL) is a widely studied phenomenon in health care. This study aimed to identify which factors can be extracted from a generic 16-dimension (16D) HRQoL instrument in a sample of adolescents seeking help for early psychiatric symptoms. Methods: Data were collected at the Helsinki University Central Hospital (HUCH), Finland, by an early intervention team. In total, 394 help-seeking adolescents (mean age 15.3 years, SD 2.14 years, 183 boys and 211 girls) completed a 16D HRQoL questionnaire. Results: Exploratory factor analysis (generalized least squares method, promax rotation) identified four factors in the 16D instrument. The first factor of “psychophysiological health” included the dimensions of vitality, breathing, distress, sleeping, physical appearance, mental functioning and depression. The second factor, “physical and social health”, consisted of the items discomfort and symptoms, friends and elimination. The items hearing, eating and speech were loaded on factor three, “health in somatosensory functioning”. Moreover, the single item of school and hobbies was loaded on factor four, “health in functioning ability”. However, the items of vision and mobility were not loaded on any factor. Since the 16D instrument was originally designed for 11–15-year-old adolescents, analysis was repeated using a subsample of this age group (n = 245). Conclusions: The results here suggest that the 16D instrument consists of four factors and forms its own latent variable structure in this specific sample of adolescents seeking help for early psychiatric symptoms. However, items such as vision, mobility and school and hobbies should be interpreted with caution as a part of the factor structure of a 16D instrument among this population.